Q3 2026 earnings call, November 4, 2026: CFO Karsten Knudsen to depart as sales return to growth

Novo Nordisk reported third-quarter adjusted sales growth of 4% to DKK 79.2 billion and lifted its 2026 outlook for the second consecutive quarter, to adjusted sales and operating profit growth of minus 2% to plus 2% at constant exchange rates. The more interesting disclosure came in the Q&A. U.S. operations chief Jamey Millar acknowledged that the Medicare Bridge program accounts for most of the sequential acceleration in U.S. Wegovy volumes, and that the broader anti-obesity category was essentially flat between May and October once Bridge is excluded.

Bridge Is the Inflection, and the Underlying Market Is Flat

Wegovy pill volumes rose around 20% sequentially in the third quarter and injectable Wegovy volumes about 10%. Millar was candid about the source. Bridge is currently running at around 60,000 weekly total prescriptions across the injectable and the pill, and he said the 20% sequential growth "is largely but not exclusively bridge volume." Stripping it out, "the whole category is relatively flat, consistent with the seasonality that you see in that period." Asked directly by Jefferies whether the GLP-1 franchise would have grown without Bridge, Millar said there would be less growth, and that "Bridge is definitely creating an inflection in the category."

This tempers the headline recovery narrative. Management expects consumer activation in the fourth quarter and New Year's resolution demand to help, but the commercial channel is not yet providing an independent lift. Guggenheim pressed on this, noting that several payers have pulled back from supporting obesity coverage. Millar said the reticence is now "increasingly about the volume concern side of the equation," since net prices keep falling, and that list prices will also be cut on January 1, 2027. Large employers, he said, retreat when they see the cost trend despite long-term medical cost offsets: "whether it's Pepsi, Starbucks, other large employers, when they see the cost trend, they move against."

Bridge is also a demonstration project that ends at the close of 2027. Millar declined to forecast the political outcome but argued that rising family insurance premiums, up 28% over five years, and growing senior use of the benefit will "put pressure politically on continuation of the program." Investors should treat Bridge as a meaningful but time-limited support to U.S. volumes.

No 2027 Guidance, but a Three-Plus, Three-Minus Framework

Several analysts asked whether Novo can return to growth in 2027. CEO Mike Doustdar declined to guide, but went "out of my way" to offer building blocks. On the positive side he listed continued Wegovy pill uptake in the U.S. and international markets, annualization of Bridge, which only started in mid-2026, and two launches, CagriSema in the U.S. and Frehemgo (denecimig) on both sides of the Atlantic. On the negative side he cited the annualization of semaglutide loss of exclusivity in early-LOE international markets, which hit harder in Q3 than in Q2, a continued China headwind of about 2% plus further loss of exclusivity there in 2027, and "some favorable gross to net in 2026 that we should maybe under normal circumstances not expect to the same degree next year."

Management would not say whether the year-to-date growth rate, the Q2 and Q3 run rate in the mid-single digits, or the 0% guidance midpoint is the better baseline. Doustdar said Novo will look at October through December and build from there. The wide implied fourth-quarter range, which Goldman Sachs put at about a DKK 12 billion swing, was explained by Knudsen as customary for a volatile category. He flagged two specific headwinds: a tough comparison because of roughly DKK 3 billion of favorable U.S. gross-to-net in Q4 2025, and a larger loss-of-exclusivity effect, mainly in Canada.

Pricing: Ozempic Erosion of 10% to 15% Stays the Planning Assumption

On net pricing, Millar reiterated that Ozempic should be expected to erode 10% to 15% annually. Q3 came in "significantly better" than that range, but he said the payer pressure in type 2 diabetes will continue. Wegovy gross-to-net deductions were 30% to 35% in the quarter, slightly at the high end, with management expecting similar or slightly better ahead. Millar said Ozempic's Medicare maximum fair price under the Inflation Reduction Act should not add an incremental negative effect, as the existing price trajectory already reflects it.

International Operations: Pill Rollout Accelerates, With Early Signs of Normalization

International operations grew 8%, with EUCAN up 18%. Obesity grew 24%, and Novo holds a 54% volume share of the GLP-1 market in the region. Wegovy pill is now in 7 markets, and management expects it in more than 20 by the first half of 2027. That is earlier than the end-2027 timeline given at the September Capital Markets Day. Emil Larsen attributed the acceleration to manufacturing running above expected line capacity, multi-country packs and faster regulatory work, noting an Australian approval on the day of the call.

Early share data are strong, at about 90% of the oral obesity segment in the U.K. and about 80% in the UAE. About 100,000 packs were sold in Germany in six weeks, mostly to GLP-1 naive patients. However, U.K. weekly pack sales have slipped to around 60,000 from the 65,000 cited at the Capital Markets Day, which Larsen attributed to a competitor launch, seasonality and the fading of pent-up demand. He emphasized that the pill is not cannibalizing injectables and that Novo's overall U.K. share is more than 10 percentage points higher than before launch. Larsen also warned that, in loss-of-exclusivity markets, the pill will carry a premium price, and that Novo will "learn next year" what that means for volumes.

The injectable franchise is also doing more than the pill headlines suggest. Larsen said year-to-date Wegovy injectable volume growth in international operations is close to 70%, with "very disciplined pricing." Wegovy 7.2 mg has been launched in 3 markets so far, with more than 30 promised by year-end, and about 5% of U.K. injectable patients have moved to the high dose since its June launch.

