Novo Nordisk A S (NVO) FY 2025 earnings call transcript

Transcript, summary, guidance, and what analysts pressed on from the Novo Nordisk A S call on July 28, 2025.

Held
July 28, 2025
Length
47 min
Tone
Cautious-0.35
Analysts
11
Words
7,028
2025 sales growth
8% to 14%constant exchange rates
2025 operating profit growth
10% to 16%constant exchange rates
2025 free cash flow
DKK 35 billion to DKK 45 billion
2025 net financial items
gain of around DKK 3 billion
Compounded GLP-1 patients
1 million patients or moreU.S. market research
NovoCare weekly prescriptions
around 11,000including telehealth collaborations
Retail cash weekly prescriptions
around 20,000additional to NovoCare

Summary

Management framed the cut as a need for faster execution, with U.S. compounding and weaker-than-expected market growth driving the reset.

  • Mike Doustdar promised sharper focus, faster decisions, greater efficiency, and stronger commercial execution.
  • International Operations growth is expected to remain healthy despite slower-than-planned Wegovy penetration in select markets.
  • The board said R&D will be combined under a new chief scientific officer, effective August 7, 2025.

Guidance

  • 8%2025 sales growth 8% to 14% at constant exchange rates; reported DKK growth 4 percentage points lower
  • 10%2025 operating profit growth 10% to 16% at constant exchange rates; reported DKK growth 7 percentage points lower
  • 3B2025 net financial items gain around DKK 3 billion
  • 35B2025 free cash flow DKK 35 billion to DKK 45 billion

What analysts pressed on

  • 012026 growth and exit rates: the CFO declined to discuss 2026, with guidance due alongside full-year results in February.
  • 02Compounding: market research still estimates 1 million patients or more using compounded GLP-1s; management gave no six-to-nine-month resolution timeline.
  • 03Ozempic prescriptions: management cited roughly 690,000 weekly TRx, flat development, and no material prescription benefit yet from the kidney-disease indication.
  • 04Pricing and gross-to-net: management said the outlook reduction is volume-driven, gave no specific net-price forecast, and awaits legal clarification on 340B.
  • 05U.S. commercial recovery: management cited CVS conversion, cash-channel growth, and campaigns, but said results remain below expectations.
  • 06Capital deployment and pipeline: the incoming CEO said external innovation remains possible but deferred specifics pending discussions with his team and board.

Notable disclosures

  • 1M1 million patients or more remain on compounded GLP-1s, despite the May 22 end of the FDA bulk-compounding grace period.
  • 120 lawsuits and 1,000 cease-and-desist letters have been issued, but management said compounded use has not yet declined.
  • Around 11,000 weekly prescriptions come through NovoCare Pharmacy and telehealth, in addition to around 20,000 retail cash prescriptions.
  • The incoming CEO said the company had sometimes overlooked things during high growth and pledged faster decisions and a broader performance culture.

Risks raised

  • Persistent compounded GLP-1 use, estimated at 1 million patients or more, is limiting branded obesity-drug growth in the U.S.
  • Slower U.S. market expansion and competition are weighing on Wegovy and Ozempic, while select international markets show slower Wegovy penetration.
  • Management said illicit foreign API and unsafe compounded products expose patients to significant risks; stronger regulatory enforcement remains uncertain.
  • 340B income recognition remains subject to pending legal clarification, adding uncertainty to U.S. gross-to-net estimates.

Tone: Cautious -0.35

The call acknowledged weaker U.S. growth, persistent compounding, and execution gaps, while emphasizing international growth and opportunities to improve.

Who spoke

Company

  • Helge LundChair of the Board of Directors
  • Mike DoustdarPresident and CEO
  • Lars Fruergaard JørgensenChief Executive Officer
  • Dave MooreExecutive Vice President of US Operations
  • Unidentified ManagementInvestor Relations

Analysts

  • Michael NovotnyAnalyst, Nordea
  • Sachin JainAnalyst, Bank of America
  • Harry SimpsonAnalyst, UBS
  • Martin PankowAnalyst, SEB
  • Evan SeigermanAnalyst, BMO Capital Markets
  • Richard RosserAnalyst, J.P. Morgan
  • Michael NedelcovychAnalyst, TD Cowen
  • Thibault BoutherinAnalyst, Morgan Stanley
  • James QuigleyAnalyst, Goldman Sachs
  • Emily FieldAnalyst, Barclays
  • Carl MadsenAnalyst, Danske Bank

Full transcript

Analyst questions are marked with a bar. Timestamps are into the recording.

Prepared remarks

00:00

Unidentified ManagementInvestor Relations

Welcome to this conference call regarding the changes to NOVO NORDISK executive leadership, as well as the lowering of the financial outlook for 2025 that we announced today. My name is Jakob Rode, and I'm the Head of Investor Relations at NOVO NORDISK. With me today I have Helge Lund, Chair of the Board of Directors at NOVO NORDISK, CEO of NOVO NORDISK, Lars Frohbo Jørgensen, Chief Financial Officer, Carsten Mung Knudsen, Executive Vice President of US Operations, Dave Moore, and finally Executive Vice President, International Operations, and incoming CEO as of August 7th, Mike Duster. All speakers will be available for the Q&A.

