Novo Nordisk projects adjusted sales for 2026 to fall between 5% and 13% at constant exchange rates, reversing last year’s 10% growth. The company’s guidance factors in a USD 4.2 billion one-time reversal of 340B rebate provisions in the U.S., which if excluded leaves mid-point sales growth at –1% and operating profit growth at +11% on a non-adjusted basis. Management cited lower realized prices under the U.S. Most Favoured Nations agreement, patent expiry of the semaglutide molecule in key markets and escalating GLP-1 competition as primary headwinds.

In U.S. Operations, Novo Nordisk anticipates pricing pressure from expanded market-access investments tied to the MFN agreement, reduced Medicaid coverage for obesity therapies and intensifying rivals’ launches. The company expects gross-to-net sales adjustments seen in 2025 (which drove positive net effects) not to recur, compounding the expected decline in realized prices. CEO Mike Doustdar warned that “in 2026, Novo Nordisk will face pricing headwinds in an increasingly competitive market,” underscoring the challenge of defending share in the injectable and emerging oral weight-loss segments.

In full-year 2025, Novo Nordisk delivered sales of DKK 309.06 billion, up 10% at CER, with operating profit rising 6% to DKK 127.66 billion—results that outpaced prior guidance of 8–11% sales growth and 4–7% profit growth. Net income reached DKK 102.43 billion and earnings per share were DKK 23.03. U.S. operations benefited from favorable gross-to-net adjustments, while the January 2026 launch of the oral Wegovy pill generated roughly 50,000 weekly prescriptions as of January 23, driven primarily by the 1.5 mg starter dose in the self-pay channel.

Outside the United States, International Operations are expected to sustain volume growth from GLP-1 treatments and new market rollouts, notably the planned introduction of a 7.2 mg Wegovy dose in multiple countries. However, the company faces semaglutide patent expiries in select regions and intensifying local competition. Investors will also monitor readouts from the late-stage CagriSema diabetes trial, which recently showed superior HbA1c and weight-loss outcomes versus semaglutide alone, and could inform regulatory discussions later this year.