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

Novo Nordisk‘s shift from a market darling to a serious underperformer has set the stage for a transitional 2026 as the Danish drugmaker fights to regain investor confidence in its weight loss business.

Novo’s stock just experienced the worst year on record since it began trading on the Copenhagen stock exchange over three decades ago. Multiple reasons lie behind the dramatic drop: a series of guidance cuts, strides by chief rival Eli Lilly, a leadership upheaval, and cheap copycat drugs flooding the crucial U.S. market.

With just about a week to go until 2026, Novo announced that its new weight loss pill under the brand name Wegovy had been approved in the U.S., making it the first oral GLP-1 treatment approved for weight loss. It sent shares up nearly 10% as investors banked on Novo being able to, at least partly, hold Eli Lilly and others at bay.

That “early Christmas present,” as one analyst called it, highlights many of the key themes Novo will have to face this year.

From injectables to pills

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

Eli Lilly is expected to get its own weight loss pill orforglipron approved by the U.S. Food and Drug Administration by no later than the second quarter of this year, and investors will closely watch how that competition plays out.

“This approval adds a layer to the whole obesity space in the future,” Sydbank analyst Søren Løntoft Hansen told CNBC. “It could be, potentially, a space where Novo Nordisk is maybe able to recapture market shares and maybe increase growth.”

Wegovy-in-a-pill, as Novo calls the oral version of the blockbuster injectable, has shown that patients lose on average 16.6% of their body weight over 64 weeks. Meanwhile, orforglipron, averages 12.4% over 72 weeks.

“Usually, you have to basically go for either convenience or efficacy when you’re discussing pills versus injections – not in this case,” Novo CEO Mike Doustdar told CNBC’s Charlotte Reed in November. “Wegovy in a pill basically will have the same efficacy as its injectable counterpart. That’s really exciting.”

The broad consensus is that pills will also be favored by consumers. They have added advantages such as not having to be stored cold like the injectable version, allowing for simpler distribution and ease of entering new markets.

A shifting narrative?

Eli Lilly’s positioning of its rival drug Zepbound as the best treatment for achieving weight loss on the market for once-weekly injections has helped it succeed in capturing significant market share to surpass Novo’s Wegovy.

Meanwhile, Novo Nordisk’s positioning has been different as they’ve often emphazised that treating obesity goes beyond losing weight. “They want to tell a story about how obesity should be seen as a disease and how Wegovy affects obesity-related diseases,” Sydbank’s Hansen said.

“As we will build and buy assets, you will often see that these assets do multiple things,” Doustdar said in early November. “They address other co-morbidities. We have seen that with semaglutide; it helps liver, kidney, heart – that’s fantastic – we should actually go and further develop those,” he said in the context of the future focus of its pipeline.

However, it seems that’s not important to Americans or the market, according to Hansen. “The fraction that prescribes Wegovy or obesity drugs in relation to obesity-related diseases is very small,” he noted, adding that even if many patients don’t necessarily want to lose more than 20% of their body weight, they at least want the opportunity to achieve that highest rate of weight loss.

“It seems like that drives the market, and if Novo Nordisk is able to tap into that story with the Wegovy pill, I think they are in a good place,” Hansen said.

Novo in late November said it filed for FDA approval of a higher dose of Wegovy injection of 7.2 mg, which could also play into a changing narrative. Trials have shown that the higher dose of Wegovy resulted in a 20.7% weight reduction on average — about the same as Lilly’s Zepbound jab.

The U.S. consumer

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

The market for weight loss pharmaceuticals is uniquely consumer-driven, contrasting many other blockbuster drugs that are typically covered by health plans in the U.S. or national health systems in Europe.

President Donald Trump’s second term in office has brought several headaches for pharmaceutical companies, Novo included. Throughout the year, Trump has teased triple-digit tariffs unless pharma companies make significant investments in the U.S., and has also waged a war on high drug prices for Americans.

The frustration that U.S. drug prices can be more than four times those in Europe isn’t new. Last year, Novo’s then-CEO Lars Fruergaard Jørgensen testified at the U.S. Senate panel chaired by Sen. Bernie Sanders, who called for the company to “stop ripping us off” with high drug prices.

But Trump has taken it further, advocating a so-called “Most Favored Nation” pricing for medicines, whereby the U.S. price is set to the lowest level compared to other wealthy countries.

In November, the Trump administration reached a deal with Novo and Lilly to lower prices of their bestselling GLP-1 medicines on both Medicare and Medicaid, as well as agreements to offer them directly to consumers at a discount on the website TrumpRx.gov, which is set to be launched in January this year.

The new direct-to-patient market is emerging as a critical driver of future sales growth, but compounders — which make cheaper copycat versions of the drug and were able to flourish during the earlier shortage of semaglutide — remain a real competitor.

“The TrumpRx deal will help Novo become more competitive with compounders on price, although a faster orforglipron launch could reduce its ability to gain momentum in the [direct-to-patient] channel ahead of Lilly,” noted Morningstar’s Karen Andersen.

“We’ve already seen the direct-to-patient market beginning to develop nicely in 2025, particularly for LillyDirect… oral GLP-1 drugs will be even better suited to this channel,” she added. “That will further push the market toward cash pay.”

Headwinds

Investors are also waiting to see if Novo’s new leadership will deliver on its attempt to improve U.S. operations.

In May, Novo ousted its CEO of eight years, citing “recent market challenges” and “the development of the company’s share price.” Six months later, all independent members of the board stepped down due to a disagreement with Novo’s controlling shareholder over the pace of change and discontent over how it had addressed challenges in the U.S. market.

“The marketable development for Wegovy and Ozempic is a must-win battle for [CEO] Mike Doustdar and the new board,” Hansen said, adding that the development in the U.S. market is a “show me case” for investors. “Right now, we really don’t see any significant positive progress here,” he told CNBC on Dec 23.

The Danish drugmaker must therefore balance progress on its pill version and higher-dose jabs of Wegovy with these multiple headwinds in 2026.

Lower pricing for both the Medicare and consumer cash-pay channel as a result of MFN, as well as patent expiries in jurisdictions including Brazil, Canada and China will “probably lead to a decreasing top line,” said Hansen.

Furthermore, 2026 will likely bring more clarity on Novo’s next-generation drug CagriSema, which combines semaglutide, a GLP-1 agonist, with cagrilintide, an amylin analogue.

Longer term, competition is likely to intensify beyond Lilly and compounders, as several drugmakers — including Pfizer, Amgen, AstraZeneca, Roche — advance late-stage candidates through their pipelines.

The future could also bring more diversification in treatments, as many new drugs are in development that could yield new ways to manage weight loss long-term, provide better safety profiles, and combine drugs that target several different appetite-modifying hormones.

“There have been so many moves this year that show Novo as a conflicted company – for example, reaching a deal with Hims and then terminating the deal… negotiating to acquire Metsera, exiting negotiations, and then jumping back in after a signed Pfizer deal,” said Andersen.

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