Novo Nordisk Q1 2026 Earnings Call - Oral Wegovy Uptake Masks Price Erosion as Pipeline Advances

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Good day, thank you for standing by. Welcome to the Q1 2026 Novo Nordisk earnings conference call. At this time, all participants are in a listen-only mode. After the speaker’s presentation, there will be a question and answer session. I would now like to hand the conference over to your first speaker today, Michael Novod, Head of Investor Relations. Please go ahead.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you very much, operator. Welcome to this Novo Nordisk earnings call for the first 3 months of 2026. My name is Michael Novod. I am the Head of Investor Relations at Novo Nordisk. With me today, I have CEO of Novo Nordisk, Maziar Mike Doustdar, EVP U.S. Operations, Jamey Millar, EVP International Operations, Emil Kongshøj Larsen, EVP Research and Development and Chief Scientific Officer, Martin Holst Lange, and Chief Financial Officer, Karsten Munk Knudsen. All speakers will be available for the Q&A session. Today’s call is being webcasted live, and a recording will be made available at our website. The call is scheduled to last 1 hour. Next slide, please. The presentation is structured as outlined on slide 2. Please note that all sales and operating profit growth statements will be at TER unless otherwise specified. Next slide, please.

As usual, we need to advise you that this call will contain forward-looking statements. These are subject to risk and uncertainty that could cause actual results to differ materially from expectations. For further information on the risk factors, please see the company announcement for the first three months of 2026 and the slides prepared for this presentation. With that, over to you, Mike, for an update on our strategic milestones in the first quarter of 2026.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk0: Thank you, Michael. Next slide, please. In 2026, Novo Nordisk is focused on driving competitiveness, progressing our pipeline, and making focus investments towards growth opportunities while delivering returns. Today, Novo Nordisk is serving more than 45 million people living with obesity and diabetes. Of those, more than 4 million people are using our obesity treatments, which means we are now treating over 50% more people living with obesity compared to just one year ago. We are excited to continue bringing new Wegovy options to patients. That includes the Wegovy pill in the U.S. and Wegovy HD, also known as high dose or 7.2 milligram, which is now approved in the U.S., U.K., European Union, and Brazil. It is no secret that the Wegovy pill is off to a record-breaking start in the U.S.

Since launching it some 16 weeks ago, we have seen over 1 million people using Wegovy pill. As the global momentum behind the peptide-based therapies accelerates, Wegovy pill is defining a novel category as the only oral peptide for the treatment of obesity, setting a new benchmark for what patients and physicians can expect. All of this is something we are very proud of. It highlights our strong innovation and launch capabilities. Within research and development, we continue to advance our pipeline across therapy areas. In the first quarter of 2026, we have had 6 regulatory approvals and more than 10 clinical trials initiations. Martin will dip dive deeper into all of these exciting accomplishments in a few minutes, along with our expected milestones for the rest of the year. Novo Nordisk is making strategic investments in growth opportunities to drive our competitiveness and progress our pipeline.

In the first quarter of 2026, we have invested about DKK 22 billion in research and development and commercial initiatives. We returned nearly DKK 38 billion to our shareholders through dividends and share buybacks. We have raised our 2026 guidance, which Carsten will get back to later on. Next slide, please. In the first three months of 2026, adjusted sales decreased by 4%, driven by lower realized prices, partly offset by GLP-1 volume growth and market expansion. U.S. operations decreased 11%, partially offset by International Operations, which grew 6%. Our GLP-1 sales in diabetes decreased by 11%, mainly driven by U.S. operations. Obesity care sales increased 22%, driven by both operating units. International Operations grew by 44%, and U.S. operations grew by 9%. Handing it to you, Jamey.

Jamey Millar, EVP U.S. Operations, Novo Nordisk: Thank you, Mike. Next slide, please. Early this year, Novo Nordisk launched the Wegovy pill in the U.S. Wegovy pill delivers weight loss efficacy on par with that of injectable Wegovy in a once-daily, easily administered oral tablet. In addition to the weight loss indication, Wegovy pill is the only oral GLP-1 product approved for the reduction of major adverse cardiovascular events, specifically a reduction in cardiovascular death, heart attack, and stroke. Furthermore, it is supported by semaglutide’s long-standing safety and tolerability profile, with around 50 million patient years of real-world experience, and does not have drug-to-drug interaction restrictions in its label. Since the launch, we have been focused on use, users, and usage. The use of Wegovy pill continues unabated, far outpacing the uptake of any prior GLP-1 drug launch in the U.S.

First quarter TRx were 1.3 million in total, and since launch, we have generated more than 2 million TRx. We estimate this translates into more than 1 million people treated since launch. For the week ending on April 17th, total weekly prescriptions were 207,000. In terms of users, our source of business analysis supports that the Wegovy pill is bringing new healthcare providers and new patients to Wegovy. In terms of patients, we see close to 80% of Wegovy pill users are GLP-1 treatment naive patients. We also see patients coming to Wegovy pill from competitor products with limited cannibalization from injectable Wegovy. Lastly, in terms of usage, we are tracking titration, refills, and stay time. While it is early in terms of usage evaluation, we are encouraged by what we see and early trends are consistent with our expectations.

