The Novo Nordisk story is being widely misunderstood because much of the market is focused on headline numbers rather than the underlying economics.
At first glance, the latest results look uninspiring. Revenue growth appears subdued, weighed down by US pricing pressure, higher rebates, and deliberate price cuts. Many investors have stopped there and concluded that the growth story is fading.
I think they've reached exactly the wrong conclusion. What we're actually seeing is a business transitioning from premium-priced exclusivity to high-volume scale.
The lower realized prices have little to do with weakening demand. They are largely the consequence of political pressure in the United States, changes to the rebate system, and management's decision to expand access to its therapies. Meanwhile, the underlying picture could hardly be stronger. The physical volume of GLP-1 treatments being supplied continues to reach record levels.
This is a classic example of what Nick Sleep would call scale economics shared.
Novo Nordisk is accepting lower average selling prices in exchange for dramatically higher manufacturing volumes. That allows its medicines to reach a much broader patient population, including cash-pay customers and expanded government reimbursement programmes. As production scales, fixed costs are spread across millions of additional doses, while new products such as the oral Wegovy pill further improve manufacturing efficiency. Per-dose margins may narrow, but unit costs also fall, helping protect overall profitability.
Volume matters far more than price in a business like this.
But here's the most important part that everyone seems to miss. Unlike most pharmaceutical products, obesity and type 2 diabetes treatments are used for chronic conditions. Every new patient is not a one-off sale but a recurring stream of revenue that can last for years, and often the life of the customer. It is about as close as you can get to a subscription business in pharmaceuticals, except better than Netflix or Amazon Prime because it's not discretionary.
Winning market share today creates an expanding base of highly recurring revenue tomorrow. That is already showing up in the data. Weekly prescriptions for Wegovy now exceed 265,000, up from around 200,000, an increase of more than 30%.
The market is focusing on lower prices per dose while overlooking the much more important metric: the number of patients entering the Novo Nordisk ecosystem continues to grow rapidly. In a chronic disease franchise, that expanding installed base compounds in value over time.
There is also a considerable amount of accounting noise in the reported figures because of the US rebate system. Strip that out, and the underlying business looks much healthier. Organic revenue grew by around 7%, which most companies would be delighted with, while operating profit increased by 11%, demonstrating that operating leverage continues to flow through the business. Once again, this is why volumetric growth matters.
Far from signalling structural weakness, today's results show a business deliberately exchanging price for scale (perhaps not by choice, but nonetheless it is beneficial). That may weigh on short-term reported growth, but it strengthens Novo Nordisk's competitive position, widens its moat, and increases the lifetime value of its patient base.
For me, that is the single most important takeaway from today's results.
Novo Nordisk's new milestone. Awiqli® (insulin icodec-abae) injection is the first-ever once-weekly basal insulin approved by the FDA for people with type 2 diabetes. It offers people an alternative to daily basal insulin injections, reducing these injections from seven to only one per week. Aside from convenience, this development has large benefits to the unit economics, both for Novo Nordisk and its customers. Novo Nordisk expects to launch Awiqli® nationwide in the US in the second half of 2026.
The National Health Service in England is rolling out the weight-loss drug Wegovy, signalling a shift toward using GLP-1 treatments to prevent serious cardiovascular events. Clinical data shows the drug, which contains semaglutide, can significantly reduce the risk of heart attacks and strokes in high-risk patients, extending its value far beyond weight loss and diabetes treatments. For Novo Nordisk, the decision reinforces Wegovy’s position as a long-term, high-demand therapy within public healthcare systems, supporting sustained revenue growth.
Eli Lilly has been up to its old marketing tricks again. It published head-to-head trial results showing its oral GLP-1 pill orforglipron beat Novo Nordisk's oral semaglutide.
But here's the thing:
- Semaglutide was dosed according to its approved oral label instructions (7 mg and 14 mg), while orforglipron used its trial doses (12 mg and 36 mg).
- At 52 weeks, participants on orforglipron lost an average of 14.6 lbs (6.7%; 12 mg) and 19.7 lbs (9.2%; 36 mg). Those on oral semaglutide lost 7.9 lbs (3.7%; 7 mg) and 11.0 lbs (5.3%; 14 mg).
The relationship between dose and efficacy is well understood, but it rarely features in the headline narrative. The result is a comparison that is directionally informative but not pharmacologically equivalent.
The relevant question for investors is the efficacy versus tolerability trade-off at those doses.
Higher doses typically bring more gastrointestinal side effects and may create pressure on adherence, while also increasing manufacturing intensity. These factors ultimately shape payer behaviour, pricing and margins.
Novo appears optimises for long-term performance and cost, focused on delivering the best outcome for consumers. In stark contrast, Lilly is more aggressive in defining its marketing narrative in the hope of being perceived by the market as suppliers of a premium product.
The gap between those approaches can create short-term misreadings, but over time outcomes converge on what patients tolerate, what payers reimburse and what can be produced at scale with the best unit economics.
Novo Nordisk (NOVO) and Hims & Hers (HIMS) have ended their patent dispute by striking a deal that transforms their relationship from adversaries to partners. The agreement allows Hims to sell FDA-approved Wegovy and Ozempic. This positions Hims as a key distribution partner for Novo Nordisk in the growing telehealth market. Increasing distribution channels is more valuable to Novo, over the long-term, than pursuing short-term litigation (whatever the merits of the claim).
- Hims will cease all advertising and promotion of compounded GLP-1 drugs on its platform and in its marketing materials.
- Hims will educate existing patients on their options and support a seamless transition to FDA-approved alternatives when clinically appropriate.
Novo Nordisk has agreed to dismiss the patent infringement lawsuit 'without prejudice', meaning it reserves the right to refile it in the future if Hims reneges on the deal.
