Our Take: Eli Lilly achieves market value of $1 trillion

Eli Lilly briefly reached a $1 trillion market valuation on Nov. 21, becoming the first drugmaker to hit the milestone.

The surge is driven primarily by tirzepatide, marketed as Zepbound (obesity) and Mounjaro (type 2 diabetes), which has propelled Lilly’s stock more than 10x since 2018.

Novo Nordisk previously dominated the GLP-1 market with semaglutide (Ozempic, Wegovy). Lilly entered later but quickly closed the gap with FDA approvals for tirzepatide in:

• May 2022 – Diabetes
• November 2023 – Chronic weight management
• December 2024 – Obstructive sleep apnea in adults with obesity

Mounjaro surpassed Ozempic as the world’s second-best-selling drug in Q2, reaching $5.2B in global sales. By Q3, Mounjaro and Zepbound represented 57% of Lilly’s total revenue, generating $10.1B for the quarter.

Year-to-date tirzepatide sales reached $24.8B, surpassing Merck’s Keytruda and making it the world’s top-selling prescription drug.

Johnson & Johnson remains Lilly’s closest peer with a market cap near $495B.

Direct-to-Employer Strategy

Lilly plans to launch a direct-to-employer model in early 2026 featuring:

• Flexible employer benefit designs
• A dedicated pharmacy network
• Customized obesity management programs

Waltz Health will support the model with fixed pricing, fulfillment, eligibility screening, pharmacy routing, and patient engagement tools. Novo Nordisk will also participate.

Novo Nordisk Developments

Novo awaits FDA decisions on:

• 25 mg oral semaglutide for obesity
• 7.2 mg injectable semaglutide (sNDA submitted Nov. 26)

In Phase III trials, the higher injectable dose produced a 20.7% average weight loss versus 17.5% for the standard dose.

The sNDA is under the FDA’s Priority Voucher program, which could lead to a decision within one to two months.

Next-Generation GLP-1 Therapies

Both companies are developing next-gen treatments:

• Lilly: Retatrutide (triple hormone agonist) – Phase III
• Novo: CagriSema – Phase III; pediatric trials beginning in 2026

Novo’s stock dipped after Alzheimer’s trial results failed to show clinical benefit despite biomarker improvements. Shares rebounded later in the week.

Disclosure: Novo Nordisk is a client of Darwin Research Group.

Health Care Rounds #194: Dr. David Shulkin

Former VA Secretary Dr. David Shulkin explains why U.S. health care reform requires structural change — not just subsidies or payment tweaks. He explores misaligned incentives, lessons from the VA’s population-based model, and what real reform will require.

Watch or listen to the episode on Health Care Rounds.

What Else You Need to Know

• CMS Drug Price Negotiations: 15 drugs will receive negotiated Medicare prices starting Jan. 1, 2027, with discounts between 38%–85%. Beneficiaries are expected to save $685M in 2027.
• 340B Lawsuit: AHA and hospital groups sued HHS over the new rebate pilot requiring upfront full-price payments.
• Amazon: Investing up to $50B in AI and high-performance computing infrastructure for federal agencies.
• PwC + AWS: Partnering on AI-driven revenue cycle management tools.
• Premier: Now fully owned by Patient Square Capital in a $2.6B deal.

D.C. Developments

• Biotech leaders called for more regulatory stability at the FDA.
• CDER leadership shifted again with Dr. Tracy Beth Hoeg appointed acting director.
• The FDA launched an agency-wide agentic AI program.
• The Priority Voucher program faces Senate scrutiny over transparency and safety.

Executive Moves

• Dr. Cristy Page named CEO of UNC Health.
• Tarek Salaway appointed CEO of OHSU Health System.
• Dr. Clint Seger named CEO of Billings Clinic-Logan Health.

What We’re Reading

• Venture Capital Investments by U.S. Academic Medical Centers — NEJM
• Federal Budget Cuts Won’t Hit All Hospitals Equally — Health Affairs
• Public Trust in Scientists for Cancer Information — JAMA Network Open

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