Today's announcements are available on our website, novenordis. com. Please note that the call is being webcasted live and a recording will be made available on our website too. The call is scheduled to last for a maximum of 45 minutes. Next slide please. The presentation is structured as outlined on slide 2. We will briefly cover both of today's announcements.

First, Heli will cover the appointment of Mike Duster as new President and CEO of NOVO NORDISK, as well as other executive level changes briefly. Following that, Carsten will review the update to the financial outlook, where NOVO NORDISK today lowered the sales and operating profit expectations for 2025. The presentation will be followed by a Q&A session beginning in approximately 15 minutes. Please note that all sales and operating profit growth statements will be a constant exchange rate unless otherwise specified. Please turn to the next slide.

Before I hand over to Juhelje, we need to advise you that this call will contain forward-looking statements. These are subject to risk and uncertainty that could cause actual results to differ materially from expectations. For further information on forward-looking statements and risk factors, please see the company announcement for the first three months of 2025, which was released on May 7th. And with that, over to you, Juhelje, for a review of the changes to NOVO NORDISK Executive Leadership.

01:48

Helge LundChair of the Board of Directors

Thank you, Jakob. Please turn to the next slide. In May of this year, it was announced that Lars Rügo Jørgensen would step down from his role as CEO of NOVO NORDISK by mutual agreement with the NOVO NORDISK board. Following this announcement, we accelerated our ongoing succession process with Lars continuing as the CEO to support a smooth transition to new leadership. Please go to the next slide. Earlier today, we announced that Lars will be succeeded by Mike Dostar as President and CEO of NOVO NORDISK. This announcement comes after a comprehensive search process which included both external and internal candidates.

The board believes that Mike's leadership, strategic vision, and commercial execution experience makes him best suited to lead the company through the current market challenges while maximizing future opportunities. Mike has been Executive Vice President and Head of International Operations since 2015, where he has consistently demonstrated his abilities to create value and drive growth. Under his leadership over the past decade, IO has more than doubled sales and grown to an organization of nearly 20,000 employees, serving around 35 million patients. Patients. Given his leadership of international operations and his role on executive management since 2015, Mike has an extensive understanding of the company, its culture, its strength, and also areas of opportunity.

As CEO, Mike will be focused on strengthening the company's global leadership in diabetes and obesity, enhancing commercial execution, and driving greater efficiency across the company. Mike is an outstanding leader and truly committed to NOVO NORDISK, our purpose, and the patience we serve. He will take up the position as President and CEO from August 7, 2025.

After 34 years of exceptional service, Lars Frugor Jørgensen leaves NOVO NORDISK with our deepest gratitude. His visionary leadership and steadfast commitment have driven the company's remarkable growth and global impact, earning him widespread respect throughout the pharmaceutical industry. On behalf of the board and all employees, we extend our sincere thanks and best wishes for his future endeavors. And a special thank you to Lars for ensuring a smooth handover to Mike. In addition to the CEO announcement, we announced today that NOVO NORDISK research and early development and the development function will be merged into one, appointing Martin Holst-Langli as the chief scientific officer and EVP for the full R&D function.

In addition, Emil Kongsøy Larsen will succeed Mike in the role as Executive Vice President for International Operations. Also, these changes will be effective as of August 7, 2025, so we have a full team in place. And on behalf of the Board, I look very much forward to working with Mike and the team to deliver the company's growth strategy. So, now over to Mike for a few words.

04:53

Mike DoustdarPresident and CEO

Thank you very much, Helge. It's really a privilege to get this job. Let me start by thanking Lars for your leadership and support over so many years. I also want to thank you, Helge, and the entire board for their unanimous support. I really appreciate that. Now, the fact that my announcement comes right after the guidance update, well, it just makes the mandate ahead even more clear. We need to increase the sense of urgency and execute differently. But we'll do that by building on the core strength that makes this company so unique. I take this job very seriously. You can expect me to be a CEO that combines strategic clarity with operational urgency. Soon, I'll be working closely with my management team, the board, and the entire organization to move forward.

We will sharpen our focus and move faster. We will operate more efficiently. We will advance our pipeline and keep pushing the boundaries of innovation, and we will invest to accelerate growth and deliver shareholder value. That is my promise to you. I'm looking forward to working with my team after we close Q2, and I'm eager to meet the investor community as soon as possible. Now back to you, Jacob.

06:01

Unidentified ManagementInvestor Relations

Thank you, Mike. Please turn to the next slide. I would like to turn it over to Karsten for an update on NOVO NORDISK financial performance and outlook for 2025.

