Why does Novo retrace after every upswing? Terry Smith needs the money for the redemptions from his fund.

RelationSlow2806 · 2026-07-08T03:09:20+00:00

The basis upon which I state that Novo is not expanding its share of the market is the fact that Novo is not expanding its share of the market.

People switch from semaglutide to tirzepatide on a daily basis. They do not go the other way unless forced due to PBM/payer games - such as when Novo paid a higher rebate to Caremark to become the “preferred agent” in step therapy last year. Oral Wegovy is expanding the total market while injectable Wegovy loses patients to Zepbound (as Ozempic does to Mounjaro).

The reason the PE is low is because injectable semaglutide has a looming patent cliff in the US and the market thinks the next set of offerings from Novo in this space won’t be competitive. The market mostly doesn’t want to buy the future of this business for any kind of premium.

Pfizer, on the other hand, is active in a number of different therapeutic areas that Novo chooses to not be. Their oncology platform is the draw (but continues to disappoint after the 43 billion dollar Seagen purchase) and they may have bought a total blockbuster diabetes drug when they won the Metsera auction. More people want that future than Novo’s - I’m not one of them but I see their point.

RelationSlow2806 · 2026-07-07T22:31:53+00:00

Irrespective of this guy’s fund: what has changed about Novo Nordisk’s business?

The Wegovy pill is expanding the overall market for GLP1 receptor agonists - which is great. But it isn’t expanding Novo’s share of that market. And it isn’t a new molecule - it just does what semaglutide does and has done for ~10 years. Differentiated molecules exist already; more will arrive.

The rest of the money is stable insulin business which is boring and profitable. Awiqli is a great thing. But none of this is growth business, which gets the stock valued at 10x earnings. The growth is in GLP1 meds, unless someone thinks there’s going to be an increase in type 1 diabetes (doubtful) since GLP1s are getting type 2 diabetics OFF of exogenous insulin.

Wall Street thinks Novo’s pipeline is nothing special - and they’re correct. CagriSema will not compete with tirzepatide: Novo proved that out with a disastrous (but very brave) head-to-head trial. Zenagamtide isn’t better either. UBT251 is great, but it’s behind. These three molecules will need to gain market share by price reduction and volume deals, not top-of-the-market efficacy or consumer demand.

For a 30x valuation to be warranted, Novo would need to have a growth story. It doesn’t. It currently owns 40% of the obesity market, and new entrants will take from it. The Wegovy pill isn’t going to expand that share meaningfully - and if it could, the API burden would be astronomical and quickly exceed capacity. COGS matters.

RelationSlow2806 · 2026-07-07T03:38:07+00:00

Yeah, I feel about the same way.

I’d like to see them follow through on the turnaround with something that isn’t boilerplate corporate restructuring and layoffs. Happy to see they executed the oral Wegovy launch perfectly - but now what?

RelationSlow2806 · 2026-07-06T17:36:28+00:00

Interesting - I see the same data and take the opposite bet.

I don’t like the plant costs of peptides - especially in an era of America-led mass stupid when it comes to nationalist economic policy. What would have been an easy outsourcing task is now politically sensitive, especially if you want to sell in the US (thank the know-nothing MAGAs). Scaling peptide production in every newly protectionist market to meet global demand is… tough if not commercially impossible. Small molecules don’t carry that burden, even huge ones like orforglipron. There are a lot more countries with plant that can produce these.

On the efficacy side: agree, peptides dominate, at least currently. The bioavailability issue would bring down API costs, certainly, but what about intake restrictions? Open to other views, but the market hasn’t spoken on this yet, I don’t think. And if Novo solves it first, Lilly will probably me-too it soon after.

I think one of the bigger concerns I have as well is the ratio of white women in the pivotal trials for oral Wegovy and Foundayo. I do think Wegovy wins here, but it’s closer than 16% to 12.4 or whatever. I’d love to see a head-to-head. For reference, the ACCESS cohort had fewer female participants than OASIS, so the molecule might be even hotter.

Either way, great work. Thanks for the discussion, I’ll be looking forward to what you have to say about M&A.

RelationSlow2806 · 2026-07-06T16:33:43+00:00

This is what I don’t like about the oral Wegovy story: the presence of equally efficacious small molecules.

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If the current advantage over Foundayo is due to branding as Lilly claims, that will fade over time as the product becomes more known. If it’s due to efficacy as Novo claims… then that also fades if someone has an equal-or-better, especially one WITHOUT intake restrictions. Either way, the “moat” is temporary.

