| Leaf | Impact | Duration | Signal | Kill condition |
|---|---|---|---|---|
| Mounjaro and Zepbound Volume Growth | High | Cyclical | Active | Combined tirzepatide quarterly revenue growth falls below 30% YoY for two consecutive quarters |
| Tirzepatide Clinical Superiority vs Semaglutide | High | Structural | Active | Head-to-head trial shows Wegovy or oral semaglutide achieves equivalent or superior weight loss at comparable dose |
| GLP-1 Global Patient Base Expansion | Medium | Structural | Active | Global GLP-1 patient count fails to reach 30M by end of 2026 as guided, or major payer coverage contracts materially |
| Leaf | Impact | Duration | Signal | Kill condition |
|---|---|---|---|---|
| Foundayo Oral GLP-1 Market Penetration | High | Catalyst | Active | Foundayo quarterly revenue fails to reach $500M within two quarters of launch or Novo oral semaglutide approved within 6 months capturing preferred formulary position |
| Retatrutide Triple Agonist NDA Filing and Approval | High | Catalyst | Uncertain | Retatrutide Phase 3 cardiovascular outcome trial fails primary endpoint or NDA filing delayed beyond Q2 2027 |
| NASH and Cardiometabolic Indication Expansions | Medium | Structural | Uncertain | FDA requires additional NASH trials or cardiovascular indication label is materially narrower than expected, reducing addressable patient population by more than 40% |
| Leaf | Impact | Duration | Signal | Kill condition |
|---|---|---|---|---|
| IRA Medicare Price Negotiation Expansion | High | Structural | Active | Mounjaro or Zepbound selected for Medicare price negotiation before exclusivity expiry, or IRA drug list expanded to include GLP-1 class broadly |
| Trump Most Favored Nation Pricing Pressure | Medium | Cyclical | Active | MFN executive order enforced without Lilly carve-out; realized net price on obesity drugs declines more than 15% YoY beyond agreed deal terms |
| Compounded GLP-1 Generic Re-entry | Medium | Cyclical | Uncertain | FDA reverses tirzepatide shortage designation allowing 503B compounders to resume copies at scale, denting branded unit volumes by more than 10% |
| Leaf | Impact | Duration | Signal | Kill condition |
|---|---|---|---|---|
| Premium Multiple Compression on Earnings Miss | Medium | Cyclical | Uncertain | Forward P/E expands above 42x on earnings miss or macro rate spike; or consensus 2027 EPS estimates revised down more than 10% in a single quarter |
| Manufacturing Capacity Constraints | Medium | Cyclical | Uncertain | Supply shortages prevent Zepbound or Mounjaro from meeting demand in key markets for two consecutive quarters, causing measurable market share loss to Novo Nordisk |
| Leaf | Impact | Duration | Signal | Kill condition |
|---|---|---|---|---|
| Tirzepatide Patent Exclusivity Runway to 2031 | High | Structural | Active | Court invalidates tirzepatide key composition-of-matter patents before 2031, or a successful paragraph IV challenge opens biosimilar entry before scheduled exclusivity expiry |
| Formulary and Payer Position Retention | Medium | Structural | Active | Major PBMs shift preferred formulary tier from Zepbound to Wegovy or a new GLP-1 entrant, reducing Zepbound prescription market share by more than 20% within 12 months |
| Leaf | Next check | Last data | Source |
|---|---|---|---|
| Mounjaro and Zepbound Volume Growth | None | None | None |
| Tirzepatide Clinical Superiority vs Semaglutide | None | None | None |
| GLP-1 Global Patient Base Expansion | None | None | None |
| Foundayo Oral GLP-1 Market Penetration | None | None | None |
| Retatrutide Triple Agonist NDA Filing and Approval | None | None | None |
| NASH and Cardiometabolic Indication Expansions | None | None | None |
| IRA Medicare Price Negotiation Expansion | None | None | None |
| Trump Most Favored Nation Pricing Pressure | None | None | None |
| Compounded GLP-1 Generic Re-entry | None | None | None |
| Premium Multiple Compression on Earnings Miss | None | None | None |
| Manufacturing Capacity Constraints | None | None | None |
| Tirzepatide Patent Exclusivity Runway to 2031 | None | None | None |
| Formulary and Payer Position Retention | None | None | None |
claude-sonnet-4-6 as judge
· models agreed on all fields