Photo by Jay Goldz
In May 2023, Dave Ricks, CEO of Eli Lilly, was impatiently waiting for one of the most important presentations in the history of the company.
A team of researchers was about to report on the results of TRAILBLAZER-ALZ 2, a phase-three trial of a potential treatment for Alzheimer’s disease, which remains the only one of the top 10 reasons for death in America still growing despite decades of study. Globally, some 55 million people suffer from the disease, with no treatment available. Health and long-term care costs for people living with dementia are projected to reach $384 billion in 2025 and nearly $1 trillion in 2050, according to the Alzheimer’s Association.
There was every reason to hope for a good result. Lilly had spent decades and billions of dollars looking at potential Alzheimer’s drug therapies, including donanemab, a man-made monoclonal antibody that mimics the body’s natural defenses to target amyloid plaques and hopefully slow the progression of the disease. But still. All the prior trials had been busts. Ricks recalls bracing himself to sit through the usual slew of boilerplate slides and admits now that he hoped the research team would simply jump ahead to the conclusions just to relieve the tension.
They did—the trial had succeeded. Kisunla, Lilly’s brand name for their breakthrough medicine, was on its way to becoming one of only two drugs available at the time for the treatment of the disease—a critical step for millions of patients and their families around the world.
Two years later, Ricks smiles sharing the memory. Moments like that? They are the best thing about his job. Moments like that also encapsulate just how different Ricks’—and his fellow pharma CEOs’—job is from other CEO jobs. While others can lean into every six-sigma-lean play in the book to ensure predictability, course correcting at every turn, drug discovery “is literally like the card flipping over and you win the hand or you don’t,” says Ricks, leaning forward in his chair in a small conference room just outside his office. “It’s a reminder, our business is one of the few businesses that you do actual discovery. It’s not development purely. You really don’t know the answer. That’s about the risk we take, but it’s also about the utility when it works. Something never happened before—and now it’s happened.”
Something else that’s never happened is also happening at Lilly. Under Ricks’ leadership since January 2017, the company has evolved from a storied-but-struggling drugmaker into the most valuable pharmaceutical outfit in history, with a market capitalization near $700 billion in September 2025. Worth around $70 billion when Ricks took the helm, it now commands a valuation that exceeds the GDP of Ireland, Israel or Norway, driven largely by the revolutionary GLP-1 drugs reshaping how medicine approaches obesity and diabetes.
The year Ricks became CEO, Lilly generated $22.87 billion in annual revenue and clocked a $204 million loss in operating income thanks in part to changes in the U.S. tax code. Today, the company could record more than $60 billion in revenue with analysts estimating $25 billion in operating income for 2025—a gain of more than 35 percent from the prior year, on track to blow past current industry drug sales leaders like J&J, AbbVie, Merck, Roche and Pfizer. Analysts project revenue could exceed $75 billion in 2026. It’s the kind of supernova typically associated with Silicon Valley unicorns, not 149-year-old family-founded pharmaceutical companies headquartered in the American Midwest.
Lilly’s success is a byproduct of both scientific and medical research but also Ricks’ ability (read: maniacal focus) to scale the company without falling victim to the management hubris, bureaucratic scoliosis and complacency that normally dog moonshot growth like Lilly’s. Taken together, it is a leadership achievement that led our selection committee to name Dave Ricks Chief Executive’s 40th CEO of the Year.
“Dave Ricks is an exemplary leader,” says Ken Frazier, the former CEO of Merck and Chief Executive’s 2021 CEO of the Year, who served on the selection committee. “His vision, resilience and commitment to Lilly’s core values of scientific excellence, patient-centered care, ethical business practices and respect for people have led the company to unprecedented levels of success, as measured by societal and shareholder value.”
Stanley Bergman, CEO of Henry Schein and our 2017 CEO of the Year, who also served on the committee, says Ricks “has not only delivered exceptional growth at Lilly but has done so with a rare combination of strategic clarity and deep respect for people. Under Dave’s leadership, Lilly has accelerated innovation, scaled breakthrough treatments and created extraordinary shareholder value, all while fostering a culture grounded in purpose and integrity.”
