Zepbound Surges, Orforglipron Impresses, and Lilly Keeps the Crown. For Now.

Eli Lilly released their Q1 2025 earnings this morning, and the story is clear. The GLP-1 race belongs to them. While they showed strength in all the usual areas, Mounjaro, Zepbound, and market share, the most important clues are buried in what comes next.

Here is the breakdown.

Zepbound is on fire

U.S. sales hit 2.31 billion dollars this quarter. New to brand share in the branded obesity space reached 74 percent. That is a 17 point jump in just three months. But this is not just demand. It is strategy. LillyDirect rolled out new 7.5 and 10 milligram single dose vials of Zepbound, giving patients more flexibility and in many cases a lower cost per injection. Smart and aggressive.

Mounjaro keeps driving the bus

Mounjaro brought in 3.84 billion dollars in Q1, up more than 100 percent from last year. Lilly now controls 53 percent of the entire U.S. incretin market, including injectables and orals. Novo is trailing at 46 percent. The gap keeps growing.

Orforglipron might be the oral that changes everything

Lilly’s oral GLP-1 just hit the mark in Phase 3. In the ACHIEVE-1 study, people on the highest dose lost 16 pounds on average and dropped their A1C by up to 1.6 percent. That is without hitting a plateau. This pill is not some watered down version of an injection. It is the real deal.

Lilly plans to file for obesity approval by the end of this year and for type 2 diabetes in the first half of next year. If it gets through, this will be the first oral GLP-1 to truly compete with injectables.

Retatrutide is not sitting quietly

Their triple agonist is in trials for obesity, osteoarthritis, sleep apnea, and more. Some of those trials are already comparing it directly to tirzepatide. Results from the TRIUMPH program are expected later this year. If this drug holds up, it could push the boundaries of what we think these meds can do.

The compound war is still very much alive

There is no mention of compounded tirzepatide in the slides. But you can see it between the lines. Six billion dollars came in from Mounjaro and Zepbound. That is Lilly’s answer to the gray market. Flood the field and let enforcement do the rest.

Meanwhile, the FDA is still fully allowed to go after compounders. The OFA sued the agency, arguing that tirzepatide should remain on the drug shortage list and that enforcement should pause. But the judge denied the OFA’s request for a restraining order, meaning the FDA is free to enforce while the case plays out.

We are now waiting for a ruling on summary judgment. That decision could come as early as tomorrow. If the FDA wins, nothing changes. Enforcement continues. If the OFA wins, the FDA could be blocked from taking future action against 503B facilities that are making tirzepatide. That would be a major blow to Lilly, and a lifeline to patients relying on compounders for access.

And then CVS took a swing

This morning, CVS announced that Wegovy will become the preferred GLP-1 for obesity across all Caremark formularies starting July 1. That is a bold move in a competitive year. Novo gets a win. Lilly gets a warning shot.

Bottom line

Lilly is not just winning. They are planning for what comes next. Orforglipron is their bridge. Retatrutide is their long game. Zepbound is paying the bills. But Wegovy is creeping into formularies, compounders are still in play, and courtrooms might do what competitors cannot.

We will update again throughout the earnings call.