Novo Nordisk A/S (NYSE:NVO) is experiencing strong early uptake for its new weight-loss pill, but intensifying competition with U.S. rival Eli Lilly and Company (NYSE:LLY) is raising concerns about whether growing prescription volumes can offset mounting pricing pressure in the obesity drug market.
The Danish drugmaker is set to report first-quarter earnings on Wednesday, with a heavy focus on the pill’s performance as it seeks to regain market share. The broader outlook for obesity treatments has become less certain, as U.S. pricing declines and increased competition challenge earlier projections of a $150 billion global market within the next decade.
A Critical Moment for Novo
The company has spent much of the past year under pressure, following setbacks including underwhelming trial results for its next-generation obesity treatment, reduced guidance, leadership changes and a significant share price decline that has erased more than $400 billion in market value since its 2024 peak.
“We are in the middle of the exam period, let’s put it that way,” said Mikael Bak, head of the Danish Shareholders’ Association.
“What I will be looking for is whether they are increasingly able to go from being rather defensive to being more offensive.”
Strong Early Demand for Oral Wegovy
Initial prescription data for Novo’s oral Wegovy treatment has exceeded expectations. According to figures from research firm IQVIA Holdings Inc., around 721,000 prescriptions were recorded in the U.S. during the first quarter, noted BMO Capital Markets analyst Evan Seigerman.
However, Novo’s first-mover advantage ended in early April when Eli Lilly secured approval for its competing pill, Foundayo, setting up direct competition in the oral obesity segment.
In a potentially encouraging sign for the sector, Eli Lilly recently reported stronger-than-expected quarterly results, boosting both its own shares and those of Novo, supported by robust demand for its weight-loss and diabetes treatments Zepbound and Mounjaro.
Volume Growth vs Revenue Pressure
Seigerman cautioned that it may be too early to draw firm conclusions from the initial launch data, noting that IQVIA figures exclude some prescriptions filled through telehealth providers, suggesting actual patient numbers could be higher.
At the same time, analysts warn that strong prescription volumes may not translate into equally strong revenue. Approximately 450,000 prescriptions were for the lowest 1.5 mg starter dose, priced at $149 per month. BMO Capital Markets estimates that first-quarter pill revenue could fall about 12% short of the roughly $1 billion consensus forecast.
“The initial launch has gone better than people thought,” said Barclays analyst James Gordon. “But are some people just starting on the cheap low dose and staying on it because it’s cheaper and they don’t need the higher efficacy and cost delivered by higher doses? There are still quite a lot of moving parts, even before Lilly’s competing oral product makes an impact”.
Patients typically begin treatment at lower doses and gradually move higher over time. A slower transition to higher doses could weigh on revenue even if prescription growth remains strong.
Novo declined to comment ahead of its results due to regulatory restrictions.
Gordon added that prescriptions for the starter dose appear to have plateaued, while uptake of higher doses has been slower than expected. He suggested that some patients may be remaining on lower-cost doses longer, while others may be discontinuing treatment altogether.
Pricing Pressures Build
Novo shareholder Lukas Leu acknowledged the strong initial launch but highlighted risks from intensifying price competition, particularly as rivals expand and U.S. President Donald Trump pushes to lower drug costs.
“The launch is definitely strong – I think no one wants to debate about that,” Leu said. “What we don’t know yet is whether it will compensate Novo for the price decline, which is faster.”
Some investors expect Novo to maintain its full-year guidance while waiting for clearer data on how the pill performs against Eli Lilly’s rival product. Others anticipate a possible increase at the lower end of the forecast range.
Competition with Eli Lilly in Focus
Investor sentiment toward Novo is increasingly shaped by comparisons with Eli Lilly, with some arguing the U.S. company has moved more decisively in advancing its pipeline and executing strategic deals.
“We see early but preliminary signs of progress. But it is still early stage – the future will show whether it is actually enough,” said Anders Schelde of AkademikerPension.