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GLP-1 Market Update: Q1 2026 Revenue & Trends

**The GLP-1 drug market has entered its most volatile chapter yet.** Eli Lilly is surging, Novo Nordisk is stumbling, patent cliffs are approaching, and oral formulations just hit pharmacy shelves. Here is where the numbers stand as of early 2026 — and what they mean for the rest of the year.

The GLP-1 drug market has entered its most volatile chapter yet. Eli Lilly is surging, Novo Nordisk is stumbling, patent cliffs are approaching, and oral formulations just hit pharmacy shelves. Here is where the numbers stand as of early 2026 — and what they mean for the rest of the year.

Table of Contents

The Big Picture: Market Size in Early 2026

The global GLP-1 receptor agonist market was estimated at roughly $70 billion in 2025 and is projected to reach $87-101 billion in 2026, depending on the research firm and how broadly they define the category. Grand View Research pegs the 2026 figure at $86.93 billion; Roots Analysis estimates $101.4 billion.

Either way, GLP-1 therapies are on track to become the highest-grossing drug class on the planet in 2026. TechTarget reported that GLP-1s are set to top global drug sales this year — a distinction previously held by oncology immunotherapies.

The weight loss segment alone is growing at a compound annual growth rate (CAGR) of 18.5%, with the GLP-1 weight loss drug market projected to hit $48.84 billion by 2030, up from $13.84 billion in 2024.

Two companies still control the overwhelming majority of this market. But the balance of power between them shifted dramatically in the past 12 months.

Eli Lilly: The New Market Leader

Eli Lilly reported Q4 2025 revenue of $19.3 billion, up 43% year-over-year. Full-year 2025 revenue hit $65.2 billion — a 45% increase over 2024.

The GLP-1 franchise drove most of that growth:

  • Mounjaro (tirzepatide for diabetes): $7.4 billion in Q4, up 110% year-over-year. U.S. revenue rose 57% to $4.1 billion. International revenue jumped from $899 million to $3.3 billion.
  • Zepbound (tirzepatide for obesity): $4.2 billion in Q4 U.S. revenue alone, up 122% from $1.9 billion in Q4 2024. Zepbound vials accounted for about a third of total prescriptions and nearly half of new prescriptions.

Combined, Mounjaro and Zepbound generated $11.7 billion in Q4 — 61% of Lilly's total sales.

Lilly now holds over 60% of the U.S. incretin market, up from roughly 40% a year ago. Mounjaro commands more than 55% of new type 2 diabetes incretin prescriptions, and Zepbound holds nearly 70% of new branded obesity prescriptions.

For 2026, Lilly guided revenue of $80-83 billion, with a midpoint implying 25% growth. That guidance came in above analyst expectations of $77.6 billion. Leerink Partners projects Lilly could reach $94.3 billion by 2027.

Novo Nordisk: A Rough Quarter, A Rougher Outlook

The contrast with Novo Nordisk could not be starker.

Novo reported full-year 2025 sales of DKK 309 billion ($45.9 billion), growing 10% at constant exchange rates — but well below the DKK 347 billion analysts had expected. Q4 showed an 8% revenue decline. Operating profit edged down 1%.

The semaglutide franchise numbers:

  • Ozempic (semaglutide for diabetes): Q1 2025 revenue was nearly $5 billion, up 19% year-over-year but down 3% sequentially.
  • Wegovy (semaglutide for obesity): Q1 2025 revenue was $2.6 billion, up 85% year-over-year but down 13% from Q4 2024.
  • Full-year Wegovy sales reached DKK 28 billion in 2025, growing 134%.

The real shock was the 2026 guidance. Novo projected adjusted sales growth of negative 5% to negative 13% at constant exchange rates — the company's first anticipated sales decline since 2017.

CEO Mike Doustdar attributed the shortfall to three factors: aggressive U.S. pricing discounts on GLP-1 drugs, upcoming semaglutide patent expirations in China, Brazil, and Canada, and competition from Lilly's Zepbound, which has overtaken Wegovy in U.S. weekly prescriptions.

Novo's stock dropped 14.6% the day of the earnings report and fell further in premarket trading.

Supply and Demand: Where Things Stand

The GLP-1 supply crunch that defined 2023-2024 has largely eased. The FDA declared the semaglutide injectable shortage resolved in February 2025, and both Wegovy and Zepbound shortages were officially cleared by May 2025.

