Novo Nordisk A S (NVO) Q2 2026 earnings call transcript

Welcome to this NOVO NORDISK earnings call for the second quarter of 2026. My name is Michael Novot, and I'm the head of investor relations at NOVO NORDISK. With me today I have CEO of NOVO NORDISK, Mike Duster, EVP US Operations, Jamie Millar, EVP International Operations, Emil Kongshoy Larsen, EVP Research and Development and Chief Scientific Officer, Martin Holtz-Lange, and Chief Financial Officer, Karsten Mok Knudsen. All speakers will be available for the Q&A session. Today's call is being webcasted live and a recording will be made available on our website. The call is scheduled to last one hour. Next slide, please.

The presentation is structured as outlined on slide two. Please note that all sales and operating growth statements will be at CER unless otherwise specified. Next slide, please. As usual, 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 the risk factors, please see the company announcement for the second quarter of 2026 and the slides prepared for this presentation.

With that, over to you, Mike, for an update on our strategic milestones for the second quarter of 2026.

Thanks, Michael. Next slide, please. In the In the second quarter of this year, we have continued to deliver on our priorities to improve commercial competitiveness, progress our pipeline, and make focused investments while delivering returns. Today, NOVO NORDISK is serving more than 46 million people living with obesity and diabetes. We are treating almost 70% more people living with obesity compared to just a year ago, with nearly 5 million people on our obesity treatments. We've taken the successful U. S. launch of Vigovi pill to global markets. We now have around 1.5 million people on the Vigovi pill worldwide. This is a testament to our increased efforts in manufacturing and across the entire value chain to bring innovation to people.

Within research and development, we continue to advance our pipeline across therapy areas. We have received more than 10 regulatory approvals and started more than five clinical trials in the second quarter. We have also announced top-line results from Zeus, the first three trials with Ziltivikimab in patients with ASCVD, chronic kidney disease, and inflammation. While the outcome was not what we had hoped for, this single event does not change our strategy.

NOVO NORDISK remains committed to helping patients with comorbidities related to obesity and diabetes, including cardiovascular disease. Martin will speak to this later. In the second quarter of 2026, we continue to invest in growth opportunities to drive competitiveness and progress our pipeline. This includes more than 26 billion Danish crowns invested into R&D and commercial activities.

Lastly, we are happy to see that we have been able to raise our 2026 guidance once again. Barstin will elaborate on this later on during the call. Next slide, please. In the second quarter of 2026, adjusted sales grew 7%, driven by volume growth, partially offset by lower realized prices. U. S. operations grew 4%, reflecting volume growth, primarily driven by GLP-1 in obesity. International operations grew 10%, mainly driven by a region, UCAN. From a therapy point of view, obesity care sales increased by 16%, driven by volume growth across the Vigobi product portfolio in both U. S. and I. O. , partially offset by lower realized prices.

Our GLP-1 sales in diabetes increased by 2%, driven by U. S. operations. GLP-1 diabetes cells in U. S. benefited from a gross-to-net rebate adjustments related to prior periods. And with that, over to you, Jamie.

Thank you, Mike. Next slide, please. We continue to see encouraging use of the Wagovi pill six months into the U. S. launch. The WGOV pill is the strongest ever GLP launch by volume, and we have now reached over 5 million total prescriptions. It took 12 weeks to reach the first 1 million TRXs, yet the latest 1 million TRXs were added in just four weeks. Weekly prescriptions as of July 17th were 267,000. The Wagovi pill uptake is driven by its efficacy, favorable tolerability profile, and ease of use. Based on the latest data, and in the face of competition launched in early April, the Wagovi pill has captured around 90% of the oral obesity medication market. Furthermore, a recently published study showed that weight loss in the real world exceeded that seen in the OASIS-4 clinical trial at the same point in time, reinforcing the efficacy of the pill and patient usage in practice.

The Wagovi pill is expanding the market as we continue to see roughly 80% of patients being GLP-1 treatment naive. We also find people coming to Wagovi pill from competitor products and limited cannibalization on injectable Wagovi, which is encouraging. On usage, we are seeing continued progress in titration dynamics, with higher dose prescriptions increasing steadily week over week. This suggests people are progressing through titration and continuing treatment, which is also supported by more than 20,000 people currently utilizing the Wagovi pill subscription model for the two higher doses. Overall, trends remain in line with our expectations. From an access perspective, quality of access for obesity GLP-1s remains poor and is a key focus area. While we see uptake for the pill in the reimbursed commercial channel, the majority of total prescriptions are self-pay.

