Novo Nordisk Pipeline: What Comes After Wegovy in 2026 and Beyond

Novo Nordisk’s next chapter after Wegovy is already underway. In 2026 the company launched two new semaglutide products in the US — the Wegovy pill (approved December 22, 2025, launched January 5, 2026) and a higher-dose injectable, Wegovy HD at 7.2 mg (approved March 19, 2026, launched April 7, 2026) ^[2][7][8][1]. The next decision on the calendar is CagriSema, a once-weekly injection that combines semaglutide with a new amylin analog called cagrilintide; its US FDA decision is expected in Q4 2026 ^[1][4][5]. Behind that sits zenagamtide, a single molecule that targets both GLP-1 and amylin receptors, which entered phase 3 in 2026 ^[1][6]. Not everything has worked: Alzheimer’s, cardiovascular inflammation, and monlunabant programs all failed or were stopped in the past year ^{[10][11][22][1]}. In the US, semaglutide patent protection runs to 2032, though generics arrived in eight other countries in 2026 ^[20][16].

Why does the Novo Nordisk pipeline matter so much right now?

Novo Nordisk’s business is concentrated in semaglutide. Of the company’s DKK 309.1 billion in 2025 net sales, Ozempic brought in DKK 127,089 million, Wegovy DKK 79,106 million, and Rybelsus DKK 22,093 million ^[2]. That concentration is why pipeline wins and losses move the stock so sharply.

In February 2026, the company guided for 2026 adjusted sales of -5% to -13% at constant exchange rates, citing lower realized prices including the US “Most Favoured Nations” agreement, the semaglutide patent expiry in certain international markets, and competition ^[2]. By August 2026, on stronger GLP-1 volumes, it raised that guidance to 0% to -6% ^[1]. The stock had fallen roughly 50% in 2025, and on February 23, 2026 — the day the CagriSema head-to-head result landed — shares closed down 16.5% at DKK 251, their lowest level since June 2021 ^[5].

What is the Wegovy pill, and what did the trial show?

The Wegovy pill is once-daily oral semaglutide 25 mg, the first oral GLP-1 approved for obesity. The FDA approved it on December 22, 2025, and it launched in the US on January 5, 2026. It is also indicated to reduce the risk of major adverse cardiovascular events such as death, heart attack, or stroke ^[2][7].

The approval rested on the OASIS 4 trial, which ran 64 weeks. Among people who adhered to treatment, the pill produced 16.6% average weight loss versus 2.7% for placebo, and 34.4% of participants lost at least 20% of their body weight ^[18][7]. Measured regardless of whether everyone stayed on treatment, weight loss was 13.6% versus 2.4% for placebo ^[7].

The pill comes in 1.5 mg, 4 mg, 9 mg, and 25 mg strengths ^[7]. For patients paying cash without insurance, the monthly price is $149 for the 1.5 mg starter dose, $199 for the 4 mg dose (after April 15, 2026), and $299 for the highest doses — a range of $149 to $299 per month depending on dose ^[7][1]. It is available at more than 70,000 US pharmacies and through nine telehealth organizations, and it received EMA approval in July 2026 ^[1].

How fast is the Wegovy pill selling?

The answer depends on who is counting. Novo Nordisk’s own figures show total weekly prescriptions exceeding 265,000 for the week ending July 17, 2026, with more than 5 million prescriptions since launch, around 2.9 million of them in Q2 2026. The company calls it the strongest-ever US GLP-1 volume launch and says external data providers are still improving how well they capture these prescriptions ^[1]. At the ADA conference in June 2026, the company said the pill had passed 3 million prescriptions and that more than 80% of them went to patients new to the GLP-1 class — a company claim ^[14].

IQVIA data, as cited by Citi in a September 11, 2026 update, showed roughly 183,000 weekly prescriptions for the Wegovy pill (181,000 the prior week), up from roughly 172,000 in late July. Lilly’s oral drug Foundayo recorded 47,500 scripts in the same update ^[19]. These IQVIA figures are from different weeks than the company’s July 17 number and are not directly comparable.

