Lilly 2025 Growth Spikes, 2026 Guides $80B-$83B on Volume (LLY Q4 2025 Earnings Call)
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Lilly framed its earnings as a volume-led momentum story, with incretin demand driving Q4 and full-year strength while pricing dynamics and ongoing investment shape 2026 guidance for revenue growth and margin.
2025 revenue up 45% as Q4 growth proves demand is outpacing constraints
Lilly reported full-year revenue of $65.2 billion, up 45% versus 2024, driven by key products, and a strong Q4 with revenue up 43% YoY. Gross margin was 83.2% in Q4, with management noting favorable product mix and improved production costs were offset by lower realized prices, a reminder that growth is still fighting price pressure.
2026 guidance targets $80B-$83B revenue, margin held despite “low to mid-teens” price drag
Lilly guided 2026 revenue to $80B-$83B, with CFO Lucas Montarce saying pricing is “expected to be a drag on growth in the low to mid-teens.” Management guided non-GAAP performance margin of 46% to 47.5%, and Montarce attributed margin direction to stable-to-slightly-down gross margin, rising R&D, and increased marketing tied to new launches.
Incretins drive the quarter, with international Mounjaro momentum and obesity channel sophistication
In cardiometabolic health, Lilly highlighted that US incretin analog prescriptions rose 33% versus Q4 2024, while Zepbound nearly doubled revenue versus Q4 2024 and led branded obesity prescriptions with nearly 70% share of new prescriptions. Internationally, CFO and segment leadership emphasized that outside the US, volume growth stayed strong, and CEO David Ricks said international rollouts of Mounjaro and Kisanlo helped Lilly enter new markets during 2025. Management also pointed to direct-to-patient engagement reaching 1 million patients in 2025, and leadership described that platform as key to driving continued access expansion.
Q&A focused on how orforglipron wins, and how Medicare access changes the growth math
On orforglipron success metrics, Kenneth Custer said management will pivot to “patient satisfaction” and “real-world efficacy,” and he tied market expansion to oral options validating demand for patients “sitting on the sidelines waiting for an oral option.” On international timing, Patrik Jonsson said outside the US launches are “mainly” late 2026 or 2027, with “a few exceptions” that could reference an FDA-approved product. On Medicare adoption, Lucas Montarce stated access will be effective no later than July 1, and he described a Medicare shift from Lilly Direct activity, with the bolus “between 10-20%” expected to move into Medicare space, building gradually into the later back half and 2027.