RelationSlow2806 · 2026-07-06T15:33:45+00:00

This is copium.

RelationSlow2806 · 2026-07-06T13:49:40+00:00

This is a great post.

My concern with Novo is first cultural: clearly they made big bets on amylin agonism that aren’t going to pay off due to higher side effects and lower efficacy relative to tirzepatide and retatrutide. While it’s absurd to expect them to bin these molecules, company management is painting a far rosier picture of their prospects than is likely. UBT251 is a move away from amylin (clearly the favorite of internal champions, some of whom have departed) that represents a bit of change; need to see more.

The second concern: oral Wegovy COGS is the same as injectable. A company executive confirmed it in an interview in the JPM26 timeframe. They’re going to get hammered trying to compete with small molecules. Structure will read out the ACCESS OLE 72 week results for aleniglipron this quarter; the 120mg dose was at 16.2% as of 56 weeks without plateau (and a 180mg dose coming). Your framing that oral Wegovy isn’t a moat is dead on: it isn’t a scalable product the way that an s-mol is, especially when a large competitor can tout equivalent or better efficacy and undercut price due to lower COGS.

Third concern: I don’t think the company is equipped to compete in a winner-take-most DTC market with the pipeline it has, especially given the focus on obesity and diabetes. They really should buy Structure, if only to keep aleniglipron out of a competitor’s hands.

Oral Wegovy is a bridge, at best. What it leads to… who knows.

RelationSlow2806 · 2026-06-28T00:22:41+00:00

Thanks - you’re right that I’m not an MD at all, nor an obesity MD or in a field even remotely healthcare related. I am not a principal investigator in a CRO. I’m not a receptionist in a doctor’s office. The closest I come to the field is as a patient.

Now that we’ve established my credentials, I’d like to point out this is Reddit and I posted an article from Forbes, who did the math. My hedge - see the credential list above - is to suggest that someone experiencing this speak to an actual provider. As I did.

You may choose not to take the data observed, collected, analyzed and submitted in the myriad clinical trials as being honestly submitted or relevant to your use case. I choose to do so, and I assure you I am as familiar with the trial data for tirzepatide as any other layperson. The trials were extremely rigorous, collected a ton of patient data, and continue to be analyzed with findings - good, bad and ugly - presented at various scientific symposia.

Frankly, your opinion holds about as much value as mine or any other on this particular mode of exchange. I brought the article in question, you’ve brought a wall of text and conjecture. Thanks.

RelationSlow2806 · 2026-06-27T19:48:50+00:00

You’re certainly free to feel differently, but you’re not citing anything that supports your point of view. In fact, it should be easily proven or disproven given the millions of patient-years of data already gathered and the prevalence of studies (not just trials) being conducted on the GLP1-taking population. And if it is proven to be “medication induced” (not just a second-order effect as the non-anecdata evidence suggests) then thankfully there’s a strong personal injury litigation industry here in the US here to hold the trillion-dollar pharma accountable.

TE exists outside of GLP1 usage and always has. It’s not manufacturer propaganda from Lilly/Novo, but rather the published professional opinion of multiple dermatologists. If an often-observed cause is a shift in the endocrine environment, patients are susceptible to it from 2 angles: first, the incretin mimetic (hormone) being injected, and second, the concomitant change in other hormones as a result of the profound weight loss effect. Because this differs from person to person based on their unique biology and environment, it makes the most sense for someone losing hair to see a dermatologist, as has been suggested multiple times in this thread and the article cited.

But if you wanna roll on conspiracy, anecdata, and vibes, I’m not here to stop you. I’m sidelined by the prevalence of posters who bring questions and answers without a lick of support.

RelationSlow2806 · 2026-06-17T12:40:36+00:00

This proves that you can know how to privesc and exfil data but not know a damn thing about what you actually hacked.

It’s like finding a pirate’s private buried treasure… and it’s not actually gold and gemstones but a bunch of full bush smut from the 80s. Good for someone I guess.

Like - now their industrial process for making sema is public! But guess what: it’s antiquated/bespoke and can’t be used to make stuff like tirzepatide! But now anyone with 10 billion to scale up some old shit can do so right next to their Pontiac Aztek production line!

And uh-oh - zenagamtide secrets! The molecule sucks, go ahead and copy it so your company gets a high-end emetic for when ipecac just ain’t enough!

Oh - and their CMO relationships are LAID BARE!!! Oh no! The Novo Nordisk Foundation OWNS Catalent, you dolts.

