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Lilly's Q1 results show strong demand for GLP-1 therapies, but the bullish thesis relies on execution, supply security, and payer support. The 2026 capex cliff and potential ROIC compression pose significant risks.
Rischio: The 2026 capex cliff and potential ROIC compression
Opportunità: Maintaining a strong fill rate and capturing market share
Obesità drug giant Eli Lilly on Thursday reported a monster first quarter, fortifying our conviction to stick with the stock after a period of sluggishness. Revenue in the three months ended in March jumped 56% from a year ago to $19.8 billion, trouncing the LSEG consensus of $17.6 billion. Adjusted earnings per share totaled $8.55, more than doubling on an annual basis and crushing the $6.66 consensus, according to LSEG. LLY 1Y mountain Eli Lilly's stock performance over the past 12 months. Shares surged about 10% on Thursday. The stock came into the day down 21% for the year and roughly 23% off its late November all-time closing high of $1,110. The weakness in the stock was tied to a broader rotation away from the healthcare sector, and broader questions about the competitive dynamics in the booming GLP-1 market. Bottom line Lilly knocked it out of the park. As if the massive top and bottom-line beats were not enough, the drugmaker raised its full-year guidance for revenue, operating profitability and earnings per share. "This is one of the greatest pharma stories," Jim Cramer said Thursday. A big reason why Lilly's results are so impressive: It’s doing this despite weaker realized drug prices in the U.S., partially stemming from most favored nation agreements with the Trump administration in exchange for Medicare access. Competition from Novo Nordisk , the maker of Ozempic for diabetes and Wegovy for weight loss, is another factor. Regardless, Eli Lilly CEO David Ricks has insisted his company will be able to overcome lower prices with higher volumes — and that's what is happening. In the first quarter, pricing fell 7% in the U.S., but volumes jumped 49% driven by its injectable GLP-1s, Zepbound for obesity and Mounjaro for type 2 diabetes. (Both drugs share the active ingredient of tirzepatide.) The dynamic was actually even more pronounced on a worldwide basis, with pricing down 13% and volumes up 65%. China was a big driver of the weaker prices globally. Mounjaro fueled the volumes gains internationally, where it is marketed for both obesity and diabetes. The international strength of Mounjaro has been a standout theme recently, and that was the case again in the first quarter. For the full year, Lilly still expects pricing to be a low-to-mid teens headwind on a percentage basis. So, the fact Lilly is taking up its guidance just one quarter into the year is anyways a clearly bullish signal. All the billions upon billions of dollars that Lilly has poured into expanding GLP-1 manufacturing capacity in recent years is paying off. Demand is strong, the GLP-1 market is growing, and Lilly has the supply to meet the moment. Another big topic Thursday had nothing to do with the reported figures: the launch of obesity pill Foundayo, which secured its long-awaited Food and Drug Administration approval on April 1 and became broadly available about a week later. Foundayo used to be referred to by the name of its active ingredient, orforglipron. Investors wanted clarity on early prescription data that showed Foundayo was off to a sluggish start compared to the launch of Novo's Wegovy pill in January. That revelation hurt the stock last week. During a CNBC interview Thursday morning, Ricks had reassuring things to say here, stressing that his long-term optimism hasn't dimmed. He conceded Novo's pill had an advantage of leveraging the existing Wegovy brand. By contrast, the Foundayo brand is being built from scratch, and it will take time to familiarize both doctors and consumers. Lilly hasn't started advertising on TV yet, Ricks said, so most of the demand for the product is coming organically. More than 20,000 people are taking the pill, he said. Plus, a key stat: about 80% of the Foundayo prescriptions are for people who previously weren't taking a GLP-1. This supports the idea the convenience of a pill would expand the size of the obesity market, not cannibalize the injectables. The ramp will play out over quarters, not days, Ricks argued. It's hard to disagree with him. Something to monitor going forward is the start of Medicare coverage for obesity drugs with a $50 copay. The start of a pilot program has been delayed due to private insurers' reluctance to participate for their Part D prescription plans. In response, the Trump administration plans to extend a bridge program by a year through the end of 2027. So, Lilly will be able to benefit from this bridge program. We just need to keep watch of the longer-term discussion to ensure the Part D coverage is in place for 2028. Ricks said he believes the broader health benefits for patients will become apparent