Eli Lilly

Eli Lilly and Company
Type	Public
Traded as	NYSE: LLY; S&P 500 component
Industry	Pharmaceuticals
Founded	10 May 1876, Indianapolis, Indiana
Founder	Colonel Eli Lilly
Headquarters	Lilly Corporate Center, Indianapolis, Indiana, United States
Area served	Approximately 125 countries
Key people	David A. Ricks (chairman and chief executive), Lucas Montarce (chief financial officer), Daniel Skovronsky (chief scientific officer)
Products	Tirzepatide (Mounjaro, Zepbound), abemaciclib (Verzenio), dulaglutide (Trulicity), ixekizumab (Taltz), empagliflozin (Jardiance), insulin lispro (Humalog), donanemab (Kisunla)
Revenue	Approximately US$45 billion (2024)
Employees	Approximately 47,000
Website	lilly.com

Eli Lilly and Company is an American pharmaceutical corporation headquartered in Indianapolis, Indiana. Founded in 1876 by the pharmaceutical chemist and Civil War veteran Colonel Eli Lilly, it is one of the oldest and largest pharmaceutical companies in the world, and in November 2025 it became the first healthcare company to reach a market capitalisation of US$1 trillion.

Lilly was the first company to mass-produce insulin, following its 1922 collaboration with the University of Toronto researchers who discovered it, and the first to mass-produce the polio vaccine developed by Jonas Salk in 1955. It was among the first pharmaceutical companies to manufacture human insulin using recombinant DNA, with Humulin in 1982, and later produced Humalog and Basaglar, the first approved biosimilar insulin in the United States. Its commercial history includes the antidepressants Prozac, launched in 1986, and Cymbalta, launched in 2004, and the antipsychotic Zyprexa, launched in 1996, all now off patent.

The company's modern position rests on incretin medicines. In 2005 it brought exenatide to market, the first GLP-1 receptor agonist, and in 2022 it launched tirzepatide, a dual GIP and GLP-1 receptor agonist sold as Mounjaro for type 2 diabetes and as Zepbound for obesity and obstructive sleep apnoea, which accounted for about 56 per cent of revenue by 2025. Other significant products include abemaciclib for advanced breast cancer, dulaglutide and empagliflozin for type 2 diabetes, ixekizumab for autoimmune disease, ramucirumab and other oncology antibodies, baricitinib for rheumatoid arthritis and alopecia areata, galcanezumab for migraine prevention, and donanemab for early Alzheimer's disease. In 2024 about 67 per cent of revenue came from the United States, 18 per cent from Europe, 3 per cent from Japan and 3 per cent from China.

The Lilly Endowment, a charitable foundation established by the founding family in 1937, owns approximately 10 per cent of the company and is among the largest private foundations in the world.

History

Colonel Eli Lilly and the founding, 1876 to 1898

Eli Lilly trained as a pharmaceutical chemist and served as a colonel in the Union army during the American Civil War, commanding an artillery battery and later a cavalry regiment, and was held as a prisoner of war. After the war he attempted cotton planting in Mississippi, which failed, and returned to pharmacy.

In 1869, after working for drugstores in Indiana, he became a partner in a store in Paris, Illinois, with James W. Binford. He left that partnership in 1873 and returned to Indianapolis, and in 1874 formed a drug manufacturing operation with John F. Johnston called Johnston and Lilly. He dissolved that partnership in 1876 and used his share of the assets to open his own manufacturing business on Pearl Street in Indianapolis. The sign above the door read simply "Eli Lilly, Chemist".

He began with three employees, one of them his son Josiah, known as J. K. Among the first products was quinine for the treatment of malaria. Sales reached US$4,470 by the end of 1876.

Lilly's approach distinguished the business from the patent medicine trade that dominated American pharmacy at the time. He resolved to manufacture only preparations of known composition, to sell them through physicians and pharmacists rather than directly to the public, and to conduct research into how they worked. These commitments, unremarkable now, were unusual in an industry built on undisclosed formulas and extravagant claims, and many of the practices he introduced became standard.

In 1878 he hired his brother James as the company's first full-time salesman, and by 1879 sales had reached US$48,000. The business moved from Pearl Street to larger premises at 36 South Meridian Street, and in 1881 to the south-side industrial site that remains the company's headquarters. That year Lilly incorporated the business as Eli Lilly and Company, elected a board and issued stock to family members and close associates.

The first significant technical innovation was a gelatin coating for pills and capsules, followed by fruit flavourings and sugar coating, which made medicines easier to take. In 1882 Colonel Lilly's only son, Josiah K. Lilly Sr., graduated from the Philadelphia College of Pharmacy and joined the business as superintendent of its laboratory. In 1883 the company contracted to make and sell Succus Alterans, its first widely successful product, marketed as a blood purifier and as a treatment for syphilis, certain forms of rheumatism and skin conditions including eczema and psoriasis.

In 1886 the chemist Ernest G. Eberhardt joined as the company's first full-time research scientist. By the late 1880s the business employed more than a hundred people with annual sales of US$200,000, and Colonel Lilly was among Indianapolis's leading businessmen, active in the Commercial Club, later the Indianapolis Chamber of Commerce, and in the Charity Organization Society.

In 1890 he handed day-to-day management to J. K., who ran the company for the next thirty-four years. In 1894 the company bought a plant devoted solely to capsule manufacture and automated its production, making tens of millions of capsules and pills annually. Colonel Lilly died in 1898, when the product line numbered 2,005 items and annual sales exceeded US$300,000.

J. K. Lilly and the entry into research, 1898 to 1932

Josiah K. Lilly Sr. inherited the company and its presidency. He introduced scientific management, organised a research department, expanded the sales force and began international distribution, while continuing his father's advocacy for federal regulation of medicines, which arrived with the Pure Food and Drug Act of 1906.

