Novo Nordisk Lifts Guidance Again as Q3 Sales Rise 4% and Operating Profit Jumps 27%; CFO Exits After 27 Years

Novo Nordisk delivered its second consecutive quarter of growth and its second guidance raise of the year on Wednesday, reporting third-quarter adjusted sales of DKK 79.2 billion, up 4% year-over-year at constant exchange rates, and adjusted operating profit of DKK 32 billion, up 27%.

“The quarterly development clearly shows that we are at the growth recovery phase, and that is progressing well,” CEO Mike Doustdar told analysts on the call. The top line has now recovered from declines of 2% in the fourth quarter of 2025 and 4% in the first quarter of 2026, returning to 7% growth in Q2 and 4% in Q3.

The quarter was not without drama. Novo announced earlier in the day that CFO Karsten Munk Knudsen is stepping down after 27 years at the company, including nine as finance chief. He will be succeeded by Luigi La Corte, currently CFO of Galderma, who brings more than 30 years of international financial leadership experience across healthcare and consumer businesses. Knudsen will remain with Novo until the end of the year to ensure a smooth transition.

Analysts on the call offered a stream of tributes to Knudsen, who has been a fixture on Novo’s earnings calls for nearly a decade. “I rarely do this on a public conference call, but I will make an exception this time for Karsten to say thanks for all the interactions over the years,” said BNP Paribas analyst Peter Verdult.

Financial Overview

MetricQ3 2026Q3 2025ChangeAdjusted salesDKK 79.2bn~DKK 76.2bn+4% (CER)Adjusted operating profitDKK 32bn~DKK 25.2bn+27%Free cash flowDKK 28bn——

The operating profit jump was flattered by a favorable comparison base: Novo booked approximately DKK 9 billion in company-wide transformation costs in the third quarter of 2025. That benefit was partially offset by around DKK 3.5 billion in one-time costs recognized this quarter within other operating expenses and R&D.

For the first nine months of 2026, Novo has delivered better-than-expected sales and operating profits. The company now expects full-year adjusted sales growth of -2% to +2% at CER, adjusted operating profit growth of -2% to +2%, and free cash flow of DKK 60-70 billion, all raised from prior guidance.

“The improvement in the outlook is mainly driven by increased expectations for GLP-1 product sales,” Knudsen said.

Obesity and the Pill Franchise Drive Growth

Obesity remains Novo’s primary growth engine. Sales rose 22% in the quarter, and the company now treats 5.6 million obesity patients, almost double the level of a year ago. Across diabetes and obesity, Novo reaches around 48 million people, two million more than a year earlier.

In the U.S., where sales grew just 1%, the Wegovy pill continues to outperform. It captured around 80% of new-to-brand prescriptions in the oral obesity segment and has generated more than 8 million cumulative prescriptions since launch, which Jamey Millar, EVP of U.S. Operations, called “the strongest U.S. pharma launch by volume in over a decade, outside of vaccines.”

Wegovy pill volumes grew around 20% sequentially in Q3 versus Q2, while injectable Wegovy volumes grew around 10%. Part of that growth came from the Medicare Bridge program, which contributes about 60,000 total prescriptions weekly across injectable and oral.

Millar was candid about the underlying trend. “Without the Bridge contribution, there is less growth than the 20% sequential growth that we talked about,” he said, adding that excluding Bridge, the entire obesity category was “relatively flat” from May to October, consistent with normal seasonality.

In diabetes, the transition from Rybelsus to the Ozempic pill is complete in the U.S., with weekly new-to-brand prescriptions for the oral franchise more than doubling since launch. More than 60% of Ozempic pill new-to-brand prescriptions come from patients new to GLP-1 treatment, suggesting the launch is expanding the market rather than merely switching patients. Novo expects potential FDA approval of Ozempic pill 25 mg by the end of the year.

International Operations: EUCAN Shines, China Weighs

International Operations grew 8%, with GLP-1 sales up 8% and obesity up 24%. The EUCAN region was the standout, delivering 18% growth. Canada was a drag, hit by lower realized prices following semaglutide’s loss of exclusivity.

“I would say very disciplined pricing where we’ve not given up,” said Emil Kongshøj Larsen, EVP of International Operations. He noted that Wegovy injectable volume growth year-to-date in IO has been close to 70%.

Novo maintains a 54% GLP-1 volume market share in IO. The Wegovy pill has now launched in seven markets, most recently Mexico, France, Spain, and Poland, and management accelerated its rollout target to more than 20 markets by the first half of 2027, up from a prior goal of 20 by year-end 2026.

Early results are strong: the pill holds around 90% market share in the U.K. and around 80% in the UAE. In Germany, about 100,000 packs have been sold in the first six weeks, mainly driven by GLP-1-naive patients. But Larsen cautioned that U.K. pack sales have moderated to roughly 60,000 per week from 65,000 at the time of the Capital Markets Day, reflecting a normalization after the bolus launch. Importantly, he stressed the pill is not cannibalizing injectables: “This is really adding to our overall market share, so we are still faring more than 10 percentage points higher than we did prior to the launch.”

China declined 2%, and Novo faces a new loss of exclusivity there next year.