We continue to seek improved pull-through of reimbursed volume, leveraging strong standard formulary positions in the commercial segment. By the end of the first quarter, all three of the largest PBMs added Wegovy pill at parity with injection on their standard template formularies. This will have an impact on the balance between reimbursed and self-pay volume over time. As expected, the early volume is largely in the self-pay segment. Next slide, please. Wegovy high dose was launched in the U.S. in April in a single-dose device, giving patients and healthcare providers the opportunity to experience greater weight loss with the Wegovy brand. Based on the STEP UP trial results, when patients adhered to treatment, the 7.2 mg dose of semaglutide delivered 20.7% mean weight loss in people with obesity, with approximately one in three people experiencing 25% or greater weight loss.

Importantly, despite the higher dose, the rate of discontinuation in the trial due to adverse events is similar to that observed with the 2.4 milligram dose. Wegovy HD has been launched nationwide across all channels, with the three largest PBMs having added Wegovy HD to their respective standard formularies as a line extension. It is still early days, but we are already seeing users titrate to the 7.2 milligram dose. Next slide, please. Our recent commercial efforts, including the expansion of Wegovy offerings with the Wegovy pill and Wegovy HD and options for accessing our medicines, have driven a notable shift in new-to-brand prescription dynamics in the branded anti-obesity medication space. The Wegovy franchise is now leading on NBRX market share with a share of around 65%. With that, over to you, Emil.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk: Thank you, Jamey. Please turn to the next slide. In the first three months of 2026, obesity care sales in international operations grew by 44% to DKK 9.2 billion. This was driven by strong volume growth and market expansion, partly offset by lower prices, particularly in China, following price reductions after the NRDA listing of a competitor product. Novo Nordisk continues to be volume market leader in international operations, with around 55% weekly injectable GLP-1 volume market share. While our market share has been declining over recent quarters, we are starting to see our share growth stabilizing, which indicates that we are gradually seeing the benefit of our efforts to drive competitiveness in the market. As examples, we are expanding our telehealth partnerships, and in some of our largest markets, around 20% of the growth sales is coming from telehealth channels.

We are also differentiating our GLP-1 portfolio with the U.K. approval of Wegovy 7.2 mg in a single-dose device, and the launches of Ozempic 2.0 mg. In addition, Novo Nordisk is expecting to launch Wegovy pill in select markets in the second half of 2026, pending regulatory decision. With that, over to you, Karsten.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Thank you, Emil. Please turn to the next slide. In the first 3 months of 2026, our reported sales increased by 32%, reaching DKK 96.8 billion. As part of our 2025 full year results, we did introduce adjusted metrics to exclude certain exceptional and non-recurring effects, primarily of non-cash nature, including the provision reversal of $4.2 billion related to the 340B drug pricing program in the U.S. That means our adjusted sales declined by 4%, driven by lower realized prices, partly offset by GLP-1 volume growth and market expansion across geographies. The adjusted gross margin decreased to 80.6% compared to 83.5% in 2025. Reflecting lower realized prices, one-time cost as well as a negative currency impact. This was partially offset by positive product mix from increased GLP-1 sales.

Adjusted operating profit decreased by 6% at CER, reflecting the lower sales and gross profit, combined with continued investments in R&D and commercial activities, including ongoing launches. Through our disciplined cost-based approach, we are on track to deliver the DKK 8 billion of savings from the company-wide transformation announced back in the third quarter of 2025, which are being reinvested into growth opportunities. At the end of the first quarter, the number of full-time employees was around 68,000, which is a decrease of almost 10,000 employees compared to 12 months ago. Please to turn to the next slide. Novo Nordisk is off to a good start, and for 2026, adjusted sales growth is now expected to be between -4% and -12% at CER. The improvement in outlook is mainly driven by increased expectations for GLP-1 product sales.

In its last operations, the outlook is based on current growth trends, including continued volume penetration from GLP-1 treatments and market expansion, mainly within obesity and negative impacts from the compound patent expiry of semaglutide molecule in certain markets. In U.S. operations, the outlook is based on current prescription trends for the injectable GLP-1 portfolio, intensifying competition as well as negative impact from reduced obesity medication coverage in Medicaid. Further lower realized prices linked to investments in market access, amplified by the Most Favored Nation agreements with the U.S. administration is assumed. Uptake related to the Wegovy pill is reflected in the outlook based on a range of assumptions related hereto, such as market penetration, potential negative impact on the growth of the injectable obesity medication category as well as channel mix.

Adjusted operating profit growth is now expected to be -4% to -12% at CER, primarily reflecting the updated sales outlook. We continue our targeted investment in growth opportunities within R&D and commercial, partly funded by reinvestment of savings from the company-wide transformation in 2025, as well as further optimization initiatives and disciplined resource allocation. Our key modeling considerations for 2026 are shown on the slides. That was the outlook for 2026. Now over to you, Martin.

Martin Holst Lange, EVP Research and Development and Chief Scientific Officer, Novo Nordisk: Thank you, Carsten Lønberg-Madsen. Please turn to the next slide. The first quarter was eventful with numerous readouts and regulatory milestones. Within obesity, we recently obtained FDA approval for high-dose semaglutide at 7.2 milligrams in the U.S. We have also initiated the two pivotal phase III trials in the zenagamtide development program, AMAZE. In addition, we have initiated phase III trials to investigate zenagamtide in people with obesity and sleep apnea, in people with obesity and knee osteoarthritis, and to investigate how well zenagamtide helps people with obesity in maintaining their weight loss. Within diabetes, we completed the pivotal phase III trial, REIMAGINE 1 for CagriSema, in people with type 2 diabetes inadequately controlled with diet and exercise.

