Novo Nordisk (NVO) Q4 2025 earnings review
Growth Slows to a Crawl, 2026 Guidance Signals Contraction
Novo Nordisk delivered 10% sales growth at CER for FY2025 but only 6% as reported in DKK, a sharp deceleration from 26% in 2024. Operating profit grew just 6% at CER, dragged by DKK 8B in restructuring costs, Catalent-related depreciation, and competitive pressure. Q4 was outright ugly: sales fell 2% at CER and 8% as reported. Diluted EPS rose only 2% to DKK 23.03. The 2026 outlook is the harshest in a decade: adjusted sales and operating profit both guided to decline 5-13% at CER. The CFO confirmed US sales will decline in the teens, driven primarily by price, while IO grows mid-single digits. Bright spots include the Wegovy pill launch (170,000+ patients on therapy by early February, over 2x the uptake of any prior AOM launch) and semaglutide 7.2mg approval expected Q1 2026. A USD 4.2B 340B provision reversal will flatter reported numbers. Two key executives — EVP US Operations and EVP Product Strategy — are departing, replaced by external hires from UnitedHealth/Optum and Merck. Capital Markets Day set for 21 September 2026 in London.
🐂 Bull Case
The Wegovy pill hit ~50,000 weekly prescriptions within 3 weeks and 170,000+ cumulative patients by early February — over 2x the uptake of any prior AOM launch in the US. The CEO stated it delivers 35% greater weight loss than Orforglipron in cross-trial comparisons. Most prescriptions are for patients new to GLP-1 therapy, suggesting genuine market expansion rather than cannibalization. Commercial access is building fast: CVS, Prime, Optum, and Anthem now covering — reaching just under half the covered lives of injectable Wegovy already.
FY2025 Obesity care sales reached DKK 82.3B, up 31% at CER. IO obesity surged 73% at CER with Wegovy launched in 35 new countries in 2025, more than tripling 2024 launches. IO Wegovy sales hit DKK 28B, growing 134%. Combined injectable+pill Wegovy is now the leading AOM by new-to-brand prescriptions in the US at 75,000+ weekly NBRx. The branded AOM market doubled in 2025 to ~735,000 weekly prescriptions.
Semaglutide 7.2mg approval expected Q1 2026 with immediate launch readiness — positions sema 'on par' with tirzepatide on weight loss plus CV/kidney/liver benefits. REDEFINE 4 (CagriSema vs tirzepatide head-to-head) results due Q1 2026. Zenagamtide Phase 3 initiating: AMAZE in obesity Q1 2026, AMBITION in T2D H2 2026. Internal tri-agonist (GLP-1/GIP/amylin) showed promising -5.3% body weight at just 4 weeks in Phase 1. CagriSema US FDA submission complete.
🐻 Bear Case
The CFO explicitly confirmed US sales will fall in the teens in 2026, driven almost entirely by price declines — not volume. MFN impact is 'low single-digit on group, roughly double on US.' Self-pay channel price elasticity remains unknown. Injectable Wegovy prescriptions are declining at the start of 2026 due to benefit changes and Medicaid coverage drops, including California. The Wegovy pill, while booming, generates far lower revenue per patient ($149-$299/month vs $1,349 list). Medicare Part D upside will be 'limited this year' with material benefit only in 2027.
Adjusted 2026 sales and EBIT both guided -5% to -13% CER. The CEO described the process as midpoint ± 4 points, implying a -9% central case. This reflects a toxic combination: MFN pricing, semaglutide patent expiry starting Q2 in IO (Canada the biggest contributor), non-recurrence of 2025 US gross-to-net benefits, Medicaid coverage cuts, and competition. Self-pay channel dynamics add a layer of unpredictability.
The heads of both US Operations (Dave Moore) and Product/Portfolio Strategy (Ludovic Helfgott) are leaving, replaced by external hires effective February 2026. While the replacements bring relevant experience (Jamey Millar from UnitedHealth/Optum, Hong Chow from Merck), the dual departure during the most challenging operating environment in years adds execution risk. The incoming US head inherits a market facing teens-level sales declines from day one.
