Novo Is Betting on Its Next Chapter as Eli Lilly Gains More Ground in GLP-1s

 Novo Is Betting on Its Next Chapter as Eli Lilly Gains More Ground in GLP-1s

**The Danish drugmaker just laid out its biggest strategic vision in years. Wall Street's response? A sharp selloff. Here's what's really at stake.**

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## The Room Where It Happened

Let me tell you about a woman named Ingrid. She's a portfolio manager at a European pension fund. She's been holding Novo Nordisk shares since 2021, back when Ozempic was still mostly a diabetes drug and Wegovy was just starting to make headlines.

She rode the stock from 400 kroner to over 1,000. She watched Novo become Europe's most valuable company. She believed in the story.

Then Eli Lilly showed up with a better molecule. And Ingrid watched her position lose nearly three-quarters of its value.

Last Monday, she sat in a conference room in London for Novo's Capital Markets Day. She listened to CEO Mike Doustdar lay out a vision for the next chapter. Five potential blockbusters. $23 billion in new sales. A broader pipeline beyond obesity.

She wanted to believe. She really did.

But when the presentation ended and the stock dropped 8%, she felt something she hadn't felt in years: resignation.

"They're asking us to trust them," she told me. "But they haven't given us a reason to."

That's the challenge facing Novo Nordisk in September 2026. It's not just about beating Eli Lilly. It's about rebuilding credibility with investors who've been burned. And as Monday's selloff showed, that's going to be a lot harder than launching a new drug.

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## The Numbers That Tell the Story

Let's get the hard data on the table, because the gap between these two companies is stark.

**Eli Lilly's Dominance:**

- Lilly commands **more than 60% of the GLP-1 market** and outsells Novo by more than two to one 

- In the Medicare GLP-1 Bridge program alone, Lilly is capturing **70% of patients** — higher than its 60% share in the broader market 

- Lilly's second-quarter revenue grew **48% year-over-year to $23 billion**, with Mounjaro and Zepbound contributing roughly $15 billion 

- Analysts rate LLY a **"Buy"** with 30 analysts covering the stock and an **86% Buy-side bias** 

**Novo Nordisk's Struggle:**

- Novo's market share has fallen to roughly **39%** in the U.S., down from its first-mover dominance 

- The company guided for **sales and profit to decline by 5% to 13% in 2026**, citing pricing pressure and loss of exclusivity in some markets 

- Novo's stock has fallen nearly **75% from its 2024 peak** 

- Analyst sentiment has deteriorated to **"Hold"** with 14 analysts covering the stock, including one Strong Sell rating as of September 

The market has spoken. Lilly is the winner. Novo is fighting for second place.

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## What Novo Actually Announced

So what did Novo put on the table at its Capital Markets Day? And why did it fall flat?

**The Pipeline Promise:**

Novo outlined plans to launch **more than five potential multi-blockbuster drugs by 2030**, with **more than $23 billion in pipeline sales by 2035** . The company also said it has manufacturing capacity to treat **10 times more obesity patients** on oral GLP-1s .

The therapeutic areas include:

- **Obesity and diabetes** (the core franchise)

- **Cardiovascular disease**

- **Liver disease**

- **Blood disorders**

**The Key Catalyst: CagriSema**

The centerpiece of Novo's near-term pipeline is **CagriSema**, a next-generation combination weight-loss treatment that combines semaglutide with cagrilintide, an amylin analog designed to enhance feelings of fullness .

In the REIMAGINE 4 head-to-head study, CagriSema produced **15.2% weight loss** and a **1.9-percentage-point A1C reduction** at 68 weeks . Novo expects a U.S. regulatory decision on CagriSema in obesity by the end of 2026, with a potential launch in 2027 .

**The Oral Strategy:**

Novo still leads in oral obesity drugs. Its Wegovy pill exceeded **161,065 weekly prescriptions** as of September 11 — more than three times the level of Lilly's Foundayo .

**The Diversification Pivot:**

After years of focusing almost exclusively on diabetes and obesity, Novo is now signaling a broader ambition. CEO Doustdar said the company has reached a point where it can "broaden our ambitions again" into cardiovascular, liver, and blood disorders .

