Novo Nordisk A/S

Good day and thank you for standing by. Welcome to the Q2 2026 Novo Nordisk A S earnings conference call. At this time all participants are in a listen only mode. After the speaker's presentation there will be a question and answer session. To ask a question during the session you will need to press star 1 and 1 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question please press star 1 and 1 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Michael Novod, Head of Investor Relations. Please go ahead.

Thank you very much, operator. Welcome to this NOVA Nordisk earnings call for the second quarter of 2026. My name is Michael Novod. I'm the Head of Investor Relations at NOVA Nordisk. With me today I have CEO of NOVA Nordisk, Mike Doustdar, EVP US Operations Jamey Millar, EVP International Operations Emil Kongshøj Larsen, EVP Research and Development and Chief Scientific Officer Martin Holst Lange, and Chief Financial Officer Karsten Munk 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 profit 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 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 have taken the successful US launch of Vigovipil to global markets. We now have around 1.5 million people on the Vigovipil 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 received, we have also announced top-line results from ZUS, the first three trials with Zyltivikimab 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. And lastly, we're happy to see that we have been able to raise our 2026 guidance once again. Karsten 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 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 sales in U.S. benefited from a growth to net rebate adjustments related to prior periods. And with that, over to you, Jamey.

Thank you, Mike. Next slide, please. We continue to see encouraging use of the Wegovy pill six months into the U.S. launch. The Wegovy pill is the strongest ever GLP-1 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 17 were 267,000. The Wegovy 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 Wegovy 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-IV clinical trial at the same point in time, reinforcing the efficacy of the pill and patient usage in practice. The Wegovy 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 Wegovy pill from competitor products and limited cannibalization on injectable Wigovi, 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 Wigovi 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 and the 65 plus age population with the recently available Bridge Program and Medicare Part D. While it is early days, we are encouraged by the strong participation in the program. Wigovi Pill appears to be the oral option of choice and we will continue to focus on educating and differentiating Wigovi 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 Wegovy 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, Jamey. 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 the highlight being obesity franchise growth of 37%. Nominois continues to be volume market leader outside the U.S. 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 growth continues to stabilize. This indicates that we are gradually seeing the benefits of our efforts, including the step-up approval and launches of Vigovi 7.2 mg and Osempic 2.0 mg. In the UK, Vigovi 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 mark. In the EU, Vigovi 7.2 mg in the single dose pen was recently approved and we look forward to launching the pen in the first EU markets 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 LOE 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 savings card program and we've seen good volume retention for both Osempic and Vigovi in the cash and private insurance channels. Next slide, please. Recently, we launched Vigovi 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 Vigovi in a once daily, easily-administrated pill in these countries. In the UK, the Vigovi 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 Vigoepil became available in early June, roughly one month after an oil competitor entered. Despite not being the first mover, Vigoepil has already captured around 50% market share in the oil segment. We are pleased to see these encouraging uptakes and expect to launch the Vigoepil 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 siltivecumab. SUSE was a large-scale cardiovascular outcomes trial with more than 6,300 people enrolled and randomized in a one-to-one ratio to receive once-monthly siltivecumab 15 mg or placebo on top of standard of care. The eligibility criteria were designed to include patients with established cardiovascular disease, established chronic kidney disease, and inflammation as measured by high sensitivity C-reactive protein equal to or above 2 mg per liter. The primary objective was to demonstrate superiority of once-monthly centivacumab versus placebo on top of standard of care to reduce the risk of major adverse cardiovascular events. 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 CILTI VEGAMAP showed target engagement and inhibition of the IL-6 pathway as reflected by expected reduction in free IL-6 and HSGIP 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 Siltivegumab and those on placebo. Consistent with targeting IL-6 inhibition, a higher proportion of people treated with Siltivegumab had serious infections compared to placebo. No difference in all-cause mortality was observed with a hazard ratio of 0.99. While the SUSE 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 evaluates Siltivecamab in people with acute myocardial infarction and heart failure with preserved ejection fraction respectively, are planned to continue with the results expected during the first half of 2027. Please go to the next slide. Beyond the Seuss readout, we have had a busy second quarter across all of our therapy areas. Starting with obesity, we successfully completed the Redefine9 trial which was a 68-week efficacy and safety trial test in CACOSEMA maintenance doses of 1.0 and 1.7 mg of each component in people with overweight or obesity. For both lower doses of CACOSEMA, there was an achievement of superior weight loss compared to placebo. In the trial, Cagliosema appeared safe and well-tolerated, consistent with the previous Cagliosema trials. We expect to share detailed data later this year. We also initiated the Cagliosema Phase IIIb trial, looking at the higher fixed-dose combination of Cagliosema with 2.4 mg of cagliontide and 7.2 mg of semaglutide. The redefined high-dose trial comprises of two individual substudies, one in people with obesity without diabetes, and other in people with obesity and type 2 diabetes. Each sub-study evaluates the body weight reduction with Carglycema high dose compared to Carglycema 2.4 mg of each component and semaglutide 7.2 mg alone. We still expect a US decision for Carglycema 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 2017. 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-trial investigating cacrocema 2.4 mg versus tazepatide 15 mg. When evaluating effects, people treated with cacrocema achieved a weight loss of 15.2% and an A1c of 1.9% response respectively at 68 weeks. For the dual primary endpoint, Cagri-Semmer demonstrated non-inferiority versus disepatite 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 senegantide in obesity and cagrelentide high-dose marking important steps in advancing our next-generation obesity portfolio. Within obesity-related comorbidities, we anticipate phase 3 safety results from the synchronous real-world trial of eferoxyfermin in people living with mesh 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 semaglutide 1.0 mg and 2.0 mg 2-cagrisemma. Results are anticipated in the second half of 27. In addition, we plan to initiate Ambition, the Phase III development program for Senna Gametide. On regulatory milestones, we continue to anticipate a U.S. regulatory decision for oral semaglutide 25 mg in type 2 diabetes, as well as U.S. and EU regulatory decisions for denesimic in Haemophilia A. We also remain on track to submit its evoprivet in both EU and US in the fourth quarter of 2026, following the positive hibiscus results announced earlier this year. Taken 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, Karsten.

