Novo Nordisk faces “must-win” battle over U.S. Wegobee and Ozempic in 2026

Novo Nordisk’s transformation from market darling to severely underperforming company has set the stage for a transitional year in 2026, as Danish drugmaker Novo Nordisk struggles to regain investor confidence in its weight-loss business.

Novo’s share price has just experienced its worst year since it began trading on the Copenhagen Stock Exchange more than 30 years ago. There are multiple reasons behind the dramatic decline: a series of guidance cuts, the rise of our biggest rivals, etc. Eli Lillyleadership turmoil, and cheap counterfeit drugs flooding the vital U.S. market.

With about a week left until 2026, Novo announced that its new weight loss drug, branded Wegovy, has been approved in the United States, making it the first oral GLP-1 treatment approved for weight loss. Investors hoped Novo could at least partially stave off the likes of Eli Lilly, sending the stock up nearly 10%.

This “early Christmas present,” as one analyst called it, highlights many of the key themes Novo must face this year.

From injections to tablets

Novo’s position as the first company to launch an oral option could help it make up for some of the ground it has lost over the past year in the GLP-1 space. Many were already expecting a positive decision by the end of the year, but analysts largely agreed that the approval of Wigovy tablets was a big deal.

Eli Lilly is expected to receive approval from the U.S. Food and Drug Administration for its weight loss drug, or Folgliprone, by the second quarter of this year at the latest, and investors will be watching closely to see how the competition plays out.

“This approval adds another layer to the overall obesity space in the future,” Sydbank analyst Soren Rontoft Hansen told CNBC. “This could potentially be an area where Novo Nordisk could regain market share and drive growth.”

Wegobee-in-a-pill, which Novo is calling the oral version of its blockbuster injectable, showed patients lost an average of 16.6% of their body weight over 64 weeks. Orforglipron, on the other hand, averages 12.4% over 72 weeks.

“Normally, when you talk about pills and injections, you basically have to go for either convenience or effectiveness, but that’s not the case here,” Novo CEO Mike Doesder told CNBC’s Charlotte Reid in November. “The pill form of Wegoby has basically the same efficacy as the injectable drug. That’s really exciting.”

The general consensus is that tablets will also be popular with consumers. These have additional benefits, such as not requiring refrigerated storage like injectable versions, simplifying distribution and making it easier to enter new markets.

A changing story?

Eli Lilly has been able to capture a larger market share than Novo’s Wigoby by positioning its rival Zepbound as the best treatment for weight loss with once-weekly injections.

Novo Nordisk, on the other hand, has a different position and has often emphasized that treating obesity is about more than just losing weight. “They want to tell the story of how obesity should be viewed as a disease and how Wegovy impacts obesity-related diseases,” said Sidbank’s Hansen.

“As we build and buy assets, you will see more and more that these assets serve multiple roles,” Dusdahl said in early November. “Those are things that address other comorbidities. We saw that with semaglutide. It’s great that it helps the liver, kidneys and heart. We really need to develop those further,” he said in relation to the future focus of the pipeline.

But Hansen said that doesn’t seem to matter to Americans or the market. “We have a very small percentage of prescribing Wegovy and obesity drugs for obesity-related conditions,” he said, adding that many patients don’t necessarily want to lose more than 20% of their body weight, but at least want the chance to achieve that highest rate of weight loss.

“That seems to be driving the market. If Novo Nordisk can capitalize on that story with the Wegoby pill, I think they’re in a good position,” Hansen said.

Novo announced in late November that it had applied to the FDA for approval of a higher-dose 7.2 mg version of its Wigovy injection, which could also influence a change in the narrative. Trials showed that high doses of Wegovy resulted in an average weight loss of 20.7%, which is about the same as Lilly’s Zepbound jab.

US consumers

The increased focus on the direct-to-consumer market will also be an important area to focus on.

The market for weight loss drugs is uniquely consumer-driven, in contrast to many other blockbuster drugs, which are often covered by the U.S. health insurance system or European national health care systems.

President Donald Trump’s second term in office has caused some headaches for pharmaceutical companies, including Novo. Throughout the year, President Trump has teased triple-digit tariffs on drug companies unless they invest heavily in the United States, and he has also waged a fight against high drug prices for Americans.

Complaints that U.S. drug prices could be more than four times higher than in Europe are not new. Last year, Novo’s then-CEO Lars Fluergaard Jorgensen testified before a U.S. Senate committee chaired by Sen. Bernie Sanders, calling on the company to “stop ripping us off” with high drug prices.

But President Trump has gone even further, advocating so-called “most-favored-nation” pricing, which would set U.S. drug prices at the lowest levels compared to other wealthy countries.

In November, the Trump administration reached an agreement with Novo and Lilly to reduce the prices of their best-selling GLP-1 drugs in both Medicare and Medicaid, and to offer them directly to consumers at discounted prices on the TrumpRx.gov website scheduled to launch in January.

Although the new direct-to-patient market is emerging as a key driver of future sales growth, compounders who produce cheaper counterfeit drugs and were able to thrive even with the previous semaglutide shortage remain the real competitors.

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

“We are already seeing the direct-to-patient market starting to develop well in 2025, especially with LillyDirect…oral GLP-1 drugs will be even more suited to this channel,” she added. “This will push the market further toward cash payments.”

Headwind

Investors will also be watching to see whether Novo’s new management succeeds in its attempts to improve its U.S. operations.

In May, Novo fired its CEO after eight years, citing “recent market issues” and “share price trends.” Six months later, all independent members of the board resigned, citing disagreements with Novo’s controlling shareholder over the pace of change and dissatisfaction with how the company was addressing the challenges of the U.S. market.

“The marketable development of Wegoby and Ozempic is a must-win battle for (CEO) Mike Doesder and the new board,” Hansen said, adding that development in the U.S. market is a “show-me case” for investors. “At this point, we don’t see any major positive developments,” he told CNBC on Dec. 23.

The Danish drugmaker will therefore need to balance these multiple headwinds in 2026 with the progress made in the development of a tablet version and a higher dose of Wigovy.

Hansen said lower prices in both Medicare and consumer cash payment channels as a result of the MFN, as well as patent expirations in jurisdictions such as Brazil, Canada and China, “will likely result in lower sales.”

Additionally, in 2026 we will learn more about Novo’s next-generation drug Kaglisema, which combines the GLP-1 agonist semaglutide with the amylin analog kagrylintide.

In the long term, competition from several drug companies beyond Lilly and compounders is likely to increase. pfizer, amgen, AstraZeneca, Roche — Advance late-stage candidates through the pipeline.

There is also potential for greater treatment diversification in the future, as many new drugs are under development that may provide new ways to manage weight loss over the long term, offer a better safety profile, and combine drugs that target several different appetite-modifying hormones.

“There have been so many moves this year that indicate Novo is an adversary, such as reaching an agreement with Hims and then terminating the deal…negotiating the acquisition of Metzer, closing the deal, then entering the deal with Pfizer and then re-entering,” Andersen said.

“After a series of disappointments with data and financial performance, this victory[of Wegovy tablet approval]is symbolically very important for Novo,” she added. “We needed a win, so we just had to execute.”