Pharmaceuticals: Major · Outside the Retail 100

Novo Nordisk

NVO

Our rating: hold
12-month target: $46.93 +16.0%
Expected vs. S&P 500: +0.5 ptsSee the math
Next earnings: Nov 4In -1 days

Lower prices cut U.S. Wegovy shot sales 22% last quarter even as volume rose, and the new Wegovy pill only just made up the difference.

Summary

Novo Nordisk sells semaglutide, the drug in Ozempic, Wegovy and Rybelsus, and insulin adds about a sixth of sales. It created the obesity drug boom but has lost the U.S. lead to Eli Lilly. At home, price cuts and a cheaper pill are replacing shot revenue; abroad, growth now runs into generics. At about 12 times expected earnings, the stock already prices in flat profits. We agree, and the next test is how much January's U.S. list-price cuts reduce what Novo collects.

$40.22

-$8.89 (-18.10%)Past year

What Novo Nordisk does

Novo Nordisk launched Wegovy in 2021, two years before Lilly's Zepbound, and now ranks second to Lilly in obesity drugs. One molecule, semaglutide, brings in about three-quarters of its sales.^1,3,19,34

What it sells

Ozempic and Rybelsus46% of adjusted sales, first half of 2026
Semaglutide for type 2 diabetes, as a weekly shot and a daily pill. Still the largest seller, but losing U.S. patients to Lilly's Mounjaro.
Wegovy shot and pill29% of adjusted sales, first half of 2026
Semaglutide for obesity. Second to Lilly's Zepbound in the U.S.; the pill, launched in January, leads Lilly's Foundayo in prescriptions.
Insulin17% of adjusted sales, first half of 2026
Novo's original business, older diabetes injections sold worldwide. Steady cash, but sales fell 7% at constant exchange rates in the first half.
Rare disease6% of adjusted sales, first half of 2026
Treatments for hemophilia, growth disorders and other rare conditions. Small, and not part of the debate.

Who buys it

Patients get Novo's drugs through pharmacies, insurers and government plans, and a growing share of Americans pay cash. Half the Wegovy franchise is self-pay, and about 90% of pill demand. The U.S. is about half of sales.

Where you've seen it

Ozempic, the diabetes shot whose name many people use for any weight-loss drug, is Novo's best-selling product.

How it got this way

Novo lost its lead in three steps. It could not make enough Wegovy: in December 2023, just as Zepbound launched, only about 5,000 Americans a week could start it. Lilly's drug also worked better: in a head-to-head trial reported in 2025, it cut weight 20.2% against Wegovy's 13.7%. And CagriSema, Novo's planned successor, missed the company's own 25% weight-loss target in December 2024, erasing about $94B of market value in a day.^22,23,21,29

What a patient pays

Who pays decides what Novo earns: the same semaglutide sells from $149 cash to a $675 list price

Novo sells one molecule through several doors, and each pays differently. About half the Wegovy franchise is now self-pay, outside insurance, according to the company, and about 90% of pill demand.

The shift was partly negotiated. Under its November 2025 deal with the White House, Novo cut cash and Medicare prices and got three years of relief from pharmaceutical tariffs. It also sells through its own NovoCare pharmacy and telehealth partners such as Ro and Hims & Hers.

Cheap channels are still profitable. Adjusted gross margin was about 78% last quarter, though Novo does not disclose margin by channel.^1,3,19,24,26

Channel	Price	What it means for Novo
Medicare (Bridge pilot from July 2026)	$245 a month government price; patients pay $50	Officials said about 10% of Medicare enrollees would qualify.
Commercial insurance	List price $675 a month from January	Net price after rebates is undisclosed; insured patients can pay as little as $25.
Cash, shot (White House deal)	About $350 on average, falling toward $250 within two years	Price set with the government, not by Novo alone.
Cash, pill	$149 to $299 a month by dose	Most pill patients; the lowest revenue per patient.
Telehealth (Ro, Hims & Hers, others)	From $149, plus a membership fee	Brings patients, but the platform owns the customer.

Where we landCash and Medicare channels raise the patient count and lower the average price. That works while volume outruns price; the risk is insured patients moving to cheaper channels too.

