Novo Nordisk A/S (NYSE:NVO) said its first quarter of 2026 was marked by rapid uptake of its newly launched Wegovy pill in the U.S., continued expansion of its obesity franchise and a series of pipeline and regulatory milestones, even as adjusted sales declined because of lower realized prices.
Chief Executive Officer Mike Doustdar said Novo Nordisk is now serving more than 45 million people living with obesity and diabetes, including more than 4 million people using its obesity treatments. That represents an increase of more than 50% in obesity patients treated compared with a year earlier, he said.
Doustdar said the company remains focused this year on “driving competitiveness, progressing our pipeline, and making focus investments towards growth opportunities while delivering returns.” He said Novo Nordisk invested about DKK 22 billion in research and development and commercial initiatives during the quarter and returned nearly DKK 38 billion to shareholders through dividends and share buybacks.
Wegovy pill sees rapid U.S. uptake
Jamey Millar, executive vice president of U.S. Operations, said the Wegovy pill has “far outpaced the uptake of any prior GLP-1 drug launch in the U.S.” since its launch early this year. The oral version of Wegovy generated 1.3 million total prescriptions in the first quarter and more than 2 million prescriptions since launch, which Novo Nordisk estimates translates to more than 1 million people treated.
For the week ended April 17, Millar said total weekly prescriptions reached 207,000. He added that close to 80% of Wegovy pill users are GLP-1 treatment-naive patients, and that the company is also seeing patients move from competitor products, with limited cannibalization of injectable Wegovy.
The company said all three of the largest pharmacy benefit managers had added Wegovy pill at parity with the injection on their standard template formularies by the end of the first quarter. Millar said early volume has largely come from the self-pay segment, but improved formulary access is expected to affect the balance between reimbursed and self-pay volume over time.
In response to analyst questions, Millar said titration trends for the Wegovy pill are “happening as expected” and are comparable to injectable Wegovy. Doustdar said Novo Nordisk believes the product has been priced appropriately based on early volume, calling the current level the “sweet spot,” while noting that pricing is dynamic and could change over a longer time horizon as the company seeks broader patient reach.
High-dose Wegovy launched as obesity sales grow internationally
Novo Nordisk also launched Wegovy high dose, or 7.2 mg, in the U.S. in April. Millar said the product is available nationwide across all channels and has been added by the three largest PBMs as a line extension. Based on the STEP UP trial, he said patients who adhered to treatment achieved 20.7% mean weight loss, with about one in three patients experiencing weight loss of at least 25%.
Millar said the Wegovy franchise is now leading the branded anti-obesity medication market in new-to-brand prescription share, with about 65% share.
Emil Kongshøj Larsen, executive vice president of International Operations, said obesity care sales outside the U.S. rose 44% to DKK 9.2 billion in the first quarter, driven by volume growth and market expansion, partly offset by lower prices, particularly in China. Novo Nordisk remains the volume market leader in international operations, with about 55% weekly injectable GLP-1 volume market share, he said.
Larsen said Novo Nordisk is expanding telehealth partnerships and that in some of its largest markets, around 20% of gross sales growth is coming from telehealth channels. He also said the company expects to launch the Wegovy pill in select international markets in the second half of 2026, pending regulatory decisions. In Q&A, he said the company plans to “go all in” where it launches the pill internationally, though the broader international focus this year remains high-dose Wegovy launches.
Adjusted sales decline, guidance raised
Chief Financial Officer Karsten Munk Knudsen said reported sales rose 32% in the first quarter to DKK 96.8 billion. However, on an adjusted basis, excluding exceptional and non-recurring effects including a provision reversal related to the U.S. 340B drug pricing program, sales declined 4%.
Knudsen said the adjusted decline reflected lower realized prices, partly offset by GLP-1 volume growth and market expansion. Adjusted gross margin fell to 80.6% from 83.5% a year earlier, reflecting lower realized prices, one-time costs and negative currency effects, partly offset by a positive product mix from higher GLP-1 sales.
Adjusted operating profit declined 6% at constant exchange rates, reflecting lower sales and gross profit as well as continued investment in R&D and commercial activities, including launches. Knudsen said the company remains on track to deliver DKK 8 billion of savings from its company-wide transformation announced in the third quarter of 2025, with those savings being reinvested into growth opportunities.
Novo Nordisk ended the quarter with about 68,000 full-time employees, down nearly 10,000 from 12 months earlier.
The company raised its 2026 outlook. Adjusted sales growth is now expected to be between a decline of 4% and 12% at constant exchange rates, with adjusted operating profit growth expected in the same range. Knudsen said the improved outlook was mainly driven by increased expectations for GLP-1 product sales.
During Q&A, Knudsen said U.S. Ozempic pricing trends remain consistent with prior expectations, with price erosion of about 10% to 15%. He also said Wegovy tablet sales were about DKK 2.3 billion in the quarter, including roughly $150 million related to pipeline filling.
Pipeline advances across obesity, diabetes and rare disease
Martin Holst Lange, executive vice president of Research and Development and chief scientific officer, said the first quarter included numerous readouts and regulatory milestones. Novo Nordisk obtained FDA approval for high-dose semaglutide 7.2 mg in obesity and initiated pivotal Phase III trials in the zenagamtide development program, including studies in obesity, sleep apnea, knee osteoarthritis and weight-loss maintenance.
In diabetes, Lange said the Phase III REIMAGINE 1 trial for CagriSema met its objectives in people with type 2 diabetes inadequately controlled with diet and exercise. CagriSema showed superior HbA1c reduction of up to 1.8 percentage points and superior weight loss of up to 13.8% at 40 weeks. Detailed results from REIMAGINE 1, 2 and 3 are expected at the American Diabetes Association Scientific Sessions in 2026.
Lange also highlighted FDA approval of Awiqli as the first and only once-weekly long-acting basal insulin for people with type 2 diabetes, with a U.S. launch in the FlexTouch device expected in the second half of 2026.
In rare disease, Novo Nordisk reported that etavopivat met both co-primary endpoints in the Phase III HIBISCUS study in sickle cell disease. Lange said the drug reduced the annualized rate of vaso-occlusive crises by 27% compared with placebo and increased the proportion of patients achieving a hemoglobin response greater than 1 g/dL to 48.7%, compared with 7.2% for placebo. Novo Nordisk plans to submit the first regulatory approval application for etavopivat in the fourth quarter of 2026.
Doustdar closed the call by saying Novo Nordisk is focused on continuing uptake of new products, advancing its pipeline across therapy areas and strengthening the company through faster decision-making, resource allocation and partnerships.
About Novo Nordisk A/S (NYSE:NVO)
Novo Nordisk A/S is a Danish multinational pharmaceutical company headquartered in Bagsværd, Denmark, best known for its leadership in diabetes care and metabolic health. The company traces its roots to early Danish insulin production in the 1920s and was established in its current form through a 1989 merger of predecessor companies. Novo Nordisk develops, manufactures and markets pharmaceutical products and devices that address chronic and serious diseases, with a strong emphasis on long-term treatment and patient support.
The company’s core product portfolio centers on diabetes therapies, including a range of insulins and modern incretin-based treatments.
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