In the trial, CagriSema demonstrated a superior HbA1c reduction of up to 1.8 percentage points and a superior weight loss of up to 13.8% respectively at 40 weeks. The detailed results from the REIMAGINE 1, 2, and 3 trials will be presented at the American Diabetes Association Scientific Sessions in 2026. Lastly, Awiqli received FDA approval as the first and only once-weekly long-acting basal insulin for people living with type 2 diabetes. We expect to launch Awiqli in the FlexTouch device in the U.S. in the second half of 2026. Please go to the next slide. Recently, we announced the top-line results from the phase III HIBISCUS study, which evaluated the potential of etavopivat in sickle cell disease in addition to standard of care.

Sickle cell disease is an inherited condition in which red blood cells take on a sickle shape because of abnormal hemoglobin. This alteration leads to blocked blood vessels, poor circulation, and episodes of severe pain known as vaso-occlusive crises or VOCs. The following complications can impact any organ and are often accompanied by anemia and fatigue and may ultimately lead to organ damage and a shortened lifespan. Approximately 8 million individuals worldwide are affected by sickle cell disease. Treatment options remain limited, and the unmet need is significant, underscoring urgent need for improved therapies that address both VOCs and hemoglobin response. Etavopivat is a novel and once-daily orally available small molecule designed to improve red blood cell health via pyruvate kinase R or PKR activation.

Etavopivat was tested in the HIBISCUS trial, a randomized double-blinded 52-week efficacy and safety trial investigating etavopivat versus placebo in 385 people aged 12 years or older with sickle cell disease. The co-primary endpoint was annualized VOC rates reduction and hemoglobin response on top of standard of care. Next slide, please. Etavopivat successfully met both co-primary endpoints in HIBISCUS, making it the first of its class to meet both co-primary endpoints by substantially reducing VOC events and improving hemoglobin response in sickle cell disease. In the trial, etavopivat demonstrated a superior reduction in the annualized rate of VOCs by 27% compared to placebo. In addition, time to first VOC event was delayed by around 4 months compared to placebo.

In the co-primary endpoint measuring hemoglobin response, etavopivat demonstrated a superior increase in the proportion of people achieving a hemoglobin response greater than 1 gram per deciliter at week 24 of 48.7% compared to 7.2% with placebo. As an exploratory analysis, etavopivat also significantly reduced the risk of blood transfusion. In the trial, etavopivat appeared to be well-tolerated with top-line safety profile in line with previous etavopivat trials. Based on the results from the HIBISCUS trial, Novo Nordisk plans to submit the first regulatory approval of etavopivat in the fourth quarter of 2026. Next slide, please. Earlier this year, Novo Nordisk and United Laboratories announced the top-line results for UBT251 in 2 Chinese phase III 2 trials, 1 in obesity and 1 in diabetes respectively. UBT251 is a long-acting synthetic peptide triple agonist targeting the receptors for GLP-1, GIP, and glucagon.

In the obesity phase II trial, the highest mean weight loss observed for people treated with UBT251 was 19.7% after 24 weeks of treatment. In the type 2 diabetes trial, the largest mean A1c reduction with UBT251 was 2.16 percentage points at 24 weeks, and the highest mean weight loss observed was 9.8%. In both trials, the safety and tolerability profile of UBT251 appeared to be consistent with tri-agonist-based therapies. Within obesity, Novo Nordisk has initiated a global phase I-B/II-A trial, with results expected in 2027. For type 2 diabetes, Novo Nordisk is poised to start a global phase II trial with UBT251 in second quarter of 2026. Next slide, please. After a busy quarter, we anticipate an exciting year ahead across all therapy areas.

Starting within obesity, we still expect a decision in the U.S. for CagriSema at the end of 26, with a potential launch in 27 around the same time of the REDEFINE 11 top-line results. In addition, we expect to initiate a phase III-B trial with CagriSema high dose in the 2nd quarter of 2026. Overall, we remain excited about the profile of CagriSema and prospect of launching soon, given the strong weight loss profile as well as the broader cardiometabolic effects observed. We also expect to initiate the AMAZE 9 trial investigating oral zenagamtide in people living with obesity in the 3rd quarter, and a phase III trial with cagrilintide high dose in the 4th quarter of 2026. In the U.S., we anticipate the decision regarding Wegovy FlexTouch that was resubmitted in Q1.

In the EU, we expect the decision on Wegovy pill and the single-dose device for injectable Wegovy 7.2 milligrams. Within obesity-related comorbidities, we expect phase III results for efroxifermine in the SYNCHRONY real-world trial in people with metabolic dysfunction associated steatohepatitis or MASH with fibrosis stage 1 to 4. The primary endpoint of the trial is safety and tolerability of efroxifermine. Within diabetes, we have initiated the phase II trial for our tri-agonist targeting GLP-1, GIP, and amylin. We also expect to initiate the senegatif phase III development program AMBITION in the fourth quarter of 2026. Within diabetes-associated comorbidities, the first readout of siltuximab from the SUSH phase III trial is anticipated in the third quarter of this year. The trial is assessing three-point MACE relative risk reduction on top of standard of care.

