Tag: Eli Lilly and Company

  • Weight-Loss Drug Price Wars Are Upending Big Pharma’s Business Model

    Weight-Loss Drug Price Wars Are Upending Big Pharma’s Business Model

    The multibillion-dollar market for GLP-1 weight-loss drugs, once a duopoly dominated by Novo Nordisk and Eli Lilly, is fracturing under intense pricing pressure, political intervention, and rising competition from compounded alternatives. What began as a revolutionary breakthrough in obesity treatment has evolved into a fierce price war that’s challenging the core business models of Big Pharma giants, raising questions about innovation, profitability, and access to life-changing medications.

    Novo Nordisk, the Danish pioneer behind Ozempic and Wegovy, stunned investors this week by forecasting a 5% to 13% sales decline in 2026 – its first drop since 2017 – amid “unprecedented” U.S. price cuts and patent expirations in key markets like China and Brazil. The company’s shares plunged 17% on Wednesday, erasing nearly $50 billion in market value, as CEO Mike Doustdar acknowledged short-term “pain” from slashing prices to boost volumes and compete with Lilly’s surging Zepbound and Mounjaro.

    In contrast, U.S. rival Eli Lilly delivered a bullish outlook, projecting 25% revenue growth to $80-83 billion in 2026, far exceeding Wall Street expectations. Lilly’s tirzepatide-based drugs raked in over $36 billion in 2025, outpacing Novo’s semaglutide portfolio and positioning Lilly as the clear leader in the GLP-1 race. “We’re seeing incredible demand, and our manufacturing investments are paying off,” Lilly CEO David Ricks told analysts, downplaying pricing headwinds as a temporary drag offset by volume gains.

    As illustrated in the accompanying chart from LSEG Workspace, Novo’s revenues have boomed in double digits for years, driven by weight-loss drug sales, but the firm now anticipates a sharp reversal in 2026 due to these pressures.

    The divergence highlights how pricing dynamics, fueled by U.S. President Donald Trump’s “most favored nation” (MFN) policy and direct-to-consumer platforms like TrumpRx.gov, are reshaping the industry. Launched on February 5, TrumpRx connects Americans to discounted drugs from manufacturers like Novo, Lilly, Pfizer, and AstraZeneca, offering prices as low as $149 for Wegovy’s starter dose – a fraction of the original $1,000 monthly list price. In exchange, companies received tariff relief and expedited approvals, but critics argue it sidesteps systemic issues, with limited impact for insured patients who may still pay less through coverage.

    “TrumpRx could have some impact, but it’s far from revolutionary,” said Craig Garthwaite, director of health care at Northwestern University’s Kellogg School of Management. Experts like economist Öner Tulum warn that MFN relies on opaque global pricing, allowing companies to game the system by raising overseas prices or delaying launches.

    Adding fuel to the fire, telehealth provider Hims & Hers Health launched a $49 compounded semaglutide pill on February 5 – just weeks after Novo’s Wegovy pill debut – prompting Novo to vow “legal and regulatory action” for alleged patent infringement and patient safety risks. Hims uses liposomal technology to aid absorption, bypassing Novo’s proprietary SNAC method acquired in a $1.8 billion deal. The FDA has warned against compounded GLP-1s, citing lack of safety evaluations, while the Department of Health and Human Services referred Hims to the Justice Department for investigation.

    This isn’t the first clash: Novo previously partnered with Hims for Wegovy injections but ended ties acrimoniously last summer. Now, compounded knockoffs – estimated to serve 1.5 million Americans – threaten the duopoly’s pricing power. “This new offering could test how far compounders can skirt Big Pharma’s patents,” said Deb Autor, Hims’ chief policy officer.

    The broader shift to cash-pay channels has made prices more sensitive, with injectables now starting at $149-$299 on company sites, down from $1,000. Analysts like Markus Manns at Union Investment fear a “no-win” price war: “There’s no assurance cuts will pay off.” Bernstein’s Courtney Breen noted Novo’s cuts are risky given its trailing position.

    Lilly holds clinical edges – Zepbound achieves higher weight loss than Wegovy’s injection, while Novo’s pill edges Lilly’s upcoming orforglipron in trials. Lilly expects orforglipron approval in Q2 2026, potentially expanding the market further. “Pills could reshape GLP-1s like consumer products,” one analyst noted.

    Yet the market is crowding: Pfizer and Amgen eye 2028 launches, while GSK focuses on obesity’s downstream effects like liver disease. Goldman Sachs raised Lilly’s target to $1,260, citing confidence in 25% growth despite pressures.

    Critics argue Big Pharma’s model prioritizes shareholders over patients. Economist William Lazonick’s research shows U.S. pharma spent $747 billion on buybacks and dividends from 2012-2021, exceeding $660 billion on R&D. During the pandemic, 18 firms distributed $377.6 billion to shareholders – over 90% of profits – while claiming high prices fund innovation. “It’s a fallacy,” said UNAIDS’ Winnie Byanyima. “Profits go to Wall Street, not cures.”

