Novo Nordisk (NVO) FY25 earnings call: guidance and Q&A

Asked for a breakdown of the 2026 guidance between volume and price, particularly for US and International Operations, and how it compares to competitor's pricing expectations.

Karsten Knudsen explained that International Operations are expected to deliver mid-single-digit growth after adjusting for LOE, implying a high-teens sales decline for the U.S. This U.S. decline is driven by price reductions from market access investments, channel mix shifts (cash channel), and MFN impact, with the goal of expanding volume.

“the U.S. decline is driven by price declines, and it's driven by both investments in market access being a key driver built off the cash channel in the U.S. at a different price point, so channel mix and then the MFN impact”

asked by James Quigley · answered by Karsten Knudsen

Inquired about the potential speed of Medicare Part D access for Wegovy, noting competitor expectations for a fast unlock starting July 1, and how Novo Nordisk's guidance reflects this.

Karsten Knudsen stated that while a benefit is expected starting mid-year, it will be a gradual ramp with limited benefit in 2026 and a bigger benefit in 2027, due to the time needed for physician education and patient access.

“it will be a gradual ramp with limited benefit this year and a bigger benefit into 2027.”

asked by James Quigley · answered by Karsten Knudsen

Asked what shifted the guidance from Q3 expectations to the current -5% to -13% range, and what needs to happen to achieve the bottom end of the guidance, questioning its conservatism.

Karsten Knudsen clarified that the guidance is based on the latest market trends, including Q4 2025 performance, new data on Wegovy pill uptake, and Wegovy injectable cash business response to lower prices. He noted the obesity market's significant dynamism, with variables like competitive dynamics, gross-to-net, sourcing, and channel dynamics influencing the range.

“The obesity market is just significantly more dynamic than most other markets... the variables I'm alluding to is really, of course, as always, competitive dynamics, as always, gross to net dynamics that are being forecasted with a lag.”

asked by Sachin Jain · answered by Karsten Knudsen

Asked about formulary access for injectable Wegovy in the commercial channel, given lower cash channel prices, and whether the strong oral launch is impacting compounder volumes.

Dave Moore indicated stable access for injectable Wegovy, with ongoing discussions. For the Wegovy pill, commercial access is progressing, with coverage from major PBMs. He noted no significant change in compounder market stability yet, but over 170,000 people are on the Wegovy pill, mostly self-pay, suggesting potential future impact.

“On the pill side, what you heard me mention is we've actually seen some positive progress in just the first month. We started out the month January having CVS covering it right out of the gate. And then we quickly were able to add Prime, Optum and Anthem”

asked by Richard Vosser · answered by David Moore

Inquired about the sustainability of Wegovy pill demand, drawing parallels to Rybelsus, and the gross margin contribution compared to the injectable version.

Maziar Doustdar highlighted the strong launch efforts and the pill's 16.6% weight loss efficacy compared to competitor's 12.4%, expressing optimism for sustained demand. Karsten Knudsen stated that the Wegovy pill's gross margin is below the injectable but still attractive, emphasizing market expansion over cannibalization.

“Wegovy pill gives you 16.6% weight loss in addition to all the CV benefits and the great stuff that it has, with 16.6% weight loss. We've also read the data from our competing product, and we have seen that they are at 12.4%.”

asked by Peter Verdult · answered by Maziar Doustdar

Asked about the impact of missing a dose of the Wegovy pill on efficacy and tolerability, and if patients can resume at a lower dose after missing days.

Martin Lange explained that due to semaglutide's long half-life, missing a dose has minimal impact on blood exposure. Patients can reinitiate at the 25mg dose without significant issues, benefiting from the drug's pharmacokinetic profile.

“semaglutide is semaglutide and the half-life of semaglutide once in steady state is very long... That basically means that when you are on a stable dose on the Wegovy pill and then you skip a dose, it doesn't have a huge impact on your blood exposure in that period of time.”

asked by Thibault Boutherin · answered by Martin Lange

Asked for confirmation on API build-out being on track given high CapEx, and if the 7.2mg Wegovy high dose will launch immediately upon approval, specifying the device type.

Karsten Knudsen confirmed CapEx is trending downwards, with new API facilities expected online this year, and the broad scheme is on track. Maziar Doustdar stated they are ready to launch the 7.2mg Wegovy immediately upon Q1 2026 FDA approval, using the same device types, emphasizing its comparable weight loss efficacy to tirzepatide.

“As soon as we get the approval, we are ready to launch. So we will not sit on that regulatory approval. And we will go all in again because I think this is really, really important that the world a little bit understands that medicine is dosed differently.”

asked by Carsten Lombard Madsen · answered by Maziar Doustdar