But the picture on the ground is more nuanced. Clinicians still report intermittent backorders, inconsistent pharmacy supply, and insurance-driven delays. Demand continues to run well above pre-2023 levels.

Both companies have poured billions into manufacturing:

  • Novo Nordisk is in the middle of a $4 billion expansion at its Clayton, North Carolina manufacturing hub, where the new oral Wegovy pill is being produced.
  • Eli Lilly has committed more than $18 billion since 2020 to build, expand, and acquire manufacturing facilities in the U.S. and Europe, including the purchase of Nexus Pharmaceuticals' plant.

On the contract manufacturing (CDMO) side, CordenPharma pledged over EUR 900 million for peptide production expansion, and Simtra BioPharma is launching a dedicated 150,000-square-foot GLP-1 fill-and-finish facility in Bloomington, Indiana, targeting production start in 2026.

Pricing Upheaval: The Trump Deal and Beyond

Pricing is the single biggest variable in 2026 GLP-1 revenue projections.

In November 2025, both Novo Nordisk and Eli Lilly entered agreements with the U.S. government to reduce GLP-1 costs for Medicare recipients starting in 2026 — the so-called TrumpRx program.

Here is what the pricing now looks like:

DrugPrevious List Price (monthly)TrumpRx / Cash-Pay Price
Ozempic~$1,000$350/month
Wegovy (injectable)~$1,349$350/month
Zepbound~$1,060~$346/month
Wegovy pill (starter dose)N/A$149/month

Novo Nordisk cut its GLP-1 list prices by up to 70%. In theory, lower prices should expand the patient pool — potentially offsetting revenue declines with volume growth. In practice, Novo's 2026 guidance suggests the pricing hit is outrunning volume gains, at least in the near term.

Meanwhile, some insurers are pushing back in the other direction. Blue Cross Blue Shield of Massachusetts plans to eliminate GLP-1 coverage for weight loss in 2026, citing the effect on premiums.

The Oral GLP-1 Race Begins

The FDA approved oral semaglutide (Wegovy pill) on December 22, 2025. Novo Nordisk launched it in the U.S. on January 5, 2026, making it the first oral GLP-1 approved for weight loss.

Early demand has been strong. The Wegovy pill hit roughly 50,000 weekly prescriptions within three weeks of launch, with about 45,000 of those self-pay. It is available at over 70,000 U.S. pharmacies.

The OASIS 4 trial showed the oral formulation achieved about 17% weight loss over 64 weeks in the on-treatment analysis (about 14% in the intention-to-treat analysis) — solid but below the ~20% weight loss seen with tirzepatide in the SURMOUNT trials.

Eli Lilly's orforglipron — an oral non-peptide GLP-1 agonist — is under FDA review with a decision expected by mid-2026. Orforglipron has a manufacturing advantage: as a small molecule rather than a peptide, it is cheaper and simpler to produce at scale. Truist Securities analysts have projected that orforglipron could combine with Mounjaro and Zepbound for peak sales of $101 billion.

The oral market represents a massive expansion opportunity. Among the approximately 102 FDA-approved peptide drugs, only 11 can be taken orally. The shift from weekly injections to daily pills could open GLP-1 treatment to millions of people who have been reluctant to inject.

New Entrants Circling the Market

The GLP-1 market is no longer a two-company race. Several companies are advancing late-stage candidates:

  • Amgen's MariTide (maridebart cafraglutide): A once-monthly GLP-1/GIP peptide-antibody conjugate that achieved up to 20% weight loss at 52 weeks in Phase 2 without a weight-loss plateau. The Phase 3 MARITIME program is actively enrolling.
  • Boehringer Ingelheim's survodutide: A GLP-1/glucagon dual agonist that showed nearly 19% weight loss in Phase 2. Multiple Phase 3 SYNCHRONIZE trials are underway.
  • Novo Nordisk's CagriSema: A combination of semaglutide and cagrilintide (a long-acting amylin analogue) that demonstrated 22.7% weight loss in the Phase 3 REDEFINE 1 trial. Regulatory filing is expected in early 2026, with a U.S. launch anticipated in 2027.
  • Lilly's retatrutide: A triple GIP/GLP-1/glucagon agonist that hit up to 28.7% weight loss in Phase 3. Seven more Phase 3 readouts are expected in 2026, with potential approval in 2027-2028.
  • Pfizer: Abandoned its oral GLP-1 candidate danuglipron in 2025 due to high discontinuation rates from gastrointestinal side effects. The company is reportedly pursuing an extended-release reformulation.

