Novo Nordisk’s Oral GLP-1 Offensive Meets a Wall Street Reality Check

Novo Nordisk faces revenue squeeze as oral Wegovy prescriptions plateau at starter doses, Eli Lilly enters the pill-based GLP-1 market, and Q1 earnings loom with expected declines.

The Danish drugmaker is charging into a new chapter of the obesity wars, but investors are demanding proof that the strategy can deliver where it counts: the bottom line.

Novo Nordisk’s oral Wegovy racked up 721,000 US prescriptions in the first quarter, according to IQVIA data — a figure that underscores strong early demand for the tablet formulation. But the numbers mask a troubling pattern. Barclays analyst James Gordon points to a plateau in starter doses, with higher-priced maintenance prescriptions rising far more slowly than anticipated. That leaves patients stuck on cheaper introductory levels or dropping out of treatment entirely, squeezing revenue per script.

The competitive landscape is also closing in. Eli Lilly secured US approval for its rival oral product Foundayo in early April, ending Novo’s brief monopoly in the pill-based GLP-1 market. Meanwhile, generic threats loom in markets like India and Canada, adding another layer of pricing pressure.

On Wednesday, Novo Nordisk reports first-quarter earnings. The consensus calls for an 8% revenue decline and a 16% drop in earnings per share. All eyes will be on management’s forward guidance, especially after the company rattled markets in February with a weak 2026 outlook.

The stock has taken a beating, losing nearly 38% over the past year. It currently trades around €38.21, though last week brought a modest 9% bounce. Bernstein recently downgraded the shares to “Underperform,” citing expectations of further US market share erosion and falling prices.

Yet there are glimmers of optimism. Novo Nordisk completed a tranche of its share buyback program worth roughly 3.8 billion Danish kroner. And a massive one-off accounting gain looms: the release of a $4.2 billion provision is expected to inflate reported earnings significantly when quarterly results land.

The company also began nationwide US distribution of oral Ozempic in early May, targeting adults with type 2 diabetes while also aiming to reduce cardiovascular risk. The move is part of a broader push to defend market share against aggressive rivals. Novo has cut prices to secure pharmacy access and is rapidly expanding domestic production capacity — a hedge against potential new US tariffs on imported drugs.

At €38.30, the stock has crept back above its 50-day moving average, recovering from March lows. The forward price-to-earnings ratio sits at roughly 13, a historically cheap valuation for a company that still dominates the GLP-1 space.

The next major catalyst comes in mid-May, when Novo presents new clinical data on its pipeline hopeful CagriSema at the European Congress on Obesity in Istanbul. But first, Wednesday’s earnings report will test whether the strong prescription volumes are enough to reverse the downward trend — or whether the structural headwinds run deeper than the headline numbers suggest.