06:11

Unidentified ManagementChief Financial Officer

Thank you, Jager. Please turn to the next slide. In the first six months of 2025, NOVO NORDISK sales increased by 18% and operating profit increased by 29% both at constant exchange rates. Sales growth in the first six months of 2025 was positively impacted by growth to net sales adjustments related to prior years of around 3 billion DKK related to the 340B U. S. rebate provision. Operating profit growth is positively impacted by the Osedurinon impairment in the second quarter of 2024 of 5.7 billion Danish kroner. This was partially countered by the incremental impact related to the acquisition of the three former cattle and manufacturing sites of around 2.6 billion Danish kroner in 2025. Please go to the next slide.

As announced earlier today, NOVO NORDISK has lowered the full year outlook for 2025 compared to the outlook issued in May of this year. For 2025, the range for sales growth is now expected to be 8% to 14% at constant exchange rates. Given the current exchange rates versus the Danish kroner, sales growth reported in DKK is expected to be 4 percentage points lower than at constant exchange rates, The change in sales outlook for 2025 is driven by lower growth expectations for the second half of 2025.

This is related to lower growth expectations for Vigovie in the U. S. obesity markets, lower growth expectations for OSMPIC in the U. S. GH1 market, as well as lower than expected penetration for Vigovie in select I. O. markets. The lower growth expectation for Vigovi in the U. S. obesity market reflects the persistent use of compounded GLP-1 along with slower market expansion and competition. Despite the expiry of the FDA grace period for mass compounding on May 22, 2025, NOVO NORDISK market research shows that the unsafe and unlawful mass compounding has continued, and that multiple providers continue to market and sell compounded GLP-1s under the false guise of personalization. NOVO NORDISK is pursuing multiple strategies, including litigation, to protect patients from knockoff semaglutide.

NOVO NORDISK is deeply concerned that without aggressive intervention by federal and state regulators and law enforcement, patients will continue to being exposed to the significant risk posed by knockoff semaglutide drugs made by illicit foreign active pharmaceutical ingredients. As unsafe and unlawful mass compounding continues, the Vigobi penetration in the cash channel is below expectations.

Within the cash channel, Vigobi prescriptions via NovoCare Pharmacy, including telehealth collaborations, are currently around 11,000 total weekly prescriptions. This is in addition to around 20,000 weekly prescriptions in the retail cash channel. NOVO NORDISK will continue to invest in the expansion of direct-to-patient initiatives such as NovoCare Pharmacy and further collaborations with telehealth organizations.

The sales outlook also reflects lower-than-expected penetration of Vigovie in the insured channel. This is due to lower market expansion and competitive dynamics, despite the initiation of new commercial activities for Vigovie in the first half of 2025. NOVO NORDISK is starting to see some positive indicators reflected in the latest NBREX data in the US, and we continue to engage in additional commercial activities.

Further, we continue to expect a regulatory decision around the Vigovie-MASH indication during the second half of 2025. Moreover, NOVO NORDISK expects a positive volume contribution from the changes to the CVS National Template Formulary, where Vigobi is now the only GLP-1 medicine covered for obesity as of July 1st.

For USEMPIC in the U. S. , the updated outlook is negatively impacted by competition in the U. S. market. NOVO NORDISK continues to invest in commercial activities and label updates towards driving further market penetration of OSEMPIC. In addition, although Vigovi sales in international operations are growing at high rates and launches are progressing, the sales outlook is reflecting lower than expected penetration of Vigovi in select I. O. markets due to slower market expansion and competition. With around 1 billion people living with obesity globally and only a few million on treatments, the outlook reflects a continued global rollout of Vigovie to more markets.

Operating profit growth is now expected to be 10% to 16% at constant exchange rates. Given the current exchange rates versus the Danish Krona growth reported in DKK is expected to be 7 percentage points lower than at constant exchange rates This is primarily due to the depreciation of the U dollar to Danish kroner exchange rate The updated expectation for operating profit growth reflects the lower sales growth outlook, partially countered by reduced spending. This includes a negative mid-single-digit operating profit growth impact related to the acquisition of the three former Catalan manufacturing sites. NOVO NORDISK now expects net financial items for 2025 to amount to a gain of around 3 billion Danish krona. This is mainly driven by expected gains on hedge currencies, primarily the US dollar, partially offset by interest expenses related to funding of the debt-financed capital transaction.

The free cash flow is now expected to be 35 to 45 billion Danish krona, reflecting the lower than planned expected sales growth. The lower growth is mainly driven by lower volume growth of GL4-1 based treatments in the US and related cash flow implications amplified by the US growth to net system. NONOR's full disclosure of the financial results for the first six months of 2025 will be published on August 6th, where more information will be available.

That covers the financial outlook for 2025. Now over to Lars.

13:02

Lars Fruergaard JørgensenChief Executive Officer

Thank you, Karsten. Our performance in the first six months of 2025 with 18% sales growth reflects our continued commitment to treating more people with serious chronic diseases. That said, we cannot ignore the fact that we have reduced our full-year outlook with headwinds from compounding in the U. S. , slower market growth, and competition challenging previous expectations. With the updated outlook and plans to execute on recent commercial initiatives, the organization is poised to perform as Carson described.