Ricks didn’t aspire to revolutionize how the world fights disease—or even try. In joining Eli Lilly in 1996, fresh from an MBA at Indiana University and a stint at IBM, he was simply following his girlfriend—now wife—who was in medical school. An Indiana native, he needed something to do in Indianapolis while she finished her degree.
He fell hard for Lilly—the mission, the brilliant people, the opportunity to learn new things and the company’s habit of pushing high-potentials to take on roles they might not seem ready for—or be ready for—again and again and again. He worked in marketing, in sales, ran the Canada business, then the China business. In 2012, he became president of its then-largest division, Bio-Medicines. His planned layover turned into a 29-year run, culminating in the top job at the most pivotal moment in the company’s history.
The story of Lilly’s ascent under Ricks is, of course, inextricably linked to the global obesity epidemic. According to CDC data, 74 percent of Americans are overweight, with 42 percent falling into the obese category. This represents what some view as the largest health epidemic in human history. The average American consumes about 3,600 calories daily, up from 2,800 in 1961. The consequences cascade through the healthcare system: diabetes, cardiovascular disease, fatty liver disease, sleep apnea and over 230 other conditions linked to excess weight. The annual global cost of obesity is projected to reach $4.3 trillion by 2035, according to the World Obesity Federation, or nearly 3 percent of global GDP—comparable to the economic impact of the Covid-19 pandemic in 2020.
Into this crisis stepped Lilly with tirzepatide, marketed as Mounjaro for diabetes and Zepbound for weight loss. The drug (which costs between $300 and $500 a month without insurance) represents two decades of research into glucagon-like peptide-1 (GLP-1) receptor agonists, medications that mimic natural hormones to regulate appetite and blood sugar. What sets Lilly’s offering apart from rivals is its dual action—combining GLP-1 with another hormone called gastric inhibitory polypeptide (GIP), which has proven more effective than single-hormone treatments.
Ricks knew they had something special in 2016, just as he was preparing to take over as CEO. One of his scientists in the diabetes group called him about early results they were receiving from a Singaporean test site doing a tirzepatide study. “We had to stop the study because people were losing too much weight to stay in it.”
Ricks was touring UC Berkeley with his daughter, standing outside the Lawrence Hall of Science, when “the team breathlessly called and said, ‘Okay, we’ve got the phase-two results and this is going to change diabetes and probably beyond.’” He knew exactly what he needed to do. And he knew how hard it would be. “Since that day, it’s been all execution,” he says. “We need to make more, we need to do more trials, we need to make this an important global product. It wasn’t difficult to see that because weight management’s such a huge problem, diabetes is such a huge problem. What was difficult was doing it. That was the difficult part.”
Ricks labored to scale manufacturing to meet monumental patient demand. In the past 12 months, Lilly announced plans to build four new state-of-the art production facilities part of a $50 billion expansion since 2020. The result: While competitor Novo Nordisk’s Ozempic grabbed early headlines, Lilly’s execution—especially in scaling Zepbound and Mounjaro—earned it some 53 percent of the global GLP-1 market, surpassing Novo for the first time in 2025.
That success could bank Lilly for a future unlike any the pharma industry has seen before. The company that brought insulin to the masses in the 1920s and revolutionized mental health treatment with Prozac in the 1980s is harnessing its unmatched financial firepower to fund billions of dollars in R&D for the defining health challenges of the 21st century—a critical effort as Washington slashes public spending on health research.
Lilly’s current agenda continues its three-decade investment in Alzheimer’s; more than 60 studies targeting cancers from breast to gastrointestinal to skin; a robust cardiovascular pipeline recently strengthened with the $1.3 billion purchase of Verve Therapeutics, a clinical stage company developing genetic medicines for heart disease; at least 100 studies of tirzepatide for various conditions and more than 10 additional pipeline projects targeting metabolic health. The company is investigating GLP-1 applications in alcohol abuse, nicotine addiction and even drug abuse, based on the medications’ effects on reward pathways in the brain. It is spending billions more on promising M&A and VC efforts. In 2027, a new $4.5 billion R&D center, the Lilly Medicine Foundry, will open its doors.