Per that IQVIA data, the pill accounts for about 35% of all Wegovy prescriptions. Total Wegovy prescriptions run about 513,500 per week, versus roughly 772,000 for Lilly’s Zepbound, and the US obesity market splits roughly 60% Lilly to 40% Novo ^[19].

What is Wegovy HD (7.2 mg)?

Wegovy HD is a higher-dose injectable version of semaglutide at 7.2 mg once weekly. The FDA approved it on March 19, 2026 — the first GLP-1 approval under the FDA Commissioner’s National Priority Voucher pilot program — and Novo Nordisk launched it in the US on April 7, 2026 ^[8][1].

In the STEP UP trial, which ran 72 weeks in about 1,400 adults with obesity, semaglutide 7.2 mg produced 20.7% mean weight loss if all participants adhered to treatment, and 18.7% regardless of adherence; 31.2% of participants lost at least 25% of their body weight ^[8]. In the STEP UP T2D trial of about 500 adults with obesity and type 2 diabetes, mean weight loss was 14.1% ^[8]. The 7.2 mg single-dose pen received EMA approval in July 2026 and has been available in the UK since June 1, 2026 ^[1].

What happened to Rybelsus and the Ozempic pill?

On February 4, 2026, Novo Nordisk announced the FDA had approved Ozempic tablets in 1.5 mg, 4 mg, and 9 mg doses, based on a bioequivalence study plus the existing Rybelsus trial data. Rybelsus tablets at 3 mg, 7 mg, and 14 mg have been available since 2019 ^[9]. The company made Ozempic pill available nationwide in the US on May 4, 2026 ^[1].

The reasoning, per Novo Nordisk: patients often asked whether an oral Ozempic existed without realizing Rybelsus was that option, so the better-known name should carry it ^[9]. A 25 mg dose of the Ozempic pill is pending, with an FDA decision expected in Q4 2026 ^[1][9]. Rybelsus still appears in the company’s Q2 2026 sales reporting, in a combined line with the Ozempic pill ^[1].

What is CagriSema, and how is it different from Wegovy?

CagriSema is a once-weekly injection that combines two drugs in one fixed dose: cagrilintide 2.4 mg, a long-acting amylin analog, plus semaglutide 2.4 mg. Amylin is a hormone released in the pancreas that affects appetite ^[3][5]. Novo Nordisk filed its US new drug application on December 18, 2025 ^[3].

The filing is built on the REDEFINE program. In REDEFINE 1, a 68-week trial in 3,417 adults with obesity or overweight, CagriSema produced 20.4% weight loss versus 3.0% for placebo regardless of adherence, and 22.7% versus 2.3% if everyone stayed on treatment. Some 91.9% of CagriSema participants lost at least 5% of body weight, versus 31.5% on placebo ^[3]. REDEFINE 2 studied 1,206 adults with type 2 diabetes, and the lower-dose REDEFINE 9 trial (1.0/1.0 mg and 1.7/1.7 mg) showed weight loss superior to placebo ^[3][1].

How did CagriSema do against Lilly’s Zepbound?

In the REDEFINE 4 head-to-head, announced February 23, 2026, CagriSema did not meet its primary goal of showing it was not inferior to tirzepatide (the ingredient in Zepbound). Over 84 weeks in 809 participants in an open-label trial, CagriSema produced 23% weight loss versus 25.5% for tirzepatide 15 mg; regardless of adherence, the figures were 20.2% versus 23.6% ^[4][5][14].

Novo Nordisk’s chief scientific officer, Martin Holst Lange, said tirzepatide performed unusually well in this trial, that the open-label design — where participants knew which drug they received — may bias results toward the better-known product, and that more tirzepatide patients reached the full 15 mg dose ^[4][5]. In the type 2 diabetes head-to-head REIMAGINE 4, CagriSema was non-inferior to tirzepatide on weight (15.2% versus 15.8%) but not on HbA1c reduction (1.9 versus 2.2 percentage points) ^[1].

