Novo Nordisk review

The short version

Novo Nordisk is a Danish company that has made insulin for a century and then, with Ozempic and Wegovy, created the modern weight-loss drug market. In 2024 it was Europe’s most valuable company. Since then the story has turned: Eli Lilly overtook it, prices are falling and patents are ending in some countries. The Q3 2026 results, on 4 November, were better than expected: sales of DKK 79.2 billion (about $12 billion), up 4% at constant exchange rates, and a higher forecast. Novo now expects 2026 adjusted sales to change by between −2% and +2%, up from −6% to 0% in August (Novo Q3 2026 report). The CEO, Mike Doustdar, took over in August 2025 and has cut costs and jobs. The finance chief, Karsten Munk Knudsen, leaves at the end of 2026 (CNBC).

What Novo makes

Nearly everything depends on one molecule, semaglutide. In the first nine months of 2026 Ozempic sold DKK 88.9 billion (about $13 billion), Wegovy injections DKK 58.1 billion and the new Wegovy pill DKK 10.9 billion. The pill is the bright spot. It sold DKK 5.4 billion in Q3 alone, against the roughly DKK 4.5 billion analysts expected (CNBC). It has passed 8 million prescriptions since its January launch, is on sale in eight markets and should reach more than 20 in 2027 (Novo Q3 2026 report). It costs $149–299 a month for people paying themselves in the US. The injection is losing ground, though: US sales of Wegovy injections fell 13% in Q3. Insulin, the company’s original business, is down 4% over nine months.

Is it really new?

Novo was the innovator. Semaglutide was not the first GLP-1 drug, but it was the first to cause large, lasting weight loss, which turned obesity into a treatable disease. The Wegovy pill is the first weight-loss pill of its kind. The problem is that the next step came from a rival: Lilly’s tirzepatide acts on two hormones instead of one and causes more weight loss. Novo’s answer, CagriSema, also combines two hormones, but in the REDEFINE 4 trial it only matched tirzepatide on weight and lost on blood sugar. A newer diabetes trial, REIMAGINE 5, was better: 12.4% weight loss against 9.1% for a lower 5 mg dose of tirzepatide.

The competition

Eli Lilly is the main rival and now the leader in both injections and sales growth. The second threat is generic semaglutide. In Canada, Novo’s patent lapsed because a maintenance fee was not paid, and at least nine companies applied to sell copies. In India and China the patent expired on 20 March 2026 (Asia IP). New entrants such as Amgen and Pfizer arrive from about 2027.

Money

Novo is still very profitable. Adjusted operating profit was DKK 98.0 billion in the first nine months of 2026, up 8% at constant exchange rates, and the free cash flow forecast for the year rose to DKK 60–70 billion (about $9–10.5 billion), from DKK 45–55 billion in August (Novo Q3 2026 report).

Watch out for one number. Novo’s reported nine-month sales of DKK 254.5 billion, up 13%, include a one-off DKK 26.8 billion accounting gain from a US rebate provision that was reversed, with no cash behind it. Without it, sales were DKK 227.7 billion, up 2%. Reported net profit of DKK 86.3 billion benefits from the same gain.

Novo is also being forced to sell for less. Under its agreement with the US government, the list price of Wegovy falls to $675 a month from 1 January 2027, about half of today’s, and Ozempic’s by about 35%, in exchange for Medicare and Medicaid coverage. Medicare coverage of obesity medicines began on 1 July 2026 through a “Bridge” program. If many more patients get the drug, lower prices can still mean more money; that is the bet.

Patents

The main US patent on semaglutide runs until about 2031–2032, so US generics are still years away. Outside the US, protection is already gone in some large markets. For comparison, Lilly’s tirzepatide is protected until about 2036.

Risks

• No real growth in 2026, lower US prices from 2027 and less obesity coverage under Medicaid.
• Trial setbacks. CagriSema was weaker than hoped, and the heart drug ziltivekimab failed its main trials in 2026, which led to a DKK 4.6 billion write-down in Q3.
• Dependence on one molecule, now under generic attack abroad.
• Currency. Novo reports in Danish kroner; the US share (NVO) is a depositary receipt, so currency moves affect its price.

Our take

Novo is no longer the growth story it was in 2023. It is a highly profitable company in a difficult period, with its shares still around 70% below their peak. Q3 2026 helped: the pill beat forecasts and the outlook went up. But the CEO himself says one good quarter is not a turnaround. The recovery case rests on three things: the Wegovy pill keeps growing, CagriSema is approved, and lower US prices bring in many more patients. If those happen, today’s price may look cheap; if not, Lilly keeps taking the market.