Amid this, Ricks remains focused on what he calls a “generational opportunity”—not just for Lilly but also for public health. With only six to seven million Americans currently on GLP-1 medications out of 110 million with obesity, and projections showing a billion people globally will have obesity within five years, the work has just begun. “That’s what Lilly is for, right?” says Ricks. Lilly, with its massive scale, is not being built to make niche drugs for niche diseases. “Lots of companies can do that—and do do that. We start with: What’s human suffering? And work backwards.”
The following conversation was edited for length and clarity.
There was a good article I read coming into this role by A.G. Lafley [former P&G CEO and Chief Executive’s CEO of the Year in 2006], which was about the jobs only the CEO can do. One of them is a classic one: culture. I observed that early in my career. I’m lucky to be here. Lilly has a promote-from-within philosophy. I’ve been here 29 years, and they put me in all kinds of jobs I had no business being in. We had this practice of saying, “Well, are you high-potential but lower skill? Let’s test people.” I was asked to run our Canadian business, which is a microcosm of the U.S. in a way. I observed that there were many things I wanted to change about the culture, but almost everything I tried to do explicitly didn’t work. But everything I did implicitly stuck.
Some of those things are trivial and interesting. You notice if you start wearing different clothes, other people will too. There’s a mimicking thing in human culture. I don’t think people are saying, “I want to dress like the boss,” but if we dress up, if we come to the office, other people tend to do that.
But more important is how you react when things go wrong. One of the tests of culture is what people do when it’s tough and no one’s watching. We would all hope as CEOs that people do the right thing. They act with integrity, pursue the mission of the company, put the interest of customers first. They solve the problems, and they work hard. So, are you doing those things? Especially under pressure and when it’s difficult?
Those are the moments that people notice. That culture imprint is much more important than the culture play. Culture is formed by doing the work and then, as a leader, leading the work in a way that creates a pattern people can see that is successful and they follow themselves.
The emphasis on speed and accountability in a science apparatus was something that made a difference here and does make a difference. The previous CEO, John Lechleiter, wrote in my first performance management document, “You have an overdeveloped sense of urgency.” I’m like, “How do I take that?” Leaders can drive a culture of urgency and speed. And if you don’t have it, that probably imprints on the organization.
Another one is curiosity. Science is discovery, and you can create a curious company, but it’s impossible if the leader’s not curious. I love learning new things. We just brought our top 140 global leaders in. Every year we do a science fair. I could listen all day to young scientists talk about what they’re working on—sometimes crazy and cutting-edge things. That’s what makes the business interesting.
Most people would say I’m a business guy. I don’t have trouble making tough calls and certainly have had lots of tough conversations with people. I run a pretty disciplined meeting, etc. But this company started as a family-run business. And because it takes so long to do things, loyalty and persistence on task is a critical attribute for our employees. If we’re always churning and changing, we have no hope of changing human disease and making a big difference. You need to act that way—whatever the adage is, “tough on problems, soft on people.” That is something I try to do. I hope the company has that. We understand each other, we listen, we’re patient with people, but we drive the problem and accountability in a tough way.
We also had a culture play—a framework called Team Lilly—about putting the collective above your own interests. That’s particularly important in pharma. Unlike a software engineering firm or maybe Boeing, where you have aerospace engineers and then managers, and those two differences are the whole construct that defines the culture, we have dozens of disciplines to make drugs. Chemists make fun of biologists who make fun of engineers. There are so many parts. To integrate and work well together is very important. Then, we get measured by drug approvals; for drugs that get used, that’s the only thing that matters. It’s very latent. It takes the industry 13–14 years to produce one drug. Most people’s careers, you don’t even see the outcome. So you need this collective spirit probably more than other places. That was the leadership play.
In 1975, the grandson of the founder, who was the chair of the board, wrote a paper. It was about what makes Lilly special. “What are our values?” He talked about pursuit of excellence and integrity, and honesty because we make a health product, but also how we treat each other. In its worst, people get that order wrong. They focus more on cohesion. Part of respect for people, though, is doing your part for the team. I think there is a version of this that drifts into being too nice.