Novo versus Lilly

Lilly now outsells Novo in diabetes and obesity shots and is closing in abroad; Novo leads only in pills

Novo's loss of the lead is broad, not one bad drug. Lilly's tirzepatide beat semaglutide in a head-to-head trial, and Lilly built factories early: it has committed more than $50B to U.S. plants since 2020.

The surprise is outside the U.S., where Novo makes about half its sales. In the second quarter, Mounjaro's international sales alone came within about 10% of all of Novo's international sales, converted at the Aug. 4 exchange rate.

The pill is the one place Novo leads, by about five to one in sales last quarter. Foundayo's sales nearly doubled in the third quarter, to $184M.^{1,3,21,27,33,35,36,4,37}

Market	Novo	Lilly	Who leads
Obesity shot	Wegovy: 13.7% weight loss in the head-to-head trial	Zepbound: 20.2%; on track to outsell Wegovy by $7B+ this year (LSEG)	Lilly
Diabetes shot, Q2 2026	Ozempic: DKK 31.4B, about $4.8B	Mounjaro: $9.9B, up 91%	Lilly
Obesity pill, Q2 2026	Wegovy pill: DKK 3.2B, about $0.5B	Foundayo: $98M, launched in April	Novo
Outside the U.S., Q2 2026	All international sales: DKK 37.6B, about $5.8B	Mounjaro alone: $5.2B, up 172%	Novo, narrowly
Next drug	CagriSema: 20.2% weight loss vs 23.6% for tirzepatide	Tirzepatide already on sale	Lilly

Where we landNovo is now second to Lilly in nearly every GLP-1 market. We don't expect it to retake the lead with semaglutide; the pill buys time and patients, not share of profits.

How the business makes money

The backstory

Novo's U.S. lead slipped as Zepbound and compounded copies took patients, and it cut its 2025 forecast in May and again in July. The Novo Nordisk Foundation, which holds 77% of the votes through Novo Holdings, stepped in: its chair joined the board as an observer when CEO Lars Fruergaard Jørgensen's exit was announced, and it replaced most directors in November 2025. New CEO Mike Doustdar cut 9,000 jobs, lowered U.S. prices and launched the Wegovy pill in January 2026.

Novo makes money selling one molecule, semaglutide, in three forms at high margins around the world. The U.S. sets the price; the rest of the world now supplies the growth.^{1,3,13,14,15,16,17,18,24,31}

1 · DemandMore patientsThe market keeps growing. U.S. branded obesity drug volume rose 87% in the year to May.
2 · PricingLower pricesNovo is trading price for patients. A November 2025 White House deal cut Medicare and cash prices, and U.S. list prices fall in January.
3 · New channelThe pillThe pill reaches people insurers don't cover. About 90% of its demand pays cash, through pharmacies and nine telehealth companies.
4 · GrowthAbroadOutside the U.S., Wegovy is early in its launch. Volume grows there even as generics cut semaglutide prices in Canada and India.
5 · Cash engineMarginsEach dose is still very profitable. Adjusted operating margin (profit from operations per dollar of sales) was about 43% last quarter.
6 · PayoutDividends, buybacksMost cash goes to shareholders. Novo paid DKK 35.3B in dividends in the first half and is buying back up to DKK 15B this year.

Advantages

The pill: first to market, stronger results

Major advantage

Novo's real remaining edge is putting semaglutide, a peptide that needs help to be absorbed from the gut, into a pill with results close to the shot. It launched three months before Lilly's Foundayo and led oral prescriptions five to one in August. We think the lead is temporary.

1.Owned the delivery tech. Novo worked with Emisphere from 2007 on SNAC, an absorption enhancer for tablet peptides, used it in Rybelsus, then bought Emisphere for $1.8B in 2020.
2.Stronger, but fussier. In separate trials, the Wegovy pill cut weight about 14% and Foundayo about 11%. Foundayo, a non-peptide pill, has no food or water rules.
3.Leads, but Lilly gains. IQVIA counted about 172,000 weekly Wegovy pill prescriptions in early August, five times Foundayo's. Foundayo's sales still nearly doubled last quarter, to $184M.
4.Volume, not price. About 90% of pill demand pays cash, from $149 a month. Foundayo starts at the same $149, so Novo's lead wins patients but not pricing power.^{20,19,30,28,27,4,3}

Half its sales come from outside the U.S.