Novo Nordisk has taken another hit in the market this week. But the headline numbers do not tell the full story.
Start with the drug itself. CagriSema combines cagrilintide, an amylin analogue, with semaglutide, a GLP 1 agonist. Novo Nordisk is first to market with a GLP 1 and amylin combination. That matters because clinical testing shows the two molecules enhance each other when used together. The combined effect is greater than either component alone.
That context helps explain the recent REDEFINE 4 head to head study against Eli Lilly’s tirzepatide. Novo Nordisk used a total of 4.8 mg of active ingredient, 2.4 mg of each component. Eli Lilly used 15 mg of tirzepatide. This was not a like for like dose comparison.
At 84 weeks, CagriSema delivered roughly 23 percent weight loss versus 25.5 percent for tirzepatide. On the surface, Lilly appears to have won. But look more closely.
First, 23 percent weight loss over 84 weeks is a strong outcome, especially at that dose. Second, patients and payers may not fixate on 23 percent versus 25.5 percent. They are likely to focus on cost.
If Novo Nordisk can deliver similar weight loss using roughly one third of the total dose, then that has cost implications. Manufacturing economics are not perfectly linear. Lilly produces a single molecule. Novo must manufacture two and use a dual chamber injection device because the compounds cannot be stored together. That adds complexity and expense. Scale also matters.
Even so, a materially lower total dose creates room to compete on price. Novo Nordisk believes it can offer meaningful weight loss at a lower price point. The market reaction suggests many investors are focused only on the efficacy gap, not on cost per outcome.
For a therapy that may be used for years, potentially for life, affordability becomes central. Over time, price influences access, reimbursement, and market share. Novo appears to be optimizing for cost efficiency as much as for peak efficacy.
That raises a different way to frame the comparison. Instead of asking which drug delivers the highest percentage weight loss at 84 weeks, it may be more useful to consider weight loss per dollar. That metric is harder to model because costs evolve with scale and manufacturing efficiency. But for investors, it is the economically relevant lens.
Importantly, Novo Nordisk plans to increase the CagriSema dose in the next head to head study to around 7 mg. Based on prior data, management expects greater weight loss at that level. Even then, the total dose would remain well below 15 mg being used by Lilly.
It is reasonable to ask what the outcome might have been if the first trial had used more comparable dosing from the outset. The current results do not close that question, but make no mistake, this was not a like-for-like test.
There is also a clinical perspective. Sustainable weight loss is typically gradual. Rapid loss can carry risks and may increase the probability of regain once treatment stops. Optimizing solely for the fastest early reduction may not align with long term health outcomes.
So were the recent head to head results good or bad?
Yesterday, the FDA made it clear it’s coming down hard on compounded GLP-1 weight-loss drugs being sold at scale. Hims & Hers was forced to pull its copycat Wegovy offering almost immediately, and Novo Nordisk piled on by filing a lawsuit. The market reaction was brutal: HIMS dropped more than 20% pre-market, hitting its lowest level since late 2024.
The message from regulators couldn’t be clearer. By tightening enforcement, the FDA has effectively widened the moat around Novo Nordisk’s and Eli Lilly’s GLP-1 franchises — and those moats were already enormous.
A very enjoyable article. Thank you! Novo Nordisk has a long track record of strong returns and has been on a remarkable journey since receiving FDA approval for Ozempic in 2017.
Wegovy's oral table approval in the US marks a new chapter.
Yesterday’s launch of the oral version of Wegovy marks a pivotal shift in metabolic health, as it finally offers a needle-free alternative for those seeking the weight-loss efficacy of semaglutide. This new daily pill represents a major victory for patient accessibility, specifically targeting the millions of people who have remained on the sidelines due to a fear of self-injection or the logistical challenges of keeping injectable medications refrigerated.
The clinical profile of the pill is remarkably strong, showing that patients can achieve weight loss of approximately 16.6% to 17% over a year. This puts the tablet on a nearly equal footing with the once-weekly injectable version, a feat many researchers once thought impossible. To achieve this, Novo Nordisk utilizes a specialized absorption enhancer that allows the drug to pass through the stomach lining, provided patients strictly follow a morning ritual of taking the pill with minimal water on an empty stomach.
However, the biology of the gut is quite stubborn, which creates a massive "bioavailability gap" between the two formats. Because the stomach is designed to digest proteins like semaglutide, only about 1% of the pill actually reaches the bloodstream. To overcome this, the daily pill contains a much higher concentration of the active ingredient (roughly 25 mg per day) compared to the 2.4 mg per week found in the injection. This means a pill user consumes about 70 times more of the drug every week than an injectable user.
This massive increase in the required dose has significant implications for Novo Nordisk’s manufacturing and profit margins. Producing the sheer volume of active ingredients needed for millions of daily pills is a gargantuan task that carries a much higher "cost of goods" than the low-dose injections. While the raw material costs are higher, the company is likely banking on the fact that tablets are far easier to package, store, and ship than complex, temperature-sensitive glass pens.
From a financial strategy perspective, Novo Nordisk is leaning into a "volume over margin" approach. By pricing the pill aggressively at a $149 to $299 cash-pay monthly rate, they are making the drug accessible to a wider demographic while simultaneously undercutting competitors. Even if the profit margin per bottle is lower than that of the injection, the massive influx of new patients is expected to drive total revenue to record heights.
The launch also serves as a defensive masterclass against their primary rival, Eli Lilly. By hitting the market first with an oral GLP-1, Novo Nordisk is securing patient loyalty and establishing a dominant footprint before Lilly can release its own oral candidate. This "first-mover" advantage is vital in a market where convenience and price are becoming the primary drivers of patient choice. Eli Lilly shares fell 5% on the news.