The competitive pipeline means that by 2028, the GLP-1 market could have 6-8 branded products competing for patients, rather than the current Novo-Lilly duopoly. That matters not just for market dynamics but for patients: more drugs with different mechanisms, dosing schedules, and side effect profiles give physicians far more tools to personalize treatment.

The escalation in weight loss efficacy tells the story of the science. Semaglutide 2.4 mg delivered about 15% weight loss. Tirzepatide pushed that to about 22%. Retatrutide, with its triple-agonist mechanism, has now shown nearly 29%. In under five years, the pharmacological ceiling for weight loss has nearly doubled. The next generation of drugs is not just incrementally better — it is closing in on results that were previously achievable only through bariatric surgery.

The Compounding Market Fallout

The FDA's decision to end its enforcement discretion on compounded semaglutide in 2025 had immediate market effects. With the official shortage resolved, compounding pharmacies lost their legal basis for producing semaglutide copies. The FDA's notice period to large-scale compounding facilities ended in May 2025.

Before the crackdown, compounded semaglutide was a significant market force. Estimates vary, but some analysts believe compounded versions accounted for hundreds of thousands of patients — many of whom were self-pay and used telehealth prescribers. Novo Nordisk specifically cited the impact of compounded GLP-1s on its sales performance.

The compounding ban has a two-sided effect on the branded market. On one hand, it pushes patients toward FDA-approved products, increasing demand for Ozempic, Wegovy, and Zepbound. On the other, many compounded semaglutide users chose that route because the branded version was unaffordable. Whether those patients convert to branded drugs at $350/month — or drop out of treatment entirely — is one of the open questions for 2026 revenue projections.

Legal battles continue. Multiple compounding pharmacy associations have challenged the FDA's decisions in court. The outcome of those cases could reopen or permanently close the compounding pathway for GLP-1 drugs.

Patent Expirations: The Semaglutide Clock

The semaglutide compound patent expires in March 2026 in Canada, India, Brazil, and China. In the U.S., the main compound patent has been extended to December 2031 through patent term adjustments. European protection lasts until March 2031 via a Supplementary Protection Certificate.

The near-term impact:

  • Canada: Sandoz and Apotex are expected to launch generic semaglutide as early as January 2026. Novo Nordisk's Canadian patent lapsed after the company failed to pay maintenance fees in 2018.
  • China: At least 15 companies are developing generic versions, with 11 in final-stage trials. Launches are expected between 2025-2027.
  • India: Lupin, Dr. Reddy's, Biocon, Sun Pharma, and others are scaling up for 2026 launches.

IQVIA estimates that at least one in three people living with obesity worldwide now resides in a country where semaglutide will be off-patent in 2026.

Generic competition is expected to drive semaglutide prices down 30-60% within 2-3 years in affected markets, and potentially 60-70% over time.

In the U.S., Novo Nordisk holds 49 additional patents beyond the compound patent, extending some protection to 2042. But formulation and device patents are generally weaker barriers to entry than compound patents.

What to Watch for the Rest of 2026

Q1 2026 earnings (expected April-May): The first quarter where Novo's pricing declines, Lilly's continued growth, oral Wegovy ramp, and generic launches in select markets will all be reflected in actual numbers.

Orforglipron FDA decision: Expected mid-2026. Approval would give Lilly a second oral weapon and potentially unlock the largest pool of untreated obesity patients.

High-dose semaglutide 7.2 mg decision: Novo submitted this to the FDA in November 2025 under the CMPV pilot program. A decision is expected in Q1 2026. This higher dose could offer improved weight loss that narrows the gap with tirzepatide.

CagriSema regulatory filing: Expected early 2026. The combination therapy's 22.7% weight loss result gives Novo a potential best-in-class product to counter Lilly's dominance.

Generic semaglutide launches: Real-world data from Canada, India, and China will show how quickly generics erode branded semaglutide share outside the U.S.