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## Why Investors Didn't Buy It

Here's the thing about Novo's presentation: it was long on vision and short on specifics.

**The "Trust" Problem:**

Barclays analysts noted **"limited new disclosure to increase confidence"** . Jefferies said the plan failed to **"derisk the trajectory or offer a strategic reset"** .

In an interview with CNBC after the selloff, CEO Doustdar acknowledged the problem directly: **"The reaction of the market is a testament that we still need to do more work on building trust of the market"** .

He added: **"Trust is compounded and is built over time"** .

**The Patent Cliff Looms:**

The core issue is semaglutide, the active ingredient in Ozempic and Wegovy. Novo has already lost exclusivity in India, Brazil, Canada, and Turkey. And it faces losing exclusivity in Europe and the U.S. starting in the 2030s .

Unlike Lilly, whose portfolio includes cancer and neuroscience medicines, Novo generates **more than 90% of its sales from diabetes and obesity treatments** .

"They need something to replace semaglutide just to stand still," one former long-term investor told the Financial Times .

**The M&A Question:**

Investors have been calling for Novo to make acquisitions to diversify its pipeline. But the company has been slow to act.

"I'm a little surprised we haven't seen anything [on deals] yet," said Michael Leuchten, an analyst at Jefferies. "They should be doing business development and thinking of adding assets to the portfolio" .

However, he added: "This is a company that hasn't been particularly successful with BD and I'm not entirely sure how brave this management team is at this point in time" .

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## Eli Lilly's Momentum Is Accelerating

While Novo was trying to convince investors it has a plan, Eli Lilly was busy executing.

**Medicare Is a Goldmine:**

The Medicare GLP-1 Bridge program launched July 1, offering eligible seniors GLP-1 obesity drugs for a $50 monthly copay. As of late September, **700,000 seniors** had started treatment .

Lilly is capturing **7 out of 10** of those patients .

"If the program keeps expanding at its current rate, Lilly could exit the year at an annualized run rate of **$3 billion to $3.5 billion**," wrote Jefferies analyst Akash Tewari .

**The Oral Race Is Tightening:**

Lilly's Foundayo obesity pill launched in April and got off to a slow start. But it's gaining ground fast.

Foundayo now accounts for **about one out of three new starts** in the oral obesity category, up from "nearly one in four" in early August .

"We're seeing week-over-week growth," CEO Dave Ricks said .

**International Expansion:**

Foundayo has already launched in "four or five international markets," with more expected in the next six months. Lilly also broke ground on a **$6.5 billion manufacturing facility in Houston** to produce the active ingredient .

**The Triple Agonist:**

The biggest long-term threat to Novo is **retatrutide**, Lilly's triple agonist that targets three receptors instead of two. It aims to reduce average weight by **up to 25%** — far beyond current treatments .

If approved, retatrutide could cement Lilly's leadership for years to come.

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## Frequently Asked Questions

**Q: What happened at Novo Nordisk's Capital Markets Day?**

A: Novo laid out a strategy to launch more than five potential blockbuster drugs by 2030, with more than $23 billion in pipeline sales by 2035. The company also highlighted CagriSema, a next-generation obesity treatment, and signaled diversification into cardiovascular, liver, and blood disorders. Shares fell 8% as investors found the plan lacking in concrete details .

**Q: Why did Novo's stock drop after the announcement?**

A: Analysts said the presentation offered "limited new disclosure to increase confidence" and failed to "derisk the trajectory." Investors were hoping for more specific financial targets and a clearer plan to address the looming loss of semaglutide exclusivity .

**Q: How far behind is Novo Nordisk in the GLP-1 market?**

A: Eli Lilly commands more than 60% of the market and outsells Novo by more than two to one. In the Medicare GLP-1 Bridge program, Lilly is capturing 70% of patients, compared to Novo's share .

**Q: What is CagriSema, and why does it matter?**

A: CagriSema is Novo's next-generation combination weight-loss treatment that combines semaglutide with cagrilintide. It produced 15.2% weight loss in clinical trials. Novo expects a U.S. regulatory decision by the end of 2026, with a potential launch in 2027. It's considered Novo's best hope for a near-term catalyst .

