Eli Lilly vs. Novo Nordisk in the GLP-1 Market (November 2025 Update)
As of November 2025, Eli Lilly and Novo Nordisk remain the undisputed leaders in the GLP-1 receptor agonist market, a segment projected to exceed $100 billion globally by 2030, with obesity indications driving 68% of sales. Lilly's dual-agonist tirzepatide (Mounjaro/Zepbound) has surged ahead in efficacy and U.S. market share, while Novo's single-agonist semaglutide (Ozempic/Wegovy/Rybelsus) holds advantages in international reach and oral delivery. This comparison draws on Q3 2025 earnings, head-to-head trials (e.g., SURMOUNT-5), and pipeline updates, highlighting Lilly's momentum amid Novo's challenges like compounded competition and guidance cuts. Both face shared pressures from pricing reforms (e.g., November 2025 U.S. government deal capping Medicare prices at $245/month) and supply constraints, but Lilly's growth trajectory positions it as the frontrunner.
This momentum, underscored by Lilly's recent $1 trillion market cap milestone on November 21, reflects not just superior efficacy (20%+ weight loss in head-to-head trials) but also strategic expansions like the $8 billion VA contract and Amazon delivery partnerships. In contrast, Novo's semaglutide franchise (Ozempic, Wegovy, Rybelsus) posted $7.9 billion in Q3 (up ~20% YoY but decelerating), triggering a third full-year guidance cut to ~$46.5 billion total revenue amid U.S. share erosion to 42% and intensified competition from compounded versions. Novo's stock has plunged 44% YTD, reflecting investor frustration over these headwinds, including the recent EVOKE Alzheimer's trial failure for semaglutide.
Pipeline dynamics further tilt the scales toward Lilly. Orforglipron, Lilly's once-daily oral GLP-1, is on track for FDA submission by year-end (with Phase 3 data showing 12%+ weight loss and superiority to oral semaglutide), potentially launching mid-2026 and capturing a $20 billion peak. Retatrutide, the triple-agonist powerhouse, eyes 24%+ loss in ongoing TRIUMPH trials, with topline readouts imminent in Q4 2025–H1 2026. Novo counters with oral Wegovy (FDA decision expected December 2025) and a higher-dose 7.2 mg Wegovy injection filing, but CagriSema's Phase 3 miss (22.7% loss vs. 25% target) has delayed its 2027 rollout, eroding confidence in next-gen potency. Recent X chatter echoes this sentiment, with traders debating long-term picks (Novo edging a poll at 38% for its global moat, but Lilly dominating growth narratives) and biohackers touting Lilly's innovations over Novo's "plateaued" offerings.
Shared headwinds—U.S. pricing deals capping Medicare costs at ~$245–350/month, compounded erosion (now waning post-FDA crackdown), and supply ramps ($27B for Lilly, $24B for Novo)—level the playing field somewhat, but Lilly's diversified pipeline (e.g., Alzheimer's Kisunla, oncology Jaypirca) and employer-direct models provide a buffer. The $150–180 billion GLP-1 opportunity by 2030–2034 can support dual winners, yet Lilly's 32% revenue growth forecast through 2029 (vs. Novo's ~10%) and "Strong Buy" consensus signal sustained dominance.
In sum, Eli Lilly is not just winning the GLP-1 war—it's redefining it through innovation and execution, positioning for a multi-decade reign in "diabesity." Novo remains a resilient contender with international scale and value appeal (P/E ~20x vs. Lilly's 56x), but recovery hinges on oral launches and CagriSema redemption. For investors: Lilly for aggressive growth; Novo for steady compounding. The era of injectable dominance is yielding to orals and beyond—Lilly holds the edge, but watch Q4 catalysts like Novo's FDA nods and Lilly's CVOT data to see if the gap widens or narrows.
