Eli Lilly (LLY) Q4 FY25 earnings call: guidance and Q&A

What metrics will Lilly track for the orforglipron launch in the next year?

Ken Custer stated that Lilly will be looking at market expansion, patient satisfaction, and real-world efficacy. He noted that oral Wegovy's success validates the belief in substantial demand for an oral option, expanding the market with mostly new starts. Lilly feels confident in orforglipron's competitive profile and expects patient satisfaction and real-world efficacy to be key.

“We're very encouraged by what we're seeing with oral Wegovy as it validates our belief that there's a substantial number of people with overweight and obesity who've been sitting on the sidelines waiting for an oral option. It looks like these are mostly new starts. That means it's expanding the market and that's good news for Lilly.”

asked by Evan Seigerman · answered by Kenneth Custer

Are there accelerated pathways for ex-U.S. orforglipron approvals that would enable 2026 launches?

Patrik Jonsson clarified that outside the U.S., most orforglipron launches are expected in the first half of 2027. He mentioned a few exceptions for late 2026 launches in specific markets like the UAE, which might reference FDA approval.

“outside of the U.S., it's mainly going to be a matter of launch in the first half of 2027. There will be a few markets late '26. And a few exceptions for countries like, for example, the UAE that might reference an FDA-approved orforglipron.”

asked by Courtney Breen · answered by Patrik Jonsson

How should investors think about the sequential growth for international Mounjaro from its Q4 $3.3 billion result, given new market launches in 2025?

Patrik Jonsson confirmed Q4 was strong for Mounjaro internationally, with Lilly becoming the shadow market leader. He advised using Q4 as a base for 2026 growth, noting a slight Q4 impact from China's NRDL listing. He highlighted that 75% of the international business is chronic weight management (out-of-pocket) and 25% is reimbursed for type 2 diabetes, with priorities for 2026 being market expansion and gaining reimbursement in more countries.

“Q4 was a very strong quarter for Mounjaro also outside the U.S. And as Lucas referred to, we became the shadow market leader for total incretins also internationally. When you look at 2026, I would just reflect back on '25. We had major launches more or less in every quarter with the exception of Q4.”

asked by Christopher Schott · answered by Patrik Jonsson

Why can't Lilly attack immunology broadly with the same aggressive investment approach as obesity, given the substantial cash generation and market opportunity?

Dan Skovronsky stated that Lilly is indeed reinvesting proceeds from the obesity opportunity into other areas, including oncology, neuroscience, and immunology. He expressed high hopes for immunology, citing promising science, including treating immunologic diseases earlier, and ongoing trials for incretins in immunology, as well as other combination therapies in late-stage clinical trials.

“across our non-obesity work, which is, of course, oncology, neuroscience and immunology, we have our thumb on the scale for investment decisions. We see lots of good opportunities in those areas and we're reinvesting some of the proceeds from the obesity opportunity to make sure we can further accelerate growth in those promising areas.”

asked by Seamus Fernandez · answered by Daniel Skovronsky

What is embedded for Medicare volume ramp in H2 2026, and has it impacted employer opt-ins on the commercial side?

Lucas Montarce expects Medicare access by July 1, 2026, with a gradual build-up, noting the $50 co-pay will be compelling and a bolus of LillyDirect Medicare patients will likely transition quickly. Ilya Yuffa added that while commercial coverage is stable, Lilly is actively engaging employers with a dedicated team and alternative access channels, expecting increased coverage in late 2026 and mostly into 2027 as the class gains recognition as a chronic disease.

“we are expecting that access to be granted no later than July 1. And as I mentioned all along, this will take time to build over time but we feel very, very positive about the opportunity to bring anti-obesity medications to patients in Medicare.”

asked by Terence Flynn · answered by Lucas Montarce

What is Lilly seeing in the contracting environment for incretins, and what is the view on price elasticity in the cash channel?

Ilya Yuffa stated that commercial access and contracting started the year similar to Q4 2025, with coverage for Zepbound in two of three large PBMs and ongoing discussions for expanding access with orforglipron's introduction. He noted that affordability and predictable costs matter in the cash channel, citing the $50 Part D out-of-pocket and the $2.99 entry price for Zepbound vials leading to increased utilization, and expects oral GLP-1s to expand the market.

“affordability and opportunity on the entry as well as predictability of cost for patients matter. That's why the out-of-pocket in Part D of $50 is an affordable option as well as we've seen an increase in utilization of even Zepbound vial at the end of the year when we implemented improved entry price of $2.99 for Zepbound.”

asked by Asad Haider · answered by Ilya Yuffa

Can the 2026 revenue guidance be delivered without orforglipron being a $5 billion product, and does guidance imply orals will grow the market, not cannibalize?

Lucas Montarce explained that the guidance is based on a bottom-up approach, factoring in growth from key products, Medicare expansion, orforglipron launch, and an accelerated price erosion of low to mid-teens. He noted that recent competitor oral launch data suggests market expansion, not cannibalization, which is consistent with Lilly's expectations and guidance. Dave Ricks added that cannibalization is not expected and strategically less critical, as Lilly aims for patients to choose the best therapy from its portfolio.

“looking at even just the last 4 weeks of the data of the competitor launch, is mainly expansion of the market. So we are very, very encouraged from, again, the first month of seeing that data and it's very much consistent with our expectations and our guide.”

asked by Steve Scala · answered by Lucas Montarce

What consumer analogs would Dave Ricks point to for long-term penetration of weight loss products, and is the guidance expecting no meaningful cannibalization between oral and injectable obesity products?

Dave Ricks stated that cannibalization is not expected and is strategically less critical, as Lilly's goal is for patients to choose the best therapy from its offerings. He acknowledged the difficulty in finding direct consumer analogs for prescription medications with profound health benefits, but sees opportunities in leveraging platforms like LillyDirect, playing with pricing, and exploring subscription models to reduce friction and engage consumers.

“I am hard-pressed to think of an analog where you have this many people paying out of pocket for a prescription medication. People could look back at the [indiscernible] and the [ ED ] drugs, we were part of that. We've learned some things from that but it's not the same as this.”

asked by Akash Tewari · answered by David Ricks