We're excited about the expansion of access for obesity medication in the 65-plus age population, with the recently available BRIDGE program in Medicare Part D. While it is early days, we are encouraged by the strong participation in the program. Wugovi Pill appears to be the oral option of choice, and we will continue to focus on educating and differentiating Wugovi injectable to capture higher market share. The branded obesity medication market continues to expand in Q2 2026, growing volumes at around 70% compared to Q2 2025. The WGOVI franchise is playing a major role in this expansion, where the franchise continues to be the leader measured on NBRX with a market share of around 60% during the month of July.

And with that, I will turn it over to Emil.

Thank you, Jamie. Please turn to the next slide. In the second quarter of 2026, GLP-1 sales in international operations grew by 13%, driven by volume growth and market expansion, with a highlight being obesity franchise growth of 37%. NOVO NORDISK continues to be volume market leader outside the US with around 58% GLP-1 volume market share. While our market share has been declining over recent quarters, we see encouraging trends as our share of growth continues to stabilize.

This indicates that we are gradually seeing the benefits of our efforts, including the step-up approval and launches of Vigoi 7.2 mg and Osempic 2.0 mg. In the UK, Vigoi 7.2 mg in a single-dose PEN is now broadly available. Since the introduction of the step-up data earlier this year, we have seen a market share increase in the GLP-1 market.

In the EU, Vigoi 7.2 mg in a single-dose PEN was recently approved, and we look forward to launching the PEN in the first EU market during Q3. OSEMPIC continues to see solid sales momentum with sales growth of 10% in the second quarter. This is partially driven by OSEMPIC 2.0 mg, which is now launched in around 10 countries with good uptake, coupled with strong overall OSEMPIC performance across key European markets.

Recently, we saw the first generic entries in the early LOE markets. While modest so far, the LOE impact is expected to be back-end loaded in the second half of 2026. Although it is early days, we generally see the market expanding in the early NOVO countries, mainly driven by more products being available at lower prices and significant promotional investments by new entrants.

While the generic players have started to capture market share, we have so far been able to grow our absolute volumes.

In Canada, our leading tactic is the saving cards program, and we've seen good volume retention for both Osempec and Begoe in the cash and private insurance channels. Next slide, please. Recently, we launched Vigoe pill in the first IO countries, the UK and UAE. This marks an important milestone, as we are now able to offer people a weight loss efficacy on par with that of injectable Vigoe in a once-daily, easily-administrated pill in these countries.

In the UK, the Vigoe pill was made broadly available in early July, becoming the first once-daily oral GLP-1 treatment for weight management. It is estimated that around 20 million adults live with obesity in the UK. Prior to the launch, around 1.6 million people were treated with obesity medication in this market.

Just three weeks into the launch, we estimate around 300,000 patients have started on the Vigoe pills. While it's early days, it appears that the majority of the new patients are DLP1 treatment naive, suggesting a market expansion. The launch uptake means that our overall DLP1 obesity market share has increased markedly. When looking at IQV sell-in data to private providers and pharmacies in July, we've seen an increase in the overall NOVO NORDISK obesity market share from around 30% prior to the launch to now 45%. In the UAE, we also observe encouraging trends. The Vigoe pill became available in early June, roughly one month after an oil competitor entered. Despite not being the first mover, Vigoe pill has already captured around 50% market share in the oil segment.

We are pleased to see these encouraging uptakes and expect to launch the Vigoe pill in selected countries in the coming quarters, starting with Germany in September. With that, over to you, Martin.

Thank you, Emil. Please turn to the next slide. Last week, we announced the headline results from SUSE, the first cardiovascular outcome trial investigating ciltivecamab. SUSE was a large-scale cardiovascular outcome trial with more than 6,300 people enrolled and randomized in a one-to-one ratio to receive once-monthly ciltivecamab 15 mg or placebo on top of standard of care. The eligibility criteria were designed The trial began to include patients with established cardiovascular disease, established chronic kidney disease, and inflammation as measured by a high-sensitivity C-reactive protein equal to or above 2 mg per liter. The primary objective was to demonstrate superiority of once-monthly cicevacomet versus placebo on top of standard of care to reduce the risk of major adverse cardiovascular events.

