Lilly Q3 earnings show Zepbound and Mounjaro selling more at lower net prices

Eli Lilly sold far more Mounjaro and Zepbound between July and September 2026, but it earned less on each pack. The Lilly Q3 earnings release, published October 29, shows worldwide volume up 53% while realized prices fell 15% against the same quarter of 2025. Revenue still rose 39% to $24.4 billion. For patients and payers, the useful part is where the price cuts came from: Zepbound in the United States and a public reimbursement listing for Mounjaro in China. The release does not say what any single patient now pays at the counter.

Volume up and prices down in the third quarter

Lilly splits its sales growth into three parts: how many units moved, the price it realized after rebates and discounts, and currency effects. The Lilly Q3 earnings show volume doing almost all of the work. The company's earnings release says worldwide revenue reached $24.4 billion, with a 53% gain in volume partly offset by a 15% drop in realized prices. In the United States, revenue rose 34% to $15.1 billion as volume grew 41% and realized prices slipped 7%. Outside the United States, revenue rose 47% to $9.3 billion on a 76% jump in volume, while realized prices fell 29%. Lilly said the quarter also carried about $900 million of one time benefits, including $410 million in Jardiance milestones and favorable changes to its rebate and discount estimates.

Those one time gains matter when reading the trend. Lilly said the first three quarters of 2026 benefited from sales milestones and from adjustments to rebate and discount estimates, and it said no further Jardiance milestones remain. Even so, the Lilly 2026 guidance went up. A TradingKey summary of the earnings presentation puts the new revenue range at $91 billion to $92 billion, up from $85 billion to $87 billion. That forecast is the company's own expectation, not a result, and it depends on demand holding up while net prices keep falling. For a reader standing at the pharmacy counter, the signal is simpler. The numbers show Lilly selling many more doses at lower average net prices, and the company says that trade is paying off for now.

Why Zepbound net price fell in the United States

The Lilly Q3 earnings name one product as the main reason for lower US prices. The release says the US decline in realized prices was driven primarily by Zepbound, partly offset by changes to rebate and discount estimates. US Zepbound revenue still rose 48% to $5.3 billion, which the company put down to strong demand. Mounjaro, the same molecule sold for type 2 diabetes, earned $5.0 billion in the United States, up 41%. A Zepbound net price can fall through larger rebates to insurers and pharmacy benefit managers, cheaper cash sales, or fixed prices for public plans. The release does not split the decline between those channels, so readers should not assume that any single program caused it.

A person with commercial cover, a cash buyer and a Medicare enrollee can each see very different numbers, and the 7% US figure blends them all.

Chief executive David Ricks pointed to access as one driver. He said growth came partly from "expanded U.S. coverage for obesity care," alongside demand for Mounjaro and Zepbound and the launch of the oral drug Foundayo. The risk section of the release also cites the company's voluntary agreement with the US government on drug pricing and access, the arrangement behind our report on the White House pricing deal. None of this tells a patient their own copay. A realized price is an average across every buyer after rebates and discounts. A person with commercial cover, a cash buyer and a Medicare enrollee can each see very different numbers, and the 7% US figure blends them all.

Mounjaro China NRDL listing cuts the price abroad

Outside the United States, the price story is mostly about China. Lilly says its lower realized prices abroad came primarily from adding Mounjaro to China's National Reimbursement Drug List, the national list of medicines that public health insurance pays for. According to the release, the listing took effect in the first quarter of 2026. Lilly does not disclose the negotiated price, but its figures show a familiar trade of a lower price for much wider use. International Mounjaro revenue rose 93% to $5.7 billion, driven by volume, while realized prices outside the United States fell 29% overall. Worldwide Mounjaro revenue reached $10.7 billion, a 65% rise on the same quarter last year.

The Mounjaro China NRDL result shows what a public listing can do to volume, although the release gives no patient numbers for China. It also offers no price per pen, no reimbursement rules and no detail on which uses the listing covers, so the effect on Chinese patients cannot be judged from this document alone. Lilly also pointed to a separate pledge, which it calls the Change the Course Commitment, aimed at treatment gaps for diabetes and obesity in low and middle income countries. The release lists that pledge by title only, without budgets or country names. Elsewhere, price and cover still vary market by market, as recent public coverage rulings on Mounjaro in Belgium and Cyprus have shown.

Medicare GLP 1 Bridge and the retatrutide black market

Public coverage in the United States is another source of volume. According to TradingKey's summary of the presentation, more than 500,000 patients were getting Lilly obesity medicines through the Medicare GLP 1 Bridge, and about 80% of them were new to incretin drugs. Seven in 10 patients new to the program chose a Lilly product, the summary says. The Bridge sets a flat monthly copay for eligible people, but its claims run outside Part D, start with a planned rejection and stop on December 31, 2027, as our guide to how the Bridge works explained. Patients who rely on it face a fixed end date, and the earnings release does not address what follows.

The release also points to the other side of strong demand. Lilly lists a recent call on online platforms, payment companies and regulators to shut down what it calls the illegal retatrutide black market. Retatrutide is still an investigational drug, so anything sold under that name outside a trial has no approval behind it and unknown contents. Health officials in New South Wales have already counted rising unapproved peptide emergency visits, most naming retatrutide. Lilly's own risk factors list counterfeit, misbranded, adulterated and illegally compounded products as a threat to its business. Legitimate access to retatrutide runs through registered clinical trials. Approved tirzepatide and orforglipron remain prescription medicines that come through a prescriber and a licensed pharmacy.

Conclusion

The Lilly Q3 earnings put a number on a trend patients have felt unevenly: more people are getting tirzepatide, and the average net price is falling, led by Zepbound at home and Mounjaro in China. What the release cannot show is the price any one person pays, or how long public deals and coverage gains will last. The higher forecast is Lilly's expectation, not a promise. The next tests are 2027 employer drug lists, the Bridge end date and any action against the retatrutide black market.