Novo Nordisk faces ‘must-win’ battle against US Wegovy and Ozempic in 2026

Novo NordiskThe move from a market darling to a serious underperformer has set the stage for a transitional year in 2026 as the Danish pharmaceutical maker fights to regain investor confidence in its weight-loss business.

Novo shares have just had their worst year on record since they were listed on the Copenhagen stock exchange more than three decades ago. Multiple reasons explain this spectacular drop: a series of reductions in forecasts and progress by the main rival. Elie Lillya leadership shake-up and cheap copied drugs flooding the crucial US market.

About a week until 2026, Novo announcement that its new Wegovy-branded diet pill had been approved in the United States, making it the first oral GLP-1 treatment approved for weight loss. That sent shares up nearly 10%, with investors counting on Novo’s ability to keep Eli Lilly and others at bay, at least in part.

This “early Christmas present” as one analyst called ithighlights many of the key themes Novo will 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 lost over the past year in the GLP-1 space. Most analysts agree that the approval of the Wegovy pill is a big deal, although many were already expecting a positive decision before the end of the year.

Eli Lilly is expected to get approval for its own diet pill, or forglipron, from the U.S. Food and Drug Administration no later than the second quarter of this year, and investors will be closely watching how this competition develops.

“This approval adds a layer to the whole obesity field going forward,” Sydbank analyst Søren Løntoft Hansen told CNBC. “This could potentially be a space where Novo Nordisk might be able to regain market share and perhaps increase its growth.”

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

“Usually when you’re talking about pills or injections, you have to prioritize either convenience or effectiveness – not in this case,” said Mike Doustdar, CEO of Novo. said CNBC’s Charlotte Reed in November. “Wegovy in pill form will basically have the same effectiveness as its injectable counterpart. That’s really exciting.”

There is broad consensus that the pills will also be favored by consumers. They have additional benefits, such as not having to be stored cold like the injectable version, allowing for simpler distribution and easier entry into new markets.

A changing story?

Eli Lilly’s positioning of its rival drug Zepbound as the best weight loss treatment on the market for weekly injections has helped it capture significant market share to overtake Novo’s Wegovy.

At the same time, Novo Nordisk’s positioning has been different, as they have often emphasized that obesity treatment goes beyond weight loss. “They want to tell the story of how obesity should be considered a disease and how Wegovy affects obesity-related diseases,” Sydbank’s Hansen said.

“As we build and purchase assets, you’ll often find that those assets do multiple things,” Doustdar said in early November. “They’re addressing other comorbidities. We’ve seen that with semaglutide; it helps the liver, kidneys and heart – that’s fantastic – we should actually continue their development,” he said in the context of the future direction of his pipeline.

However, it appears that this is not important to Americans or the market, according to Hansen. “The fraction that prescribes Wegovy or obesity medications for obesity-related illnesses is very small,” he noted, adding that while many patients don’t necessarily want to lose more than 20 percent of their body weight, they at least want the opportunity to achieve that highest rate of weight loss.

“It seems like it’s driving the market, and if Novo Nordisk is able to exploit that story with the Wegovy pill, I think they’re in a good position,” Hansen said.

Novo end of November said he had filed for FDA approval of a higher dose of Wegovy injection of 7.2 mg, which could also play a role in a changing narrative. Trials showed that a higher dose of Wegovy resulted in a 20.7% weight reduction on average, about the same as Lilly’s Zepbound vaccine.

The American consumer

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

The market for weight loss pharmaceuticals is solely consumer-driven, 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 has brought several headaches for pharmaceutical companies, including Novo. Throughout the year, Trump has teased triple-digit tariffs unless pharmaceutical companies make significant investments in the United States, and has also waged a war on tariffs. 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, Lars Fruergaard Jørgensen, then CEO of Novo testified during a US Senate panel chaired by Senator Bernie Sanders, who called on the company to “stop ripping us off” with high drug prices.

But Trump went further, advocating so-called “most favored nation” drug pricing, under which the U.S. price is set at the lowest level compared to other rich countries.

In November, the Trump administration reached an agreement with Novo and Lilly to lower the prices of their top-selling GLP-1 drugs on Medicare and Medicaid, as well as agreements to offer them directly to consumers at a discount on the website. TrumpRx.govwhich is expected to launch in January this year.

The new direct-to-patient market is emerging as a key driver of future sales growth, but compounders – who make cheaper, copied versions of the drug and were able to thrive during the previous semaglutide shortage – remain a real competitor.

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

“We have already seen the direct-to-patient market start to develop well in 2025, particularly for LillyDirect…oral GLP-1 medications will be even better suited to this channel,” she added. “This will push the market more towards cash payment.”

Headwinds

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

In May, Novo ousted its CEO of eight years, citing “recent market challenges” and “developments in the company’s stock price.” Six months later, all independent members of the the board of directors resigned due to a disagreement with Novo’s majority shareholder over the pace of change and dissatisfaction with how it had met the challenges of the US market.

“The marketable development of Wegovy and Ozempic is an unavoidable battle for [CEO] Mike Doustdar and the new board,” Hansen said, adding that the development of the U.S. market is an “example” 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 Wegovy’s higher-dose injections with these multiple headwinds in 2026.

Lower prices for Medicare and the consumer cash payment channel due to MFN, as well as patent expirations in jurisdictions like Brazil, Canada and China “will likely lead to lower revenue,” Hansen said.

Additionally, 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, Rock — advance late-stage candidates in their pipelines.

The future may also bring greater diversification of treatments, as many new drugs are in development that could offer new ways to manage long-term weight loss, offer better safety profiles, and combine drugs targeting multiple appetite-altering hormones.

“There have been so many moves this year that show Novo as a company in conflict – for example, reaching a deal with Hims, then end the agreement…negotiating acquire Metseracoming out of negotiations and then coming back in after signing a deal with Pfizer,” Andersen said.

“This [Wegovy pill approval] “The victory is symbolically very important for Novo, after a series of disappointments in terms of data and financial performance,” she added. “He needed a win, and now all he has to do is execute it.”