Overall, the trial demonstrated robust execution with treatment adherence and discontinuation rates consistent with the expectations. No unexpected findings were observed with respect to dosing, treatment exposure, or imbalances in standard of care management across treatment groups. While Celcivecamab showed target engagement and inhibition of the IL-6 pathway as reflected by expected reduction in free IL-6 and HSGAP respectively, This does not translate into MACE reductions with a hazard ratio of 0.99. From a safety standpoint, the overall rates of adverse events and serious adverse events were similar between those treated with Ciltivegamab and those on placebo. Consistent with targeting IL-6 inhibition, a higher proportion of people treated with Ciltivegamab had serious infections compared to placebo. Importantly, no difference in all-cause mortality was observed with a hazard ratio of 0.99.

While the Seuss trial did not validate the IL-6 hypothesis in this specific high-risk population, this does not change our strategic commitment to cardiovascular disease. The trial will inform our ongoing cardiovascular research and the development of treatments for the millions of people living with cardiovascular disease. Cardiovascular outcomes trials Artemis and Hermes, which evaluate ciltivegamab in people with acute myocardial infarction and heart failure with preserved ejection infection respectively, are planned to continue with results expected during the first half of 2027. Please go to the next slide. Beyond the Suez readout, we have had a busy second quarter across all of our therapy areas. Starting with obesity, we successfully completed the Redefined 9 trial, which was a 68-week efficacy and safety trial test in Cagrocema maintenance doses of 1.0 and 1.7 mg of each component in people with overweight or obesity.

For both lower doses of Kagosema, there was an achievement of superior weight loss compared to placebo. In the trial, Kagosema appeared safe and well tolerated consistent with the previous Kagosema trials. We expect to share detailed data later this year. We also initiated the Kagosema Phase 3b trial looking at the higher fixed-dose combination of Kagosema The SIGRASEMA with 2 mg of cadrillentide and 7 mg of semacritide The redefined high trial comprises of two individual substudies one in people with obesity without diabetes and another in people with obesity and type 2 diabetes Each substudy evaluates the body weight reduction with caragrycema high dose compared to caragrycema 2.4 mg of each component and semaglutide 7.2 mg alone. We still expect a US decision for caractosema and obesity at the end of 2026, with a potential launch in 2027.

We also initiated the Phase 2 trial for our triple agonist targeting GLP-1, GIP, and amylin receptors, evaluating different dose escalation regimen for up to 39 weeks. The Phase 2 trial is expected to read out in the second half of 2027. Within diabetes, we initiated a phase 2 trial for UBT251 in people living with type 2 diabetes. The trial will investigate the safety, tolerability, and efficacy of once-weekly UBT251 for up to 40 weeks. The trial is expected to read out by the end of 2027. We also completed the open label head-to-head reimagined four trials investigating caracusema 2.4 mg vs. tesepatide 15 mg. When evaluating the effects, people treated with caracusema achieved a weight loss of 15.2% and an A1C of 1.9% response respectively at 68 weeks.

For the dual primary endpoint, Cagrysema demonstrated non-ferioluset versus desapatite for weight reduction, but not for A1C reduction. Looking ahead to the remainder of 26, we are set to deliver a number of important milestones and regulatory achievements. In obesity, we plan to initiate several large stage programs, including oral sanagantide in obesity and cargillentide high dose, marking important steps in advancing our next generation obesity portfolio.

Within obesity-related comorbidities, we anticipate phase 3 safety results from the synchrony real-world trial of ephroxyfermin in people living with MASH and fibrosis stages F1 to F4. The trial's primary endpoint is safety and tolerability. In diabetes, we expect to initiate reimagined switch, evaluating the safety and tolerability of switching from semaglitype 1.0 mg and 2.0 mg to cagrysema. Results are anticipated in the second half of 27. In addition, we plan to initiate AMBITION, the phase 3 development program for Senna Gamta. On regulatory milestones, we continue to anticipate a U. S. regulatory decision for oil semaglutide 25 mg in type 2 diabetes, as well as U. S. and EU regulatory decisions for denesimig in hemophilia A. We also remain on track to submit a Tavopivet in both EU and U. S. in the fourth quarter of 2026, following the positive hibiscus results announced earlier this year.

