Novo Nordisk (NVO) Q3 2026 earnings review
Novo raises its outlook again, but US prices keep falling
Novo is selling far more medicine but earning little more for it, because US prices keep falling. Sales excluding one-offs rose 4% after stripping out currency moves, and the company added 1.3 million patients in the quarter. Chief executive Mike Doustdar raised the full-year outlook for a third time, but a DKK 8.7 billion write-down on a failed heart drug and spare factory capacity cut reported operating profit.
| Sales, excluding one-offs | DKK 79.2 billion +4% from a year ago at constant currency, +6% in kroner |
|---|---|
| Operating profit, excluding one-offs | DKK 31.7 billion +27% at constant currency against a quarter with DKK 9 billion of restructuring costs |
| People on Novo obesity drugs | 5.6 million about +75% from a year ago, by our math |
| Full-year sales outlook | Raised middle of the range: 0% growth, from -3% in August |
⚖️ Verdict: 🟢 Bullish
The story got better because volume now grows in both diabetes and obesity, and the outlook moved up again. Patient numbers fell early in the year; they have risen for two quarters running, and the Wegovy pill is on sale in eight countries ahead of plan. The bad news: Medicare's new Bridge programme did most of the US volume growth, and the rest of the US obesity market stood still from May to October. Beating what the August plan pointed to says that plan was cautious, not that the January price cuts have gone away.
The question now is whether lower prices can keep buying enough new patients to make 2027 a growth year. One answer is that the pill, the Medicare programme and the CagriSema launch add more than the January price cuts and generic semaglutide in Canada and China take away; the other is that revenue per patient falls faster than patient numbers rise. The 2027 outlook in February will tell.
🐂 Bull Case
Wegovy Pill Sales Rose Two-Thirds in a Quarter
Wegovy pill is Novo's once-daily weight-loss tablet, on sale in the US since January. Chief executive Mike Doustdar wants it to reach people who will not inject, and in September the Danish drugmaker promised to sell it in 20 countries by the end of 2027.
This quarter the tablet brought in DKK 5.4 billion, up from DKK 3.2 billion in the three months before. Novo launched it in Germany, Mexico, France, Spain and Poland, so eight countries now stock it. Emil Kongshøj Larsen, who runs the business outside the US, now expects more than 20 markets by mid-2027, six months early.
- Share of group sales: 6.8%, up from 4.1% last quarter, by our math
- Share of new prescriptions for oral obesity drugs: about 80% in the US and 90% in the UK
- Germany: about 100,000 packs sold in six weeks
- US: more than 8 million prescriptions since launch
The standing worry was that a rival tablet, on sale in the US since the spring, would take share and that weekly adds would slow. The share figures argue against the first part. The second part is showing in the UK, where Larsen described "a normalization in the uptake" as weekly packs eased to about 60,000 from 65,000 in September.
What to watch: fourth-quarter pill sales against this quarter's DKK 5.4 billion, due in February. A lower number would mean the first markets filled their pent-up demand faster than new countries add to it.
Novo Is Adding Patients in Diabetes Again
Novo counts how many people take its diabetes and obesity drugs, and early this year that figure fell as diabetes patients left. Since then the group added 1.2 million people in the second quarter and 1.3 million in the third, Doustdar said, so it now treats about 48 million.
Diabetes did the turning. After losing 0.8 million patients in the first quarter, that business added one million over the past two quarters. One reason is the US relaunch of the tablet Rybelsus under the Ozempic name: weekly new-patient starts on the oral franchise have doubled since the switch, and more than 60% of them are new to this class of drug, Jamey Millar, head of US operations, said.
What to watch: net patient additions in the fourth quarter. Another figure above one million would show the second-quarter turn was not a one-off.
Novo's August Plan Was Cautious
Novo only forecasts the full year, so the outlook it set in August carried a number for the second half. By our math, that outlook pointed to sales excluding one-offs falling about 5% in the second half, because last year's second half contained roughly DKK 5 billion of one-off rebate gains in the US.
The third quarter came in 6% higher in kroner instead, and finance chief Karsten Munk Knudsen raised the outlook for the third time this year. The three raises moved the middle of the sales range by 1, 5 and 3 percentage points. That says the August plan was cautious; it does not say the January price cuts weigh less, and Knudsen still said "we do have a tough comparator in the 4th quarter".