The company grew rapidly around its Indianapolis site, which developed into one of the city's principal industrial districts and eventually covered more than two dozen buildings across fifteen blocks, with further production plants on Kentucky Avenue. Sales reached US$1 million in 1905. Expanded facilities at the McCarty Street plant included a new Science Building in 1911 and a capsule plant in 1913, and in 1913 the company began building Lilly Biological Laboratories on 150 acres near Greenfield, Indiana.

Capsule manufacture became a business in itself. Scientific American described Lilly in 1917 as the largest capsule factory in the world, capable of producing 2.5 million capsules a day, and the company sold its surplus capacity to other manufacturers. In 1909 Eli Lilly, the founder's grandson, introduced a method of blueprinting manufacturing tickets, producing multiple copies of a formula and eliminating transcription errors.

The decisive step came in 1919, when J. K. Lilly hired the biochemist George Henry Alexander Clowes as director of biochemical research. Clowes brought research expertise and connections across the scientific community, and his first major collaboration determined the company's future.

Insulin

In 1921 the University of Toronto researchers Frederick Banting, Charles Best, John Macleod and James Collip isolated the pancreatic extract that became insulin. Clowes proposed a collaboration in December 1921 and again in March and May 1922. The researchers were reluctant to work with a commercial firm, particularly since the university's Connaught Laboratories could produce the extract without one, but the scale required to supply patients exceeded what Connaught could manage. Clowes and Eli Lilly met the Toronto group in 1922 and agreed terms for mass production.

The manufacturing problem was severe. Insulin extracted from animal pancreases degraded rapidly, varied in potency and was contaminated with material that caused reactions at the injection site. Lilly's chemist George Walden discovered that adjusting the pH to the isoelectric point of insulin allowed it to be precipitated and purified, producing a stable product of consistent strength. Without that work the discovery would have remained a laboratory result.

In 1923 the company began selling Iletin, the first commercially available insulin in the United States, over objections from the university's Insulin Committee about the use of a trade name, which were later dropped as a concession. Banting and Macleod received the Nobel Prize that year and shared it with Best and Collip. Lilly held an effective monopoly on American insulin sales for nearly two years, until Frederick Stearns and Co. entered as a licensee in June 1924.

Insulin was the most important product in the company's history and did more than anything else to make it one of the world's major pharmaceutical manufacturers. Its success allowed Lilly to attract scientists and to enter further university collaborations. By the company's fiftieth anniversary in 1926 sales had reached US$9 million across more than 2,800 products.

In 1928 Lilly introduced Liver Extract 343 for pernicious anaemia, developed with the Harvard researchers George Minot and William Murphy, and in 1930 Liver Extract No. 55 with George Whipple of the University of Rochester. The three shared the Nobel Prize in Physiology or Medicine in 1934. Thimerosal, developed by Morris Kharasch at the University of Maryland in the late 1920s, was marketed by Lilly as Merthiolate, an antiseptic and preservative that later became controversial as a vaccine preservative.

International expansion began in the 1930s with Eli Lilly and Company Limited in London in 1934 and a manufacturing plant at Basingstoke. Despite the Great Depression, sales rose to US$13 million in 1932.

Eli Lilly Jr., the war and the antibiotic era, 1932 to 1953

In 1932 Eli Lilly, the founder's eldest grandson, who had joined the company in 1909, became president, succeeding his father, who remained chairman until 1948. In the 1920s he had introduced straight-line production to the pharmaceutical industry, in which raw materials entered a facility at one end and finished product emerged at the other. Building 22, a five-floor plant opened in Indianapolis in 1926, was designed around the principle and was described by one historian as probably the most sophisticated production system in the American pharmaceutical industry. The efficiency it produced allowed the company to retain a permanent workforce, manufacturing lower-cost medicines in slack periods rather than laying workers off and recalling them.

In 1934 the firm opened Lilly Research Laboratories at the McCarty Street complex, among the best-equipped facilities in the world at the time, alongside a replica of the 1876 laboratory, and conducted clinical studies at Indianapolis City Hospital. The same year it patented secobarbital, marketed as Seconal, a barbiturate sedative and hypnotic that remained in the company's catalogue until the early 2000s when rights passed to Ranbaxy.

The Second World War expanded production to unprecedented levels. Lilly manufactured penicillin as a partner of the United States government in the large-scale production programme, along with other antibiotics, antimalarials, blood plasma, encephalitis, typhus and influenza vaccines, gas gangrene antitoxin, Merthiolate and insulin. Merthiolate became United States Army standard issue. The company produced aviator survival kits and seasickness medication for the Normandy landings. Working with the American Red Cross it dried more than two million pints of blood plasma, about 20 per cent of the national total.

International operations expanded further during the war. Eli Lilly International Corporation was formed in 1943 to develop trade abroad, and by 1948 employees worked in 35 countries, most as sales representatives in Latin America, Asia and Africa.

After three generations of family leadership, the company announced a reorganisation in 1944 that prepared for expansion and for the eventual separation of management from ownership. In 1945 it began a major expansion including the purchase of the Curtiss-Wright propeller plant on Kentucky Avenue, which on completion of renovation in mid-1947 manufactured antibiotics and capsules and housed the shipping department. By 1948 the company employed nearly 7,000 people.

After the war the patents and research records of IG Farben were confiscated by the Allies, and the United States Department of Commerce made the expropriated rights available to American companies for one dollar. Lilly acquired the rights to methadone and in 1947 became its first American distributor, marketing it as Dolophine. Methadone is an analgesic and is now widely used in the treatment of opioid dependence.

Eli Lilly retired from active management in 1948 after sixteen years as president, during which sales had risen from US$13 million to US$117 million, becoming chairman and handing the presidency to his brother Josiah K. Lilly Jr., known as Joe, who had joined in 1914 and concentrated on personnel and marketing. Joe served as president from 1948 to 1953 and then as chairman until his death in 1966.

