諾和諾德 (NVO) 2023 Q3 法說會逐字稿

Welcome to everyone in the room, welcome to everyone on the line to view the lunch meeting at the Novo Nordisk 9 Months Roadshow. I'm Richard Vosser, European pharma analyst at JPMorgan. It's my great pleasure to host Novo today, and I'll just get out of the way and hand over to Kasim for a few introductory remarks, and then we'll go to Q&A. Kasim?

歡迎在座的各位，歡迎在線觀看諾和諾德 9 個月路演午餐會的各位。我是理查德‧沃瑟，摩根大通歐洲製藥分析師。我很高興今天主持 Novo，我將讓開，交給 Kasim 做一些介紹性發言，然後我們將進行問答。卡西姆？

Thank you, Richard Vosser. And thank you to JP Morgan for hosting Novo Nordisk and our Q3 roadshow presentation. As you can imagine, we're in a very good place. It's amazing results at Novo Nordisk these days, growing more than 30% top and bottom line organically. And very good progress on pipeline, SELECT readout, flow interim. So a pleasure to be here this quarter. I'm here with Camilla Sylvest, our Head of Corporate Affairs and Commercial Strategy. And Martin Lange, Head of Development. So this is really the dream team being here. So we're ready for a lot of questions. And we'll do a brief presentation 10 minutes or so just as a warm up, and then we do the full Q&A after that.

謝謝你，理查沃瑟。感謝摩根大通主辦諾和諾德和我們的第三季路演演示。正如您可以想像的那樣，我們處於一個非常好的位置。如今，諾和諾德的業績令人驚嘆，營收和利潤有機成長了 30% 以上。在管道、SELECT 讀出、流程臨時方面取得了非常好的進展。很高興本季來到這裡。我和我們的企業事務和商業策略主管卡米拉·西爾維斯特 (Camilla Sylvest) 一起來到這裡。還有開發主管 Martin Lange。所以這裡確實是夢幻隊在這裡。所以我們準備好回答很多問題。我們將進行 10 分鐘左右的簡短演示作為熱身，然後進行完整的問答。

So hopefully, you have some exciting questions to share with us. So just reminding you about that we'll be talking about the future and the future has in tendency to fall out slightly different than what we believe or even significantly differently. So that's the name of the game. So now we're all aware about that and reminded about that. And then as a company, we are communicating through our strategic aspirations. Every quarter, we keep ourselves accountable on our progress on our strategy execution and this quarter, I'd just like to mention a few highlights without going through the full deck.

希望您有一些令人興奮的問題可以與我們分享。因此，只是提醒您，我們將討論未來，而未來往往會與我們所相信的略有不同，甚至顯著不同。這就是遊戲的名稱。所以現在我們都意識到了這一點並提醒了這一點。然後作為一家公司，我們透過我們的策略願景進行溝通。每個季度，我們都會對策略執行的進展負責，本季度，我只想提一些亮點，而不是完整介紹。

So first of all, in terms of why we're here as a company, this is really to reach patients, to make a difference for patients and society, to live better lives with diabetes, obesity, et cetera. And this quarter, we reached 40 million people living with diabetes. So we've been around for 100 years. And I try to million here, and we would look a little bit older, but we've been around for 100 years, and now we reached 40 million patients. But what's even more remarkable is that the acceleration you've seen in our business performance, that's a function of reaching 4 million patients more just during the last 1 year.

