The fierce rivalry between Novo Nordisk and Eli Lilly is alive and well, as the two companies are expected to face off with their new obesity pills this year.
Eli Lilly is on a path to achieving $94.3 billion in annual revenue by 2027, with 2026 serving as a critical year that will define the Big Pharma’s future.
Leerink Partners predicted the 109% revenue jump from the $45 billion Lilly achieved in 2024 in a Sunday note to investors. The climbing revenue and projected entry to the oral obesity market pushed the Indianapolis pharma to a $1 trillion market capitalization late last year. The company now sits at about $975 billion, according to Leerink’s note.
Lilly has plenty to do this year and a fierce rivalry with Novo Nordisk will again be one of the major headlines. Key to hitting the massive revenue target will be the performance of the burgeoning oral obesity drug market, Leerink said.
Novo received approval for its Wegovy pill just before Christmas and announced Monday that the product has launched. Novo, eager to make a comeback in the space it once dominated, debuted the pill with a competitive price of $149 per month for the 1.5-mg and 4-mg doses, sliding up to $299 for the higher doses.
Analysts will be watching Novo’s launch closely. Both Novo and Lilly struggled with the launch of the injectable versions of their weight loss drugs, with shortages dogging supply and compound pharmacies stepping in to fill the gap. The oral drugs are expected to be easier to manufacture overall, but Lilly is projected to have the edge since orforglipron is an easier-to-manufacture small molecule, compared to Novo’s peptide offering.
Lilly is close behind with orforglipron, which Leerink expects to be approved in the second quarter. In November 2025, Lilly received a priority review voucher from the FDA commissioner, which cuts down the regulatory review time from 10–12 months to 1–2 months. Analysts from Truist Securities previously predicted that the drug could combine with Lilly’s current GLP-1s Mounjaro and Zepbound to one day bring in $101 billion in peak sales.
Another key milestone this year will be the release of Phase III results from Novo’s head-to-head obesity study comparing CagriSema with Lilly’s tirzepatide, the active ingredient in Mounjaro and Zepbound. Leerink said that study is expected to read out in the first quarter.
Both Novo and Lilly have been conducting these head-to-head studies, pitting their obesity products against each other to secure an edge in the market. Lilly has come out on top so far, with orforglipron beating Novo’s semaglutide in reducing A1C in patients with type 2 diabetes. Tirzepatide also beat semaglutide in achieving greater weight loss at 72 weeks.
This time the study is being run by Novo, however. “If CagriSema surprisingly demonstrates superiority,” Lilly’s shares could fall slightly, according to Leerink. But the analysts suggested this would be an opportunity to buy the dip, as Novo’s product is more difficult to produce and has a record of causing more injection-site reactions.
Elsewhere in Lilly’s pipeline, the second quarter will bring Phase III results for weight loss drug retatrutide. In mid-December, Lilly reported that the drug cut body weight by 26.6% on a placebo-adjusted basis and reduced knee osteoarthritis pain by 75%. Analysts expect the therapy to tackle more severe cases of obesity. For the next readout, Lilly will report retatrutide’s effect on cardiovascular disease.
On the policy side, Leerink is watching the voluntary Medicare GLP-1 payment demonstration, which is expected to begin in July. The plan, which was announced on December 23, provides a pathway for states to cover the drugs through negotiated prices. Eligible patients in Medicare Part D could pay as little as $50 under the agency’s proposal.
Leerink believes this could be the beginning of mandatory coverage for GLP-1 drugs that could take effect in January 2027.
Otherwise, Lilly, like many peers, secured a drug pricing deal with the Trump administration to clear Most Favored Nation and tariff concerns last year.
