Novo Nordisk Crashes 17% After Warning Sales Could Fall 13%

Novo Nordisk just warned investors that 2026 will be rough. The stock responded with its worst day in years.

Shares of the Wegovy and Ozempic maker plunged 17% in Copenhagen trading Wednesday after the company guided for sales and operating profit to decline between 5% and 13% at constant exchange rates. Analysts were expecting growth.

The news wiped roughly $60 billion from Novo's market cap in a single session. It's a stark reversal for a stock that dominated the pharma narrative throughout 2024 and early 2025.

What's Driving the Decline

Three headwinds are converging at once.

First, pricing. The "Most Favored Nations" agreement with the U.S. government is forcing Novo to cut prices on its GLP-1 drugs. Under the TrumpRx program, Novo set the starting price for its Wegovy pill at $149 per month—far below the injectable version's original price point. That's good for patients but compresses margins.

Second, patent expiries. Semaglutide—the active ingredient in both Wegovy and Ozempic—is losing exclusivity in Canada, Brazil, and China this year. Generic competition in those markets will eat into revenue faster than new launches can offset.

Third, competition. Eli Lilly's Mounjaro and Zepbound aren't just catching up—they're pulling ahead. Cheaper compounded versions of semaglutide are also proliferating in the U.S., despite the FDA's efforts to crack down.

Eli Lilly Widens the Gap

The contrast with Lilly couldn't be sharper.

While Novo was issuing profit warnings, Lilly crushed Q4 estimates and guided 2026 revenue to $80-83 billion. Lilly now commands 60.5% of the U.S. obesity and diabetes drug market—up 2.6 percentage points from last quarter. Novo's share has slipped to 39.1%.

Lilly expects to launch an oral GLP-1 for obesity in the second quarter, pending FDA approval. If that happens, Novo's pill advantage—earned just months ago with Wegovy's oral approval—evaporates quickly.

Management Shake-Up

Novo isn't just reshuffling guidance—it's reshuffling leadership.

Dave Moore, head of U.S. operations, and Ludovic Helfgott, chief of product and portfolio strategy, are both departing. The company has tapped replacements from UnitedHealth and Merck Healthcare. When you're changing the executives responsible for your largest market and your product pipeline simultaneously, it signals more than routine succession planning.

CEO Mike Doustdar acknowledged the challenge directly: "In 2026, Novo Nordisk will face pricing headwinds in an increasingly competitive market."

The Bigger Picture

Novo's struggles reflect a broader maturation of the GLP-1 market. The days of unchecked growth and premium pricing are ending. Payers are demanding discounts. Politicians are scrutinizing costs. Competitors are multiplying.

For investors who rode Novo's ascent from obesity-drug pioneer to one of Europe's most valuable companies, Wednesday's plunge raises uncomfortable questions. The stock fell nearly 50% in 2025—its worst year on record. Another year of sales declines would make this look less like a temporary setback and more like a structural problem.

The obesity drug market is still growing. But Novo's share of that growth is shrinking, and the company's ability to command premium prices is eroding. That's a fundamentally different investment thesis than the one that propelled shares to record highs.

What to Watch

Q1 results will show whether the 5-13% decline guidance is conservative or optimistic. Pay attention to U.S. prescription trends for Wegovy and Ozempic—if volumes can't offset the price cuts, the lower end of guidance becomes more likely.

Watch Lilly's oral GLP-1 launch timeline. If it hits Q2, Novo loses its differentiation in the pill category almost immediately.

And track the executive transitions. New leadership sometimes brings fresh strategy. But it also creates execution risk during a period when Novo can't afford missteps.

The obesity drug revolution isn't over. Novo just isn't leading it anymore.