首先，就我們作為一家公司存在的原因而言，這實際上是為了接觸患者，為患者和社會帶來改變，讓糖尿病、肥胖等患者過上更好的生活。本季度，我們的糖尿病患者人數達到了 4,000 萬人。所以我們已經存在了 100 年了。我在這裡嘗試百萬，我們看起來有點老了，但我們已經存在了 100 年，現在我們已經有 4000 萬患者。但更值得注意的是，您在我們的業務績效中看到的加速是在過去一年中接觸到 400 萬患者的結果。

So the pace in which we are reaching more patients is higher than pretty much ever before. And that is a function of the innovation we're bringing out there, in the form of Ozempic in diabetes rebases also. And really meeting needs of patients on a global scale. So I just want to share that one. Then we reached a couple of really important milestones. So first of all, according to IQVIA MAT. Now we are at exactly 1/3 of the global diabetes care market, measured in value market share. So 33.3% global diabetes value market share, which is the target we set up for '25. Now we reached that already here in late '23. And then for obesity care, we'll come back to that, but we reached 30 billion in 9 months. And as you know, we had a target on aspiration of 25 billion, more than 25 billion by '25. So really good progression and the performance behind our strategy execution.

因此，我們接觸更多患者的速度比以往任何時候都要快。這是我們在糖尿病基礎上以 Ozempic 的形式推出的創新的一個功能。並真正滿足全球範圍內患者的需求。所以我只想分享這一點。然後我們達到了幾個非常重要的里程碑。首先，根據 IQVIA MAT 的說法。現在，以市場價值份額衡量，我們佔據了全球糖尿病護理市場的 1/3。因此，全球糖尿病市佔率為 33.3%，這是我們為 25 年設定的目標。現在我們已經在 23 年末達到了這個目標。然後對於肥胖護理，我們會回到這個主題，但我們在 9 個月內達到了 300 億。如您所知，我們的目標是 250 億美元，到 25 年超過 250 億美元。我們的策略執行背後的進展和表現非常好。

Martin will talk further about the pipeline and on financials, 33% sales growth and 37% operating profit growth at constant exchange rates. I think the numbers, they stand for themselves. And of course, that uses attractive cash flow generation and capital allocation to shareholders through dividends and share buyback. I call it almost a Novo classic, but at a higher growth market than normal.

馬丁將進一步討論管道和財務狀況，以固定匯率計算，銷售額成長 33%，營業利潤成長 37%。我認為這些數字本身就代表了它們。當然，這利用了有吸引力的現金流產生和透過股息和股票回購向股東進行資本分配。我稱之為 Novo 經典，但其市場成長速度高於正常水平。

And then over to Camilla on commercial performance.

然後是卡米拉的商業表演。

[:p id="534349653" name="Camilla Sylvest" type="E" :]

[:p id="534349653" name="卡米拉·西爾維斯特" type="E" :]

Yes. Thanks a lot, Kasim, 33% sales growth driven by both of our operating units, international operations and North America operations, you see the majority of the growth coming from North America. When we look at the regions, we have double digit in all of the regions that you see mentioned here. And when we look at the peers, you see that the primary part of the growth is driven by obesity but also by GLP-1. So it's really Ozempic rebuilds drive the vast part of our growth.

是的。非常感謝，Kasim，我們的營運部門、國際業務和北美業務推動了 33% 的銷售成長，您會看到大部分成長來自北美。當我們查看這些區域時，您在此處看到的所有區域中都有兩位數。當我們觀察同行時，您會發現成長的主要部分是由肥胖驅動的，但也由 GLP-1 驅動。因此，臭氧重建確實推動了我們的成長。

When we look at insulin, in particular, in IO, you see the negative growth. It's primarily impacted by VBP in China. So just to say without that VBP, volume-based procurement effect of China, we have growth in insulin also in international operations. Obesity for the first time in the U.S. is now adding more growth contribution than diabetes in the U.S. alone. So that's, of course, sort of a new paradigm in our growth of the future. And then you see rare disease still being impacted by production problems, and that basically just means that we see a negative growth in that space. If we just move on to zoom in a little bit on obesity, we see 174% sales growth in the first 9 months of this year. Primarily driven by the U.S., you see also here how, on the bar chart, the U.S. North America has lifted the sales contribution. And we basically see that more than 95% of the sales growth is driven by Wegovy as of now.

