Novo Nordisk’s Oral Wegovy Smashes Expectations, but Margin Pressure and Rival Threats Cloud the Outlook

Oral Wegovy nearly doubles Q1 sales, Citi boosts long-term forecast to 50B kr, but competition and pricing headwinds lead to full-year profit decline guidance.

Novo Nordisk’s oral version of Wegovy has delivered a far stronger commercial debut than analysts anticipated, pushing first-quarter revenue past estimates and prompting Citi to double its long-term sales forecast for the pill to 50 billion Danish kroner. Yet the Danish drugmaker’s Q1 numbers also laid bare the strategic dilemma: despite a 54% jump in operating profit, intensifying competition and pricing headwinds are forcing management to guide for a full-year decline of up to 12%.

The oral Wegovy, approved by the FDA in December 2025 and launched in the US early this year, generated 2.26 billion kroner in first-quarter sales—nearly double the 1.16 billion kroner the market had penciled in. Some 1.3 million prescriptions were written in the quarter alone, bringing the cumulative total in the US to over 2 million. That performance underpins Citi’s revised view, though the bank maintains a neutral stance and a 290-kroner price target, citing the high competitive stakes ahead.

Adding to the positive news flow, a pooled analysis of the STEP studies showed that semaglutide at a 2.4 mg dose helped adults aged 65 and older lose 15.4% of their body weight over 68 weeks, versus 5.1% for placebo. Nearly three in ten participants shed at least 20%. Serious adverse events occurred in 19.0% of the semaglutide group, compared with 12.7% on placebo—a gap the company will need to address as prescribers weigh efficacy against tolerability in older patients.

The broader Q1 picture remains robust. Group net sales climbed 24% to 96.82 billion kroner, with the combined revenue from Ozempic, Wegovy and Rybelsus hitting 63.25 billion kroner—roughly two-thirds of total quarterly sales. Operating profit surged 54% to 59.62 billion kroner, reflecting the strong operational leverage still embedded in the GLP-1 franchise. In light of the results, Novo Nordisk slightly raised its full-year guidance, now expecting revenue and operating profit to contract by 4% to 12%—a narrower band than previously flagged.

Yet the competitive landscape is shifting fast. Eli Lilly launched its own oral GLP-1, Foundayo, in the US this April, and Viking Therapeutics and Structure Therapeutics are progressing through Phase 3 studies. The pricing environment is also becoming less friendly: according to the Business Group on Health, 67% of US employers currently cover GLP-1 drugs for weight loss, but around 10% may drop that coverage by 2027. The MFN (Most Favored Nation) pricing agreement continues to weigh on margins, while analysts at TD Cowen—who rate the stock a Hold with a $42 target—point to sustained pressure on US list prices.

Management has responded with a capital-return boost, expanding the share buyback programme to as much as 15 billion kroner. On the commercial front, Amazon Pharmacy now offers same-day delivery of Ozempic tablets in the US, a move that could help sustain prescription momentum as patient demand pivots toward oral formulations.

The stock’s recent recovery reflects the optimism around the pill’s start. The shares closed at 39.42 euros on Monday, gaining 22.5% over the past month. Yet the longer-term chart tells a more cautious story: the stock is still down 11.9% year-to-date and roughly 35% over twelve months, trailing its 200-day moving average by 7.3%.

Analyst sentiment remains split. SB1 Markets raised its price target to 350 kroner with a Buy rating, betting that the Wegovy pill’s volume surge can absorb forthcoming price erosion. Citi sticks with Neutral, warning that Eli Lilly’s oral entry and potential margin compression limit upside. For now, the oral Wegovy has bought Novo Nordisk time and trust—but the real test will be whether the company can convert prescription power into sustainable profit growth once the novelty fades and rivals close the gap.