Novo has the cash and the pill; it needs new products to stop the U.S. slide

The technology

Novo Nordisk built the GLP-1 market with semaglutide, sold as Ozempic for diabetes and Wegovy for obesity. Those two injectables still carry the company: Ozempic sold DKK 31.4 billion and Wegovy DKK 19.5 billion in the second quarter of 2026, per Novo's Q2 report. The newest growth driver is the same molecule in pill form. The Wegovy pill launched in January, sold DKK 3.2 billion in the second quarter and passed 265,000 weekly U.S. prescriptions in July.

The next wave includes CagriSema (semaglutide plus the amylin analogue cagrilintide), a 25 mg oral semaglutide for diabetes, and a 7.2 mg Wegovy dose. Novo is also buying outside ideas, such as Hengrui's weekly oral peptide HRS-1596.

The odds

The near-term regulatory book is late-stage. Novo's report lists U.S. decisions on CagriSema and the 25 mg pill in the fourth quarter of 2026. Industry data put the odds of approval for a filed drug at 90.6%. Denecimig shows that filings can still slip on manufacturing: its FDA review was extended in October over facility remediation, though the FDA did not flag clinical problems.

Outside semaglutide, Novo's record this year is weak. Ziltivekimab missed in ZEUS with a hazard ratio of 0.99, and monlunabant was dropped with a DKK 4.0 billion impairment. HRS-1596 has not entered human trials, where the base rate of eventual approval is 7.9%.

The money

Novo is highly cash-generative. First-half free cash flow was DKK 55.3 billion, and the full-year guide is now DKK 45 billion to DKK 55 billion, with capital spending of about DKK 55 billion, per the 6-K. It is returning cash through a buyback of up to DKK 15 billion; by October 16 it had repurchased DKK 10.9 billion of B shares, per an October 19 filing. The Q2 report did not disclose a cash balance.

The risks

U.S. erosion is the main risk. U.S. sales fell 2% at constant exchange rates in the second quarter while International Operations grew 10%, per the 6-K. Full-year guidance, even after the August raise, is flat to down 6% for adjusted sales.

Competition is the second. Lilly's revenue grew 48% in the same quarter, per its release, and its retatrutide produced up to 22.6% weight loss in TRIUMPH-3. Lilly is also attacking Novo's oral position with cross-trial comparisons of its Foundayo pill.

Execution is the third: impairments, a failed outcomes trial and a manufacturing delay in one quarter.

Our read

Novo remains a very profitable company with a franchise that still sells more than DKK 50 billion a quarter between two brands. The problem is direction. U.S. sales are shrinking, the next big readouts outside semaglutide have disappointed, and the company is paying for outside assets to fill gaps. The Wegovy pill is the clearest positive, and the fourth-quarter U.S. decisions on CagriSema and the 25 mg pill will show whether Novo can add new products fast enough to offset pressure on the old ones.

Two more tests follow in 2027. HERMES and ARTEMIS will show whether ziltivekimab has any future after ZEUS, with readouts due in the first half of 2027, and Novo aims to launch denecimig in the U.S. in the same window if the FDA signs off on its factory fixes. Until then, the share of U.S. obesity prescriptions that Novo keeps against Lilly is the number that matters most for the company's direction.