Taking together, these milestones underscore the breadth and the strength of our pipeline as we continue to advance innovative therapies across obesity, diabetes, rare diseases, and associated comorbidities. With that, over to you, Kaspi.

Thank you, Martin. Please turn to the next slide. In the second quarter of 2026, our adjusted sales increased by 7% at constant exchange rates, reaching 78.5 billion Danish kroner. This was driven by GLP-1 volume growth across geographies and a favorable rebate adjustment related to prior periods. The adjusted gross margin was realized at 78.2% compared to 82.7% in Q2 25, reflecting lower realized prices, one-time cost of around 3 billion Danish kroner related to right-sizing of manufacturing capacity agreements, as well as a negative currency impact. This was partially countered by productivity gains and a positive product mix from increased GF1 sales.

Adjusted operating profit increased by 11% at constant exchange rates, driven by higher sales and lower costs for the quarter. Through our disciplined cost-based approach, we are now ahead of plan to deliver the 8 billion Danish kroner of savings from the company-wide transformation announced back in the third quarter of 2025, which are being reinvested into growth opportunities. At the end of the second quarter, the number of full-time employees was around 66,700, which is a decrease of almost 12,000 employees corresponding to roughly a 15% decline compared to 12 months ago. Please go to the next slide. For the first six months of 2026, NOVO NORDISK has delivered a better than expected start to the year. As a result, we have raised our guidance again.

The adjusted sales growth is now expected to be 0% to minus 6% at constant exchange rates. The improvement in the outlook is mainly driven by increased expectations for GAP1 product sales. The outlook reflects expectations for sales growth within international operations and expectations for sales decline within U. S. operations. In international operations, the outlook is based on current growth trends, including continued volume penetration for GLP-1 treatments and market expansion, mainly within obesity. In addition, the outlook is based on negative impacts from the compound patent expiry of the semaglutide molecule in certain markets.

NOVO NORDISK continues to roll out the Vigobi product portfolio in more markets during 2026, including the Vigobi pill. In U. S. operations, the outlook is based on current prescription trends for the injectable GLP-1 portfolio, intensifying competition as well as negative impact from reduced obesity medication coverage in Medicaid. Further lower realized prices linked to investments in market access amplified by the most favored nations agreement with the U. S. administration is assumed. NOVO NORDISK further focuses on expanding access, particularly in the self-pay channel through NovoCare Pharmacy and collaborations with telehealth organizations, as well as the BRIDGE program in Medicare Part D. Uptake related to the launch of Vigovipil in January 2026 is reflected in the outlook based on a range of assumptions as outlined in the company announcements.

Adjusted operating profit is now expected to be 0% to minus 6% at constant exchange rates. The expectation for adjusted operating profit growth primarily reflects the improved sales outlook combined with targeted investments in current and future growth opportunities within R&D and commercial, So, partly funded by reinvestment of savings from the company-wide transformation in 2025, as well as further optimization initiatives and disciplined resource allocation.

Other key modeling considerations for 2026 are shown on the slides. That was the outlook for 2026. Now, over to you, Mike.

Thank you, Carson. Please go to the next slide. While 2026 continues to be a challenging year for NOVO NORDISK, it has also been an exciting and an important one. We are encouraged by the first half results and by the progress we have made across several areas compared with the expectations we had at the beginning of the year. At the same time, the year is far from over and we maintain mindful for the headwinds we are facing in the second half. Our priorities for 2026 remain clear, and there's still significant work ahead of us. As Jamie and Emil explained, we continue to strengthen our competitiveness by expanding our product offerings globally and bringing innovation to many more people.

Our pipeline continues to advance at speed with additional first-in-human dosing and initiation of late-stage clinical trials across multiple therapy areas. And finally, we're progressing ahead of our transformation plan announced last September, creating greater capacity to invest in future growth opportunities.