⚖️ Verdict: 🔴
Bearish. FY2025 shows decelerating growth, margin compression, and a troubled US market. The earnings call confirmed the worst fears: US sales declining in the teens, IO growing mid-single digits, and self-pay price elasticity still unknown. Wegovy pill is a genuine bright spot with record uptake, but at dramatically lower revenue per patient. The dual executive departure adds execution risk at the worst possible time. The 2026 pipeline catalyst slate (7.2mg approval, REDEFINE 4 readout, zenagamtide Phase 3 start) offers medium-term hope, but near-term financials will deteriorate. The 340B windfall is accounting, not operating improvement.
Key Themes
MFN Agreement and Pricing Headwinds Reshape US Economics
In November 2025, Novo Nordisk signed the MFN agreement with the US Administration, covering Wegovy and Ozempic in Medicare Part D, Medicaid, and the self-pay channel. The CFO confirmed on the earnings call that MFN will have a 'low single-digit impact on group sales, meaning roughly double on US,' making it the primary driver of US sales declining in the teens in 2026. US decline is driven overwhelmingly by price, not volume. Self-pay now makes up ~30% of injectable Wegovy prescriptions and ~120,000 weekly TRx across Wegovy and Ozempic. The self-pay introductory offer of $199/month launched in November 2025 accelerates price dilution. The CFO acknowledged that 'price elasticity in the self-pay channel is something we are still exploring,' adding uncertainty. Combined with semaglutide products entering IRA price negotiations (effective Jan 2027), the multi-year pricing trajectory is firmly negative.
US GLP-1 Diabetes Franchise in Decline
US GLP-1 diabetes sales fell 6% at CER in Q4 and grew only 5% at CER for FY2025 — a fraction of 24% in 2024. Dave Moore confirmed weekly Ozempic prescriptions are ~610,000, with the GLP-1 diabetes market growing 'just over 10%' in Q4 — meaning Novo is losing share even as the market expands. Ozempic self-pay is only ~8,000 Rx/week, a small fraction of the total. Novo Nordisk's global GLP-1 diabetes value share fell from 55.1% to 45.8% over 12 months. The updated Rybelsus formulation ('Ozempic pill') was just approved by FDA, but the CFO's guidance implies US diabetes will continue declining in 2026 as MFN amplifies pricing pressure.
Wegovy Pill: Record-Breaking Launch Expands the Market
FDA approved oral semaglutide 25mg (Wegovy pill) on 22 December 2025, launched 5 January 2026. By 23 January, weekly prescriptions reached ~50,000, of which ~45,000 via self-pay — over 2x the uptake of any prior AOM launch in the US. By early February, 170,000+ cumulative patients were on the pill. Dave Moore stated 'most prescriptions appear to be for patients new to these medications,' suggesting genuine market expansion. The CEO positioned the pill as delivering '35% greater reported weight loss' than Orforglipron in cross-trial comparisons. Commercial access is building rapidly: CVS from launch, with Prime, Optum, and Anthem added in January, covering just under half the insured lives of injectable Wegovy. EU submission has been filed. The pricing is disruptive at $149-$299/month, and combined injectable+pill Wegovy now leads all AOMs by new-to-brand prescriptions at >75,000 weekly NBRx.
International Obesity Expansion Accelerating
IO obesity sales surged 73% at CER to DKK 31.1B. Wegovy was launched in 35 new countries in 2025, more than tripling 2024 launches. IO Wegovy sales reached DKK 28B, growing 134% at CER. Novo Nordisk remains the IO GLP-1 market leader with 62% volume share. The CFO guided IO to mid-single-digit growth in 2026 (from 8% Q4 run rate, adjusted for patent expiry). EUCAN grew 62%, Emerging Markets 59%, APAC 122%, and China added DKK 824M. The IO branded obesity market grew 97% by volume. Wegovy 7.2mg received positive CHMP opinion, and Novo expects further IO launches in 2026. IO is now 38% of total obesity sales, up from 28% in 2024.
