Maintain Underperform: The Upgrade from Coramitug Is Insufficient to Reverse Weak Risk-Reward

Overview

The report reassesses Novo Nordisk's medium- to long-term earnings, GLP-1 competitive landscape, ATTR-CM pipeline, and valuation. After incorporating the Phase III-stage Coramitug, the analysts raise sales and earnings forecasts for 2026 to 2031, but believe this new opportunity is insufficient to offset pressure from share losses in the U.S. obesity and diabetes GLP-1 markets, pricing pressure, and semaglutide patent expiries. Therefore, they maintain the Underperform rating.

Core views

Bernstein believes the market has not yet fully priced in Novo Nordisk's share losses to LLY in the U.S. injectable GLP-1 market, and also underestimates the impact of U.S. GLP-1 pricing pressure on margins. The report expects Wegovy Pill to lose most of its share in the U.S. oral weight-loss market by 2028, while CagriSema no longer represents a clear source of upside under existing expectations. Coramitug has clinical and commercial potential, but Phase III results are far off, and the institution's forecasts are far below consensus, making it difficult to change the weak short- to medium-term view.

Analysis framework

The report combines product-level sales forecasts, an earnings model for 2026 to 2031, ATTR patient epidemiology and diagnosis-rate assumptions, bull-bear scenario analysis, discounted cash flow analysis, and enterprise value multiple valuation relative to large European pharmaceutical companies. The target price is based on the simple average of the discounted cash flow valuation and the 2027 to 2029 enterprise value multiple valuation.

Methodology notes

• Absolute valuationDiscounted cash flow method

  Estimate intrinsic value based on long-term free cash flow

  Using an 8% weighted average cost of capital and a 0% perpetual growth rate, the discounted cash flow valuation is raised from DKK 201 to DKK 206.

• Relative valuationEnterprise value to EBITDA multiple

  Value the company using European large pharma peer multiples with a discount applied

  A 30% discount is applied to 2027 to 2029 peer multiples, resulting in a valuation of approximately DKK 199; this discount reflects Novo Nordisk's growth outlook below peers.

• Scenario analysisBull-bear scenario analysis

  Assess earnings risk under changes in key product sales and competitive assumptions

  Using 2035 EBIT as a proxy for discounted cash flow, the bull-case scenario has approximately 4% upside, while the bear-case scenario has approximately 40% downside risk.

• Market size forecastingEpidemiology and penetration model

  Forecast the ATTR market based on patient numbers, diagnosis rates, and drug penetration rates

  The model references ATTR patient data provided by AstraZeneca and assumes the U.S. diagnosis rate rises steadily from 25% in 2024 to above 45% by 2035.

Asset mapping & comparison

Structured mapping from thesis to named assets (strengths, weaknesses, peers, risks).

• Novo Nordisk A/S (NOVOB.DC)

  Core covered stock

  Strengths

  Has an established GLP-1 product portfolio including Ozempic, Wegovy, and Rybelsus, while Coramitug provides a new long-term growth option in ATTR-CM.

  Weaknesses

  U.S. GLP-1 share is under pressure, pricing pressure may weigh on margins, growth from 2026 to 2031 is below European peers, and important near-term catalysts are limited.

  Comparison

  The valuation applies a 30% enterprise value multiple discount to European pharma peers; the 2027 and 2030 valuations represent discounts of 59% and 49%, respectively, versus LLY.

  Risks

  Deteriorating U.S. competition, semaglutide facing staggered patent expiries between 2026 and 2032, limited commercial contribution from CagriSema, and Coramitug Phase III failure or commercialization below expectations.

• LLY

  Core GLP-1 competitor

  Strengths

  Strong marketing and sales capabilities, with injectable and oral weight-loss products potentially continuing to gain U.S. market share.

  Weaknesses

  The report does not analyze its own operating weaknesses in detail.

  Comparison

  Bernstein expects Novo Nordisk to lose further share to LLY in the U.S. injectable GLP-1 market, and expects Wegovy Pill to trail Foundayo in the U.S. oral weight-loss market by 2028.