On behalf of the entire management team, we look forward to discussing these areas in greater depth at our Capital Market Day in September. And with that, let me hand it back to you, Michael.

Thank you, Mike. Next slide, please. With that, we're now ready for the Q&A. We kindly ask all participants to limit her or himself to one or maximum two questions, including sub-questions. Operator, we're now ready to take the first question.

Thank you very much, James. First question for Carsten, and second question for Emil.

Yeah, James, thanks for the question. In terms of outlook and the balance of year logic you're after, then the simple version is that we take our current run rate where we deliver 2% growth in the first half and continue with that run rate. And then you factor in two factors, one being loss of efficiency for CIMA in a few markets, Canada and Brazil mainly, which we see happening here, predominantly starting in the second half.

And then you take into account the favorable gross-to-net effects we had in Q3 and Q4 last year of combined $5 billion. And if you take that, carry forward, then, of course, the comparative effect, we don't carry forward into next year, whilst the loss of exclusivity impact will annualize into next year.

On your second question, we, of course, are very encouraged by the UK. Mind you, almost 3 out of 10 obesity patients on a once-weekly GLP-1 and IO live in the UK. But it's still only, you know, 1.6 million patients being treated out of 20. So the room for market expansion is tremendous in the UK. And as you rightly point out, there was a pent up demand. A lot of patients have been on the sidelines even more than we could have hoped for. And it just goes to show that injections, the injection barrier is very real. And this uptake is, of course, tremendous. We also believe the fact that we don't have drug-drug interactions that allow patients on oral contraceptives, on statins, etc. , to start easily on a one-day verification option here.

So we are super encouraged. We are, of course, optimistic on the continuous uptake based on what we hear from the providers and also the media sentiment. In terms of the read-across to Germany, it is quite a different market, but Germany is also a market that, versus a year ago, is now driven by telehealth. More than half of the growth and a third of the market is already sold through telehealth channels, and there is an increasing awareness in the population and an even larger unmet need because treatment rates are lower. So the base, we start from a different base, but we will use a lot of the same tactics in Germany, and we are bullish on the uptake there as well.

Thank you very much, Emil.

Thanks, Carson, and thanks, James.

Thank you very much. First question on reimagined for Martin, and then the supply question for Carsten.

Yeah, thank you very much, Richard. I'll just remind you that across the cagosemotype 2 diabetes trials, we've seen a 1C lowering between minus 1.8 and 2.3%, so very, very strong glycemic control in the reimagined foyer was 1.9. And at the same time, we've seen an almost unprecedented 15% weight loss. Also reminding you that carcosema is obviously the combination of synaglocyte that has a very well established in obesity. It's basically the only, and in diabetes, it appears to be the strongest CVMACE risk reduction asset in the field. That carries into carglycema and the benefits that we seen on blood pressure on glycemic control on lipid improvements and what we also seen in the preclinical space on potential bone preservation potentially other benefits of the animal in biology that calls for a really really strong proposition not only in diabetes obviously but also in obesity where we seen a 23 weight loss So across the board we really meet a lot of excitement from investigators but also treating physicians looking forward to having yet another new biology with very strong glycemic control weight loss but also other benefits from a combination therapy Thank you, Martin.

Kasten? Richard, on your question, in terms of API supply from our new facilities, I believe you visited one of the plants in connection with the latest Capital Markets Day in Denmark a couple of years ago. What I would say is that we have validated the first product in the first finger in the first facility. That's as specific as I can be. So it's progressing very nicely, and we're happy with progress. So far, in terms of commercial supply into the marketplace, very low utilization from these facilities, which makes us also bullish in terms of being able to supply significant volumes in the years to come, I will now turn the call over to management for the Vigovic pill for XUR's rollout.

Very clear, Carsten. Thank you very much, and thank you, Richard.

Great. First question for Mike on BD and then on M. Christian, also in the gamutide for Martin afterwards.

Thanks, Michael. So I don't measure our ambition by the number or the size of the acquisition we make. I measure it by the quality of innovation we bring to the patients. I repeatedly have said, Michael, that I'm very proud of our internal R&D and pipeline, But no company has a monopoly on good ideas. So what I look right now is what Martin is doing within the areas we are operating and some of the co-morbilities of obesity and diabetes. And while getting incredibly proud, I've also said we are in every data room. Try and see who else has a better idea, who else can give us assets that we can bolt on and complement what basically Martin and Co are doing.

