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 file because it started buying and selling on the Copenhagen inventory change over three a long time in the past. A number of causes lie behind the dramatic drop: a collection of steerage cuts, strides by chief rival Eli Lilly, a management upheaval, and low-cost copycat medication flooding the essential U.S. market.

With nearly every week to go till 2026, Novo introduced that its new weight reduction capsule below the model title Wegovy had been accredited within the U.S., making it the primary oral GLP-1 therapy accredited for weight reduction. It despatched shares up practically 10% as traders banked on Novo having the ability to, no less than partly, maintain Eli Lilly and others at bay.

That “early Christmas current,” as one analyst referred to as it, highlights lots of the key themes Novo should 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 area. Analysts largely agreed that the Wegovy capsule’s approval was a giant deal, although many had already anticipated a constructive choice earlier than the top of the 12 months.

Eli Lilly is anticipated to get its personal weight reduction capsule orforglipron accredited 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 area sooner or later,” Sydbank analyst Søren Løntoft Hansen instructed CNBC. “It could possibly be, probably, an area the place Novo Nordisk is possibly capable of recapture market shares and possibly improve 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.

“Often, it’s a must to principally go for both comfort or efficacy whenever you’re discussing tablets versus injections – not on this case,” Novo CEO Mike Doustdar instructed CNBC’s Charlotte Reed in November. “Wegovy in a capsule principally could have the identical efficacy as its injectable counterpart. That is actually thrilling.”

The broad consensus is that tablets will even be favored by customers. They’ve added benefits comparable 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 therapy for reaching weight reduction available on the market for once-weekly injections has helped it reach capturing important market share to surpass Novo’s Wegovy.

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

“As we’ll construct and purchase property, you’ll typically see that these property do a number of issues,” Doustdar stated in early November. “They deal with different co-morbidities. We now have seen that with semaglutide; it helps liver, kidney, coronary heart – that is incredible – we must always truly go and additional develop these,” he stated within the context of the longer term focus of its pipeline.

Nonetheless, evidently’s not essential to People or the market, in accordance with Hansen. “The fraction that prescribes Wegovy or weight problems medication in relation to obesity-related illnesses may 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 no less than need the chance to realize that highest fee of weight reduction.

“It looks as if that drives the market, and if Novo Nordisk is ready to faucet into that story with the Wegovy capsule, I believe they’re in an excellent 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. shopper

The elevated concentrate on the direct-to-consumer market will probably be one other key space to look at.

The marketplace for weight reduction prescription drugs is uniquely consumer-driven, contrasting many different blockbuster medication which might be usually lined by well being plans within the U.S. or nationwide well being methods in Europe.

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

The frustration that U.S. drug costs might 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 referred to 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 international locations.

In November, the Trump administration reached a take care of 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 customers 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 essential driver of future gross sales progress, however compounders — which make cheaper copycat variations of the drug and had been capable of flourish in the course of the earlier scarcity of semaglutide — stay an actual competitor.

“The TrumpRx deal will assist Novo turn into extra aggressive with compounders on worth, though a quicker orforglipron launch might scale back its potential 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 probably be even higher suited to this channel,” she added. “That may additional push the market towards money pay.”

Headwinds

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

In Might, 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 because of 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 constructive progress right here,” he instructed CNBC on Dec 23.

The Danish drugmaker should due to this fact stability 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 shopper cash-pay channel because of MFN, in addition to patent expiries in jurisdictions together with Brazil, Canada and China will “most likely result in a reducing high line,” stated Hansen.

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

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

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

“There have been so many strikes this 12 months that present Novo as a conflicted firm – for instance, reaching a take care of 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 crucial for Novo, after a collection of disappointments with knowledge and monetary efficiency,” she added. “It wanted a win, and now it simply must execute.”