Novo Nordisk expects 2026 sales to fall as much as 13% on US pricing pressure

Novo Nordisk said it expects both sales and adjusted operating profit to fall between 5% and 13% in 2026 at constant exchange rates, ending a run of double-digit gains ^[1][2]. Analysts polled by the company had on average forecast a 2% sales decline, according to Reuters ^[2].

The guidance sent Novo's US depositary shares down as much as 14% in afternoon trading after a trading halt ^[1]. Reuters reported the shares were down 16% in European trading, wiping nearly $50 billion from the company's value ^[2]. Novo's market value was $259 billion at Tuesday's close, down from more than $600 billion in 2024 ^[2].

"Novo has provided shocking guidance for 2026," said Markus Manns, a portfolio manager at Union Investment, which holds both Novo and Eli Lilly shares. "Nobody had a double-digit profit decline on the agenda" ^[2].

CEO Mike Doustdar said the company faces "pricing headwinds in an increasingly competitive market," while pointing to early demand for the new Wegovy pill ^[1]. On a call with journalists, he described 2026 as "a year of unprecedented pricing pressure" and said he hoped the "painful" effect would be "an investment for our future" ^[2].

Chief Financial Officer Karsten Munk Knudsen told Reuters the US pressure is coming from a larger-than-expected shift toward patients who pay cash and from rising rebate demands from insurers, more than from the Trump administration's most-favored-nation policy on drug prices ^[2]. He said US sales are expected to fall "in the teens," which could be steeper than the overall decline the company guided to ^[2].

What Novo reported

In the fourth quarter, net sales were 79.1 billion Danish kroner ($12.5 billion), slightly above analysts' estimate of 77.8 billion kroner, according to LSEG ^[1]. Operating profit was 31.7 billion kroner, down 14% from a year earlier ^[1]. Ozempic sales were 31.8 billion kroner, up 1% at constant exchange rates, and Wegovy sales were 21.9 billion kroner, up 17% ^[1]. For the full year, sales rose 10% and operating profit rose 6% ^[1].

Semaglutide, the active ingredient in Ozempic and Wegovy, loses exclusivity in Canada, Brazil and China during 2026 ^[1]. The company also faces copycat competition: as many as 1.5 million Americans use compounded versions of GLP-1 weight-loss drugs rather than branded products, Reuters reported ^[2]. Knudsen said Novo is "still frustrated" that marketing of an FDA-unapproved product continues, and said it is up to US regulators and politicians to address it ^[2].

Why it matters for patients

Much of Novo's US business now runs through cash-pay channels rather than insurance. About 90% of US sales of the new Wegovy pill are cash-pay, Knudsen said ^[2]. Novo sells lower doses of the daily pill at $149 a month for self-paying patients, with that price rising to $199 in April, and has sold the Wegovy injection at $349 a month to cash payers since November ^[2]. Lilly plans to cap higher doses of its obesity pill, if approved, at $399 a month for repeat cash buyers ^[2].

Novo and Lilly agreed with the Trump administration in November to cut prices for their GLP-1 drugs for Medicare and Medicaid in 2026 and to offer discounts directly to consumers through the planned TrumpRx.gov site ^[1]. Whether those arrangements change what any individual patient pays for a specific product has not been disclosed.

Novo said it assumes the global GLP-1 market will keep expanding in 2026, allowing it to reach more patients and grow volumes even as prices fall ^[1]. Weekly prescriptions for the Wegovy pill reached about 50,000 by January 23, above the 20,000 a week shown in market tracking data that does not capture cash-pay sales through NovoCare and telehealth services ^[2].

What happens next

Novo said it will roll out Wegovy in more markets in 2026 and plans to introduce a higher 7.2 mg dose in a number of countries ^[1]. The company is also counting on its experimental injectable CagriSema and on the oral Wegovy launch to rebuild US market share ^[1]. Eli Lilly is expected to launch its own weight-loss pill in the first half of 2026 ^[1]. Novo has not said when it expects pricing pressure to ease; Knudsen said of the compounding market, "Predicting if and when the tide turns is really hard" ^[2].