**Q: What is Eli Lilly's biggest advantage?**

A: Lilly has a superior molecule (tirzepatide, the active ingredient in Zepbound and Mounjaro), a broader pipeline including a triple agonist (retatrutide), and longer patent exclusivity. Tirzepatide should be protected into "the back half of the 2030s" in major markets .

**Q: How does the Medicare program affect the competition?**

A: The Medicare GLP-1 Bridge program, launched July 1, offers eligible seniors GLP-1 obesity drugs for a $50 monthly copay. It has enrolled 700,000 seniors so far. Lilly is capturing 70% of those patients, which is expanding the market while cementing Lilly's dominance .

**Q: What is the oral GLP-1 market, and who's winning?**

A: Novo leads in oral GLP-1s with its Wegovy pill, which exceeded 161,065 weekly prescriptions as of September 11. Lilly's Foundayo now captures about one out of three new starts in the oral category, up from one in four in August. The gap is narrowing .

**Q: What are analysts saying about Novo stock?**

A: The consensus rating for Novo is **"Hold"** with 14 analysts covering the stock. The average price target is around $46.80, implying roughly 21% upside from current levels. However, sentiment has been deteriorating, with one Strong Sell rating added in September .

**Q: What are analysts saying about Eli Lilly stock?**

A: The consensus rating for Lilly is **"Buy"** with 30 analysts covering the stock. The average price target is around $1,325, implying roughly 12% upside. The Buy-side bias is 86% .

**Q: What should investors watch for next?**

A: Key catalysts include: (1) the U.S. regulatory decision on CagriSema by year-end, (2) continued growth of Foundayo in oral GLP-1s, (3) any M&A announcements from Novo, and (4) data on Lilly's retatrutide triple agonist .

**Q: Is Novo Nordisk a buy at these levels?**

A: This article is not financial advice. Novo trades at a low valuation (P/E around 9.5) and offers a 4.7% dividend yield, which may attract value investors . However, the company faces significant structural challenges, and analysts remain divided. Do your own research and consult a financial advisor.

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## Conclusion: Trust Is the Only Currency That Matters

Here's what I keep coming back to when I think about Ingrid, the portfolio manager in London.

She didn't sell her Novo shares after the Capital Markets Day. She's holding. But she's not buying more either.

"I need to see something," she told me. "A deal. A data readout. Something that tells me they're not just going to fade away."

That's the core problem for Novo Nordisk. It's not that the company is doomed. It has real assets:

- A **$170 billion market cap** and a **35% profit margin** 

- The **leading oral obesity drug** with a three-to-one prescription advantage 

- **CagriSema** awaiting approval with launch expected in 2027 

- A **pipeline of early-stage assets** in cardiovascular, liver, and blood disorders 

But it's competing against a company that's executing flawlessly, has a better molecule, a broader pipeline, and longer patent protection.

Novo's management knows the clock is ticking. CEO Doustdar has slashed **more than 9,000 jobs** and rebranded the company, dropping "Nordisk" from its name in a symbolic break from the past . He's promised a cultural reset called **"The Novo Way"** .

But culture doesn't matter if the science doesn't deliver. And investors don't care about rebranding if the stock keeps falling.

For Ingrid, the decision is simple: show her something real. A deal. A data point. A reason to believe.

"I don't need a miracle," she says. "I just need evidence that they have a plan that works."

Until Novo provides that evidence, the stock will likely stay where it is — in the penalty box, waiting for redemption.

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## Disclaimer

**This article is for informational and educational purposes only. It does not constitute investment, financial, or medical advice. The author has no position in Novo Nordisk (NVO), Eli Lilly (LLY), or any related securities. Information presented here is based on publicly available sources and reported figures as of the publication date. Clinical trial results are not guarantees of future performance or regulatory approval. The stock market involves risk, including the potential loss of principal. Past performance does not guarantee future results. Always consult with a qualified financial advisor before making any investment decisions.**