Novo Nordisk shares fell by more than 14% following the company’s release of its full-year 2026 outlook. Management now expects adjusted sales to decline between 5% and 13% at constant exchange rates, compared with a 10% increase in 2025, and adjusted operating profit to fall by a similar 5% to 13%. The sell-off reflects investor concerns over pricing headwinds from the U.S. Most Favoured Nations agreement, patent expiry of semaglutide in selected markets and intensifying competition in the GLP-1 class, as well as reduced Medicaid coverage for obesity drugs.

The company’s guidance incorporates a one-time reversal of USD 4.2 billion in U.S. rebate provisions under the 340B Drug Pricing Program, which boosts non-adjusted growth metrics by roughly one percentage point at the midpoint. Excluding that item, sales are projected to shrink by up to 13% and operating profit by up to 13% at constant exchange rates. International Operations is expected to deliver modest volume growth from ongoing market expansion of GLP-1 therapies and new dose launches, while U.S. Operations will suffer from lower realised prices, heightened competition and channel mix shifts in self-pay versus payer-reimbursed prescriptions.

In parallel with its guidance update, Novo Nordisk reported positive headline results from the REIMAGINE 2 trial of CagriSema in type 2 diabetes. In 2,728 patients over 68 weeks, the 2.4 mg/2.4 mg combination achieved a mean weight reduction of 14.2% and an HbA1c drop of 1.91 percentage points, outperforming semaglutide monotherapy (10.2% weight loss, 1.76 percentage-point HbA1c reduction). No weight-loss plateau was observed, and 43% of participants lost at least 15% of baseline body weight. The safety profile was consistent with incretin- and amylin-based therapies, with predominantly mild-to-moderate gastrointestinal events.