In 1949 the company entered a partnership with the United States Army Reserve, establishing a local Strategic Intelligence Research and Analysis unit allowing employees to research scientific logistics and Eurasian subjects, an arrangement characteristic of the early Cold War relationship between American industry and the military.

Production expanded beyond Indianapolis with Tippecanoe Laboratories at Lafayette, Indiana, in 1950, which increased antibiotic capacity following the company's patent on erythromycin. During the 1950s Lilly introduced two antibiotics that remain in use, vancomycin, a glycopeptide reserved for resistant infections, and erythromycin, a macrolide. It also began diversifying into agricultural and veterinary products, organising those operations in 1954 into the Agricultural and Industrial Sales Division, which later became Elanco.

Expansion and the modern research company, 1955 to 1998

In 1955 Lilly became the first company to mass-produce the poliomyelitis vaccine developed by Jonas Salk, manufacturing the largest share of the national supply during the mass immunisation campaign that effectively ended epidemic polio in the United States. Salk had declined to patent the vaccine, and the manufacturing was undertaken at the request of the National Foundation for Infantile Paralysis.

The decades that followed brought a series of products from the company's own research. The vinca alkaloids vinblastine and vincristine, isolated from the Madagascar periwinkle in collaboration with researchers at the University of Western Ontario, were introduced in the 1960s and became foundational chemotherapy agents; vincristine in particular transformed the treatment of childhood leukaemia from a uniformly fatal disease into one usually curable. The cephalosporin antibiotics Keflex and Keflin followed, and in 1971 the company introduced nalidixic acid derivatives and other anti-infectives that made it for a period the largest antibiotic manufacturer in the world.

Lilly acquired the cosmetics company Elizabeth Arden in 1971 and the medical device maker IVAC in 1977 and Cardiac Pacemakers Inc. in 1977, part of a general movement among pharmaceutical companies toward diversification that was largely reversed in the following decade; Elizabeth Arden was sold in 1987.

In 1982 the company introduced Humulin, human insulin produced by recombinant DNA in genetically modified bacteria, developed with Genentech. It was the first genetically engineered medicine approved for human use anywhere in the world, and it ended the industry's dependence on insulin extracted from the pancreases of slaughtered pigs and cattle, a supply that could not have kept pace with the growth of diabetes. Humalog, an insulin analogue modified to act more rapidly than natural human insulin, followed in 1996.

Prozac

Fluoxetine, marketed as Prozac, was discovered at Lilly by a team including Bryan Molloy, Klaus Schmiegel, David Wong and Ray Fuller, and approved in the United States in December 1987 after a development period of nearly two decades. It was the first selective serotonin reuptake inhibitor to achieve wide use, and its effect on medicine and on culture is difficult to overstate.

Earlier antidepressants, the tricyclics and monoamine oxidase inhibitors, were effective but carried side effects severe enough that general practitioners prescribed them cautiously and patients frequently stopped taking them. Fluoxetine was far safer in overdose and better tolerated, which meant that depression could be treated in primary care rather than only by psychiatrists. Prescriptions rose accordingly, and the number of Americans taking antidepressants increased several-fold within a decade.

The consequences were contested from the beginning. Supporters argued that a treatable and widely undertreated illness was finally being treated. Critics, including the psychiatrist Peter Breggin and the author Elizabeth Wurtzel from opposite directions, argued variously that the drug was being prescribed for ordinary unhappiness, that the serotonin hypothesis of depression on which its marketing rested was not established, and that the company had understated risks including agitation and suicidal thinking in a minority of patients. Litigation on the latter point continued for years, and regulators eventually required warnings about suicidal ideation in young people across the drug class.

Prozac became the company's first product to exceed US$1 billion in annual sales and at its peak generated around US$2.6 billion a year, roughly a third of revenue. Its patent expired in August 2001, and generic competition removed approximately 80 per cent of its sales within two months, an event known within the industry as the Prozac patent cliff and used ever afterwards as the standard illustration of the risk of dependence on a single product.

Zyprexa

Olanzapine, marketed as Zyprexa and approved in 1996, is an atypical antipsychotic used for schizophrenia and bipolar disorder. It replaced Prozac as the company's largest product, reaching annual sales above US$4 billion, and it carried both clinical benefit and substantial metabolic side effects including weight gain and increased risk of diabetes. Its marketing produced the largest criminal fine then imposed on any company in the United States, described below.

The lean years, 1998 to 2016

The two decades after the Prozac patent expiry were difficult. The company faced the loss of exclusivity on Prozac in 2001, on Zyprexa in 2011, on Cymbalta in 2013 and on Evista and Alimta subsequently, a succession of expiries unusually concentrated even by the standards of the industry, and its pipeline did not replace them at the same rate.

In September 2002 Lilly partnered with Amylin Pharmaceuticals to develop exenatide, derived from a peptide isolated from the venom of the Gila monster, which was approved in April 2005 as the first GLP-1 receptor agonist. The class mimics a gut hormone released after eating that stimulates insulin secretion, suppresses glucagon and slows gastric emptying, and its eventual significance far exceeded what was anticipated at the time.

In 2003 the company introduced tadalafil as Cialis, developed in partnership with Icos as a competitor to Viagra, distinguished by an active period of about 36 hours that led to its being nicknamed the weekend pill. In 2004 it introduced duloxetine as Cymbalta, a serotonin-norepinephrine reuptake inhibitor used for major depressive disorder, generalised anxiety, fibromyalgia, neuropathic pain and osteoarthritis, which ranks with Prozac among the most commercially successful pharmaceuticals ever produced.

In January 2007 Lilly acquired Icos for US$2.1 billion after raising its offer against opposition from Institutional Shareholder Services, then closed Icos's manufacturing operations and terminated nearly 500 employees; the remaining biologics facility at Bothell, Washington, with 127 staff, was sold to CMC Biopharmaceuticals in December 2007. In 2008 it acquired ImClone Systems for US$6.5 billion, gaining the colorectal cancer antibody Erbitux and, more importantly, an antibody research capability that underpinned its later oncology portfolio.

