Novo Nordisk A/S (NVO) Earnings

Management highlights

### Commercial Operations Highlights - U.S. Vigovipil (Wegovy pill) has reached over 5 million total prescriptions six months post-launch, with 267,000 weekly prescriptions as of mid-July 2026; ~80% of Vigovipil patients are GLP-1 treatment naive, indicating market expansion, and cannibalization of injectable Vigovi is limited. Access for obesity GLP-1s remains poor, with most prescriptions being self-pay; early participation in the new Medicare Part D Bridge Program for patients 65+ is encouraging. - International commercial progress: Vigovipil launched in the UK and UAE; after three weeks in the UK, ~300,000 patients have started treatment, increasing Novo Nordisk's obesity market share from 30% to 45%, with most new patients GLP-1 treatment naive. In the UAE, Vigovipil captured 50% market share despite being a late entrant. Upcoming launches include Germany in September 2026. First generic entries to early loss of exclusivity (LOE) semaglutide markets have been modest so far, with LOE impact expected to be concentrated in H2 2026; Novo Nordisk has grown absolute volumes even as generics gain share. - The company's 2025 company-wide transformation is ahead of plan, with 8 billion Danish kroner in target savings on track, and full-time headcount reduced by ~15% (12,000 employees) year-over-year. Pipeline & R&D Highlights - The SUSE trial of Zyltivikimab (siltivecumab) for ASCVD, chronic kidney disease, and inflammation did not meet its primary endpoint of reducing major adverse cardiovascular events (hazard ratio 0.99), though the drug met target engagement for IL-6 pathway inhibition and had a similar safety profile to placebo aside from higher rates of serious infections. Two ongoing siltivecumab trials (Artemis for acute myocardial infarction, Hermes for heart failure with preserved ejection fraction) will continue, with results expected H1 2027. - The Redefine 9 Phase III trial for Cacosema (cagrisema) low-dose maintenance for overweight/obesity completed, with superior weight loss vs placebo and a favorable safety profile; detailed data will be released later in 2026. A Phase IIIb high-dose Cacosema trial is ongoing, with a U.S. regulatory decision expected end-2026 and potential 2027 launch. A head-to-head trial (ReImagine 4) found cagrisema 2.4 mg achieved non-inferior weight loss vs tirzepatide 15 mg, but did not meet non-inferiority for A1c reduction. - New trials initiated in Q2 include: a Phase 2 trial for a triple GLP-1/GIP/amylin agonist (readout H2 2027), a Phase 2 trial for UBT251 once-weekly therapy for type 2 diabetes (readout end-2027). Upcoming 2026 milestones include initiation of oral semaglutide obesity trials, Phase III results for efruxifermin in NASH, and multiple regulatory submissions and decisions across the portfolio.

Guidance

- Management has raised full-year 2026 guidance for the second time, with adjusted sales growth expected to range from 0% to -6% at constant exchange rates, and adjusted operating profit growth also expected to range from 0% to -6% CER. - The outlook for international operations assumes continued GLP-1 volume growth and market expansion (especially in obesity), partially offset by negative impacts from semaglutide compound patent expiry in several markets in H2 2026. - The U.S. outlook assumes continued headwinds including intensifying competition, reduced obesity medication coverage in Medicaid, lower realized prices from market access investments and the U.S. Most Favored Nations agreement, with uptake of Vigovipil reflected in guidance based on conservative assumptions. - Guidance incorporates reinvestment of transformation savings into R&D and commercial growth opportunities, with disciplined resource allocation ongoing. No formal 2027 guidance was provided, but management noted the GLP-1 market remains a fast-growing category with long runway, and the company delivered 7% Q2 2026 growth, positioning it well for future growth.