Next in the program: REDEFINE 11, testing a higher dose against placebo, reads out in the first half of 2027, and a phase 3 trial of CagriSema 2.4/7.2 mg versus both CagriSema 2.4/2.4 mg and semaglutide 7.2 mg reads out in the first half of 2028 ^[4][1]. CEO Mike Doustdar has pushed back on the focus on a single number, calling CagriSema a combination of “the best of the two worlds” ^[14]. Jefferies analyst Michael Leuchten estimated CagriSema could account for 15% to 25% of Novo Nordisk’s revenue by 2030 — an analyst estimate, not a company figure ^[5].

What is zenagamtide (formerly amycretin)?

Zenagamtide is the new name for amycretin. It is a single molecule that acts as an agonist at both GLP-1 and amylin receptors, and it is under investigation in both oral and subcutaneous forms ^[6].

At the ADA conference on June 5, 2026, Novo Nordisk reported phase 2 results in 262 adults with type 2 diabetes, testing six subcutaneous doses from 0.4 mg to 40 mg over 36 weeks. The highest dose produced weight loss up to 14.6% versus 2.1% for placebo, with no apparent weight loss plateau at week 36. A1C fell by up to 1.71 percentage points from a baseline of 7.8%, and up to 89.1% of participants reached A1C below 7% ^[6]. The most common side effects were gastrointestinal and mostly mild to moderate, and a phase 3 program in type 2 diabetes is planned for the second half of 2026 ^[6].

In obesity, the AMAZE phase 3 program was initiated in the first half of 2026. AMAZE 8 compares zenagamtide with semaglutide over two years and reads out in the first half of 2029. A heart failure outcomes trial, HF-POLARIS, plans to enroll about 5,600 people with HFpEF or mildly reduced ejection fraction and obesity and reads out in the second half of 2029 ^[1].

What else is in the obesity and metabolic pipeline?

Cagrilintide on its own — the amylin analog inside CagriSema — has its own phase 3 program, initiated in 2025, with a high-dose phase 3 start expected in Q4 2026. Doustdar has framed it as a lower-efficacy, better-tolerability option for people who want less nausea and vomiting ^[2][1][14].

UBT251, an in-licensed triple agonist, completed a phase 2 trial in China, and a new phase 2 trial in about 300 people with overweight or obesity and type 2 diabetes runs up to 40 weeks with a readout expected at the end of 2027 ^[1][2]. A second triple agonist targeting amylin, GIP, and GLP-1 (called “Triple”) is in phase 2 dose-finding in about 230 people over 39 weeks, reading out in Q1 2027 ^[1][14].

On February 25, 2026, Novo Nordisk struck a deal worth up to $2.1 billion with US-based Vivtex to develop oral forms of biologic drugs for obesity and diabetes, and a phase 1 trial of an ACSL5 inhibitor has started ^[13][1].

What is Novo Nordisk doing in liver disease?

Novo Nordisk announced on October 9, 2025 that it would acquire Akero Therapeutics for $54 per share in cash (about $4.7 billion), plus a contingent value right of $6 per share (about $0.5 billion) payable on US approval in compensated cirrhosis; the deal closed around year end ^[12][2].

The prize is efruxifermin, a once-weekly FGF21 analog for MASH (metabolic dysfunction-associated steatohepatitis). In phase 2 trials over 96 weeks, it improved liver fibrosis in 49% of patients with F2-F3 disease and 29% with F4 (cirrhosis), versus 19% and 11% for placebo. The phase 3 SYNCHRONY program includes about 3,500 participants, and safety results from SYNCHRONY Real-World are expected in Q4 2026 ^[12][1]. Separately, semaglutide 2.4 mg was approved in the US for MASH with moderate to advanced fibrosis (not cirrhosis) in 2025 ^[2][8].

What is Novo developing outside obesity and diabetes?

