llion early in the next decade. The stakes are high. Novo has spent much of the past year on the defensive, hit by disappointing trials for its next-generation obesity drug, outlook cuts, leadership change and a share price slide that has wiped more than $400 billion off its market value since a 2024 peak. “We are in the middle of the exam period, let’s put it that way,” said Mikael Bak, head of the Danish Shareholders’ Association, which has 17,000 members, a majority of them invested in Novo. “What I will be looking for is whether they are increasingly able to go from being rather defensive to being more offensive.” Prescriptions for Novo’s new oral Wegovy pill have beaten expectations so far. Closely watched data from research firm IQVIA track about 721,000 prescriptions in the US in the first quarter, BMO Capital Markets analyst Evan Seigerman said. But Novo’s window as the only oral obesity pill on the US market closed in early April when Eli Lilly won regulatory approval for its rival pill Foundayo, setting up a head-to-head battle. In a potential positive sign for both companies, Lilly last week posted better-than-expected first-quarter results, lifting both its own and Novo’s shares, helped by strong volume growth for its weight-loss and diabetes drugs Zepbound and Mounjaro. Wegovy pill exceeds forecasts Seigerman cautioned against drawing firm conclusions so soon after launch, noting that the IQVIA data do not include prescriptions filled through some authorized telehealth providers, meaning patient numbers could be higher. Analysts also warn that strong volume may be masking softer revenue. Around 450,000 of the prescriptions were for the cheapest 1.5mg starter dose, priced at $149 a month. BMO Capital Markets estimates first-quarter pill revenue could come in about 12 per cent below analyst consensus of roughly $1 billion. “The initial launch has gone better than people thought,” said Barclays analyst James Gordon. “But are some people just starting on the cheap low dose and staying on it because it’s cheaper and they don’t need the higher efficacy and cost delivered by higher doses? There are still quite a lot of moving parts, even before Lilly’s competing oral product makes an impact.” Patients typically start low and move to higher doses over several months as their bodies adjust. A slower-than-expected shift would weigh on revenue even if headline prescription growth remains strong. Novo declined to comment during the regulatory quiet period ahead of results. Gordon said prescriptions for the starter dose had plateaued, while higher-dose numbers had risen more slowly than would be expected if patients were stepping up after a month. The most likely explanation was a mix of patients staying on the cheaper dose for longer and others dropping off treatment altogether, he said. Price war intensifies Novo shareholder Lukas Leu praised the pill’s fast start but flagged risks from intensifying price pressures as competition grows and US President Donald Trump pushes to lower drug costs. “The launch is definitely strong – I think no one wants to debate about that,” Leu said. “What we don’t know yet is whether it will compensate Novo for the price decline, which is faster.” Some investors expect Novo to hold full-year guidance steady as it waits for clearer evidence on how the pill stacks up against Lilly’s rival. Two investors said they expect Novo to lift the lower range of its guidance. The comparison with Lilly is key to investor attitudes toward Novo, with some saying the US drugmaker has moved more decisively on both its pipeline and dealmaking. “We see early but preliminary signs of progress. But it is still early stage – the future will show whether it is actually enough,” Anders Schelde at Novo shareholder AkademikerPension told Reuters. Reporting by Stine Jacobsen in Copenhagen and Maggie Fick in London. Additional reporting by Soren Jeppesen. Editing by Adam Jourdan and Mark Potter. All courtesy of Reuters.