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 2025, reflecting lower realized prices One-time cost of around 3 billion Danish kroner related to rightizing 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 GFP1 sales. Adjusted operating profit increased by 11% at constant exchange rates driven by higher sales and lower cost 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 compared to corresponding to roughly a 15% decline compared to 12 months ago. Please go to the next slide. For the first six months of 2026, 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 GLP-1 product sales. The outlook reflects expectations for sales growth within international operations and expectations for sales decline within US 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. 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. 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 Vigo Repel 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, 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 slide. That was the outlook for 2026. Now over to you, Mike.

Thank you, Karsten. Please go to the next slide. While 2026 continues to be a challenging year for NOVA 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 Jamey 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'll 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. As a reminder, to ask a question you will need to 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. And our first question comes from the line of James Quigley from Goldman Sachs. Please go ahead, your line is open.

Great, thank you for taking my questions. I've got one on the guidance and one on XUS Wegovia pill trajectory. From the guidance, the second half implies around 5% or so negative growth, but can you talk to the dynamics and the headwinds that you have there? Which of those headwinds could potentially also move forward into And secondly, on the ex-US regulatory appeal trajectory, UK, you said 300,000 patients in the first three weeks or so since launch. That compares to 48,000 for the US. So how comparable are the launch trajectories for the US What have you seen in terms of waiting lists and things like that for the UK? And are there any similar metrics or expectations you have for the Germany launch that you've seen with the UK launch as well? Thank you.

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

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 exclusivity for SEMA 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 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 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 allow patients on all contraceptives, on statins, etc. to start easily on a one-day very efficacious 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, Karsten. And thanks, James. Next question, please.

And our next question comes from the line of Richard Vosser from J.T. Morgan. Please go ahead. Your line is open.