We’re in the Midwest, that can be a problem. This isn’t a one-company town, but it’s close to it. The likelihood of me seeing someone in the cafeteria here is equal to the Starbucks in my neighborhood on a Saturday. It’s a small town where people live next to their coworkers. Those conversations get a little harder when you’re proximate all the time. I think we’ve changed that for the better; we wrap process around it. We do have performance turnover. It’s necessary. But the way that I think about it is back to that Team Lilly approach. If you’re not playing your position, and you’re not passing the ball, then you don’t deserve to be on the team. It is an honor to have a Lilly badge. You’ve got to uphold that.
I’m obsessed with this. Critical for two reasons. One is that a lot of parts of our businesses do benefit from size. The clinical development apparatus does, certainly manufacturing, maybe commercial, but really, one thing doesn’t, and that’s discovery. Having the leaders really close to the people doing innovative things is important because all the studies on middle management find they tend to squash deviations, but the deviations are the people doing stuff off strategy, in the labs, the things that make the next breakthrough. I guarantee you that obesity was not on our corporate strategy document 10 years ago. But tirzepatide was first formulated in 2011. So, someone was off strategy, and it may be the biggest drug in the history of our industry. You have to have an allowance for that. Only senior people have the kind of confidence and awareness to let that happen. So, that’s mission-critical for the discovery apparatus.
There are tons of companies that grow really fast and then become less competitive overall. The senior leader group, the people who work for the people who work for me, two steps from the CEO? When I started, there were 137 of them. This week, there were 138. We’ve grown by one every 10 years. That feels about right. You have to grow your capacity as a leader. We’re not growing the number of leaders.
Because it’s subtraction by addition. You’re making the company more complicated and more siloed. Also, prioritization is good. Constraint can be good. If someone has to knock things off the bottom of their list, that’s probably healthy for the company. But one other thing about our culture: This is a place where we expect all the people in that room to know each other. There was a new employee—I host dinner for all the new ones every year—who said, “Wow, you introduced us all.” That’s because I interviewed them all. No one gets promoted or hired at that level in the company unless I approve it. If it grows, I won’t be able to do that, right?
If we all know each other, it solves so many problems that no org chart, committee structure or computer system can. If I have a problem in a complex, highly complicated, regulated industry, how do I solve it? Well, I call the woman or guy who runs that part of the company. Each one of those people, there’s no replacement for them. There’s no redundancy across that group. If there’s a problem in a plant in Wisconsin, I know who that person is, and I call them and we talk about it. If there’s someone leading diabetes research and they need to talk to someone about a risk of a cancer signal with that mechanism, well, they talk to the person who runs the cancer research. They just know each other.
It’s agility at scale. How do you actually do the work at scale? You have to expand the span of control for people and expect them to manage more scope. But humans have a lot of capacity.
Most of that group started at Lilly in a more junior position and grew up. We have a strong bias on best-athlete kind of staffing over skill. Not always. I mean, there are some jobs where you don’t want that risk. But as I said, I was put in jobs where I wasn’t really the most qualified person. That implies high learning agility, good people skills, some extra in terms of, “Okay, can you see around corners better than the next person? Can you drive the energy level in the organization and lead people better?” Those attributes tend to be portable and matter. And those are mostly attributes we use to promote people to these ranks. They are given scope they’ve never had before, but they’ve got those fundamental attributes.
Commitment to the cause matters, too. It’s not just personal loyalty; it’s company loyalty. I have an aversion to personal loyalty structures. That creates a different fragility. Really believing in what we do and wanting to work in a business where you can create solutions to the biggest health problems in the world being more important to you than compensation or title—those people get promoted.
We try to do four things. Of course, the content and the moment changes what those things are. The theme this year was basically re-underwriting, revisiting what our goals are. “What’s our ambition?” Because already we’re the largest, fastest-growing company in the industry. We have the highest market cap. It could be easy to say, “Hey, we’re at the top of the mountain.” But there’s always another mountain. And what is that? So, that was really what we talked a lot about.
But we always focus a lot on rejuvenating the connective tissue between the group so the company can solve problems quickly and organically, without structure. If I have to tell people how to organize and solve problems, we’re losing. They need to know how to do that. That’s a lot of social cohesion.