Ultimately, this release signifies the "mainstreaming" of weight-loss therapy. By removing the needle and the high price tag, Novo Nordisk has turned a specialized medical treatment into a daily wellness habit for a much larger portion of the population. As manufacturing scales up at their massive new facilities in North Carolina, the focus will now shift to whether they can produce enough of this high-dose medication to meet what is expected to be unprecedented global demand.
A nice problem for Novo Nordisk to have and likely the catalyst for a long over due re-rating of the stock which was heavily over sold during 2025. This year promises strong returns for shareholders.
Novo Nordisk launched its Wegovy weight-loss pill in the U.S. today. Cash price is $149 a month. Available at Costco and CVS. First oral GLP-1 approved specifically for weight loss. The stock responded positively with a 5% move higher.
On November 25, 2025, Medicare wrapped up its second round of drug price negotiations under the Inflation Reduction Act (IRA), targeting 15 high-spend medicines. The government expects the newly negotiated prices, set to take effect on January 1, 2027, to slash annual spending on these drugs by 36%, translating into roughly $8.5 billion in savings. Among the targets were the blockbuster GLP-1 agonists used for diabetes and weight loss, the very drugs reshaping modern healthcare.
The instinctive reaction is that this is a blow to the companies behind them, especially Novo Nordisk. But that's entirely the wrong way to look at it.
The industry is undergoing a deeper structural shift. For decades, pharma has lived on a “low-volume, high-price” model, where specialist drugs commanded premium margins. Yet the unprecedented demand for GLP-1s is pushing the market toward a consumer-like dynamic: lower prices but massive, sustained volume.
It’s the kind of “scale economics shared” dynamic Nick Sleep famously described, only this time, it isn’t being voluntarily implemented. It’s being imposed by the state.
Counterintuitive as it sounds, the forced price cuts could become a long-term catalyst for Novo Nordisk.
Millions of eligible patients are currently shut out because insurers simply can’t shoulder the cost of GLP-1s, despite their many benefits. Drop the monthly price to something like $274, and the cost-benefit equation flips. Suddenly, Medicare and more private payers can afford it and since these medications are used over the long-term, sometimes all of life, the market shifts from a medical niche to a mass-market subscription model. A 36% price cut becomes meaningless if the patient pool expands from five million to fifty million.
There’s a catch, though: this only works for companies with the manufacturing muscle to meet that surge in demand. This is why Eli Lilly and Novo Nordisk are scaling manufacturing so aggressively.
But why has the Eli Lilly share price recently touched all time highs, while Novo Nordisk is stuck in the mud?
This is where the U.S. economic backdrop comes in. America remains a deeply protectionist market, and the IRA’s negotiation criteria reflects that. Drugs without generic competition become eligible for price negotiation after seven years (for small molecules) or eleven years (for biologics). Novo Nordisk’s Ozempic, approved in 2017, crossed that threshold early and was swept into the first negotiation round. Its price will be cut in 2027. Eli Lilly’s Mounjaro and Zepbound, approved in 2022, won’t face negotiation until 2030 or later. In effect, the European innovator is punished while the U.S. based copy-cat gets a multi-year free ride.
The market has assumed that Lilly can maintain premium pricing for years, protecting its margins, while Novo Nordisk is forced to discount. But they may be looking down the wrong end of the telescope.
Think about this from a demand perspective: why would customers opt for a higher-priced drug if the clinical outcomes are broadly similar? In reality, Lilly will either need to reduce its pricing to remain competitive, or else, if Novo can fix its supply issues, it will become the “affordable default” for Medicare’s massive patient base. And once Medicare standardizes around a product, that position is extraordinarily difficult to dislodge.
So the story may not be bad news at all. Novo Nordisk faces short-term pressure, yes. But if the GLP-1 category becomes a mass-market utility, the company forced to lower its prices first may actually end up owning the largest slice of an enormously expanded pie.
NovoNordisk Down 10% | Over Reaction Of The Market?
Novo Nordisk has released top-line results from its two-year primary analysis of the evoke and evoke+ phase 3 trials, which tested whether oral semaglutide could slow progression in early-stage symptomatic Alzheimer’s disease. The randomized, double-blind studies enrolled 3,808 adults and compared semaglutide with placebo alongside standard care.
The company pursued the Alzheimer’s indication after real-world evidence, pre-clinical data and post-hoc analyses from its diabetes and obesity programs hinted at potential benefits, despite what executives described as a “low likelihood of success.”
Chief scientific officer Martin Holst Lange said Novo Nordisk was proud to have run two rigorous, well-controlled studies, but confirmed that semaglutide did not outperform placebo in reducing disease progression, measured by changes in the Clinical Dementia Rating–Sum of Boxes score.
Because the trials failed to show efficacy, Novo Nordisk will discontinue the planned one-year extension phase of both evoke studies.
Having managed the expectations of the market by always declaring these tests to have a low likelihood of success, proving efficacy in these trials was never priced in to the company's valuation. As such, the knee-jerk reaction of the market to sell off 10% appears over done.
This was something of a moonshot for the company and, while it would have presented an opportunity to boost sales, it has absolutely no bearing on the core diabetes and weight-loss businesses of the company which are going from strength to strength.
Trials continue in relation to other health conditions that GLP-1 medicines may be able to effectively treat.
At the close last night, Eli Lilly once again outperformed expectations. The company beat third-quarter estimates and lifted its full-year revenue guidance to between $63 and $63.5 billion, up from the prior range of $60 to $62 billion. Sales of its blockbuster drugs Zepbound and Mounjaro have surged to a combined $25 billion year-to-date, with Zepbound tripling and Mounjaro doubling from last year’s levels.
