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Novo Nordisk A/S NYSE: NVO executives used the company’s fourth-quarter results presentation to walk investors through a year marked by weaker-than-expected growth, a sharp shift in the U.S. pricing environment, and an early—though still nascent—commercial signal from the newly launched Wegovy pill in the United States.
Management reflects on a volatile year and evolving obesity dynamics
CEO Mike Doustdar said the past five years have delivered substantial scale gains for the company, including more than doubling sales and profit since 2019 and treating 46 million people on Novo Nordisk products—16 million more than in 2019. He highlighted obesity care growth and noted the company has “added DKK 76 billion” to obesity care over that period.
However, Doustdar described the most recent year as disappointing, referencing “triple profit warnings” and stating that an initial forecast of 20% growth ultimately proved too high as the company delivered 10% growth. He said growth was driven by the U.S. and international operations, with 8% growth in the U.S. and 14% in international operations, while China underperformed management’s hopes.
On China, Doustdar said the shortfall was tied to distribution-channel constraints: Wegovy’s obesity-only indication limits promotion and direct online sales in China’s e-health channels, while a competitor’s single brand spanning diabetes and obesity “has a bit of an advantage.”
Wegovy pill launch: early momentum, heavy marketing push
Management repeatedly emphasized the early traction of the Wegovy pill launch in the U.S., while cautioning that it is still “one month into it.” Doustdar called it one of the best pharma launches he has seen “so far,” citing prescription and patient figures disclosed during the session.
According to Doustdar, the latest U.S. data showed about 50,000 new prescriptions (NBRxs), translating to roughly 170,000 patients choosing the product. He also said that, at the latest data point, “no other brand,” including competitors, was generating more NBRxs than the Wegovy brand.
On demand drivers, Doustdar pointed to efficacy and label advantages, arguing the pill’s 16.6% weight loss compares favorably with a competitor’s 12.4% figure. He also said the cardiovascular benefits established with Wegovy injection translate to the pill and provide an additional differentiator.
He attributed early performance in part to significant marketing and partner support. Beyond a Super Bowl ad, Doustdar said high-visibility advertising included placements such as Boston and New York’s Grand Central Terminal, where he said viewers would see “probably no other ad than the Wegovy pill ad.” He said the company is “going really all in” with partners and wants to capitalize quickly on first-mover advantage, including gathering real-world patient experience to counter competitive messaging around dosing constraints.
Doustdar also suggested early prescribing skew indicates the launch is expanding the market, not merely converting existing patients. He said 88% of pills sold were the lowest 1.5 mg dose, which he interpreted as evidence many patients are new to therapy. He expects titration patterns to evolve over time, while acknowledging some patients may remain on low doses for “microdosing” behavior seen online.
Pricing pressure and 2026 outlook: declines driven by extraordinary effects
CFO Karsten Munk Knudsen outlined the company’s forward view and key pricing headwinds, stating the company is guiding for a top-line decline of 5% to 13%. He attributed the outlook primarily to “extraordinary effects,” including:
- Loss of exclusivity (LOE) in international operations in specific markets
- “MFN” impact in the U.S.
- Declining U.S. prices driven by a higher proportion of cash business and “rate enhancements” on the insured side
Knudsen said the company expects continued volume growth and more patients on Novo products, but that price effects outweigh expected volume gains in the outlook.
On U.S. pricing, Knudsen said Novo continues to see declining prices in diabetes GLP-1s (mainly Ozempic), referencing prior commentary of an underlying “-10 to -15” directional trend. In obesity, he emphasized the combination of channel mix shifts, insured-channel dynamics, and MFN effects as driving “quite substantial price reduction” for Wegovy injectable. For the oral product, he noted the company has only a “starter price” so far, making direct comparison difficult.
Margins, cost discipline, and capital allocation
Knudsen said Novo delivered DKK 100 billion in net profit for 2025 and converted that into “almost DKK 120 billion” in cash from operations, describing cash conversion as very strong. He outlined capital deployment including DKK 60 billion in capital expenditures tied to manufacturing capacity buildout and DKK 30 billion spent on business development and M&A, which he said was largely linked to the Akero transaction for MASH F4. The company also paid DKK 53 billion in dividends related to 2025, and Knudsen said the proposed dividend would mark 30 consecutive years of dividend per share increases, reflecting a consistent 50% payout ratio.
