"The best-selling drug on Earth"? Citigroup: Inclusion in Medicare changes everything, Eli Lilly's oral GLP-1 sales next year will be twice the market forecast

Citi raised Eli Lilly's target price to $1,500. Analysts stated that as Medicare opens the door to obesity treatments, the launch process and market penetration speed of Eli Lilly's oral GLP-1 new drug Orforglipron will experience a "violent" surge far exceeding market expectations.

According to Wind Information, Citi's report on November 12 indicated that after a roadshow communication with Eli Lilly CEO Dave Ricks, the outlook for the company's oral GLP-1 drug Orforglipron has become "increasingly optimistic." This drug will bring "significant option value" to Eli Lilly's stock price. Based on the expected approval in the first quarter of 2026 and the broad Medicare coverage to be achieved in the spring, analysts believe its commercialization timeline has been advanced.

Citi raised its sales forecast for Orforglipron in 2026 from $500 million to $1.8 billion, in stark contrast to the market consensus of about $470 million. Looking further ahead, the peak sales forecast for this drug is as high as $40 billion.

Medicare Shift Brings Domino Effect

Citi emphasized that with the official change in stance by Medicare to include obesity in its coverage, Orforglipron is undergoing a milestone transformation.

Analysts believe that commercial and private insurance companies are likely to follow the government's lead, thereby opening up a huge market space for GLP-1 drugs. Whether it is the ICER report highlighting that GLP-1 drugs are more cost-effective than mere lifestyle interventions, or the "politically correct" alignment with government channels, both indicate that "significantly improved access prospects are just around the corner."

Moreover, government payers outside the United States are also closely monitoring this dynamic and may consider it when formulating budgets for 2026/2027.

Faster Initial Market Launch

Citi believes that the explosive potential of Orforglipron will stem from the perfect combination of "volume" and "price."

On one hand, expanded Medicare coverage will directly bring a huge patient population; on the other hand, lower pricing will significantly reduce the usage threshold for patients. Both factors have been proven to help improve patient compliance and persistence, thereby driving the drug to achieve a faster sales ramp-up in its initial launch compared to predecessors (such as tirzepatide).

Therefore, although Citi maintains its peak sales expectation for Orforglipron to exceed $40 billion after 2030, it has significantly raised its sales forecast for 2030 from the previous $11.2 billion to $18.2 billion (market consensus is $12.1 billion).

Sensitivity analysis shows that even in the worst-case scenario (assuming a monthly price of $149 and a penetration rate of 0.1%), its first-year sales could reach $590 million, easily surpassing market expectations. This faster ramp-up speed will significantly increase Eli Lilly's cash flow in the near to mid-term, which is an upside catalyst that the market has yet to fully recognize.

At the same time, Eli Lilly's injectable products Zepbound and Mounjaro will also benefit from expanded market access, with sales forecasts for 2030 raised to $26.2 billion and $38.1 billion, respectively.

Key Opinion Leaders (KOLs) Are Optimistic

Currently, investors' focus on Orforglipron has shifted from "Can it be commercialized?" to "How large will the commercialization scale be?"

Citi cited a wealth of positive feedback from key opinion leaders (KOLs), providing strong endorsement for the drug's potential. Dr. Louis Philipson, director of the Kovler Diabetes Center at the University of Chicago, described its Phase 3 ACHIEVE-1 data at the ADA conference as "spectacular overall," supporting its use as a first-line treatment for type 2 diabetes. Dr. Vanita Aroda from Harvard Medical School also expressed a similar view on "first-line use."

Perhaps the most exciting comment came from Dr. Mehmet Burak of Brigham and Women's Hospital, who emphasized the comprehensive advantages of Orforglipron in terms of weight loss efficacy, tolerability, ease of dose titration, lack of food effect, and broad applicability to obesity-related complications, which could make it "the best-selling drug on Earth." These insights from top experts provide a high degree of credibility to the drug's commercial prospects