Eli Lilly and Novo Nordisk are the two defining companies in the modern incretin market. Both have powerful franchises in diabetes and obesity, both are spending heavily to expand supply, and both have late-stage candidates intended to extend their leadership. Yet their latest results describe very different operating trajectories. Lilly entered 2026 with accelerating tirzepatide sales and a newly approved oral GLP-1, while Novo Nordisk faced pricing pressure, difficult accounting comparisons, and pipeline setbacks even as its Wegovy portfolio reached more patients.
This comparison uses each company’s official 2025 annual report and results reported through the second quarter of 2026. It separates reported and adjusted figures, keeps each company in its reporting currency, and avoids treating one quarter as a complete valuation thesis.
Reviewed by Shingo Harada Last reviewed: September 12, 2026
Historical comparison: Financial figures cover 2025 and Q2 2026. Product status, clinical results, and management outlooks reflect information reviewed on September 12, 2026; they are not a current-quarter update.
Key takeaways
- Lilly has the stronger current growth profile. Its 2025 revenue rose 45%, followed by 48% growth in Q2 2026. Novo Nordisk’s 2025 sales rose 10% at constant exchange rates, while adjusted Q2 2026 sales grew 7% at constant exchange rates.
- Both companies are concentrated in incretins. Mounjaro and Zepbound generated approximately 56% of Lilly’s 2025 revenue. Ozempic alone represented about 41% of Novo’s 2025 sales, before including Wegovy and Rybelsus.
- Lilly’s next wave is closer to commercialization. Foundayo, its oral small-molecule GLP-1, received U.S. approval in 2026. Retatrutide completed the clinical data package Lilly says can support global obesity-related submissions.
- Novo retains meaningful franchise breadth. It markets injectable and oral semaglutide, has expanded Wegovy doses and geographies, and has CagriSema and several amylin or next-generation incretin programs in development.
- Manufacturing remains a competitive variable. Both companies are committing billions to active ingredient, fill-finish, device, and packaging capacity. Those investments support volume but suppress near-term free cash flow.
- Growth is not valuation. A sound decision still requires assumptions for price, volume, margins, reinvestment, patent life, and the discount rate.
2025 financial comparison
The table deliberately preserves U.S. dollars for Lilly and Danish kroner for Novo Nordisk. Converting currencies at a single spot rate would create false precision and would not make accounting policies identical.
| 2025 metric | Eli Lilly | Novo Nordisk | Investor interpretation |
|---|---|---|---|
| Revenue / sales | $65.18bn, +45% | DKK309.06bn, +6% reported; +10% CER | Lilly had materially faster growth |
| Gross margin | $54.13bn; 83.0% | 81.0% | Both remain high-margin manufacturers |
| Operating profit | $26.30bn | DKK127.66bn; -1% reported, +6% CER | Novo absorbed restructuring and acquired-site effects |
| Operating cash flow | $16.81bn | See company-reported FCF below | Working capital and capacity spending matter |
| PP&E capital expenditure | $7.84bn | DKK60.1bn | Both are in a heavy investment cycle |
| Free cash flow | $8.97bn simple OCF less PP&E capex calculation | DKK28.3bn company-reported | Definitions are not directly comparable |
| Largest disclosed product | Mounjaro: $22.97bn | Ozempic: DKK127.09bn | Each depends heavily on one molecule family |
Lilly’s revenue expanded by $20.14 billion in one year. Mounjaro revenue rose 99% to $22.97 billion and Zepbound rose 175% to $13.54 billion. Together they produced $36.51 billion, approximately 56% of company revenue. The favorable mix and improving production costs helped gross margin rise to 83.0%, despite lower realized prices.
Novo Nordisk’s sales increased to DKK309.06 billion, with Ozempic sales of DKK127.09 billion. Total obesity-care sales, primarily Wegovy but also Saxenda, reached DKK82.35 billion versus DKK65.15 billion in 2024. Gross margin declined from 84.7% to 81.0%, affected by depreciation and amortization from the three former Catalent manufacturing sites, capacity expansion, restructuring, and currencies. Operating profit was DKK127.66 billion. Management said it would have increased 6% in Danish kroner and 13% at constant exchange rates without approximately DKK8 billion of restructuring costs.
Q2 2026 operating comparison
Lilly: volume is outrunning price pressure
Lilly reported Q2 2026 revenue of $22.97 billion, up 48%. Volume contributed 60 percentage points, while realized prices reduced growth by 13 percentage points. Mounjaro sales rose 91% to $9.94 billion and Zepbound sales rose 46% to $4.93 billion. First-half revenue reached $42.77 billion, up 51%.
Reported gross margin was $19.7 billion, or 85.8% of revenue, versus 84.3% a year earlier. Reported net income rose 25% to $7.10 billion even though the quarter included $2.8 billion of acquired in-process research and development charges and $703 million of asset impairment, restructuring, and other special charges. Lilly raised 2026 revenue guidance to $85–87 billion.
