Novo Nordisk raises its 2026 outlook a second time, still expecting US sales to fall

Novo Nordisk raised its 2026 outlook for the second time, now expecting adjusted sales and adjusted operating profit to change by between -2% and +2% at constant exchange rates, according to its financial report for the first nine months filed on November 4.

The range moved up and now straddles zero

In its August 4 report, the company had guided to 0% to -6% for both measures. The new range of -2% to +2% still allows for a small decline. Novo said the improvement is driven by higher expectations for sales of GLP-1 drugs, the class that includes semaglutide, the active ingredient in Wegovy and Ozempic.

The third quarter was stronger than the guidance implied. Adjusted and reported sales rose 4% at constant exchange rates. Adjusted operating profit was DKK 31,720 million, up 27% at constant rates, which the company tied partly to a favorable comparison base: the third quarter of 2025 carried DKK 9 billion of company-wide transformation costs.

Reported operating profit moved the other way, falling 9% at constant rates, after DKK 8.7 billion of non-cash impairments. Of that, DKK 4.6 billion related to ziltivekimab, whose phase 3 trials ZEUS and HERMES did not meet their primary endpoint, and DKK 4.1 billion to a right-sizing of the manufacturing network.

The pill sold DKK 5.4 billion in its third quarter, mostly in the US

Wegovy pill sales were DKK 5,394 million in the quarter, of which DKK 4,178 million came from the US. Novo launched the pill there on January 5, and said prescriptions were about 3.6 million in the quarter and more than 8 million since launch. Self-pay prices in the US range from USD 149 to USD 299 a month by dose.

International sales of the pill were DKK 1,216 million. By region, sales in the US rose 1% in the quarter at constant rates, while International Operations rose 8%.

Guidance still assumes that US sales fall

The outlook is not a forecast of a broad recovery. Novo said it reflects expectations for sales growth within International Operations and a sales decline within US Operations. For the US, it assumes lower realized prices linked to investment in market access and to the agreement with the US administration that Novo calls MFN, for "most favoured nations".

A further price step is already scheduled. From January 1, 2027, Novo lowers its US list prices to USD 675, a cut of about 50% from the current Wegovy list price and about 35% from the current Ozempic list price.

Capital spending falls while cash flow guidance rises

Capital expenditure is now expected at about DKK 50 billion in 2026, against DKK 60 billion in 2025. Free cash flow is now expected at DKK 60-70 billion for the year, up from DKK 45-55 billion in August.

The nine-month figure is already higher than that range: free cash flow was DKK 83.8 billion, compared with DKK 71.1 billion a year earlier. The company attributed the increase to the timing of operating expenses, US rebate payments and tax payments, and to lower capital expenditure. A full-year range of DKK 60-70 billion would therefore imply a free cash outflow of DKK 13.8 billion to DKK 23.8 billion in the fourth quarter, by simple subtraction. In the first nine months Novo paid DKK 51.9 billion in dividends and spent DKK 10.0 billion on share repurchases.

A better year that still rests on one product family

We think the raise is real but narrow. The case for it rests on one drug family: the pill is selling, the US is the market where Novo itself expects revenue to shrink this year, and the list-price cut in 2027 will test whether volume can keep outrunning price. The cash-flow figures look strong, but the full-year range sits below the nine-month total, so we would not read the first nine months as a run rate.

The opportunity is that capital spending is falling while volume grows, which, if the guidance holds, leaves more cash for the dividend and the pipeline. The threat is that the profit gain in the quarter came partly from an easy comparison base and the 2027 list-price cut is still ahead. We expect the next test to be fourth-quarter US sales, and our view would change if US sales return to growth despite lower prices.

The view in this final section is FinanceInTime's editorial opinion, for information only. It is not investment, tax, legal or other advice, and it does not take your circumstances into account. Forecasts are uncertain and past results do not guarantee future ones.