Lilly Q3 earnings show tirzepatide volume outrunning price cuts

INDIANAPOLIS, Oct 29. Lilly Q3 earnings show the drugmaker sold 53% more medicine by volume than a year earlier while its realized prices fell 15%. Revenue rose 39% to $24.4 billion, led by the tirzepatide brands Mounjaro and Zepbound, the company said. Lilly raised its 2026 revenue forecast to between $91 billion and $92 billion. About $900 million of the quarter came from milestone payments and changes to rebate estimates, the company said, so not all of the gain reflects demand.

Volume rose faster than prices fell

Lilly reported revenue of $24.4 billion for the three months to September, up from $17.6 billion a year earlier, according to its third quarter earnings release. The company attributed the gain to a 53% rise in volume, partly offset by a 15% drop in realized prices. Realized price is what a drugmaker keeps after rebates and discounts, not the list price. In the United States, revenue rose 34% to $15.1 billion on 41% higher volume and 7% lower realized prices. Lilly said the U.S. price decline came mainly from Zepbound, partly offset by changes to its rebate and discount estimates. Outside the United States, revenue rose 47% to $9.3 billion as volume climbed 76% and realized prices fell 29%.

The split shows that growth in peptide obesity and diabetes drugs now rests on reaching more patients rather than on holding price. BioSpace reported that analysts had expected revenue of about $22.6 billion and that Lilly shares rose 4% in early trading on Thursday. The Lilly Q3 earnings release does not give volume and price changes for each product, so the exact price effect on any single drug is not public. Lilly's presentation also says the U.S. incretin market grew 32% in the quarter, based on IQVIA prescription counts. Lilly said its incretin revenue grew 54%, driven by that market growth and a higher global share. Readers who want the headline figures in brief can see our earlier report on Mounjaro and Zepbound sales. This story looks at the numbers underneath them.

Mounjaro sales lead as China reimbursement cuts price

Mounjaro sales reached $10.7 billion worldwide in the quarter, up 65% from a year earlier, the company said. U.S. Mounjaro revenue was $5.0 billion, up 41%, while revenue outside the United States rose 93% to $5.7 billion. Both brands contain tirzepatide, a peptide that acts on GIP and GLP 1 receptors, and the release says the obesity brand Zepbound is sold in the United States, Canada and Japan. Lilly said overseas prices fell after Mounjaro was added to the China reimbursement list, formally the National Reimbursement Drug List, in the first quarter of 2026. Such listings generally trade a lower price for wider public insurance coverage. The release does not say how much of the overseas volume gain came from China.

The company attributed the gain to a 53% rise in volume, partly offset by a 15% drop in realized prices.

Zepbound revenue in the United States rose 48% to $5.3 billion. Lilly said demand drove that gain and lower realized prices partly offset it, the same Zepbound price pressure it named for the overall U.S. decline. The company's investor presentation puts Zepbound's U.S. share of total prescriptions at 58% at the end of the quarter and Mounjaro's at 56%. Across all U.S. incretin drugs, Lilly put its share at 63.0% against 36.6% for Novo Nordisk, based on IQVIA data to late September. Outside the United States, its incretin market share by revenue was 58.4%, the presentation says. These figures are company summaries of IQVIA data, not independent market studies, and the slides do not show how they were adjusted.

Foundayo launch adds a pill that is not a peptide

Foundayo, the brand name for Lilly's oral GLP 1 drug orforglipron, brought in $184 million in the quarter and $281 million so far this year, the release shows. Unlike tirzepatide or semaglutide, orforglipron is a small molecule rather than a peptide, a difference our report on its first Phase 3 obesity result explained. Lilly's slides say the Foundayo launch reached about 40% of new patient starts by the end of September, a figure BioSpace described as the share of people starting an oral GLP 1 drug. The company credited broad commercial and Medicare coverage for obesity and growing interest from consumers and prescribers. Foundayo is now sold in the United Arab Emirates, Mexico, Saudi Arabia and the United Kingdom, Lilly said.

The company said Foundayo is under regulatory review in more than 40 other countries. BioSpace reported that the drug had reached more than 45,000 patients, but the slide Peptide Zone reviewed charts new prescriptions in thousands without a stated patient total, so we could not confirm that number. Lilly also said more than 500,000 patients were getting its obesity medicines through a Medicare GLP 1 bridge arrangement, and that 80% of them were new to incretin drugs. In a separate type 2 diabetes study called ACHIEVE 4, the presentation reports that orforglipron was not inferior to insulin glargine on major heart events. It lists 57 events on the pill against 67 on insulin, a difference that was not statistically conclusive. The presentation does not cite a journal publication.

Full year guidance rises on demand and one time items

With the Lilly Q3 earnings, the company raised its full year guidance for 2026 revenue from a range of $85 billion to $87 billion to a range of $91 billion to $92 billion. That lifts the midpoint by $5.5 billion, the company said. These are company forecasts, not results. Reported earnings per share rose 16% to $7.22, while adjusted earnings per share rose 7% to $7.48. Both figures absorbed $4.57 per share of charges for acquired research projects, compared with $0.71 a year earlier. Lilly said those charges, about $4.2 billion in total, related mainly to its purchases of AtaiBeckley and Curevo. The company lowered its adjusted full year earnings range to $35.00 to $36.00 per share because the deal charges outweighed a higher underlying forecast. Gross margin was 83.9% of revenue.

Part of the quarter will not repeat. Lilly said about $900 million of revenue came from one time benefits, mainly $410 million in Jardiance milestone payments from its partnership with Boehringer Ingelheim, and favorable changes to rebate and discount estimates. The release says no further Jardiance milestones remain. Chief executive David Ricks said the company had "another strong quarter, exceeding our prior expectations and allowing us to raise our full-year outlook." Next on the calendar, Lilly plans Phase 3 trials of its EloraTZP combination to start in the fourth quarter of 2026, and it is building plants in Houston and Richmond. Its experimental triple agonist peptide also beat Ozempic on blood sugar and weight loss in a retatrutide head to head trial, the company said.

Conclusion

Lilly Q3 earnings point to a business that grows by selling more peptide medicine at lower net prices, in the United States and abroad. The 53% volume rise outran a 15% price drop, but about $900 million of the quarter came from items the company does not expect to repeat. The higher 2026 forecast is Lilly's own projection. Watch the fourth quarter for the effect of China pricing, Foundayo uptake abroad and further Zepbound price changes.