Flush with cash from their GLP-1 franchises, Eli Lilly and Novo Holdings have become the most active participants in Series A biotech funding. They are leveraging their deep pockets to stimulate company formation and strategically branch into new therapeutic areas, shaping the next wave of innovation.

Unlike small-molecule drugs, biologics manufacturing cannot be simply scaled up on demand because "the process is the product." A superior manufacturing and supply chain capability is not a back-office function but a key market differentiator that commercial teams must leverage to win customers and outpace competitors.

Breakthrough drugs aren't always driven by novel biological targets. Major successes like Humira or GLP-1s often succeeded through a superior modality (a humanized antibody) or a contrarian bet on a market (obesity). This shows that business and technical execution can be more critical than being the first to discover a biological mechanism.

Competing on a prescription drug like a GLP-1 is difficult. The real opportunity for entrepreneurs is in the surrounding ecosystem. This includes selling supplements to counteract muscle loss, providing nutritional counseling, and creating lifestyle management programs for patients using these drugs.

Eli Lilly is leveraging its massive GLP-1 drug revenue for a long-term strategic play. Instead of just acquiring single assets, the company is investing in global innovation hubs, supercomputing with NVIDIA, and incubators to build a sustainable innovation backbone, aiming to avoid typical patent cliff-driven downturns.

For small biotechs, the playbook for success extends beyond scientific discovery. It requires creativity and innovation in the operational process itself—finding efficient paths through regulatory checkpoints, securing non-traditional funding, and leveraging external resources to advance development with limited capital.

According to Novartis's CEO, a top reason for rejecting potential biotech partners is their underinvestment in Chemistry, Manufacturing, and Controls (CMC). Startups often neglect this unglamorous work, leading to deal failure because the acquirer can't be sure the drug can be scaled efficiently and safely.

In therapeutic areas with no existing treatments, the first company to market can define the entire commercial landscape. By building the physician call points and delivery infrastructure from scratch, as Sarepta did for DMD, a biotech like NervGen can create a significant and lasting competitive advantage.

While Europe's Novo Nordisk invented the famous Ozempic GLP-1 drugs, American competitor Eli Lilly captured 60% of the market. Lilly's dominance comes from superior business execution—securing insurance coverage, scaling production, and nailing marketing—proving that operational excellence can outperform initial invention.