siltuximab has the potential to be first-in-class treatment, targeting systemic inflammation in people living with atherosclerotic cardiovascular disease and chronic kidney disease. 2026 is an exciting year in rare disease as well. Besides the big HIBISCUS results I just mentioned, we are awaiting regulatory decisions in the U.S. and EU later this year for donese-mak, previously known as Bimaate, for people living with hemophilia A. With that, over to you, Martin.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Martin. Next slide, please. With that, we are now ready for the Q&A. We kindly ask all participants to limit her or himself to 1 or maximum 2 questions, including sub-questions. Operator, we are now ready to take the first question.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. We will now take the first question. Your first question today comes from the line of Richard Vosser from J.P. Morgan. Please go ahead.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk6: Thanks for taking my question. 2 questions, please. Both on oral Wegovy. You’ve seen very strong uptake, there seems to be a bit of a drop-off in the patients going between the 4 mg and the 9 mg doses in terms of titration. Just wanted your views on what might be behind that. Is that the jump in price? Is it tolerability or is it weight loss results? How you’re thinking that will impact the stay time of the product and the growth going forward. One just on supply of oral Wegovy as well. You’ve referenced launches in a couple of international operations markets. How many markets do you think you can sustain and generally, how’s supply going? Thanks very much. Thank you, Richard.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: 2 questions, 1, starting with Jamey and then over to Carsten on supply.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk0: Yes, thank you for the question. Overall, titration is happening as expected and comparable to what we see with injectable Wegovy, so we’re pleased with the progress there. Of course, it’s early, post-launch in the evaluative kind of period of usage. We also see movement toward the 9 and 25 milligram doses, continued uptake on a week-over-week basis.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Great. Thanks, Jamey. Richard, thanks for the question on supply. The way I’ll put it is, while we do not have unlimited supply for the Wegovy pill due to the product design, despite the fact that we are setting a new record in terms of product uptake in the U.S. market with the Wegovy tablet, we’re still able to announce launches in the first markets ex-U.S. already this year. This speaks really to scaling of supply and the inventories we’ve put in place. Then we play it gradually from here in terms of the pace of international rollout. Thanks, Jamey. Thanks, Carsten. Thanks, Richard. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Sachin Jain from Bank of America. Please go ahead.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk7: Thank you for taking my questions too again, please. Firstly, I guess, Carsten, on SG&A. It’s the lowest absolute number for a number of quarters. Feels a little bit odd into a product launch. Should we think of this as a new commercial model with telehealth, and this is a base or anything to think about the cadence of SG&A through the course of the year? The second one’s a broad question around price, maybe for Mike or Jamie, and 2 media into your comments around no intention to lower prices and oral price at the sweet spot. I wonder if you could just dig into that a little bit further. Is the no intention to lower a comment for 150, 149 lower oral dose holding?

If oral price is a sweet spot, how do we think about price mix across the business shifting to this lower price bracket? I guess that, you know, trends to higher dose oral pricing, reimbursed pricing, any beliefs, diabetes pricing. Thank you.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Thanks, Sachin. First question to Carsten, then second goes to Mike. Thanks, Sachin, for this question. On SG&A in the quarter, first and foremost, it’s important to note that we have a one-off, which is favorable in the fact that we are adjusting a legal provision, which has a benefit of, I would say, a notch more than DKK 100 million that favorably impacts the quarter. One should adjust for that. In terms of continued investment, I promise you that we have gone pretty much all in in terms of the Wegovy pill launch and resourcing of that. You’ve seen the Super Bowl ads, etcetera.

With the model that we’re deploying together with the telehealth partners, then that yields a different scalability in terms of promotional presence between paid versus earned media. That has yielded a very high share of voice here in the first quarter. Through the coming quarters, expect us to be disciplined around our spending. We are less employees in the company, which of course helps on SG&A. At the same time, we are truly investing in the growth drivers we have be that Wegovy HD, the launch products coming up and the Wegovy tablets. In terms of SG&A ratio, we’re in the low 20s for the full year.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, Carsten. Mike?

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk0: Good. Sachin, I think price is dynamic and a element of volume uptake. If you take a look at where we are with our volume uptake, that’s why we say we are at the sweet spot. We are seeing a situation where at the current prices, we have had 2 million scripts after 16 weeks, more than 200,000 scripts per week, despite competitor having come now more than a month into the game, and having more than 1 million patients on our product. At this point, I would say we have priced this product perfectly correct.

We also have said that, of course, it’s dynamic because if you look at this in a longer spectrum, then we foresee a situation where volume uptakes continues, of course, to continue, and then that would mean that, you know, prices have to come down. If your ambition is to get to hundreds of millions of patients at one point or the other, at that point, of course, the prices will be very different. For now, this is the right price.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, Mike. Thanks, Sachin. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Simon Baker, Rothschild & Co. Please go ahead.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk8: Thank you very much for taking my questions. Two, if I may, please. Really following off from Sachin’s questions. Firstly, on the oral Wegovy. I just wonder, in light of the launch and success of the launch, if you’re getting a better handle on this price volume dynamic. As part of that, what’s been your feedback for patients choosing the pill? Is it convenience? Is it efficacy? Or is it cost because it’s the cheapest option in the market at the moment? Just some idea on how this price elasticity is evolving. Secondly, going back to cost, one for Carsten. Not only was SG&A, even after the legal adjustment, low in the quarter, R&D was as well.

I just wonder if you could give us an idea on the phasing of R&D through the rest of the year. Thanks so much.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. First question for Jamey Millar, and then second question for Carsten Lønberg-Madsen.

Jamey Millar, EVP U.S. Operations, Novo Nordisk: I think on price elasticity, as Mike said, the volume uptake and receptivity in the market suggests that we found that sweet spot in terms of price leading to record volumes. In terms of oral attractiveness to consumers and patients, the key decision criteria still is magnitude of weight loss, and the Wegovy pill demonstrated 17% weight loss. In addition, the attractiveness of the limited time offer pricing for the initial starting dose brings people to the product as well.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Thanks.

