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

Novo Nordisk’s transition from market darling to serious underperformer has set the stage for a transitional 2026 in which the Danish drugmaker struggles to regain investor confidence in its weight-loss business.

Novo’s shares had their worst year on record since they began trading on the Copenhagen stock exchange three decades ago. There are many reasons behind the dramatic decline: a series of guidance cuts, breakthroughs by the chief rival Eli Lillya leadership revolt and cheap counterfeit drugs flooding the critical US market.

With just a week to go until 2026, Novo announced that its new weight loss pill under the brand name Wegovy has been approved in the US, making it the first oral GLP-1 therapy approved for weight loss. Shares rose nearly 10% as investors relied on Novo to at least partially keep Eli Lilly and others at bay.

This “early Christmas present,” as one analyst put it, underscores many of the important themes Novo will have to confront this year.

From injections to pills

Novo’s position as the first company to launch an oral option could help it make up some of the ground it lost last year in the GLP-1 space. Analysts mostly agreed that approval of the Wegovy pill was important, but many had already expected a positive decision before the end of the year.

Eli Lilly is expected to have its own weight-loss pill, or forglipron, approved by the U.S. Food and Drug Administration by the second quarter of this year at the latest, and investors will be watching closely to see how this competition plays out.

“This approval adds a new layer to the future obesity space,” Sydbank analyst Søren Løntoft Hansen told CNBC. “Potentially this could be an area where Novo Nordisk could recapture market shares and perhaps increase growth.”

Wegovy-in-a-pill, which Novo calls the oral version of the blockbuster injectable drug, showed patients lost an average of 16.6% of body weight over 64 weeks. Meanwhile, orforglipron averages 12.4% at 72 weeks.

“Usually when debating pills vs. injections, you have to choose either convenience or effectiveness; not in this case,” Novo CEO Mike Doustdar told CNBC’s Charlotte Reed in November. “Wegovy in a pill will have essentially the same effectiveness as its injectable counterpart. That’s really exciting.”

The general consensus is that the pills will also be preferred by consumers. They also added advantages such as no need for cold storage like the injectable version, simpler distribution, and ease of entering new markets.

A changing narrative?

Eli Lilly’s positioning of its rival drug, Zepbound, as the best once-weekly injection weight loss treatment on the market has helped it gain significant market share, overtaking Novo’s Wegovy.

Meanwhile, Novo Nordisk’s positioning was different because they often emphasized that treating obesity goes beyond weight loss. “They want to tell a story about how obesity should be viewed as a disease and how Wegovy affects obesity-related diseases,” Sydbank’s Hansen said. he said.

“As you build and acquire assets, you will often find that those assets do more than one thing,” Doustdar said in early November. he said. “They touch on other comorbidities as well. What we’ve seen with semaglutide is that it helps the liver, the kidney, the heart – that’s great – we should actually go and develop those further,” he said in terms of the future focus of the pipeline.

But that doesn’t seem to matter to Americans or the market, according to Hansen. “The proportion of people who prescribe Wegovy or obesity medications for obesity-related diseases is very small,” he said, adding that even if many patients do not want to lose more than 20% of their body weight, they at least want the opportunity to achieve the highest rate of weight loss.

“That seems to be what’s driving the market, and if Novo Nordisk can capitalize on that story with the Wegovy pill, I think they’re in a good place,” Hansen said.

Novo at the end of November Said it was filed for FDA approval of the higher Wegovy injection dose of 7.2 mg, which may contribute to a changing narrative. Trials showed that the higher dose of Wegovy resulted in an average weight reduction of 20.7%; this was almost identical to Lilly’s Zepbound shot.

US consumer

The increased focus on the direct-to-consumer market will be another important area to watch.

The market for weight loss drugs is uniquely consumer-focused, unlike many other blockbuster drugs that are typically covered by health plans in the United States or national health systems in Europe.

President Donald Trump’s second term in office has caused many headaches for pharmaceutical companies, including Novo. Throughout the year, Trump has teased triple-digit tariffs if pharmaceutical companies fail to make significant investments in the United States, and he has also waged war on high drug prices for Americans.

Frustration that drug prices in the United States can be more than four times those in Europe is not new. Last year, Novo’s then-CEO Lars Fruergaard Jørgensen testified before a U.S. Senate panel chaired by Senator Bernie Sanders and called on the company to “stop ripping us off” with high drug prices.

But Trump took this further, advocating so-called “Most Favored Nation” pricing for drugs, setting U.S. prices at the lowest level compared to other rich countries.

In November, the Trump administration reached a deal with Novo and Lilly to lower prices on both Medicare and Medicaid for their best-selling GLP-1 drugs and also offer them directly to consumers at a discount on its website. TrumpRx.govIt is planned to be released in January this year.

The new direct-to-patient market is emerging as a critical driver of future sales growth, but compounds that make cheaper knockoff versions of the drug and that were able to thrive during the earlier semaglutide shortage remain a real contender.

“The TrumpRx deal will help Novo be more competitive with compounders on price, but a faster launch of orforgliprone may reduce its ability to gain momentum in the market.” [direct-to-patient] Morningstar’s Karen Andersen noted that Lilly has a pipeline ahead of it.

“We have already seen the direct-to-patient market starting to develop nicely in 2025, particularly for LillyDirect…oral GLP-1 drugs will be even more suited to this channel,” he added. “This will push the market further towards cash payments.”

headwinds

Investors are also waiting to see whether Novo’s new leadership will follow through on efforts to improve its U.S. operations.

In May, Novo ousted its CEO of eight years, citing “recent challenges in the market” and “improvement in the company’s share price.” Six months later, all independent members of the board resigned due to disagreement with Novo’s controlling shareholder over the pace of change and dissatisfaction with how the company was coping with challenges in the US market.

“Marketable development for Wegovy and Ozempic is a must-win battle for us. [CEO] “Mike Doustdar and the new board,” Hansen said, adding that the development in the U.S. market was “an example to me” for investors. “We’re not really seeing any significant positive progress here right now,” he told CNBC on Dec. 23.

The Danish drugmaker therefore needs to balance progress in the pill version and higher doses of Wegovy injections with these multiple downsides in 2026.

Lower pricing for both Medicare and the consumer cash payment channel as a result of MFN, as well as patent expirations in countries such as Brazil, Canada and China, “will likely lead to a decline in revenue,” Hansen said.

2026 will also likely bring greater clarity to Novo’s next-generation drug, ÇağrıSema, which combines semaglutide, a GLP-1 agonist, with cagrilintide, an amylin analog.

In the long term, competition from many drugmakers, including many others, is likely to intensify beyond Lilly and its compounders. Pfizer, amgen, AstraZeneca, Roche — advancing late-stage candidates through their pipelines.

The future may bring greater diversity in treatments, as many new drugs are being developed that may offer new ways to manage weight loss in the long term, provide better safety profiles, and combine drugs that target several different hormones that regulate appetite.

“There have been a lot of moves this year that have made Novo look like a conflicted company, for example, reaching a deal with Hims and then terminating the deal… negotiating to buy Metsera, exiting negotiations, and coming back in after the Pfizer deal was signed,” Andersen said.

“This [Wegovy pill approval] “The win is symbolically very important for Novo after a series of disappointments with data and financial performance,” he added. “It needed a win and now it just needs to execute.”