    A Senate HELP Committee report echoed this: In 2022, Bristol Myers Squibb spent $12.7 billion on buybacks, dividends, and exec pay versus $9.5 billion on R&D. Overall, 10 firms with drugs under Medicare negotiation spent $162 billion on shareholder handouts and marketing in 2023 – far outpacing $95.9 billion on R&D.

    As shown in the second chart from LSEG, Novo’s market cap peaked in June 2024 before a sharp plunge, reflecting these pressures and Lilly’s ascent toward a trillion-dollar valuation.

    What tames Big Pharma? Tulum suggests emulating the VA system’s deep discounts via centralized negotiation. Biden’s Inflation Reduction Act (IRA) enabled Medicare negotiations for 10 drugs in 2026, including GLP-1s like Ozempic in 2027. Yet industry lobbies fiercely, with $83.2 million in trade dues funding opposition in 2023.

    Mark Cuban’s Cost Plus Drugs offers transparent markups, but scalability is limited. Ultimately, reformers like Lazonick advocate banning buybacks and stock-based pay to redirect profits toward innovation.

    As prices fall and competition rises, the GLP-1 war may force Big Pharma to adapt – or face a reckoning. For patients, lower costs could mean broader access, but sustained innovation requires reining in financialization.

  • The High Cost of Trump’s Drug Tariffs: A Political Minefield

    The High Cost of Trump’s Drug Tariffs: A Political Minefield

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    President Trump’s decision to move a step closer to imposing tariffs on imported medicines poses considerable political risk, because Americans could face higher prices and more shortages of critical drugs.

    The Trump administration filed a federal notice on Monday saying that it had begun an investigation into whether imports of medicines and pharmaceutical ingredients threaten America’s national security, an effort to lay the groundwork for possible tariffs on foreign-made drugs.

    Mr. Trump has repeatedly said he planned to impose such levies, to shift overseas production of medicines back to the United States. Experts said that tariffs were unlikely to achieve that goal: Moving manufacturing would be hugely expensive and would take years.

    It was not clear how long the investigation would last or when the planned tariffs might go into effect. Mr. Trump started the inquiry under a legal authority known as Section 232 that he has used for other industries like cars and lumber.

    Mr. Trump said in remarks to reporters on Monday that pharmaceutical tariffs would come in the “not too distant future.”

    “We don’t make our own drugs anymore,” Mr. Trump said. “The drug companies are in Ireland, and they’re in lots of other places, China.”

    While some drugs are made at least in part in the United States, America’s reliance on China for medicines has generated alarm for years, with both Republicans and Democrats identifying it as a national security vulnerability.

    Many drugs are not produced without at least one stage of the manufacturing process happening in China. Even India’s giant generic drug sector is deeply dependent on China, because Indian manufacturers typically obtain their raw materials from Chinese plants.

    Imposing disruptive levies on lifesaving medications creates risks for Mr. Trump that were not a major concern with some of his other tariff targets, like steel and aluminum, where Americans generally aren’t directly exposed to increased prices.

    He could face a harsh backlash if pharmaceutical tariffs lead to significant drug price increases or shortages for patients. The number of drug shortages reached a record-level high last year. Americans fill several billion prescriptions a year, on top of purchasing over-the-counter products like cough syrup and Tylenol.

    On Tuesday, Mr. Trump signed an executive order outlining a series of actions intended to lower drug prices, including helping states import drugs from Canada. The idea behind these imports is to bring in cheaper drugs, but tariffs could mean that those imports would not offer the same savings as in the past.

    If pharmaceutical tariffs cause an increase in any drug prices, Democrats could jump on the issue for the midterm elections next year and try to undercut Mr. Trump’s popularity among working-class voters.

    Democrats have already seized on the issue. In a letter sent to Trump officials last week, a group of lawmakers led by Representatives Doris Matsui of California and Brad Schneider of Illinois wrote that “reckless tariffs” on medicines threatened to harm Americans.

    “The supply disruptions of critical medical products will unavoidably hurt U.S. patients, force providers to make impossible rationing decisions, and potentially even result in death as treatments are delayed, or more effective medicines and products are swapped for less effective alternatives,” they wrote.

    Kush Desai, a spokesman for the White House, said in a statement on Monday that “President Trump has long been clear about the importance of reshoring manufacturing that is critical to our country’s national and economic security.”

    Targeting pharmaceuticals also risks further inflaming relations with allies like the European Union and India, whose economies are supported by drug exports to the United States. Officials of those countries fear that drug tariffs could prompt companies to renege on investments, resulting in a loss of jobs, factories and tax revenue.