And that's what we are active on. The comment to Financial Times, just for clarity, has been, is there one day that you can foresee a transformation and a transformative M&A? And I have said that I'm a person who never starts with a no. One day maybe, but you have to be in a very different situation than NOVO NORDISK is today for that one day for us to think about it. Today, we are trying to bolt on to what Martin is doing in various areas.

Okay, Mike, and Martin on the Gepha.

Yeah, thank you very much, Michael, for that question. So, obviously, as we've discussed before, we do not believe that we've seen the final data on HAPU-SEMA in and of itself. As we've previously discussed, there is a need for individualized treatment. We are testing that in what we believe is the right setting in redefining 11. And therefore, both from a weight loss potential and potentially also from a glycemic control potential, just with cagrocema, we do believe that we could potentially see even further weight loss and potentially even further glycemic control.

As you remember from phase 2 for senagantide, in obesity, we've seen 24% weight loss. We have a lot of questions about weight loss in a matter of six months treatment. This seems to be a very powerful proposition. I cannot at this point speculate whether it's going to be fundamentally different from CAC with CEMMA, but right now the indications are both in diabetes and obesity when it comes to glycemic control and weight loss, that Sender Gamzeit will be a substantial addition to what we can do in obesity and certainly also in diabetes.

Again, I'm looking forward to also show the Redefine 9 data, the individualized treatment, getting patients to their desired weight loss or their desired target at different doses will also come clearly through from Redefine 9, and we'll share those data later this year to give you further insights.

Thank you, Martin.

Thank you very much, Karsten. That's one for you, Jamie.

Yeah, thanks very much for the question. I think as we highlighted at the beginning of the year, we were expecting volume growth but continued price pressure. And that's what we've seen. I think you answered the question almost in your question. And we did see volume growth with Wagovia Injectable, but that was offset by lower realized prices that we anticipated.

So no new price dynamic impacting it. It's the price dynamic that we started the year with.

Karsten, can I add on? Yeah, and just building on Jamie's comment, what you should also be conscious of, Karsten, is that the business mix has changed for Vigovie Injectable in the U. S. , and actually what Jamie and the team have very successfully pulled off in terms of the brand is to get self-pay going. So right now for Vigovi injectable in the US, self-pay is to the tune of 35% of total Vigovi injectable compared to a year ago where we were around the 10-15% range. It's at a different price point, but it's a good way to unlock volume. And then I would secondly say that we don't see a lot of direct cannibalization from switching to the Vigobi pill.

But of course, indirectly, we don't know how many on the pill would otherwise have started on the injectable. So it's just important to take that into account when you look at the script trends.

Thank you very much, Carsten. Thanks, Jamie. And also thank you, Carsten.

Thank you. Two questions for Martin, one on 50 milligrams of Alzheimer's and then the second one on Zuz.

Yeah, absolutely. So, as you say, we have conducted a 50-milligram study. It showed some really good results on both efficacy and tolerability. As you've clearly seen, with the 25-milligram, we come out with 17% weight loss and the best tolerability profile, as far as we can see, in the oil space. That is a very competitive offering with all Senagamtide and with actually three more oil assets in our current pipeline and portfolio.

We do expect to be able to further leverage the oil space on efficacy, on tolerability, and potentially also on comorbidities. And therefore, at this point in time, we do not see a need to launch the 15 milligram. I think on tenagantide, obviously the jury is still out. You could argue that while you see a reduction in CRP and R6 and then no improvement in MACE, it is because there is an observation. I mean, the original idea was there was an observation that patients who have inflammation have higher risk of CV events. We apparently do not see the opposite. That can be caused by several reasons. Either there is no pharmacological correlate, or it was maybe a two-deceased population that was investigated.

It could also be that IL-6 in this specific population is too far downstream in terms of the inflammation cascade and LNRP3 are higher up. As you know, the cancer trial showed that anti-IL-1 beta action introduced substantial CV benefits. So I think it's too early to conclude that inflammation in CV should not be addressed. Actually, we believe the opposite, and therefore you also see us continue the two other SUS trials. As you've already mentioned, we have currently in the clinic one, and we have additional NLRP-free assets in our preclinical pipeline, and we intend to progress those as well. The unmet need is huge, and we need to address that.

