The Weight of the Promise: How Novo Nordisk’s Ozempic Boom Tests Its Century-Old Insulin Legacy
It was a frigid 1942 day in Copenhagen when 2-year-old Erik Hageman tripped over his wooden clogs, his face slamming hard into the floor. Surgeons repaired his split tongue in the emergency room, but a strange pattern emerged during his recovery: he shrieked nonstop for water, and his urine turned thick, sticky, and sweet. The diagnosis was unmistakeable: type 1 diabetes, the autoimmune condition where the body destroys its own insulin-producing pancreatic cells.
Denmark was under Nazi occupation then, and eugenics was the regime’s foundational medical doctrine. Some claimed Erik’s fall had activated his diabetes, branding his bloodline “poisoned.” The doctor gave his parents a grim ultimatum: three weeks of neglect, and their son would die of ketoacidosis or starvation. “The best you can do is nothing,” he told them.
Against the Nazi master-race ideology that saturated every corner of public life, the Hagemans made a rebellious choice: their boy deserved to live. When Erik’s father, a custodian at a local sports college, shared his son’s diagnosis with coworkers, one had a connection.
That link led to Hans Christian Hagedorn, a short-tempered physician with wild tufts of hair running the Nordisk Insulinlaboratorium on Copenhagen’s outskirts. At the time, Hagedorn was refining insulin extracted from cow and pig pancreases to make it work longer and more reliably for humans. Under his care, Erik began receiving twice-daily injections of protamine insulin, a breakthrough formulation that extended insulin’s active life in the body. That drug, Neutral Protamine Hagedorn (NPH), remains on the World Health Organization’s list of essential medicines to this day. By age 5, Erik was injecting himself with a needle so wide he still compares it to a tree trunk, a story he has told to hundreds of visitors over decades.
Now 85, Hageman is a sharp, warm dapper grandfather, compact and energetic like a veteran tap dancer. He is one of the longest-living type 1 diabetics in Denmark. I spent an afternoon with him at Domus Hagedorn, a modernist Copenhagen mansion owned by Novo Nordisk—the global pharmaceutical giant that grew out of Hagedorn’s small lab. “Hagedorn was rather crazy,” Hageman told me. But without his care? “I’d be blind, I’d have lost my legs, I’d have kidney failure. I’d be dead.”
Today, Novo Nordisk produces half of the world’s insulin supply. But right now, the company is globally famous for a different blockbuster: Ozempic, the runaway hit semaglutide drug that has upended global diet culture and health care.
Shortly before meeting Erik, I sat down with Lars Fruergaard Jørgensen, the CEO who has overseen Novo’s dramatic transformation, at the company’s headquarters in the Copenhagen suburb of Bagsværd. The building’s centerpiece is a giant helix-shaped indoor spiral staircase, modeled after the insulin molecule itself—a tribute to the miracle that built the company. In a sunlit conference room, Jørgensen spoke warmly of Erik, the company’s unofficial poster child. It was clear Novo’s leadership wanted me to leave understanding their greatest legacy is not their stratospheric market valuation, but a hundred years of saving lives with insulin.
But these days at Novo, semaglutide overshadows everything else. In 2024, Ozempic was the second highest-selling drug in the world. It was originally developed for type 2 diabetes, the non-autoimmune condition where the body cannot properly use the insulin it produces. But from day one, its most famous effect has been its biggest draw: dramatic appetite suppression. The drugs containing semaglutide—Ozempic for diabetes, the higher-dose Wegovy for weight loss—have turned Novo into a global weight-loss juggernaut. In 2023, the company surpassed Paris luxury giant LVMH to become the most valuable company in Europe, with a staggering market capitalization of $424 billion. Even after a rocky 2024, it still ended the year worth more than Bank of America, Coca-Cola, and Toyota.
But for all the glowing before-and-after photos and hype, Jørgensen says the future scares him. “Parts of what’s coming scare the hell out of me,” he told me.