In rare disease, denecimig (Mim8) for hemophilia A has US and EU regulatory decisions expected in 2026 and has been submitted in China on the FRONTIER program data ^[1][2]. Etavopivat for sickle cell disease met both co-primary endpoints in the HIBISCUS phase 3 trial, with US and EU submissions expected in 2026 ^[1]. Sogroya has a Turner syndrome decision expected in Q4 2026 in the US and in the first half of 2027 in the EU and Japan ^[1].

In diabetes beyond GLP-1s, Awiqli was approved in the US in the first half of 2026, and IcoSema is among the company’s potential next-generation insulins ^[1][14]. Earlier-stage work includes an oral NLRP3 inhibitor, NNC6022-0004, in phase 1 for inflammation in cardiometabolic diseases, with a readout expected in the second half of 2027 ^[1].

Which programs failed in the past year?

The evoke and evoke+ Alzheimer’s trials, announced November 24, 2025, did not show a statistically significant slowing of disease progression. The trials enrolled 3,808 adults aged 55 to 85 with mild cognitive impairment or mild dementia due to Alzheimer’s with confirmed amyloid, taking oral semaglutide 14 mg. The CDR-SB score did not improve significantly versus placebo over 104 weeks, even though Alzheimer’s-related biomarkers improved, and the one-year extension was discontinued ^[10].

The ZEUS trial, announced July 31, 2026, tested ziltivekimab 15 mg monthly in more than 6,300 people with cardiovascular disease, chronic kidney disease, and inflammation (hsCRP at or above 2 mg/L). It did not reduce major adverse cardiovascular events (hazard ratio 0.99, with a 95% confidence interval of 0.88 to 1.11), and more patients on the drug had serious infections. Novo Nordisk expects a non-cash impairment charge in Q3 2026 ^[11]. In early September 2026, the company halted two more ziltivekimab trials, HERMES (heart failure) and ATHENA, after a data monitoring committee found them unlikely to succeed; the ARTEMIS trial in people after a heart attack had been planned to read out in the first half of 2027 ^[22][23][11].

Monlunabant was terminated in Q2 2026 for portfolio reasons, contributing DKK 4.0 billion of the DKK 6.3 billion in pipeline impairments that quarter ^[1].

When does the semaglutide patent expire?

In the US, semaglutide’s patent protection runs to 2032 ^[20]. Before that, Novo Nordisk fought compounding: in February 2026 it said it would sue Hims & Hers over a $49 copycat Wegovy pill, and on March 9, 2026 it dropped the case after an agreement under which Hims sells Ozempic and Wegovy at the same price as other telehealth platforms and stops advertising compounded GLP-1s ^[20].

Abroad, the first wave of patent expiries hit eight markets in 2026: Canada, Brazil, China, India, Mexico, Turkey, Saudi Arabia, and South Africa, with India, China, and Brazil expiring in March 2026. Together these markets account for 38% of the world’s adults living with obesity ^[16][15]. In Canada, the loss of exclusivity has meant lower realized prices while Novo Nordisk’s volumes have remained broadly stable ^[1]. A consultant estimate from Primus Partners suggests generics could cut costs by up to 80% in some cases, and Lupin and Dr. Reddy’s are among the generic makers preparing to enter ^[15]. A second wave follows in the Baltics and Central and Eastern Europe, and a third wave covers the US and most of Europe ^[16].

What milestones should you watch next?

On September 14, 2026, Novo Nordisk rebranded as “Novo” under the tagline “Lasting Health Starts Now,” though Novo Nordisk A/S remains the legal company name ^[21]. Its Capital Markets Day was scheduled for September 21, 2026 in London, where the company said it would introduce new Strategic Aspirations and provide a detailed overview of its updated corporate strategy, R&D pipeline, business operations, and performance ^[2][17][21].

