Where Are They Now? Novo Nordisk

By Ben Comer, Chief Editor, Life Science Leader

Then: In a February 2016 Life Science Leader cover story, Novo Nordisk Inc. (U.S.) CEO at the time Jesper Høiland recalled his baptism by fire into the U.S. market. In 2013, just two weeks into his new U.S. leadership role, Høiland was told that Express Scripts, or ESI, had excluded Novo’s Victoza — an injectable Type 2 diabetes drug, and a precursor to Ozempic — from its national formulary. “I was so new that I had to figure out what ESI stood for, what a PBM was all about, and what market access meant to our business opportunities,” Høiland said in the article. (Interestingly, Victoza’s direct competition in the GLP-1 Type 2 diabetes space was Eli Lilly’s Trulicity, a head-to-head match-up fated to repeat itself, times two, with Novo’s Ozempic/Wegovy duo in one corner, and Eli Lilly’s Mounjaro/Zepbound in the other). As a result of the ESI decision, which also excluded Novo’s top selling insulin product at the time, NovoRapid, Høiland had to figure out how maintain and grow Novo’s U.S. operations, which contributed 46% of Novo’s annual global sales of $14.8 billion. Prior to dropping Victoza from its formulary, ESI had accounted for between 15% and 20% of the product’s sales; significant belt-tightening would be needed to mitigate the loss. Høiland assembled a team to identify cost-cutting targets, and to look for ways to improve the business. “We didn’t just ask them where to cut,” Høiland said. “We asked them where they thought the money that was just saved could be better used.” By the end of 2017, Høiland had departed from Novo Nordisk for a president and CEO role at Radius Health, and Ozempic (semaglutide) had received FDA approval for the treatment of Type 2 diabetes.

Now: Victoza lost patent protection this year, and last November, Novo announced that it would deprioritize Victoza manufacturing in an effort to increase Ozempic manufacturing, which has so far been unable to consistently keep up with product demand. Wegovy (semaglutide), a slightly higher dosage amount of semaglutide, was approved by the FDA for obesity in June of 2021. Amid reports of Novo Nordisk’s company valuation surpassing the value of the entire Danish economy — and company global sales in 2023 topping $34 billion, with room to grow — belt-tightening is now a thing of the past. In February, Novo Holdings announced the acquisition of Catalent, a large CDMO, for $16.5 billion. As part of the transaction, Novo Nordisk acquired three fill-finish manufacturing sites for $11 billion, to help support growing demand for its obesity and diabetes products. In obesity, insurance coverage remains an issue, although Doug Langa, current head of Novo Nordisk’s U.S. operation, told Life Science Leader last August that 40 million patients have access through their insurance providers to anti-obesity medications, and that “all major PBMs” are covering Wegovy. Even so, another 80 million obese patients in the U.S. do not have sufficient insurance coverage, or any coverage at all, including the Medicare population. Langa said Novo is working to change the law that prevents Medicare from covering obesity drugs but acknowledged that it could take some time. “When I’m on Capitol Hill, there is not anyone on either side of the aisle that doesn’t want to help seniors or that doesn’t want to give them an opportunity to have a branded anti-obesity medication,” says Langa. “I think it’s just a matter of how we get it funded and which bill we put it on.” Surveys suggest a majority of adults over 50 in the U.S. are in favor of Medicare coverage for obesity drugs, too, but the cost of Medicare coverage for Wegovy, which has a list price of $1,349.02 per month without insurance coverage or financial assistance, would be substantial. If 10% of the Medicare population diagnosed as obese received coverage for semaglutide (the active ingredient in Wegovy and Ozempic), it would cost $13.6 billion annually, according to a New England Journal of Medicine (NEJM) estimate. If the entire obese Medicare population were covered, it would cost $135.6 billion annually, or 4.6% of Medicare’s total net spending, per the NEJM. At a time when many pharmaceutical companies are looking for new products to supplant older therapies racing toward a patent cliff, Novo Nordisk is leading one of the hottest therapeutic areas in the industry. “We’ve been in R&D now for 20 years, and we’re really excited about our current portfolio,” said Langa.