While Novo is majority controlled by the world’s largest charitable foundation, it still has to operate with the cold, tactical focus of any global oil or defense corporation. The semaglutide business has become a brutal, self-devouring ouroboros: insatiable global demand, exorbitant manufacturing costs, cutthroat competition from Eli Lilly, pricing pressure from governments worldwide, and the broken, profit-driven private insurance system in the U.S.—Novo’s largest market by far, where some 15 million people now take semaglutide.
But the core moral tension runs deeper. Semaglutide does almost nothing for the 8.4 million people around the world living with type 1 diabetes, who still rely on insulin to survive. What keeps Jørgensen up at night is the fear that the current structure of global drug markets, U.S. health care, and investor pressure will push his company to abandon the original patients who built it: people like Erik Hageman, who cannot live a single day without insulin.
For its first 75 years, Novo was a quiet, indispensable industry workhorse, an anonymous producer of the life-saving commodity insulin. That anonymity began to fade in 1991, when Danish chemical engineer Lotte Bjerre Knudsen began researching a new treatment for type 2 diabetes, which accounts for up to 95% of all diabetes cases globally. Over 18 years, she led a Novo team to develop liraglutide, an analog of the natural human hormone GLP-1 (glucagon-like peptide-1), which our bodies secrete for just a few minutes after we eat from the brain stem and gut.
Think of GLP-1 as a natural tranquilizer for the body’s appetite, a balm for our most primal cravings. It tells the body: you’ve eaten, you’re safe, you don’t need more. But natural GLP-1 breaks down in the body in just a couple of minutes, leaving hunger to return almost immediately.
Knudsen’s challenge was to create a synthetic GLP-1 that would last longer, to keep blood sugar stable for hours. She solved the problem by attaching a fatty acid to a precise point on the hormone’s amino acid chain. The result was a molecule that worked just like natural GLP-1 but stayed active in the body for a full day.
Liraglutide was approved in the U.S. for type 2 diabetes in 2010, and for weight loss in 2014. But daily injections were a turnoff for many patients, so Novo assembled a new research team led by peptide engineer Jesper Lau, who developed semaglutide—named for the French word semaine, meaning “week,” because it stays active in the body for seven full days.
A full week of stable blood sugar, and a full week free from the constant ravenous hunger that defines modern life. One shot a week, and you feel like you’ve just eaten a satisfying meal. In 2018, the world learned the Novo Nordisk name when the company launched semaglutide as Ozempic, complete with a catchy, ubiquitous jingle: Oh oh oh Ozempic!
The hype around semaglutide has drowned out the century-old celebration of insulin that built the company. It does have common side effects: nausea, vomiting, diarrhea. Rare but serious risks, including potential vision loss, have also been documented. But overall, it is widely well-tolerated, and proponents hail it as a near-panacea: it is being tested for everything from alcoholism and heart disease to polycystic ovary syndrome, Alzheimer’s, Parkinson’s, sleep apnea, and “food noise”—the constant obsessive preoccupation with food and dieting that is especially common in the U.S.
Most Danes have never even heard the Ozempic jingle. Like nearly every country on earth except the U.S. and New Zealand, Denmark bans direct-to-consumer advertising of prescription drugs. But the U.S., with its obsession with weight loss and open consumer advertising, was perfectly primed for semaglutide’s takeover. Under Jørgensen’s leadership, Novo hired global media giant Wavemaker—whose clients include L’Oréal and Tiffany—and reportedly spends close to $200 million a year promoting semaglutide to American consumers. Americans quickly got hooked on the jingle, the end of constant hunger, and the compliments on their weight loss.
Making money in the U.S. requires navigating the tangled mess of American health care and diet culture. One of Novo’s biggest strategic goals was to shake the reputation of semaglutide as a “vanity drug.” Framing it as a serious treatment for a chronic disease, like insulin, rather than a quick weight-loss fix, was the only way to get it covered by U.S. insurance companies. And if semaglutide was covered by insurance while it was still under patent, it would be exponentially more profitable.