    Along with cars and electronics, pharmaceuticals are one of the categories of goods that the United States imports the most, measured by value.

    Tariffs on drugs would add tens of billions of dollars of import costs for a powerful industry that relies on a complex global supply chain. Production of most medications consumed in the United States happens in more than one part of the world, with plants in different countries handling different stages of the process.

    Expensive patented medications, like the popular weight-loss drug Wegovy, are more likely to be made in Europe or the United States.

    China and India do most of the production of cheaper generic drugs, which account for the vast majority of U.S. prescriptions. For example, plants in those countries make nearly all of the world’s supply of the active ingredients in the painkiller ibuprofen and the antibiotic ciprofloxacin, according to Clarivate, an industry data provider.

    Pharmaceuticals are the latest sector that Mr. Trump has targeted. Tariffs of 25 percent are already in effect for imported steel, aluminum and cars. The Trump administration has also initiated Section 232 investigations, or inquiries into national security concerns, for copper, lumber and computer chips.

    Investigations under the 232 provision must be completed within nine months.

    The drug industry has been lobbying the Trump administration to phase in tariffs gradually or to exempt certain types of products, such as medications at risk of shortages or those deemed essential, like antibiotics.

    John Murphy III, the head of a trade group that represents manufacturers of generic drugs, said in a statement on Monday that tariffs “will only amplify the problems that already exist in the U.S. market for affordable medicines.”

    The tariffs would be paid by drug companies importing products or ingredients into the United States. Many of those manufacturers would most likely try to pass at least some of the added costs to employers and government programs like Medicare and Medicaid that cover most of the tab for Americans’ prescription drugs. That would ultimately affect patients.

    Levies could cause shortages of some cheaper generic drugs, because prices are so close to production costs. Manufacturers with such thin margins may be forced to curtail or end production.

    Industry experts said they were not concerned about shortages for brand-name drugs, which generally have high profit margins that could absorb tariffs.

    Patients whose insurance requires them to pay a deductible or a percentage of a drug’s price could eventually face higher out-of-pocket costs for some drugs. They may also have to pay a higher co-payment if shortages resulting from the tariffs force them to switch to a different, pricier medication. In future years, people could face higher health insurance premiums.

    In some cases, contractual agreements and steep financial penalties may discourage manufacturers from sharply raising prices. With patented products, manufacturers typically have such large margins that their sales would still be highly profitable even if they absorbed the cost of tariffs.

    David Ricks, the chief executive of Eli Lilly, told the BBC earlier this month that his company expected to eat the cost of tariffs. But Lilly could reduce its research spending or cut staffing as a result, he said.

    Mr. Trump has been saying that his tariffs will prompt drugmakers to move their overseas production back to the United States. In recent weeks, several of the industry’s richest companies — Eli Lilly, Johnson & Johnson and Novartis — announced plans to spend billions of dollars to build new plants in the United States.

    But experts say the tariffs aren’t nearly enough to bring most drug production back to the United States. The obstacles are especially steep with crucial generic drugs. Building a new plant takes years. Even shifting production to an existing American plant may be too costly. Labor and other production expenses are much higher in the United States.

    Joaquin Duato, chief executive of Johnson & Johnson, said on a call with analysts on Tuesday that “if what you want is to build manufacturing capacity in the U.S., both in med-tech and in pharmaceuticals, the most effective answer is not tariffs, but tax policy.”

    The Trump administration has been taking aim at Ireland, where nearly all of the largest American drugmakers have a manufacturing presence, in some cases dating back decades. One of Ireland’s biggest appeals for the industry is the tax advantages it offers. Some drugmakers shift their profits there to lower their overall tax bills.

    Last month, Mr. Trump said that Ireland “took our pharmaceutical companies away.” Howard Lutnick, the commerce secretary, saidthat Ireland was running a “tax scam” that American pharmaceutical companies were exploiting. “That’s got to end,” Mr. Lutnick said.

    Some of the industry’s biggest blockbusters, including the cancer drug Keytruda and the anti-wrinkle injection Botox, are partly produced in Ireland. The United States imports more pharmaceutical products, as measured by their value, from Ireland than any other country.

    Irish officials fear that tariffs could prompt drugmakers to pull back from investments in the country. But experts said that drugmakers may be reluctant to undergo the costly, disruptive process of uprooting their operations there, especially while uncertainty persists about how long Mr. Trump’s tariffs will last.

    Pharmaceuticals have historically been spared from tariffs under a World Trade Organization agreement meant to ensure that patients have access to vital medications.

    Medications were mostly exempted from the round of global tariffs Mr. Trump announced earlier this month and then partly delayed for 90 days. Drugmakers importing from China into the United States have been subject to tariffs, initially 10 percent and later 20 percent, that Mr. Trump had imposed on Chinese imports earlier this year.