If those numbers are any indication, demand for GLP-1 medications remains red-hot. That sets the stage for an interesting week ahead, with Novo Nordisk set to report its own third-quarter results next week.
Adding to the intrigue, Novo Nordisk is currently locked in a bidding war with Pfizer for Metsera, an obesity drug developer valued at up to $9 billion. It’s another sign that this GLP-1 duopoly is not just thriving but aggressively expanding through both organic growth and strategic acquisitions
There is little sign of momentum slowing anytime soon.
On a relative valuation basis, one of these businesses certainly looks way over sold!
Novo Nordisk Foundation Seizes Board Control: Leadership Shake-Up Marks the Start of a Bold New Chapter for the Danish Drugmaker
Novo Nordisk is facing one of its most dramatic leadership overhauls in years. The company’s powerful chair, Helge Lund, will not seek re-election, and six independent directors are stepping down. The move follows months of rising tension between the board and Novo Nordisk’s controlling shareholder, the Novo Nordisk Foundation, which has grown frustrated with the pace of change inside the pharmaceutical giant.
Behind the scenes, the Foundation has been tightening its grip, determined to speed up decision-making and inject new energy into a company. It has nominated former CEO Lars Rebien Sørensen, a veteran who once led Novo through a golden age, to return as chair. His appointment, expected to last two to three years, would mark a striking comeback and a clear signal that the Foundation wants to restore the company’s old discipline and drive.
Novo Nordisk, long celebrated for its dominance in diabetes care, enjoyed a meteoric rise on the back of its obesity medication that briefly made it Europe’s most valuable company. However, the company hit some turbulence. Production bottlenecks limited supply just as demand surged. Notwithstanding intellectual property protection, the FDA temporarily permitted generic drug makers to fill the gap in the market. That caused a dip in earnings and in the share price - but that chapter is now in the past.
Earlier this year, new CEO Mike Doustdar announced sweeping layoffs (9,000 jobs worldwide) and promised a more agile, focused business. But the Foundation evidently wants to accelerate the turnaround.
Now, the upcoming November 14 shareholder meeting has the air of a reckoning. The Foundation’s assertive push could reshape Novo’s governance and set the tone for a new era, one that prizes speed and accountability over consensus.
The market response has been mixed: some investors have welcomed the decisive action, while others worry that such upheaval could unsettle a company already navigating intense global competition.
What’s certain is that the quiet stability that once defined Novo Nordisk’s boardroom is gone, replaced by an unmistakable sense of urgency and a fight to reclaim the company’s edge. This is a business that is genetically programmed to be a winner. Reading between the lines, it won't settle for anything less. If its success over the past century is anything to go by, it would take a very brave person to bet against it.
Novo Nordisk's next earnings release is expected on 5th November, but there are two more significant near term catalysts that may have a greater impact - not only on the stock price, but also on the company's long-term growth trajectory.
The first, and arguably most anticipated, catalyst is the EVOKE trial readout for oral semaglutide in early Alzheimer’s disease. While the Phase 3 trials were slated for primary completion in September 2025, topline data is expected to surface in or around November. Alzheimer’s has long been one of the toughest frontiers in drug development and analysts like those at Morgan Stanley peg Novo’s odds of success at just 25%. However, with such low expectations comes a higher chance of a surprise to the upside. A positive readout would instantly open the door to a multi-billion-dollar market and reposition Novo Nordisk as a key player in neuroscience, potentially transforming both its pipeline and market narrative overnight.
The second key event is more regulatory than scientific but equally important: the U.S. Medicare price negotiations for Novo Nordisk’s GLP-1 drugs, including Ozempic, Wegovy and Rybelsus. Negotiations between Novo and the Centers for Medicare & Medicaid Services (CMS) are expected to wrap up around November. The outcome will determine how much Medicare pays for these blockbuster treatments, setting the pricing floor for years to come. While analysts estimate this could ultimately affect more than 7% of the company’s gross sales, the impact won’t be immediate: new prices won’t kick in until 2027. Even so, this decision will help shape long-term revenue expectations and valuation multiples for Novo’s most profitable product line in its largest single market, the U.S.
Amid these headline catalysts, Novo Nordisk is also reshaping its internal structure to sharpen focus and efficiency. The company is winding down its entire cell therapy division, a decisive move that highlights its renewed concentration on metabolic diseases like diabetes and obesity. The closure will affect roughly 250 employees and forms part of a broader restructuring plan aimed at generating savings by reducing around 9,000 global positions through 2026.
Looking ahead, Novo is already preparing for the next evolution of its obesity franchise: the launch of its high-dose oral semaglutide pill, dubbed by some as “Wegovy-in-a-pill.” Pending regulatory approval, the company intends to launch the product through digital-first channels such as Ro and WeightWatchers. Novo is also exploring a subscription-based commercial model, offering discounted 6- to 12-month medication plans - this would greatly improve working capital dynamics and cash-flow conversion rates, providing Novo with a source of free financing. But this is not merely about improving Novo's unit economics, it also delivers benefits to the customer. This approach signals a strategic shift toward a more consumer-oriented, direct-to-patient model, one that could streamline access, reduce friction and strengthen Novo’s position against fierce competitors like Eli Lilly in the fast-growing obesity market. If all goes to plan, this is likely to be a win/win for both the business and the recipients of its medicines.
In short, Novo Nordisk’s story heading into late 2025 is one of transformation and tension. These catalysts are high-impact, high-stakes moments that could reshape how markets value one of the world’s most influential and consequential pharmaceutical companies of this century.
The Novo Nordisk story is being widely misunderstood because much of the market is focused on headline numbers rather than the underlying economics.