That led to Novo joining a broad public health effort to reframe obesity not as a matter of body size, but as a chronic metabolic disease. By the time Wegovy—the higher-dose semaglutide formulation specifically for weight loss—was approved in 2021, obesity was widely recognized as a standalone disease, and semaglutide was positioned as its cure. Not long after, the FDA reinforced that win when it approved Wegovy to reduce the risk of serious heart events in people with higher body weights, noting that 70% of U.S. adults fall into that category.
Even amid the semaglutide frenzy, insulin is still framed as the company’s “heart” at Novo’s headquarters. Recombinant human insulin is one of biotech’s greatest achievements: the first golden molecule of the biotech era, engineered in 1978. It is a biologic, a drug made from large, complex molecules derived from living organisms—bacteria, yeast, animal tissue—that are extremely expensive and complex to manufacture.
At Novo, insulin is grown in baker’s yeast, a microorganism that produces high biomass and is perfect for engineering therapeutic molecules. But engineered proteins grown in yeast are notoriously finicky.
Monika Nøhr Løvgreen, a Novo research scientist I spoke with in her lab, told me her work with these molecules is like a volatile relationship. “It’s not enough for a molecule to do what we need it to do biologically,” she said. “It has to be injectable without causing redness or itching, it can’t degrade in storage, it has to stay stable in solution.” She describes some molecules as prima donnas, while others are steady, elegant, even “queenly.”
Getting the molecule right is everything, explains Brian Vandahl, Novo’s head of global research technology. It all starts with one single engineered cell, which is then scaled up into huge production cultures in massive manufacturing tanks across the company’s facilities.
Growing, fermenting, and purifying these living cells for biologics like insulin is incredibly expensive. (Semaglutide is produced the same way as insulin, but because its engineered protein has fewer than 40 amino acids, the FDA classifies it as a small-molecule drug rather than a biologic.) Like tending a garden or caring for a pet, these microorganisms require constant, careful care: controlled temperatures, steady sugar feeds, regular cleaning with solutions that don’t kill the cells. At Novo’s secretive biologic manufacturing plant in West Lebanon, New Hampshire, a local once described the facility to me as “the place where they teach fleas to sing and dance.”
By comparison, making blockbuster small-molecule pills like Prozac, Viagra, or Tylenol is relatively simple and cheap. They are made from nonliving chemical compounds, no careful tending required. “Chemistry is much easier to control,” Vandahl told me. “But I’m far more fascinated by biology.”
Now that Novo produces both the world’s most popular GLP-1 weight loss drugs and half the global insulin supply, the company is pouring tens of billions of dollars into expanding its manufacturing capacity. Each new facility costs $2 to $3 billion and takes five years to bring online: half the time to build, half to test and validate the equipment.
Last year, the company broke ground on a massive new manufacturing campus in the Danish seaport town of Kalundborg on the island of Zealand. The campus is a biotech hub that produces active pharmaceutical ingredients (APIs) for both insulin and semaglutide from living cells. When I asked how to spot the site from a distance, a Novo employee told me “just look for Dubai”—a reference to the massive scale of the construction.
The site is a sprawling expanse of harbor cranes and construction dust. Michael Hallgren, Novo’s senior vice president of API manufacturing, gave me a tour. After we suited up in sterile gowns, he let me hold a small vial of deep molasses-colored liquid: the original engineered starter cell culture grown in the lab. They wouldn’t tell me if it was for insulin or semaglutide, but the thick, rich texture immediately reminded me of something. “Is this like a sourdough starter?” I asked.
“Exactly,” he said. Walking through the massive production halls, the most striking feature was the silo-sized mixing vats, where a thick mixture that looked like cake batter bubbled away. The whole facility smelled strongly of bread and beer, warm and alive and fizzy. When that starter culture is fully scaled, Hallgren told me, “it’s enough to treat 500,000 diabetics for a full year.”
Novo employs roughly 30,000 people in Denmark, 5,000 of them in Kalundborg alone. A young engineer who moved from the Philippines to work there told me she took the job because her aunt has diabetes and uses Novo’s products. With $8.5 billion invested in expanding the Kalundborg campus, hundreds more jobs are on the way. Not long after I left Denmark, Novo announced another $1.2 billion facility in Odense. A Copenhagen politician even joked he expects a brain drain of U.S. scientists to Denmark if Donald Trump wins a second term.
