Inside the GLP-1 Gold Rush: Eli Lilly CEO on New Breakthroughs, Addiction & Mental Health, Pricing

Eli Lilly’s obesity breakthrough was a decade-long bet, not an overnight discovery. Tirzepatide began in 2014, and a 2016 trial was stopped because healthy volunteers were losing too much weight; Lilly then accelerated factories, supply and clinical development years before demand exploded.

Tirzepatide has become one of pharma’s biggest commercial successes, generating $8.1 billion in a single quarter while growing 80%. CEO Dave Ricks said it surpassed Keytruda as the world’s best-selling drug in Q2, while roughly 20 million people globally now use prescription GLP-1 medicines.

Lilly is using its GLP-1 windfall to build another growth engine rather than simply return the cash to shareholders. It spends about 25% of sales on R&D—$14.2 billion this year—employs roughly 4,200 PhD scientists, and is building six U.S. plants with four more planned.

The biotech financing market has collapsed even as large pharmaceutical companies remain hungry for external innovation. Ricks said annual new biotech investment fell from roughly $20 billion to $5.5 billion and about half of listed biotech companies trade at or below their cash holdings, while Lilly is doing roughly one deal every two weeks.

China’s competitive advantage in biotech increasingly comes from rapidly designing around Western patents rather than simply copying protected drugs. Because U.S. firms disclose inventions early under first-to-file rules, Chinese teams can reverse-engineer published structures—sometimes using AI—to create similar molecules outside the original patent scope.

GLP-1 drugs may ultimately matter far beyond obesity and diabetes. Lilly found a 93% reduction in progression from pre-diabetes to diabetes, observed unexpected reductions in smoking and other compulsive behaviors, and is now testing a more brain-active GLP-1 in bipolar disorder and major depression.

Ricks openly favors reducing pharmaceutical advertising despite acknowledging that it works. He described drug advertising as a competitive “prisoner’s dilemma,” said more than half of Lilly’s consumer spending is already outside television, and would rather shift money toward R&D or better ways of informing patients.

Lilly believes the traditional pharmacy-benefit-manager model is nearing the end of its useful life. Ricks said the original claims-processing function is no longer technologically difficult, criticized major PBMs for optimizing for themselves rather than customers, and said Lilly itself is moving to a more transparent alternative.