Novo Nordisk raises 2026 outlook as oral Wegovy drives GLP-1 market expansion
The global branded obesity-medication market grew volumes by roughly 70% from the second quarter of 2025, a demand environment that carried Novo Nordisk A/S through a margin-pressured quarter and into an upgraded full-year…
Key takeaways
- Novo Nordisk raised its 2026 outlook, reporting second-quarter adjusted sales of DKK 78.5 billion, up 7% at constant exchange rates.
- Oral Wegovy crossed 5 million total U.S. prescriptions within six months of launch and holds roughly 90% of the U.S. oral obesity-medication market.
- About 80% of Wegovy pill users are new to GLP-1 therapy, indicating market creation rather than patient switching.
- Adjusted gross margin fell to 78.2% from 82.7% a year earlier due to lower prices, currency effects, and a one-time manufacturing charge, though adjusted operating profit still rose 11% at constant exchange rates.
- The 2026 guidance explicitly assumes a U.S. sales decline amid competition, reduced Medicaid coverage, and most-favored-nation pricing agreements.
The global branded obesity-medication market grew volumes by roughly 70% from the second quarter of 2025, a demand environment that carried Novo Nordisk A/S through a margin-pressured quarter and into an upgraded full-year forecast. The Danish drugmaker reported second-quarter adjusted sales of DKK 78.5 billion, up 7% at constant exchange rates, as GLP-1 volume gains across its obesity and diabetes franchises offset lower realized prices and a DKK 3 billion one-time manufacturing-capacity charge.
Oral Wegovy captures 90% of a new U.S. market segment
Six months after launching in the United States, the oral formulation of Wegovy crossed 5 million total prescriptions and was running at 267,000 weekly prescriptions as of July 17, according to Jamey Millar, executive vice president of U.S. Operations. The product holds roughly 90% of the U.S. oral obesity-medication market despite a competitor entering in early April. About 80% of Wegovy pill users are new to GLP-1 therapy entirely, which points to market creation rather than a straightforward patient-switching dynamic.
Reimbursement remains limited. Most prescriptions in the oral channel are self-pay, and even in the injectable Wegovy franchise, the self-pay share has risen to about 35% of U.S. sales from roughly 10% to 15% a year ago. Millar said the company's Medicare Part D Bridge program for patients age 65 and older is running, though Novo Nordisk is still assessing whether early uptake will hold.
International rollout adds cross-border reach
Against the backdrop of U.S. pricing headwinds, the international picture offered a different read-through. International Operations GLP-1 sales climbed 13%, with the obesity franchise up 37%. Emil Kongshøj Larsen, executive vice president of International Operations, said Novo Nordisk holds about 58% of GLP-1 volume market share outside the United States, though that share has slipped in recent quarters.
The U.K. launch of Wegovy pill in early July drew approximately 300,000 patients within three weeks of broad availability, lifting Novo Nordisk's overall obesity market share in the country from around 30% to 45%, based on July IQVIA sell-in data to private providers and pharmacies. The company also launched in the United Arab Emirates and expects Germany to follow in September.
Margins under pressure, cost program ahead of schedule
The sector-wide pricing dynamic landed on the income statement. Adjusted gross margin declined to 78.2% from 82.7% a year earlier, weighed by lower realized prices, currency effects, and the one-time manufacturing charge. Chief Financial Officer Karsten Munk Knudsen said productivity gains and a favorable product mix partly offset those headwinds. Adjusted operating profit still rose 11% at constant exchange rates.
Novo Nordisk's DKK 8 billion cost-savings program is running ahead of schedule, with savings reinvested in research and commercial growth. Total headcount fell to approximately 66,700 full-time employees, down nearly 12,000 people (roughly 15%) from a year earlier.
Raised guidance, with a U.S. caveat attached
The 2026 guidance revision reflects stronger GLP-1 expectations, though the forecast explicitly assumes a sales decline in the United States. Intensifying competition, reduced Medicaid coverage for obesity drugs, and most-favored-nation pricing agreements with the U.S. administration all weigh on the second half. The approaching loss of semaglutide exclusivity in markets including Canada and Brazil is expected to have a greater effect later in the year and to continue into 2027. On the pipeline, the ZEUS cardiovascular outcomes trial of ziltivekimab did not meet its primary objective, reporting a hazard ratio for major adverse cardiovascular events of 0.99. The company's next potential growth catalyst is the anticipated U.S. regulatory decision on CagriSema in obesity near the end of 2026.
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