Thanks, Jamey. Thanks, Simon, for the question on R&D cost. As you heard from Martin’s introductory comments, we have a lot going in R&D, and it’s a strategic priority for the company to expand our pipeline to drive growth, not only for the medium term, but also for the long term. So the R&D ratio in the quarter is a notch on the low side compared to what we expect for the full year. Expect us to lean in on R&D investment in the coming quarters.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk8: Great. Thanks a lot.

Very clear. Thanks, Carsten. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Peter Verdult from BNP Paribas. Please go ahead.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk5: Yeah. Thanks, Peter Verdult, BNP. 2 questions, one for Martin and one maybe for Jamie as well. Martin, can I just push you for some more info on your next gen GLP-1? Is it fair to assume this will be differentiated on dosing frequency, or do you still believe there is scope within the GLP-1 class to differentiate on efficacy or safety? Then maybe Jamie, for you, just because you are new to the management team and you bring an outsider’s perspective inwards, could you just give us a flavor of what you found when you arrived in your role at Novo and some of the biggest changes you’ve made since taking the role on? Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, Pete. First question to Martin and then to Jamey.

Martin Holst Lange, EVP Research and Development and Chief Scientific Officer, Novo Nordisk: Yeah. Thank you for the question, Peter Verdult. I think you’ve heard me talk about before when we talk about differentiation, we look at efficacy, differentiation, tolerability, dosing frequency and maybe scalability. Let’s assume that this one has one or more of these potential traits, but we’ll not go further into detail, and you’ll have to maybe attend Capital Markets Day to learn more.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. Thanks, Martin. Jamey, what have you learned?

Jamey Millar, EVP U.S. Operations, Novo Nordisk: It’s a big question, but a short answer. Firstly, just a lot of opportunity. I think the first quarter milestones, whether it’s approvals, clinical data, readouts, have produced a great environment to make a change in the trajectory of the business. Specifically, obviously, Wegovy pill, as we’re discussing, but also Wegovy high dose. The 7.2 milligram strength really allows us to level the playing field from an efficacy standpoint. A lot of opportunities and levers to leverage. I think the second thing, just in a snapshot, Mike talks about it often, is the opportunity to integrate our thinking across market access, sales, marketing, medical, regulatory in a differentiated way.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. Thank you, Jamey.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk5: Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, Pete. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Michael Leyson from Jefferies. Please go ahead.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk1: Oh, thank you. Two questions as well, please, and linked. Ozempic had a pretty strong first quarter. Can you talk to the price erosion in the U.S. you saw in Q1, and how should that or would that look like once the Medicare GLP-1 Bridge kicks in? Would there be collateral damage for Ozempic in diabetes in the second half? That links to the second question on guidance. Carsten, you haven’t changed the lower end of the range, when Q1 came in quite robustly. What, what’s the variables that doesn’t allow you to lift that lower-end double-digit decline for the rest of the year? Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks a lot. Two questions for Carsten.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Yeah. Thanks, Michael, for those very relevant questions. First, in terms of Ozempic and Ozempic performance, I’d say what we’ve seen here in the 1st quarter in the U.S. setting, which is what you’re alluding to, is very much a continuation of what we saw towards the end of last year and what the same commentary in connection with full year. Both on volume trending and on pricing the same, we’re looking at these, call it -10% to -15% price erosion. Really no change there. And that’s what we’re looking into for the full year.

I really don’t want to get into the quarters, same guidance this year as last year and even the year before on Ozempic U.S. price. As to guidance and where we are now, the important point on guidance and our thinking behind guidance here at Q1 is that now we’re 3 months down the road and we’ve seen a number of items actually partially playing our way in terms of the oral script trends. We’ve got the Wegovy high dose approved in U.S. We have decided to launch Wegovy tablet ex U.S. in a few select markets.

Then we’ve gotten more info both on competition as well as LOE approvals in IO. Based on that, we’re more confident in our outlook. As a consequence, we parallel shifted both the sales and OP ranges by one percentage point. You should see that as increased confidence. Yes, I’m with you that the range is a notch wide, but you should take it as a signal of confidence that we lifted the range by one percentage point.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. Thank you, Carsten. Thank you, Michael. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Michael Nedelcovych from TD Cowen. Please go ahead.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk2: Thank you for the questions. I have two. My first is on Ciltavecumab. I’m wondering if you could tell us between ZEUS, Hermes, Artemis, and Athena, which trial you view as having the largest opportunity. Then my second question is on Wegovy IP in the U.S. I know that you guide to expiration of the semaglutide composition of matter patent as the loss of exclusivity date, but there’s almost a decade difference between the drug substance patent and the latest dated patents for Wegovy pill and Wegovy injection. My question is, does Novo plan to defend that IP? Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Mike. One question for Martin and one for Carsten.

Martin Holst Lange, EVP Research and Development and Chief Scientific Officer, Novo Nordisk: Thank you for that. From an indication and a potential perspective for Ciltavecumab, ZEUS, Hermes, and Artemis are the only ones that will lead to potential indications, respectively in ASCVD, heart failure with preserved ejection fraction and post-myocardial infarction. From a medical perspective, obviously, we have a high level of confidence in the biology. There is a potential of improving outcomes in all of these three categories. We still have to flag the high risk. This is first in class. And we need to establish not only the efficacy in terms of improved outcomes, but also of the safety and tolerability of an anti-IL-6.

