Novo Nordisk's M&A Strategy: Paving the Path to Sustained Dominance in Diabetes and Obesity Therapeutics

Novo Nordisk A/S (NVO) has long been a titan in diabetes care, but its recent strategic pivot toward obesity therapeutics has redefined its market trajectory. With Wegovy and Ozempic dominating the GLP-1 receptor agonist space, the Danish pharmaceutical giant now faces a critical juncture: sustaining its growth amid intensifying competition and patent expiration risks. To evaluate Novo's capacity to maintain its leadership, one must dissect its M&A strategy-a mosaic of acquisitions, partnerships, and licensing deals aimed at diversifying its pipeline and securing long-term revenue streams.

Strategic M&A: From GLP-1s to Metabolic Disease Ecosystems

Novo Nordisk's M&A activities since 2023 reveal a deliberate effort to expand beyond its GLP-1 blockbuster portfolio. The 2023 acquisition of Inversago Pharma for up to $1.075 billion, which brought the oral CB1 inverse agonist INV-202, signaled Novo's interest in novel mechanisms for obesity and metabolic disorders, as noted in the Inversago announcement. This was followed by a $2.2 billion collaboration with Septerna in 2025 to develop oral small molecules for obesity and type 2 diabetes, according to a Q3 2025 earnings report, and an $812 million deal with Deep Apple Therapeutics to access non-incretin GPCR targets, as described in a MedCity article. These moves underscore a shift from incretin-based therapies to a broader metabolic disease ecosystem.

The most transformative acquisition, however, was the $5.2 billion purchase of Akero Therapeutics in 2025, reported in a Pharmaceutical-Technology report. Akero's lead candidate, efruxifermin (EFX), demonstrated significant reductions in liver fibrosis for patients with metabolic dysfunction-associated steatohepatitis (MASH), a condition closely linked to obesity and diabetes. This acquisition not only bolsters Novo's pipeline but also positions it to capitalize on the $25.7 billion MASH market by 2032. As John McDonald, Novo's global head of business development, noted, the company's M&A strategy is "modality agnostic," prioritizing therapeutic innovation over traditional partnerships.

Financial Resilience Amid Competitive Pressures

Despite these strategic gains, Novo's financial outlook has faced headwinds. In Q3 2025, the company revised its full-year sales growth projection to 8–14% (from 13–21%) due to compounded GLP-1 drugs and competition from Eli Lilly's Zepbound, a point highlighted in the Q3 2025 earnings coverage. Yet, Novo's first-half 2025 results remain robust: Wegovy sales surged 67% year-on-year to $1.87 billion in Q2 2025, while Ozempic generated $17 billion in 2024 sales. Total revenue for 2024 grew 26% to $41 billion, with operating profits hitting $18 billion.

The company's aggressive expansion of manufacturing capacity-via the acquisition of three Catalent sites-has helped mitigate supply constraints. However, the rise of compounded GLP-1 alternatives, which mimic Wegovy and Ozempic at lower costs, remains a thorn. Novo's response includes legal action against illegal compounders and the launch of NovoCare Pharmacy to streamline direct-to-patient distribution.

Long-Term Growth: Innovation vs. Patent Expiry

The looming expiration of semaglutide's patent in 2031 necessitates a pipeline of next-generation therapies. Novo's $600 million partnership with Metaphore Biotechnologies for next-gen GLP-1 agonists and its $532 million licensing deal with Omega Therapeutics for epigenomic controllers highlight this urgency. These bets on cutting-edge science aim to extend Novo's dominance beyond GLP-1s, targeting obesity's root causes through metabolic reprogramming.

Yet, the path is fraught. Eli Lilly's Zepbound has already captured significant U.S. market share, with sales rising 172% year-on-year in Q2 2025. Meanwhile, compounded drugs-often unregulated and unsafe-threaten to erode Novo's pricing power. Regulatory action against compounding pharmacies will be critical, but Novo's M&A-driven innovation offers a complementary shield.

Conclusion: A Calculated Gambit

Novo Nordisk's M&A strategy reflects a calculated gambit to future-proof its leadership in metabolic diseases. By diversifying its pipeline into MASH, epigenomics, and non-incretin pathways, the company is hedging against patent expiry and competitive erosion. While near-term growth projections have softened, the underlying fundamentals-blockbuster sales, strategic acquisitions, and a robust R&D engine-remain intact. For investors, the key question is whether Novo can translate its M&A activity into differentiated therapies that outpace rivals. If history is any guide, the Danish giant's blend of innovation and execution may yet cement its dominance.