Novo Nordisk enters a critical stretch of 2026 facing compounding pressure from investors, competitors, and pricing dynamics across multiple markets, with the company’s annual meeting on Thursday set to serve as a formal reckoning for leadership that has had only months to demonstrate its vision.

Chairman Lars Rebien Sorensen will address shareholders for the first time since he orchestrated the removal of former chief executive officer Lars Fruergaard Jorgensen last May, a boardroom intervention that Sorensen and newly installed chief executive officer Mike Doustdar positioned as necessary to accelerate the company’s pace of innovation and commercial aggression. The reception from investors is expected to be pointed. Novo shares have declined approximately 45% since Sorensen moved to oust Jorgensen, a trajectory that has sharpened scrutiny of the leadership change and the strategic rationale behind it.

The same period has been considerably kinder to Eli Lilly, Novo’s principal rival in the glucagon-like peptide-1 receptor agonist class. Lilly’s market value grew by approximately one-fifth over the comparable period, briefly elevating the Indianapolis-based drugmaker to the status of the world’s first pharmaceutical company to reach a $1 trillion market capitalization. The divergence in share performance between the two companies has made every Novo strategic decision subject to comparative analysis, and recent missteps have provided investors with specific grievances to raise.

Two events in particular have drawn scrutiny. In the fall of 2025, Novo mounted an unsuccessful attempt to acquire an obesity-focused startup that Pfizer had positioned for sale. The effort failed, leaving the company without the acquisition target and raising questions about its capacity to compete for assets in a deal environment that has grown more contested as obesity pharmacotherapy has attracted capital from across the pharmaceutical sector. Earlier in 2026, Novo released a forecast that fell short of market expectations and sent shares lower. The combination of a failed acquisition attempt, a disappointing guidance update, and a 45% share price decline since the leadership change constitutes the backdrop against which Sorensen and Doustdar will face shareholders Thursday.

The structural challenge Novo confronts is not confined to leadership credibility or deal-making execution. The company is navigating a global pricing environment that is in flux, shaped in part by ongoing discussions within the United States administration regarding a proposed most-favored-nation policy that would link domestic drug prices to those offered in peer countries. That policy framework, still under development, has introduced uncertainty into the reference pricing calculations that multinational pharmaceutical companies use when entering or repricing markets abroad.

Novo’s experience in South Africa illustrates the difficulty of operating under that uncertainty. The company launched Wegovy, its semaglutide-based weight management therapy, in South Africa in August 2025 at price points that, in the assessment of Novo’s own market access leadership, were not appropriate for local market conditions. Thabeng Leping, who oversees market access and public affairs for the company in South Africa, stated that reference pricing uncertainty tied to the U.S. most-favored-nation discussions contributed to the initial pricing decisions and that the company elected to proceed with the launch rather than delay, with a commitment to adjust pricing over time.

The subsequent adjustments have been substantial. An initial reduction took effect in December 2025. A second round of cuts was submitted for approval in the days preceding Thursday’s annual meeting, with the lowest injected dose declining 60% to $110 and the highest dose falling 27% to $221. A further 12% reduction to the 1.7-milligram dose, the second-highest available, is pending regulatory approval. Taken together, the price reductions represent a considerable downward revision from the launch prices established seven months prior.

The competitive pressure from Eli Lilly’s tirzepatide, marketed under the brand name Zepbound for obesity indications, is cited as a contributing factor in the South African market. Lilly has demonstrated a capacity for pricing flexibility in emerging and developing markets that has placed pressure on Novo to respond in kind. The South African situation reflects a broader dynamic in which the two dominant GLP-1 manufacturers are engaging in market-by-market competition that extends well beyond the United States, with pricing now functioning as a primary competitive variable in markets where reimbursement infrastructure is limited and out-of-pocket costs are determinative of access.

The clinical profile of semaglutide is well-established. The SELECT trial, a large cardiovascular outcomes study, demonstrated a statistically significant reduction in major adverse cardiovascular events among participants with obesity or overweight who did not have diabetes, providing a clinical rationale for Wegovy’s use beyond weight reduction alone. That evidence base has supported the drug’s reimbursement applications in multiple jurisdictions and underpins the commercial forecasts that investors evaluate when assessing Novo’s long-term revenue trajectory. The pricing volatility now observable in markets such as South Africa does not alter the clinical evidence, but it does complicate the revenue modeling that analysts and investors rely upon when projecting the drug’s contribution to Novo’s top line.

The most-favored-nation framework being developed by the U.S. administration represents a structural variable that extends well beyond any single market. If implemented in a form that links U.S. drug prices to prices offered in lower-income markets, pharmaceutical manufacturers may face pressure to either raise prices in those markets or accept lower U.S. prices. Neither outcome is straightforward. Raising prices in markets where affordability is constrained would reduce access and generate reputational consequences. Accepting lower U.S. prices would compress margins in the company’s largest and highest-value market. Novo is among the companies most directly affected by this policy discussion given its position in the GLP-1 category and the substantial proportion of its revenue derived from the United States.

The annual meeting on Thursday will not resolve the pricing policy questions or the competitive dynamics that have compressed Novo’s share price over the past ten months. Sorensen and Doustdar are likely to present a strategic framework intended to convey urgency and direction, but the substantive measures required to restore investor confidence will unfold over a longer time horizon. Pipeline progress, particularly in cardiovascular and rare endocrine disease indications where Novo has historically held strong positions, will receive attention as potential evidence that the company’s assets extend beyond its current dependence on the GLP-1 class.

The competitive situation in the obesity pharmacotherapy category merits continued observation. The GLP-1 receptor agonist class has attracted entry from additional manufacturers, and the pipeline of oral agents and next-generation injectable therapies at various stages of development suggests that the pricing and competitive pressures Novo currently faces in markets such as South Africa may intensify in coming years. For a company whose share price once reflected near-singular command of the obesity treatment category, the current environment requires a recalibration of competitive strategy that goes beyond price reductions and failed acquisition attempts.

Investors attending Thursday’s meeting will be assessing whether Sorensen and Doustdar have internalized the lessons of the past ten months and whether the leadership team assembled following the boardroom change possesses the operational capability to execute a credible recovery. The 45% share price decline since the leadership transition, set against Eli Lilly’s concurrent rise to the $1 trillion market capitalization threshold, provides a precise and unfavorable quantitative frame for that assessment.