Finally, I would like to congratulate Mike with the role as CEO. So I am confident that under Mike's leadership, NOVO NORDISK will see significant growth opportunities and ultimately reach millions more patients. Now, back to you, Jakob.

Questions and answers

13:46

Unidentified ManagementInvestor Relations

Thank you, Lars. And next slide, please. With that, we are now ready for the Q&A. We are kindly asking all participants to limit her or himself to one question. I remind that the focus of this call, including this Q&A session, is only on the changes related to the NOVO NORDISK executive leadership team, as well as the financial outlook for 2025. Operator, we are now ready to take the first question, please.

14:07

Thank you. As a reminder to ask a question, please press star 1 and 1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1 and 1 again. We are now going to proceed with our first question. And the questions come from the line of Michael Novot from Nordea. Please ask your question.

14:28

Michael NovotnyAnalyst, Nordea

Thank you very much. Michael Novot from Nordea and Copenhagen. So looking into the second half of the year and very sort of muted expectations, can you try to give us a split between growth in IEO versus US for the second half and also what kind of implications that could have for sort of the exit rates or entry rate into 2026, which also could sort of drive some concerns? Thanks.

14:57

Unidentified ManagementInvestor Relations

Thank you for that question, Michael. On the question, I'll hand it over to you, Karsten.

15:02

Unidentified ManagementChief Financial Officer

Thank you, Michael, and thank you, Jakob. So with 18% growth in the first half of the year and the guidance range that we put out today with a midpoint of around 11%, then the applied growth in the second half of this year is mid-single digits. Do bear in mind we have a tough comparator from last year linked to the growth to net adjustment of 5 billion we did in the fourth quarter last year, which would take a growth rate up from the mid-signal digits to probably high single digits. In terms of growth contribution from a geography point of view, then it's important to note that the lowering of outlook we're doing today is predominantly linked to performance of our U. S. business.

It's a smaller piece that is related to a slower than plant penetration of Vigovian IO, and as a consequence, when we release our results next week, you will see very healthy growth in IO in the first half of this year, and we expect that to continue into the second half of this year. As to implications into 2026, of course we will not guide for 2026 today. We will do that in conjunction with our full year results come February. So I will not go into further deliberations around 2026 for today.

16:35

Unidentified ManagementInvestor Relations

Thank you for that, Karsten. Very clear. And thank you also to you, Michael, for the question. With that, I believe we are ready for the next question, please. We are now going to proceed with our next question. And the questions come from the line of Sachin Jane from Bank of America. Please ask your question.

16:52

Sachin JainAnalyst, Bank of America

Hi there. Thanks for having my question. I just wanted to get a better understanding of what you're assuming for both Wigovi and Zempic as we exit this year and into next year. So for Wigovi, I guess you're citing the main issue being compounders. So any color on how many patients still do you think a compounder versus a million prior? And outside of litigation, which I guess could take quite a while, is there anything that you can point to that would change that on a six to nine month time frame?

And I guess similar question on Zempick. You have much looser commentary within the PR around path to growth. Comments remain tough. Scripts aren't inflecting. Assuming given a five to ten percent price decline, fair to think that Zempick is now trending towards sales declines from here. Thank you.

17:36

Unidentified ManagementInvestor Relations

Thank you for that question, Sachin. On compounding, I will give it first to Carsten.

17:44

Unidentified ManagementChief Financial Officer

Yeah, thank you Sachin. So specifically on compounding, at Q1 in May we said our market research estimate was 1 million patients using compounded GLS-1 for obesity treatments. Then the FDA grace period for bulk compounding on the 503B ended on May 22nd, and our assumption was that that would lead to increased patients using branded DLF1s in the second half of this year.

Unfortunately, our latest market research indicates that that has not happened, and that's one of the assumptions that we have changed. So the latest market research still indicates 1 million patients or more being on compounded DLF1 OBs in the U. S. market test.

18:32

Unidentified ManagementInvestor Relations

Thanks for that, Kastin. And your second question, Sachin, on OSEMPIC Dynamics, I'll hand it over to you today.

18:43

Dave MooreExecutive Vice President of US Operations

Thank you for the question, Sachin. Yes, in regards to your question about OSEMPIC, we are seeing a flattish TRX development currently. We're seeing approximately 690,000 TRXs per week on par with competition. But the current competitive dynamics, we see we're capturing about 40% of the NBRX, and we do see patients switching from Ozempic to the competitor product as well. We haven't seen a solid pickup from our newly approved indication in chronic kidney disease, although we do hear positive comments from clinicians. We haven't seen that materialize into prescriptions as of yet. And then secondly, we continue to see slower class growth of GLP-1 diabetes. And to some degree, there's also an impact from compounding, meaning if someone is coming in and looking for Ozempic branded product, it is possible that they would end up on a compounded semagrotide.

Thank you.

