Novo Nordisk raises 2026 outlook again, but shares fall about 7%
Novo Nordisk beat forecasts and raised guidance, but analysts flagged one-time rebate credits and cost cuts, as the company prepares large US list-price reductions in 2027.
Novo Nordisk raised its 2026 sales and profit outlook for the second time this year on Aug. 4, 2026, after second-quarter adjusted operating profit beat forecasts — and its shares still fell about 7% [1][2].
The Danish maker of Ozempic and Wegovy reported adjusted operating profit of DKK 33.4 billion (about US$5.15 billion) for the quarter ended June 29, up 11% from a year earlier and above the DKK 28.74 billion average forecast in a company-compiled poll [1][2]. Adjusted sales rose 7% [2]. Novo now expects adjusted sales and adjusted operating profit for 2026 to come in between 0% and -6% at constant exchange rates compared with 2025, an improvement from its previous range of -4% to -12% [1].
Reported profit looks different. Operating profit fell 19% and earnings per share fell 20% after DKK 6.3 billion in non-recurring, non-cash impairment charges tied to pipeline assets, including DKK 4.0 billion for monlunabant, an oral obesity drug the company terminated [1][2]. The raised guidance still implies second-half adjusted sales of roughly -2% to -14% [2].
Analysts focused on two items inside the beat. On the earnings call, US head Jamey Millar put favorable US rebate adjustments — corrections to prior-period accruals, not new demand — at roughly DKK 2 billion, about three-quarters of it Ozempic gross-to-net and the rest insulin [2]. Sales and distribution costs fell 13% at constant currency, and adjusted research spending fell 2% [2]. Excluding the rebate credit and the cost reduction, group adjusted sales growth falls from 7% to about 4%, US operations goes from +4% to roughly -1%, and adjusted operating profit declines [2]. Guidance states that research spending and promotional activity increase in the second half [2].
The US business is the central issue. US Wegovy injectable sales fell 22% at constant currency even as weekly injectable prescriptions rose to about 310,000 from roughly 280,000 a year earlier [2], with lower-priced self-pay now about 35% of US injectable Wegovy volume, up from 10% to 15% a year earlier [2]. Total US obesity care revenue rose 4% while the US branded obesity market grew 87% by volume [2].
The Wegovy pill is growing fast. It passed 5 million US prescriptions in 30 weeks and was running at about 265,000 weekly scripts, against about 22,000 for oral orforglipron, with Novo saying the pill holds roughly 90% of the US oral obesity market and that about 80% of pill patients had never taken a GLP-1 [2]. Second-quarter US pill sales were DKK 3,141 million, priced at $149 to $299 a month depending on dose [2]. Novo also noted the weekly rate of new pill prescriptions has slowed and that 70% of pill prescriptions are for lower, cheaper doses [2].
Why it matters for patients
Prices and coverage are moving in opposite directions. Novo says that from Jan. 1, 2027 it will cut US list prices to $675 for Wegovy injection and tablets and for Ozempic — reductions of about 50% and 35% — and that this will affect 2027 cash flow [2]. List price is not the same as what a patient pays, and the sources do not say how the cuts will reach insured or self-pay customers.
On coverage, CVS Caremark will add other weight-loss medications to its largest commercial template formularies effective Oct. 1, 2026, ending an exclusive position Novo won in July 2025 at a pharmacy benefit manager with roughly 26% of the US market [2]. That can change which drug a plan steers patients toward. On the other side of the ledger, the Medicare Part D "Bridge" pilot went live July 1, 2026, covering a majority of beneficiaries at a $50 copay, and management said early volumes were encouraging but that it is too early to judge durability [2]. The report also cites Medicaid coverage reductions in several states [2].
What happens next
A US decision on CagriSema for obesity is due at the end of 2026; a head-to-head trial showed it non-inferior to tirzepatide 15 mg on weight loss (15.2% versus 15.8%) but failed non-inferiority on blood sugar in type 2 diabetes (1.9 versus 2.2 percentage points) [2]. Novo has flagged a possible further non-cash impairment in the third quarter related to ziltivekimab, after its ZEUS trial missed its primary endpoint [2]. First generic semaglutide entries have arrived in some early loss-of-exclusivity markets, with the impact expected to be back-end loaded into the second half [2]. Executive Mike Doustdar has now led the company for a year, and Novo is also suing Eli Lilly in a US federal court over advertising; Lilly denies wrongdoing [1].
Sources
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