Full-year 2025 results: sales DKK 309.1 billion, first guided sales decline for 2026

Novo Nordisk reported full-year 2025 sales of DKK 309.1 billion, up 6% as reported and 10% at constant exchange rates, but told investors it expects sales to shrink in 2026 ^[1]. The company guided to adjusted sales growth of -5% to -13% at constant exchange rates, the first guided contraction since semaglutide turned Novo into one of the world's largest drugmakers ^[1].

Operating profit fell 1% in Danish kroner to DKK 127.7 billion, though it rose 6% at constant exchange rates ^[1]. Novo said roughly DKK 8 billion in costs tied to a company-wide restructuring and the purchase of three former Catalent manufacturing sites drove the decline; without those costs, operating profit would have risen 13% at constant rates ^[1]. Net profit was DKK 102.4 billion, up 1% ^[1].

What drove 2025

Obesity care was the growth engine. Those sales rose 31% at constant exchange rates to DKK 82.3 billion, up from DKK 6 billion in 2019 ^[1]. GLP-1 diabetes sales grew far more slowly, at 6% at constant rates ^[1]. US sales rose 8% at constant rates and were helped by favorable gross-to-net adjustments — accounting changes tied to rebates — while international sales grew 14% ^[1]. Novo's diabetes value market share fell 3.6 percentage points to 30.1% ^[1]. The company said it treated about 46 million people with diabetes and obesity medicines in 2025, including 3.6 million people living with obesity ^[1].

The fourth quarter was weaker than the year as a whole: sales fell 2% and operating profit fell 4% at constant exchange rates, which one trade publication described as evidence of pricing pressure and competition already biting ^[2].

The 2026 guidance, in detail

Novo blamed the projected decline on lower realized prices, including effects of the "Most Favoured Nations" pricing agreement in the US, the patent expiry of the semaglutide molecule in certain international markets, and competition ^[1]. Adjusted operating profit is also expected to fall 5% to 13% at constant rates ^[1]. Reported in Danish kroner, adjusted sales would be 3 percentage points lower and operating profit 5 points lower than the constant-currency figures ^[1].

The "adjusted" label matters. Novo's 2026 headline sales and profit will be boosted by a one-time reversal of USD 4.2 billion in sales rebate provisions tied to the US 340B Drug Pricing Program — money set aside for rebates that is now being released back into revenue ^[1]. Stripping that out is what produces the negative guidance. PharmExec also reported that Medicaid coverage reductions for obesity treatments are among the US pressures management flagged ^[2].

Novo still expects the overall GLP-1 market to grow, and says new products will let it "continue to increase patient reach and expand volumes" ^[1]. The FDA approved once-daily oral semaglutide 25 mg as Wegovy pill on 22 December, the first oral GLP-1 for obesity; it launched on 5 January 2026, and by 23 January weekly prescriptions were running around 50,000, driven mainly by the 1.5 mg starter dose in the self-pay channel ^[1].

Why it matters for patients

A guided sales decline built on "lower realised prices" is, from the other side of the counter, a signal that what payers and cash-paying patients are charged for GLP-1s is heading down in 2026 ^[1]. Novo explicitly ties that to the Most Favoured Nations agreement in the US and to loss of exclusivity for semaglutide in some markets outside the US ^[1]. At the same time, the company says volumes should keep rising, meaning more people on treatment at lower prices per prescription ^[1].

The Wegovy pill numbers offer a hint at how that is playing out: early uptake is concentrated in the self-pay channel at the starter dose, not through insurance ^[1]. Novo also cited Medicaid coverage reductions for obesity drugs as a 2026 headwind, per PharmExec ^[2]. Whether commercial insurance coverage broadens or narrows this year is not spelled out in these documents.

Supply is not mentioned as a constraint in the report. What is not yet known from these sources is how list prices, cash-pay prices, or copays will change for specific products.

What happens next

Novo has submitted semaglutide 7.2 mg and CagriSema to the FDA for obesity, and expects a US regulatory decision on CagriSema during 2026, along with a decision on Mim8 (denecimig) in hemophilia ^[1]. The annual general meeting is set for 26 March 2026, where the board will propose a final dividend of DKK 7.95 per share, bringing the 2025 total to DKK 11.70, alongside a new share buyback of up to DKK 15 billion ^[1]. New multi-year strategic targets are due at a Capital Markets Day on 21 September 2026 ^[1].