JPM: Novo Nordisk CEO gives insight into new strategy

Novo Nordisk's new chief executive, Mike Doustdar, has told the JPM Healthcare conference that the key to competing in the GLP-1 agonist category for weight loss will be to make the most of cash-pay channels.

In his first major strategy update since taking over from Lars Fruergaard Jørgensen last year, Doustdar conceded the company has made mistakes in the last year or so – including casting its net too wide in the GLP-1 category – and vowed to keep a tighter focus on its core area of obesity, weight-related diseases, diabetes and, to a lesser extent, rare diseases.

Near-term, that means making the most of its newly approved Wegovy (semaglutide) pill, now rolling out across the US, and keeping ahead of closest rival Eli Lilly, which is waiting for a verdict from the FDA on its oral GLP-1 orforglipron.

One part of that will be emphasising what Doustdar said was the greater weight-reducing efficacy for oral Wegovy versus orforglipron, which the company claims matches the earlier injectable therapies, including once weekly subcutaneous Wegovy, but also "mastering and expanding" DTC channels.

He pointed to the "massive amount" of partnerships signed by Novo Nordisk with DTC partners, including most recently Amazon Pharmacy, as the key to tapping the self-pay market.

Moreover, while Novo Nordisk and Lilly are currently fighting over a current combined market of 10 to 15 million people using injectables in the US, the availability of oral GLP-1s could provide an option for "the other 85 million" and grow the market, said Doustdar. "Many of them don't want an injection and are waiting for the pill," he added.

Responding to a question about a short lead over Lilly for the oral drug, Doustdar pointed to the efficacy and strong brand recognition for the Wegovy brand.

He also downplayed suggestions that the requirement to take oral Wegovy on an empty stomach and wait 30 minutes before eating or drinking could lend an edge to orforglipron, which has no such restrictions, saying this has not been an impediment to use of its oral version of semaglutide used to treat diabetes, sold as Rybelsus, as well as thyroid medications.

Furthermore, clinical trial data for orforglipron also shows that for people taking statins – commonly used by people who are overweight – the protocol required them to wait two to four hours before dosing, he pointed out.

Doustdar took the helm at Novo Nordisk at a time when the company had seen its share price pummelled by Lilly's encroachment into the GLP-1 category, as well as competition from compounded GLP-1 drugs, which remain widely available in the US and could be used by as many as 1.5 million people in the states – despite semaglutide no longer being on the FDA shortage list.

Another challenge will be the loss of patent protection for injectable semaglutide in some markets, which could start next year. Doustdar told the conference that investors are underestimating the potential of CagriSema (semaglutide and cagrilintide), as well as cagrilintide monotherapy.

While there is currently an obsession with weight loss reduction as a percentage of body weight, with a push to pitch as high as possible above 20%, cagrilintide as a monotherapy could offer lesser efficacy, but with much better tolerability, and that could become increasingly important.

"There are a number of people that are happy with 12%, 13%, or 15% weight loss, if the tolerability is almost like a placebo," he said.