Strong advantage

Real, but shrinking. International sales are about half of Novo's total and grew 10% last quarter, as Wegovy launches country by country. Lilly is attacking here too: Mounjaro's sales outside the U.S. rose 93% last quarter. Generic semaglutide in Canada and India caps prices where patents have ended.^1,25,27

Still a cash machine

Supporting

Even shrinking, semaglutide throws off cash. Novo expects DKK 45–55B of free cash flow this year, funding the dividend and buybacks. The catch is that cash pays shareholders while the pipeline has yet to replace semaglutide.¹

What's changing

Cheaper prices, a pill, and lower targets

Novo is cutting prices to win patients and asking investors to wait. In September it set 2030 goals of growth in line with peers and broadly stable margins, and the U.S. shares fell 8% that day. In January, U.S. list prices fall about 50% for Wegovy and 35% for Ozempic. Novo is targeting a U.S. CagriSema launch early next year.^1,3,6,32

Competitors

Who else an investor would consider, and how they compare.

Company	Market value	What it does	Compared with Novo Nordisk
Novo Nordiskthis stock	$179.70B	Novo Nordisk launched Wegovy in 2021, two years before Lilly's Zepbound, and now ranks second to Lilly in obesity drugs. One molecule, semaglutide, brings in about three-quarters of its sales.
Eli LillyLLY	$1.20T	Mounjaro and Zepbound shots, plus Foundayo, a pill with no food rules.	Lilly's shots cause more weight loss; Novo's pill had the head start in oral treatment.^27,21,30
Hims & Hers HealthHIMS	—	Online clinic selling weight-loss drugs by subscription, and once a big seller of compounded copies.	Hims owns the customer; since March it sells Novo's Wegovy alongside some compounded drugs.²⁶
SandozSDZNY	—	Swiss generics maker bringing cheap semaglutide where Novo's patents have ended, starting with Brazil.	Sandoz sells semaglutide on price; Novo defends price with its brand and new drugs.²⁵
Dr. Reddy's LaboratoriesRDY	—	Indian generics maker that launched semaglutide copies in India and Canada in 2026.	Dr. Reddy's wins where patents lapsed; Novo's U.S. patent runs into the early 2030s.^25,3

Bull vs. bear: two bets on the same stock

1
A share is a small slice of the company. Its value comes from the profits the company will make in the future.
2
Nobody knows those profits yet. Buyers (bulls) pay today's price betting they'll beat what most people expect. Sellers (bears) bet they'll fall short.
3
When results come in, the price moves toward whichever side was right, and that side makes money.

The question they disagree on

Will Novo's first 2027 forecast, due in February, show adjusted sales flat or better (0% growth or more) despite January's U.S. list-price cuts?^{1,2,3,4,11,19,25,28,33}

Bull case: why buyers buy

If pill and Medicare volume outruns lower U.S. prices and sales abroad keep growing, earnings hold steady and a stock priced for decline gets a higher multiple.

The pill is winning new patients. By Novo's count, weekly U.S. Wegovy pill prescriptions passed 265,000 in July, almost as many as the shot.
Novo beat forecasts last quarter. Adjusted earnings per ADR beat consensus (the average Wall Street forecast) by about 25%, helped by U.S. rebate adjustments, and it raised 2026 guidance.
Growth abroad is broad. International sales rose 10% at constant exchange rates (stripping out currency moves) last quarter, and insulin sales there rose 4%.
Shareholders are paid to wait. Novo expects DKK 45–55B of free cash flow (cash left after running the business and capex) this year.

Bear case: why sellers sell

If January's price cuts and generics abroad shrink revenue faster than the pill grows, 2027 earnings fall and the low multiple proves deserved, not cheap.