In January 2009 the company was fined US$1.415 billion, at the time the largest criminal penalty ever imposed in the United States on any company, for the illegal marketing of Zyprexa.

In January 2011 Lilly and Boehringer Ingelheim announced a global diabetes alliance covering Boehringer's oral agents including linagliptin and later empagliflozin, and two Lilly insulin analogues, an arrangement under which each company could earn several hundred million dollars from the other's products and which gave Lilly access to Jardiance, subsequently shown in cardiovascular outcome trials to reduce death in heart failure and chronic kidney disease regardless of diabetes status.

In April 2014 the company bought Novartis's animal health business for US$5.4 billion to strengthen Elanco, divesting a heartworm treatment to Virbac for regulatory approval. A series of smaller transactions followed in 2015, including collaborations with Hanmi Pharmaceutical on a Bruton's tyrosine kinase inhibitor, with Innovent Biologics in China on antibody development, and a restarted arrangement with Pfizer on tanezumab. In April 2015 it engaged CBRE to sell its 52-acre biomanufacturing campus at Vacaville, California, one of the largest biopharmaceutical manufacturing sites in the country, a decision that looked considerably less sound a decade later when the company was spending tens of billions of dollars building capacity.

John Lechleiter, chief executive from 2008, retired in July 2016 and was succeeded by David Ricks.

Ricks, oncology and the incretin era, 2017 to 2026

Under David Ricks the company pursued a strategy of acquiring clinical-stage science rather than building scale through large mergers, in contrast to several competitors.

In January 2017 Elanco, then still a subsidiary, acquired Boehringer Ingelheim's American feline, canine and rabies vaccine portfolio for US$885 million. In March 2017 Lilly acquired CoLucid Pharmaceuticals for US$960 million, obtaining lasmiditan for migraine. In May 2018 it acquired Armo Biosciences for US$1.6 billion and, days later, AurKa Pharma for up to US$575 million.

In January 2019 it agreed to acquire Loxo Oncology for US$235 a share, about US$8 billion, gaining the TRK inhibitor larotrectinib, the RET inhibitor selpercatinib and the non-covalent Bruton's tyrosine kinase inhibitor pirtobrutinib. Loxo's approach, developing drugs against specific genetic alterations regardless of where in the body a tumour arose, transformed Lilly's oncology position, and the Loxo organisation was retained as an internal research unit rather than absorbed.

Elanco was separated by corporate spin-off in March 2019, ending 65 years of animal health within the company, and subsequently acquired Bayer's animal health business for US$7.6 billion.

In January 2020 Lilly acquired Dermira for US$1.1 billion, obtaining lebrikizumab for atopic dermatitis. In October 2020 it agreed to acquire Disarm Therapeutics for US$135 million plus up to US$1.225 billion in milestones, and in December 2020 Prevail Therapeutics for US$1 billion, adding gene therapy for neurodegenerative disease. In July 2021 it agreed to acquire Protomer Technologies for more than US$1 billion, obtaining technology for glucose-sensing insulin intended to respond automatically to blood sugar. In October 2022 it acquired the gene therapy developer Akouos for US$487 million upfront.

COVID-19

In June 2020 Lilly began, in collaboration with the Vancouver company AbCellera, the first clinical study of a monoclonal antibody against SARS-CoV-2. By August 2020 the difficulty of running trials in long-term care facilities during a pandemic led the company to convert recreational vehicles into mobile research units carrying laboratories and trial materials, deploying a fleet to facilities experiencing outbreaks across the United States.

In September 2020 Amgen agreed to manufacture the antibodies. In October the National Institutes of Health ACTIV-3 trial found bamlanivimab ineffective in hospitalised patients, while other data indicated it reduced viral load, symptoms and hospitalisation in outpatients, and the Food and Drug Administration issued an emergency use authorisation in November 2020. The authorisation for bamlanivimab used alone was revoked in April 2021 as resistant variants spread. A second antibody, bebtelovimab, received authorisation in February 2022 with a United States government commitment to buy up to 600,000 doses for US$720 million, and distribution of the earlier product was paused in January 2022 because it was ineffective against the omicron variant.

Tirzepatide

In May 2022 the Food and Drug Administration approved tirzepatide as Mounjaro for type 2 diabetes. The molecule activates both the GLP-1 and the glucose-dependent insulinotropic polypeptide receptors, and in trials produced reductions in blood glucose and in body weight substantially greater than the GLP-1 agonists that preceded it. Approval for chronic weight management followed in November 2023 under the name Zepbound, and for obstructive sleep apnoea in obese adults in December 2024.

The commercial effect was without modern precedent. Tirzepatide and the competing semaglutide products from Novo Nordisk created a market for obesity treatment that had not previously existed at scale, because earlier weight-loss drugs had produced modest effects and, in several cases, serious harms. Demand exceeded manufacturing capacity for two years, producing shortages, the widespread compounding of copies by pharmacies, and litigation by Lilly against telehealth companies and compounders selling unapproved versions. The company committed more than US$50 billion to new manufacturing facilities in Indiana, North Carolina, Wisconsin, Virginia, Ireland and Germany, the largest capital programme in the history of the pharmaceutical industry.

By 2025 tirzepatide accounted for around 56 per cent of the company's revenue, and Lilly's market value rose from about US$150 billion at the start of 2021 to above US$1 trillion in November 2025, the first healthcare company to reach that level. Its research programme extended into oral incretins, including orforglipron, a small-molecule GLP-1 agonist that would not require injection or the cold chain that peptide manufacture demands, and retatrutide, a triple agonist producing still greater weight reduction in trials.

Alzheimer's disease

Lilly pursued amyloid-targeting therapies for Alzheimer's disease for more than two decades, through the failures of semagacestat in 2010 and solanezumab in 2016, both of which ended in trials that showed no benefit and, in the first case, harm. Donanemab, an antibody directed at a modified form of amyloid beta found in plaques, showed a slowing of cognitive decline in early symptomatic disease and was approved in the United States in July 2024 as Kisunla.