19:50

Unidentified ManagementInvestor Relations

Thank you, Dave. And I'll just hand over to you, Kasim, for some final comments.

19:53

Unidentified ManagementChief Financial Officer

Yeah, so just adding on to my prior comments on compounding in the U. S. marketplace, it's important that this is something we don't take lightly. It's a key patient safety concern, and of course we are active on many, many fronts in terms of improving patient safety and reducing compounding to what is easily allowed. So we, amongst other things, are active in litigation, and we're working with regulators.

And of course, we are hopeful that this can, over time, lead to a reduction in compounding and hence a potential inflow of additional patients into the granted segments.

20:36

Unidentified ManagementInvestor Relations

Thanks for that, Karsten, and also thank you to you, Dave. Then we are ready to move on to the next question, please.

20:41

Sure. We are now going to proceed with our next question. And the questions come from the line of Harry Sempton from UBS. Please ask your question.

20:51

Harry SimpsonAnalyst, UBS

Brilliant. Thank you very much for taking the question. So maybe can you just contextualize the bottom end of the guidance? So it would imply that there's limited sequential growth in the second half for that bottom end. We've seen the uptick in prescriptions with the CVS switch. Novocare seems to have come through even if modestly and below your initial expectations. What are you expecting for the bottom end of that conservatism? And maybe just to add on to that, what are you expecting in terms of the net price erosion for both Wigobi and Zempick in the US for the full year and going forward? Thank you.

21:34

Unidentified ManagementInvestor Relations

Thanks for that, Harry. And I'll give that presentation to you, Karl.

21:37

Unidentified ManagementChief Financial Officer

Yeah, so first of all, we have narrowed our range compared to the first quarter release back in May, so now we are guiding plus minus three to the midpoint.

It's not like we have a specific scenario taking us to the floor. It's an assessment of the risk profile that we're looking at that can take us both to the top end and to the low end of the range. And of course, we are, you know, working hard each and every day to get the closest possible to the top end.

So really, the uncertainty factors to this is related to, I would say, the fairly usual uncertainty factors around performance of OSMPEC and Vigovi, and then the classic uncertainties around growth to net estimates in the U. S. Perfect.

22:35

Unidentified ManagementInvestor Relations

Thanks for that, Karsten. And with that, I think we're ready to move to the next question. We are now going to move to the next question.

And the questions come from the line of Martin Pakhoi from SEB. Please ask your question.

22:52

Martin PankowAnalyst, SEB

Yes, Martin Pakhoi from SEB. Just a question to Mike. Now as a new CEO, but you have, of course, also been there your entire career. If we look back over the last two years what would you have done differently in NOVO NORDISK in order to prevent this situation that you are standing in today and what do you see as the main catalyst to see a rebound in growth over the next two or three years Can it be driven by improved commercial execution, or do we need new products like AllSemmer and KakaSemmer before we can see a real change to where you are today?

23:41

Unidentified ManagementInvestor Relations

Thanks for that, Martin Parker. I'll give that to you, Mike, reflecting on past challenges leading into the future also.

23:48

Mike DoustdarPresident and CEO

Thanks very much. Martin, I would say in the tumble of high growth, we sometimes can overlook things, and that's probably a bit what has happened. As we go forward, my promise is that we're going to accelerate the growth and the shareholder value creations by predominantly two big things. One, we need to progress our pipeline and the innovation that helps us mid and longer term, but also short term, get more out of what we have, the assets that we have, and predominantly we do that by improving the commercial execution. We will focus more on some of the things that matters most in terms of that growth.

I have no doubt we're going to be faster and become more clear in our decision making, reducing the white space in various different processes that we have. We'll bring the performance culture that I'm very well aware of from my part of the world and try to do that across the whole organization. And then we will invest competitively in finding, you know, in the areas where we really need to invest, and we will try to find efficiency and savings in the so-called less important areas.

24:58

Unidentified ManagementInvestor Relations

Thank you for that, Mike, and also thank you to you, Martin. And with that, we're going to move to the next question, please.

25:05

We are now going to proceed with our next question. And the question comes from the line of Evan Sigerman from BMO Capital Markets. Please ask your question.

25:15

Evan SeigermanAnalyst, BMO Capital Markets

Guys, thank you so much for taking my question and providing the updates today. So as we think about kind of the go-forward for your businesses, how would you characterize the competitive dynamics in the United States? I know there's a lot with compounding. Do you believe that the CDS switchover will be enough to reignite sales, or do you need to look at other potential factors that can help kind of reignite the business? Thank you very much.

25:46

Unidentified ManagementInvestor Relations

Hi, Evan. Thanks for those questions. Dave, I'll turn it over to you on U. S. Dynamics.

25:52

Dave MooreExecutive Vice President of US Operations

Thanks for the question, Evan. Overall, we believe there's still substantial growth opportunity in the U. S. for GLP-1s. This is in both diabetes and in obesity. And we do have to continue to execute on the roadmap that we've presented earlier in the year, and as Mike said, with a focus and a sense of urgency around commercial execution. And let me just comment on a few areas and put a finer point to it. The first, it is compounding, as you mentioned, and we have to continue to be aggressive and push avenues to limit unlawful compounding. You could say, in a way, we're competing against compounding with a fake alternative of our medicine that is not safe for patients.