CagriSema, 7.2mg Approval, and Stacked Pipeline Catalysts
The earnings call added critical detail on near-term pipeline catalysts. Semaglutide 7.2mg: filed under CNPV, approval expected Q1 2026, 'ready to launch immediately' in same pen devices. The CEO positioned it as 'very close on par with tirzepatide' at 20% weight loss, plus CV/kidney/liver benefits competitors lack. REDEFINE 4 (CagriSema vs tirzepatide head-to-head in obesity): results due Q1 2026, testing non-inferiority first then superiority, 84-week duration with ~800 participants. REIMAGINE 1 (CagriSema pivotal in obesity) also due Q1 2026. Zenagamtide: AMAZE Phase 3 in obesity initiating Q1 2026, AMBITION Phase 3 in T2D initiating H2 2026, both exploring doses up to 40mg. Internal tri-agonist (GLP-1/GIP/amylin): Phase 1 completed with -3.6% to -5.3% body weight at 4 weeks; Phase 1b/2a in obesity initiated, readout H1 2027. UBT251: Phase 2 data expected H1 2026 in Chinese T2D and obesity populations.
Semaglutide Patent Expiry: Canada Delays but IO Erosion Continues
The semaglutide compound patent is expiring in certain IO markets, explicitly cited as a driver of negative 2026 outlook. The CFO confirmed sema LOE will have a 'low single-digit' impact on group sales, with Canada the biggest contributor. A new data point from the call: an analyst revealed that all semaglutide generics in Canada have received 'notices of deficiency' from Health Canada and are not expected until H2 rather than H1 2026 — a potential upside to guidance timing. The CFO acknowledged timing uncertainty but did not change the direction of travel. IO GLP-1 diabetes value share collapsed 21.7pp from 67.6% to 45.9% over 12 months, reflecting both tirzepatide competition and patent erosion. LOE impacts in IO begin from Q2 2026 according to the CEO.
Compounding Persists: No Change Despite Pill Launch
Dave Moore confirmed on the call that the compounding market remains 'relatively stable' despite the Wegovy pill launch and lower self-pay pricing. 'We haven't seen a change yet. It's early days.' While 170,000+ patients are now on the Wegovy pill, longitudinal data on switching from compounders is unavailable. An estimated 1+ million US patients remain on compounded GLP-1s. The Strive antitrust lawsuit filed January 2026 adds legal complexity. The persistence of compounding despite FDA enforcement action expiry (May 2025) and a competitively priced branded alternative is a material headwind for Novo's self-pay economics.
Gross Margin Deterioration Not Yet Bottoming
FY2025 gross margin fell to 81.0% from 84.7% in 2024, a 370bps decline. The CFO attributed it to Catalent site amortisation/depreciation, DKK 3B+ restructuring costs in COGS, and capacity expansion. With 2026 bringing lower US realised prices (MFN, self-pay mix shift, Wegovy pill at drastically lower price points), ongoing CapEx-driven depreciation (DKK 55B guided), and rising self-pay channel mix, margin recovery will be slow. Operating margin fell from 44.2% to 41.3%. The only offset is DKK 8B annualised restructuring savings expected by end-2026.
Executive Turnover: Two Key Leaders Depart During Crisis Year
Both EVP US Operations (Dave Moore) and EVP Product & Portfolio Strategy (Ludovic Helfgott) are leaving — Moore for 'personal reasons' after 8+ years, Helfgott to 'pursue new opportunities' after a shorter tenure. Replacements are external: Jamey Millar joins as US head effective 5 February from UnitedHealth Group where he was CEO of Optum Specialty Holdings — bringing deep market access expertise critical for navigating MFN and Medicare Part D. Hong Chow joins as Product Strategy head effective 15 February from Merck Healthcare, bringing global cardiovascular and metabolic portfolio experience. Both departing executives will transition through end Q1 2026. A Capital Markets Day is set for 21 September 2026 in London, where new strategic aspirations will be introduced — the first update since 2019's targets that were concluded in 2025.
Company-Wide Transformation: DKK 8B Cost, 9,000 Jobs Cut
The restructuring announced in Q3 2025 cost DKK 8B and eliminated 9,000 positions (10% reduction to 68,794 FTE). The CFO confirmed excluding restructuring, operating profit would have grown 13% at CER vs reported 6%. Expected DKK 8B in annualised savings by end-2026, earmarked for reinvestment in R&D and commercial activities, particularly the Wegovy pill launch and late-stage pipeline trials. This is positioned as sharpening focus on core obesity/diabetes therapy areas.
