Novo Nordisk, once Europe’s most valuable company and the undisputed leader of the GLP-1 obesity revolution, is now facing mounting structural headwinds. Pricing pressure, intensifying competition, pipeline uncertainty, and heavy reliance on the U.S. market have combined to shake investor confidence.

Shares are down roughly 75% from their mid-2024 peak above 1,000 Danish kroner — a dramatic reversal for a company that had symbolized the weight-loss drug boom.

Here are four key trends defining Novo Nordisk’s current challenges.

1. Fewer Blockbusters Than Rivals

Novo Nordisk is often described as a diabetes and obesity “pure play.” In 2025, it reported six drugs generating at least $1 billion in annual sales — fewer than key competitors.

Eli Lilly currently has eight blockbuster drugs, along with broader exposure to oncology and gene therapy.

Novo’s dependence on its GLP-1 franchise is particularly stark. Combined sales of Ozempic and Wegovy reached about $32 billion last year — roughly 67% of total company revenue. By comparison, Lilly’s Mounjaro and Zepbound accounted for about 56% of its revenue base, reflecting stronger diversification.

While Novo still sells insulin brands such as Tresiba and NovoRapid and rare-disease treatments, none approach the commercial scale of its GLP-1 portfolio.

Meanwhile, pharmaceutical giants including AstraZeneca, Roche, Amgen, and Pfizer are preparing entries into the weight-loss space — most with significantly deeper blockbuster pipelines.

2. Rising Exposure to a Weakening U.S. Pricing Environment

The United States has accounted for more than half of Novo Nordisk’s total sales since 2023, making it the company’s most important market — and its biggest vulnerability.

GLP-1 pricing in the U.S. has begun to compress. Novo and Eli Lilly agreed to lower prices for Medicare and Medicaid and offer discounted direct-to-consumer options. While politically strategic, the move is weighing on margins.

CEO Mike Doustdar has warned that 2026 will bring “pricing headwinds in an increasingly competitive market.” With such heavy U.S. concentration, even modest reimbursement changes can materially impact topline performance.

3. Stock Performance Lags Sharply Behind Peers

Investor confidence has eroded dramatically.

Novo shares are only about 11% higher than they were four years ago — a striking underperformance relative to Eli Lilly, whose shares have surged more than 400% over the same period.

Compared to the broader European benchmark STOXX Europe 600, which has gained roughly 55% in five years, Novo’s stagnation is even more apparent.

The most recent shock came after disappointing trial data for next-generation obesity drug CagriSema versus Lilly’s tirzepatide (Zepbound), sending Novo shares down more than 16% in a single session.

Analysts now describe sentiment as deeply depressed, with confidence “at rock bottom.”

4. Sales Contraction Expected in 2026

Earlier this month, Novo Nordisk guided for a 5% to 13% decline in sales and profits in 2026 — potentially the first annual sales contraction since 2017 in local currency terms.

FactSet consensus estimates project roughly an 8% revenue decline in 2026 versus 2025.

The near-term slowdown stems from:

• Price competition from Lilly
• Pressure from compounding pharmacies offering cheaper GLP-1 alternatives
• Slower ramp expectations for next-generation therapies

Longer term, additional big pharma entrants threaten to fragment market share further. Novo is betting heavily on CagriSema and an oral Wegovy formulation, but commercial durability remains uncertain — especially if Lilly launches its rival pill as expected.

The Bigger Picture

Novo Nordisk remains a dominant player in obesity and diabetes treatment. However, the competitive landscape has shifted from a near-duopoly to an arms race involving multiple global pharmaceutical giants.

What once looked like an unassailable growth runway now faces margin compression, pipeline scrutiny, and pricing reform.

The next 18–24 months will likely determine whether Novo reasserts leadership — or settles into a slower-growth, lower-multiple phase.