(Reuters) – Eli Lilly and Co on Tuesday reported lower-than-expected first-quarter sales for its top-selling diabetes drug Trulicity, saying they were partly hurt by programs that allow patients to try newer drugs at little or no cost to them as insurance companies weigh coverage decisions.

Shares of the U.S. drugmaker were down 2.6 percent at $116.46.

The company said net price declines in the United States could also negatively impact sales. Lilly also cited a number of other near-term challenges it faces, such as cheap generic competition for erectile dysfunction treatment Cialis and the recent global withdrawal of cancer drug Lartruvo after it failed to prove its benefit in a confirmatory clinical trial.

Lilly has been banking newer drugs such as Trulicity and psoriasis treatment Taltz to grow revenue and help weather pricing pressures and sales declines for other products.

Trulicity sales of $879.7 million in the quarter fell well short of Wall Street estimates of $952 million, partly hurt by lower net prices after providing rebates and discounts to payers in the United States.

Sales of $252.5 million for Taltz, another of Lilly’s more important growth drivers, also fell short of analysts’ estimates.

And intense political pressure over the high price of insulins has led Lilly to offer a half-priced version of its widely-used Humalog insulin.

Lilly’s patient affordability programs have also eaten into revenue, Chief Financial Officer Joshua Smiley told Reuters.

“We’ve got lots of programs in place to bridge patients who may not have adequate insurance coverage or are in a high deductible phase of their plan. That is the piece that is new relative to a couple of years ago,” Smiley said.

New migraine treatment Emgality, seen as a future billion-dollar product, had sales of $14.2 million in the quarter.

Lilly said it expects Emgality to overtake Amgen’s rival drug Aimovig in new prescriptions in the current quarter.

“We view this as a mixed quarter, as growth for certain new products came in below our expectations,” Edward Jones analyst Ashtyn Evans said, adding that Lilly’s newer drugs are expected to account for 60 percent of the company’s sales by 2022.

Lilly said it now expects 2019 revenue of between $22 billion and $22.5 billion, down from its prior forecast of $25.1 billion to $25.6 billion. The forecast takes into account the spin-off of Lilly’s animal health unit, Elanco.

The company, however, raised its 2019 adjusted earnings forecast by 5 cents to $5.60 to $5.70 per share, with the new midpoint slightly ahead of the average analyst estimate of $5.63.

Excluding items, the company earned $1.33 per share, 2 cents higher than the average analyst estimate of $1.31, according to IBES data from Refinitiv.

Revenue rose nearly 3 percent to $5.09 billion, but missed estimates of $5.13 billion.