Segment performance

Q2 2026 overall adjusted sales reached 78.5 billion Danish kroner, growing 7% at constant exchange rates (CER), driven by GLP-1 volume growth and prior-period rebate adjustments. Adjusted operating profit grew 11% CER, as 3 billion Danish kroner in one-time manufacturing capacity restructuring costs and lower realized prices were offset by productivity gains and favorable product mix. By geography: - U.S. operations: grew 4% CER, driven by GLP-1 obesity volume growth; injectable Vigovi saw volume growth that was offset by anticipated lower realized prices, leading to a 22% constant exchange rate revenue decline for U.S. Vigovi. - International operations: grew 10% CER, driven by UCAN region growth; GLP-1 sales grew 13% overall, with obesity franchise growth of 37%. By therapy area: - Obesity care: sales grew 16% CER, driven by volume growth across the Vigovi product portfolio in both regions, partially offset by lower realized prices. Vigovipil (Wegovy pill) captured 90% of the U.S. oral obesity medication market, and the full Vigovi franchise holds 60% U.S. market share by NBRX. Novo Nordisk holds 58% GLP-1 volume market share outside the U.S. - GLP-1 diabetes: sales grew 2% CER, driven by U.S. operations and a favorable prior-period net rebate adjustment; Osempic (semaglutide diabetes) saw 10% Q2 sales growth internationally, partially driven by uptake of the 2.0 mg dose launched in 10 markets.

Risks & headwinds

- Semaglutide loss of exclusivity in multiple international markets (Canada, Brazil) is expected to be back-loaded to H2 2026, and will create headwinds that annualize into 2027. - Access barriers for obesity GLP-1s remain poor, particularly in the U.S., limiting uptake in the reimbursed commercial and public insurance segments. - New drug development and pipeline advancement carries inherent risk, particularly for novel mechanisms targeting understudied disease pathways (such as inflammation in cardiovascular disease) that have higher failure probabilities. - U.S. pricing headwinds from the Most Favored Nations agreement, Medicaid coverage cuts, and generic competition will pressure realized prices through 2026 and into 2027. - Intensifying competition across GLP-1 markets in both the U.S. and internationally could pressure market share and margins.

Analyst Q&A

• Q: What are the drivers of expected second half 2026 negative growth, and how does the ex-UK Vigovipil launch trajectory compare to the U.S. launch, what is expected for the upcoming German launch?

  A: The projected negative H2 growth reflects two main factors: semaglutide loss of exclusivity impact, which is concentrated in H2 2026 and will annualize into 2027, and difficult annual comparisons against favorable 5 billion Danish kroner gross-to-net effects in H2 2025 that do not repeat. The extremely strong early uptake of Vigovipil in the UK reflects large pent-up demand and a widespread injection barrier, and the drug's lack of drug-drug interactions makes it accessible to many patients. While Germany has a different market structure, it also has lower current treatment rates and large unmet need, and management is bullish on uptake using similar tactics to the UK launch.

• Q: How will Cagri-Semra be positioned in diabetes given its non-inferior failure on A1c reduction compared to tirzepatide, and what is the progress on API manufacturing capacity ramp-up?

  A: Across Cagri-Semra diabetes trials, A1c reduction has averaged 1.8-2.3%, with 1.9% in the ReImagine 4 trial, alongside an unprecedented 15% average weight loss. Cagri-Semra also carries the proven cardiovascular risk reduction benefits of semaglutide, with additional benefits for blood pressure, lipids, and potential other effects, creating a strong value proposition for patients. API manufacturing validation for new facilities is progressing well, but current utilization of the new capacity is very low, leaving substantial headroom to supply volume for future ex-U.S. Vigovipil rollout.

• Q: What is Novo Nordisk's current M&A strategy, and what does the failed SUSE trial mean for the future of the company's inflammation-focused cardiovascular R&D?

  A: Management is focused on small-to-mid-sized bolt-on acquisitions that complement the company's internal pipeline in obesity, diabetes, and related comorbidities. While management does not rule out transformative large M&A in the future, that is not a current priority. The SUSE trial result does not mean inflammation is not a causal factor in cardiovascular disease; the result could reflect IL-6 being too far downstream in the inflammation cascade, rather than inflammation itself not driving risk. The company continues to advance NLRP3 inhibitors (which act higher upstream in the inflammation pathway), and two ongoing siltivecumab trials will continue to generate data.

• Q: Will Novo Nordisk file the 50mg dose of oral semaglutide for approval given mounting competition, and what is the company's M&A focus, specifically in consumer/ aesthetics?

  A: The 50mg dose of oral semaglutide showed good efficacy and tolerability, but the already approved 25mg dose delivers 17% weight loss with a best-in-class tolerability profile, which is already a very competitive offering. With multiple oral GLP-1 assets already in the pipeline and portfolio, management sees no current need to launch the 50mg dose. Management views obesity as a broad condition with diverse patient needs, and prioritizes deals that align with the company's existing scientific, manufacturing, and commercial strengths; the company will provide more detail on its strategic priorities at the upcoming Capital Market Day.