How Novo Nordisk misread the US market for its weight loss sensation

Novo Nordisk's top executives ignored internal warnings that the company was not sufficiently prepared for the launch of its weight-loss drug Wegovy, leaving the Danish drugmaker in a more vulnerable position when rival Eli Lilly entered the market, six former employees involved in the discussions told Reuters.

Novo has enjoyed a tremendous windfall of $46 billion (292 billion Danish crowns) in net profit since mid-2021, when Wegovy became the first highly effective obesity treatment approved in the United States. But Lilly's Zepbound therapy outstripped Wegovy in weekly new prescriptions this year and the company struggles to convince investors it can remain competitive in the weight-loss boom.

In response, Novo is reorganizing its leadership team following the surprise ouster of Chief Executive Lars Fruergaard Jorgensen. Other key executives had already stepped down, including US chief Doug Langa, who, according to two former employees, had insisted on a commercial launch very soon after Wegovy's US approval.

The sources spoke to Reuters under the condition of anonymity to speak frankly about their former employer.

In heated internal discussions, sales and marketing executives urged Langa to first secure more supply and health insurance coverage, the two former employees said. Without robust coverage, many patients could not afford Wegovy's monthly cost of up to $1,300. Lilly wasn't expected to enter the market for at least two years and Novo could have been better prepared, they said.

Langa hewed to guidance from company headquarters in Copenhagen, which assumed much more modest sales through 2025, the two sources said. While demand for Wegovy proved to be unprecedented in a global obesity epidemic, the Novo view was too conservative based on its own indicators, they said.

"The forecasting was way, way off," said one of the sources. Sales and marketing executives said at the time "we've got a lot of research that tells us this is going to take off like crazy. We need to wait until the pharmacies are stocked and ready to go. But Doug Langa said ... 'no, we're going to launch.'"

Langa, who continues to work for Novo in an advisory role, did not reply to a Reuters request for comment.

Details of Novo's internal discussions have not been previously reported. Jorgensen and other executives such as Chief Financial Officer Karsten Munk Knudsen have said publicly they were surprised by the overwhelming demand at Wegovy's launch.

A Novo spokesperson said the company "utilized available data and modelling forecasts to predict demand" for Wegovy and is committed to improving access. The drugmaker has since secured wider insurance coverage and offered discounts to reduce out-of-pocket costs.

Soon after launch, Novo faced repeated supply shortages, leaving patients scrambling to get their next doses and preventing others from starting treatment. High out-of-pocket costs pushed many to the compounding market for cheaper copies.

"Novo didn't understand the market they were building and were so inflexible in their approach," said Evan Seigerman, an analyst at BMO Capital Markets. At a recent analyst and investor meeting, "every time someone would bring up something that Lilly had done that was kind of creative or strategic, (Jorgensen)'s like, 'Well I don't know if we can do that.'"

'CAPPED' LAUNCHES

Clinical trial data showed in 2018 that Wegovy could help people lose about 16% of their body weight, a major advance for the more than 100 million American adults living with obesity. Other signs suggesting massive demand for Wegovy included physician feedback and prescribing data for Ozempic, Novo's diabetes drug that contains the same active ingredient as Wegovy, four of the former employees said.

Yet Novo stuck by its "strategic aspiration" from late 2019, that annual obesity sales would double by 2025 due to Wegovy.

The company reported obesity sales of 5.7 billion Danish crowns ($895 million) in 2019 from Saxenda, a far less effective weight-loss drug. In 2024, obesity sales had already reached 65.1 billion crowns ($10.2 billion).

"Even though they saw the data, even though they heard all the feedback from the market, they never reflected it in the forecasts," said a third source, a former senior manager. "Many of us said again and again (internally) that this is going to be huge."

Analysts had also questioned the forecasts when Novo announced them during a 2019 investor conference.

"You're sitting on the biggest product launch you've ever done," said Keyur Parekh, at the time a Goldman Sachs analyst, according to a recording of the meeting. "Why isn't the board pushing you more towards a higher aspirational target?"

Novo repeated the pattern in other countries, introducing "volume-capped launches" with minimal supplies. Only Denmark, its home market, was spared, one of the former employees said.

Novo prioritised supply for high-price markets like Japan and the United Arab Emirates over key European countries where doctors influence global prescribing trends, the source said.

Lilly entered with ample supply; it quickly became the dominant player in parts of Europe and the Middle East, said two of the former employees.

Novo's spokesperson said the company remains a leader in obesity treatments, but did not comment on market share estimates.

PRICING MISSTEP

Novo also drew backlash from insurers, doctors and patients for launching Wegovy in the US at more than $1,300 per month, about $350 more than Ozempic. Lilly priced Zepbound at $1,080, similar to its diabetes drug Mounjaro, which uses the same active ingredient. The US drugmaker offered steep discounts, including out-of-pocket prices starting at $349 through its LillyDirect pharmacy for some uninsured patients.

One of the former employees said Novo was reluctant to offer meaningful rebates to pharmacy benefit managers (PBMs), who negotiate on behalf of health insurers and employers.

Lilly entered a market where "payers were frustrated with the way Novo negotiated the pricing," the employee said. "They were looking for some relief on the pricing, which Novo wasn't giving them."

"I felt like during this whole journey, Novo is more conservative compared to Lilly," said Lukas Leu of Bellevue Asset Management in Switzerland, citing how Novo entered the direct-to-consumer pharmacy market later than Lilly. Leu's fund holds both Novo and Lilly shares. "And Lilly is more bold. Lilly is just going in there."

($1 = 6.3684 Danish crowns)