The clinical significance of the effect has been contested. The slowing observed is real but modest, the treatment requires infusion and repeated brain imaging, and it carries a risk of amyloid-related imaging abnormalities including brain swelling and bleeding, which have caused deaths in trials. Regulators have reached differing conclusions, with European authorities initially declining approval before a narrowed authorisation. The approvals nonetheless established that the amyloid hypothesis could produce a clinically effective medicine after thirty years of failure, and the company's blood-based diagnostic work is directed at identifying patients early enough for treatment to matter.

Recent corporate developments

In August 2022, after the Dobbs decision and Indiana's subsequent near-total ban on abortion, Lilly said publicly that the law would make it difficult to attract talent to the state and that it would be obliged to look elsewhere for employment growth, an unusual intervention by a company so identified with its home state.

In early 2020 the company introduced the Lilly Insulin Value Program, allowing people with commercial insurance or none to obtain a monthly prescription of any Lilly insulin for US$35, and in March 2023 it announced a 70 per cent reduction in the list prices of its most-prescribed insulins and extended the US$35 cap generally. The Inflation Reduction Act of 2022 had already capped insulin costs at US$35 a month for Medicare beneficiaries. Its competitors announced comparable reductions within weeks.

Lilly Direct, launched in January 2024, sells certain medicines directly to patients at published prices through a company-operated platform, bypassing the intermediaries whose rebate arrangements have driven the difference between list and net prices in the United States. It has been presented as an answer to the criticism of drug pricing and criticised as an attempt to establish a direct commercial relationship with patients outside the insurance system.

Further acquisitions have included Point Biopharma in 2023 for radioligand therapy, Versanis for obesity, Dice Therapeutics for oral immunology, Morphic Holding in 2024 for integrin inhibitors in inflammatory bowel disease, and Scorpion Therapeutics in 2025 for a targeted breast cancer programme.

Products

Diabetes and obesity

Tirzepatide, sold as Mounjaro for type 2 diabetes and Zepbound for obesity and obstructive sleep apnoea, is the company's largest product. Dulaglutide, sold as Trulicity, is a once-weekly GLP-1 agonist that was the leading product in its class before tirzepatide. Empagliflozin, sold as Jardiance and developed with Boehringer Ingelheim, is a sodium-glucose cotransporter-2 inhibitor that lowers glucose by causing its excretion in urine and which has shown benefit in heart failure and chronic kidney disease independent of diabetes.

The insulin portfolio comprises Humulin, human insulin produced by recombinant DNA; Humalog, the rapid-acting analogue insulin lispro; Basaglar, a long-acting insulin glargine and the first approved biosimilar insulin product in the United States; and Lyumjev, an ultra-rapid formulation. Insulin remains, a century after its introduction, a product whose pricing in the United States has been among the most politically contentious questions in healthcare.

Oncology

Abemaciclib, sold as Verzenio, is a CDK4/6 inhibitor for hormone receptor-positive advanced and early breast cancer and is the company's second-largest product. Ramucirumab, sold as Cyramza, is an antibody against the VEGF receptor used in gastric, lung, liver and colorectal cancers. Selpercatinib, sold as Retevmo, targets RET fusions across tumour types; larotrectinib, sold as Vitrakvi, targets TRK fusions and was among the first medicines approved on the basis of a genetic alteration rather than the organ in which a tumour arose; pirtobrutinib, sold as Jaypirca, is a non-covalent BTK inhibitor for patients whose disease has become resistant to earlier agents in the class. Pemetrexed, sold as Alimta, was for many years a leading lung cancer treatment and lost exclusivity in 2022.

Immunology

Ixekizumab, sold as Taltz, is an interleukin-17A antibody for psoriasis, psoriatic arthritis and axial spondyloarthritis. Baricitinib, sold as Olumiant and licensed from Incyte, is a Janus kinase inhibitor approved for rheumatoid arthritis, severe alopecia areata and, during the pandemic, for hospitalised COVID-19 patients. Mirikizumab, sold as Omvoh, treats ulcerative colitis and Crohn's disease. Lebrikizumab, sold as Ebglyss, treats atopic dermatitis.

Neuroscience

Donanemab, sold as Kisunla, treats early symptomatic Alzheimer's disease. Galcanezumab, sold as Emgality, is a CGRP antibody for migraine prevention. Lasmiditan, sold as Reyvow, treats acute migraine through a different mechanism from the triptans and is usable in patients with cardiovascular contraindications.

Research and development

Lilly spends a very large proportion of revenue on research, and its scientific organisation is centred on Lilly Research Laboratories in Indianapolis, with sites in San Diego, Boston, New York, Cambridge in England, Madrid, Kobe and Shanghai. The Lilly Institute for Genetic Medicine in Boston, opened in 2024, concentrates on nucleic acid therapeutics, and the Lilly Seaport Innovation Center on the same site on new modalities.

The company's research strategy has been unusual among large pharmaceutical firms in several respects. It has largely declined transformational mergers, on the argument that combining two research organisations destroys more than it creates, and has instead bought small companies with specific assets and retained their scientific teams, as with Loxo. It has maintained therapeutic focus in diabetes and obesity, oncology, immunology and neuroscience rather than pursuing every area. And it has been willing to sustain programmes through long sequences of failure, most conspicuously in Alzheimer's disease, where it pursued amyloid for more than two decades and through two major trial failures before donanemab succeeded.

Its external research arrangements have included the Innovative Medicines Initiative in Europe, the InnoMed PredTox consortium on drug safety, collaborations with Innovent Biologics in China, and an open innovation drug discovery platform that allowed academic chemists to submit compounds for screening against company assays.