Novo Nordisk: read reported and adjusted results together
Novo Nordisk reported Q2 2026 sales of DKK78.49 billion, up 2% in Danish kroner and 3% at constant exchange rates. Adjusted sales growth was 7% at constant exchange rates. The adjustment excludes a prior-year reversal of a U.S. 340B rebate provision, which makes the unadjusted comparison unusually difficult.
Reported operating profit fell 19% to DKK27.06 billion, or 16% at constant exchange rates. Adjusted operating profit was DKK33.39 billion, up 11% at constant exchange rates, with a 42.5% margin. The difference also reflects DKK6.3 billion of non-cash pipeline impairments, including DKK4.0 billion related to monlunabant. Management’s updated 2026 outlook calls for adjusted sales and adjusted operating-profit growth of 0% to negative 6% at constant exchange rates. This contrast—Lilly raising high-growth guidance while Novo guides to a decline—is the clearest near-term operating distinction.
Product franchises: tirzepatide versus semaglutide
Mounjaro and Zepbound contain tirzepatide, a dual GIP and GLP-1 receptor agonist, but are marketed for different indications. Mounjaro is the diabetes brand. Zepbound is the obesity brand in the United States, Canada, and Japan. Their extraordinary growth gives Lilly scale across both conditions, but it also creates concentration: a manufacturing, safety, reimbursement, or competitive problem affecting tirzepatide could influence more than half of current revenue.
Novo’s corresponding molecule is semaglutide. Ozempic serves type 2 diabetes, Wegovy serves obesity, and Rybelsus provides an oral diabetes formulation. Novo also launched Wegovy pill in the United States and reported more than five million cumulative prescriptions 30 weeks after launch, based on company and IQVIA estimates. By July 2026, the weekly U.S. Wegovy pill prescription estimate exceeded 265,000. These figures demonstrate uptake, but prescription counts are not revenue and should not be treated as such.
Investors researching Lilly in greater depth can continue with our Eli Lilly stock analysis. The central question is no longer whether incretin demand exists. It is how much volume each company can supply, what net price it retains, and how much of the future market shifts toward pills, higher-dose products, or new mechanisms.
Pipeline comparison
| Company | Program | Status reviewed on September 12, 2026 | Strategic role |
|---|---|---|---|
| Lilly | Foundayo / orforglipron | U.S.-approved for obesity; type 2 diabetes submitted in the U.S. | Oral, small-molecule GLP-1 without food or water restrictions |
| Lilly | Retatrutide | Phase 3 data package complete; U.S. obesity-related BLA planned for Q1 2027 | Triple GIP/GLP-1/glucagon agonist |
| Novo | Wegovy pill | Launched in U.S.; approved in EU in July 2026 | Extends semaglutide franchise into oral obesity treatment |
| Novo | Wegovy 7.2 mg | Approved in U.S., UK, and EU | Higher-dose franchise extension |
| Novo | CagriSema | Submitted in U.S.; additional Phase 3b high-dose trial initiated in Q2 2026 | Semaglutide plus amylin analogue |
| Novo | Zenagamtide | Subcutaneous Phase 3 ongoing; oral Phase 3 planned | Next-generation amylin/GLP-1 approach |
Lilly reported striking topline retatrutide results. In TRIUMPH-1, participants receiving 12 mg lost an average 28.3% of body weight at 80 weeks. In TRIUMPH-2, adults with type 2 diabetes and obesity or overweight lost up to an average 20.8% at 80 weeks. These are company-reported topline results rather than a guarantee of approval, label breadth, commercial access, tolerability in wider use, or market share.
Novo’s pipeline offers several mechanisms, but 2026 also illustrated development risk. The company terminated monlunabant and recorded an impairment. Its ZEUS Phase 3 trial of ziltivekimab did not meet the primary cardiovascular endpoint, reporting a hazard ratio of 0.99 with a 95% confidence interval of 0.88–1.11. A diversified list of candidates is valuable only when programs generate clinically meaningful data and survive regulatory review.
Manufacturing and free cash flow
Supply is part of the product proposition in a market where demand can exceed available doses. Lilly spent $7.84 billion on property and equipment in 2025 and generated $16.81 billion of operating cash flow. Subtracting those amounts produces $8.97 billion of simple free cash flow. This is an analytical calculation, not a company-defined non-GAAP measure. Lilly also committed another $4.5 billion to two Indiana sites in 2026, taking its Indiana capital expansion commitments since 2020 above $21 billion.
Novo spent DKK60.1 billion on PP&E in 2025, primarily for active pharmaceutical ingredient production and fill-finish capacity. It reported DKK28.3 billion of free cash flow. The company invested approximately $2 billion in U.S. manufacturing during 2025 and plans another $5.6 billion through 2028. Its three former Catalent fill-finish sites are being integrated into the network. For 2026, Novo expects approximately DKK55 billion of capital expenditure and DKK45–55 billion of free cash flow under its updated definition.
