Novo Nordisk enters 2026 on the defense as it faces a ‘must-win’ battle in the U.S. market

Novo Nordisk’s shift from a market darling to a serious underperformer has set the stage for a transitional 2026 as the Danish drugmaker fights to regain investor confidence in its weight loss business.

Novo’s stock just experienced the worst year on record since it began trading on the Copenhagen stock exchange over three decades ago. Multiple reasons lie behind the dramatic drop: a series of guidance cuts, strides by chief rival Eli Lilly, a leadership upheaval, and cheap copycat drugs flooding the crucial U.S. market.

With just about a week to go until 2026, Novo announced that its new weight loss pill under the brand name Wegovy had been approved in the U.S., making it the first oral GLP-1 treatment approved for weight loss. It sent shares up nearly 10% as investors banked on Novo being able to, at least partly, hold Eli Lilly and others at bay.

That “early Christmas present,” as one analyst called it, highlights many of the key themes Novo will have to face this year.

From injectables to pills

Novo’s position as the first company to launch an oral option could help it make up some of the ground it’s lost over the past year in the GLP-1 space. Analysts mostly agreed that the Wegovy pill’s approval was a big deal, even though many had already expected a positive decision before the end of the year.

Eli Lilly is expected to get its own weight loss pill orforglipron approved by the U.S. Food and Drug Administration by no later than the second quarter of this year, and investors will closely watch how that competition plays out.

“This approval adds a layer to the whole obesity space in the future,” Sydbank analyst Søren Løntoft Hansen told CNBC. “It could be, potentially, a space where Novo Nordisk is maybe able to recapture market shares and maybe increase growth.”

Wegovy-in-a-pill, as Novo calls the oral version of the blockbuster injectable, has shown that patients lose on average 16.6% of their body weight over 64 weeks. Meanwhile, orforglipron, averages 12.4% over 72 weeks.

“Usually, you have to basically go for either convenience or efficacy when you’re discussing pills versus injections – not in this case,” Novo CEO Mike Doustdar told CNBC’s Charlotte Reed in November. “Wegovy in a pill basically will have the same efficacy as its injectable counterpart. That’s really exciting.”

The broad consensus is that pills will also be favored by consumers. They have added advantages such as not having to be stored cold like the injectable version, allowing for simpler distribution and ease of entering new markets.