Novo Nordisk bets on Wegovy pill to win weight loss battle beyond U.S.

Novo Nordisk has told CNBC how it is preparing to go “all in” on launching its Wegovy pill outside the U.S, as the battle for dominance of the weight-loss market goes global.

“When we launch, we’ll go all in,” Novo’s Executive Vice President for International Operations, Emil Kongshøj Larsen, told CNBC in an interview on Tuesday. “It’s a major opportunity.”

Novo announced last week that it expects to start the first launches outside of the U.S. later this year, pending approvals, after the pill continues to impress with unparalleled U.S. uptake.

The U.S. market accounts for more than half of the sales of both Novo and its chief rival Eli Lilly. But the companies are now looking increasingly to expand the market for weight-loss drugs that have revolutionized the pharmaceutical space in recent years.

Larsen wouldn’t name specific countries where Novo might launch the Wegovy pill first, saying the drugmaker will “go according to potential,” highlighting factors such as patient interest in obesity treatment, how well-trained doctors are, and the existence of potential telehealth partners.

Larsen said that telehealth had been one way of broadening access to patients, saying that, in Germany, “it’s been slow for a while, and all of a sudden, telehealth helps patients get access to treatment in a way that is very convenient and appreciated.”

While Eli Lilly expects sales to grow 28% at the midpoint of its guidance this year, Novo has forecast a drastic decline in sales.

Novo hiked its guidance slightly last week, but still expects profits and sales to decline between 4% and 12% in 2026, hurt by lower prices in the U.S. and generic competition in markets including India, Canada, Brazil, and China.

This is despite Novo gaining an early lead in the oral weight loss drugs with the U.S. launch of the Wegovy pill in January. Last week, Novo said total prescriptions had reached more than 2 million, as sales massively beat expectations in its first quarter despite its lower price point. 

“We cannot have a better pre-launch in a world that’s become very small when it comes to social media, digital, sentiment, etc.,” Larsen said, referring to the U.S launch. “It’s also very exciting for our injectable franchise, because it’s energizing the whole Wegovy brand,” he added.

Nordea analysts said in a note to clients that Wegovy is becoming the number one household weight loss brand in the U.S., based on Google Trends data, which aligns with prescription trends.

Meanwhile, Lilly said on April 30 that more than 20,000 people had started taking the rival pill Foundayo since it launched earlier that month.

According to analysts closely tracking weekly U.S. prescription data, Foundayo has recorded far fewer prescriptions compared with the Wegovy pill in the comparable period, according to IQVIA data, which doesn’t capture all prescriptions, but gives market watchers an indication of demand. 

Lilly CEO David Ricks told CNBC late last month that establishing Foundayo as a brand would “take some time.” Foundayo uses a different active ingredient than Lilly’s blockbuster injectables Mounjaro and Zepbound, while Novo’s Wegovy pill is essentially an extension of the company’s injectable equivalents. 

“Our ramp is going to be a little different, because it’s a new brand, a new molecule,” Ricks said. “This is going to play out over quarters, not days… ask people to take a beat and let us execute.”

Barclays analyst Emily Field noted last week that oral Wegovy and Foundayo are going for different patient segments, with the former having “injectable-like efficacy” and the latter perhaps being viewed as more of a “starter” GLP-1.

Both Ricks and Novo CEO Mike Doustdar say the pills are expanding the market, rather than significantly capitalizing on demand for the injectables.

Studies have suggested that the pill results in more pronounced weight loss than Foundayo and has certain cardiovascular benefits, but so far, no clinical trial has directly compared the two drugs.

Larsen said that Novo expects a “very strong uptake” of the Wegovy pill internationally but not necessarily with the same kind of curve as in the U.S.

He said the U.S. isn’t a good comparison with other countries because uptake will depend on the relative price difference compared to injectable versions.

“We’re not detailing our pricing approach so far, but you could say in the U.S., there’s a fantastic product, but there’s also another price point compared to injectable treatments.”

He predicted international sales could have “an optic curve that’s maybe slightly more bent than the U.S. curve.”

Sydbank analyst Soren Hansen told CNBC on Wednesday that Wegovy’s launch outside the U.S. could be “more selective” and will reflect the company’s “ability to meet the demand.” He highlighted big European markets such as the U.K. and Germany as likely early markets for launch, as well as Novo’s home country, Denmark. 

Larsen told CNBC that Novo saw most growth for obesity GLP-1s coming from cash-paying customers, as opposed to those covered by national healthcare systems or insurers.

“Even in socialized healthcare systems like the Danish, 99% of all patients are paying out of pocket. We wouldn’t have imagined that a few years back, when we started with obesity care,” he added.

In late April, Lilly CEO Ricks told CNBC that international launches gave the company a “big runway.”

“There are a billion people on the planet who could benefit from these medications… right now we’re reaching about 20 million, he said.

Lilly’s first-quarter revenue outside of the U.S. jumped 81% to $7.7 billion, fuelled by a 95% surge in volume. Revenue in the U.S. climbed 43% in the quarter to $12.1 billion. “It turns out people like to lose weight all around the world,” Ricks said.

President Donald Trump’s so-called most-favored-nation drug pricing policy, whereby prices in the U.S. market are tied to prices in a set of reference countries, has complicated drug launches for many pharmaceutical companies.

Novo’s Larsen said that how European countries address pricing for medicines wouldn’t affect out-of-pocket launches.

“It’s, of course, critical that the European governments also accept that paying for quality innovation that changes public health, because otherwise investments and clinical trials, etc, will keep moving towards the U.S. or China, as we see at the moment,” Larsen said.