High capital expenditure is not automatically negative. It can create durable capacity and reduce lost sales. But investors should distinguish growth investment from maintenance needs and test how quickly spending becomes productive. Our free cash flow yield guide explains why cash flow should be evaluated relative to enterprise or equity value rather than in isolation.
The risks that matter most
- Net pricing and reimbursement: Lilly’s Q2 volume growth was partially offset by lower realized prices. Novo’s outlook incorporates lower U.S. prices, including its Most Favoured Nations agreement.
- Product concentration: Tirzepatide drives most of Lilly’s incremental growth; semaglutide dominates Novo’s economics. Concentration magnifies product-specific risks.
- Competition: The companies compete with each other while new oral, injectable, amylin, and combination therapies advance across the industry.
- Manufacturing execution: Delays, quality findings, device constraints, shortages, or weak utilization of new plants can affect sales and returns on capital.
- Clinical and regulatory outcomes: Late-stage success does not guarantee approval. Approved labels, safety warnings, discontinuation rates, and payer access influence commercial value.
- Patent exposure: Novo identifies 2032 as U.S. compound-patent expiry for semaglutide brands, while exclusivity expires sooner in some international markets. Patent litigation and local rules can alter timing.
- Capital allocation: Both companies must balance manufacturing, internal R&D, acquisitions, dividends, and repurchases. Acquired IPR&D and impairments show the cost of unsuccessful bets.
How to compare valuation without forcing an answer
A company can deliver superior operating growth and still offer a weaker prospective return if its valuation already discounts exceptional execution. Conversely, slower growth is not automatically cheap if margins, pricing, or market share remain under pressure. A useful model should separate diabetes, obesity, and other products; forecast volume and net price independently; and connect capacity spending to achievable sales.
For a return-on-capital approach, compare normalized ROIC with the cost of capital using our ROIC versus WACC framework. For an intrinsic-value approach, build scenarios rather than one point estimate with the DCF valuation guide. At minimum, test lower pricing, delayed capacity, pipeline failure, and faster competitive entry. The best company and the best-priced security are related questions, not identical ones.
Bottom line
On the operating evidence reviewed on September 12, 2026, Lilly had the stronger momentum: faster growth, expanding margins, an approved oral GLP-1, and a late-stage triple agonist. Novo Nordisk still owns a broad global semaglutide franchise, meaningful oral and high-dose extensions, and a substantial development portfolio. Its challenge is to convert product reach and capacity into renewed growth while managing lower prices and recent pipeline disappointments.
The decisive future variables are net price, supply, persistence and access, not headline prescription demand alone. Investors should update the comparison each quarter and treat both management outlooks and clinical timelines as conditional. Explore additional company and metric analysis in the Stock Metric Lab Research Hub.
Frequently asked questions
Which company grew faster in 2025?
Eli Lilly grew faster. Its revenue increased 45% to $65.18 billion. Novo Nordisk’s sales increased 6% in Danish kroner and 10% at constant exchange rates to DKK309.06 billion. The percentages are comparable directional measures, but the absolute revenue figures should not be compared without currency and accounting adjustments.
Are Mounjaro and Zepbound the same medicine?
Both contain tirzepatide, but they are marketed under different brands for different indications. Mounjaro is the type 2 diabetes brand. Zepbound is the obesity brand in the United States, Canada, and Japan. Labels and availability vary by jurisdiction.
Does faster growth make Lilly the better investment?
Not by itself. Investment return depends on the price paid and on future outcomes relative to expectations. An investor should compare normalized cash flow, reinvestment needs, patent duration, pipeline probabilities, and valuation before reaching a conclusion.
Sources
- Eli Lilly 2025 Form 10-K, filed February 12, 2026.
- Eli Lilly Q4 and full-year 2025 results, February 4, 2026.
- Eli Lilly Q2 2026 results, August 5, 2026.
- Eli Lilly Q2 2026 Form 10-Q, including the regulatory-development update.
- Lilly TRIUMPH-1 topline results, May 21, 2026.
- Lilly TRIUMPH-2 and TRIUMPH-3 topline results, July 23, 2026.
- Novo Nordisk Annual Report 2025: financial performance, February 2026.
- Novo Nordisk 2025 Form 20-F.
- Novo Nordisk Q2 2026 company announcement, August 4, 2026.
- Novo Nordisk Q2 2026 investor presentation.
- Novo Nordisk Annual Report 2025: commercial execution and manufacturing.
This article is for educational and informational purposes only. It is not investment advice, a recommendation, or an offer to buy or sell any security. Financial and clinical information can change after publication. Verify current filings, product labels, regulatory decisions, and market data, and consider your objectives and risk tolerance before making an investment decision.