Novo Nordisk's Oral Weight-Loss Gambit: Cheaper Doses Tested as Competitive Heat Intensifies

Novo Nordisk launches Phase 3 trial for low-dose Wegovy pill to reduce costs and expand access, amid fierce obesity market competition and pipeline setbacks.

The Danish pharmaceutical giant is betting that smaller can be better. Novo Nordisk launched a Phase 3 trial on August 12 designed to determine just how little active ingredient its Wegovy pill truly requires — a question with profound implications for both patient access and the company's profit margins in the fiercely competitive obesity market.

The 60-week study will enroll 450 adults with a body-mass index of at least 30, or 27-plus with a comorbid condition. Two low-dose formulations of the oral semaglutide tablet will be pitted against placebo, with weight loss as the primary endpoint. Researchers will also track the proportion of patients shedding five, ten, or fifteen percent of their body weight.

A Pricing Pivot

The strategic logic behind the trial is straightforward. While the pill's current dosage range stretches from 1.5 to 25 milligrams, more than two-thirds of US patients already opt for the lowest available strengths — which cost self-paying customers roughly half as much as the higher tiers. That price differential has become a flashpoint in the broader debate over who can actually afford these blockbuster treatments.

The oral formulation has clearly outgrown its reputation as a side project. Second-quarter sales reached 3.22 billion Danish kroner — nearly $500 million — up from around $350 million in the first quarter. Weekly US prescriptions for the pill now exceed 265,000, against roughly 575,000 across all Wegovy delivery formats.

Competitive Crossfire

The timing of the trial is hardly coincidental. Just two days earlier, on August 10, rival Eli Lilly secured its first European approval for an oral GLP-1 candidate — orforglipron, marketed as Foundayo — via the UK's MHRA. Lilly's injectable offerings Zepbound and Mounjaro have already demonstrated weight-loss efficacy comparable to Wegovy, and its triple-agonist retatrutide posted reductions of up to 22.6 percent in Phase 3 trials among severely obese patients with cardiovascular disease, with a regulatory submission penciled in for 2027.

The market opportunity remains enormous — forecasts put the obesity drug sector above $100 billion by 2030 — but Novo Nordisk's pipeline has hit a rough patch. The Phase 3 ZEUS study of ziltivekimab missed its primary endpoint on reducing major cardiovascular events in chronic kidney disease patients, despite confirmed biological activity. The Reimagine-4 trial of CagriSema failed to match Lilly's tirzepatide on blood sugar control, though it demonstrated non-inferiority on weight loss. Development of monlunabant, an oral CB1 receptor blocker acquired through the Inversago Pharma deal, was scrapped after neuropsychiatric side effects emerged in clinical testing.

Analyst Divergence

The investment community remains split on valuation. Berenberg downgraded the stock from "Buy" to "Hold" on August 17, trimming its price target to 305 Danish kroner (roughly $47), arguing that further pipeline progress is required to justify a richer multiple. Deutsche Bank, meanwhile, reaffirmed its neutral stance with a 290-kroner target on Wednesday. Bernstein moved the other direction on August 18, lifting its target to 203 kroner while staying cautious on current levels.

The broader consensus leans toward "Hold," and the skepticism is visible in the numbers. Analysts have slashed their 2030 revenue expectations for CagriSema to a fraction of the original peak forecast of 400 billion kroner. The stock trades around 39.88 to 40.20 euros — roughly 27 percent below its 52-week high of 54.86 euros set in January — with a year-to-date decline of 8.7 to 9.4 percent depending on the trading day, and a 15 percent drop over twelve months.

Institutional Caution

Regulatory filings reveal notable position trimming among institutional holders. KMG Fiduciary Partners cut its stake by 30.5 percent in the second quarter to 51,957 shares, while First Trust Advisors slashed its holding by a staggering 94.5 percent in the first quarter, leaving just 27,466 shares.

A Riskier Posture

CEO Mike Doustdar — the first foreigner to lead the company — struck a defiant tone in a Financial Times interview, vowing to make the organization more risk-tolerant and open to larger acquisitions to reduce its heavy reliance on the weight-loss franchise. The company also registered a Phase 1 trial on August 18 for NNC0721-8060, an undisclosed obesity candidate to be tested against semaglutide in 142 participants.

Investors will get a fuller picture at the capital markets day on September 21, followed by third-quarter results on November 4. The low-dose pill study, meanwhile, won't read out until 2028 — leaving plenty of time for the competitive landscape to shift again.