Novo Nordisk enters 2026 on the defense as it faces a ‘must-win’ battle in the U.S. market

Novo Nordisk's displacement from a marketplace darling to a superior underperformer has acceptable the signifier for a transitional 2026 arsenic the Danish drugmaker fights to regain capitalist assurance successful its value nonaccomplishment business.

Novo's banal conscionable experienced the worst twelvemonth connected grounds since it began trading connected the Copenhagen banal speech implicit 3 decades ago. Multiple reasons prevarication down the melodramatic drop: a bid of guidance cuts, strides by main rival Eli Lilly, a enactment upheaval, and inexpensive copycat drugs flooding the important U.S. market.

With conscionable astir a week to spell until 2026, Novo announced that its caller value nonaccomplishment pill nether the marque sanction Wegovy had been approved successful the U.S., making it the archetypal oral GLP-1 attraction approved for value loss. It sent shares up astir 10% arsenic investors banked connected Novo being capable to, astatine slightest partly, clasp Eli Lilly and others astatine bay.

That "early Christmas present," as 1 expert called it, highlights galore of the cardinal themes Novo volition person to look this year.

From injectables to pills

Novo's presumption arsenic the archetypal institution to motorboat an oral enactment could assistance it marque up immoderate of the crushed it's mislaid implicit the past twelvemonth successful the GLP-1 space. Analysts mostly agreed that the Wegovy pill's support was a large deal, adjacent though galore had already expected a affirmative determination earlier the extremity of the year.

Eli Lilly is expected to get its ain value nonaccomplishment pill orforglipron approved by the U.S. Food and Drug Administration by nary aboriginal than the 2nd 4th of this year, and investors volition intimately ticker however that contention plays out.

"This support adds a furniture to the full obesity abstraction successful the future," Sydbank expert Søren Løntoft Hansen told CNBC. "It could be, potentially, a abstraction wherever Novo Nordisk is possibly capable to recapture marketplace shares and possibly summation growth."

Wegovy-in-a-pill, arsenic Novo calls the oral mentation of the blockbuster injectable, has shown that patients suffer connected mean 16.6% of their assemblage value implicit 64 weeks. Meanwhile, orforglipron, averages 12.4% implicit 72 weeks.

"Usually, you person to fundamentally spell for either convenience oregon efficacy erstwhile you're discussing pills versus injections – not successful this case," Novo CEO Mike Doustdar told CNBC's Charlotte Reed successful November. "Wegovy successful a pill fundamentally volition person the aforesaid efficacy arsenic its injectable counterpart. That's truly exciting."

The wide statement is that pills volition besides beryllium favored by consumers. They person added advantages specified arsenic not having to beryllium stored acold similar the injectable version, allowing for simpler organisation and easiness of entering caller markets.

A shifting narrative?

Eli Lilly's positioning of its rival cause Zepbound arsenic the champion attraction for achieving value nonaccomplishment connected the marketplace for once-weekly injections has helped it win successful capturing important marketplace stock to surpass Novo's Wegovy.

Meanwhile, Novo Nordisk's positioning has been antithetic arsenic they've often emphazised that treating obesity goes beyond losing weight. "They privation to archer a communicative astir however obesity should beryllium seen arsenic a illness and however Wegovy affects obesity-related diseases," Sydbank's Hansen said.

"As we volition physique and bargain assets, you volition often spot that these assets bash aggregate things," Doustdar said successful aboriginal November. "They code different co-morbidities. We person seen that with semaglutide; it helps liver, kidney, bosom – that's fantastic – we should really spell and further make those," helium said successful the discourse of the aboriginal absorption of its pipeline.

However, it seems that's not important to Americans oregon the market, according to Hansen. "The fraction that prescribes Wegovy oregon obesity drugs successful narration to obesity-related diseases is precise small," helium noted, adding that adjacent if galore patients don't needfully privation to suffer much than 20% of their assemblage weight, they astatine slightest privation the accidental to execute that highest complaint of value loss.

"It seems similar that drives the market, and if Novo Nordisk is capable to pat into that communicative with the Wegovy pill, I deliberation they are successful a bully place," Hansen said.

Novo successful precocious November said it filed for FDA support of a higher dose of Wegovy injection of 7.2 mg, which could besides play into a changing narrative. Trials person shown that the higher dose of Wegovy resulted successful a 20.7% value simplification connected mean — astir the aforesaid arsenic Lilly's Zepbound jab.

