Novo Nordisk faces tougher U.S. market

Novo Nordisk is overhauling how it sells obesity drugs in the United States after fourth-quarter sales and profit slipped and management warned 2026 will be weaker. (novonordisk.com) (pharmexec.com) The Danish drugmaker said on February 4 that 2025 sales rose 10% at constant exchange rates to 309.1 billion Danish kroner, but fourth-quarter sales fell 2% and operating profit fell 4% at constant exchange rates. U.S. operations grew 8% for the full year, slower than international operations at 14%. (novonordisk.com) (pharmexec.com) Novo Nordisk told investors that 2026 sales and operating profit are each expected to decline 5% to 13% at constant exchange rates on an adjusted basis. The company pointed to lower realized prices in the United States, reduced Medicaid coverage for obesity drugs, and the effect of its November 2025 pricing deal with the U.S. administration. (pharmexec.com) (ft.com) That November agreement committed Novo Nordisk to lower semaglutide prices in Medicare Part D, Medicaid, and its direct-to-patient cash channel starting in 2026. The company said at the time that the deal would have a direct negative low-single-digit effect on global sales growth in 2026. (ft.com) Semaglutide is the ingredient in Wegovy for obesity and Ozempic for diabetes, and the United States has been Novo Nordisk’s biggest profit engine for both. In 2025, obesity-care sales still rose 31% at constant exchange rates to 82.3 billion Danish kroner, but the company said price pressure and competition were increasing. (novonordisk.com) (pharmexec.com) Competition is no longer only about doctors and insurers. Novo Nordisk has been pushing harder into consumer-style pricing and subscriptions, including Wegovy offers through NovoCare Pharmacy and a March 31 U.S. launch of a multi-month subscription program that the company said could save patients up to $1,200 a year. (wegovy.com) (novocare.com) (novonordisk-us.com) Eli Lilly has added to that pressure with lower cash-pay offers for Zepbound, advertising self-pay pricing starting at $299 a month for some patients. Novo Nordisk’s own Wegovy materials show starter-dose offers at $199 a month for eligible new patients through June 30, 2026. (zepbound.lilly.com) (novocare.com) Supply has also changed the market. The Food and Drug Administration said on February 21, 2025 that the semaglutide injection shortage was resolved, reducing one advantage Novo Nordisk had when branded supply was tight and compounded copies spread through telehealth and specialty pharmacies. (fda.gov) Novo Nordisk had already begun cutting costs before this latest reset. In September 2025, it announced a company-wide transformation, about 9,000 planned job cuts, and a target of 8 billion Danish kroner in annualized savings by the end of 2026 as it tried to move faster in what it called a more consumer-driven obesity market. (ft.com) The immediate test is whether lower prices can protect volume without eroding profit faster than demand grows. Novo Nordisk’s own guidance says 2026 will answer that question in the toughest market it has faced since Wegovy turned obesity treatment into a mass-market business. (pharmexec.com) (novonordisk.com)