Novo Nordisk begins 2026 fighting to defend its U.S. weight-loss franchise as lower prices, rising competition, and political pressure test whether the Danish drugmaker can regain investor trust after its worst year on record.
The company enters the year after a sharp share price decline driven by guidance cuts, rapid advances by rival Eli Lilly, and the spread of cheaper copycat drugs in the United States, its most important market. Analysts describe the coming months as a decisive test for the maker of Wegovy and Ozempic.
With days left in 2025, Novo announced U.S. approval of an oral version of Wegovy, the first GLP-1 pill cleared for weight loss. The decision sent shares up nearly 10%, offering brief relief after a turbulent year.
“This approval adds a layer to the whole obesity space,” Sydbank analyst Søren Løntoft Hansen said. “It could be a space where Novo Nordisk is able to recapture market shares and maybe increase growth.”
Wegovy Pill Approval Lifts Shares but Competition Looms
Novo says patients taking the Wegovy pill lost an average of 16.6% of body weight over sixty-four weeks in trials, comparable to the injectable version. Pills are expected to appeal to consumers who prefer oral treatments and simpler distribution that does not require refrigeration.
Chief Executive Mike Doustdar said the oral drug matches the injectable’s performance. “Wegovy in a pill basically will have the same efficacy as its injectable counterpart,” he told CNBC in November. “That’s really exciting.”
The advantage may be short-lived. Eli Lilly is expected to secure U.S. approval for its own oral obesity drug, Orforglipron, by the second quarter. Lilly already leads in once-weekly injections with Zepbound, which has helped it overtake Wegovy in market share.
Investors are also watching Novo’s filing for a higher-dose Wegovy injection. Trials show the seven-point-two milligram dose produced average weight loss of 20.7%, roughly in line with Lilly’s Zepbound.
Pricing, Politics, and Consumers Reshape the U.S. Market
The U.S. obesity drug market is unusually driven by consumers rather than insurers, making pricing a central risk. President Donald Trump’s second term has intensified scrutiny of drug costs, with threats of tariffs and support for “Most Favored Nation” pricing that ties U.S. prices to the lowest paid abroad.
In November, the administration reached deals with Novo and Lilly to cut prices for Medicare and Medicaid and to sell GLP-1 drugs directly to consumers at discounts through a new federal website launching this month.
“The TrumpRx deal will help Novo become more competitive with compounders on price,” Morningstar analyst Karen Andersen said, though she warned that Lilly’s faster pill launch could limit Novo’s momentum in direct sales.
Cheaper compounded versions of semaglutide, which spread during earlier shortages, remain a threat as the market shifts further toward cash-paying customers.
Leadership Turmoil and Patent Expiries Add Headwinds
Novo Nordisk challenges extend beyond pricing. The company removed its chief executive in May after eight years, citing market and share price concerns. Six months later, all independent board members stepped down following disputes with the controlling shareholder over the pace of change.
“The marketable development for Wegovy and Ozempic is a must-win battle for Mike Doustdar and the new board,” Hansen said, calling the U.S. performance a “show me case” for investors.
Patent expiries in Brazil, Canada, and China, along with lower prices in the United States, are expected to pressure revenue in 2026. Analysts also await clearer data on Novo’s next-generation drug CagriSema as competition grows from Pfizer, Amgen, AstraZeneca, and Roche.
“This win is symbolically very important for Novo Nordisk,” Andersen said. “It needed a win, and now it just needs to execute.”
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