Insurance coverage trends: Whether more payers follow Blue Cross Blue Shield of Massachusetts in dropping GLP-1 weight loss coverage — or whether government pricing deals expand access — will shape volume growth significantly.

FAQ

How big is the GLP-1 market in 2026?

Estimates range from $87 billion to $101 billion globally, depending on the source and scope. The market grew from roughly $70 billion in 2025 and is projected to approach $130-180 billion by the early 2030s.

Which company leads the GLP-1 market?

Eli Lilly overtook Novo Nordisk in U.S. incretin market share in early 2025 and now holds over 60% of the U.S. market. Novo retains a larger global GLP-1 volume share at about 62%, but the momentum has clearly shifted toward Lilly.

Why are Novo Nordisk's sales declining?

Three factors: aggressive U.S. pricing discounts (including the TrumpRx deal), semaglutide patent expirations in markets like Canada and China, and direct competition from Lilly's Zepbound, which has overtaken Wegovy in U.S. weekly prescriptions.

Is there still a GLP-1 drug shortage?

The FDA declared the semaglutide and tirzepatide shortages resolved in 2025. Intermittent supply issues persist at the pharmacy level, but the acute national shortage phase has ended. Both companies have committed billions to manufacturing expansion.

When will generic semaglutide be available?

Generic semaglutide is launching in Canada, India, China, and Brazil in 2026. The U.S. compound patent does not expire until December 2031, so American patients will not see generics for several more years. However, oral formulations and competition from other branded GLP-1s may apply downward pricing pressure before then.

How much does a GLP-1 drug cost in 2026?

Under the TrumpRx program, Ozempic and Wegovy injections cost about $350/month. The Wegovy pill starts at $149/month. Zepbound costs approximately $346/month. Patients with insurance coverage may pay as little as $25/month.

The Bottom Line

The GLP-1 market in early 2026 is defined by a single narrative: Eli Lilly ascending while Novo Nordisk adjusts to a new competitive reality. Lilly's tirzepatide franchise is growing at triple-digit rates, its market share has expanded from 40% to over 60% in a year, and its 2026 revenue guidance of $80-83 billion signals continued momentum. Novo, despite launching the first oral GLP-1 for obesity, faces pricing headwinds, patent cliffs in major international markets, and a 2026 outlook that includes its first projected sales decline in nearly a decade.

The broader market, though, keeps expanding. Global GLP-1 revenue is on track to nearly double from its 2024 levels by 2028. New entrants — MariTide, survodutide, retatrutide, CagriSema — promise more effective treatments and more options for patients. The shift to oral formulations could open GLP-1 therapy to tens of millions who have avoided injections. And generic semaglutide is beginning to reach patients in markets where a year's supply previously cost more than many earn in a month.

For investors, the numbers are clear: Lilly is the growth story. For patients, the trajectory is encouraging: more competition, lower prices, and better drugs are all arriving at once.

References

  1. Eli Lilly and Company. "Lilly Reports Fourth-Quarter 2025 Financial Results and Provides 2026 Guidance." investor.lilly.com, February 2026.
  2. Novo Nordisk. "Annual Report 2025." novonordisk.com, February 2026.
  3. Grand View Research. "GLP-1 Receptor Agonist Market Size, Share & Trends Analysis Report." grandviewresearch.com, 2025.
  4. Roots Analysis. "Global GLP-1 Market Size, Forecast & Growth Industry 2035." rootsanalysis.com, 2025.
  5. FDA. "FDA Approves Oral Semaglutide as First GLP-1 Pill for Weight Loss." ajmc.com, December 2025.
  6. Novo Nordisk. "Wegovy Pill Now Broadly Available Across America." prnewswire.com, January 2026.
  7. CNBC. "Eli Lilly Blows Past Quarterly Estimates, Posts Strong Outlook." cnbc.com, February 2026.
  8. CNBC. "Eli Lilly's GLP-1 Growth Is Only Getting Started as Novo Nordisk Braces for Decline." cnbc.com, February 2026.
  9. Drug Discovery & Development. "Novo Cuts GLP-1 Prices 70%, but Semaglutide Revenue Could Grow in 2026." drugdiscoverytrends.com, 2026.
  10. BioPharma Dive. "Novo Cuts Forecasts as Compounded GLP-1s Weigh on Sales." biopharmadive.com, 2025.