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…