We take it seriously. We have stepped up our dialogue recently with FDA. And you may have seen last week, there were some letters from congressional leaders asking FDA to move on the illicit importation of API coming in from around the world, which is not even approved for use from where it's coming from. It has to stop. Secondly, as you mentioned, we do continue to expand in other channels. And right now, the expansion of the cash channel is important. We are encouraged with some of the signs that we have seen, but it is still not picked up to our expectation that we got it in May, which is still overly due to compounding. But we have seen our cash business move from 4% early in the year to now 12%, and that is an encouraging sign that there's an opportunity to meet patients where they are and have a cash offering.

Second, the third is commercial execution, and that is of utmost importance. Continuing to push our investments behind campaigns that we know are working. We have a new Wagovi DTC campaign that will launch in the second half of the year, and we have launched real-world evidence around weight loss that we also discussed with you earlier in the year.

And then lastly, the CVS conversion is on track. We think it's an important element, but we're also seeing the opportunity for increased growth in other channels of retail as well. We are encouraged with recent trends, but we still have a ways to go to meet the expectations.

28:18

Unidentified ManagementInvestor Relations

Thanks, Evan. Thank you, Dave. And before going to the next question, just hand over to you, Mike, on the current dynamics in international operations.

28:33

Mike DoustdarPresident and CEO

I would say in international operations, of course, next week we will release the full numbers. But what you will see is that we are having a fantastic growth right now with Vigobi on the back of many, many more launches than was originally planned. It is true that we are falling a bit short of our own ambition and plans that we made earlier on, but the numbers will hopefully satisfy you that this is going very, very well. So besides, of course, expanding the footprint on VGOVI across the world, we're also, as alluded to some time ago at the last quarter, we have restarted our OSEMPIC promotions across the world, and that should give us, in addition to VGOVI, an extra bit of growth.

And we are increasing our online presence and telehealth partnerships, so we also open up that channel besides, of course, the other channels that we have had. And if you look at IQVIA numbers today, we basically have about two-thirds of the patients and the value of GLP-1 in international operations. If you add rebelces to that number, then you're closer to three-fourths. And I would say we are very serious on upholding that and defending that as we go forward.

29:49

Unidentified ManagementInvestor Relations

Thanks for that, Mike. And also thanks again to you, Evan, for the question. And with that, we are now ready to move to the next one, please.

29:54

We are now going to move to our next question. And the question has come from the land of Richard Rosser from JP Morgan. Please ask your question.

30:04

Richard RosserAnalyst, J.P. Morgan

Hi, thanks for taking my question. I just wanted to go back on a question on the pricing dynamics in the U. S. With the pickup in CVS, I think the guidance, certainly at the bottom end and probably the middle, implies continued price erosion, I think, certainly for Wagovia and some of the brands. Could you give us an idea how to think on pricing going forward in the US? And also, just on price to net, we've seen substantial 340B benefits in the first half this year. What's to stop more benefits from 340B and part of the redesign, et cetera, coming through in the second half? Thanks very much.

30:51

Unidentified ManagementInvestor Relations

Thanks. So those two, Richard, they both go to you, Karsten, firstly on high-level pricing and then on gross net adjustments.

31:00

Unidentified ManagementChief Financial Officer

Thank you for those questions, Richard. So in terms of high-level pricing, then it's important to say that the lowering of the guidance that we're doing today compared to what we issued back in May is volume-driven. So there are no major changes to pricing compared to what we announced last time.

And then on top of that, when we look at pricing between the different brands, I would say that there are no major changes to what we've been discussing on OSEMPI as a general trend. And then for Vigovi, what we've been saying is that as we expand the market and reach more patients, the market should expect that the average pricing to go down gradually over time, linked to channel dynamics and reaching more patients. So it continues to gradually decline on ARP, which, of course, is enabling reaching many, many more patients in U. S. marketplace. Then in terms of growth to net dynamics and Part D redesign, I would say for Part D redesign first, it's relatively smaller in fact to our numbers.

It's more like a spacing across the year of a few percentage points that we're discussing, but beyond that on an annual basis, no major change on that front. As to 340B, we're still awaiting at least one key legal clarification in terms of interpretation of the rules in place. So pending that and just the general test of time will be kind of the deciding factor to how we deal with the partial income recognition that we have under 340B.

33:05

Unidentified ManagementInvestor Relations

Thank you, Carson, and thank you also to you, Richard. With that, we're then ready to take the next question, please.

33:12

We are now going to proceed with the next question. And the questions come from the line of Mike Nidalkovich from TD Cowan. Please ask your question.

