Novo Nordisk's Dual Track: CagriSema Pipeline and Oral Wegovy Expansion Battle Margin Headwinds

Novo Nordisk pushes oral Wegovy global rollout after strong US launch; CagriSema combo therapy awaits FDA decision amid Eli Lilly rivalry.

Novo Nordisk is navigating a delicate balancing act. The Danish drugmaker is pushing ahead with a next-generation obesity combination therapy while simultaneously racing to roll out its oral Wegovy pill globally. The stock, trading at 38.72 euros in Europe, has clawed back 12 percent over the past month but remains 35 percent lower than a year ago — a clear sign that investors are weighing pipeline promise against mounting profit pressure.

The oral Wegovy pill has delivered a strong start in the United States since its launch in January 2026. Weekly prescriptions have surged past 200,000, with cumulative prescriptions exceeding two million by mid-April. That leaves Eli Lilly's competing oral product Foundayo, which averaged 62,000 weekly scripts, far behind. Where Foundayo offers the convenience of no fasting requirement, Novo Nordisk counters with a tolerability advantage: clinical data show patients on the rival drug are 14 times more likely to discontinue treatment due to gastrointestinal side effects.

That US success is now the springboard for an international push. Emil Kongshøj Larsen, vice president for international business, has outlined plans for a massive rollout outside the US, expected to begin later this year pending regulatory approval. The European Medicines Agency is currently reviewing the oral Wegovy pill, with analysts pointing to the UK, Germany and Denmark as likely first markets. To support the expansion, Novo Nordisk is investing $500 million in a manufacturing facility in Ireland.

Yet even as the oral pill gains traction, the company's future growth hinges on CagriSema, a once-weekly fixed-dose combination of cagrilintide and semaglutide. A regulatory application is already before the FDA, with a decision expected around the end of 2026. If approved, CagriSema would become the first injectable combination of a GLP-1 receptor agonist and an amylin analogue. The supporting data are compelling: in the REDEFINE 1 trial, patients lost an average of 20.4 percent of their body weight over 68 weeks, versus 3.0 percent on placebo. When assuming all patients remained on therapy, the mean weight loss hit 22.7 percent, compared with 2.3 percent for placebo.

But Eli Lilly's Zepbound, assessed over 84 weeks, showed slightly greater weight reduction in a head-to-head comparison. That has tempered expectations for CagriSema's commercial potential. Novo Nordisk is responding with further research: a phase 3 trial of a higher CagriSema dose is slated to begin in the second half of 2026, offering a potential edge in a market where differentiation is critical. The company will also host an R&D event for investors at the ADA conference on June 7, where it can showcase CagriSema's credentials.

The pipeline ambitions come against a backdrop of financial headwinds. Reported first-quarter revenue rose 32 percent on a currency-adjusted basis, boosted by the release of provisions under the US 340B drug-pricing program. Stripping out that one-off effect, organic revenue declined 4 percent. The obesity business alone grew 22 percent, though lower realised prices ate into volume gains. For the full year, Novo Nordisk has narrowed its guidance: it now expects organic revenue and operating profit to fall between 4 percent and 12 percent — previously the outlook had been a decline of 5 to 13 percent.

Profitability remains solid. Net profit reached 48.6 billion Danish kroner in the quarter, free cash flow stood at 12.8 billion kroner, and the company returned 37.7 billion kroner to shareholders via dividends and buybacks. Still, the stock at 38.42 euros in the broader market — slightly below the current 38.72 euro level — trades 9.29 percent below its 200-day moving average and has lost 35.56 percent over the past twelve months.

Adding to the pressure, generics are encroaching on Novo Nordisk's established GLP-1 franchise. Ozempic patent protection expires in China in 2026, and first-quarter sales of Ozempic there already slipped 8 percent. Meanwhile, cheaper copies are appearing in emerging markets such as India and Brazil. The oral Wegovy pill's international rollout will therefore be a critical test of the company's ability to defend market share even as margins tighten. The EMA's decision, expected before year-end, will determine whether Europe becomes the next battleground.