The U.S. GLP-1 story is old news by now. The bigger one is happening overseas.
Eli Lilly's Q1 revenue jumped 56% to $19.80 billion, with international sales up 81% and U.S. sales up 43%. The beat sent shares more than 7% higher in premarket trading.
Adjusted earnings came in at $8.55 per share, well above the $6.66 Wall Street had penciled in. Net income of $7.40 billion was sharply higher than the $2.76 billion Lilly posted a year ago.
Lower prices were supposed to be the bear case for Lilly. They've turned into the bull case.
Mounjaro, Lilly's diabetes drug, brought in $8.66 billion last quarter, more than double the year-ago period and well ahead of the $7.26 billion Wall Street expected. Zepbound, the obesity version, posted $4.16 billion in U.S. sales, up 80%.
The pattern is the same in both: cheaper drugs, but a lot more buyers. U.S. volumes (actual prescriptions filled) rose 49%, and international volumes climbed 95%.
That's the story behind the guidance hike. More pills out the door, even as the average price per pill drops.
CEO David Ricks told CNBC that global GLP-1 use should climb from roughly 20 million patients at the end of last year to 30 million by the end of 2026. That's the math Lilly is pricing in.
Lilly now expects 2026 revenue between $82 billion and $85 billion, up $2 billion from its prior range. Adjusted earnings should land between $35.50 and $37 per share, up from $33.50 to $35.
The company also said it holds 60.1% of the U.S. obesity and diabetes drug market, with Novo Nordisk at 39.4%. Between them, they basically own the category.
Foundayo, Lilly's new GLP-1 obesity pill, launched in Q2 and didn't show up in Thursday's numbers. It's the question Wall Street wants answered.
Ricks said more than 20,000 people have started on the drug in its first few weeks, with over 1,000 new patients a day. Eight in ten are new to GLP-1 medicines, and Lilly hasn't run a single TV ad for it yet.
The pill is going up against Novo Nordisk's Wegovy oral version, which had a three-month head start in the U.S. Ricks called the early take-up "basically organic demand," since the rollout has happened with no broadcast ads.
Lilly also expects Medicare coverage for obesity drugs to come online later this year, which would widen demand for both Foundayo and Zepbound.
Pricing pressure is the wildcard. Lower cash-pay prices for Zepbound and a drug pricing deal with the Trump administration both land in 2026, both of which compress what Lilly can charge per script.
Lilly's bet is that volume will more than make up for it. International launches are also hitting their third or fourth quarter in major markets like Europe, China, and Brazil, where many patients are paying out of pocket - the depth of demand abroad is what gave Ricks the confidence to raise guidance.
Eight in ten Foundayo patients have never tried a GLP-1 before, which means the runway is longer than it looked a quarter ago.