We still see this as very, very high potential across those 3 indications, but also, high risk until we’ve seen the first data.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, Martin. Carsten?

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Yeah. On IP, as you know, Michael, this industry works in the way that we take very significant risks in early investments in R&D, with a fairly low probability of success early on. Those big risks and investments in return, we get the patent protection for a certain period of time. That’s why when we then get into that period, it’s very important for us to defend that patent protection. It’s granted by patent authorities in the different geographies. This is not something that we decide on our own. When granted, of course, we intend to defend all our patents in court, should they be challenged by generics.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Carsten. Thanks, Mike. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of James Gordon from Barclays. Please go ahead.

James Gordon, Analyst, Barclays: Hello, James Gordon from Barclays. Thanks for taking 2 questions. First question was just on long-term semaglutide in general obesity pricing. I know you’ve invested tens of billions in CapEx to brew sema very efficiently at scale, but then in India, I think it’s at least 8 generics approved and some very low prices, at least for the vial form, just DKK 14. It does look like the generic companies chemically synthesize at very low cost. Your latest thinking about manufacturing efficiency, do you still think like long term with synthesis generics would struggle to match you on price with your different technique? Do you think we are gonna have an order of magnitude fall once the patents go in the West, and that does make it tougher for next-generation obesity therapies?

The second question was just a follow-up on some of the comments about SG&A, just trying to square it, ’cause you did a 47% adjusted EBIT margin. It sounds like with the one-off legal, it’s still mid-40s, but the midpoint of the full year guide is more like 40%. Is it because of lots more R&D, or is it also like you’re allowing for doing a load more sales and marketing for an ex U.S. or a Wegovy launch? Otherwise, it seems like if you would get to a higher margin.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, James. 2 questions for Carsten, 1 on sema and manufacturing mode and pricing, and then 1 on SG&A.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Thanks, James, for those two questions. First and foremost on sema manufacturing. Based on our many process and setup and we believe that we are hypercompetitive in terms of unit cost in producing sema and hypercompetitive in terms of scale also in terms of how much sema we are able to produce and the reach we can do in pretty much at a global scale. What that leads into in pricing in different healthcare systems and and different channels remains to be seen. I think it’s important to note that over time, more of this is gonna be available in the cash segment with different partners and at different go-to-market models.

Let’s see where pricing pans out, how much pricing can brand recognition and brand loyalty carry compared to generics in this market. Consequently, how much price differentiation and price upgrade can we go for for next generation products remains to be seen. I think India is not a good proxy for other markets, to be honest. Then to a second question on margins, then I would say it’s important to note that our point of departure is an already very competitive margin if you look at it compared to the rest of our peers in the industry.

Being at, call it 40% operating margin or 40% plus is already very high. Strategically for us as a company, it’s more important for us to invest in future growth more so than short-term margin optimization. That’s why it’s important that of course, we optimize the opportunity we have short and medium term with the assets in the market or coming to the market soon, as well as investing in pipeline. That’s the key driver. Yes, we could drive for higher margin, but that’s not our strategy and nor the intention.

I would though say that we are very disciplined and rational, as I also said in the beginning, with our resources and having less almost 10,000 less FTEs today compared to a year ago. We are really reallocating our resources towards our key growth opportunities. I think that covers the SG&A comments. Thanks.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Very clear, Carsten. Thank you very much. Thanks, James. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Evan Seigerman from BMO Capital Markets. Please go ahead.

Evan Seigerman, Analyst, BMO Capital Markets: Hi, all. Thank you so much for taking my question. First question on the impact of generic semaglutide in Canada. How are you thinking about that as you have contemplated your guidance? Maybe some, you know, illustrative kind of concepts around that would be great. Secondarily, on a bigger, you know, taking a step back, you had some pretty striking data for sickle cell disease. Is rare disease, I know it’s a pillar of the company, but is this an area where you should be leaning in more to complement what you’re doing in obesity and diabetes to kind of give investors that next leg of growth? Thank you so much.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Evan. one for Emil on Canada and then one for Mike on rare disease.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Yeah. As you well know, most of you, we now have, of course, 2 approved generics in Canada. Slight delay compared to where they could have come in from a regulatory point of view, took some time to get the approvals. Now they’re there. It has not made us change our overall guidance at the group level that we will see low single digit impact on at group level. We don’t guide on country level in terms of impact, but I can tell you we are very ready and the leading tactic in Canada, that is a savings card that has seen a very good uptake both for Ozempic and Wegovy. That gives us a lot of maneuverability as we see how this unfolds.

I think you all know the framework in Canada. After 3 generics, there’s a mandated 65% price decline versus our list. We know sort of the game there, and we are ready to play it, particularly with the savings card. We have optionality on a second brand as well.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, Emil.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk0: Evan, our strategy is to really ensure that we drive growth short, medium, and long term. We will do that with the current products and we plan also to do that with our pipeline of our products across all therapy areas. Incredibly proud and happy of what I have seen with etavopivat. That comes in a family of a lot of other best in class and great rare blood and hematology drugs. That of course is no secret. All in all, stay tuned and of course, we’ll share with you more and more about our overall strategy. The main aim is to really make sure we have multiple legs to stand on so we can drive growth short, medium, and long term for you guys.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. Thank you, Mike. Very clear. Thanks, Evan. Next question please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of James Quigley from Goldman Sachs. Please go ahead.

