Quarterly Outlook
Q1 Outlook for Traders: Five Big Questions and Three Grey Swans.
John J. Hardy
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Strap yourself in for key market questions that must be answered in 2026.
A new reality for Novo Nordisk
Ruben Dalfovo
Investment Strategist
Key Takeaways
- Fourth-quarter results beat expectations, but the market focuses on sharply lower guidance for 2026.
- US prescription data point to slower momentum for Wegovy and Ozempic, with the pill launch not yet large enough to offset it.
- Expectations have reset to 2022 levels, shifting the story from growth celebration to execution under pressure.
The wake-up call investors did not expect
Another sharp reset in expectations hit Novo Nordisk on Tuesday evening, when the company updated the market on its outlook for 2026. The message was enough to trigger a heavy reaction at the Danish market open, with the stock falling by around 18%. For investors, the disappointment is understandable. Novo Nordisk has been priced for continued momentum, and the new guidance forces a reassessment of how fast growth can continue. Expectations for 2026 are now materially lower than most had imagined, and that reset is what dominates today’s trading.
If we start with the positive lens, the fourth quarter of 2025 is actually a little better than feared. Both revenue and earnings came in slightly above expectations. Ozempic sales reached just under 31.8 billion DKK, compared with expectations of 29.7 billion DKK. Wegovy sales landed at 21.8 billion DKK, versus expectations of 21.1 billion DKK (according to data compiled by Bloomberg). Novo Nordisk also highlights a solid early reception for the Wegovy pill. In total, around 50,000 prescriptions are written in the first three weeks after launch.
On a normal day, that would be enough for cautious optimism. This is not a normal day. The market is focused on one thing only. The outlook for 2026.
When guidance steals the spotlight
Novo Nordisk now expects adjusted revenue in 2026 to be 8% to 16% lower in DKK terms. That implies total revenue of roughly 257 to 284 billion DKK. For a company that, until recently, was seen as one of the clearest growth stories in Europe, this is a brutal reset.
What makes this cut even more striking is the historical comparison. The market’s current expectation for 2026 revenue is roughly the same level investors expected back in late 2022. At that time, the share price was remarkably close to where it is today. In other words, three years of excitement, upgrades, and ambition have been unwound in a matter of months.
Since spring 2025, consensus expectations for 2026 revenue have trended steadily lower. After Tuesday’s announcement, it is reasonable to expect further analyst downgrades, potentially pushing the average expectation closer to 270 billion DKK.
Prescriptions tell an uncomfortable story
The guidance cut aligns closely with what weekly US prescription data have been signalling for some time.
Wegovy prescriptions in the United States have largely stalled. Ozempic prescriptions are trending lower. Zepbound, Eli Lilly’s competing product, has also shown signs of flattening in early 2026. These data points come from Symphony Health and are not perfect. They do not capture global sales and can be revised. But directionally, they matter.
The message is simple and uncomfortable. Momentum in the US weight-loss market has slowed. Looking at the same prescription numbers and the development of Ozempic (the same drug as Wegovy), and Mounjaro, which is Eli Lilly's counterpart to Ozempic, the development at Novo Nordisk also looks a bit depressing. The prescription curve is clearly downward, and although sales outside the US may offset the indicated downturn, investors should not expect a big positive surprise in the upcoming quarters.
The Wegovy pill does provide a bright spot. Early prescription numbers show a decent start, with around 26,000 prescriptions by week three after launch. That is encouraging, but not yet decisive. At this stage, the pill is not large enough to offset weaker trends in injections.
This helps explain why the market reaction is so severe. Investors are not just reacting to management guidance. They are seeing confirmation of trends that had already started to worry them.
Watching Eli Lilly for the next clue
Later today, Eli Lilly reports its results. That matters more than usual.
If Lilly confirms similar pressure on growth expectations, it would suggest the entire weight-loss market is growing more slowly than hoped. That would turn this from a Novo-specific problem into an industry-wide reality check.
If, on the other hand, Lilly shows stronger momentum, the spotlight will move firmly back to Novo Nordisk’s execution, competitive positioning, and product mix.
Either way, the days of assuming endless demand and effortless growth are over. The market now wants proof, not promises.
Risks to keep in mind
The first risk is that expectations fall further. Even after this reset, analysts may still be too optimistic if US prescription trends fail to improve.
The second risk is competitive pressure. If rivals gain share while Novo Nordisk struggles to re-accelerate growth, margins and pricing power could come under strain.
The third risk is narrative fatigue. Investors have spent years hearing about the size of the opportunity. Now they want evidence that demand, access, and adherence can support those ambitions in the real world.
From excitement to execution
There is a temptation, especially for long-term investors, to look at today’s drop and argue that “bad news is priced in”. That may eventually prove true. But in the short-term, the stock is no longer driven by dreams of market size. It is driven by weekly data, quarterly delivery, and cautious guidance.Novo Nordisk remains a world-class company with strong products and global reach. That has not changed overnight. What has changed is the bar it needs to clear. The weight-loss story is entering a more mature phase. Growth still exists, but it is slower, more competitive, and more scrutinised.
The irony is that lower expectations can eventually become an advantage. When optimism fades, even small positive surprises can matter again. For now, though, the market has made its message clear. This is no longer a story about how big the opportunity could be. It is about how well Novo Nordisk executes in a more demanding, less forgiving reality.
This material is marketing content and should not be regarded as investment advice. Trading financial instruments carries risks and historic performance is not a guarantee of future results.
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