Will Novo Nordisk report Q1 2026 adjusted sales decline greater than 10% YoY at constant exchange rates?

Q4 2025 total sales were -2% at CER, and jumping to >-10% in a single quarter requires an 8+ percentage point acceleration in decline rate. While US Operations were already -7% at CER, international markets provided an offset. The MFN agreement is the key new variable, but Medicare Part D pilot begins mid-2026 — suggesting H2-weighted impact. Oral Wegovy launch creates a genuine Q1 volume tailwind. Management guided -5% to -13% for the full year, implying Q1 is likely at the shallower end with headwinds building through the year.

Ozempic — the largest revenue product — faces dual headwinds of lower realized prices AND market share losses. GLP-1 value share erosion of 9.3pp in 12 months equates to roughly 0.8pp monthly, implying another 2-3pp of share loss by Q1. Self-pay at $199/month versus ~$1,300 list means each incremental self-pay conversion destroys ~85% of revenue per script — with 30% mix and growing, this is an accelerating price headwind. However, management's guidance midpoint of -9% suggests they see the central tendency below the -10% threshold, and management had visibility into Q1 trends when issuing February guidance.

The committee's unresolved debate centers on whether MFN impact is front-loaded or back-loaded. Position A (shallow Q1) is supported by the distinction between the MFN framework agreement and Medicare Part D pilot implementation beginning mid-2026. Even if the agreement dampens realized prices pre-implementation, the full force is H2-weighted. Q4 2025 total was -2% with international performing relatively better than US — patent expiry in international markets is a gradual headwind, not sudden. The 9,000-position restructuring signals management preparing for sustained pressure but doesn't directly worsen Q1 revenue. Oral Wegovy as a Q1 launch tailwind supports shallower decline.

Q4 total was -2% CER. Asking whether Q1 exceeds -10% is asking whether decline accelerates 5x in one quarter. The math is hostile to that outcome. US was -7% but international offset — both geographies face headwinds but international deterioration from patent expiry is gradual. Management's guidance floor of -5% for the full year would be nonsensical if Q1 was tracking -10%+. Oral Wegovy launch creates genuine new volume preventing worst-case scenarios.

The bear case is more plausible than it appears. Q4 US was already -7% at CER. If US declines accelerate to -12% to -15% — plausible given MFN pricing concessions, accelerating share loss (9.3pp/year), and self-pay mix expansion — that alone drags total to -7% to -8.5% (US = 57% of sales). Add international patent expiry pushing intl from flat to -2% to -5%, and total reaches -8% to -11%. Wegovy's Q4 CER print of -4% after +41% FY is ominous — if Wegovy turns more negative while Ozempic continues declining, the combined GLP-1 franchise drags total below -10%. The self-pay mix at $199 is likely INCREASING as awareness grows, compressing realized prices further.

Full-year guidance midpoint is -9% with Q1 typically the mildest quarter of a declining year. Management issued guidance February 3 with full knowledge of January Q1 trends — if Q1 was tracking >-10%, they'd likely have flagged it or guided more conservatively. The three headwinds (MFN, patent expiry, Lilly competition) all persist but MFN is primary and its implementation is graduated with Medicare Part D pilot mid-2026. The MFN agreement itself may cause immediate PBM/payer renegotiation dampening realized prices, but full implementation is H2-weighted. Oral Wegovy creates a launch tailwind unique to Q1 that won't recur in later quarters.

Q4 2025 total decline was -2% at CER. Going from -2% to >-10% in one quarter is a major step-down requiring both US and international to deteriorate significantly simultaneously. Management guided -5% to -13% for full year, suggesting Q1 is at the shallow end. Oral Wegovy launch provides Q1 volume offset. International patent expiry headwinds are gradual, not sudden.

When companies guide for full-year decline of -5% to -13%, they typically front-load conservatism by starting with better quarters and deteriorating through the year as headwinds compound. Management issued this guidance in February knowing Q1 trends. Self-pay mix shift and GLP-1 share loss are real but predictable and priced into guidance. Pattern says first quarter of guided decline year is usually shallower than full-year midpoint.

Full year guidance midpoint is -9%. Q1 should be better than full-year average because MFN/Medicare Part D effects are H2-weighted. If full year is -9% at midpoint and Q1 is the mildest quarter, Q1 is likely -4% to -7%. Ozempic's dual headwinds (price and volume) and accelerating self-pay could surprise downside, but the -10% threshold requires multiple compounding negatives exceeding expectations simultaneously.