What to watch: the 2027 outlook in February. If Novo sets it with the same caution, a range centred below zero would again leave room to beat it.
🐻 Bear Case
US Volumes Grew, but US Sales Barely Did
"We delivered a stronger-than-expected third quarter and are raising our full-year outlook for adjusted sales and adjusted operating profit," chief executive Mike Doustdar said. US sales did grow, by 1% after stripping out currency moves. Volumes grew far faster: Wegovy injections rose about 10% from the previous quarter and the pill about 20%, Jamey Millar, head of US operations, said.
- Wegovy net price in the US: down 30% to 35% from a year ago, Millar said
- Ozempic net price: down 10% to 15% a year, a trend Millar expects to continue
- Pill prescriptions: about 90% paid in cash, outside insurance
The gap is price. Novo is trading price for volume through cash-pay channels and its pricing agreement with the US administration, so each new patient brings in less than the one before. In January the list price of Wegovy and Ozempic drops to USD 675 a month and Medicare's negotiated price for semaglutide takes effect. Millar said the Ozempic trend already reflects that, with "Price keeps coming down, net prices", but gave no figure for Wegovy.
What to watch: US sales growth in the first quarter of 2027, the first with the new list price. A decline there would mean the price reset is bigger than the pill and Medicare volume can cover.
Medicare's Bridge Programme Did the US Growth
Since July a US government pilot, the Medicare Bridge, lets older Americans get Wegovy through Medicare Part D, and it runs until the end of 2027. Millar said the programme now fills about 60,000 prescriptions a week across the injection and the pill, and that the quarter's 20% volume growth was "largely but not exclusively Bridge volume".
Strip it out and "the whole category is relatively flat" from May to October, Millar said, for Novo and its rivals alike. Employers are the reason: companies such as Pepsi and Starbucks have pulled coverage because the cost of treating so many people rises even as net prices fall. So the one growing US channel is a temporary government programme.
What to watch: Millar's next Bridge figure and whether Washington extends the pilot beyond 2027. Flat prescriptions outside Bridge for another quarter would mean US obesity demand has stopped growing at current prices.
Write-downs Cut Reported Profit by DKK 8.7 Billion
Two standing risks turned into charges this quarter. Novo wrote off DKK 4.6 billion on ziltivekimab, a heart drug whose main trial failed in the summer, and DKK 4.1 billion for "right-sizing of manufacturing network", factory capacity built for a shortage that no longer exists. Reported operating profit fell 9% at constant currency and net profit 17% in kroner, by our math.
The figure the Danish drugmaker asks readers to use excludes those charges, and on that basis operating profit rose 27% against a year-ago quarter that carried about DKK 9 billion of restructuring costs. Even that number includes DKK 3.5 billion of one-time costs, Knudsen said, so comparing it with a quarter full of one-offs flatters the growth rate. The write-offs follow DKK 6.3 billion of pipeline impairments last quarter.
What to watch: further impairments on acquired assets, and the factory spending line, which Novo just trimmed to around DKK 50 billion for the year. Another right-sizing charge would say the capacity problem is bigger than one quarter's fix.
Generic Semaglutide Is Cutting Prices in Canada
Semaglutide, the molecule in Ozempic and Wegovy, lost patent protection in Canada and Brazil this year, and generic makers have moved in. Larsen said Canada was "negatively impacted by lower realized prices following the loss of exclusivity for semaglutide", and Knudsen said the hit will be bigger in the fourth quarter than in the first nine months.
So far the rest of the region carries it: Europe and Canada together grew 18%, while Asia-Pacific fell 7% and China 2%. Doustdar told analysts to "annualize that and see how that goes" for 2027, and added that China loses exclusivity next year. Novo's own slides put price declines in early generic markets at 50% to 70%.
What to watch: growth in Europe and Canada in the fourth quarter against this quarter's 18%. A sharp drop would mean the Canadian price cuts outweigh the pill launches across Europe.
👓 Other Themes
Finance Chief Karsten Munk Knudsen Is Leaving
Knudsen, finance chief for nine years and at Novo for 27, leaves at the end of the year. Doustdar said "Luigi joins us from Galderma as CFO", meaning Luigi La Corte, finance chief of the skincare group. The timing matters because La Corte will present the 2027 outlook in February, the first after the US price reset.