Timing	Expected event
Q4 2026	CagriSema US FDA decision [1]
Q4 2026	Oral semaglutide 25 mg (Ozempic pill) US decision [1][9]
Q4 2026	Efruxifermin SYNCHRONY Real-World safety results [1]
Q4 2026	Cagrilintide high-dose phase 3 start [1]
Q1 2027	Triple phase 2 readout [1]
H1 2027	REDEFINE 11 (higher-dose CagriSema) readout [4]
H1 2027	ARTEMIS readout (planned) [11]
H1 2028	CagriSema 2.4/7.2 mg phase 3 readout [1]
H1 2029	AMAZE 8 (zenagamtide vs semaglutide) readout [1]
H2 2029	HF-POLARIS readout [1]

All of the drugs listed as pending or in trials — CagriSema, zenagamtide, cagrilintide alone, UBT251, Triple, efruxifermin, and the rest — are investigational and not available outside of clinical trials.

Sources

1. US Securities and Exchange Commission. Novo Nordisk A/S Form 6-K report of foreign private issuer. August 4, 2026.
2. US Securities and Exchange Commission. Novo Nordisk A/S Form 6-K report of foreign private issuer. February 4, 2026.
3. Pharmaceutical Executive. Novo Nordisk Submits NDA to FDA for CagriSema. December 18, 2025.
4. BioSpace. Novo’s CagriSema Falls to Lilly’s Zepbound in Daring Head-to-Head Test. February 23, 2026.
5. CNBC. Novo Nordisk sinks 16% after weight loss drug fails to match Eli Lilly’s in trial. February 23, 2026.
6. PR Newswire. Novo Nordisk’s investigational zenagamtide shows significant A1C reductions with up to 14.6% weight loss in adults with type 2 diabetes—presented at ADA 2026. June 5, 2026.
7. Fierce Pharma. Novo’s Wegovy pill makes US debut, with starter dose launching at $149 per month for cash-paying patients. January 5, 2026.
8. GlobeNewswire. Novo Nordisk A/S: Wegovy HD (semaglutide 7.2 mg) approved in the US, providing 20.7% mean weight loss. March 19, 2026.
9. Reuters. Novo to launch Ozempic pill for diabetes in second quarter of 2026. February 4, 2026.
10. GlobeNewswire. Novo Nordisk A/S: Evoke phase 3 trials did not demonstrate a statistically significant reduction in Alzheimer’s disease progression. November 24, 2025.
11. GlobeNewswire. Novo Nordisk provides update on the ZEUS phase 3 trial in people with ASCVD, CKD and inflammation. July 31, 2026.
12. GlobeNewswire. Novo Nordisk to acquire Akero Therapeutics and its promising phase 3 FGF21 analogue to expand MASH portfolio. October 9, 2025.
13. Reuters. Novo Nordisk partners with Vivtex in up to $2.1 billion deal for oral obesity drugs. February 25, 2026.
14. Fierce Pharma. ‘I’m a lot more optimistic today’: Mike Doustdar tells Fierce about pivotal first year as Novo Nordisk CEO. June 11, 2026.
15. Chemical & Engineering News. Looming GLP-1 drug patent expirations draw generics firms. December 9, 2025.
16. IQVIA. Your Questions Answered: Off-patent Semaglutide in 2026. April 7, 2026.
17. Novo Nordisk. Capital Markets Day 2026 - webcasts and presentations. September 21, 2026.
18. Applied Clinical Trials Online. Novo Nordisk’s Phase III OASIS 4 Analyses Highlight Cardiometabolic Benefits of Oral Semaglutide 25 mg. November 6, 2025.
19. Fierce Pharma. The Oral GLP-1 Tracker: Novo’s Wegovy pill, Lilly’s Foundayo continue prescription climb. September 11, 2026.
20. CNBC. Hims & Hers shares surge after Novo Nordisk drops patent infringement case over compounded weight loss drugs. March 9, 2026.
21. GlobeNewswire. Novo Nordisk enters next chapter to bring better health to more people supported by Novo rebrand and updated corporate culture. September 14, 2026.
22. STAT. Novo Nordisk stops two cardiovascular trials of drug aimed at lowering inflammation. September 7, 2026.
23. Endpoints News. Updated: Novo Nordisk cans two more trials of IL-6 heart drug for futility. September 7, 2026.