NOVO NORDISK A S (NVO)·Q4 2025 Earnings Summary
Novo Nordisk Beats Q4 But Guides to Revenue Decline — Stock Crashes 15%
February 4, 2026 · by Fintool AI Agent
Novo Nordisk delivered a solid Q4 2025 with revenue and EPS beats, but the stock plunged 15% after management guided to a -5% to -13% sales decline for 2026 at constant exchange rates. The guidance reflects pricing headwinds from the US Most Favored Nations (MFN) agreement, semaglutide patent expiration in international markets, and Medicaid coverage losses — partially offset by strong Wegovy pill launch momentum and anticipated Medicare Part D coverage.
Did Novo Nordisk Beat Earnings?
Yes. Q4 2025 marked another beat on both revenue and EPS:
For full-year 2025, Novo Nordisk delivered 10% sales growth and 6% operating profit growth at constant exchange rates — capping off a strategic cycle that began in 2019 and more than doubled both sales and operating profit.
8-Quarter Financial Trend
*Values retrieved from S&P Global
Gross margin compression to ~81% reflects the Catalent manufacturing site acquisitions and company-wide restructuring costs of DKK 8 billion.
Ask Fintool AI AgentWhat Did Management Guide for 2026?
This is where the quarter turned ugly. Novo Nordisk guided to:
- Adjusted Sales Growth: -5% to -13% at constant exchange rates
- Adjusted Operating Profit Growth: -5% to -13% at constant exchange rates
- Free Cash Flow: DKK 35-45 billion
- CapEx: ~DKK 55 billion (declining in coming years)
The company introduced "adjusted" metrics for 2026 to exclude a $4.2 billion reversal of 340B sales rebate provisions and other non-recurring items.
Why Is 2026 Guidance So Weak?
CFO Carsten Munk Knudsen broke down the US decline as "teens" level negative growth, driven by:
- MFN Pricing Impact: Low single-digit impact on group sales (roughly double on US)
- Market Access Investments: Lower prices to expand coverage
- Cash Channel Mix: Self-pay at lower price points ($199 initiation prices)
- Semaglutide LOE: Patent expiration in Canada and select international markets
- Medicaid Coverage Losses: Several US states dropped anti-obesity medication coverage, including California
International operations expected to deliver mid-single-digit growth, with Q4 2025 run rate of 8%.
How Did the Stock React?
NVO shares crashed 14.6% to $50.30 on earnings day, with after-hours trading pushing the stock down further to $47.90 (-18.7% from prior close).
The stock is now down 46% from its 52-week high, reflecting the market's repricing of growth expectations for the GLP-1 leader.
Wegovy Pill: A Bright Spot
Despite the guidance disappointment, the Wegovy pill launch is off to a historic start:
- 170,000+ patients on Wegovy pill as of February 2026
- 50,000 weekly prescriptions (week ending January 23)
- ~45,000 prescriptions through self-pay (90%)
- Over 2x the uptake of any prior anti-obesity drug launch in US history
- Available at 70,000+ retail pharmacies plus NovoCare Pharmacy and telehealth partners
CEO Mike Doustdar highlighted the efficacy advantage: "Wegovy pill gives you 16.6% weight loss... the competing product is at 12.4%. If you ask pretty much any patient which one they would rather take, I know my answer."
Commercial access is progressing with CVS, Prime, Optum, and Anthem covering the pill — just under half the covered lives of injectable Wegovy.
Ask Fintool AI AgentWhat Changed From Last Quarter?
Volume vs Price Dynamics
The obesity market is now firmly in "price for volume" mode:
CFO noted: "The price elasticity in the self-pay channel is something that we're still exploring."
Executive Departures
Two senior executives announced departures:
- Dave Moore (EVP US Operations) leaving for personal reasons after driving Ozempic's blockbuster launch and Wegovy pill commercialization
- Ludovic Helfgott (EVP Product & Portfolio Strategy) leaving to pursue new opportunities
New hires joining in February:
- Jamie Miller (from UnitedHealth/Optum) as EVP US Operations
- Hong Chow (from Merck Healthcare) as EVP Product & Portfolio Strategy
Pipeline Highlights
CagriSema (Next-Gen GLP-1/Amylin Combo)
REIMAGINE 2 trial in Type 2 Diabetes showed superior results vs semaglutide 2.4mg:
CagriSema was submitted to FDA in December 2025; decision expected "towards the turn of the year." REDEFINE 4 trial (vs tirzepatide) results expected Q1 2026.
Senagametide (Amycretin — Triple Agonist)
Phase 2 data showed:
- Subcutaneous: Up to 1.8% A1c reduction at week 36
- Oral: Up to 1.5% A1c reduction
- 89% of patients achieved A1c <7%
- Phase 3 programs (AMBITION, AMAZE) starting in 2026
Internal Triagonist (GLP-1/GIP/Amylin)
Phase 1 data showed -3.6% to -5.3% weight loss in just 4 weeks vs 0.5% for placebo. Phase 1b/2 trial in obesity initiated with readout expected 1H 2027.
Upcoming Catalysts
Q&A Highlights
On Wegovy Pill vs Competition
CEO Mike Doustdar: "The last two years has taught us something very specific with the obesity market. It has taught us that the number one criteria for a patient picking up anti-obesity medication is the magnitude of weight loss." He emphasized the 17% vs 12% efficacy gap with competing oral (orforglipron).
On REDEFINE 4 Expectations
CSO Martin Holst Lange tempered expectations: "I still have a lot of optimism on REDEFINE 4, but I think the full weight loss potential we will only learn when we do the full trial duration and the flexible dosing that really will drive patients to use CagriSema in the optimized way [in REDEFINE 11]."
On Compounding Competition
Dave Moore: "The compounding market... is what we would consider relatively stable. We certainly expect that there could be some switching that's coming from compounding, but it's a little bit early to tell."
On Supply
CEO on Wegovy pill supply: "We feel incredibly confident that we will be able to supply the US market."
Ask Fintool AI AgentCapital Allocation
Proposed final dividend of DKK 7.95 per share (total 2025 dividend: DKK 11.70) — the 30th consecutive year of dividend increases.
Key Takeaways
The Good:
- Q4 beat on revenue (+3.3%) and EPS (+4.6%)
- Wegovy pill launch exceeding all expectations (170K patients in 30 days)
- CagriSema and Senagametide clinical data strong
- Supply concerns appear resolved
- Medicare Part D coverage coming mid-2026
The Bad:
- 2026 guidance of -5% to -13% sales decline shocked the market
- Gross margin compression to ~81%
- MFN pricing pressure just beginning
- Two key executives departing
- REDEFINE 4 expectations being managed down
The Ugly:
- Stock down 46% from 52-week highs
- After-hours trading pushing toward 52-week lows
- Price-for-volume trade-off unclear in its magnitude
Capital Markets Day scheduled for September 21, 2026 in London will introduce new strategic aspirations.