The most important business battle you're probably not watching

The Other $85 Trillion series | redebuter.com

A battle more riveting than the World Cup?

You've almost certainly heard of Ozempic. A friend's on it, maybe, or a colleague, or you've just seen the ads. What you probably haven't heard of is the company that makes it. Novo Nordisk is a Danish drugmaker that, until a few years ago, almost nobody outside pharmaceuticals had ever encountered.

Here's the plain version of what Novo actually did. The body makes a hormone that tells your brain you've had enough to eat. Novo isolated it, turned it into a once-weekly injection, and in doing so built something that hadn't really existed before: a drug that treats obesity about as effectively as surgery, without the surgery. It took twenty years of research to get there. When the weight-loss version, Wegovy, was approved in 2021, Novo wasn't stepping into a market that already existed. It built the market, and for a couple of years, it had that market almost entirely to itself. By early 2023, Novo held as much as 63% of new-to-brand GLP-1 prescriptions in the US, according to its own filings.

That's the part most people know, in outline at least. Here's the part they don't. Novo is now losing that war - to a company most people have heard of even less. Eli Lilly, an American drugmaker, sells a rival drug called tirzepatide under two names: Mounjaro for diabetes, Zepbound for weight loss. In 2025, Lilly's two drugs outsold Novo's two drugs outright - $36.5 billion for Lilly's pair against roughly $30 billion for Ozempic and Wegovy combined. The company that invented this category is being out-competed inside the market it created.

That's worth pausing on, because it's a different, more useful problem than the usual one. Christensen's Innovator's Dilemma explains why comfortable incumbents get blindsided by things they didn't see coming. This isn't that. Novo saw the future before anyone. It built it, patented it, and spent two decades getting there first. And it's losing ground anyway - not because it missed something, but because inventing a category and defending one are two completely different jobs. Novo is exceptional at the first. It's now finding out, expensively, that the second doesn't come free.

Why the leader can't just out-invent the challenger

The clearest single proof of this sits in a trial result from earlier this year. Novo spent years developing a next-generation drug, CagriSema, built specifically to beat Lilly's tirzepatide. In February 2026, the results of a head-to-head trial came in: CagriSema delivered a genuinely strong 23% average weight loss on its own terms. But it missed the one thing it needed to prove - that it was at least as effective as the rival drug it was designed to beat. Novo's best new idea, years in the making, couldn't clear the bar Lilly had already set with a drug already on shelves.

Why would that happen to the company with the head start? Not because Novo was slow, or coasting, or complacent - if anything, the opposite is true. Novo set itself an aggressive internal target for CagriSema, telling investors to expect 25% weight loss, and it was Novo's own decision to run the head-to-head trial against Lilly's drug in the first place - deliberately testing itself against the toughest bar available, not something a challenger forced on it.

The real explanation is more specific, and more useful, than a story about speed. CagriSema wasn't designed from a blank sheet of paper. It combines semaglutide - the same active ingredient already inside Wegovy and Ozempic - with cagrilintide, a second hormone-mimicking compound Novo engineered in-house, building on the same long-acting drug design technology it had already developed for semaglutide. Rather than build one new molecule, Novo built its next-generation drug by combining two things it already owned, delivered through a pen that injects both components separately. That choice came at a real cost: in the trials, only around six in ten patients could tolerate escalating all the way to the highest, most effective dose, which capped the real-world results below where a simpler drug might have landed. Lilly's rival, tirzepatide, was designed from the outset as a single molecule that hits two hormone targets at once - easier to dose, easier to tolerate, and able to bring more patients up to full strength.

That's the leader-versus-challenger problem in its most specific, checkable form. Not slower reflexes. A next-generation product shaped by extending an asset Novo already had, rather than starting clean. The same twenty years that gave Novo its lead also gave it a specific, valuable thing to build around - and building around what you already own is a genuinely different design problem to building with nothing to reuse. It isn't a failure of nerve or effort. It's a structural constraint that comes bundled with being first.