At first glance, the latest results look uninspiring. Revenue growth appears subdued, weighed down by US pricing pressure, higher rebates, and deliberate price cuts. Many investors have stopped there and concluded that the growth story is fading.
I think they've reached exactly the wrong conclusion. What we're actually seeing is a business transitioning from premium-priced exclusivity to high-volume scale.
The lower realized prices have little to do with weakening demand. They are largely the consequence of political pressure in the United States, changes to the rebate system, and management's decision to expand access to its therapies. Meanwhile, the underlying picture could hardly be stronger. The physical volume of GLP-1 treatments being supplied continues to reach record levels.
This is a classic example of what Nick Sleep would call scale economics shared.
Novo Nordisk is accepting lower average selling prices in exchange for dramatically higher manufacturing volumes. That allows its medicines to reach a much broader patient population, including cash-pay customers and expanded government reimbursement programmes. As production scales, fixed costs are spread across millions of additional doses, while new products such as the oral Wegovy pill further improve manufacturing efficiency. Per-dose margins may narrow, but unit costs also fall, helping protect overall profitability.
Volume matters far more than price in a business like this.
But here's the most important part that everyone seems to miss. Unlike most pharmaceutical products, obesity and type 2 diabetes treatments are used for chronic conditions. Every new patient is not a one-off sale but a recurring stream of revenue that can last for years, and often the life of the customer. It is about as close as you can get to a subscription business in pharmaceuticals, except better than Netflix or Amazon Prime because it's not discretionary.
Winning market share today creates an expanding base of highly recurring revenue tomorrow. That is already showing up in the data. Weekly prescriptions for Wegovy now exceed 265,000, up from around 200,000, an increase of more than 30%.
The market is focusing on lower prices per dose while overlooking the much more important metric: the number of patients entering the Novo Nordisk ecosystem continues to grow rapidly. In a chronic disease franchise, that expanding installed base compounds in value over time.
There is also a considerable amount of accounting noise in the reported figures because of the US rebate system. Strip that out, and the underlying business looks much healthier. Organic revenue grew by around 7%, which most companies would be delighted with, while operating profit increased by 11%, demonstrating that operating leverage continues to flow through the business. Once again, this is why volumetric growth matters.
Far from signalling structural weakness, today's results show a business deliberately exchanging price for scale (perhaps not by choice, but nonetheless it is beneficial). That may weigh on short-term reported growth, but it strengthens Novo Nordisk's competitive position, widens its moat, and increases the lifetime value of its patient base.
For me, that is the single most important takeaway from today's results.
Novo Nordisk's new milestone. Awiqli® (insulin icodec-abae) injection is the first-ever once-weekly basal insulin approved by the FDA for people with type 2 diabetes. It offers people an alternative to daily basal insulin injections, reducing these injections from seven to only one per week. Aside from convenience, this development has large benefits to the unit economics, both for Novo Nordisk and its customers. Novo Nordisk expects to launch Awiqli® nationwide in the US in the second half of 2026.
Another Win For Novo Nordisk (NOVO)
The National Health Service in England is rolling out the weight-loss drug Wegovy, signalling a shift toward using GLP-1 treatments to prevent serious cardiovascular events. Clinical data shows the drug, which contains semaglutide, can significantly reduce the risk of heart attacks and strokes in high-risk patients, extending its value far beyond weight loss and diabetes treatments. For Novo Nordisk, the decision reinforces Wegovy’s position as a long-term, high-demand therapy within public healthcare systems, supporting sustained revenue growth.
Source: https://www.england.nhs.uk/2026/04/million-people-offered-wegovy-cut-heart-attack-stroke-risk/
Eli Lilly has been up to its old marketing tricks again. It published head-to-head trial results showing its oral GLP-1 pill orforglipron beat Novo Nordisk's oral semaglutide.
But here's the thing:
- Semaglutide was dosed according to its approved oral label instructions (7 mg and 14 mg), while orforglipron used its trial doses (12 mg and 36 mg).
- At 52 weeks, participants on orforglipron lost an average of 14.6 lbs (6.7%; 12 mg) and 19.7 lbs (9.2%; 36 mg). Those on oral semaglutide lost 7.9 lbs (3.7%; 7 mg) and 11.0 lbs (5.3%; 14 mg).
The relationship between dose and efficacy is well understood, but it rarely features in the headline narrative. The result is a comparison that is directionally informative but not pharmacologically equivalent.
The relevant question for investors is the efficacy versus tolerability trade-off at those doses.
Higher doses typically bring more gastrointestinal side effects and may create pressure on adherence, while also increasing manufacturing intensity. These factors ultimately shape payer behaviour, pricing and margins.
Novo appears optimises for long-term performance and cost, focused on delivering the best outcome for consumers. In stark contrast, Lilly is more aggressive in defining its marketing narrative in the hope of being perceived by the market as suppliers of a premium product.
The gap between those approaches can create short-term misreadings, but over time outcomes converge on what patients tolerate, what payers reimburse and what can be produced at scale with the best unit economics.
Novo Nordisk (NOVO) and Hims & Hers (HIMS) have ended their patent dispute by striking a deal that transforms their relationship from adversaries to partners. The agreement allows Hims to sell FDA-approved Wegovy and Ozempic. This positions Hims as a key distribution partner for Novo Nordisk in the growing telehealth market. Increasing distribution channels is more valuable to Novo, over the long-term, than pursuing short-term litigation (whatever the merits of the claim).
- Hims will cease all advertising and promotion of compounded GLP-1 drugs on its platform and in its marketing materials.
- Hims will educate existing patients on their options and support a seamless transition to FDA-approved alternatives when clinically appropriate.
Novo Nordisk has agreed to dismiss the patent infringement lawsuit 'without prejudice', meaning it reserves the right to refile it in the future if Hims reneges on the deal.
