Lilly Crushes Q4 Estimates, Forecasts $80–83B as GLP‑1 Sales Surge

Lead: Eli Lilly reported a stronger-than-expected fourth quarter on Feb. 4, 2026, driven by surging demand for its GLP‑1 drugs Zepbound and Mounjaro. The company posted $19.29 billion in Q4 revenue and a sharply raised 2026 revenue outlook of $80 billion to $83 billion, well above analysts’ $77.62 billion projection. Lilly also set adjusted EPS guidance of $33.50–$35.00 for 2026, exceeding the LSEG consensus of $33.23. Shares jumped in premarket trading as the results underscored rapidly growing volumes despite downward pressure on realized prices.

Key takeaways

• Lilly reported Q4 revenue of $19.29 billion, up 43% year‑over‑year, beating the LSEG consensus of $17.96 billion.
• Adjusted Q4 EPS was $7.54 versus expectations of $6.67; GAAP net income for the quarter was $6.64 billion ($7.39/sh).
• Mounjaro generated $7.41 billion in Q4 revenue (up 110% YoY); U.S. Mounjaro sales were $4.1 billion, up 57%.
• Zepbound posted $4.2 billion in U.S. Q4 revenue, a 122% increase YoY and above StreetAccount’s $3.91 billion estimate.
• For 2026 Lilly guided revenue of $80–$83 billion (midpoint implies ~25% growth) and adjusted EPS of $33.50–$35.00.
• The company expects a low‑ to mid‑teens percentage global pricing decline tied to the Trump administration deal, new direct‑to‑consumer rates and lower Medicaid pricing on some legacy products.
• Lilly cited Medicare coverage expansion and a pending GLP‑1 oral obesity pill expected in Q2 (pending U.S. approval) as growth drivers.
• Lilly’s U.S. market share for obesity and diabetes drugs rose to 60.5% in Q4 versus 39.1% for Novo Nordisk.

Background

Global demand for GLP‑1 therapies accelerated dramatically in 2023–2025, reshaping the obesity and diabetes drug market and producing multi‑billion dollar blockbusters. Lilly and Novo Nordisk emerged as the dominant suppliers, each developing injectable and oral formulations that widened patient access. In late 2025 both companies struck agreements with the U.S. administration to lower prices for Medicare and Medicaid beneficiaries and to offer discounted direct‑to‑consumer options via a White House platform, a policy shift intended to broaden access while lowering government drug costs.

Those pricing deals create a trade‑off: broader patient coverage and higher prescription volumes in return for lower realized prices per unit. Policymakers and payers have signaled further attention to affordability, while manufacturers are adapting commercial strategies to preserve margins through volume growth, new formulations and international pricing. Competition has also intensified with planned launches of oral GLP‑1s and new brands entering major markets including the U.S., China, Brazil and Canada where exclusivity dynamics are changing.

Main event

On Feb. 4, 2026 Lilly released fourth‑quarter results showing revenue of $19.29 billion and adjusted EPS of $7.54, both materially above Wall Street expectations. The company attributed the upside to a roughly 50% increase in global volume for its key products, led by Mounjaro and Zepbound, while acknowledging that realized prices for those drugs declined. Net income on a GAAP basis rose to $6.64 billion from $4.41 billion a year earlier.

Mounjaro posted $7.41 billion in revenue for the quarter, a 110% year‑over‑year gain; U.S. sales alone were $4.1 billion, up 57%. Zepbound delivered $4.2 billion in U.S. revenue, a 122% increase from the prior year and above StreetAccount estimates. Management said prescription volume gains, not price increases, were the primary driver of the revenue jump.

Lilly provided 2026 guidance calling for $80–$83 billion in revenue and $33.50–$35.00 in adjusted EPS. Management flagged several tailwinds: expanded Medicare coverage for obesity treatments, continued strong global demand for Mounjaro and Zepbound, and an anticipated U.S. launch of an oral GLP‑1 pill for obesity in Q2, subject to regulatory approval. At the same time the company warned of a low‑ to mid‑teens percentage global pricing decline tied to the Trump administration agreement, new direct‑to‑consumer pricing, and lower Medicaid rates for some older products.