Thank you very much, Martin.

Thank you very much, Pete. First question on 27th for Carsten, and then the second question on bridge for Jamie.

Yeah, Pete, thanks for that question, and we look forward to a guide for 2027 come February next year. So what I can say today, talking just in principles around it, is we're nicely positioned in a rapidly growing category. So the GLP-1 market is growing close to 40% when we look at moving annual totals. So it's a fast-growing market with a long runway. So that's, of course, a positive. We've laid out the recent dynamics, and actually we did deliver 7% growth in the second quarter, so don't count us out yet. And then generally speaking, into next year, then the starting point is always the current run rates, and then adjust it for the various factors. So you start with the current run rate, current script trends, and then to call out into next year, I think you should look at Kekrasima, where we have regulatory action at the end of this year for obesity in the U. S. We have MyMate regulatory decision also in the second half of this year, and then you have loss of exclusivity annualization, as I spoke to before, in certain I. O. markets.

So I think that's as much as I can talk to in terms of run rate into 27, and then we'll come back in February.

Thanks, Karsten.

Jamie, on the bridge? As it relates to bridge, firstly, NOVO's long advocated for coverage for Medicare Part D patients for obesity medications, so pleased that we have that now in the form of the pilot program known as bridge. I think going into July 1st there were questions about the simplicity and ease of the process for beneficiaries and then secondly the activation of patients So quick comment on the process The market seems to be learning very quickly and in terms of identifying eligible patients screening for that eligibility and then ultimately determining based on the prior authorization clinical BMI and comorbidity criteria that process seems to be going very well Well, ease of patients navigating that system with HCPs and pharmacies seems to be going very well, so that's a positive.

In terms of the patient activation, it is still just the first few weeks, but in terms of absolute volume of patients making it through the eligibility screen and the PA criteria and gaining treatment through a paid prescription claim, we're very pleased with the volume. So far, whether or not that is durable and sustainable is yet to be seen. We'll be monitoring that as we continue and progress. And we will be focused on gaining our fair share of the prescriptions as well as we move forward.

Thank you, Jamie. Thanks, Pete.

Thank you, Matthew. First question for Martin on Senegamtide, and the second question for Jamie.

Yeah, thank you, Matthew. So first and foremost, we've learned a lot from Cagosemma. This is a combination of GLP-1 and amine agonism, and everything that we've learned from Cagosemma, we've obviously, as we previously discussed, put into the Redefine 11 trial, which is where we really test the way that we titrate and the way that we dose this biology. And we have, in addition to what we did in the early Seneganta studies, not only employed all of our learnings from Kagosema, we've also added an extra titration step, which is why we, from a modeling perspective, feel quite confident that we'll see a safety and tolerability profile in line with what we've seen with, for example, Kagosema.

And I'll just remind you that in Redefine 1, the K-Grysema tolerability profile was comparable to that of Wigoe, so a quite attractive tolerability profile. Of course, I cannot issue assurances. We have to do the data generation, and we'll have to see the Phase 3 results. But based on what we can see at this point, both from CAC-RASM from our phase 1-2 trials and what we've done, we do expect to see a quite attractive solubility profile combined with that efficacy profile that we also discussed before. So, Ned, I'll just remind you, we'll not only have that as a subcutaneous injection, we'll also have that as an oil offering, meaning that will take a further step up in terms of efficacy when it comes to oil treatment without, hopefully, compromising on safety and solubility.

Thank you, Martin. And Jamie on the Gobi pill pricing.

Yeah, a couple of comments on the titration dynamics that we see. So we do see steady movement to the higher doses of oral WGOVI. We have roughly 30% of prescriptions at the 9 and 25 milligram strength currently. Our preference would be to address consumer concerns about escalating prices as the product is titrated with this subscription model that we introduced just a couple of months ago. We've had good uptake of that. We have 30,000 patients enrolled in the subscription model. 20,000 of them specifically will go be pill patients. And that's continuing to grow. We'll continue to use what I'll call more of a targeted surgical solution to that than a universal wholesale change to pricing. So hopefully that answers your question.