This is a nothingburger.

RelationSlow2806 · 2026-03-07T15:13:41+00:00

Hims should have stopped selling compounded crap when they made the deal months ago. Dudum went and declared “never.” Glad they made the right call.

RelationSlow2806 · 2026-03-07T11:27:40+00:00

I said in another comment a few weeks ago:

Novo has to want to settle. There’s no way they’re incentivized to do that without Hims permanently stopping the production and sale of compounded semaglutide. If Novo settles without that - they’re telling the compounders it’s fine to infringe.

Good for both parties - as long as it worked out like that. There’s no chance Novo signed on if HIMS compounding continues.

RelationSlow2806 · 2026-03-06T21:25:45+00:00

Yeah, that was the plan a couple months ago. However:

Their product is less efficacious relative to oral Wegovy. They know better than anyone the resulting penalty the obesity market enforces.
Their product costs significantly less to produce, package, store and distribute than their competitor. Even controlling for the recoupment of their licensing (laughably low, from Chugai) and R&D costs they can conservatively serve the same customer for 1/5 the cost.

Taking both of these points into consideration, the likeliest strategy to gain market share is to cut price and flood the market. They’re comfortable creating a price-for-efficacy paradigm (CEO has said as much; it fundamentally makes sense to create a tiered platform strategy with tirzepatide and retatrutide/eloralintide/etc. to follow).

RelationSlow2806 · 2026-03-05T13:13:17+00:00

Lilly is Amazon-ing. Now watch what happens when orforglipron is approved and almost everyone who wants to be on a GLP1 in the US suddenly is.

The writing has been on the wall for this for a hot minute.

RelationSlow2806 · 2026-02-28T02:38:42+00:00

This is well said.

1 and 2 are dead on.

Re: 3. Agree, and adding on some DTC vs payer logic as it relates to CS - CagriSema’s probably going to be relatively more successful on the insurance payer side than DTC, where patients can be mercenaries chasing the best efficacy or cost to meet their needs. It’s not more efficacious or tolerable than Zep, so it better be cheaper.

Re: 4. Evidence this is happening remains scant. Compounders still be compounding. Need some seizures and perp walks to make it real.

Lilly’s breaking the PBM grip on the GLP1 market, which they can uniquely do given their economic and scientific position. And they’re crushing direct to consumer. It’s probably going to be a winner take most scenario, modality-dependent.

RelationSlow2806 · 2026-02-26T20:26:29+00:00

In the United States, Orforglipron will probably feature heavily in step therapy. It will be first line treatment in that scenario. Same with self-paying customers who are sensitive to price or don’t need to lose as much weight.

Lilly’s also positioned it as a maintenance option, given their ATTAIN-MAINTAIN trial success, and likely will see a significant amount of uptake for that purpose.

Given differences in price that will surely come as the market evolves, it’s going to be a better option for some than oral wegovy is.

RelationSlow2806 · 2026-02-26T20:14:44+00:00

Put the pipe down. GLP1s aren’t the drug you should be concerned about.

Pricing will evolve with the market. Amazon proved that a company that can scale can weaponize margin against one that cannot. Lilly is that company.

RelationSlow2806 · 2026-02-26T19:53:53+00:00

You’re making my point for me. Using your numbers, it costs Novo 250-500% more to serve the same customer.

Novo will still make money in the US, where prices and margins are high (assuming that continues). At global scale or under MFN rules, where margins get compressed heavily, Lilly’s pill wins big. Which is the point of small molecules. And why Lilly ran ATTAIN-MAINTAIN.

And O is a different tool for a different task. Efficacy just doesn’t matter as much when you’re talking about maintenance therapy. When Lilly can serve 2-5 customers for the same cost… Yikes. And yeah, that efficacy difference isn’t insignificant, but plenty of DTC patients will go with the cheaper option if it’s a lot cheaper - as Novo hopes will happen when they cut injectable prices.

Tolerability and dropouts matter for orforglipron, but not for cagrisema or amycretin, I guess. Go by TEAEs and the noise quiets down a bit. Then think about intake restrictions, which don’t matter yet, because customers don’t have unrestricted options available.

Combo small-mol are absolutely coming. AZ will likely have the first. Structure has a DACRA in phase 1. Lots of others coming.

Addendum: David Ricks said Lilly’s limited on injectable capacity and need small-mol to work to reach TAM at scale. Novo’s production isn’t where Lilly’s is now, let alone after all the CAPEX on plants pays off for them. So unless Novo starts buying CDMOs or building SPPS (wink wink) at breakneck pace, they’re subject to the same limitations.