CagriSema and Frehemgo Launches Are Being Prepared
Novo expects a US decision on CagriSema, its combination of semaglutide and the amylin drug cagrilintide, in the fourth quarter and plans a launch across all channels early in 2027. New trial data showed 21% weight loss at a low dose. Frehemgo, a haemophilia drug, won a positive EU opinion in September and launches in Europe around the turn of the year.
💲 Other KPIs
Faster than last quarter's 16%, and the fastest-growing part of Novo. Obesity drugs now reach 5.6 million people, up about 75% from a year ago by our math, so revenue per patient keeps falling even as the total grows. Outside the US obesity sales rose 24%.
Back up after two weaker quarters: 80.6% in the first quarter and 78.2% in the second. The cost of making the products as a share of sales fell as the pill and the high-dose pen scaled; Novo aims to hold this margin broadly stable to 2030.
Selling costs fell 9% at constant currency and took 2.4 percentage points less of sales than a year ago, the clearest sign of the 2025 job cuts. Knudsen said the savings now fund research and marketing, which is why the full-year profit plan rose no faster than the sales plan.
Cash after factory spending fell 13% from a year ago by our math, but the nine-month total reached about DKK 84 billion. That is above the whole-year range Novo just raised, so the plan assumes a cash outflow in the fourth quarter.
🔮 Guidance
Raised. The plan now has sales excluding one-offs about flat for the year after currency moves, up from a 3% decline in August. By our math that leaves the fourth quarter at roughly -1% in the middle of the range, anywhere from -8% to +7%. Knudsen said the fourth quarter laps about DKK 3 billion of US rebate gains and takes a bigger hit from generic semaglutide in Canada. Third raise this year; the moves were +1, +5 and +3 points.
Raised. Profit excluding one-offs is now planned flat for the year, against a 3% decline in August. The catch is the fourth quarter: by our math the middle of the range implies operating profit of about DKK 27 billion, 15% below a year ago, with a margin near 34%. Knudsen put the reason down to "targeted investments in current and future growth opportunities within R&D and commercial", partly funded by savings from the 2025 restructuring.
Raised. Novo now expects DKK 60 to 70 billion of cash after factory spending this year, DKK 15 billion more than in August. By our math the first nine months already produced about DKK 84 billion, so the range implies an outflow of DKK 14 to 24 billion in the fourth quarter. Last year's fourth quarter was also negative, at about DKK 11 billion on the same definition; this one would be larger, and management did not explain it.
Cut. Novo trimmed factory spending for the year by DKK 5 billion, after DKK 60 billion in 2025. The first half absorbed DKK 24 billion, so the plan leaves about DKK 26 billion for the second half. It is the second trim in a year and sits beside the DKK 4.1 billion write-down for spare manufacturing capacity.
Cut. The expected net financial loss widened by DKK 0.5 billion, the second worsening this year after February's plan for a gain of DKK 2.3 billion. Net interest on borrowings outweighs currency hedging gains.
Unchanged. The first-half rate of 21.9% sat in the middle of the range, so nothing in the fourth quarter needs to move for Novo to land inside it.
❓ Key Questions
Where does DKK 84 billion of cash go in the fourth quarter?
By our math nine-month free cash flow already exceeds the raised full-year range, which implies a DKK 14 to 24 billion outflow. Management did not say whether rebate payments, tax, deals or a definitional difference explain it.
How much US volume grows without the Medicare Bridge?
Millar said the category is flat from May to October once Bridge is removed, and the pilot ends in December 2027. Investors need the ex-Bridge growth rate to judge what the US business does after it.
What does January's price reset do to US Wegovy sales?
Millar said the Ozempic trend already absorbs Medicare's negotiated price, but gave no net figure for Wegovy, whose list price falls about half. The first-quarter 2027 outlook depends on this number.
What share of US Wegovy injectable is now self-pay?
Last quarter management put it at about 35%; this quarter it gave a net price decline of 30% to 35% instead. The share determines how much more price can fall as cash channels grow.
What are the fourth-quarter investments that cut profit 15%?
The full-year profit plan implies fourth-quarter operating profit about 15% below a year ago, by our math. Knudsen cited targeted R&D and commercial spending without sizing it or saying whether it continues into 2027.