NVO, a leading pharmaceutical company focused on diabetes and obesity treatments, exhibits compliant core business activities under Shariah principles. However, its financial metrics, particularly the debt-to-market capitalization ratio of 41.22%, fail thresholds across AAOIFI, MSCI, and S&P standards, resulting in non-compliance. The company is excluded from all major Shariah-compliant indices due to elevated leverage from R&D and acquisitions. A purification rate of 1.45% is recommended based on interest income. Overall, while ESG factors are positive with low risk, financial concerns dominate the assessment.