33:23

Michael NedelcovychAnalyst, TD Cowen

Hi, thank you for the question. My question is for Mike. Do you plan to make any changes to NOVO's approach to business development? It would seem that now more than ever, the company is in need of mature late-stage pipeline opportunities, and I know that NOVO has ambitions to broaden its cardiology footprint. To what extent will NOVO pursue these ambitions through internal versus external R&D? Thank you.

33:49

Unidentified ManagementInvestor Relations

Thank you, Mike. That goes to you, Mike.

33:51

Mike DoustdarPresident and CEO

Yeah, so I would have to, of course, get started first and foremost and have a good dialogue with my team and the board on the details. But what I can say today is we are going to focus on the two issues I touched upon earlier on, and one of it was progressing the pipeline and the innovation. We need to basically do that better and faster, and that does not exclude external innovation, as well as, of course, seeing what we can do internally. So that's where I leave it for now.

34:26

Unidentified ManagementInvestor Relations

Thank you, Mike. Then we're ready to move to the next question, please.

34:30

Sure. We are now going to take our next question, and the questions come from the line of Thibaut Bousserin from Morgan Stanley. Please answer your question.

34:37

Thibault BoutherinAnalyst, Morgan Stanley

Thank you. The question is on the dynamics in international markets with Wigovi. You mentioned the growth through launches in new geographies, but that's a competition in some select markets. When we look at some IQVIA data in Europe on markets like UK Germany Spain we see very very strong traction for Monjaro and maybe a bit more limited update for Wigovi So if you could give a bit more details on the dynamics you see in these countries was there still any supply gating here and how you think you can reverse that in this key developed market ex-US.

35:17

Unidentified ManagementInvestor Relations

Hey, Thibaut, thanks a lot for that. I think it goes to you, Mike, on competitive dynamics in international operations.

35:21

Mike DoustdarPresident and CEO

Yes, so I think you're correct. If you handpick just a handful of markets, then you will probably find that in those handful of markets, amongst the ones you mentioned, then we are right now not the leading player. And that's something, of course, we like to change. But if you actually do look at the rest of the IQV data, you will see that in a lion's share of markets, we are upholding those leadership. We are having, of course, in a number of markets, take China as an example, a bit of a retraction of the market size, and we'll allude to this more next week. And in other markets where we start with 100% market share and Manjaro joins, then I think they should get their fair share, but not more than that, in market share.

And in general, I would say we are seeing in some of the markets where we were trading behind quite a bit of movement related to our acceleration. But we also have said that most of the product supply source I. O. will be coming in in the second half of the year. So that also you need to kind of be aware of.

36:33

Unidentified ManagementInvestor Relations

Thank you, Mike. And also thank you to you, Tipu, for the question. Then we are ready to take the next question, please.

36:37

We are now going to proceed with the next question, and the next question comes from the line of James Quigley from Goldman Sachs. Please ask your question.

36:47

James QuigleyAnalyst, Goldman Sachs

Great, hopefully you can hear me. Thank you for taking my questions. We've got a question on the total U. S. market for obesity. So how is that developing? When we look at IQVIA trends since sort of last week of May there, the prescriptions have been around about 670,000 between you and Zetbound. Obviously, the share has been shifting between that. But when you think about that, plus the most recent data you have on compounding, what's the total market doing?

And how is that volume opportunity unlocked? And what is NOVO doing in order to take steps to unlock the total market opportunity? Obviously, the share of the compound is a key growth driver. But from a total obesity perspective going forward in terms of patients, how is that progressing? And how are NOVO going to unlock that opportunity?

37:36

Unidentified ManagementInvestor Relations

Okay, so I have a question that goes to you, Dave, on efforts to further expand the market in the U. S. Yeah, thanks very much, James.

37:43

Dave MooreExecutive Vice President of US Operations

I appreciate the question. There's still a tremendous opportunity in the U. S. market, as you mentioned. Over 100 million people living with obesity. You've heard from us before that we now have coverage with over 55 million people where employers have opted in to be able to receive WGOV for a low and reasonable copay. In terms of the market development and the script trends, we do continue to see WGO be impacted by compounding. And as Carson mentioned earlier, we estimate that's about 30% of the market, around 1 million patients. And I'll come back to what we're doing to curtail compounding. But in terms of the in-market growth, we are encouraged with early signs that we are seeing.

We're seeing Wigoldi come in as of late, around 275,000 prescriptions per week, and the MBRX is now up to 42%. We continue to compete for patients on an ongoing basis, and keep in mind, we are awaiting the MASH indication the second half of this year, which we do believe is an opportunity. With 20 million people in the U. S. living with MASH, 80% of them have obesity, over 40% of them have type 2 diabetes. It gives us an encouraging opportunity ahead. But compounding continues to be an issue that we have to address for patient safety and also to bring this back to a traditional, safe, and branded market. And here are a few of the things that we are doing, James.