Manufacturing

The manufacture of peptide medicines at the scale demanded by the incretin market presented a problem the industry had not previously faced. Peptides are synthesised chemically or by fermentation and then purified, filled into injection devices and distributed under refrigeration, and the capacity required to treat tens of millions of people did not exist.

Lilly's response was the largest manufacturing investment programme in the history of the industry, exceeding US$50 billion in announced commitments. Sites include the Lebanon, Indiana, campus, the largest single investment in the company's history; expansions at Concord, North Carolina, and Research Triangle Park; a site at Kenosha County, Wisconsin, acquired from Nexus; a facility in Virginia; expansions at Kinsale and Limerick in Ireland; a plant at Alzey in Germany; and sites in Puerto Rico, Italy, France and China. The company also acquired an existing injectable facility in New Jersey from Nexus Pharmaceuticals and another from BMS.

The programme illustrates a wider change in pharmaceutical economics. For decades the industry's costs were concentrated in research and marketing, with manufacturing a small proportion; for a peptide product sold to a very large population, manufacturing capacity became the binding constraint on revenue and therefore the principal call on capital.

Corporate affairs

Leadership

The company was led by members of the founding family for its first seventy-seven years: Colonel Eli Lilly from 1876 to 1898, Josiah K. Lilly Sr. from 1898 to 1932, Eli Lilly Jr. from 1932 to 1948 and Josiah K. Lilly Jr. from 1948 to 1953. Subsequent chief executives have included Eugene Beesley, Richard Wood, Vaughn Bryson, Randall Tobias, who came from outside the industry and imposed substantial restructuring in the 1990s, Sidney Taurel from 1998 to 2008, John Lechleiter from 2008 to 2016, and David A. Ricks since 2017.

Ricks joined the company in 1996 and ran its Bio-Medicines business before his appointment. Daniel Skovronsky, a physician and scientist who founded the diagnostics company Avid Radiopharmaceuticals and joined Lilly when it was acquired in 2010, is chief scientific officer and president of research and development, and is closely associated with both the Alzheimer's and the incretin programmes.

Employees and locations

Lilly employs approximately 47,000 people, a figure rising rapidly with the manufacturing expansion. Its headquarters occupy the Lilly Corporate Center on the near south side of Indianapolis, on the site the company has held since 1881, and it is among the largest private employers in Indiana and the dominant corporate presence in the city alongside Elevance Health.

The Lilly Endowment

The Lilly Endowment was established in 1937 by Josiah K. Lilly Sr. and his sons Eli and Joe with gifts of company stock. It is legally and operationally separate from the company, holds approximately 10 per cent of its shares, and is among the largest private foundations in the world, with assets that rise and fall with the share price and which exceeded US$70 billion following the appreciation of the 2020s.

Its giving is concentrated in Indiana, in religion, particularly the study and practice of Christianity, in community development and in education. It has been the principal funder of a very large number of institutions in Indianapolis, including the Indianapolis Museum of Art, the Children's Museum, the Indiana Historical Society and Butler University, and its scale relative to the state has made it an unusually consequential private actor in Indiana public life. Because the endowment's wealth is concentrated in a single stock, its capacity to give has multiplied several times over in the period since tirzepatide's approval.

The founding family were also individually significant collectors and philanthropists. Eli Lilly Jr. was a serious amateur archaeologist and historian of Indiana, and Josiah K. Lilly Jr. assembled collections of rare books, coins, stamps and militaria, parts of which went to Indiana University as the basis of the Lilly Library, one of the major rare book collections in the United States.

Science of the incretin class

The medicines on which the company's current position rests derive from a physiological observation made in the 1960s: glucose taken by mouth produces a far larger insulin response than the same quantity given intravenously. The difference, known as the incretin effect, is caused by hormones released from the gut during digestion, principally glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide.

GLP-1 stimulates insulin secretion only when blood glucose is elevated, which means that drugs acting on its receptor lower glucose without the risk of hypoglycaemia that insulin and the sulphonylureas carry. It also suppresses glucagon, slows gastric emptying and acts on receptors in the hypothalamus and brainstem that regulate appetite and satiety. The last of these effects, incidental to the original diabetes purpose, produced the weight reduction that transformed the class commercially.

Natural GLP-1 is degraded within minutes by the enzyme dipeptidyl peptidase-4, so a usable medicine required a molecule resistant to that degradation. Exenatide, derived from the lizard peptide exendin-4, was naturally resistant; later agents including dulaglutide and semaglutide were engineered for resistance and for binding to albumin, extending their action to a week.

Tirzepatide added activity at the GIP receptor. The role of GIP had been unclear for decades, since its insulin-stimulating effect is diminished in type 2 diabetes and its activation had been expected to promote fat storage, and the reason that dual agonism produces greater weight loss than GLP-1 alone remains incompletely understood. The empirical result was unambiguous: in the SURMOUNT trials, mean weight reduction at the highest dose exceeded 20 per cent of body weight, approaching what bariatric surgery achieves.

The consequences extend well beyond the products. Trials have shown reductions in cardiovascular events, in progression of chronic kidney disease, in the severity of obstructive sleep apnoea and in metabolic liver disease, and studies are under way in heart failure, osteoarthritis, addiction and neurodegeneration. If the effects prove as general as the early evidence suggests, the class will have altered the treatment of a substantial part of the burden of chronic disease in wealthy countries, and the economic question of how health systems pay for medicines taken indefinitely by a large fraction of the adult population will become the dominant issue in pharmaceutical policy.

Pricing and access

The pricing of Lilly's products in the United States, and the difference between American prices and those elsewhere, has been the company's most persistent public difficulty.

The American system has no single negotiator. Manufacturers set a list price, pharmacy benefit managers negotiate confidential rebates against it in exchange for formulary placement, and the net price a manufacturer receives may be far below the list price. Patients whose insurance requires coinsurance calculated on list price, or who have no insurance, pay something close to the list price while the rebate accrues to intermediaries. The system gives manufacturers an incentive to raise list prices in order to offer larger rebates, which is the mechanism that produced the insulin situation.