U.S. Wegovy Pill and High Dose: Strong Share, Low Capture

Wegovy pill holds around 80% of new-to-brand prescriptions in the oral segment, with more than 8 million cumulative prescriptions, which Millar called the strongest U.S. pharma launch by volume in more than a decade outside of vaccines. The Wegovy franchise holds more than 50% of new-to-brand prescriptions across the obesity category. Millar noted that IQVIA understates Wegovy pill scripts because Novo's wider partner ecosystem and subscription channels do not report in absolute terms, so the franchise's capture rate is structurally lower than that of its oral competitor.

Wegovy 7.2 mg is running at about 20,000 prescriptions a week, or 5% of Wegovy volume, against about 15% of total injectable prescriptions industry-wide at the highest dose, which suggests room to grow. Millar said 80% of high-dose use is titration from 2.4 mg, so those scripts "otherwise would have been lost to the Wegovy franchise." That points to a defensive benefit more than an expansion of the market.

Ozempic Pill Rebrand Shows Early Traction

The transition from Rybelsus to Ozempic pill is complete, and weekly new-to-brand prescriptions for the oral franchise have more than doubled since launch. More than 60% of Ozempic pill new-to-brand prescriptions come from patients new to GLP-1 treatment. An FDA decision on the 25 mg dose is expected by year-end. Larsen said Novo has not decided to carry the rebrand into international markets, where it is prioritizing Ozempic 2.0 mg, launched in 13 markets so far and planned for 20 by year-end, to defend against increased competition in reimbursed markets.

Pipeline: CagriSema Beats Tirzepatide 5 mg and Moves Toward Launch

Chief Scientific Officer Martin Lange presented the REIMAGINE 5 results, a 60-week head-to-head study in over 1,000 type 2 diabetes patients comparing CagriSema at 1 mg of each component against tirzepatide 5 mg. CagriSema achieved weight loss of 12.4% versus 9.1%, with a non-inferior HbA1c reduction of about 1.7 percentage points. Lange argued the comparator is relevant because around 50% of global tirzepatide patients are on 5 mg or less. The caveat is that this tests a low-dose arm against a low-dose comparator rather than the top doses. In obesity, REDEFINE 9 showed 21% weight loss at 68 weeks on the lower maintenance dose of 1 mg of each component.

Post-hoc analyses in women from REDEFINE 1 showed average weight loss of 25%, ranging from 27% in pre-menopausal to 25% in peri-menopausal and 23% in post-menopausal women. A Phase II study in painful diabetic peripheral neuropathy showed a 2.4-point reduction on the pain scale, roughly a 38% reduction, with more than 53% of patients achieving at least a 30% reduction. Phase III trials in neuropathic pain across the portfolio are planned for 2027.

On whether CagriSema will benefit from the Wegovy halo, Doustdar rated the probability as "medium," arguing that "it's much, much more than semaglutide on the back of amylin being mixed with it." Millar would not detail launch segmentation but said a portfolio of "singlets, doublets, triplets" will matter as competition intensifies. Management says it is preparing to launch directly to consumers through NovoCare and partners as soon as approval arrives.

Oral zenagamtide, a unimolecular GLP-1 and amylin dual agonist, has entered Phase III in AMAZE 9, with a readout in 2028. Several readouts are due in 2027: Phase III RENEW 1 and 2 for cagrilintide around mid-year, Phase I/II data for two tri-agonists (UBT251 and an internal GLP-1/GIP/amylin molecule) in the first half, Phase II data for Amylin 355 in the second half, and Phase I data for oral ACSL5 inhibition in the second half. Asked about adverse event risk in the tri-agonist trials, Lange said that Phase I tolerability data are partly artificial because of dose-escalation designs, and that the Phase II readouts should be more representative. He said the aspiration is a safety profile in line with Wegovy, and potentially better for the GIP-containing triple. On efruxifermin, he suggested that Novo will not rush a launch for earlier-stage fibrosis, saying "we already have a drug on the market for F2 and F3. It's called Wegovy."

Financials and Management Change

Adjusted operating profit rose 27% to DKK 32 billion, helped by a comparison against roughly DKK 9 billion of transformation costs in Q3 2025, and partly offset by about DKK 3.5 billion of one-time costs in other operating expenses and R&D this quarter. Free cash flow was more than DKK 28 billion, and full-year free cash flow guidance is now DKK 60 billion to DKK 70 billion. Guidance assumes sales growth in international operations and a decline in U.S. operations, with lower realized prices tied to market access investments and the most-favored-nation agreement.

Novo also announced that Knudsen, CFO for nine years and a 27-year company veteran, will leave at year-end. Luigi La Corte, currently CFO of Galderma, will succeed him. The timing means the 2027 guidance in February will be delivered by a new finance chief, and several analysts used their questions to thank Knudsen. Doustdar said Novo is now reporting progress against its 2030 commitments: 7 first-in-human trials started this year, 10 Phase III programs ongoing, and 5.6 million obesity patients treated, almost double a year ago. Patient additions of 1.2 million in Q2 and 1.3 million in Q3 compare with a net decline in diabetes patients of 0.8 million in Q1, showing a real volume turnaround, albeit one that is currently supported by a time-limited government program and offset by price erosion.