Hi. Thanks for taking my question. Two questions, please. First question just on the re-imagine for implications. Apologies. For the launch of Cagri-Semra in diabetes, Just thinking about the positioning of the product given the HbA1c was inferior compared to Monjaro and of course the focus in diabetes on blood glucose control. And then the second question just is on supply. Could you remind us where you are in the ramp up of the new API manufacturing facilities? What sort of utilization are you at the new plants? How quickly can you anticipate being at full capacity? Where are we heading on there in terms of supply? Thanks very much.

Thank you very much. First question on Reimagine 4 for Martin and then the supply question for Karsten.

Yeah, thank you very much, Richard. I'll just remind you that across the glycosameter true diabetes trials, we've seen A1C 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 CacoSema is obviously the combination of senaglutide that has very well established in obesity. It's basically the only, and in diabetes, it appears to be the strongest CV-Mase risk reduction asset in the field. That carries into chagosema and the benefits that we've seen on blood pressure, on glycemic control, on lipid improvements, and what we've also seen in the preclinical space on potential bone preservation, potentially other benefits of the amyloid biology that calls for a really, really strong proposition, not only in diabetes, obviously, but also in obesity, where we've 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.

Karsten? 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 is as specific as I can be, so it is progressing very nicely and we are happy with progress. So far, in terms of commercial supply into the marketplace, low utilization, 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, especially for the Vigovipil for ex-US rollout.

Very clear, Karsten. Thank you very much. And thank you, Richard. Next question, please.

And our next question comes from the line of Michael Luketon from Jefferies. Please go ahead, your line is open.

Thank you. Two questions please. One for Mike. Just a clarification, Mike, on your BD strategy. I think there was an FT article that suggested you'd be willing to look at larger transactions and then I think this morning on the media call you said you're more focused on Bolton acquisitions, just sort of clarifying. What size of potential additions to the portfolio are you looking at and why are you making that choice? And then going back to Martin, the reimagined fall failure, can you help me think through what that may or may not mean for Imicotin? Because we keep seeing data points that suggest that adding a novel GLP-1 with an amylin doesn't get us to 1 plus 1 to equal 2, it's more like 1.5. And I just wonder what that means for a unimolecular acid that is combining those two, where you just have less ability to titrate the two components up or down. Like, how do I think about the ability to get that unimolecular structure into the right landing zone from an efficacy and tolerability perspective?

Great. First question for Mike on BD and then on M. Chrisson, also for Martin afterwards.

Thanks, Michael. So I don't measure our ambition. 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 comorbidities 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 what 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.

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 Capucema 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 Redefine11. And therefore, both from a weight loss potential and potentially also from a glycemic control potential, Just with Calcrisema, we do believe that we could potentially see even further weight loss and potentially even further glycemic control. As you remember from phase two for Senegantide, in obesity we've seen 24% 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 SEMA, but right now the indications are both in diabetes and obesity, when it comes to glycemic control and weight loss, that Senegantide 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 Redefine9 data, the individualized treatment Getting patients to their desired weight loss or their desired target at different doses will also come clearly through Food Redefine 9, and we'll share those data later this year to give you further insights.

Thank you, Martin. Very clear. Thank you, Michael. And operator, next question, please.

And our next question comes from the line of Karsten Lundborg Madsen from Danske Bank. Please go ahead. Your line is open.

Yeah, thank you very much for taking my question. I think I'll just take one question here, disguised in two questions, I guess. Vigovi US performance minus 22% in constant exchange rates. Jamey, could you try to give us some info on the dynamics you're seeing here in Q2 for Vigovi in the US market, and also maybe help us understand a little bit the very large discrepancy versus Q1, and also the prescription data that we can see with Thank you very much, Karsten. That's one for you, Jamey. 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. We did see volume growth with We'll Go Be 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? And just building on Jamey's comment, what you should also Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, Carsten Munk Knudsen, to unlock volume. And then I'd 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, Karsten. Thanks, Jamey. And also thank you, Karsten. And operator, next question, please.

Thank you. Our next question comes from the line of Michael Nedelkovich from TD Cohen. Please go ahead. Your line is open.