Novo also has manufacturing facilities in Brazil, China, France, Algeria, Iran, and the U.S. In December 2024, it acquired New Jersey-based global manufacturing firm Catalent for $11.7 billion to expand capacity further.
The company’s impact on Denmark’s small economy (the country has fewer than 6 million people) is staggering. Its recent growth has pushed Denmark’s total GDP above that of Egypt, a country of 112.7 million. In 2023, Novo paid $3.6 billion in global income taxes, $2.3 billion of that to Denmark. Corporate tax revenue in Kalundborg has increased tenfold since 2010. “A big thank you to overweight Americans for keeping my mortgage low,” one Danish economist tweeted in 2023.
Ever since semaglutide’s weight loss effects became public, demand has far outstripped supply. In 2022, the FDA listed semaglutide products as in shortage. Desperate patients turned to compounding pharmacies selling unregulated knock-offs, which have sometimes led to serious illness and death.
Meanwhile, as Novo created the GLP-1 market, U.S.-based Eli Lilly launched its own competing GLP-1 drugs, Mounjaro and Zepbound. Some analysts warn Denmark now faces the “Nokia risk”: the same fate that hit Finland in the 2000s, when the country’s entire economy was tied to Nokia’s early smartphone dominance, only to be wiped out when Apple launched the iPhone.
The U.S. government has also taken note of the GLP-1 boom. At the end of 2024, the Biden administration proposed a rule to allow Medicare and Medicaid to cover semaglutide for weight loss. “It’s a game changer for Americans who can’t afford these drugs otherwise,” Health and Human Services Secretary Xavier Becerra said. While the incoming Trump administration is widely expected to scrap the rule—Trump’s nominee for health secretary, Robert F. Kennedy Jr., has criticized semaglutide, claiming obesity and diabetes can be cured with diet and discipline, and once called Americans “stupid and addicted to drugs” for buying Novo’s products—demand is not expected to drop. Even Elon Musk got in on the hype, styling himself as “Ozempic Santa” last Christmas after showing off his dramatic weight loss.
Nothing is more important to Novo than growing its U.S. business, which means constantly navigating the same broken health care system that frustrates ordinary Americans. In September 2024, Senator Bernie Sanders grilled Jørgensen at a congressional hearing on Ozempic and Wegovy’s sky-high prices. Sanders pointed out that a month of Ozempic costs $59 in Germany, and around $600 in the U.S. even after rebates. “From a moral perspective, does it bother you that keeping the price of Ozempic and Wegovy so high could lead to the preventable deaths of tens of thousands of Americans?” Sanders asked.
Jørgensen did not give Sanders the fiery confrontation he wanted. Novo spends an estimated $5 million a year on lobbying to influence U.S. policymakers, but Jørgensen volunteered to testify to educate lawmakers. He calmly explained the high cost of manufacturing biologics, and shifted blame to the real villain in his view: pharmacy benefit managers, or PBMs.
PBMs are the middlemen like CVS Caremark that manage drug formularies for health plans, negotiate prices for insurance companies, and decide which drugs get covered by insurance. Jørgensen has called them the real enemy of affordable drugs for years. Facing Sanders, he laid out one of the most absurd paradoxes of U.S. health care: PBMs make money both from insurance premiums and from rebates paid by drug companies. The more expensive a drug is, the higher the rebate PBMs collect. If a drug company like Novo cuts its price too much, PBMs will often drop coverage entirely to protect their profits.
The best example of this is Levemir, a long-acting insulin Novo sold in the U.S. for decades. Last year, as Novo reaped $18.5 billion in semaglutide profits, it announced it would discontinue Levemir entirely in the U.S. by the end of 2024. Thousands of American type 1 diabetics still relied on the drug, which metabolizes faster than other long-acting insulins and works particularly well for children, pregnant people, and highly active patients. Novo said patients could switch to its other insulin products, but many were stunned. Jørgensen told the committee what happened: “We lowered