Medicaid Coverage Cuts Including California
Dave Moore confirmed on the call that 'several states have decided to not cover AOMs,' explicitly naming California as a major loss. The CFO cited this as a headwind in the 2026 US outlook. The presentation shows all 50 states cover Wegovy for the CV indication, but obesity-specific coverage has been cut. Injectable Wegovy prescriptions are declining at the start of 2026, 'largely attributed to benefit changes at the turn of the year.' Moore indicated Novo will 're-engage with those states' to restore coverage at lower prices, but the near-term impact is negative. Estimated coverage for obesity dropped from 10+ million people at Q3 2025.
R&D Setbacks and Portfolio Pruning Offset by New Programmes
Evoke/Evoke+ Alzheimer's trials failed. Terminated programmes include GLP-1/GIP co-agonist, oral NLRP3 inhibitor, Pumpsulin, and others. R&D costs reached DKK 52B (16.8% of sales). However, 2026 brings an exceptional catalyst slate: sema 7.2mg US decision Q1, REDEFINE 4 readout Q1, REIMAGINE 1 readout Q1, Etavopivat HIBISCUS Q2, Ziltivekimab SOUL H2, Denecimig regulatory decisions H2, plus zenagamtide Phase 3 initiations. The CSO highlighted the internal tri-agonist (GLP-1/GIP/amylin) Phase 1 success as 'confirming our belief in the potential for high weight loss efficacy' — a potential third-generation asset.
Shareholder Returns Exceed DKK 60B with Buyback Resumption
Total cash returns to shareholders in 2026 expected to exceed DKK 60B. DKK 15B buyback programme approved for 12 months starting February 2026 — the first since suspension for Catalent/CapEx. Total 2025 dividend of DKK 11.70/share (DKK 52B, +2.6% YoY), marking the 30th consecutive year of dividend increases. The CFO noted cash from operations of ~DKK 120B in 2025 supported DKK 60B CapEx and DKK 52B dividends. CapEx is declining ('first step down' to DKK 55B, 'steeper slope in coming years' ahead), and new API facilities expected online in 2026.
Other KPIs
Sales declined 8% as reported and 2% at CER — the first negative CER quarter in years. US Operations fell 7% at CER driven by pricing across all segments: GLP-1 diabetes -6%, Obesity -4%, Insulin -24%. IO grew 8% at CER but decelerated from 10% in H2 2025. The CFO confirmed Q4 run rates form the baseline for 2026 guidance, with IO at mid-single-digit growth after LOE adjustment and US in the teens decline.
Net profit rose only 1%, with margin compressed to 33.1% from 34.8%. Adjusted net profit (excluding DKK 8B restructuring, amortisation, impairments): DKK 116.4B, +5%. Diluted EPS +2% to DKK 23.03; adjusted EPS +6% to DKK 26.17. The CFO noted that excluding restructuring, operating profit would have grown 6% in DKK and 13% at CER.
Recovery from negative DKK 14.7B in 2024 (Catalent acquisition). The CFO stated Novo generated 'close to DKK 120 billion in cash from operating activities,' deployed ~DKK 60B on CapEx and ~DKK 30B on business development (Akero). 2026 FCF guided DKK 35-45B on a new simplified definition (operating CF minus PP&E CapEx only). CapEx declining to ~DKK 55B as a 'first step down' with 'steeper slope in coming years.' New major API facilities expected online in 2026.
Up 8% as reported and 10% at CER. The increase reflects late-stage clinical trials and early research investments. Q4 R&D was DKK 14.6B (18.5% of sales). The CSO outlined a packed 2026 catalyst schedule: sema 7.2mg US decision Q1, REDEFINE 4 Q1, REIMAGINE 1 Q1, zenagamtide Phase 3 starts (AMAZE Q1, AMBITION H2), Ziltivekimab SOUL H2, Etavopivat HIBISCUS Q2, Denecimig decisions H2. R&D intensity to remain elevated as CagriSema and zenagamtide enter large Phase 3 programmes.
Net debt rose from DKK 69.7B at end-2024 to DKK 95.4B, driven by Akero (DKK 30B intangibles) and CapEx. Total borrowings DKK 131.0B. Cash DKK 26.5B. Equity ratio improved to 35.7% from 30.8%. Inventories increased 21% to DKK 49.6B. Despite elevated debt, 2026 FCF of DKK 35-45B plus CapEx step-down supports total shareholder returns exceeding DKK 60B.
