Novo Nordisk's Pill and Needle Strategy Faces a Competitive and Financial Crossroads

Novo Nordisk launches high-dose & oral Wegovy in the US and eases EU cold-chain rules to compete with Eli Lilly, but faces pricing pressure and slowing sales growth.

Novo Nordisk is deploying a two-pronged offensive in the weight-loss drug market, but its strategic moves are unfolding against a backdrop of intense competition and significant financial pressure. The Danish pharmaceutical giant is simultaneously easing distribution for its injectable Wegovy in Europe and launching new high-dose and oral versions in the United States, aiming to capture new patients and defend its turf.

In a key regulatory win, the European Medicines Agency (EMA) approved a change for Wegovy injections on Thursday, allowing shipment at temperatures up to 30 degrees Celsius for 48 hours. This relaxation of the cold-chain requirement slashes packaging volume and transport weight, a move designed to streamline deliveries for online pharmacies and direct-to-patient services across the EU. The company's oral Wegovy formulation, currently under review in Europe, requires no refrigeration at all.

The push in the US is even more aggressive. Novo Nordisk launched its high-dose 7.2 mg Wegovy HD injection nationwide this week, making it available in over 70,000 pharmacies. Clinical data from the STEP-UP study shows this dose delivers an average weight loss of around 21 percent over 72 weeks, targeting patients who did not meet their goals on lower strengths. This launch is a direct attempt to close the gap with Eli Lilly's Zepbound, which commands over 60 percent of the US obesity drug market.

Perhaps more transformative is the early performance of oral Wegovy in the US. Launched just three months ago, it has already drawn tens of thousands of new prescriptions, primarily from an estimated quarter of US adults with needle phobia who previously avoided GLP-1 therapies. This represents fresh patient growth rather than cannibalization of existing injectable users. A March analysis from GlobalData projects the entire Wegovy portfolio will grow from $13.5 billion in 2026 to $18.9 billion by 2031, with the pill contributing $2.76 billion alone.

However, Eli Lilly is not standing still. On April 2, it received accelerated FDA approval for Foundayo (orforglipron), an oral drug that can be taken without fasting. Novo Nordisk's pill requires a 30-minute fasting period beforehand. While Novo Nordisk claims its drug shows "significantly higher mean weight loss" than Foundayo, it bases this on previously published studies rather than new head-to-head data.

The competitive and pricing environment is taking a tangible financial toll. For 2026, Novo Nordisk forecasts adjusted sales growth of minus 5 to minus 13 percent at constant exchange rates, pressured by a Most-Favored-Nation pricing agreement with the US government and reduced Medicaid reimbursements. Additional headwinds include generic competition in India, where the semaglutid patent recently expired, and ongoing US price pressure. The stock reflects this strain, down roughly 28 percent since the start of the year and trading near its 52-week low.

In this challenging climate, management is using share buybacks to support the equity. By early April, the company had repurchased nearly ten million shares worth approximately 2.59 billion Danish kroner under its ongoing program. The stock currently trades at 32.58 euros, up about two percent on the week but still deep in negative territory for the year.

Analysts remain cautious. Bernstein rated the stock "Underperform" in March, warning of a persistent earnings revision cycle. It views the upcoming FDA decision on CagriSema—a combination of cagrilintide and semaglutid submitted for approval and expected around the turn of 2026/2027—as the clearest near-term catalyst ahead of a Capital Markets Day in September 2026. The company will provide concrete figures on the financial impact of this competitive landscape when it reports first-quarter 2026 results on May 6.