We have a lot of leaders presenting back to the group, whether it be a leadership-lessons-learned thing or what they’re doing that’s new that people need to know about. We talk a lot about our strategy, how we’re going to keep winning. So, that’s more of the substantive piece that we try to be pretty open about. Strategy is not a secret. It’s about how you execute it, and your odds of execution go up if more people know about it.
We have all the systems everyone else does. We do a 360-feedback process every spring. Every leader gets a report on that. I do that. The board gets mine. Everyone’s supervisor gets theirs. We have an annual performance management review with three-times-a-year written feedback. It’s pretty disciplined.
But to your point on ‘can you be too nice?’ We have a new system where, rather than just green light, red light, we’ve introduced a yellow light—what we call a “badge.” It’s not a badge of honor but “you need to improve.” The idea there is that, look, the company grew 45 percent in Q1. Did you grow 45 percent in Q1? As a leader, the implications are that if not, you’re actually slowing us down. So, what are you learning? How is your capacity growing? This is the hardest thing; people tend to think that if they did well last time and they’ve done a little bit better now, that’s good. But we need to introduce a lot more stretch.
This yellow light, for some, is a warning: “I’m not sure you’re on a path to be sustainably at this level.” For others, it’s a little bit a wake-up call that helps them renegotiate with themselves.
But the most important thing is candor and a culture where people can say what’s honestly happening. I love to spend—and my reports do this extensively as well—20 percent of my time visiting the people doing the work: labs, factories, commercial affiliates, customers. Usually, I have a format for a note I write, a two-paragraph email after every visit to the leader of that place. It’s two paragraphs because the notes always point out things that I really liked that were new and I want them to share, and things that need to be improved and they need to learn. It’s just simple structure. One, two, three points. I always pull that up before I go again. People have learned that if you don’t have those things solved when Dave’s back, that’s a problem.
It’s changed through time. I spend more time externally now. Back to: “What are the jobs only I can do?” I’ve both become better at that and more networked and can have a bigger impact on the company, but also I learn about how the world sees us. There’s more of that. But I always do some pretty extensive contact with the frontline people at the site, whether it’s having lunch or walking the floor in a factory, spending an hour or two talking to the people doing the stuff. Then of course, we sit with the leaders and go through what their version of success is. One of the things I care a lot about is: How are your metrics and your deliverables laddering to mine and the company’s?
We talk about that a lot. That’s a kind of sclerotic moment for a lot of companies; you could look at 100 dashboards of senior people and it’s hard to see that it’s one company. We want to see a lot of meshing of those things and constantly revisiting those goals because they change and the company’s adapting.
We usually do a leader-to-many communication. I always like to do that with the leaders of the site, again, so it’s not like, “Oh, here’s this alien CEO arriving. We’re going to treat him specially. He’s got his own room he sits in, takes calls. And suddenly we have special food this day. Oh, now he’s on stage.” It’s this performative CEO thing. And then when he leaves, we just do what we’re doing anyway. I believe in a group activity with the leader of the site and me. Often they interview me, or I interview them. That’s a good style. People see cohesion in the management.
I know! That is a battle, an unbelievable battle. Not just on beating back the invasion into time for yourself but actually the quality of the time you spend. It’s tough for everybody in these jobs. There were two skills I really lacked coming into the CEO job. That was one of them because I underestimated the demands. And the other one is managing my board.
I’d never done them before. So, I have a system I use. I forward-plan every quarter. I do things in 90-day increments. I set goals for those periods of time and priorities for me. Some of the priorities I set, I can give to others, and they drive them, but some of them are just mine. Then, I build my calendar around those priorities.
I try to do this a couple months out from the quarter I’m talking about. Then, I share all that with my board. I have a slide, it says: “Top of mind items,” and I’m like, “This is where I’m going to spend my time. Any questions, or is there something I’m missing?” Then I build a calendar around that and try to spend disproportionate time on those things. Sometimes, those are things I really need to learn about. That’s a category. Another is things I really need to get involved with because they’re broken and need to get fixed.
