Eli Lilly's Shopping Spree

To understand what Eli Lilly (NYSE:LLY) is doing right now, you have to start a few years back, with a drug that changed everything, a middleman nobody elected (health insurance), and a company that watched its own history and decided it was not going to repeat it (when generic versions of Prozac flooded the market and Eli Lilly had a far less diversified portfolio than they are currently building ¹).

The GLP-1 Machine

I just want to firstly mention that GLP-1 drugs have a specific, targeted, and complicated relationship with women. We’ve seen the weight loss narrative, the use of GLP-1s, off-label, to treat Polyendocrine Metabolic Ovarian Syndrome (PMOS), and the fact that we are still learning how GLP-1s affect female physiology specifically. I’ll discuss those details in my next post.

Zepbound and Mounjaro, Lilly's GLP-1 drugs for weight loss and diabetes, turned the company into a cash making machine almost overnight². By the end of 2025, Lilly reported over $65 billion in revenue³, a 45% increase⁴ from the year prior. The company's market cap crossed $1 trillion. To me this is one of the most dramatic pharmaceutical ascents in modern history.

But the road wasn't so easy peasy. In mid-2025, CVS Caremark, one of the three largest pharmacy benefit managers (PBM… I just learned about this today) in the US, collectively managing drug coverage for the majority of Americans, removed Zepbound from its formulary and prioritized a competing GLP-1, Novo Nordisk's Wegovy, instead. An estimated 200,000 patients lost coverage overnight. Lilly's stock tumbled. Class action lawsuits followed, with plaintiffs alleging CVS preferred Novo Nordisk's larger rebate payments over patient outcomes rather than any clinical benefits, which is especially notable given that Zepbound has demonstrated stronger weight loss results in clinical trials than Wegovy. Anyway…

This is the unsexy reality of American drug access. A PBM is a middleman between drug companies and insurance plans. They decide what gets covered and at what cost. The list price for Zepbound is $1,086 per month. With good insurance coverage and the additional Lilly's savings stacked on top, patients can pay $25 a month⁵. Without coverage, that's a drug most people simply cannot access. The gap between those two numbers is where PBM power lives.

Is The Drug Worth $1,086?

The $1,086 price tag is not what anyone actually pays in the supply chain. It's the starting point for a negotiation.

Here's how the money actually flows:

Lilly sets a high list price. The PBM (CVS Caremark, etc.) then negotiates a rebate, which is like a discount paid by Lilly back to the PBM in exchange for formulary placement. That rebate can be 20-40% or more of the list price. So the PBM collects a large check from Lilly just for agreeing to cover the drug. Basically, Lilly is paying a PBM to make their drug a more attractive cost to patients and customers while insurance companies foot the bill.

The insurance plan then pays most of the remaining cost. The patient pays a copay, which is sometimes as low as $25 with a manufacturer savings card that Lilly layers on top.

So Where Does Lilly Actually Make Money?

Even after paying the PBM rebate and subsidizing the patient copay card, Lilly is still collecting a substantial net price per prescription, usually somewhere in the $500-700 range per month depending on the deal. Multiply that by millions of prescriptions and the math and motive becomes very clear.

The savings card actually doesn’t cost Lilly much per patient because it only applies to commercially insured patients, and the volume it generates by removing the access barrier more than compensates.

Real Volume, Real Money

A $25 copay means millions more patients can actually fill the prescription. More patients filling prescriptions at $500+ to Lilly per month is far more profitable than fewer patients paying full price. The discount is essentially a customer acquisition cost.

Two days ago, CVS reversed course entirely, announcing it will restore Zepbound to its formularies starting October 1 and add Lilly's new oral GLP-1 pill Foundayo starting June 1⁵. Lilly's shares jumped nearly 6% on the news⁶. The move puts Lilly's drugs in the same league as Novo across all three major PBMs, a coverage landscape that didn't exist a year ago and that seriously widens the targetable patient pool heading into the last half of 2026.

The GLP-1 money machine just got bigger.

What Are They Doing With All This Cash?

Lilly has been on an acquisition spree that started in earnest in 2025 and has accelerated into something that analysts are struggling to track in real time. The spending is its highest ever in a single year, already eclipsing the prior 10-year record.

The company is explicit about the strategy. Jake Van Naarden, Lilly's head of oncology and business development, said at a recent conference: "We are making more offers than you can possibly imagine. What's interesting is how many of the multibillion dollar deals we are attempting to do and getting rebuffed with some frequency." His team looks at "at least" 10 potential deals every week ¹.