The rest of the evidence points the same way. Novo announced Lars Fruergaard Jørgensen's departure as chief executive in May 2025, after the board concluded the company was losing the race it had started. His successor, Mike Doustdar, took over in August 2025 and cut 9,000 jobs - 11% of the workforce - within weeks of starting. And Novo is currently buying back its own shares: since May, roughly 24 million of them, at prices well below where the stock traded a year earlier. A share buyback is normally a board saying the market has this wrong, and we're happy to bet our own money on it. The stock has kept falling anyway. In June 2024, Novo's shares hit an all-time high of $137, and its market value briefly touched around $600 billion - at the time, genuinely more than Denmark's entire GDP, a fact that made international headlines. Today the shares sit around $50, and the company's market value has fallen to roughly $225 billion - a loss of about $375 billion.

The find that started it all

It's worth going back to where this began, because the origin story complicates the tidy version of events. The GLP-1 effect wasn't the product of a boardroom strategy. It was found, almost by accident, inside Novo's own diabetes research in the 1990s - spotted by a scientist named Lotte Knudsen, whose first job at the company had actually been testing detergent enzymes. She noticed a naturally occurring gut hormone that suppressed appetite and spent the following two decades convincing the company to take it seriously. The insight underneath the entire $600-billion rise - that appetite itself could be treated as a medical problem, not a willpower one - came from noticing something nobody had been looking for, not from executing a plan to find it.

That's the honest complication in this story, and the place the luck question belongs. Novo's rise wasn't only engineering and patience, real as both were. Part of it was a discovery that could easily have gone unnoticed, made by someone who wasn't even looking for it, inside a company that took twenty years to bring it to market before the world had caught up to the idea. If the original breakthrough carried that much luck in it, the current reversal deserves the same honesty. Is Lilly's overtake proof that Novo's strategy was always thinner than it looked - or is it simply the other side of the same coin, the moment fortune, having run one way for two decades, starts running the other?

Where this leaves the rest of us

Neither answer lets Novo off the hook, and neither should. The company still has real advantages - a pill version of Wegovy that logged over 18,000 prescriptions in its first week alone, faster than either the original Wegovy or Zepbound managed at launch, and more than 1.3 million prescriptions in its first quarter; a diabetes and obesity franchise that remains enormous by any ordinary measure; and years to course-correct. But by early 2026, the market itself had flipped: Lilly held roughly 60% of the combined US GLP-1 market, Novo just 39%. The CagriSema result says something that should worry any organisation that's ever built a category and started coasting on the fact that it got there first: being the one who invented the thing gives you no automatic right to keep winning it. The market doesn't care who arrived first. It cares who keeps building.

So here's the question worth carrying into your own business, whatever you make or sell. If you're the one who built the category you compete in - how much of your next big idea is a genuinely new answer, and how much of it is really just a clever way of reusing what you already had?

Sources: Novo Nordisk Annual Report / Form 20-F, FY2025 and FY2023; Novo Nordisk 6-K quarterly filings, 2023; Eli Lilly Q4 2025 earnings release and FY2025 10-K; Novo Nordisk REDEFINE 4 trial results announcement (February 2026); CNBC, "Novo Nordisk sinks 16% after weight loss drug fails to match Eli Lilly's in trial" (February 2026); Morningstar, "Novo Nordisk: Another Disappointing Cagrisema Trial Adds Pressure to High-Dose Strategy" (February 2026); Reuters, "Novo's CagriSema setback may shift investor focus to M&A strategy" (February 2026); Journal of Medicinal Chemistry, "Development of Cagrilintide, a Long-Acting Amylin Analogue" (Novo Nordisk in-house R&D); Beta Finch, "The GLP-1 Race in 2026: Lilly vs. Novo Nordisk" (May 2026); FirstWord Pharma, Novo Nordisk Q1 2026 results coverage (May 2026); BioSpace, "Novo Rises as Oral Wegovy Reaches Over 3,000 Patients in First Week" (January 2026); Shotlee, Wegovy pill launch prescription data (January 2026); Fierce Pharma, "Novo Nordisk to lay off 9,000 workers" (September 2025); CBS News, "Scientist behind Novo Nordisk's Ozempic, Wegovy started her career developing laundry detergent" (November 2024); Fortune, "Novo Nordisk's market value of $570 billion is now bigger than Denmark's GDP" (2024); Wikipedia/Novo Nordisk market cap history; Macrotrends and Yahoo Finance NVO stock and market cap data (July 2026); company share buyback disclosures, July 2026.

Part of "The Other $85 Trillion" series | redebuter.com

Tags: Leadership, Innovation, Strategy, Luck, Redebuter