Guidance
The CFO provided key regional granularity: IO expected to grow mid-single digits (from 8% Q4 run rate, adjusted for LOE), while US declines in the teens. US decline driven primarily by price: MFN ('low single-digit on group, roughly double on US'), self-pay channel mix, non-recurrence of 2025 GTN benefits, and Medicaid coverage cuts. Wegovy pill uptake reflected 'based on a range of assumptions related to market penetration, potential negative impact on injectable category, and channel mix.' Canada generic delays (notices of deficiency, H2 not H1) represent potential timing upside. Medicare Part D benefit 'limited this year, bigger into 2027.' On non-adjusted basis (including USD 4.2B 340B reversal), midpoint is -1% CER.
Mirrors sales outlook. The CFO noted it 'primarily reflects the sales growth outlook combined with targeted investments in current and future growth opportunities within R&D and commercial.' The DKK 8B restructuring savings will fund Wegovy pill commercial investment and late-stage pipeline trials. The CEO described the guidance methodology as midpoint ± 4 points, calibrated from Q4 run rates plus assumptions on new variables. On a non-adjusted basis, midpoint is +11% CER (340B reversal). Akero adds ~3pp negative drag.
New definition: operating CF minus PP&E CapEx only. CapEx declining to ~DKK 55B ('first step down' from DKK 60B, 'steeper slope in coming years' ahead as expansion projects finalise). New major API facilities expected online in 2026. Lower US sales and GTN cash implications are a headwind, offset by CapEx reduction and restructuring savings. Sufficient to fund total shareholder returns exceeding DKK 60B (DKK 52B+ dividends + DKK 15B buyback).
Financial items gain reflects hedging on USD, offset by net debt interest. Down from DKK 2.9B in 2025. Effective tax rate stable at 21-23%. Hedging covers 12 months for USD, CNY, JPY. A 5% USD move impacts adjusted operating profit by DKK 4.3B. DKK currently weak vs USD, adding 3pp drag on reported sales growth vs CER and 5pp on operating profit.
Key Questions
Wegovy Pill Cannibalization vs Market Expansion
Dave Moore said most pill prescriptions are from 'patients new to these medications,' but the CFO acknowledged cannibalization of injectable category is a risk factor built into guidance. With 170,000+ cumulative patients in ~4 weeks, what is the verified split between truly new-to-therapy patients vs switches from injectable Wegovy, injectable tirzepatide, or compounding? What is the net revenue impact per patient switching from injectable ($1,349 list) to pill ($149-$299)?
US Sales 'Teens' Decline: Volume vs Price Decomposition
The CFO confirmed US sales decline is in the teens, driven 'primarily by price.' Can management quantify the specific pricing headwinds? How much is MFN (estimated 'roughly double low single-digit on US' = ~mid-single-digit), how much is self-pay channel mix shift, how much is Medicaid losses, and how much is GTN non-recurrence? Is underlying US volume growth still positive?
Self-Pay Price Elasticity
The CFO stated price elasticity in the self-pay channel is 'something we are still exploring.' With ~120,000 weekly self-pay TRx across Wegovy and Ozempic, and self-pay comprising ~30% of injectable Wegovy, what early data exists on volume response curves at different price points? Is there a price point where volume gains offset revenue per prescription losses?
Canada Generics Timing and IO LOE Quantification
An analyst revealed all semaglutide generics in Canada received notices of deficiency from Health Canada, pushing launches to H2 from H1 2026. Canada is the biggest contributor to LOE impact. What is the specific revenue exposure in Canada? Does the H2 delay materially change the 'low single-digit' group impact for 2026, or is it already embedded as a range variable?
REDEFINE 4: Head-to-Head Implications
The CSO confirmed REDEFINE 4 (CagriSema vs tirzepatide, 84 weeks, ~800 participants) tests non-inferiority first then superiority. Results due Q1 2026. If CagriSema shows non-inferiority but not superiority, is that commercially sufficient for the obesity franchise? How does this interact with REDEFINE 11 (higher weight-loss potential, early 2027 readout) and the planned CagriSema high-dose Phase 3 later in 2026?