Novo Nordisk faces ‘must-win’ battle over U.S. Wegovy, Ozempic in 2026

Novo Nordisk’s shift from a market darling to a severe underperformer has set the stage for a transitional 2026 because the Danish drugmaker fights to regain investor confidence in its weight reduction enterprise.

Novo’s inventory simply skilled the worst 12 months on document because it started buying and selling on the Copenhagen inventory alternate over three a long time in the past. A number of causes lie behind the dramatic drop: a collection of steering cuts, strides by chief rival Eli Lilly, a management upheaval, and low cost copycat medication flooding the essential U.S. market.

With nearly per week to go till 2026, Novo introduced that its new weight reduction capsule below the model identify Wegovy had been authorized within the U.S., making it the primary oral GLP-1 remedy authorized for weight reduction. It despatched shares up almost 10% as traders banked on Novo having the ability to, a minimum of partly, maintain Eli Lilly and others at bay.

That “early Christmas current,” as one analyst known as it, highlights lots of the key themes Novo must face this 12 months.

From injectables to tablets

Novo’s place as the primary firm to launch an oral possibility might assist it make up a number of the floor it is misplaced over the previous 12 months within the GLP-1 house. Analysts principally agreed that the Wegovy capsule’s approval was a giant deal, despite the fact that many had already anticipated a optimistic choice earlier than the top of the 12 months.

Eli Lilly is anticipated to get its personal weight reduction capsule orforglipron authorized by the U.S. Meals and Drug Administration by no later than the second quarter of this 12 months, and traders will intently watch how that competitors performs out.

“This approval provides a layer to the entire weight problems house sooner or later,” Sydbank analyst Søren Løntoft Hansen informed CNBC. “It may very well be, doubtlessly, an area the place Novo Nordisk is perhaps in a position to recapture market shares and perhaps enhance progress.”

Wegovy-in-a-pill, as Novo calls the oral model of the blockbuster injectable, has proven that sufferers lose on common 16.6% of their physique weight over 64 weeks. In the meantime, orforglipron, averages 12.4% over 72 weeks.

“Normally, you need to mainly go for both comfort or efficacy once you’re discussing tablets versus injections – not on this case,” Novo CEO Mike Doustdar informed CNBC’s Charlotte Reed in November. “Wegovy in a capsule mainly can have the identical efficacy as its injectable counterpart. That is actually thrilling.”

The broad consensus is that tablets will even be favored by shoppers. They’ve added benefits corresponding to not having to be saved chilly just like the injectable model, permitting for less complicated distribution and ease of coming into new markets.

A shifting narrative?

Eli Lilly’s positioning of its rival drug Zepbound as one of the best remedy for reaching weight reduction available on the market for once-weekly injections has helped it achieve capturing important market share to surpass Novo’s Wegovy.

In the meantime, Novo Nordisk’s positioning has been completely different as they’ve typically emphazised that treating weight problems goes past reducing weight. “They wish to inform a narrative about how weight problems ought to be seen as a illness and the way Wegovy impacts obesity-related ailments,” Sydbank’s Hansen stated.

“As we are going to construct and purchase belongings, you’ll typically see that these belongings do a number of issues,” Doustdar stated in early November. “They deal with different co-morbidities. We’ve got seen that with semaglutide; it helps liver, kidney, coronary heart – that is improbable – we must always truly go and additional develop these,” he stated within the context of the long run focus of its pipeline.

Nevertheless, plainly’s not vital to People or the market, in line with Hansen. “The fraction that prescribes Wegovy or weight problems medication in relation to obesity-related ailments could be very small,” he famous, including that even when many sufferers do not essentially wish to lose greater than 20% of their physique weight, they a minimum of need the chance to attain that highest fee of weight reduction.

“It looks like that drives the market, and if Novo Nordisk is ready to faucet into that story with the Wegovy capsule, I believe they’re in a superb place,” Hansen stated.

Novo in late November stated it filed for FDA approval of a better dose of Wegovy injection of seven.2 mg, which might additionally play right into a altering narrative. Trials have proven that the upper dose of Wegovy resulted in a 20.7% weight discount on common — about the identical as Lilly’s Zepbound jab.

