By Dr Trevor Polischuk, Portfolio Manager of Worldwide Healthcare Trust PLC, Partner: OrbiMed Capital LLC
Eli Lilly NYSE:LLY stands at the centre of one of the most transformative developments in modern healthcare. While GLP-1 therapies are often framed narrowly as obesity or diabetes drugs, the reality is far broader. Lilly’s leadership across commercial execution, pipeline innovation, and global expansion positions the company for sustained multi-year compounding well beyond current market expectations.
Multiple, durable sources of upside
Despite record-setting revenues, GLP-1 penetration in the United States remains in the low single digits. This highlights how early the adoption curve still is. The next leg of growth will be driven by expanding reimbursement, not just within commercial insurance plans but increasingly across federal channels as well. As coverage broadens, the addressable patient population grows materially, unlocking demand that already exists but remains under-served.
Importantly, Lilly has also identified and successfully developed a nascent cash-pay market in the U.S. Millions of patients without insurance coverage are accessing therapy through direct-to-consumer channels. This represents a structurally new demand pool for branded pharmaceuticals and one that Lilly is uniquely positioned to scale. Continued investment in this channel should meaningfully augment volumes and revenues.
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Geographic expansion remains another underappreciated growth driver. Today, reimbursement exists in only eight countries, yet Lilly is already generating sales in more than 50. International demand, particularly for cash-pay patients has been exceptionally strong. Globally, GLP-1 revenues are expanding at nearly $1 billion per quarter, underscoring both the scale of unmet need and the early stage of market development outside the U.S.
Pipeline leadership extends the franchise
Lilly’s pipeline further reinforces the long-term durability of the GLP-1 franchise. The company has two critical next-generation assets that meaningfully expand both reach and clinical impact.
The first is an oral GLP-1 therapy that has demonstrated biologic-like efficacy. Expected to launch in early 2026, this product will come at a lower price point and eliminate the need for injections. As a result, it will open access to millions of patients who face barriers related to affordability, availability, or needle acceptance, dramatically expanding the market.
The second is a next-generation injectable therapy that has already delivered record-setting weight loss of up to 29% of body weight, with additional trials expected to push outcomes beyond 30%. At this level of efficacy, the therapy has the potential to replace bariatric surgery for patients with BMI greater than 35. Moreover, early data suggest it may preferentially reduce fat mass while preserving lean muscle, allowing it to become the treatment of choice across the full spectrum of obesity at lower doses.
Beyond weight loss: a platform, not a product
While obesity and diabetes remain the initial focus, GLP-1 therapies are rapidly evolving into a platform technology. Evidence already demonstrates that these drugs can prevent the development of Type 2 diabetes in up to 94% of obese patients. Beyond this, expanding use cases in cardiovascular disease, metabolic disorders, kidney and liver disease, heart failure, pain, and sleep disorders may only represent the beginning.
Looking further ahead, combinations of GLP-1s with new and existing targets are likely to create “super medicines” with enhanced efficacy and broader indications. These combinations could expand the eligible patient population by as many as 500 million people worldwide, fundamentally reshaping chronic disease management.
Valuation: growth that justifies the multiple
At first glance, Eli Lilly’s valuation trading at over 30x earnings may appear demanding. However, no other biopharmaceutical company is positioned to grow earnings at greater than 30% annually over the next decade. The scale and visibility of Lilly’s accelerating cash flows provide exceptional durability and flexibility, including an unprecedented ability to pursue strategic business development and pipeline expansion.
When viewed through a long-term compounding lens, the current valuation reflects not excess optimism but the early innings of an earnings growth cycle that remains unmatched in the sector.
Portfolio implications: owning the category leader
In any discussion of GLP-1 exposure, Eli Lilly must be the starting point. The company leads commercially, taking share on a weekly basis, and holds leadership positions in both first-generation oral therapies and next generation injectables. With more than 20 years of pioneering work in this field, Lilly’s depth of expertise and execution capability is simply unmatched.
That said, the opportunity is enormous, potentially a $200 billion market within the next decade leaving room for additional winners. AstraZeneca LON:AZN stands out as an emerging competitor, pursuing a systematic entry into the space with multiple mid-stage assets. Another attractive strategy is selective exposure to small- and mid-cap companies that could become acquisition targets, a trend already playing out across the sector. In this regard, Structure Therapeutics is particularly compelling, with the potential to reset the efficacy bar for oral weight-loss therapies.
Eli Lilly remains the clear long-term leader
Eli Lilly is not merely benefiting from a cyclical tailwind in obesity treatment it is building a global healthcare franchise with multiple growth engines, expanding indications, and unmatched pipeline depth. As GLP-1 therapies redefine how chronic disease is treated worldwide, Lilly remains the clear long-term leader and a cornerstone investment in the next era of biopharmaceutical innovation.
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