This seems to be a win/win for all concerned.
À great article . Thanks.
Novo Nordisk has taken another hit in the market this week. But the headline numbers do not tell the full story.
Start with the drug itself. CagriSema combines cagrilintide, an amylin analogue, with semaglutide, a GLP 1 agonist. Novo Nordisk is first to market with a GLP 1 and amylin combination. That matters because clinical testing shows the two molecules enhance each other when used together. The combined effect is greater than either component alone.
That context helps explain the recent REDEFINE 4 head to head study against Eli Lilly’s tirzepatide. Novo Nordisk used a total of 4.8 mg of active ingredient, 2.4 mg of each component. Eli Lilly used 15 mg of tirzepatide. This was not a like for like dose comparison.
At 84 weeks, CagriSema delivered roughly 23 percent weight loss versus 25.5 percent for tirzepatide. On the surface, Lilly appears to have won. But look more closely.
First, 23 percent weight loss over 84 weeks is a strong outcome, especially at that dose. Second, patients and payers may not fixate on 23 percent versus 25.5 percent. They are likely to focus on cost.
If Novo Nordisk can deliver similar weight loss using roughly one third of the total dose, then that has cost implications. Manufacturing economics are not perfectly linear. Lilly produces a single molecule. Novo must manufacture two and use a dual chamber injection device because the compounds cannot be stored together. That adds complexity and expense. Scale also matters.
Even so, a materially lower total dose creates room to compete on price. Novo Nordisk believes it can offer meaningful weight loss at a lower price point. The market reaction suggests many investors are focused only on the efficacy gap, not on cost per outcome.
For a therapy that may be used for years, potentially for life, affordability becomes central. Over time, price influences access, reimbursement, and market share. Novo appears to be optimizing for cost efficiency as much as for peak efficacy.
That raises a different way to frame the comparison. Instead of asking which drug delivers the highest percentage weight loss at 84 weeks, it may be more useful to consider weight loss per dollar. That metric is harder to model because costs evolve with scale and manufacturing efficiency. But for investors, it is the economically relevant lens.
Importantly, Novo Nordisk plans to increase the CagriSema dose in the next head to head study to around 7 mg. Based on prior data, management expects greater weight loss at that level. Even then, the total dose would remain well below 15 mg being used by Lilly.
It is reasonable to ask what the outcome might have been if the first trial had used more comparable dosing from the outset. The current results do not close that question, but make no mistake, this was not a like-for-like test.
There is also a clinical perspective. Sustainable weight loss is typically gradual. Rapid loss can carry risks and may increase the probability of regain once treatment stops. Optimizing solely for the fastest early reduction may not align with long term health outcomes.
So were the recent head to head results good or bad?
You decide.
GLP-1: NOVO and LILLY
Yesterday, the FDA made it clear it’s coming down hard on compounded GLP-1 weight-loss drugs being sold at scale. Hims & Hers was forced to pull its copycat Wegovy offering almost immediately, and Novo Nordisk piled on by filing a lawsuit. The market reaction was brutal: HIMS dropped more than 20% pre-market, hitting its lowest level since late 2024.
The message from regulators couldn’t be clearer. By tightening enforcement, the FDA has effectively widened the moat around Novo Nordisk’s and Eli Lilly’s GLP-1 franchises — and those moats were already enormous.
James,
A very enjoyable article. Thank you! Novo Nordisk has a long track record of strong returns and has been on a remarkable journey since receiving FDA approval for Ozempic in 2017.
Wegovy's oral table approval in the US marks a new chapter.
Roger
Oral Wegovy - What does it mean?
Yesterday’s launch of the oral version of Wegovy marks a pivotal shift in metabolic health, as it finally offers a needle-free alternative for those seeking the weight-loss efficacy of semaglutide. This new daily pill represents a major victory for patient accessibility, specifically targeting the millions of people who have remained on the sidelines due to a fear of self-injection or the logistical challenges of keeping injectable medications refrigerated.
The clinical profile of the pill is remarkably strong, showing that patients can achieve weight loss of approximately 16.6% to 17% over a year. This puts the tablet on a nearly equal footing with the once-weekly injectable version, a feat many researchers once thought impossible. To achieve this, Novo Nordisk utilizes a specialized absorption enhancer that allows the drug to pass through the stomach lining, provided patients strictly follow a morning ritual of taking the pill with minimal water on an empty stomach.
However, the biology of the gut is quite stubborn, which creates a massive "bioavailability gap" between the two formats. Because the stomach is designed to digest proteins like semaglutide, only about 1% of the pill actually reaches the bloodstream. To overcome this, the daily pill contains a much higher concentration of the active ingredient (roughly 25 mg per day) compared to the 2.4 mg per week found in the injection. This means a pill user consumes about 70 times more of the drug every week than an injectable user.
This massive increase in the required dose has significant implications for Novo Nordisk’s manufacturing and profit margins. Producing the sheer volume of active ingredients needed for millions of daily pills is a gargantuan task that carries a much higher "cost of goods" than the low-dose injections. While the raw material costs are higher, the company is likely banking on the fact that tablets are far easier to package, store, and ship than complex, temperature-sensitive glass pens.
From a financial strategy perspective, Novo Nordisk is leaning into a "volume over margin" approach. By pricing the pill aggressively at a $149 to $299 cash-pay monthly rate, they are making the drug accessible to a wider demographic while simultaneously undercutting competitors. Even if the profit margin per bottle is lower than that of the injection, the massive influx of new patients is expected to drive total revenue to record heights.
The launch also serves as a defensive masterclass against their primary rival, Eli Lilly. By hitting the market first with an oral GLP-1, Novo Nordisk is securing patient loyalty and establishing a dominant footprint before Lilly can release its own oral candidate. This "first-mover" advantage is vital in a market where convenience and price are becoming the primary drivers of patient choice. Eli Lilly shares fell 5% on the news.