1. Company and Product Overview
- Eli Lilly
Primary molecule: Tirzepatide (dual GLP-1/GIP agonist)
Brands: Mounjaro (type 2 diabetes), Zepbound (obesity)
Administration: Weekly subcutaneous injection (5–15 mg)
Key strength: Highest efficacy on the market
Key limitation: Still injection-only (oral coming 2026) - Novo Nordisk
Primary molecule: Semaglutide (single GLP-1 agonist)
Brands: Ozempic (diabetes), Wegovy (obesity), Rybelsus (oral diabetes)
Administration: Weekly injection (0.25–2.4 mg) or daily oral tablet
Key strength: First-to-market, only approved oral GLP-1, global scale
Key limitation: Lower weight-loss efficacy than tirzepatide
2. Efficacy and Safety (Head-to-Head Data, 72 Weeks at Maximum Dose)
- Weight loss (obesity, no T2D)
Lilly (tirzepatide 15 mg): 20.2–20.9%
Novo (semaglutide 2.4 mg): 13.7–14.9%
→ Lilly superior by ~6 percentage points (SURMOUNT-5, NEJM May 2025) - A1C reduction (type 2 diabetes)
Lilly: –2.0 to –2.3%
Novo: –1.5 to –1.9%
→ Lilly superior by ~0.4–0.5% - Patients achieving ≥25% weight loss
Lilly: 32%
Novo: 16% - Waist circumference reduction
Lilly: –14.7 cm
Novo: –10.5 cm - Gastrointestinal side effects
Both similar; nausea 25–44%, vomiting 10–18%
Tirzepatide generally better tolerated at highest doses - Cardiovascular benefit label
Novo: Already approved (SELECT trial)
Lilly: Expected Q4 2025 (SURPASS-CVOT)
3. Q3 2025 Sales Performance
- Eli Lilly
Mounjaro: $5.8 billion (+90% YoY)
Zepbound: $4.3 billion (+200% YoY)
Total tirzepatide: $10.1 billion
U.S. prescription share: 58% - Novo Nordisk
Ozempic + Wegovy + Rybelsus: $7.9 billion (+20% YoY)
U.S. prescription share: 42% (down from near-parity in 2024)
4. Full-Year 2025 Guidance
- Eli Lilly: Raised multiple times → $63–63.5 billion total revenue (+32%)
- Novo Nordisk: Cut three times → $46.5 billion total revenue (+10%)
5. Near-Term Pipeline (2026–2027 Launches)
- Eli Lilly
Orforglipron (once-daily oral small-molecule GLP-1)
– Phase 3 completed (12.4% weight loss, superior to oral semaglutide)
– FDA submission by end-2025 → expected U.S. launch mid-2026
– Peak sales estimate: $20+ billion Retatrutide (weekly triple GLP-1/GIP/glucagon agonist)
– Phase 2: 24.2% weight loss (best ever reported)
– Phase 3 topline H2 2026 → potential launch 2027
– Peak sales estimate: $25+ billion - Novo Nordisk
Oral semaglutide 50 mg (Wegovy pill)
– FDA decision expected December 2025
– U.S. manufacturing secured CagriSema (semaglutide + cagrilintide dual agonist)
– Phase 3 missed 25% weight-loss target (22.7%) → new trial required
– Launch delayed to 2027 at earliest
– Peak sales estimate: $15 billion
6. Key Challenges & Risks
- Shared
Supply shortages (improving but still limiting growth)
U.S. Medicare price caps starting 2026 (~$245–350/month)
Compounded/semaglutide copies (hurting Novo more severely) - Lilly-specific
High valuation (P/E ~56×)
Oral launch execution risk - Novo-specific
Ongoing U.S. market-share erosion
Three guidance cuts in 2025
Stock down 44% YTD
Workforce reduction of ~9,000 jobs for cost savings
7. Investment Summary (as of late November, 2025)
- Eli Lilly: Clear growth leader; analysts’ consensus “Strong Buy”; expected to remain #1 in GLP-1 revenue and market cap through 2030
- Novo Nordisk: Value play after steep correction (P/E ~20×); international moat intact, but U.S. obesity dominance lost to Lilly.
8. Retatrutide: Eli Lilly’s Triple-Agonist Weight Loss Breakthrough
What It Is
- Development code: LY3437943
- Class: Once-weekly injectable triple receptor agonist
- Targets: GLP-1 + GIP + glucagon receptors
- Current status: Phase 3 (TRIUMPH program) – not yet FDA-approved
- Expected U.S. launch: 2027 (possible FDA submission as early as late 2025)
- GLP-1 receptor: Suppresses appetite, slows gastric emptying
- GIP receptor: Enhances insulin secretion, improves fat metabolism
- Glucagon receptor: Increases energy expenditure, promotes liver fat burning and lipolysis
→ Result: Greater weight loss + superior liver fat reduction vs. dual-agonist tirzepatide
- Placebo: –2.1%
- 1 mg dose: –8.7%
- 4 mg dose: –17.1%
- 8 mg dose: –22.8%
- 12 mg dose: –24.2% (≈58 lbs / 26 kg for average patient)
→ Patients had not yet hit plateau → many experts believe 28–30% is possible with longer treatment
- Liver fat reduction: Up to 82% at 12 mg (best ever reported for an obesity drug)
- Waist circumference: –15 to –20 cm
- Blood pressure improvement: –8 to –12 mmHg
- Triglycerides: ↓25–40%
- HDL cholesterol: ↑8–12%
- TRIUMPH-1: Obesity without diabetes – topline expected mid-2026
