Summary of Key Points
In the 2026 Fortune Global 500 list of pharmaceutical companies, 15 companies remain the same as last year, but their rankings have changed significantly: Eli Lilly has soared 112 places to become the third-largest pharmaceutical company in the world due to the huge success of its GLP-1 dual-target drug, tirzepatide; Merck has dropped to fourth place due to declining revenue from its older products; Novo Nordisk has made the fastest ranking improvement and also has the highest profit margin; the competition in the GLP-1 weight loss drug sector is intensifying, as the industry enters its “second half.”
1. Eli Lilly: A 112-place Jump in One Year – Tirzepatide as the Key to Success
Eli Lilly’s performance this year can be described as phenomenal: it went from 336th in the overall list and 11th among pharmaceutical companies in 2025 to 224th and 3rd respectively in 2026, only behind Johnson & Johnson and Roche. The main contributor to this rise is its star drug, tirzepatide, a GLP-1 dual-target medication that can both lower blood sugar levels and aid in weight loss.
In 2025, Eli Lilly’s total revenue was $65.179 billion (a year-on-year increase of 44.7%), with profits reaching $20.64 billion (a year-on-year increase of 94.9%). Nearly half of its revenue came from tirzepatide, which sold for $36.5 billion—more than Novo Nordisk’s semaglutide, which generated $36.1 billion. The diabetes version of tirzepatide (Mounjaro) sold for $22.965 billion (up 99%), and the weight loss version (Zepbound) sold for $13.542 billion (up 175%). Both indications have been extremely successful.
2. Merck: From Third to Fourth Due to Declining Revenue from Key Products
Merck was still the third-largest pharmaceutical company in the world in 2025, but it has dropped to fourth place in 2026. The reason is simple: its two main sources of revenue are struggling.
First, the revenue from its cancer drug K药 (pembrolizumab) has slowed down; this drug was once the best-selling cancer treatment globally, but it may now face patent expiration or competition from newer alternatives. Second, revenue from its HPV vaccines has decreased, possibly due to market saturation or increased competition. As a result, Merck’s revenue in 2025 only grew by 1.3% ($65 billion), far lower than Eli Lilly’s 44.7%, leading to its ranking drop.
3. Novo Nordisk: The Highest Profit Margin Among Pharmaceutical Companies, Competing with Eli Lilly in the Weight Loss Drug Sector
Novo Nordisk has climbed 35 places this year, the second-fastest improvement among pharmaceutical companies. What’s even more impressive is its profit margin of 33.1%, the highest among the Fortune 500 companies (Eli Lilly ranks second at 31.7%).
Why such a high profit margin? Both Novo Nordisk and Eli Lilly are leaders in GLP-1 weight loss drugs, which offer substantial profit margins due to the large market demand. The two companies are in fierce competition: with tirzepatide just surpassing semaglutide as the most popular drug in this category, Novo Nordisk is unlikely to accept this setback, and the competition is set to intensify.
4. The GLP-1 Sector Enters Its “Second Half”: What Are Companies Focusing On?
GLP-1 weight loss drugs have been popular for several years, and now the industry has entered a new phase. The focus is on developing more advanced versions of these medications:
- Oral small molecules: These do not require injections and are more convenient for patients.
- Ultra-long-acting formulations: These allow injections to be administered less frequently, once a week or even once a month.
- Multi-target agonists: These drugs act on multiple targets simultaneously, enhancing weight loss effectiveness.
- Fat reduction without muscle loss: These medications help patients lose fat while preserving muscle mass, promoting better health outcomes.
Companies that can develop these new technologies will gain an advantage in the market.
Conclusion
The changes in this year’s list reflect a “shift from old to new innovations” in the pharmaceutical industry. Traditional companies that rely on their established products are no longer able to maintain their dominance; those that have seized the opportunity with GLP-1 weight loss drugs, such as Eli Lilly and Novo Nordisk, are rising rapidly. In the future, competition in the GLP-1 sector will become even more intense, and other companies will need to focus on developing the next generation of innovative therapies if they want to succeed.