Analysis & implications

Lilly’s results illustrate how volume growth can offset—and in some cases outpace—downward pressure on prices. A midpoint revenue forecast of $81.5 billion implies roughly 25% year‑over‑year growth, signaling that prescription uptake and new patient access may more than compensate for per‑unit price cuts in 2026. That dynamic is central to Lilly’s strategy: broaden the pool of treated patients through coverage expansions and new product forms.

The company’s ability to expand market share to 60.5% in the U.S. for obesity and diabetes drugs suggests operational advantages in distribution, prescriber relationships and inventory management. Yet falling realized prices will compress gross margins on GLP‑1s unless offset by cost efficiencies, higher treatment adherence, or premium products. Investors will watch how quickly volume gains translate into steady cash flow at the lower price points.

Competitively, the divergence between Lilly and Novo Nordisk’s near‑term outlooks is notable. Novo warned of an as‑much‑as 13% decline in sales and profit in 2026, citing price reductions and loss of exclusivity in several international markets. Lilly’s bullish guidance indicates management expects stronger net benefits from U.S. coverage expansions and upcoming product launches, though outcomes hinge on regulatory timing, payer implementation and direct‑to‑consumer platform execution.

Comparison & data

The table summarizes headline Q4 figures cited by Lilly and independent data providers. Volume increases—about a 50% rise in units sold in the U.S.—were the principal driver of U.S. revenue growth ($12.9 billion). Management notes that realized prices fell, with a planned global pricing decline in the low‑ to mid‑teens percent range, a factor investors must weigh when modeling 2026 margins.

Reactions & quotes

“It’s a big multiplier on the eligible pool,”

Dave Ricks, CEO, Eli Lilly (on Medicare coverage expanding patient access)

Ricks said Medicare coverage will expand the pool of patients eligible for obesity treatments and that volume gains should accelerate later in the year.

“We see sales and profit declining as much as 13% this year,”

Novo Nordisk (company guidance)

Novo’s guidance, provided earlier in the week, framed a contrasting near‑term outlook tied to U.S. price reductions and expiring exclusivities in several international markets.

Unconfirmed

• The precise launch date and adoption rate for the Trump administration’s direct‑to‑consumer platform (TrumpRx) remain unclear and could shift the timing of consumer‑level price effects.
• The exact approval timing and commercial rollout schedule for Lilly’s oral GLP‑1 obesity pill are pending U.S. regulatory action and could change expected Q2 launch assumptions.
• How quickly Medicare implementation details translate into broader prescriptions and payer reimbursements is uncertain and will materially affect volume ramps.

Bottom line

Lilly’s Q4 beat and bullish 2026 guidance show that in the near term the company expects volume growth and new coverage policies to more than offset price concessions. The firm is leveraging strong demand for Mounjaro and Zepbound and positioning an oral GLP‑1 to sustain momentum. Investors should monitor realized price trends closely: a low‑to‑mid‑teens global price decline is material and will test the company’s ability to convert higher prescription volumes into lasting profit growth.

For policymakers and payers, the results underscore the trade‑offs of broader coverage—greater access and public‑health benefits versus lower per‑unit revenue for manufacturers. Outcomes over 2026 will depend on how quickly Medicare coverage expands in practice, the timing of new product approvals, and competitive moves from Novo Nordisk and other entrants.

Sources

• CNBC — news report on Lilly Q4 results and guidance (media)
• Eli Lilly Investor Relations — company presentation and earnings release (official)
• LSEG — consensus estimates referenced for analyst expectations (market data provider)
• StreetAccount (Dow Jones) — quarterly product sales comparisons and analyst expectations (market analytics)
• Novo Nordisk — company guidance and commentary (official)