The 2025 spree began with a $2.5 billion acquisition of Scorpion Therapeutics and its PI3Kα inhibitor STX-478, a targeted cancer therapy. From there, Lilly shifted focus into gene therapy, genetic medicine, and AI-assisted drug discovery². Then in 2026, the pace became something else entirely.

Here is what they've announced just this year so far:

Ventyx Biosciences ($1.2B) —> small molecule NLRP3 inhibitors for inflammatory disease.

Orna Therapeutics ($2.4B) —> in vivo CAR-T for autoimmune disease.

Centessa Pharmaceuticals ($7.8B) —> narcolepsy and sleep-wake disorders, the second biggest Lilly acquisition in a decade.

CrossBridge Bio ($300M) —> dual-payload antibody-drug conjugates for cancer.

Kelonia Therapeutics ($7B) —> in vivo CAR-T for blood cancers.

Ajax Therapeutics ($2.3B) —> rare blood cancers.

Profluent Bio ($2.25B*) —> AI-powered DNA editing.

Insilico Medicine ($2.75B*) —> AI drug discovery.

And this week: Curevo, LimmaTech Biologics, and Vaccine Company Inc., a nearly $4 billion bet on infectious disease, including a shingles vaccine competitor to GSK's Shingrix, a vaccine targeting sexually transmitted bacterial infections, and a viral pathogen platform.

That's nine companies plus three more announced in the last 72 hours, totaling over $25 billion in potential commitments.

The Science Worth Knowing

The most technically interesting deal in this entire spree is Kelonia. CAR-T therapy, engineering a patient's T cells to attack cancer, has been one of the most transformative advances in oncology over the past decade (shameless plug for my first article posted on Femme X Formula), but it has a fundamental access problem. Current CAR-T requires harvesting a patient's immune cells, engineering them in a lab outside the body, and reinfusing them. The process is logistically brutal, expensive, and largely confined to major academic medical centers. Most patients who could benefit from it never receive it.

Kelonia's platform, called iGPS, uses engineered lentiviral particles to reprogram T cells directly inside the body, a single intravenous infusion, no leukapheresis, no centralized manufacturing. Its lead candidate KLN-1010 is in Phase 1 for multiple myeloma with early data showing tolerability and platform proof-of-concept⁷. If this holds in later trials, it represents not just a new drug but a structural shift in who can access cell therapy at all.

Orna Therapeutics is pursuing the same in vivo logic for autoimmune disease. Together, these two acquisitions signal that Lilly is making a serious, expensive bet that in vivo cell reprogramming is the next major platform in medicine. Not just in oncology, but across disease categories.

Why Everyone Is Doing This At Once

Lilly is not alone in their mission. The entire pharmaceutical industry is in acquisition mode right now, and the timing is not a coincidence.

The GLP-1 boom did not happen in isolation. Massive revenue flowing into a handful of large pharma companies coincided with, and in my opinion, arguably accelerated the AI drug discovery moment. Companies flooding with cash began writing large checks to AI biotech firms, which funded those platforms, which attracted more capital, which produced the wave of AI-pharma partnerships we are now seeing across the industry. The money and the technology amplified each other.

What Lilly is doing has clear strategic logic, and it’s something I would do for my own portfolio. The company has roughly a decade of patent protection left on Mounjaro and Zepbound, and executives say they don't want to just wait and see what happens. Lilly itself fell victim to that trap before in the early 2000s, where the loss of patent protections on Prozac sent the company into a spiral that took a decade to recover from. The acquisition spree is Lilly building its next act before the current one ends¹.

But the broader pattern raises questions that go beyond any single company's strategy. When the world's largest pharmaceutical company is evaluating at least 10 acquisition targets per week, what happens to the smaller biotech companies that might otherwise have grown into competitors? When the same three or four giants are simultaneously buying up gene therapy platforms, AI drug discovery companies, CAR-T developers, and vaccine makers, all at the same time, all with GLP-1 windfall capital, who is left to challenge them, and who will bear the cost that arises when competition disappears?

About a third of Lilly's pipeline is now genetic medicines, mostly still in early stages of development. The company is building a platform portfolio rather than paying premiums for individual drugs. That is rational portfolio management. It is also a way of ensuring that the most promising early-stage science ends up under one very large roof and, I suppose, is more likely to succeed ¹.

Innovation and consolidation are not mutually exclusive. But they are worth naming separately. The GLP-1 boom created the capital. The acquisition spree is deploying it. Whether what emerges is a more innovative pharmaceutical ecosystem or a more concentrated one is the question the next decade will answer.

Cover Photo by Myriam Zilles on Unsplash