Ultimately, this release signifies the "mainstreaming" of weight-loss therapy. By removing the needle and the high price tag, Novo Nordisk has turned a specialized medical treatment into a daily wellness habit for a much larger portion of the population. As manufacturing scales up at their massive new facilities in North Carolina, the focus will now shift to whether they can produce enough of this high-dose medication to meet what is expected to be unprecedented global demand.
A nice problem for Novo Nordisk to have and likely the catalyst for a long over due re-rating of the stock which was heavily over sold during 2025. This year promises strong returns for shareholders.
Novo Nordisk launched its Wegovy weight-loss pill in the U.S. today. Cash price is $149 a month. Available at Costco and CVS. First oral GLP-1 approved specifically for weight loss. The stock responded positively with a 5% move higher.
Bad News For Novo Nordisk - Or Is It?
On November 25, 2025, Medicare wrapped up its second round of drug price negotiations under the Inflation Reduction Act (IRA), targeting 15 high-spend medicines. The government expects the newly negotiated prices, set to take effect on January 1, 2027, to slash annual spending on these drugs by 36%, translating into roughly $8.5 billion in savings. Among the targets were the blockbuster GLP-1 agonists used for diabetes and weight loss, the very drugs reshaping modern healthcare.
The instinctive reaction is that this is a blow to the companies behind them, especially Novo Nordisk. But that's entirely the wrong way to look at it.
The industry is undergoing a deeper structural shift. For decades, pharma has lived on a “low-volume, high-price” model, where specialist drugs commanded premium margins. Yet the unprecedented demand for GLP-1s is pushing the market toward a consumer-like dynamic: lower prices but massive, sustained volume.
It’s the kind of “scale economics shared” dynamic Nick Sleep famously described, only this time, it isn’t being voluntarily implemented. It’s being imposed by the state.
Counterintuitive as it sounds, the forced price cuts could become a long-term catalyst for Novo Nordisk.
Millions of eligible patients are currently shut out because insurers simply can’t shoulder the cost of GLP-1s, despite their many benefits. Drop the monthly price to something like $274, and the cost-benefit equation flips. Suddenly, Medicare and more private payers can afford it and since these medications are used over the long-term, sometimes all of life, the market shifts from a medical niche to a mass-market subscription model. A 36% price cut becomes meaningless if the patient pool expands from five million to fifty million.
There’s a catch, though: this only works for companies with the manufacturing muscle to meet that surge in demand. This is why Eli Lilly and Novo Nordisk are scaling manufacturing so aggressively.
But why has the Eli Lilly share price recently touched all time highs, while Novo Nordisk is stuck in the mud?
This is where the U.S. economic backdrop comes in. America remains a deeply protectionist market, and the IRA’s negotiation criteria reflects that. Drugs without generic competition become eligible for price negotiation after seven years (for small molecules) or eleven years (for biologics). Novo Nordisk’s Ozempic, approved in 2017, crossed that threshold early and was swept into the first negotiation round. Its price will be cut in 2027. Eli Lilly’s Mounjaro and Zepbound, approved in 2022, won’t face negotiation until 2030 or later. In effect, the European innovator is punished while the U.S. based copy-cat gets a multi-year free ride.
The market has assumed that Lilly can maintain premium pricing for years, protecting its margins, while Novo Nordisk is forced to discount. But they may be looking down the wrong end of the telescope.
Think about this from a demand perspective: why would customers opt for a higher-priced drug if the clinical outcomes are broadly similar? In reality, Lilly will either need to reduce its pricing to remain competitive, or else, if Novo can fix its supply issues, it will become the “affordable default” for Medicare’s massive patient base. And once Medicare standardizes around a product, that position is extraordinarily difficult to dislodge.
So the story may not be bad news at all. Novo Nordisk faces short-term pressure, yes. But if the GLP-1 category becomes a mass-market utility, the company forced to lower its prices first may actually end up owning the largest slice of an enormously expanded pie.
NovoNordisk Down 10% | Over Reaction Of The Market?
Novo Nordisk has released top-line results from its two-year primary analysis of the evoke and evoke+ phase 3 trials, which tested whether oral semaglutide could slow progression in early-stage symptomatic Alzheimer’s disease. The randomized, double-blind studies enrolled 3,808 adults and compared semaglutide with placebo alongside standard care.
The company pursued the Alzheimer’s indication after real-world evidence, pre-clinical data and post-hoc analyses from its diabetes and obesity programs hinted at potential benefits, despite what executives described as a “low likelihood of success.”
Chief scientific officer Martin Holst Lange said Novo Nordisk was proud to have run two rigorous, well-controlled studies, but confirmed that semaglutide did not outperform placebo in reducing disease progression, measured by changes in the Clinical Dementia Rating–Sum of Boxes score.
Because the trials failed to show efficacy, Novo Nordisk will discontinue the planned one-year extension phase of both evoke studies.
Having managed the expectations of the market by always declaring these tests to have a low likelihood of success, proving efficacy in these trials was never priced in to the company's valuation. As such, the knee-jerk reaction of the market to sell off 10% appears over done.
This was something of a moonshot for the company and, while it would have presented an opportunity to boost sales, it has absolutely no bearing on the core diabetes and weight-loss businesses of the company which are going from strength to strength.
Trials continue in relation to other health conditions that GLP-1 medicines may be able to effectively treat.
At the close last night, Eli Lilly once again outperformed expectations. The company beat third-quarter estimates and lifted its full-year revenue guidance to between $63 and $63.5 billion, up from the prior range of $60 to $62 billion. Sales of its blockbuster drugs Zepbound and Mounjaro have surged to a combined $25 billion year-to-date, with Zepbound tripling and Mounjaro doubling from last year’s levels.