Hi. Thank you so much for the questions. I have two. My first is on the WeGoVPill franchise. Novo conducted a phase three trial of the 50 milligram dose of oral semaglutide that showed even better results than the currently approved 25 milligram dose. Especially as competition mounts and we see what might be early signs of a potential slowing in momentum in the US, would Novo consider filing the 50 milligram dose at any point? That's my first question. And then my second question is on the implications of the ZUS trial. Its failure amidst a reduction in CRP and IL-6 would seem to suggest that these inflammatory biomarkers are correlates of cardiovascular disease rather than causal factors. To what extent do you agree with that conclusion? And in this context, what data serves as the basis for continued enthusiasm around NLRP3 in cardiometabolic disease? Thank you.

Thank you. Two questions for Martin. One on 50 milligrams of Alzheimer and then the second one on .

Yeah, absolutely. So as you said, we have conducted a 50 milligram study. It showed some really good results on both efficacy and tolerance. As you have clearly seen, with the 25 mg, 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 Senegantide 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 tenogantide, 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 true disease 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 NGIL-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 SUSE trials. And 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, Michael. And the next question, please.

Thank you. Our next question comes from the line of Peter Verdalt from BNP Paribas. Please go ahead. Your line is open.

Thank you. Peter Verdalt, BNP Paribas. Two questions. Michael Karsten, a key investor debate is whether 2027 can mark a return. to revenue growth consensus currently flatness for our last check now I realize Q2 numbers is not the forum for official guidance but I think it's worth kicking tight the tires I'm interested to gauge your level of comfort where consensus sits or your level of optimism about NOVA returning to top line growth in 27 given all the various pushes and pulls and then secondly for Jamey just could I push you further on the Medicare bridge program Your competitor has been more bullish on the volume inflection potential. I think Novo has been trying to keep expectations down, but just what you're seeing at the moment and just to clarify or to confirm that the current guidance still bakes in conservative assumptions on the BRIDGE program volume uplift. Thank you.

Thank you very much. The first question on 27 for Karsten and then the second question on BRIDGE for Jamey.

Pete, thanks for that question and we look forward to 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 Karsten Munk Knudsen, Elin Jager, Martin Holst Lange, Karsten Munk Knudsen, Thilde Hummel Bogebjerg

Jamey, on the bridge?

As it relates to bridge, firstly, you know, 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 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. 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, Jamey. Thanks, Pete. And next question, please.

Thank you. And our next question comes from the line of Matthew Weston from UBS. Please go ahead. Your line is open.

Thank you. Two questions, please. The first for Martin. Xenogamtide is a critical next-gen pipeline driver. I think one of the key observations at ADA for many was that Novo maybe hasn't got the titration right yet to get the optimal balance of efficacy and tolerability, but you're still moving forward into phase three at pace. So given the challenges we all experienced around Kagrisema, what assurances can you give investors that Novo will get dosing right? and will investors see data prior to the full phase three readout to reassure us that that's the case? And then secondly for Jamey, I guess ultimately, is it the right time to lower the price for higher doses of oral Wegovy? There's a big gap between 149 and 299 for the lower two and higher two doses. Momentum seems to be stalling. What can you do about it?

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

Yeah, thank you, Matthew. So first and foremost, we've learned a lot from Kagosema. This is a combination of GLP-1 and animal agonism. And everything that we've learned from Kagosema, we've obviously, as we previously discussed, put into the Redefine11 trial, which is where we really test The way that we titrate it 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 Cargizema, 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 solubility profile in line with what we've seen with, for example, Cargizema. And I'll just remind you that in Redefine One, the chagrissima 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 three results. But based on what we can see at this point, both from chagrissima from our phase one, two 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. And then I'll just remind you, we'll not only have that as a subcutaneous injection, we will also have that as an all-offering, meaning that will take a further step up in terms of efficacy when it comes to all treatment. without hopefully compromising on safety and solubility.

