GLP-1 juggernauts Eli Lilly and Novo Nordisk, whose combined $1.18 trillion market cap now exceeds Johnson & Johnson, AbbVie, and Merck combined, have staked their claim as stock market darlings. This momentum is particularly evident in Novo Nordisk’s remarkable trajectory, reaching a $604 billion market capitalization by March 2024 and securing its position as the 12th most valuable company globally. Despite these valuations, neither company ranks in the top eight by revenue. Market leader Merck ($60.1B revenue) commands just 36% of Lilly’s market value despite generating nearly triple its annual sales.

The saga of Lilly and Novo Nordisk is something of a microcosm for the continued dominance of North America and Europe. Novo Nordisk’s strategic expansion, including the acquisition of Austrian fluid management service company Single Use Support in May 2024 and plans for a $4.1 billion production facility in Clayton, North Carolina, exemplifies this trans-Atlantic industrial synergy. In terms of geographic concentration, the industry reveals efficiency contrasts across eight major innovation hubs totaling $3.3 trillion in market capitalization. The NJ-NY corridor maintains traditional leadership with $905.5 billion across six companies. Anchoring that region is Johnson & Johnson’s $372.0 billion market cap valuation (which spans pharma and medtech). J&J also has an extensive patent portfolio of 5,394 therapeutic innovations.

Yet the emergence of single-company powerhouses challenges this traditional pecking order. Indianapolis commands $709.9 billion through Eli Lilly alone, while Copenhagen’s $488.4 billion cluster derives 97% of its value from Novo Nordisk — a concentration reinforced by the Danish government’s November 2024 strategy to double exports of pharmaceuticals and medical equipment to 350 billion DKK by 2030. This concentration contrasts sharply with the distributed innovation model of Boston-Cambridge, where $429.8 billion spreads across a dozen companies. The efficiency metrics are also telling: Copenhagen generates $602 million in market value per patent, while Tokyo’s extensive research output of 2,582 therapeutic patents translates to just $58 million per innovation.

Note: Market cap for conglomerates are unedited. Abbott, for instance, has a significant medical device presence that is larger than its pharma segment. Similarly, J&J has sizable medtech and pharma divisions.