James Quigley, Analyst, Goldman Sachs: Great. Thank you for taking my question. I’ve got 2, please. First of all, can you talk to what you’re seeing in the early stages of the Fontideo launch? What’s the latest feedback here from physicians and patients, particularly on how to manage relative food and water interactions, but also in terms of the awareness of the weight loss differential between the 2 products? Are there any patterns or trends in terms of the patients that are going on each drug? That’s number 1. Number 2, for the AMAZE program, you started 7 phase III trials on clinicaltrials.gov. Can you talk to the dosing protocol here in the obesity trials?

The primary endpoint is running out to week 84, so taking into account 1 of the key learnings from the CagriSema program, but how flexible is the dosing in the protocol, particularly given the unpredictability we saw in CagriSema, and also before seeing the results of REDEFINE 11? Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, James. First question for Jamey regarding what we see post Fontideo launch, and then the second question to Martin on what he can say about AMAZE.

Jamey Millar, EVP U.S. Operations, Novo Nordisk: Of course, it’s early days, but I think what we see so far is an affirmation of the strength of the Wegovy pill profile. As mentioned before, the number one decision criteria is efficacy, and we have, you know, unsurpassed efficacy with that 17% weight loss with Wegovy pill. We also introduced very quickly an indirect treatment comparison, which is a well-respected health, economic population health approach to comparing indirectly studies based on population adjustment in the phase III trials. That showed better efficacy with Wegovy pill than the competitor, as well as a lower likelihood of discontinuation due to adverse events and specifically GI events. What we’ve heard in the market is consistent with the strength of our profile.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thanks, Jamey. Martin?

Martin Holst Lange, EVP Research and Development and Chief Scientific Officer, Novo Nordisk: Thank you for the question. Obviously very relevant. We did take a lot of learnings from the REDEFINE program, as you know. They were both around the patient population. The need and wish to lose a substantial amount of weight is obviously a key imperative, and we’ve implemented that starting with REDEFINE 11 but also in the AMAZE program. We’ve adapted the flexible dosing so that we prompt patients more. We work or we allow investigators to work more with patients to get them to higher doses while maintaining the flexible nature of trials. We’ve clearly learned also from REDEFINE that approximately one-third of patients do need flexible dosing to achieve the full weight loss potential, and we need to allow that as well while helping and guiding the patients.

We implemented that in REDEFINE 11. Without going into too much detail, we can already now see a substantial impact in REDEFINE 11. I haven’t seen the weight loss data, I have to say, but I’m looking at dehydration data and the model seems to work. We have employed more or less the same algorithm in the AMAZE program. We’re quite confident that we’ll help patients really achieve the full weight loss potential of amycretin or zenagamtide.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Martin. Thanks, James. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Graham Parry from Citigroup. Please go ahead.

Graham Parry, Analyst, Citigroup: Great. Thanks for taking my questions. On Wegovy pill, can you quantify the total inventory impact on Wegovy pill sales in the quarter? You flagged in the release pre-launch inventory build. Has there been any further inventory increase through the quarter, and do you expect that to run off, or should we expect further inventory increases in subsequent quarters? Secondly, a question just on the CagriSema co-formulation, why the decision to terminate? Is that a technical or a commercial decision? Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Graham. Two questions. First for Carsten regarding the Wegovy pill inventory, and then the second to Martin on the co-formulation.

Karsten Munk Knudsen, Chief Financial Officer, Novo Nordisk: Yeah. Thanks for that question, Graham. For the Wegovy tablet, we reported around DKK 2.3 billion sales in the first quarter, to the tune of $150 million of those were related to what we would call pipeline filling. The pipeline filling covers both the initial inventory built with the wholesalers and in pharmacies, the customary launch orders, if you will. The second piece is just also the customary inventory built in connection with the brand getting bigger and in this case very, very fast. That happens for all products. It’s just a question of the pace of the inventory build.

It’s, you know, it’s like we manage inventories in the company, you know, in terms of days on hand of inventories, the same way it works with pharmacies and wholesalers in the U.S. This is absolutely normal what we’re seeing. In terms of going forward, then it’s also absolutely normal that there will be a certain degree of inventory built in conjunction with the brands continuing to expand. That what you see in terms of when you see IQVIA scripts, then there will be additional sales, especially in the early phases of a product life cycle, which is linked to inventory built across the chain. That happens for all products, and we’ve seen it for decades.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Is that clear? Martin?

Martin Holst Lange, EVP Research and Development and Chief Scientific Officer, Novo Nordisk: Yeah. Thank you for the question. As you know, we’ve always talked so that we are scaling the dual-chamber device of CagriSema to a full scale launch. We are very confident in that. We saw the co-formulation as a flexibility upside. The way we now think about it is that we have front-loaded and sped up the AMAZE program and the type 2 diabetes program, as well as the oral program. With full scalability on the dual-chamber device combined with anything zenagamtide coming in more or less the same time or even before as the co-formulation, it really didn’t make sense to progress. It was not a technical thing.

You heard me talk about last quarter, we did see full bioavailability, so it actually worked. There was just no need from a production perspective to progress it.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Martin. Thank you, Graham. Next question, please.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your next question comes from the line of Florent Cespedes from Oddo BHF. Please go ahead.