Tirzepatide's pricing has been contested on different grounds. Its list price in the United States has been well above prices in Europe and Japan for the same product, and because obesity affects a very large proportion of the population, the aggregate cost of treating even a fraction of those eligible would exceed what public programmes have previously spent on any drug class. Medicare was prohibited by statute from covering medicines for weight loss, a restriction dating from 2003 when the available drugs were of little value, and its partial relaxation has been debated continuously. The company has argued that treating obesity prevents the diabetes, cardiovascular disease and other conditions that follow from it, and that the relevant comparison is with those costs rather than with zero.

Lilly Direct and the LillyDirect self-pay pricing for single-dose vials, introduced in 2024 and repeatedly reduced since, were presented as a response, offering the medicine at a published price without insurance. They also represent an attempt to establish a commercial relationship with patients that does not pass through benefit managers, and the structural conflict between manufacturers and those intermediaries has become one of the defining commercial disputes of the American healthcare system.

The Inflation Reduction Act of 2022 gave Medicare authority to negotiate prices for selected high-expenditure drugs for the first time, and several Lilly products have entered the process. The industry, including Lilly, has litigated against the provision on constitutional grounds without success to date, and has argued that reduced revenue will reduce research investment; the Congressional Budget Office has estimated the effect on the number of new medicines as small, an assessment the industry disputes.

Global operations

Lilly operates in approximately 125 countries with manufacturing in the United States, Puerto Rico, Ireland, France, Italy, Spain, Germany, China, Japan and Brazil, and clinical development activity worldwide. Its Irish operations at Kinsale and Limerick have grown substantially, part of a concentration of pharmaceutical manufacturing in Ireland driven originally by tax arrangements and sustained by an established workforce and regulatory track record.

Its Chinese presence includes manufacturing at Suzhou and research collaborations including the long relationship with Innovent Biologics. The company withdrew from its arrangement to market Innovent's sintilimab in the United States after a Food and Drug Administration advisory committee in 2022 declined to accept trial data generated entirely in China as representative of the American population, a decision that had wide consequences for the strategy of licensing Chinese-developed oncology drugs into Western markets.

Emerging markets have grown more slowly for Lilly than for competitors with broader primary care portfolios, a consequence of concentration in products that require refrigeration, injection devices and specialist prescribing.

Competition

Lilly's principal competitor in incretins is Novo Nordisk, the Danish company whose semaglutide products Ozempic and Wegovy created the obesity market and whose position Lilly has progressively taken with tirzepatide. The two companies together account for almost the entire market, and their rivalry has driven an unusual sequence of head-to-head trials, of which the first directly comparing tirzepatide with semaglutide for weight loss favoured Lilly's product.

A substantial number of companies are developing competing agents, including oral small molecules, amylin analogues and combinations intended to preserve muscle mass, among them Amgen, Pfizer, AstraZeneca, Roche, Boehringer Ingelheim, Structure Therapeutics and several Chinese developers. The expiry of semaglutide's patents, beginning in Canada, India, Brazil and China in the later 2020s, will introduce generic competition in markets covering a majority of the world's population well before it reaches the United States.

In oncology the company competes with Pfizer and Novartis in CDK4/6 inhibition, and across the field with the large antibody and targeted therapy portfolios of Merck, Bristol Myers Squibb, AstraZeneca and Roche. In immunology it competes with AbbVie, Johnson and Johnson, Sanofi and Regeneron. In Alzheimer's disease its competitor is Eisai and Biogen's lecanemab.

Corporate culture and reputation

Lilly has historically been regarded as conservative, technically serious and closely identified with Indianapolis, characteristics inherited from the founding family and sustained by the endowment's ownership stake, which has given the company a long-term shareholder insulated from short-term pressure.

It was among the earliest large American companies to publish clinical trial results comprehensively, establishing a public registry in 2004 following criticism of selective publication across the industry, and among the first to disclose payments to physicians, before federal law required it.

Its reputation has nonetheless been damaged by the Zyprexa marketing case, by insulin pricing and by the general decline in public regard for the pharmaceutical industry over the past two decades, a decline that accelerated during the opioid crisis, in which Lilly was not a significant participant, and during the pandemic, in which the industry's scientific achievement did not translate into improved public standing.

The scale and speed of its recent growth have created their own difficulties. A company that employed 35,000 people in 2020 and is building the largest manufacturing programme in industry history has had to recruit and train very large numbers of staff quickly, and the political attention that follows a trillion-dollar valuation has brought scrutiny of pricing, of its tax arrangements and of the distributional consequences of a medicine that is transformative for those who can obtain it and unavailable to most of those who would benefit.

Legal and ethical issues

Diethylstilbestrol

Lilly was among the manufacturers of diethylstilbestrol, a synthetic oestrogen prescribed to pregnant women from 1938 into the 1970s in the belief that it prevented miscarriage, a benefit later shown not to exist. Daughters exposed in utero were found to have markedly elevated rates of a rare vaginal cancer and of reproductive abnormalities, and effects were later identified in sons and in a third generation.

The resulting litigation produced one of the most significant developments in American tort law. Because the drug had been made by many manufacturers to a common formula and taken decades earlier, plaintiffs frequently could not identify whose product they had been exposed to. In Sindell v. Abbott Laboratories in 1980 the Supreme Court of California adopted market share liability, apportioning damages among manufacturers according to their share of the market rather than requiring proof of which one caused the injury. The doctrine has been applied sparingly since but remains a foundation of mass tort law.

Zyprexa marketing

In January 2009 Lilly pleaded guilty to a misdemeanour violation of the Food, Drug, and Cosmetic Act and agreed to pay US$1.415 billion, comprising a US$515 million criminal fine, then the largest ever imposed on a corporation in the United States, and up to US$800 million in civil settlements.

