It’s a tale of two drugmakers in the red-hot obesity drug market. 

Both Novo Nordisk and Eli Lilly are grappling with lower prices in the U.S., but their 2026 outlooks are diverging sharply: While Novo is bracing for a sales decline, Lilly sees revenue jumping again thanks to its blockbuster medicines. 

The split in guidance – despite similar headwinds – underscores the strength of Lilly’s position in the obesity and diabetes drug market, underpinned by its more effective injections and early foray into direct-to-consumer sales, among other factors. While Novo Nordisk effectively made the drugs mainstream, Lilly has since taken a clear edge in market share — and the forecasts show it will likely only extend its advantage this year.

“The difference in sales momentum and market share trend was visible throughout 2025, but the dichotomy between the two companies’ prospects was accentuated within this 24-hour period in which Novo guided below consensus and Lilly guided above consensus expectations,”  Leerink Partners analyst David Risinger told CNBC on Wednesday. 

“That really solidified an investor’s mind that Lilly is going to be the dominant player in obesity going forward,” he added. 

This year, all eyes will be on how Lilly’s upcoming obesity pill, orforglipron, fares against Novo’s own oral Wegovy drug, which has had an explosive U.S. launch this year.

In an interview on CNBC’s “Squawk Box” on Wednesday, Lilly CEO Dave Ricks said 20 million to 25 million patients are currently taking both companies’ medicines. But he said the total addressable market of patients in the obesity space is “gigantic.” 

Lilly similarly pointed to a “global pricing decline in the low- to mid- teens [percentages] this year.” That comes after the landmark “most favored nation” deals both companies struck with President Donald Trump in November to slash obesity and diabetes drug costs, along with their recent efforts to further reduce direct-to-consumer prices for their treatments. 

The agreements with Trump are expected to take a bite out of both companies’ sales, but eventually increase volumes of prescriptions for their drugs. Still, Lilly is bullish about other factors that will help offset that pricing pressure. 

That includes continued worldwide demand for its obesity drug Zepbound and diabetes counterpart Mounjaro and the expected launch of its GLP-1 pill for obesity in the second quarter, pending U.S. approval. Lilly also pointed to government Medicare coverage of obesity treatments starting for the first time by at least July, one of the winning features of the drug pricing deals with Trump. 

Lilly’s Ricks told CNBC that coverage will open up access to 40 million new Medicare beneficiaries, “and that could be quite expansive to volume.”

Overall, Risinger called Lilly’s guidance “very encouraging” and said the “price per volume trade-off is playing out well” for the company.

He said tirzepatide, the active ingredient in Zepbound and Mounjaro, is “superior” in its effectiveness and tolerability compared to semaglutide, the ingredient in Novo’s obesity and diabetes drugs. That was proven in a head-to-head clinical trial conducted by Lilly in 2024, and prescription trends show that the company’s drugs are preferred among prescribers.  

“I think that’s what is driving Lilly’s market share gain” relative to Novo, Risinger said. 

Another factor that sets Lilly and Novo apart is patent exclusivity. While Novo said expiring patents in some international markets pose a challenge, Lilly’s Ricks said tirzepatide should be protected into “the back half of the 2030s” in major markets. 

Risinger noted that Lilly is still working to drive global uptake for tirzepatide, which won U.S. approval for obesity in 2023. 

The share of U.S. homeowners with high rates on their mortgages has jumped sharply in just the last few years.

That’s having a marked impact on the refinance market and a somewhat more muted impact on home sales. Rates have been front and center in the debate over how to improve home affordability — and for good reason.

In 2022, after mortgage interest rates hit more than a dozen record lows, sparking a refinance bonanza, barely 10% of homeowners had 30-year fixed mortgages with rates above 5%. Just four years later, that share has jumped to over 30%, according to ICE Mortgage Technology. About 20% of borrowers have mortgages with a rate over 6%.

Home sales have been less than robust over the last few years, with the National Association of Realtors reporting a historically low 4.06 million sales last year, basically unchanged from 2024. This, after hitting a 15-year high of 6.12 million home sales in 2022.

More recent sales, combined with some cash-out refinancing, pushed the share of higher-interest-rate borrowers up.

There has been a major focus by the Trump administration to lower mortgage rates as a way to boost home affordability.

The president recently announced a plan for Fannie Mae and Freddie Mac to buy more than $200 billion in mortgage-backed bonds. It is still a subject of debate as to how much lower that would push mortgage rates once the purchase is made, but just the announcement alone caused rates to drop a bit.

Industry experts say the actual purchases could shave perhaps about an eighth of a percentage point off the current 30-year rate, putting it right around 6%. Last year at this time, the average rate on the 30-year fixed mortgage was just over 7%, according to Mortgage News Daily.  

If the average on the 30-year fixed moved to 6%, 5.5 million current homeowners would be able to benefit from a refinance, according to ICE Mortgage Technology. Those homeowners could save at least 75 basis points on their rate, which makes the fees involved financially worthwhile, it said.

If rates dropped to 5.88%, that number grows to 6.5 million homeowners.

“The most popular interest rate that’s been used to buy a home over the last 3.5 years is between 6.875% and 6.99%, right? Nobody wanted to tell their neighbors they used a 7% interest rate to buy a home, so everybody bought down into this high 6% range,” said Andy Walden, ICE Mortgage Technology’s head of mortgage and housing market research.

“Coincidentally, those 15-basis-point-spread moves from this $200 billion in MBS purchase is moving rates from what would have been six and a quarter right now down to six and an eighth. And so it’s providing meaningfully more refinance incentive than would otherwise be out there, and it’s having an oversized impact on the market,” he said.

Applications to refinance a home loan are now about 120% higher than they were one year ago, according to the Mortgage Bankers Association.

As for home sales, the last four years were characterized by the so-called rate “lock-in” effect, meaning potential sellers didn’t want to give up their historically low rates. They therefore put off moves that they might otherwise have wanted to make.

Entering 2025, there were roughly 39 million homeowners with an interest rate below 5% and roughly 12 million with an interest rate below 3%, according to Walden.

“If you look at how those borrowers behaved last year, only about 6% of those folks gave up those low rates, either through a refinance to pull equity out of their home or through the sale of their home. Close to 95% of homeowners held on to those rates tight,” he said.

As for prospective homebuyers, a 15-basis-point drop on the 30-year fixed rate would save only about $35 a month on the mortgage payment for the average-priced home. Alternately, they could keep the rate and buy 1.5% more home.

“Certainly a move in the right direction, but not a massive movement for those homebuyers,” said Walden.