Lilly is pulling further ahead. Zepbound is on track to outsell Wegovy by more than $7B this year, according to LSEG data.
The pill earns less per patient. Self-pay prices run $149 to $299 a month, and pills are now more than a third of U.S. Wegovy prescriptions.
Generics have started abroad. Copies of semaglutide launched in India in March and Canada in May, and Brazil approved one in July.
The next drug trails Lilly's. CagriSema lost to tirzepatide on weight loss in a head-to-head obesity trial, 20.2% to 23.6%, and on blood-sugar control in diabetes.

Where Delphi landsholdWe think today's price already weighs both sides fairly.See why

Price versus patients

Novo is selling more Wegovy in the U.S. for barely more money, and January cuts list prices again

The shot is being repriced. Novo says its U.S. Wegovy injection sales fell last quarter because of lower realized prices, the price it collects, partly offset by higher volume. Adding the new pill, U.S. Wegovy sales rose 4% at constant exchange rates.

The pill is why volume holds. It sold DKK 3.1B in the U.S. in its second quarter, mostly to cash buyers paying $149 to $299 a month. The shot is drifting to cash too: about 120,000 of its 310,000 weekly U.S. prescriptions were self-pay in mid-July.

January brings the next step. List prices fall about 50% for Wegovy and 35% for Ozempic, to $675 a month. List price is the starting point before rebates to insurers and pharmacy middlemen, and Novo has not said how much its net price will fall.

Novo does not report sales per prescription or the pill's margin, so investors see this trade only in totals. February's 2027 forecast is the first place the January cut will show.^1,19

U.S. Wegovy sales, shot plus pill: +4%
Pill sales in the U.S.: DKK 3.1B
Self-pay share of shot scripts: About 39%
New list price: $675 a month

Where we landThis is the risk that matters. Volume has offset price so far, but January's cut is the largest yet and Novo has given no number for its effect. That is why we wait for February rather than buy now.

Who controls Novo

A foundation holds 77% of Novo's votes, so outside shareholders can push but not decide

Novo has two share classes. Unlisted A shares carry 100 votes each and listed B shares 10. Novo Holdings, the investment arm of the Novo Nordisk Foundation, holds the A shares and about 28% of the capital, giving it 77.3% of the votes.

In 2025 it used that control. Foundation chair Lars Rebien Sørensen joined the board as an observer when CEO Lars Fruergaard Jørgensen's exit was announced in May. In October the board said it could not agree with the Foundation on its makeup; in November seven directors left and Sørensen became chair.

The upside is a patient owner that can fund long projects and cannot be outvoted in a takeover fight. The downside is that minority shareholders cannot force a sale, a break-up or a faster change of course.^{18,31,13,16,17}

Novo Holdings' share of votes: 77.3%
Directors who left: 7

Where we landControl did not cause the stock's fall, but it shapes the recovery. The Foundation acted quickly once the shares slid, which we count as a plus. Don't expect an activist or a bidder to unlock value.

What to watch

The numbers that will settle the debate.

U.S. Wegovy weekly prescriptions (shot plus pill)■ unclear

About 575,000 in the week to July 17 (company count), of which the pill more than 265,000¹

Volume has to outgrow price cuts. Rising totals while Foundayo grows would show the pill is holding its patients.

International Operations sales growth (constant exchange rates)▲ improving

+10% in Q2 2026, +8% in the first half; insulin +4% outside the U.S. in Q2¹

Abroad is where Novo grows and where generics are arriving. Growth below about 5% would mean generics are winning.

Adjusted gross margin▼ worsening

78.2% in Q2 2026, down from 82.7% a year earlier, including about DKK 3B of one-time manufacturing costs¹

Shows what lower prices cost. Holding near 80% after January would mean volume and savings offset the list-price cuts.

Next earnings report

Nov 4

In -1 days

Expected earnings per share: $0.81
Expected revenue: —

What to listen for: Whether U.S. Wegovy pill prescriptions still grow as Foundayo gains, and what Novo says about net prices after January's list-price cuts.^1,7,11

What would prove this wrong

✕February's 2027 guidance calls for adjusted sales to fall more than about 5%.
✕U.S. Wegovy pill prescriptions fall for two quarters in a row as Foundayo grows.
✕International sales growth drops below 5% as generic semaglutide spreads.
✕Upside: 2027 guidance for sales growth above 5% would make it a Buy.