  Risks

  If Novo Nordisk's core products perform better than expected or the competitiveness of new products strengthens, the relative competitive pressure from LLY may be lower than the report assumes.

• Sanofi

  European large pharma valuation reference

  Strengths

  The report believes its business moat is deeper.

  Weaknesses

  The report does not elaborate on its specific operating weaknesses.

  Comparison

  The analysts believe that even at a 2026 P/E of around 10x based on the target price, Novo Nordisk still trades at a valuation premium relative to companies with deeper moats such as Sanofi.

  Risks

  Changes in peer valuation multiples will affect Novo Nordisk's relative valuation result.

Key data

• Target price203 DKKPreviously DKK 200, based on the average of discounted cash flow and relative valuation results.
• Closing price305.10 DKKAs of August 7, 2026.
• Implied target-price return-33%Downside of the target price relative to the closing price used in the report.
• 2026 to 2031 EPS compound growth rate3.7%Previously 3.4%, still 420 basis points below European peers.
• Earnings forecast revisionSales and operating profit raised by 2% to 5%, EPS raised by 2% to 4%Mainly due to the first-time inclusion of Coramitug forecasts.
• EPS gap versus consensusUp to 15% lowerRefers to 2026 to 2031 forecasts, mainly due to more cautious U.S. GLP-1 share and pricing assumptions.
• Bull-bear scenarios+4%／-40%Upside and downside magnitude relative to 2035 EBIT forecasts.
• Coramitug Phase II resultsNT-ProBNP decreased by 48%The range was 22% to 65%, with statistical significance of p=0.0017.
• Coramitug peak sales forecastBernstein USD 928 million; consensus USD 6.3 billionThe consensus forecast corresponds to peak sales in 2034.
• Coramitug Phase III readoutSecond half of 2029The cleopATTRa program is planned to last four years.
• Valuation multiples2027 P/E of 10x; 2030 P/E of 8.7xDiscounts of 30% and 23%, respectively, versus European peers.

Impact & implications

The forecast upgrade mainly comes from the long-dated ATTR pipeline, not an improvement in core GLP-1 business trends. Because the target price remains significantly below the current price, earnings forecasts are below consensus, and near-term catalysts are limited, the report argues that the current valuation is still insufficient to support a more positive stance. If U.S. share losses and pricing pressure materialize, market earnings expectations and valuation still face downward revisions; only a significant beat from core marketed products or a narrowing of the competitive discount could bring material upside.

Risks

• Share losses in the U.S. injectable GLP-1 obesity and diabetes markets may be greater than market expectations.
• U.S. GLP-1 pricing pressure may cause revenue and margins to fall below consensus expectations.
• Wegovy Pill may lose the majority of its share in the U.S. oral weight-loss market around 2028.
• Semaglutide faces staggered patent expiries between 2026 and 2032, pressuring long-term growth and cash flow.
• CagriSema may fail to create a clear inflection point in U.S. market share, and other pipeline catalysts may also be delayed or fail.
• There is substantial uncertainty around Coramitug's Phase III clinical results, approval timing, market penetration, and peak sales.
• If marketed products significantly exceed expectations or the valuation discount to peers narrows, the bearish view may face upside risk.

What to watch

• Comments on 2027 business trends and the competitive landscape at the Capital Markets Day on September 21, 2026.
• U.S. approval decision for the CagriSema obesity indication in the fourth quarter of 2026.
• U.S. approval decision for high-dose Ozempic Pill in the fourth quarter of 2026.
• Regulatory filing progress for Etavopivat in the U.S. and Europe in the fourth quarter of 2026.
• U.S. regulatory decision for the CagriSema diabetes indication in 2027.
• Phase III clinical results for injectable and oral Zenagamtide in 2028.
• Coramitug cleopATTRa Phase III clinical readout in the second half of 2029.
• Changes in U.S. GLP-1 market share, net prices, and margins, as well as ATTR diagnosis rates and treatment penetration rates.