- TRIUMPH-2: Obesity + type 2 diabetes – topline expected Q4 2025
- TRIUMPH-3: Obesity + knee osteoarthritis – data expected late 2025
- TRIUMPH-4: Cardiovascular outcomes trial – ongoing
- Maintenance study: 80-week induction + 36-week maintenance – started Feb 2025
- Most common: Nausea (40–55%), vomiting (15–25%), diarrhea (20%)
- Heart rate increase: +2 to +4 bpm (dose-dependent)
- Gallbladder events: Higher risk than tirzepatide due to rapid fat mobilization (≈4–6% incidence)
- Discontinuation rate in Phase 2: 7–13%
- Biohacker tip trending on X: Many users take TUDCA 500–1,000 mg/day or ursodiol to protect gallbladder/liver
- Consensus peak sales estimate: $25–35 billion annually by 2035
- Expected list price at launch: Similar to Zepbound (~$1,060/month pre-rebates)
- Medicare negotiated price (post-2026): Likely $245–350/month
- Patent protection: Until ≈2040
- Tirzepatide (Lilly, dual agonist): 20–22% weight loss
- Semaglutide (Novo, single agonist): 14–15% weight loss
- CagriSema (Novo, dual agonist in late-stage): 22.7% (missed target)
- Retatrutide (Lilly, triple agonist): 24.2% at 48 weeks and still falling → projected 27–30% long-term
Conclusion: Eli Lilly vs. Novo Nordisk in the GLP-1 Market (November 2025 Perspective)
The GLP-1 showdown between Eli Lilly and Novo Nordisk has reached a pivotal inflection point as of late November 2025, with Lilly firmly establishing itself as the market leader while Novo grapples with mounting challenges. Lilly's tirzepatide duo—Mounjaro and Zepbound—delivered explosive Q3 results, generating $10.1 billion in combined revenue (up over 100% YoY for both indications), propelling total company sales to $17.6 billion and solidifying a commanding 58% U.S. prescription share.This momentum, underscored by Lilly's recent $1 trillion market cap milestone on November 21, reflects not just superior efficacy (20%+ weight loss in head-to-head trials) but also strategic expansions like the $8 billion VA contract and Amazon delivery partnerships. In contrast, Novo's semaglutide franchise (Ozempic, Wegovy, Rybelsus) posted $7.9 billion in Q3 (up ~20% YoY but decelerating), triggering a third full-year guidance cut to ~$46.5 billion total revenue amid U.S. share erosion to 42% and intensified competition from compounded versions. Novo's stock has plunged 44% YTD, reflecting investor frustration over these headwinds, including the recent EVOKE Alzheimer's trial failure for semaglutide.
Pipeline dynamics further tilt the scales toward Lilly. Orforglipron, Lilly's once-daily oral GLP-1, is on track for FDA submission by year-end (with Phase 3 data showing 12%+ weight loss and superiority to oral semaglutide), potentially launching mid-2026 and capturing a $20 billion peak. Retatrutide, the triple-agonist powerhouse, eyes 24%+ loss in ongoing TRIUMPH trials, with topline readouts imminent in Q4 2025–H1 2026. Novo counters with oral Wegovy (FDA decision expected December 2025) and a higher-dose 7.2 mg Wegovy injection filing, but CagriSema's Phase 3 miss (22.7% loss vs. 25% target) has delayed its 2027 rollout, eroding confidence in next-gen potency. Recent X chatter echoes this sentiment, with traders debating long-term picks (Novo edging a poll at 38% for its global moat, but Lilly dominating growth narratives) and biohackers touting Lilly's innovations over Novo's "plateaued" offerings.
Shared headwinds—U.S. pricing deals capping Medicare costs at ~$245–350/month, compounded erosion (now waning post-FDA crackdown), and supply ramps ($27B for Lilly, $24B for Novo)—level the playing field somewhat, but Lilly's diversified pipeline (e.g., Alzheimer's Kisunla, oncology Jaypirca) and employer-direct models provide a buffer. The $150–180 billion GLP-1 opportunity by 2030–2034 can support dual winners, yet Lilly's 32% revenue growth forecast through 2029 (vs. Novo's ~10%) and "Strong Buy" consensus signal sustained dominance.
In sum, Eli Lilly is not just winning the GLP-1 war—it's redefining it through innovation and execution, positioning for a multi-decade reign in "diabesity." Novo remains a resilient contender with international scale and value appeal (P/E ~20x vs. Lilly's 56x), but recovery hinges on oral launches and CagriSema redemption. For investors: Lilly for aggressive growth; Novo for steady compounding. The era of injectable dominance is yielding to orals and beyond—Lilly holds the edge, but watch Q4 catalysts like Novo's FDA nods and Lilly's CVOT data to see if the gap widens or narrows.
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