Our ratingHoldas of Nov 2 close, $40.45 · what ratings mean

We agree earnings stay flat; at about 12 times them the model gains about 20% if right and loses about 18% if wrong, no better than the S&P 500.

12-month target: $46.93 (+16.0%)
Plus dividend: +3.0%
S&P 500, same method, with dividends: +18.5%
Expected vs the market: +0.5 points

The math behind the recommendation

Three 12-month price scenarios, weighted by probability, compared with the S&P 500 under the same method.

Now $40.45

Target $46.93

bull case25% likely

$58.03 +43%

Pill and Medicare volume outrun price cuts, sales abroad keep growing near 10%, CagriSema is approved, and 2028 earnings land near the top of forecasts.

$3.72 earnings per share × 15.6 = $58.03

base case50% likely

$48.36 +20%

2027 sales are roughly flat, cost cuts protect margins, and 2028 earnings match the roughly $3.41 per ADR consensus.

$3.41 earnings per share × 14.2 = $48.36

bear case25% likely

$32.97 -18%

January's price cuts and generics abroad shrink 2027 sales, Foundayo takes pill share, and earnings fall toward the low end of forecasts.

$3.15 earnings per share × 10.5 = $32.97

Why these odds: Novo beat last quarter's earnings estimate by about 25% and 2027 estimates rose over 90 days. But third-quarter estimates fell about 10% in a month, and Novo has given no guidance on January's price cuts, so bull and bear odds are equal.

How the prices are built: Wall Street expects earnings per share of $3.41 for the year starting a year from now (analysts range from $2.88 to $4.03). Today the stock trades at 12.3 times next year's earnings per share; its five-year middle is 34.8.^{7,8,9,10,11,12,1}

What tests the call: Full-year 2026 results with first 2027 guidance (Feb 3)

Buy means expected to beat the S&P 500 by 10+ points over 12 months; Sell means expected to trail it by 10+. Inputs gathered Oct 29; the recommendation updates with the price every day. Model-generated, not personalized investment advice. How ratings work · Track record

What the price assumes

At $40.45, investors pay less for each dollar of Novo Nordisk's earnings than for the average stock's

Novo Nordisk trades at 12 times the earnings analysts expect over the next 12 months. That ratio is the multiple: what investors pay today for each dollar of a year's earnings. That is cheaper than it has been 80% of the time over the past five years, when the middle was 35.

Analysts expect earnings to grow about 4% the year after, against about 16% for the S&P 500. The S&P 500 trades at 19 times. At the market's multiple, today's price would only make sense if Novo Nordisk earned about 34% less than forecast over the next year.

Novo Nordisk multiple: 12×
S&P 500 multiple: 19×
Base case: +20%
Bear case: −18%

The skewOur bear case loses about 95¢ for every $1 our base case makes. That ratio, how much you stand to lose against how much you stand to make, is the skew.

Last earnings

Q2 2026 results, reported Aug 4

Adjusted operating profit rose 11% at constant exchange rates, and Novo raised its 2026 forecast to flat to down 6%, from down 4% to 12%.^1,2,4,5,11

Reported Aug 4	Expected	Actual	Difference
Earnings per share	$0.81	$0.96	+18.6%
Revenue	—	—	—

Beat expectations in 5 of the last 6 quarters

Stock reaction: Down 6.0% that day, closing at $44.28

Why the stock moved

Weighing: Wegovy pill sales of DKK 3.2B missed the roughly DKK 3.6B analysts expected.
Weighing: CagriSema failed to match Lilly's tirzepatide on blood-sugar control in a head-to-head diabetes trial.
Positive: guidance rose on higher expected sales of GLP-1 drugs.
Context: reported operating profit fell 16% at constant exchange rates on the write-offs.

What it means for the stock: Mixed: cost cuts, the pill and U.S. rebate adjustments held earnings up, but the pill miss and the CagriSema result weakened the case for growth after semaglutide.