Novo vs Lilly: the pill battle begins

Three scoreboards that decide the next leg

Investors love grand narratives, but obesity drugs usually move on small, measurable realities. In 2026, Novo’s pill launch is the headline, but the market grades the company on three scoreboards, not one.

First: does the pill scale beyond curiosity?
Consensus expectations still imply pill revenue is small relative to injections in 2026, partly because Novo prices it lower. That makes early traction important. A strong first half can lift expectations for 2026 and beyond, because the market starts extrapolating. A weak start does the opposite, because the “convenience” argument loses force fast.
Watch item: early 2026 momentum in starts and refills, not just social media buzz or one-off launch demand.

Second: can Novo stabilise the injection franchise while the pill grows?
Even if 2026 gets labelled “the year of the pill”, injections still pay most of the bills. That keeps the Wegovy versus Zepbound battle front and centre. If Zepbound keeps pulling away on prescriptions and revenue, the pill risks looking like a side project. If Wegovy shows signs of re-acceleration, investors may regain confidence that Novo can defend its base while building the next format.
Watch item: the trend in Wegovy prescriptions and revenue versus Zepbound, looking for a clear change in direction, not just a one-week wobble.

Third: can the next generation reset the long-term race?
The pill is about format and access. The longer game is about what comes after Wegovy. This is where CagriSema returns to the story. After disappointing data in late 2024 helped trigger a sharp sell-off and renewed doubts, the follow-up readout matters for credibility. REDEFINE 4 is designed as a head-to-head trial versus tirzepatide, the active ingredient in Lilly’s Zepbound. That makes it one of the cleaner “who has the stronger next step?” comparisons investors are likely to get.

Risks to watch before they become earnings surprises

The most common risk is a gap between trial results and real-world persistence. Side effects, stop-start use, and uneven access can reduce revenue per patient even when demand looks strong.

The second risk is a visible price war. If both firms compete in public, net pricing can compress quickly. The early warning sign is not an angry headline. It is commentary about higher rebates, lower revenue per prescription, or slower margin progression.

The third risk is pipeline credibility. If next-generation data disappoint again, investors may treat growth as more fragile, because they start modelling a shorter runway.

Investor playbook: what to watch next

• Track pill traction: starts plus refills through the first half of 2026.
• Track net price: revenue per prescription matters more than list prices.
• Track injections: Wegovy versus Zepbound trends, because that is still the cash engine.
• Track the pipeline catalyst: REDEFINE 4 headlines, because it anchors the 3 to 5-year view.

Conclusion: the pill is easy, the economics are the exam

Novo’s Wegovy pill makes obesity treatment feel a little more like everyday healthcare and a little less like a specialist procedure. That is a meaningful shift. The clinical profile looks strong, and the cardiovascular label adds weight to the medical case. But markets do not pay for approval letters. They pay for repeatable economics.

In 2026, Novo gets a cleaner, simpler test than it has had in a while: can it scale a lower-priced pill without giving away the margin story, can it stop losing momentum in injections, and can it rebuild long-term confidence with the next generation of data? If it delivers on those three scoreboards, the rebound has a foundation. If it does not, the pill still matters, but the stock story stays fragile.