First is our own supply of safe approved WGOVI. It's important to note that we have supply of WGOVI on the injectable side to treat all patients in the U. S. , those that are seeking branded medications and those that are on safe compounded and wish to transition over. We also have commercial and medical affairs activities. We continue to raise the awareness of compounding, the safeties, the substandard, and the uncontrolled manufacturing, and we have an ongoing effort on the legal side. We have issued over 120 lawsuits. We've issued 1,000 cease and desist letters, and we're starting to see some of the effects of those efforts where compounding has been shut down. But importantly, we must have regulatory action.

We must have enforcement from FDA. And as I mentioned earlier, we have stepped up that dialogue, and we will continue to around the importation of illicit API, as well as compounding that takes place with fake API. And that will give us an opportunity to convert those patients back to Brandon Wigobi, as Carson mentioned, just has not developed yet because we haven't seen that market reduced yet to this date.

40:25

Unidentified ManagementInvestor Relations

Thank you. Thank you. We have time for two quick questions. Let's take the first one, please.

41:00

We are now going to take our next question, and the questions come from the line of Emily Field from Barclays. Please ask your question.

41:09

Emily FieldAnalyst, Barclays

Hi. Thanks for taking my question. I just wanted to, you know, kind of dig into these efforts to limit compounding. Your company is very consistent in this message around safety, but, you know, for better or for worse, That's not really resonating with whatever the subsegment of American patients. So, you know, in the prior answer, Dave, you mentioned the lawsuits and the cease and desist letters. But, you know, have you filed suit against HIMSS? Can you see preliminary injunctions as part of these lawsuits?

You know, given that we're off the drug shortage list, we all expected compounding to come down following this May 22nd, you know, grace period deep. So I guess I sort of was wondering, you know, what is within the company's purview to get more aggressive in getting this to stop and, you know, defend your IP and defend your product? Thank you.

42:04

Unidentified ManagementInvestor Relations

Thank you. Thank you, Maria. I'll give that to you, Dave, to expand on previous answer.

42:08

Dave MooreExecutive Vice President of US Operations

Yeah, absolutely. Happy to expand on that. So we won't rule out anything categorically. All legal actions, as well as efforts that we can take with the government, as well as taking legal action. So no ruling any of that out. We can't comment on specific lawsuits, and we wouldn't do that. We wouldn't comment on legal strategies either, but certainly pursuing all angles to ensure that we get this back to a branded market. We believe in our brands, and we believe in the opportunity and confident in our ability to compete in a branded pharmaceutical market.

42:59

Unidentified ManagementInvestor Relations

Thank you. Thanks for that, Dave. And then we're ready for the final question, please.

43:03

Sure. We are now going to proceed with one final question. And the questions come from the line of Carlston Lomburg Madsen from Danske Bank. Please ask your question.

43:13

Carl MadsenAnalyst, Danske Bank

All right. Thank you very much. So when considering the turmoil and the challenges we have here, and also the huge CAPEX program you have been running, where you never really have told us exactly how much supply and how many patients you are actually able to supply Synecrotide to, then I was wondering whether you could share some thoughts about what will happen in case that you are not even close to maximizing on the production.

43:43

Unidentified ManagementInvestor Relations

Thanks, Michael. Karsten, I will turn that over to you, Karsten.

43:58

Unidentified ManagementChief Financial Officer

Yeah, thank you for that question. And in this context, it's important to remember what we heard from both Mike and Dave before, We have talked about the significant unmet needs in both diabetes and obesity and the portfolio that we're working with. So as you know, in diabetes, when we look at the internal operations, we're looking at a penetration of only around 7% of scripts being on a GP1 compared to 19 or so in the So a very significant runway, especially in IO, but also in the US in the diabetes GF1 penetration, and that runway is even bigger on the obesity side.

And then I say on top of that, as I said in the beginning, this is predominantly a US shortfall, and the volume split between IO and US is like 9 to 10 or something like that. So we believe that we will have good use of the factories that we're putting in place and we're building right now in terms of what we're going to deliver. And then also do bear in mind that the factories we're building, they are, of course, for the inline products that are on the market today. But the factories, they're based on technologies that we expect to be able to apply for our pipeline products also. And here I'm thinking of products like Kacryzima and EmiCretin to mention a few.

So at this point, no indications of any potential write-downs.

45:42

Unidentified ManagementInvestor Relations

Thank you, Kirsten. Thank you. And with that, we are concluding the Q&A session. Thank you for participating, and feel free to contact Investor Relations in regards to follow-up. Before handing off, I'll give it to Helier for some final comments.

45:57

Helge LundChair of the Board of Directors

Thank you, Jakob. I would like to once again say thank you to Lars for his service as president and CEO of NOVO NORDISK. Congratulations to Mike in his new role. The board looks forward to working with Mike and the executive manager. It's important moments in time for NOVO NORDISK. I also want to say that a reduction in guidance is a matter we approach with utmost seriousness. Nonetheless, NOVO NORDISK has launched a variety of strategic investment and commercial initiatives, And they are already observing positive early indicators that support the company's revised outlook and progress towards our mission to treat more patients with serious chronic diseases. So thank you.

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