Novo Nordisk Faces a Tug-of-War: US Formulary Losses Meet European Reimbursement Gains

Novo Nordisk loses exclusive CVS formulary status for Wegovy as Eli Lilly gains ground, but French reimbursement and Indian adolescent approval offset pressures. Stock up 2% but still down 44% from high.

The Danish drugmaker is caught between two powerful currents. Just as France prepares to become the first EU member to publicly reimburse obesity treatments from mid-June 2026, Novo Nordisk has lost its exclusive preferred status on one of America’s largest pharmacy benefit manager formularies. The conflicting signals leave investors weighing expanding demand against intensifying price pressure.

CVS Caremark, which manages prescriptions for roughly 25 to 30 million insured Americans, will reinstate Eli Lilly’s injectable Zepbound and add its oral GLP-1 pill Foundayo to the formulary starting next year. Zepbound becomes a preferred option on 1 October 2026, while plans covering Foundayo can begin reimbursement from 1 June 2026. Novo Nordisk had secured an exclusive contract for Wegovy by offering a lower price in July 2025, but that advantage now evaporates. From October, Wegovy shares the preferred tier with both Lilly products. CVS framed the move as broadening choice while lowering costs for employers and insurers, though individual employer plans can still tailor their formularies.

On the other side of the Atlantic, the French government is opening its wallet. Starting mid-2026, roughly one million severely obese patients — those with a BMI of 40 or above, or 35 with relevant comorbidities — will receive state reimbursement for Wegovy injectable and Lilly’s Mounjaro. The standard coverage is 65%, but most patients are expected to qualify for full coverage through existing chronic illness schemes. The programme is expected to cost the French healthcare system around €100 million annually, replacing the roughly €300 monthly out-of-pocket expense currently borne by patients.

Novo Nordisk has also scored a regulatory win in India. The CDSCO approved Wegovy for adolescents aged 12 and older who weigh more than 60 kilograms, a population segment that Lilly’s Mounjaro has not yet reached. This early mover advantage complements the early prescription data from the US oral GLP-1 market. Market researcher Spherix Global Insights found that in the first month after launch, 73% of primary care physicians and 78% of endocrinologists prescribed Wegovy pill, versus 27% and 47% for Foundayo. Wegovy pill recorded more than three times the number of new patient starts in the comparable launch window, despite the practical drawback of requiring fasting before meals, while Foundayo does not. CEO Mike Doustdar noted that Wegovy pill has already been used by over one million patients since its January launch, helping lift the company’s full-year guidance.

The stock has responded partly to these signals. On Thursday shares advanced roughly 2% to trade near €39, extending a 30-day gain of over 11%. That recovery still leaves the equity more than 44% below its 52-week high of €70.13, and the year-on-year decline stands at roughly 36% after touching a March low of €30.48. Deutsche Bank rates the stock a “Hold” with a price target of 290 Danish kroner, citing growing international pricing pressures.

Those pressures are mounting from multiple directions. In Canada, GLP-1 drugs are already discounted by 40% to 65%. The US administration’s “TrumpRx.gov” initiative is advancing a most-favoured-nation model explicitly targeting Ozempic. The tension between expanding reimbursed access in Europe and the erosion of formulary exclusivity in the US creates a nuanced outlook: volume gains could be offset by margin compression, with the summer US prescription data for Wegovy pill set to provide the next real test of whether Novo Nordisk can hold its early lead even as Lilly gains wider coverage.