The U.S. client

The elevated give attention to the direct-to-consumer market will likely be one other key space to look at.

The marketplace for weight reduction prescribed drugs is uniquely consumer-driven, contrasting many different blockbuster medication which are usually coated by well being plans within the U.S. or nationwide well being programs in Europe.

President Donald Trump’s second time period in workplace has introduced a number of complications for pharmaceutical corporations, Novo included. All year long, Trump has teased triple-digit tariffs except pharma corporations make important investments within the U.S., and has additionally waged a struggle on excessive drug costs for People.

The frustration that U.S. drug costs will be greater than 4 instances these in Europe is not new. Final 12 months, Novo’s then-CEO Lars Fruergaard Jørgensen testified on the U.S. Senate panel chaired by Sen. Bernie Sanders, who known as for the corporate to “cease ripping us off” with excessive drug costs.

However Trump has taken it additional, advocating a so-called “Most Favored Nation” pricing for medicines, whereby the U.S. worth is about to the bottom stage in comparison with different rich nations.

In November, the Trump administration reached a cope with Novo and Lilly to decrease costs of their bestselling GLP-1 medicines on each Medicare and Medicaid, in addition to agreements to supply them on to shoppers at a reduction on the web site TrumpRx.gov, which is about to be launched in January this 12 months.

The brand new direct-to-patient market is rising as a vital driver of future gross sales progress, however compounders — which make cheaper copycat variations of the drug and had been in a position to flourish throughout the earlier scarcity of semaglutide — stay an actual competitor.

“The TrumpRx deal will assist Novo develop into extra aggressive with compounders on worth, though a quicker orforglipron launch might scale back its skill to achieve momentum within the [direct-to-patient] channel forward of Lilly,” famous Morningstar’s Karen Andersen.

“We have already seen the direct-to-patient market starting to develop properly in 2025, notably for LillyDirect… oral GLP-1 medication will likely be even higher suited to this channel,” she added. “That may additional push the market towards money pay.”

Headwinds

Buyers are additionally ready to see if Novo’s new management will ship on its try to enhance U.S. operations.

In Could, Novo ousted its CEO of eight years, citing “latest market challenges” and “the event of the corporate’s share worth.” Six months later, all unbiased members of the board stepped down attributable to a disagreement with Novo’s controlling shareholder over the tempo of change and discontent over the way it had addressed challenges within the U.S. market.

“The marketable growth for Wegovy and Ozempic is a must-win battle for [CEO] Mike Doustdar and the brand new board,” Hansen stated, including that the event within the U.S. market is a “present me case” for traders. “Proper now, we actually do not see any important optimistic progress right here,” he informed CNBC on Dec 23.

The Danish drugmaker should subsequently steadiness progress on its capsule model and higher-dose jabs of Wegovy with these a number of headwinds in 2026.

Decrease pricing for each the Medicare and client cash-pay channel on account of MFN, in addition to patent expiries in jurisdictions together with Brazil, Canada and China will “in all probability result in a lowering prime line,” stated Hansen.

Moreover, 2026 will possible deliver extra readability on Novo’s next-generation drug CagriSema, which mixes semaglutide, a GLP-1 agonist, with cagrilintide, an amylin analogue.

Long term, competitors is more likely to intensify past Lilly and compounders, as a number of drugmakers — together with Pfizer, Amgen, AstraZeneca, Roche — advance late-stage candidates by way of their pipelines.

The longer term might additionally deliver extra diversification in therapies, as many new medication are in growth that would yield new methods to handle weight reduction long-term, present higher security profiles, and mix medication that concentrate on a number of completely different appetite-modifying hormones.

“There have been so many strikes this 12 months that present Novo as a conflicted firm – for instance, reaching a cope with Hims after which terminating the deal… negotiating to accumulate Metsera, exiting negotiations, after which leaping again in after a signed Pfizer deal,” stated Andersen.

“This [Wegovy pill approval] win is symbolically essential for Novo, after a collection of disappointments with knowledge and monetary efficiency,” she added. “It wanted a win, and now it simply must execute.”