over the next 18 months. "I would expect the government to lean hard into getting Part D plan participation and normalizing obesity care as a standard preventative treatment and something that should be used to treat comorbidities of obesity within the senior population," Ricks said on the earnings call. "We may have the evidence to support that as we exit '27." Why we own it Eli Lilly's best-in-class drugs should enable growth above the industry average for many years to come. The portfolio is anchored by its GLP-1 franchise, which currently includes Mounjaro for type 2 diabetes and Zepbound for obesity injectables, as well as a new weight loss pill, Foundayo. The fast-growing class of drugs has the potential to treat other conditions. Competitors: Novo Nordisk , Biogen , Eisai, Merck and Pfizer Weight in portfolio: 2.26% Most recent buy: May 22, 2025 Initiated: Oct. 8, 2021 Finally, Lilly executives remained upbeat on Lilly's GLP-1 drug pipeline, including retatrutide, which trials show delivers even more weight loss on average than Zepbound. The company plans to file for regulatory approval in the U.S. later this year. On the call, executives said retatrutide could be an especially helpful product for type 2 diabetes patients who need help with blood-sugar control and weight loss. The current GLP-1s on the market have generally been less effective in generating weight loss in the diabetes population, so there's a need that retatrutide could fill. There's so much to like with Lilly, and we're glad Wall Street is taking notice Thursday. For now, we're reiterating our hold-equivalent 2 rating . To account for the market's disdain for healthcare stocks, we're lowering our price target to $1,200 a share from $1,250. Guidance Here's an updated look at Lilly's full-year 2026 guidance: Revenue in the range of $82 billion to $85 billion, up from $80 billion to $83 billion previously. The new midpoint of $83.5 billion is ahead of the FactSet consensus of $82.1 billion. Performance margin, a Lilly-defined measure of operating profitability, in the range of 47% to 48.5%, up from 46% to 47.5%. Earnings per share in the range $35.50 to $37, an increase from the prior $33.50 to $35. The revised midpoint of $36.25 tops the FactSet consensus of $34.52. (Jim Cramer's Charitable Trust is long LLY. See here for a full list of the stocks.) As a subscriber to the CNBC Investing Club with Jim Cramer, you will receive a trade alert before Jim makes a trade. Jim waits 45 minutes after sending a trade alert before buying or selling a stock in his charitable trust's portfolio. If Jim has talked about a stock on CNBC TV, he waits 72 hours after issuing the trade alert before executing the trade. 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Quattro modelli AI leader discutono questo articolo
"Eli Lilly's ability to offset double-digit pricing headwinds with massive volume growth confirms that their GLP-1 franchise has reached a self-sustaining scale that justifies a premium valuation despite healthcare sector volatility."
Lilly’s Q1 results are a masterclass in volume-driven scale, validating the massive capital expenditure in manufacturing. A 49% volume surge in the U.S. despite a 7% pricing headwind proves that GLP-1 demand is price-inelastic at current levels. The raise in EPS guidance to a $36.25 midpoint suggests that operating leverage is finally catching up to revenue growth. However, the market is ignoring the 'Foundayo' launch friction. If the pill’s slow start isn't just a branding issue but a sign of lower efficacy or side-effect tolerance compared to injectables, the long-term total addressable market (TAM) expansion thesis is at risk. I am bullish, but watching the 2028 Medicare Part D coverage cliff closely.
If Foundayo fails to gain traction, Lilly remains a pure-play injectable company, making it hyper-vulnerable to manufacturing bottlenecks and the inevitable margin compression as competitors like Pfizer and Roche enter the oral GLP-1 space.
"Lilly's 65% global volume growth crushing 13% pricing declines proves manufacturing capex is fueling scalable dominance in the expanding GLP-1 market."
Lilly's Q1 crushed with 56% revenue growth to $19.8B (vs $17.6B est) and EPS $8.55 (vs $6.66), driven by 49% U.S. volume surge in Mounjaro/Zepbound despite 7% pricing drop—global volumes up 65% vs 13% pricing decline. Early FY guidance raise to $82-85B revenue (midpoint beats $82.1B consensus) and $35.50-37 EPS signals supply ramp paying off amid strong demand. Foundayo's 80% new-to-GLP-1 prescriptions suggest market expansion, not just cannibalization, while retatrutide filing later 2025 targets diabetes gaps. International Mounjaro strength offsets China pricing weakness. This validates long-term GLP-1 dominance despite sector rotation.
Persistent low-to-mid teens pricing headwinds for FY, intensifying Novo competition, and Foundayo's sluggish launch versus Wegovy's pill could cap upside if supply gluts emerge or Medicare coverage stalls beyond 2027.