Florent Cespedes, Analyst, Oddo BHF: Good afternoon, Florent Cespedes from Oddo BHF. Thank you very much for taking my questions. Two quick ones, please. First, a follow-up on the GLP-1 franchise in diabetes. I was wondering, how could you really drive the business in the coming years? It would be mainly driven by innovation, and you could maybe give us a little bit more color on the two different geographical areas, U.S. and ex-U.S. My second question for Martin regarding your tri-agonist, when should we have more visibility on the profile of the two products, whether you intend to decide to keep one or both going forward, depending on the profile? If you could have more color on this point would be great. Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you, Florent. Two questions. We’ll split the first in two. One to Emil on how to drive Ozempic in IO and also to Jamey on driving Ozempic pill in U.S., and then over to you, Martin, afterwards.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk: Yeah, thanks for the question. We are very much focused on getting back in the game with Ozempic, now that we have full supply as of 8, 9 months, and we are seeing already some emerging positive trends in terms of share growth, particularly in U.K. What will further increase the momentum, we believe, is our 2.0 launch. We’ve had the first launches in 3 European markets, particularly in Germany. We’re seeing very good traction, but also in the Netherlands. In the U.K., it always takes a bit longer with local payers, et cetera, but remain optimistic there as well. You might know that in IO, 2/3 of all patients have already gotten to our 1 mg dose, and many would benefit from uptitrating both in terms of weight and A1C.

If I can maybe add another combo angle here, it’s also that we’ve actually in China launched Kyinsu, which is our once-weekly combination of a GLP-1 and our weekly insulin. Sorry, we will launch it come this summer. We just got the approval, we have good expectations. We have seen very good traction so far. In insulin in China, we own the two leading brands, Ryzudeg and Xultophy, also have good traction for our once-weekly insulin in China. Whether it’s insulins or it’s GLP-1, we still have a strong belief in diabetes across IO.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. Thanks, Emil. Jamey, on U.S. and Ozempic pill, maybe.

Jamey Millar, EVP U.S. Operations, Novo Nordisk: Yeah. In the U.S., we’ll continue to focus on the efficacy in terms of A1C reduction in type 2 diabetes, but also the holistic benefits in terms of cardiovascular benefits that semaglutide uniquely owns in that space. As mentioned, the Ozempic pill we’ve just introduced this week. We think that will breathe new life into Ozempic, basing a pill on the iconic naming and awareness of Ozempic generally.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Thank you. Martin?

Martin Holst Lange, EVP Research and Development and Chief Scientific Officer, Novo Nordisk: Yeah. Thank you very much. So it’s important to call out the two tri-agonists are two different biologics, one combining GLP-1, GIP, and glucagon, the other GLP-1, GIP, and amylin. I think based on what we see so far, they both have a substantial potential to introduce weight loss across the board with a good safety and tolerability profile. They may also contain individual traits that will clearly differentiate them. That could be on effect on liver, it could be on effect on bone, respectively, and it could also be differentiated weight loss in different subpopulations. If you take that approach, obviously it’s early days. We intend to progress both so we understand the full efficacy framework for both biologics, but also the safety and tolerability. We’ll see more insights.

We already have phase II data of UBT251. We’ve seen the weight loss potential in both obesity and diabetes. It seems to be quite stellar. Obviously with phase II data coming in from our internal tri-agonist next year, we’ll have better visibility on how to potentially differentiate.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. Thank you, Martin. Thank you, Florent. Operator, we’ll take the last question.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. Your last question for today comes from the line of Carsten Lønberg-Madsen from Danske Bank. Please go ahead.

Carsten Lønberg-Madsen, Analyst, Danske Bank: Thank you very much. I was just interested in hearing your wording on the ex-U.S. or the Wegovy launch. When you launched in the U.S., you were quite clear that this would be a full broad-based, sort of, very aggressive U.S. launch of oral Wegovy. What’s, what’s your sort of commentary on the ex-U.S. launch, including maybe observations on pricing levels outside the U.S. for the Wegovy tablet? Thank you.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk: Great. Thank you, Carsten. That’s a question for me. Yeah. We of course excited to have the opportunity to launch in selected key markets that lend themselves particularly well to the Wegovy pill in IO. We see a lot of halo effects from the U.S. already also on our injectable franchise. So we are going to go all in when we get the chance to launch. There will not be any half measures in IO where we launch. Of course, the general play in IO this year, that’s the high-dose launches of 7.2, where we see good traction with the messaging already. Of course, when we then bring the device, we have a strong belief that that will be part of turning around brand sentiment.

That’s why we have 20 launches planned, and that’s the main play. Of course, it’s a, it’s a nice addition where we get to launch the Wegovy pill.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: Great. Very clear. Thank you, Emil.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk: Thanks, Carsten.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk3: This concludes the Q&A session. Thank you for participating, and please feel free to contact investor relations regarding any follow-up questions you might have. Before we close the call, I would like to hand over to you, Mike, for the final remarks.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk0: Thank you, Michael. Please go to the next slide. I am very satisfied with our announcement today. 2026 is off to an exciting start, but we have much work left to do. Expect continued hard work from all of us in all fronts. This year, we are looking forward to, first and foremost, continuing to drive uptake with new products while providing access to many more patients worldwide. Secondly, progressing our pipeline across the therapy areas and development stages, building innovation from within and through business development. Third, continuing to make this the best organization for our employees and patients we seek our medicine through fast decisions and intentional resource allocation.

Fourthly, strengthening the foundation of Novo Nordisk by sustaining our purposeful direction and thoroughly building partnerships such as the collaborations with OpenAI to help ensure strong positioning, not only for this year, but for many more years to come. Thank you very much. Stay tuned.

Emil Kongshøj Larsen, EVP International Operations, Novo Nordisk4: Thank you. This concludes today’s conference call. Thank you for participating. You may now disconnect.