"The best-selling drug on Earth"? Citi: Inclusion in health insurance changes everything; Eli Lilly's oral GLP-1 sales next year will be twice as high as market forecasts.

Citi raises its price target for Eli Lilly to $1,500. Analysts say that as U.S. Medicare opens the door to obesity treatment, the launch and market penetration of Lilly's new oral GLP-1 drug Orforglipron will experience a “violent” surge far exceeding market expectations.

According to Zhuifeng Trading Desk, Citi stated in its November 12 report that after a roadshow discussion with Eli Lilly CEO Dave Ricks, it has become “increasingly optimistic” about the prospects of the company’s oral GLP-1 drug Orforglipron.

This drug will bring “significant option value” to Lilly’s stock price. Based on the expected approval in the first quarter of 2026 and the imminent broad Medicare coverage in the spring, analysts believe its commercialization timeline has advanced.

Citi raised its 2026 sales forecast for Orforglipron from $500 million to $1.8 billion, a sharp contrast to the market consensus of about $470 million. Looking further ahead, the drug’s peak sales forecast exceeds $40 billion.

Medicare’s shift brings a domino effect

Citi emphasizes that as U.S. Medicare formally changes its stance to include obesity in its coverage, Orforglipron is undergoing a milestone transformation.

Analysts believe that commercial and private insurers are likely to follow the government’s lead, opening up huge market space for GLP-1 drugs. Whether it’s the ICER report stressing GLP-1s are more cost-effective than simple lifestyle intervention, or the “political correctness” of aligning with government channels, both suggest that “significantly improved access prospects are imminent.”

Moreover, government payers outside the U.S. are closely watching this development and may consider it in their 2026/2027 budgets.

Faster ramp-up in early market launch

Citi believes Orforglipron's explosive growth will come from the perfect combination of “volume” and “price.”

On one hand, expanded Medicare coverage will directly bring a massive patient population; on the other hand, lower pricing will significantly lower patients’ barrier to entry. Both factors have been proven to help increase patient adherence and persistence, driving a faster sales ramp-up at launch than predecessors such as tirzepatide.

Therefore, although Citi maintains its expected peak sales for Orforglipron above $40 billion after 2030, it has sharply raised its 2030 sales forecast from $11.2 billion to $18.2 billion (market consensus is $12.1 billion).

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

Meanwhile, Lilly’s injectable products Zepbound and Mounjaro will also benefit from expanded market access, with 2030 sales forecasts raised to $26.2 billion and $38.1 billion, respectively.

Key opinion leaders (KOL) unanimously optimistic

At present, investors’ focus regarding Orforglipron has shifted from “can it be commercialized” to “how large will the commercialization scale be.”

Citi cites extensive positive feedback from key opinion leaders (KOLs), strongly endorsing the potential of the drug. Dr. Louis Philipson, Director of the Kovler Diabetes Center at the University of Chicago, said at the ADA conference that its Phase 3 ACHIEVE-1 data are “in summary, spectacular” and he supports it as a first-line treatment for type 2 diabetes. Harvard Medical School’s Dr. Vanita Aroda also expressed similar “first-line use” views.

Perhaps the most exciting remark came from Dr. Mehmet Burak of Brigham and Women’s Hospital, who highlighted Orforglipron’s comprehensive advantages in weight loss effect, tolerability, ease of dose titration, no food effect, and broad applicability to obesity-related complications, which may make it “the world’s best-selling drug.” These top experts’ opinions offer extremely high credibility for the drug’s commercial prospects.

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