"LLY delivered exceptional execution but the stock's 10% pop Thursday prices in most of the upside; the real risk is whether 33x forward P/E holds if pricing headwinds widen or Foundayo adoption disappoints."
LLY's beat is real—56% revenue growth, 28% EPS beat, guidance raise—but the article conflates operational excellence with valuation safety. At $1,200 PT on $36.25 midpoint 2026 EPS, that's 33x forward P/E. The stock was down 21% YTD before Thursday's pop partly because growth-at-any-price healthcare rotated out; one quarter doesn't reverse that macro. Volume growth (+49% US, +65% global) masking -7% to -13% pricing erosion is impressive operationally but signals commoditization risk. Foundayo's 20k users and 80% incremental claim need validation—early Wegovy adoption curves matter here. Medicare Part D delay to 2028 is a real headwind the article downplays.
If GLP-1 pricing compression accelerates beyond mid-teens guidance and Novo's pill gains share faster than Foundayo's organic ramp suggests, LLY's volume-over-price thesis breaks. A 33x multiple offers little margin of safety if growth decelerates.
"Durable upside hinges on Medicare/Part D coverage for obesity care and rapid Foundayo adoption, not just the near-term GLP-1 volume spike."
Lilly's F1Q beat and raised guidance highlight a demand surge for GLP-1 therapies, with volume-driven strength intact even amid price headwinds. The Foundayo launch adds optionality by expanding the obesity TAM beyond injections, while international growth supports a multi-year upcycle. Still, the bullish case rests on payer support translating into pricing resilience and rapid Foundayo adoption—risks if Medicare Part D coverage stalls or private insurers delay, potentially capping margins. Competition from Novo Nordisk remains intense, and retatrutide's regulatory path and real-world uptake are big unknowns. Capacity expansion and execution will be tested as the GLP-1 wave evolves beyond a single quarter.
The strongest counter-case is that quarterly strength may be elevated by mix and one-offs rather than durable demand, and longer-run pricing pressure or slower Foundayo uptake could erode margins even if volumes stay high.
"Lilly's valuation premium is supported by superior supply chain execution compared to competitors, which serves as a defensive moat against pricing erosion."
Claude is right to flag the 33x forward P/E, but everyone is ignoring the manufacturing 'moat' as a valuation floor. Lilly isn't just selling a drug; they are selling supply chain security in a market where Novo Nordisk is consistently failing to meet demand. If Lilly maintains a 95%+ fill rate while competitors struggle with shortages, that premium multiple is justified by market share capture, not just growth. The real risk isn't pricing; it's the 2026 capital expenditure cliff.
"Gemini's fill rate moat is unverifiable, and capex cliff threatens ROIC if next-gen pipeline slips."
Gemini, your 95%+ Lilly fill rate claim vs Novo's 'consistent failures' is unsubstantiated by the article or openings—no fill rates mentioned, and both firms have reported GLP-1 shortages. This overstates the moat. Linking to your 2026 capex cliff: $10B+ cumulative spend (per prior calls) risks ROIC drop below 20% if retatrutide delays hit, turning volume scale into a value trap at 33x P/E.
"Capex risk is real, but ROIC deterioration hinges on demand deceleration—not capex alone—and Q2 will be the tell."
Grok's ROIC math deserves scrutiny. If Lilly deploys $10B+ capex through 2026 and retatrutide delays, the denominator (incremental NOPAT) matters more than absolute spend. At 56% revenue growth and 28% EPS growth, ROIC compression below 20% assumes demand stalls—plausible but not inevitable. The real test: does Q2 guidance hold, or does Foundayo's 20k user base signal slower TAM expansion than the 80% 'incremental' claim implies?
"The key risk to Lilly’s upside is the 2026 capex cliff and ROIC compression, which could trigger multiple contraction even with strong near-term demand."
Even if Lilly’s fill rate isn’t publicly disclosed, the real vulnerability isn't moat rhetoric—it’s the 2026 capex cliff and potential ROIC compression. 10B+ of incremental capex with retatrutide delays could erode incremental NOPAT and justify multiple contraction, even with healthy near-term growth. So the bullish thesis rests on execution and supply security, not just demand leverage; a 33x forward P/E looks fragile if margins stall.
Verdetto del panel
Nessun consensoLilly's Q1 results show strong demand for GLP-1 therapies, but the bullish thesis relies on execution, supply security, and payer support. The 2026 capex cliff and potential ROIC compression pose significant risks.
Maintaining a strong fill rate and capturing market share
The 2026 capex cliff and potential ROIC compression