Pipeline: CagriSema and Frehemgo Prep for 2027

Novo is preparing two major launches for 2027: CagriSema for obesity and diabetes, and Frehemgo for hemophilia.

Martin Holst Lange, Chief Scientific Officer, highlighted positive Phase III data. In the REIMAGINE 5 trial in type 2 diabetes, CagriSema 1 mg of each component demonstrated superior weight loss of 12.4% versus 9.1% for tirzepatide 5 mg, with non-inferior HbA1c reduction of around 1.7 percentage points. In obesity, the REDEFINE 9 trial showed 21% weight loss at 68 weeks with the 1 mg dose of each component.

Post-hoc analyses of women in REDEFINE 1 showed average weight loss of 25%, with substantial weight loss across premenopausal (27%), perimenopausal (25%), and postmenopausal (23%) women, supporting a potential positioning in women’s health.

“The brand name ends with ‘Sema,’ so there is semaglutide in there, but there is more than Sema inside,” Doustdar said of CagriSema. Asked about a potential halo effect from the Wegovy brand, he rated it “medium.”

Other pipeline milestones include oral amycretin advancing into Phase III (AMAZE 9, readout expected 2028), denecimig potentially launching in Europe by the turn of the year and in the U.S. in the first half of 2027, and Phase I/II results for two tri-agonists in the first half of 2027. Novo also submitted MASH data for orforglipron 25 mg in the U.S., with a decision expected in the first half of 2027.

2027 Outlook: Three Pluses, Three Minuses

Management declined to provide formal 2027 guidance but offered unusually detailed building blocks in response to persistent analyst questioning.

“We’re not going to guide, but let me go out of my way and provide even more building blocks for next year, so maybe you can do your own math,” Doustdar said.

He listed three positives: continued Wegovy pill uptake in the U.S. and internationally; the annualization of the U.S. Bridge program, which started mid-year; and the launches of CagriSema and Frehemgo. On the negative side: the annualization of international loss-of-exclusivity impacts; continued headwinds in China including a new LOE; and a less favorable gross-to-net comparison after a favorable 2026.

“I think the starting point, of course, is that we are nicely positioned in a growing GLP-1 market with a good runway,” Doustdar said. He noted that the 0% midpoint for 2026 is the base from which to think about next year, while acknowledging that the second-half exit rate is positive.

Asked repeatedly to clarify whether the 0% midpoint or the mid-single-digit second-half growth rate is the better proxy, Doustdar would only say: “We will, of course, guide with all of this in mind in 2027 at the full year announcement.”

Q&A Highlights: Pricing Pressure, Payer Resistance, and Political Risk

Analysts pressed on U.S. pricing dynamics. Millar reiterated that Ozempic faces 10-15% annual price erosion, though Q3 was better than that range. Wegovy has seen 30-35% erosion, and he expects that or slightly better going forward. He also said the most-favored-nation pricing agreement does not create an incremental negative beyond the existing trajectory, and that list prices will come down on January 1, 2027, as previously announced.

On payer resistance to obesity coverage, Millar acknowledged a difficult battle. “The reticence on behalf of the downstream payers, employers, government, private payers, is increasingly about the volume concern side of the equation,” he said. “Price keeps coming down… but how payers control the cost trend that they see, which is the price times volume equation, is the challenge.” He noted that large employers such as Pepsi and Starbucks have moved against coverage despite long-term medical cost offsets.

On the Medicare Bridge program’s future beyond its current end date in 2027, Millar said the political environment is uncertain but pointed to rising healthcare costs—family insurance premiums up 28% over five years—and predicted political pressure will build as more seniors benefit. “The benefit of this demonstration project is to document eligibility, inclusion, cost, and outcomes so that they can make a determination,” he said.

Analysts also probed the 2026 guidance range. The implied Q4 range is very wide—around DKK 12 billion at the extremes. Knudsen attributed the breadth to “navigating a rapidly growing category with a certain degree of volatility,” adding that the fourth quarter faces a tough comparator from DKK 3 billion in U.S. gross-to-net adjustments in Q4 2025 and a larger LOE impact from Canada.

On the tri-agonist adverse event profile, Lange sought to manage expectations. “What we typically see adverse events rates being captured in a very rigorous way is in phase I,” he said, calling the rates “a little bit technical, but also a little bit artificial.” He added that Phase II readouts should show a profile in line with Wegovy, and potentially better for the internal triple.

2030 Ambition Unchanged

Doustdar reiterated Novo’s 2030 ambition, set out at its September Capital Markets Day, of mid-single-digit compounded annual sales growth from 2026 to 2030, in line with industry peers. Novo has initiated seven first-human-dose trials so far this year and has 10 ongoing Phase III programs.

“We have delivered a strong quarter, raised our guidance again, and introduced a new strategy, culture, and a brand for Novo,” Doustdar said. “Across the organizations, we are focusing on turning our innovation into successful launches that make a meaningful difference for patients and society.”

For investors, the quarter confirms that Novo’s growth recovery is real but heavily dependent on the Wegovy pill, the Bridge program, and the 2027 launches. With the CFO transition adding a layer of uncertainty and 2027 guidance still months away, the pressure will be on Doustdar and La Corte to show that the recovery can extend beyond a favorable comparison base.