00:00We're speaking days ahead of July 1st, which is when Medicare coverage for obesity
00:04coverage alone begins. And, you know, as we head into that date, I'm curious on Novo's side,
00:10what sort of patient ramp up you're expecting when it comes to injections and pills?
00:15Yeah, a bit of uncertainty whether there will be a bolus kind of volume of patients immediately
00:21July 1st or whether it will come over time. But we've been preparing for either situation,
00:26working with health care providers to educate them on the CMS bridge program and patient
00:32eligibility criteria, as well as pharmacists who will largely fulfill the prescriptions for the
00:40Medicare beneficiaries. And like you said, I mean, plenty of uncertainty here, but I'm curious,
00:45you know, what your projections look like when it comes to older Americans, whether you're expecting
00:49they'll prefer the pills or the shots when that reimbursement program does roll out.
00:54Great, great question. We've done some primary research on that question. And about 75% of
01:01Medicare beneficiaries do state intentional preference toward weekly injectable or daily
01:09pill. And the favorability toward the pill is two to one in that preference. So quarter of seniors are
01:16undecided as to form. But those who declare a preference prefer the pill on a two to one basis.
01:23Is that preference just simply because of the difference between a shot versus a pill? Or is
01:27it more about drug interactions and some of the other issues seniors might face?
01:30I think primarily it's the concordance with the multiple medications that are already taking.
01:36Average senior takes eight medications, most of them oral, and most of them filled at retail
01:42pharmacies. So this program will flow in a natural way, the way seniors have been interacting with
01:49medication. Are you confident about the number of new consumers that you'll get through the CMS program?
01:54And more importantly, are you confident that the reimbursement rates are going to make it worth your
01:58while? Yeah. In terms of activation, CMS and CBO estimate about anywhere from 15 to 20 million eligible
02:07patients. From there, you would deduct patients that already have coverage to Wagovi, for example,
02:15for cardiovascular disease as a primary indication. As we discussed previously, Wagovi is the only GLP-1
02:23that's proven a reduction in cardiovascular risk, specifically cardiovascular death, MI and stroke.
02:28So that's already approved through Part D plan sponsors, as well as fatty liver disease, MASH.
02:34So you deduct from the 15 to 20 million. And then how many patients will be motivated to seek
02:42treatment? Systemically in the U.S. across the opportunity, we've seen about 10 to 12 percent
02:48penetration or activation of patients against the eligible population. So CBO has used that 10 percent
02:55as a marker. In terms of your second question, affordability, $50 out of pocket per month in this
03:03program, which is really nice affordability, recognizing, however, that many seniors on
03:09fixed incomes will still find $50 a month unaffordable. Well, to your first point, I mean,
03:16you think about obesity comorbidities. What proportion of your volume when it comes to Wagovi currently
03:23comes from Medicare and Medicaid when you think about their use treating those comorbidities?
03:28Yeah, it's a small but growing part of our overall volume. MASH in particular just was introduced
03:36late last year. The benefit in terms of cardiovascular outcomes is well known and
03:43acknowledged with semaglutide. So we see a large part of our growing business in the self-pay
03:52direct-to-patient opposed to the traditional reimbursed. Clearly with pill, we're about 90 percent
03:59of our volume with Wagovi pill since launch has been on the self-pay side versus reimbursed.