Looking ahead, he said capital expenditures should come down as facilities are finalized, while the company would continue BD investment “pending that we have attractive assets.” He also said Novo initiated a DKK 15 billion share buyback program that started this week.
On profitability, Knudsen acknowledged that a price-driven top-line decline is typically “brutal on a margin in a high-margin business,” but said operating profit is not expected to fall as much due to a combination of factors. These included restructuring costs in 2025 creating an easier comparison, partially offset by Akero running costs in 2026, and “super-disciplined resourcing,” with budget cuts across the company while stepping up investment in top priorities such as selected R&D programs.
Knudsen also explained why the company shifted to adjusted measures in guidance: in the first quarter of 2026, Novo expects a non-cash provision reversal related to the “340B rebate provision,” creating a positive one-off accounting impact of $4.2 billion. Management said the adjusted presentation is intended to better reflect underlying business performance.
In response to a question about why guidance was released the night before the presentation, Knudsen said the company needed more recent data—particularly January performance—along with scenario work and board approval. He said that because the guidance was “materially away from expectations,” the company disclosed immediately after board sign-off rather than waiting until the next morning. Doustdar added that Novo delayed internal budget formation into January due to how dynamic the obesity market has become and said small changes in assumptions can have large impacts on reported expectations.
Pipeline and competitive positioning: readouts, rare disease, and segmentation
Doustdar described 2026 as an “exciting year” for diabetes and obesity R&D, citing planned readouts, initiations, and regulatory decisions across programs including cagrilintide, semaglutide, CagriSema, amycretin, and two tri-agonists (one external acquisition and one internal program). In comorbidities, he said the ZEUS trial for ziltivekimab (anti-IL-6) is expected to read out in the second half of the year, calling it “high risk” but “high potential.” He also pointed to expected regulatory approvals for Mim8 in hemophilia A and a phase III readout for etavopivat in sickle cell disease.
On the competitive landscape, Doustdar acknowledged that in the U.S. injectable market, preference share has favored a competitor, suggesting “from 10 patients, 7 or 8 go to my competitor,” while Novo captures “2 on a good day, 3.” He said Novo hopes higher-dose semaglutide (7.2 mg) can help address perceptions of weight loss magnitude and, over time, shift attention back to differentiated outcomes like cardiovascular, kidney, and liver benefits.
Internationally, he said Novo was hearing of potential “upsides” related to possible delays from generic competition, but also noted that U.S. social media narratives about product comparisons can spill over into other markets and influence patient and prescriber perceptions abroad.
Management also discussed how it views long-term pricing and market structure in obesity. Doustdar said price is an important factor in unlocking volume, referencing learnings from compounded products that attracted patients who “couldn’t afford the original.” He compared the first-month performance of the Wegovy pill launch to prior launches, stating it was “15 times more” than the first month of Wegovy injectable and “two times better” than the first month of a competitor’s launch, while emphasizing that the company views the price reset as a near-term investment intended to drive medium-term volume.
On intellectual property, Knudsen said compound loss of exclusivity is the same for oral and injectable semaglutide, but that tablet formulation IP provides longer protection. He said the newly launched Wegovy pill formulation has longer IP “into the late 30s.”
Chief Scientific Officer Martin Holst Lange argued the obesity market will segment between high-volume consumer demand and subpopulations with greater medical complexity, such as severe obesity and comorbidities. Management said that in areas like MASH—especially advanced disease—pricing and value discussions may be anchored not to other GLP-1s but to the cost and outcomes associated with severe disease interventions, such as liver transplant, and that the company’s job is to demonstrate return on investment to payers.
Doustdar closed by emphasizing the uncertainty inherent in forecasting a consumer-influenced obesity market and said Novo aims to provide more detail at its Capital Markets Day on September 21 in London, including how the company plans to compete across both injectable and oral offerings while maintaining financial discipline and expanding manufacturing capacity without repeating past supply constraints.
About Novo Nordisk A/S NYSE: NVO
Novo Nordisk A/S is a Danish multinational pharmaceutical company headquartered in Bagsværd, Denmark, best known for its leadership in diabetes care and metabolic health. The company traces its roots to early Danish insulin production in the 1920s and was established in its current form through a 1989 merger of predecessor companies. Novo Nordisk develops, manufactures and markets pharmaceutical products and devices that address chronic and serious diseases, with a strong emphasis on long-term treatment and patient support.
The company’s core product portfolio centers on diabetes therapies, including a range of insulins and modern incretin-based treatments.
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