Thank you, Martin. And Jamey 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 gobi. We have roughly 30% of prescriptions at the 9 and 25 milligram strength currently. Our preference would be to address Thank you very much. Thank you, Jamie.

And thank you, Matthew. Next question, please.

Thank you. Our next question comes from the line of Graham Parry from Citi. Please go ahead. Your line is open.

Great. Thanks for your questions. So just on the rebase assessments, could you quantify where they sit across the portfolio, particularly You know, Zempic, and I think on Zempic US price mix outlook, you'd previously been saying around 10% to 15% decline. So on an underlying basis, was that what you would have been seeing? And is that what we should be thinking the remainder of the year? And then as you look into 2027, how do you think the IRA maximum fair price would impact on that sort of trend on pricing? And then on US injectable with Govee, you said there wasn't a shift in pricing dynamic between Q1 to Q2. But if you look at the gap between prescription growth and price, you had a negative price mix effect of about 57% up from about 40% in Q1. So is that just the cash pay mix that you're seeing? Or is there more pressure on commercial contracts? Thank you.

Thank you very much. So first question on Ozempic rebates or pricing volume to Jamey.

Yeah, in terms of the gross to net adjustments, the two billion DKK that we've highlighted, you know, the strongest proportion of that is Ozempic. About three quarters of the impact is Ozempic gross to net. And then the balance is insulin. So that's the dynamic there. In terms of 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.

Great. Thank you very much, Jamey. Graham, next question, please.

Thank you. And our next question comes from the line of Kerry Holford from Berenberg. Please go ahead, your line is open.

Thank you for taking my question. Sticking on the theme of channel mix, Karsten, I think you said around 35% of that injectable demand is now by the cash channel. What proportion of that cash channel demand is ultimately eligible for Medicare Bridge and what degree of transfer do you expect In the second half of the year and beyond, and effectively what kind of price impact should we anticipate as a result of that transition? And then on the pill, it would seem that the demand for some of the lower doses is starting to slow in terms of growth. Just interested in your thoughts on whether this may be a sign that seasonality is going to play a role in the demand of obesity pills. and could you just confirm what the current IQVA capture rate is for the pill? Thank you.

Thank you, Carrie. Two questions for Jamey. One on the Vigobi self-pay injectable and then also on Vigobi pill.

Yeah, thanks, Carrie, for the question. We see a small 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 four milligram strength. So considering new patient starts, we are increasingly looking at both 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 as you say.

Thanks, Jamey. Thanks, Kerry. Next please.

Our final question comes from the line of James Gordon from Barclays. Please go ahead, your line is open.

Hello, James Gordon from Barclays. Thanks for taking the questions. Two questions, please. One was M&A, which was beyond deal size, which you addressed. What are you looking for in terms of deals? I think there were some comments distributed a few weeks ago about maybe interest in things like aesthetics and the more consumer side. So how do you think about that versus more physician-led pharma deal making? and is the focus that you definitely want to do obesity and within obesity where are you now seeing the biggest unmet needs in obesity given all the things you've already got in the pipeline and sort of linked to that in terms of R&D so some setbacks and is that partly just because you're operating in tough areas like you're having to build on what's already good therapies so does that change at all how you think about R&D what the risk is and other areas that are higher risk now because there's good drugs out there and you'd maybe want to change about how you thought about where you want to be doing trials

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 Basically 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 We have seen this with our own semaglutide and we are seeing it of course with a number of other biologies that are coming into this Business, Martin just alluded to Amelin, 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 are we able to manufacture it in the same way as we are doing it historically and on the commercialization 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 WopiVet 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 there's success. We've all along called out that silvacumab 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've communicated at the US of around 50% or less because we acknowledge as a general observation, we have a pipeline with disease areas and modalities where we actually can generate a lot of value. 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 Thank you, Martin. Thank you, James.

So this concludes the Q&A session. Thank you for participating and please feel free to contact Investor Relations regarding any follow-up questions you might have. Thank you very much for dialing in.

This concludes today's conference call. Thank you for participating. You may now disconnect, speakers please stand by.