If those numbers are any indication, demand for GLP-1 medications remains red-hot. That sets the stage for an interesting week ahead, with Novo Nordisk set to report its own third-quarter results next week.
Adding to the intrigue, Novo Nordisk is currently locked in a bidding war with Pfizer for Metsera, an obesity drug developer valued at up to $9 billion. It’s another sign that this GLP-1 duopoly is not just thriving but aggressively expanding through both organic growth and strategic acquisitions
There is little sign of momentum slowing anytime soon.
On a relative valuation basis, one of these businesses certainly looks way over sold!
Novo Nordisk Foundation Seizes Board Control: Leadership Shake-Up Marks the Start of a Bold New Chapter for the Danish Drugmaker
Novo Nordisk is facing one of its most dramatic leadership overhauls in years. The company’s powerful chair, Helge Lund, will not seek re-election, and six independent directors are stepping down. The move follows months of rising tension between the board and Novo Nordisk’s controlling shareholder, the Novo Nordisk Foundation, which has grown frustrated with the pace of change inside the pharmaceutical giant.
Behind the scenes, the Foundation has been tightening its grip, determined to speed up decision-making and inject new energy into a company. It has nominated former CEO Lars Rebien Sørensen, a veteran who once led Novo through a golden age, to return as chair. His appointment, expected to last two to three years, would mark a striking comeback and a clear signal that the Foundation wants to restore the company’s old discipline and drive.
Novo Nordisk, long celebrated for its dominance in diabetes care, enjoyed a meteoric rise on the back of its obesity medication that briefly made it Europe’s most valuable company. However, the company hit some turbulence. Production bottlenecks limited supply just as demand surged. Notwithstanding intellectual property protection, the FDA temporarily permitted generic drug makers to fill the gap in the market. That caused a dip in earnings and in the share price - but that chapter is now in the past.
Earlier this year, new CEO Mike Doustdar announced sweeping layoffs (9,000 jobs worldwide) and promised a more agile, focused business. But the Foundation evidently wants to accelerate the turnaround.
Now, the upcoming November 14 shareholder meeting has the air of a reckoning. The Foundation’s assertive push could reshape Novo’s governance and set the tone for a new era, one that prizes speed and accountability over consensus.
The market response has been mixed: some investors have welcomed the decisive action, while others worry that such upheaval could unsettle a company already navigating intense global competition.
What’s certain is that the quiet stability that once defined Novo Nordisk’s boardroom is gone, replaced by an unmistakable sense of urgency and a fight to reclaim the company’s edge. This is a business that is genetically programmed to be a winner. Reading between the lines, it won't settle for anything less. If its success over the past century is anything to go by, it would take a very brave person to bet against it.
Novo Nordisk's next earnings release is expected on 5th November, but there are two more significant near term catalysts that may have a greater impact - not only on the stock price, but also on the company's long-term growth trajectory.
The first, and arguably most anticipated, catalyst is the EVOKE trial readout for oral semaglutide in early Alzheimer’s disease. While the Phase 3 trials were slated for primary completion in September 2025, topline data is expected to surface in or around November. Alzheimer’s has long been one of the toughest frontiers in drug development and analysts like those at Morgan Stanley peg Novo’s odds of success at just 25%. However, with such low expectations comes a higher chance of a surprise to the upside. A positive readout would instantly open the door to a multi-billion-dollar market and reposition Novo Nordisk as a key player in neuroscience, potentially transforming both its pipeline and market narrative overnight.
The second key event is more regulatory than scientific but equally important: the U.S. Medicare price negotiations for Novo Nordisk’s GLP-1 drugs, including Ozempic, Wegovy and Rybelsus. Negotiations between Novo and the Centers for Medicare & Medicaid Services (CMS) are expected to wrap up around November. The outcome will determine how much Medicare pays for these blockbuster treatments, setting the pricing floor for years to come. While analysts estimate this could ultimately affect more than 7% of the company’s gross sales, the impact won’t be immediate: new prices won’t kick in until 2027. Even so, this decision will help shape long-term revenue expectations and valuation multiples for Novo’s most profitable product line in its largest single market, the U.S.
Amid these headline catalysts, Novo Nordisk is also reshaping its internal structure to sharpen focus and efficiency. The company is winding down its entire cell therapy division, a decisive move that highlights its renewed concentration on metabolic diseases like diabetes and obesity. The closure will affect roughly 250 employees and forms part of a broader restructuring plan aimed at generating savings by reducing around 9,000 global positions through 2026.
Looking ahead, Novo is already preparing for the next evolution of its obesity franchise: the launch of its high-dose oral semaglutide pill, dubbed by some as “Wegovy-in-a-pill.” Pending regulatory approval, the company intends to launch the product through digital-first channels such as Ro and WeightWatchers. Novo is also exploring a subscription-based commercial model, offering discounted 6- to 12-month medication plans - this would greatly improve working capital dynamics and cash-flow conversion rates, providing Novo with a source of free financing. But this is not merely about improving Novo's unit economics, it also delivers benefits to the customer. This approach signals a strategic shift toward a more consumer-oriented, direct-to-patient model, one that could streamline access, reduce friction and strengthen Novo’s position against fierce competitors like Eli Lilly in the fast-growing obesity market. If all goes to plan, this is likely to be a win/win for both the business and the recipients of its medicines.
In short, Novo Nordisk’s story heading into late 2025 is one of transformation and tension. These catalysts are high-impact, high-stakes moments that could reshape how markets value one of the world’s most influential and consequential pharmaceutical companies of this century.