The conduct concerned the promotion of olanzapine for uses the Food and Drug Administration had not approved, principally in elderly patients with dementia, where the drug increased the risk of death, and in children. Internal documents disclosed in the litigation described marketing campaigns directed at primary care physicians for symptoms including agitation and sleep disturbance in the elderly, and indicated that the company had been aware of the metabolic effects of the drug, including weight gain and elevated blood glucose, earlier and more fully than it had disclosed. Separate settlements with state attorneys general and private plaintiffs over the drug's side effects brought the total cost to well over US$2.5 billion.

Evista marketing

In December 2005 the company paid US$36 million to resolve criminal and civil charges relating to the promotion of raloxifene, sold as Evista and approved for osteoporosis, for the prevention of breast cancer and cardiovascular disease, indications for which it was not then approved.

Foreign bribery

In December 2012 Lilly agreed to pay US$29.4 million to settle charges brought by the U.S. Securities and Exchange Commission under the Foreign Corrupt Practices Act, relating to payments made by its subsidiaries to government officials in Russia, Brazil, China and Poland to secure business. The Russian conduct involved payments routed through offshore entities described as marketing agreements. The company did not admit or deny the findings and agreed to an independent compliance review.

Insulin pricing

The list price of insulin in the United States rose several-fold between the late 1990s and the late 2010s, in parallel across the three manufacturers that supply almost all of it, while prices in other countries remained flat. The increases were accompanied by rising rebates paid to pharmacy benefit managers, so that the net price received by manufacturers rose far less than the list price, but patients whose cost-sharing was calculated on list price bore the full increase. Reports of patients rationing insulin, in some cases fatally, made the issue politically salient.

Lilly was named in class actions and in suits brought by several state attorneys general alleging that the list price increases were a scheme conducted with the benefit managers. The company introduced its US$35 Insulin Value Program in 2020 and in March 2023 cut the list prices of Humalog and Humulin by 70 per cent and capped out-of-pocket costs at US$35, changes that followed the Inflation Reduction Act's Medicare cap and the announcement by Civica Rx that it would produce low-cost insulin, and which the company's competitors matched within weeks. Critics observed that the reductions came only after two decades of increases, extensive litigation and legislation.

The 340B dispute

The 340B programme requires manufacturers to sell outpatient drugs at steep discounts to hospitals and clinics serving low-income populations. From 2020 Lilly and several other manufacturers began restricting the discounts where covered entities dispensed through contract pharmacies, arguing that the arrangement had expanded far beyond the statute's purpose and that discounted drugs were being dispensed to insured patients with the margin retained by hospitals and pharmacy chains rather than passed to patients.

The Health Resources and Services Administration found the restrictions unlawful and referred the manufacturers for penalties. Lilly sued, and appellate courts have reached mixed conclusions, with the Third Circuit largely upholding manufacturers' ability to impose conditions. The dispute concerns a programme that has grown from a modest safety-net measure into one accounting for a substantial share of American drug purchases, and neither side's account of where the money goes is fully documented.

The Canadian patent claim

After Canadian courts invalidated Lilly's patents on atomoxetine and olanzapine under the promise doctrine, a rule requiring that a patent deliver the utility its specification promises, the company brought a claim against Canada under Chapter 11 of the North American Free Trade Agreement, seeking C$500 million and arguing that the doctrine amounted to expropriation of its intellectual property. The tribunal dismissed the claim in 2017 and ordered Lilly to pay costs. The case was among the most widely discussed investor-state arbitrations of the period, because it tested whether a company could use an investment treaty to challenge a national court's interpretation of patent law, and its dismissal was treated as significant by governments resisting similar claims.

Bovine growth hormone

Elanco, then a Lilly subsidiary, acquired the recombinant bovine somatotropin product Posilac from Monsanto in 2008. The hormone increases milk yield in dairy cattle and has been the subject of sustained objection on animal welfare grounds, because of increased rates of mastitis and lameness, and of consumer resistance sufficient that many American retailers and processors now decline milk from treated herds. It is not authorised in the European Union, Canada, Japan, Australia or New Zealand. The product passed out of Lilly's ownership with the Elanco separation in 2019.

Incretin litigation

As tirzepatide use expanded, litigation followed alleging that the manufacturers failed adequately to warn of gastrointestinal effects including gastroparesis and intestinal obstruction, consolidated in multidistrict proceedings alongside claims against Novo Nordisk. The company has also litigated extensively against compounding pharmacies, telehealth companies and sellers of unapproved copies produced during the shortage period, and against sellers of research chemicals marketed as equivalents.

Discrimination claims

The company settled a class action brought by Black employees alleging discrimination in pay and promotion, and has faced individual claims of a similar kind, outcomes common across large American employers but notable in a company that has presented workforce diversity as a corporate commitment.

Assessment

Eli Lilly's history divides into three phases. For its first fifty years it was a manufacturer distinguished from its competitors chiefly by its refusal to sell patent medicines. From the 1920s to the 1990s it was a research company whose contributions, insulin above all, but also the vinca alkaloids, vancomycin, erythromycin, human insulin by recombinant DNA and fluoxetine, were among the most consequential of the era. From the late 1990s it endured two decades in which its products expired faster than its laboratories replaced them, and it survived that period without merging, which several comparable companies did not.

The position it has reached since 2022 is without parallel in the industry's history in scale, and rests on a single molecular class addressing a condition affecting a very large proportion of the population of wealthy countries. That is both the strength and the risk of the position: no company has previously derived a majority of its revenue from a product used by tens of millions of people indefinitely, and neither the long-term clinical consequences nor the long-term pricing of such a product is yet established.

The criticisms directed at the company are those directed at the industry generally, concerning the promotion of medicines beyond their approved uses, the pricing of products in the United States relative to other countries, and the use of litigation and patent strategy to extend exclusivity. In Lilly's case they are complicated by insulin, a medicine the company did more than any other to make available and whose American price became the most widely cited example of what is wrong with how the country pays for drugs.