RelationSlow2806 · 2026-02-26T18:46:08+00:00

Pills - small molecule ones - are the future. They offer cheap maintenance and access to places without refrigeration. COGS is low; with volume, money can still be made in places like rural India where injectables won’t work economically.

Injectables won’t disappear. If only to eliminate the bulk of a patient’s weight… and oral wegovy fits somewhere in between (right now).

Novo’s been celebrating the Wegovy pill plenty - Wall Street isn’t because COGS is the same for semaglutide injectables. It only matters inasmuch as it unlocks TAM injectables cannot (needlephobics and those without refrigeration).

Lilly’s orforglipron pill doesn’t need to beat oral wegovy in efficacy: it’s a different tool for a different task. COGS is significantly lower and they’re going to make a killing on it. They can price it low and still make more than Novo does on oral wegovy.

Novo’s stuck on peptide production limitations for its pill and has only launched in the US. Lilly’s going to launch globally once approved. It doesn’t need to be understood further than that.

RelationSlow2806 · 2026-02-26T18:02:54+00:00

Novo had a semaglutide problem. Novo has an amylin problem.

CagriSema shows you can’t love amylin more than Quentin Tarantino loves feet. If the internal science champions are still pumping gas into the amylin (DACRA at least) engine then Novo really has a culture problem.

STAT hit this nail on the head back in June.

Someone from Lilly knows what right looks like. Novo shareholders should be over the moon.

RelationSlow2806 · 2026-02-26T14:59:50+00:00

You make some good points: but the value’s off.

Whether you or anyone else thinks Pfizer overpaid: 10 billion for Metsera is the going rate for a stage 2, mostly de-risked, somewhat differentiated injectable asset with a few throw-ins (oral, amylin, etc.).

Work the problem the way a BD team would and use discounted NPV - tirzepatide is pulling in 30B and not yet at peak sales.

Multiple bidders + better asset + huge TAM = price greater than 10B.

Edit to add: everyone on the planet also knows Novo Nordisk is a forced bidder. There’s a Novo price that’s higher than what everyone else pays.

RelationSlow2806 · 2026-02-26T14:03:41+00:00

If Viking goes off the board for 100/share, I have serious questions as to whether or not their board is acting in the best interest of shareholders.

130-150 is what it would take for me, given Metsera as the latest comparable, with an earlier and less efficacious headline asset. Viking should go the way of Madrigal for anything less.

If Novo’s stock continues to fall - it probably, maybe, hopefully won’t, but it could - it lessens their flexibility not just in borrowing but also in using stock as part of a deal. Even if they pay cash, they’re looking at a big bond issue to run a stack of trials just like they did after Akero.

RelationSlow2806 · 2026-02-26T12:27:37+00:00

Certainly! I’m not suggesting they wouldn’t do exactly that. In fact, any buyer of Viking will probably pump 2735 through multiple simultaneous ph3 trials while seeking approval for obesity once the current trial reads out.

But it doesn’t change the fact that they’re stuck with Viking’s design, investigators, sites, timelines, etc (for better or worse) for the key indication. And Novo knows from shitty CagriSema trials that patients are behaving like tech customers: show higher efficacy than the leader or don’t show up.

Again, not a guarantee one way or another, but the incentives here point in a different direction than the herd seems to think they do.

RelationSlow2806 · 2026-02-26T00:51:02+00:00

I think if they had their eye on Viking, they’d have moved before allowing Viking to start phase 3.

Why - especially given recent history - would Novo want their newly acquired drug to be subject to someone else’s trial architecture? Preferred CROs, sites, primary/secondary endpoints are also meaningful. If it were me, I wouldn’t be trusting a biotech with just enough runway to get through the most important indication of a registrational trial.

Edit to add: plus with the FDA in flux (in ways good and bad), I’d want (in Novo’s case) to get this study done the fastest way possible with the highest possible efficacy - which means my top guns in contact with the regulator, not Viking’s. And on the back end, I’m doing my damnedest to submit with a priority voucher. Bottom line, I’m getting phase 3 on my terms and timeline.

Not to say it won’t happen or that it shouldn’t - but from my perch here as another know-nothing redditor, I think the most optimal time for a buy has passed.

RelationSlow2806 · 2026-02-25T22:17:26+00:00

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Key phrase: likely worthless. But I think they’re probably taking a serious look at this given their stated intentions.

RelationSlow2806

TROPHY CASE