Eli Lilly Reports Q1 Thursday and Wall Street Wants Numbers on Mounjaro, Zepbound, and the Next Generation Pipeline

Eli Lilly reports first quarter 2026 earnings before the open Thursday, May 1, with a 9 a.m. Eastern conference call. Wall Street consensus from Visible Alpha sits at $13.84 billion in revenue and $4.27 in adjusted earnings per share. The revenue number, if hit, would represent 38 percent year-over-year growth and would mark the seventh consecutive quarter Lilly has cleared 30 percent top-line growth. The stock closed Monday at $1,047.20, down 4 percent year to date despite the broader S&P 500 gains.

The single biggest piece of the report is the GLP-1 franchise. Mounjaro, the type-2 diabetes brand, and Zepbound, the obesity brand, both run on the same molecule, tirzepatide. Combined Q4 revenue was $9.4 billion. Q1 consensus has the combined franchise at $9.8 billion to $10.2 billion. Investors will be watching whether Zepbound continues to outpace Wegovy from Novo Nordisk in U.S. weekly prescription share. IQVIA data through April 18 showed Zepbound holding 51.4 percent of U.S. branded weight-loss prescriptions, up from 47.2 percent in January.

Pricing is a watch item. Lilly has been moving its self-pay direct channel, LillyDirect, to $349 per month for Zepbound starter doses. That price compares to roughly $1,300 per month for full retail without insurance. The expansion of self-pay access has been the company's response to ongoing political pressure around U.S. drug pricing. CFO Anat Ashkenazi will likely be asked about the gross margin impact during the call. Consensus assumes Zepbound gross margin of roughly 78 percent, lower than the 84 percent the prescription channel produces.

Manufacturing capacity has shifted from being a problem to being a tailwind. Through 2024 and most of 2025 Lilly was supply-constrained on tirzepatide. The Concord, North Carolina facility came online in Q3 2025 and the Indianapolis API expansion came online in Q1 2026. Lilly told investors in March that all dose strengths of Zepbound and Mounjaro are now in adequate supply across U.S. markets. The capacity unlock is part of why analysts have raised 2026 revenue forecasts by an average of 6.4 percent over the last 90 days.

The bigger pipeline event is orforglipron, Lilly's next-generation oral GLP-1. Orforglipron does not require refrigeration or food restrictions. Phase 3 obesity data released in February showed 14.7 percent average weight loss at 72 weeks, comparable to Wegovy. The FDA approval target is December 2026, with launch expected Q1 2027. If orforglipron gets approved, Lilly will hold both the leading injectable and the leading oral GLP-1, a position no competitor has matched. Goldman Sachs estimates the orforglipron franchise at $22 billion in peak annual revenue.

Beyond GLP-1, the company has several other pipeline reads pending in 2026. Donanemab, the Alzheimer's product, has continued to ship under the trade name Kisunla. Q4 sales were $312 million. Consensus has Q1 at $380 million to $410 million. Verzenio, the breast cancer treatment, continues to grow. Mounjaro for sleep apnea is awaiting FDA action. The diabetes franchise outside of GLP-1 has been declining year over year as Trulicity volume migrates to Mounjaro.

The political backdrop matters for the report. The Trump administration has continued to negotiate the second tranche of Medicare drug price negotiations. Lilly does not have a drug in the current negotiated set but has been preparing for a Mounjaro inclusion in the 2027 cycle. Senator Bernie Sanders has held two HELP Committee hearings since January focused on GLP-1 pricing in the U.S. compared to Europe. The political risk is real but most sell-side analysts have it priced into models at the current valuation.

The valuation context is part of why the stock has been weak in 2026. Lilly trades at roughly 32 times forward earnings, expensive on a historical basis but in line with peer Novo Nordisk. The 2026 underperformance is partly a sentiment issue. After a 2024 run that took the stock from $580 to $1,000, a flat year was always likely. The bullish case rests on orforglipron approval and on the muscle-preserving compound retatrutide, which is in late-stage trials. The bearish case rests on margin compression from Zepbound self-pay and on the political overhang.

Options pricing implies a roughly 4.2 percent move on the print, slightly below the 12-month average of 5.1 percent. The earnings reaction in the broader healthcare complex will matter. XLV, the healthcare ETF, is up 4.3 percent year to date versus the S&P 500 at 9.7 percent. A clean Lilly print could pull XLV higher into May. A miss on either revenue or guidance could pressure the entire GLP-1 trade including Novo Nordisk and Viking Therapeutics.