04:06That's actually what I was wondering, you know, when you think about that direct-to-consumer
04:09channel, what the difference between the pill versus the injection looks like. So for the pill,
04:14very heavy volume there. What does it look like on the injection side? And, you know,
04:19are there any trends that are developing there? Yeah, on the injectable side, about 30 percent of
04:23our business is self-pay. So we see, you know, a blend, a mix of reimbursed traditional coverage
04:30and the self-pay. I think the opportunity here with Bridge is the $50 out-of-pocket. Our self-pay
04:37prices start at $149 for the pill, $199 for the injectable. So $50 out-of-pocket is certainly
04:44attractive for seniors that now for the first time have coverage for the obesity indication,
04:51which is super exciting. Do you still have plans to actually raise that price from the
04:54introductory level from that $149 to $199? We have no plans to change the pricing construction
05:01on the self-pay side. And the early adoption of Wagovi pill has been stellar. So we have exceeded
05:11three million total prescriptions since the launch of Wagovi pill. We did the first million in the
05:18first 12 weeks. We did two additional million prescriptions in the next 10 weeks. So it's even
05:24accelerated in the face of competition. One more question on the affordability issue. And I am
05:28curious about the stickiness of people using this particular drug at a time when health care costs
05:33for regular people are continuing to go up across the board. And that, of course, requires some people
05:38to make choices about what they take. And obviously they're going to take the things that are more
05:42about saving their life or prolonging their life and maybe look at other things in the stack and
05:47decide, maybe I can do without this. Is there a risk that they look at Wagovi and they look at
05:52those
05:52GLP ones and say, maybe I can do without this if it is an affordability issue? Yeah. I mean, to
05:58the
05:58first part of your question, that's the amazing thing about semaglutide and Wagovi, is they don't have
06:03to make a trade-off between weight loss and long-term outcomes. Semaglutide is very effective
06:09in terms of immediate magnitude of weight loss, but it's the only GLP one that comes with the long-term
06:15outcomes in terms of cardiovascular risk reduction, as I mentioned. So they don't have to make that
06:22trade-off. In terms of stickiness and stay time, we see strong retention rates, both with injectable
06:28and so far with pill. It's earlier days in terms of tenure with the Wagovi pill. But there's motivation
06:37seeking with these consumers or patients. And they have both, as I said, the short-term motivation and
06:44the long-term benefit. Well, in addition to affordability, I also want to talk about dosage
06:49as well, because you think about high-dose Wagovi. It was approved a couple of months ago. What have the
06:55past few months looked like in terms of uptake when it comes to the U.S.? Yeah, we've seen almost,
07:00I'll
07:00call it a halo effect on the franchise with the stellar growth of Wagovi pill, but also growth in
07:09Wagovi injectable. So there's kind of a harmonious effect, if you will, a synergistic effect across the
07:15brand. And we are the only molecule that's available in both an injectable and oral form.
07:22I do want to touch a little bit on your background. I mean, you've been in the pharma space for
07:26a long
07:26time. You've helped bring a lot of products to market across a wide variety of ailments and
07:32solutions. There are still a lot of investors that look at Novo Nordisk as a basically one drug
07:38company, whether that's fair or not. We can debate that later. What is the discussion like right now
07:43about trying to expand the pipeline beyond just the GOP-1 space and the obesity space?
07:48Yeah. I mean, when you have two blockbuster brands, the same molecule, semaglutide in Wagovi
07:56and Ozempic, it's easy for people to focus on the magnitude of that. But what attracted me to Novo
08:04was the breadth of the portfolio. I'm so excited about our rare disease portfolio. We are anticipating
08:11FDA approval for denesimig and hemophilia A in the fall. And then we released recently phase three
08:19results on a top of a pivot. First innovation in sickle cell disease in years. Yeah. But on the
08:26rare disease side, and a lot of investors have talked about because obviously the margins, at least
08:29from what we can see, are a lot higher. But that's still such a tiny percentage of your business in
08:33terms of revenue. So what actually gets that up from, you know, the mid single digits into something
08:38that's maybe a little bit more palatable to Wall Street? Yeah. To your question about ongoing
08:44conversations, we continue to look at adjacencies and, you know, potential bolt-on M&A activity to
08:52expand the breadth of our portfolio. But we have a rich, you know, pipeline in both diabetes, obesity,
09:00rare disease, cardiovascular disease that is emerging. And we anticipate in September to share
09:09the latest on that pipeline activity and the corporate strategy at our Capital Markets Day.
09:15So, you know, you think about your chief rival when it comes to the GLP-1 space, Eli Lilly. They've
09:20been
09:20extremely acquisitive, especially when it comes to expanding their pipeline. It sounds like you said
09:26that, you know, Novo might be interested in a potential bolt-on acquisition. Would you be
09:32considering a blockbuster deal here when you think about, you know, potentially expanding
09:37that pipeline? I think, you know, we're open to, you know, opportunities, I think, more likely in the
09:44bolt-on category, you know, delivering synergistic kind of adjacencies to the current portfolio. But yeah,
09:53there's a bright future both in the pipeline and potentially opportunities outside.
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