Novo Nordisk ends 2025 down nearly 49% and forecasts a sales decline for 2026

Novo Nordisk's shares fell nearly 49% during 2025 in Copenhagen trading, the worst annual performance in the company's history, and the Danish drugmaker now expects sales and operating profit to decline in 2026 ^[1][2].

For the full year 2025, Novo Nordisk reported sales of DKK 309.06 billion, up 6% as reported and 10% at constant exchange rates, slightly above the DKK 307.62 billion analysts expected ^[1]. Operating profit was DKK 127.66 billion, down 0.5% as reported but up 6% at constant currencies, and net profit rose 1.4% to DKK 102.43 billion ^[1]. Obesity care sales grew 31% at constant rates, while GLP-1 diabetes products grew 6% ^[1]. U.S. sales rose 8% at constant exchange rates and international sales rose 14% ^[1].

Fourth-quarter sales were DKK 79.14 billion, down 7.6% from a year earlier but above the DKK 76.9 billion analysts expected. Wegovy sales in the quarter reached DKK 21.86 billion, beating expectations of DKK 21.07 billion, and full-year Ozempic sales totaled DKK 127.09 billion against forecasts of DKK 124.87 billion ^[1].

The 2026 outlook was the surprise. Novo Nordisk said sales and operating profit at constant exchange rates could fall 5% to 13%, compared with analyst expectations of a 1.4% sales decline and a 3.1% operating profit decline ^[1]. That would be the company's first annual sales drop in nine years; the last was in 2017, when U.S. insulin prices came under pressure ^[1]. The stock fell about 18% in Copenhagen trading, and Novo Nordisk's U.S.-listed shares were down 5.37% at $47.60 as of late morning on February 4 ^[2].

The company attributed the guidance to lower realized prices under the "most-favored-nation" agreement with the U.S. government, the expiration of the semaglutide molecule patent in some international markets, and intensifying competition ^[1]. It also cited reduced Medicaid coverage for obesity medicines and said favorable U.S. gross adjustments recorded in 2025 are not expected to repeat ^[1]. Ozempic and Wegovy face competition from Eli Lilly's Zepbound and from generic versions of Ozempic abroad ^[1]. CEO Mike Doustdar told CNBC that "people should expect that it goes down before it comes back up" ^[2].

The oral Wegovy pill launched in the U.S. on January 5, 2026, and by January 23 weekly prescriptions had reached about 50,000, with growth driven by the starting dose in the cash-pay channel ^[1]. A separate report said roughly 170,000 patients had started the pill within four weeks, and that the starting dose is priced at $149 ^[2]. Doustdar said that "no matter how well it does in the initial period, the price hit on the existing business trumps, basically, the great pill launch that we've had" ^[2]. Bank of America's Sachin Jain said the new guidance sits about 8% below consensus at the midpoint, and Morgan Stanley's Thibault Boutherin said it "surprised to the downside, confirming our concerns on U.S. prices and mix" ^[2].

Novo Nordisk's board approved a share buyback of up to DKK 15 billion, about $2.4 billion, and proposed a final dividend of DKK 7.95 per share, bringing the total for 2025 to DKK 11.70 ^[1]. The company said it provided treatments to 46 million patients in 2025 ^[1]. Dave Moore, who led U.S. operations through the pill launch, is leaving for personal reasons and will be succeeded by Jamey Millar, formerly with UnitedHealth Group ^[2].

Why it matters for patients

The guidance points to lower realized prices, not fewer products. Novo Nordisk said the most-favored-nation agreement is meant to make GLP-1 drugs more affordable for more people in the U.S., and the $149 starting dose of the oral Wegovy pill is well below typical injectable pricing ^[1][2]. At the same time, the company listed reduced Medicaid coverage for obesity medicines as a drag on U.S. revenue ^[1].

Nothing in the results indicates Ozempic or Wegovy is being withdrawn, and no supply interruption was reported. Whether U.S. list prices for the injectable versions change has not been disclosed ^[1][2]. The company said it plans to launch a 7.2 mg Wegovy dose in several countries and bring Wegovy to additional markets in 2026 ^[1].

Patent expiration matters mainly outside the U.S. for now: the guidance cites semaglutide patent expiry in certain international markets, not in the United States ^[1].

What happens next

Novo Nordisk's annual general meeting is set for March 26, 2026, where shareholders will vote on the proposed dividend ^[1]. The company expects regulatory decisions in 2026 for Mim8 for hemophilia and CagriSema for obesity, plus Phase 3 results for etavopivat and ziltivekimab ^[1]. It has not given a date for any changes to U.S. prices.