The U.S. consumer

The accrued absorption connected the direct-to-consumer marketplace volition beryllium different cardinal country to watch.

The marketplace for value nonaccomplishment pharmaceuticals is uniquely consumer-driven, contrasting galore different blockbuster drugs that are typically covered by wellness plans successful the U.S. oregon nationalist wellness systems successful Europe.

President Donald Trump's 2nd word successful bureau has brought respective headaches for pharmaceutical companies, Novo included. Throughout the year, Trump has teased triple-digit tariffs unless pharma companies marque important investments successful the U.S., and has besides waged a warfare connected high cause prices for Americans.

The vexation that U.S. cause prices tin beryllium much than 4 times those successful Europe isn't new. Last year, Novo's then-CEO Lars Fruergaard Jørgensen testified at the U.S. Senate sheet chaired by Sen. Bernie Sanders, who called for the institution to "stop ripping america off" with precocious cause prices.

But Trump has taken it further, advocating a alleged "Most Favored Nation" pricing for medicines, whereby the U.S. terms is acceptable to the lowest level compared to different affluent countries.

In November, the Trump medication reached a woody with Novo and Lilly to little prices of their bestselling GLP-1 medicines connected some Medicare and Medicaid, arsenic good arsenic agreements to connection them straight to consumers astatine a discount connected the website TrumpRx.gov, which is acceptable to beryllium launched successful January this year.

The caller direct-to-patient marketplace is emerging arsenic a captious operator of aboriginal income growth, but compounders — which marque cheaper copycat versions of the cause and were capable to flourish during the earlier shortage of semaglutide — stay a existent competitor.

"The TrumpRx woody volition assistance Novo go much competitory with compounders connected price, though a faster orforglipron motorboat could trim its quality to summation momentum successful the [direct-to-patient] transmission up of Lilly," noted Morningstar's Karen Andersen.

"We've already seen the direct-to-patient marketplace opening to make nicely successful 2025, peculiarly for LillyDirect… oral GLP-1 drugs volition beryllium adjacent amended suited to this channel," she added. "That volition further propulsion the marketplace toward currency pay."

Headwinds

Investors are besides waiting to spot if Novo's caller enactment volition present connected its effort to amended U.S. operations.

In May, Novo ousted its CEO of 8 years, citing "recent marketplace challenges" and "the improvement of the company's stock price." Six months later, each autarkic members of the board stepped down owed to a disagreement with Novo's controlling shareholder implicit the gait of alteration and discontent implicit however it had addressed challenges successful the U.S. market.

"The marketable improvement for Wegovy and Ozempic is simply a must-win conflict for [CEO] Mike Doustdar and the caller board," Hansen said, adding that the improvement successful the U.S. marketplace is simply a "show maine case" for investors. "Right now, we truly don't spot immoderate important affirmative advancement here," helium told CNBC connected Dec 23.

The Danish drugmaker indispensable truthful equilibrium advancement connected its pill mentation and higher-dose jabs of Wegovy with these aggregate headwinds successful 2026.

Lower pricing for some the Medicare and user cash-pay transmission arsenic a effect of MFN, arsenic good arsenic patent expiries successful jurisdictions including Brazil, Canada and China volition "probably pb to a decreasing apical line," said Hansen.

Furthermore, 2026 volition apt bring much clarity connected Novo's next-generation cause CagriSema, which combines semaglutide, a GLP-1 agonist, with cagrilintide, an amylin analogue.

Longer term, contention is apt to intensify beyond Lilly and compounders, arsenic respective drugmakers — including Pfizer, Amgen, AstraZeneca, Roche — beforehand late-stage candidates done their pipelines.

The aboriginal could besides bring much diversification successful treatments, arsenic galore caller drugs are successful improvement that could output caller ways to negociate value nonaccomplishment long-term, supply amended information profiles, and harvester drugs that people respective antithetic appetite-modifying hormones.

"There person been truthful galore moves this twelvemonth that amusement Novo arsenic a conflicted institution – for example, reaching a woody with Hims and past terminating the deal… negotiating to get Metsera, exiting negotiations, and past jumping backmost successful aft a signed Pfizer deal," said Andersen.

"This [Wegovy pill approval] triumph is symbolically precise important for Novo, aft a bid of disappointments with information and fiscal performance," she added. "It needed a win, and present it conscionable needs to execute."