Novo Nordisk’s Oral GLP-1 Assault Begins as Earnings Cloud Hovers Over the Stock

Novo Nordisk rolls out oral semaglutide for diabetes and weight loss as Q1 earnings loom, with stock down 46% from highs and analysts forecasting revenue decline.

The Danish drugmaker is rolling out its oral semaglutide franchise on two fronts just as investors brace for a first-quarter earnings report that could set the tone for the rest of the year. Novo Nordisk’s Ozempic pill for type 2 diabetes hit more than 70,000 US pharmacies on Monday, while the Wegovy version of the same oral therapy — approved for weight loss — has been building momentum since its US launch in early January. The timing, two days before the company publishes its Q1 2026 results on Wednesday, looks deliberate.

For most insured diabetes patients, the Ozempic tablet will cost just $25 for a three-month prescription. Uninsured patients face monthly bills ranging from roughly $150 to $300, depending on dosage. Novo is manufacturing the pills entirely within the US, a move that may help insulate the supply chain from trade disruptions.

A Market Starved for Good News

The share price has been battered. Novo Nordisk stock has shed about 15 percent since the start of the year and now trades nearly 46 percent below its 52-week high of €70.13. On Monday, the shares bounced more than 5.5 percent to €37.92 on the Ozempic pill news, but the recovery is fragile. Over the past twelve months, the stock is still down roughly 38 percent.

Analysts expect Wednesday’s report to show an 8 percent drop in revenue year-on-year, with earnings per share falling 16 percent. The company itself has guided for a 5 to 13 percent decline in both core revenue and operating profit for the full year, citing US pricing pressure, competition from Eli Lilly, and currency headwinds. A one-time reversal of $4.2 billion in US 340B rebates will flatter the headline numbers but is excluded from adjusted metrics. Free cash flow is forecast at 35 to 45 billion Danish kroner, with capital expenditure of around 55 billion kroner.

The Pill That Could Change the Calculus

The Q1 results will be the first to include meaningful sales from oral Wegovy, which received FDA approval on December 22 and hit the US market on January 5. By the week ending January 23, roughly 50,000 prescriptions had already been written. Crucially, the pill appears to be drawing in patients who previously avoided injectables — including those with needle phobia — rather than simply cannibalising the existing injection market. If that trend holds, it expands the total addressable market for obesity treatments rather than just reshuffling market share.

Novo holds a roughly three-month lead over Eli Lilly’s oral competitor Foundayo, but the Danish company’s pill comes with a notable drawback: it must be taken 30 minutes before any food, drink, or other oral medications. Lilly’s product has no such restriction. Novo is leaning on efficacy data to counter that disadvantage, pointing to the OASIS-4 study, which showed weight loss of around 17 percent compared with Lilly’s self-reported 12 percent. Whether that gap translates into real-world prescribing patterns will become clearer as prescription data accumulates.

Pipeline Progress Beyond GLP-1

Novo is not putting all its chips on the GLP-1 table. The company presented new data on Wegovy and next-generation candidates at the European Congress on Obesity. Meanwhile, the HIBISCUS study for Etavopivat in sickle cell disease met both co-primary endpoints, with a 27 percent reduction in the rate of vaso-occlusive crises. In haemophilia A, the drug Denecimig reduced bleeding rates by up to 99 percent compared with on-demand therapy, and the FDA is already reviewing the approval application.

What Wednesday Will Reveal

The central question for investors is whether the oral Wegovy launch can generate enough momentum to offset the erosion in Novo’s core business. Citi and Bernstein have both downgraded the stock recently, and the possibility of new FDA restrictions on ingredients used in obesity drugs adds another layer of uncertainty. The management’s full-year guidance — including an operating profit decline of up to 13 percent — will be tested against the Q1 numbers. If the outlook disappoints, the stock could revisit its recent lows near €30.

Wednesday morning will tell whether the pill-powered optimism is enough to shift the narrative — or whether the headwinds in Novo’s legacy business are simply too strong to ignore.