Eli Lilly just dropped their Q4 2024 earnings report, and while the numbers will have Wall Street talking, there’s plenty in here that actually matters for patients. With major updates on Zepbound, Mounjaro, and a pipeline stacked with new obesity and diabetes treatments, the company is making big moves—some expected, some worth keeping a closer eye on.
Zepbound continues to dominate headlines, now officially FDA-approved as the first prescription treatment for moderate-to-severe obstructive sleep apnea in adults with obesity. The latest data from the SURMOUNT-5 trial backs up what many already suspected—tirzepatide is setting a new bar for weight loss medications, delivering a 47% greater reduction in body weight compared to Wegovy. But it’s not just about weight loss. The SUMMIT trial showed that tirzepatide significantly reduces the risk of worsening heart failure in people with both obesity and heart disease, while long-term data published in The New England Journal of Medicine confirms that it can also cut the risk of developing type 2 diabetes in prediabetic patients.
Meanwhile, Mounjaro continues its rapid takeover of the type 2 diabetes market, now holding a 37% share of the U.S. injectable incretin space and claiming 44% of new prescriptions. Sales numbers reflect that momentum, with Mounjaro pulling in $2.6 billion in the U.S. last quarter, plus another $899 million internationally. And on the obesity side, Zepbound isn’t far behind—Lilly’s branded weight loss drug now holds 48% of the total market, with an even higher 56% share of new prescriptions.
Beyond what’s already on the market, Lilly's pipeline hints at where things are headed next. Higher-dose formulations of tirzepatide are officially listed, suggesting a possible expansion that could allow for more flexibility in treatment. The company is also pushing forward with orforglipron, an oral GLP-1 being developed for obesity, obstructive sleep apnea, and type 2 diabetes, as well as retatrutide, which is being studied for obesity, cardiovascular and renal outcomes, and more. While retatrutide’s Phase 3 readout was originally expected later, the timeline has been pulled forward slightly—raising the question of whether Lilly plans to file for FDA approval sooner than expected.
For now, there are two big things to watch during today’s earnings call Q&A: Will Lilly finally address the demand for higher Zepbound doses and a more affordable cash-pay option? And does the earlier-than-expected Phase 3 retatrutide readout mean they’re looking to accelerate their regulatory timeline?
I’ll be live-updating this article throughout the call, so check back as we get more answers.
WILL LILLY ANNOUNCE RELEASE OF HIGHER DOSE VIALS?
YES
NO
LIVE CALL UPDATES:
UPDATE # 1: 1.5X the amount of incretin sellable doses in second half of 2024 vs second half of 2023
UPDATE # 2: No wholesaler backorders of Mounjaro or Zepbound at the end of 2024
UPDATE # 3: Mounjaro has been launched in a limited capacity in China, and will increase as supply increases
UPDATE # 4: Zepbound (as measured by new prescriptions) became the market leader in anti-obesity medicine
UPDATE # 5: Lilly expects to launch Mounjaro in more x-US markets especially in Europe in 2025
UPDATE # 6: Lilly expects to produce 1.6x the amount of incretin sellable doses during the first half of 2025 vs first half of 2024. Concord plant will come online in 2025
UPDATE # 7: Orforglipron advanced into phase 3 Obstructive Sleep Apnea trial
UPDATE # 8: Orforglipron to be tested in hypertension
UPDATE # 9: Data in 2025 for 5 studies in type 2 diabetes, vs 2 studies in obesity
UPDATE # 10: Lilly expects weight loss in diabetics using orforglipron will be far less than people with obesity alone
UPDATE # 11: New incretin focus areas: brain health, substance abuse disorders, pain, neuropsychiatry, and inflammation
UPDATE # 12: Zepbound Access - commercial insurance access for patients is at 27%
UPDATE # 13: Lilly believes they have full supply, and compounding should not be allowed. "New sheriff in town" in DC. Unsafe practice that shouldn't exist. Undermines innovation.
UPDATE # 14: Diabetes prevention doesn't have precedent as an indication. Will not likely meaningfully increase coverage for Zepbound in the near term.
UPDATE # 15: Orforglipron continues to be referred to as a "relief valve" for Lilly injectable supply
UPDATE # 16: Access to Mounjaro through medicare or commercial insurance is over 90%
UPDATE # 17: Adherence to Mounjaro is better than Trulicity and Ozempic
UPDATE # 18: Zepbound vials and partnership with Ro is about allowing patients to leverage the Ro platform to access FDA approved versions of tirzepatide. More partnerships like this to come.
UPDATE # 19: Plan an aggressive early 2026 launch for Orforglipron in obesity
UPDATE # 20: Retatrutide readout for osteo arthritis trial is not a point estimate of what the longer straight weight loss trials will show