Thank you, Jamie. And thank you, Matthew.

Thank you very much. So first question on OSEMPIC rebate or pricing volume to Jamie.

Yeah, in terms of the gross to net adjustments, the $2 billion DKK that we've highlighted, The strongest proportion of that is Ozempic. About three quarters of the impact is Ozempic gross tonight. And then the balance is insulin. So that's the dynamic there. In terms of Wagovia injectable, you're going to see quarter to quarter fluctuation in terms of the price volume dynamics. And I think the mix in terms of channel mix reimbursed versus self-pay, as Karsten mentioned, is also impacting that.

Thank you very much, Jamie.

Thank you, Kerry. Two questions for Jamie. One on Vigobi, self-pay, injectable, and then also on Vigobi Pill.

Yeah, thanks, Kerry, for the questions. We see a small population, minority population of 65 plus in our self-pay environment today, and obviously we would encourage them to participate in the bridge given the affordability benefit there of the $50 out-of-pocket copay. But it's the vast minority of our self-pay business. And in terms of low-dose, 1.5 milligram starts, what we do see is many patients start on the 4 milligram strength. So considering new patient starts, we are increasingly looking at both of the low doses to calculate that. But we don't see, and there isn't scientific or epidemiology-based seasonality in this disease state like there is in some others. What there is is behavioral motivation that waxes and wanes through the year.

Obviously, it heightens at the beginning of the year, concurrent with New Year's resolutions, etc. But we can induce motivation through promotional activity, and we will have a heightened presence in the back half of the year here. And Bridge in and of itself is creating activation of patients to buck what ordinarily might be a calendarized view of security, as you say.

Thanks, Jamie. Thanks, Kerry.

Thank you very much. First question for Mike on BD and focus areas, and then the second one to Martin on R&D.

So James, when we look at obesity, unlike many of our peers, we see this as not a single disease, but multiple conditions with a billion people suffering from it differently and needing different solutions. So we start thinking about the patients and then the solutions that we currently actually are building.

First, we segment the population into injectable versus orals. Actually, we are more and more ourselves getting surprised how many people are after a pill rather than an injection, frankly speaking. And none of us probably know, but we can start guessing by the end of the decade what portion of this business is going to be uninjectable and unappealed. We want to make sure that we have both and we are covered on both of these fronts.

Then we are seeing more and more, of course, some of the biologies that predominantly was used to reduce weight has other benefits. We have seen this with our own semaglutide, and we are seeing it, of course, with a number of other biologists that are coming into this business. Martin just alluded to amylin, but of course, we are seeing it also with GIP and glucagon.

Within that, then we are seeing which one of those therapy areas or areas, basically, are closer to us, and we understand something from the area scientifically, but also perhaps, you know, Are we able to manufacture it in the same way as we are doing it historically and under commercialization? It's the same. That will pivot us probably to left and right hand side of where we are. And we will, of course, elaborate a lot of this more during our capital market day, as we have touched upon. In that search, we then look around already today to see who else is active and what is out there to bolt on from a business development point of view in addition to what we're doing.

So that's all I can share with you until now.

Thank you, Mike.

Martin, any comments? Yeah, so in general, obviously, there's risk in doing R&D and drug development. I'll just remind you that a couple of months ago, we announced it's a WOPVET phase 3 data. These were among the most groundbreaking in sickle cell disease that we've seen for many years, and we're aiming for regulatory submission of that very, very soon. So, that's a success. We've all along called out that SILC-Vecimab was high risk. There was a question on the correlation between the biomarkers and the actual outcomes, and that was the leap of faith that had to be tested. We have communicated at the US of around 50% or less because we acknowledge the risk. As a general observation, we have a pipeline with disease areas and modalities where we actually can generate a lot of value, but with reasonably low risk.

But we also have disease areas and new mode of actions where there is an inferred higher risk. And by understanding the disease areas, the pathophysiology, the biology and the pharmacology, of course we can improve the risk profile. But it's actually a good place to be to have that balance between high value, reasonably low risk portfolio projects, but also higher risk, but equally higher value projects. In that way, we see both successes, and obviously we have to acknowledge there will be some attrition also.

Thank you, Martin.