And sometimes, there are opportunities, an M&A transaction or something that I need to go deep on and feel good about before we get directly involved with or hire someone new. I like to spend a lot of time more deeply on a few things, too, to really learn something. You don’t have to go back to it too often if you really took the time to go to ground, you know? So, there’ll be a few items where I’ll spend a day, a week on this topic and just really go deep. And then, you have all the governance, external commitments, things that come up that you didn’t plan on.
Then, I audit the time afterwards. The very best quarter, after nine years of doing this, is about 50 percent of my time on my priorities, which sounds ridiculous, but that’s the nature of it. I’ve had quarters in the 30s.
The science is one of the most interesting things we do. Curiosity, whether it’s about that or some other topic, is super important in this job but also in the culture of a company. You want to be what Satya Nadella says about Microsoft, “a learn-it-all company.” That’s what we want. I love learning, and I want to be around people who love learning. When you love to learn, you’re going to adapt, right? That’s a self-fulfilling thing if you set that goal and choose to learn about things and go deep. It also eliminates a pretty big risk, which is getting satisfied. Because there’s always someone doing something more interesting and better. If you’re looking at that, you’re going to push your company.
We have 4,000 PhDs here—which, by the way, is the same as MIT and Harvard combined. But often, they have a PhD in something they’re not even doing. They’re a world expert, but they’ve moved their skillset. Executives, especially in technical businesses, need to do the same. The idea that you’re just managing isn’t very interesting, No. 1. No. 2, it’s pretty disconnected from the business. We’re a product company. We make stuff that’s important, and knowing where it comes from and how it gets developed and the diseases we’re treating—that’s all critical.
I’m on a board of a tech company [Adobe] that’s deeply embedded with AI, [Lilly has] followed it for a while, and my first job was in the tech industry. So, I’m a big optimist on this.
The real gold right now for us is what I’ll call repurposed AI. AI built for general purpose or maybe a specific purpose, but we take it and put it in a pharma-specific business process that only we can do. We can take today’s free open-source models, Claude or Llama, and retrain them on very specific pharma problems. It works pretty well to predict or streamline things. Last year, we had 40 or 50 things like this, probably half of them worked really well.
We reviewed them at this meeting we were just at. A few are billion-dollar items with a $250,000 investment. This is why we’re optimistic, and the winners in the next three years will be big companies that do a lot of that, where you can use models built for language prediction to predict other things. What’s another language? Your DNA, right? It’s got four letters. The words are shorter, but there are more words. You can train it on the human genome and predict things. That’s pretty useful for scientists. What else? We can tokenize parts in a manufacturing process and have the machines optimize manufacturing. It’s pretty good at that.
No software company’s going to write that code for us. We take these general models and apply them to our very narrow problems. They work brilliantly at this. That, to me, is the AI breakthrough that’ll ring the register today and create medicines faster, etc.
It’s one bounty. I mean, we can invest differentially in AI, but the biggest thing we can do is invest differentially in other medicines. Everyone’s talking about NIH [National Institutes of Health] funding being reduced. About $32 billion of the NIH’s $40 billion funds the entire academic biomedical research apparatus in the U.S. Maybe it will go south. This year, Lilly will spend $14.5 billion. That’s above Germany and Japan as a nation and headed closer to the NIH.
Think about the scale of what we could achieve. If we’re good, we can direct that at the problems that are both big and solvable in a way that governments never could. We could have a huge impact with that surplus.
I don’t dwell on that much. Honestly, it feels like the kind of question where someone with a good answer would have a foot out the door. I’m pretty focused on winning now and making the most of what we have.
Probably all CEOs start and have one goal: survive the first two years. Then you move into “okay, how can I become the best in our sector?” We’ve probably done those things. Now, it’s about sustaining success. Next May 10, we’ll celebrate 150 years as an entity. There’s only one drug company that’s been around longer, Pfizer. There’s maybe a handful of other American companies that have been around longer.
That’s amazing. And I feel a duty to that in a unique way. We’re probably having our best moment in 150 years. But how can we make sure to continue that invention, that usefulness to solving healthcare problems? Each time you solve one, you get another one because people are aging. There’s no end to our opportunity to help people and keep the company and what makes it good. That’s the goal I have.
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