Novo Nordisk’s shift to oral GLP-1 drugs faces pricing pressure and Eli Lilly competition as Q1 earnings loom, with revenue expected to drop 8%.

The Danish drugmaker is charging into a new era with oral GLP-1 therapies, but the market is demanding proof that the strategy can withstand a brutal pricing war. All eyes turn to Novo Nordisk’s first-quarter results on May 6, when investors will scrutinize whether the shift from injections to tablets is delivering where it matters most: the bottom line.

A Promising Start, but Not Without Wrinkles

Early demand for the company’s oral Wegovy pill has been robust. IQVIA data shows roughly 721,000 prescriptions were written in the US during the first quarter, suggesting the tablet format is drawing in patients who previously shied away from the injectable version.

Yet there is a catch. Barclays analyst James Gordon notes that the starter dose has hit a plateau, with higher-dose prescriptions climbing more slowly than anticipated. Patients typically move up to a stronger variant after a month, and any delay in that transition chips away at revenue.

The stakes are even higher now that Novo Nordisk has rolled out oral Ozempic nationwide. The tablets, available since the start of May, target adults with type 2 diabetes and aim to lower both blood sugar and cardiovascular risk. The company has slashed prices to secure US market access and is rapidly expanding local production capacity — a move analysts see as a hedge against potential new tariffs on imported drugs.

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Eli Lilly Enters the Ring

The competitive landscape shifted dramatically in early April when the US regulator approved Eli Lilly’s Foundayo pill, ending Novo Nordisk’s monopoly on oral GLP-1 treatments. Both companies now charge self-pay patients $149 per month, but Lilly has a convenience edge: Foundayo can be taken at any time, while oral Wegovy requires an empty stomach and a 30-minute fast afterward.

RBC analyst Trung Huynh advises patience, predicting it will take one to two years for stable market shares to emerge. For now, the battle lines are drawn, and the margin pressure is intensifying.

A Battered Stock Looks for a Lifeline

The market has been unforgiving. Novo Nordisk shares trade at €38.35, down roughly 37% over the past year. The stock did notch a 9% gain last week, lifting it above the 50-day moving average and off its March lows, but the damage has been severe. Billions in market value have evaporated since the all-time high.

Valuation tells the story: with a forward price-to-earnings ratio of about 13, the stock is historically cheap. But cheap doesn’t mean a bargain if earnings keep sliding. Analysts expect Q1 revenue to fall 8% year-on-year, with earnings per share dropping 16%.

The February guidance shock still stings. Management warned that 2026 revenue could decline by as much as 13%, a forecast that crushed investor sentiment. Some shareholders now hope for a lift to the lower end of that range when the company reports.

The Wild Card in the Numbers

One factor could dramatically alter the earnings picture. The market is anticipating a massive one-off gain from the release of a $4.2 billion provision, which would inflate reported profit. That non-cash item may mask underlying weakness, so investors will focus on operational metrics and cash flow.

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The company also just completed a tranche of its share buyback program, spending roughly 3.8 billion Danish kroner. That signals confidence, but the real test is whether the oral pivot can sustain profitability amid the price war.

What to Watch on Wednesday

The Q1 report will set the near-term direction. Key items on the checklist include prescription trends for the new pill, pipeline updates — particularly after recent clinical trial disappointments dented confidence — and any revision to the full-year outlook.

If Novo Nordisk holds firm on its weak 2026 guidance, the stock could face another leg down. But if management can convince the market that oral GLP-1s will protect margins despite the Foundayo threat, the current recovery might build enough momentum to challenge the 100-day moving average near €40.

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