當我們觀察胰島素時，特別是 IO 中的胰島素，您會看到負成長。它主要受到中國VBP的影響。因此，如果沒有中國的 VBP（基於數量的採購效應），我們的胰島素在國際業務中也會成長。在美國，肥胖對經濟成長的貢獻首次超過了糖尿病。當然，這是我們未來發展的新典範。然後你會看到罕見疾病仍然受到生產問題的影響，這基本上意味著我們看到該領域出現負成長。如果我們繼續關注肥胖問題，我們會看到今年前 9 個月的銷售額成長了 174%。主要由美國推動，您還可以在長條圖上看到美國北美地區的銷售貢獻如何提高。我們基本上看到，到目前為止，超過 95% 的銷售成長是由 Wegovy 推動的。

You see on the right-hand side, that we have done launches in more countries than just the U.S. But in the U.S., you also see that we have been restricting starter doses as you know, to make sure that we can cater for patient continuity. So that's what you see the effect of here. And of course, we are looking at significantly scaling our supply also for next year. We have launched Wegovy international operations now in 5 countries. First 2 countries like the U.S., we've seen a very, very high demand. So as a consequence of that, when we have launched in U.K. and Germany, we are focused on a more restricted amount of supply into those markets, so that we from the get-go could communicate around that and could ensure patient continuity. And those 2 markets are generally, we have decided to launch in those because we wanted to focus on governments that have been -- want to be working, of course, with us on Wegovy to make sure we could get, we go with those most in need.

您在右側看到，我們在美國以外的更多國家/地區進行了上市。但在美國，您也看到我們一直在限制起始劑量，如您所知，以確保我們能夠滿足患者的連續性。這就是你在這裡看到的效果。當然，我們也正在考慮大幅擴大明年的供應量。我們現已在 5 個國家推出 Wegovy 國際業務。前兩個國家，例如美國，我們看到了非常非常高的需求。因此，當我們在英國和德國推出時，我們專注於對這些市場的供應進行更嚴格的限制，以便我們從一開始就可以圍繞這一點進行溝通，並確保患者的連續性。一般來說，我們決定在這兩個市場推出，因為我們希望專注於那些一直希望與我們在 Wegovy 上合作的政府，以確保我們能夠獲得，我們與那些最有需求。

So in the U.K. via Nice and in Germany via New Disease Management Program, that is in the making in Germany at the moment. So those were the opportunities that we are pursuing, but in a more controlled and restricted fashion than what you've seen in the U.S. and in Denmark and Norway. And with that, over to Martin for more on the pipeline.

因此，在英國透過尼斯，在德國透過新疾病管理計劃，目前德國正在製定該計劃。因此，這些就是我們正在尋求的機會，但其方式比您在美國、丹麥和挪威看到的更受控制和限制。接下來，請馬丁了解更多有關管道的資訊。

Yes, thanks very much, Camilla. So as you probably know, it's a lot of fun to be in R&D and Novo Nordisk states. Progress across the pipeline, we see very nice readouts. While Investor Relations didn't want to give me a slide on SELECT, I do want to give a shoutout to SELECT next week because obviously, we are looking forward to getting to share more data than just the 20% lowering in risk of getting myocardial infraction stroke or cardiovascular test. And so much more in SELECT and please tune in next week, it's going to be incredibly exciting, we think.

是的，非常感謝，卡米拉。正如您可能知道的那樣，在研發州和諾和諾德州非常有趣。整個管道的進展，我們看到非常好的讀數。雖然投資者關係部不想給我介紹 SELECT 的幻燈片，但我確實想在下週對 SELECT 進行大力宣傳，因為顯然，我們期待分享更多的數據，而不僅僅是心肌梗塞風險降低 20% 的數據。梗塞中風或心血管測試。 SELECT 中還有更多內容，請下週收聽，我們認為這將非常令人興奮。

Being on SELECT and being in the spirit of SELECT and really not disclosing very much, you also know we announced that we will close down the flow trial. That is a reasonably large outcomes trial in the nephrology space, approximately 3,500 patients being randomized driver magnetite 1.0 milligram of placebo. The primary endpoint of the trial is a composite endpoint of 5 components, where free components are looking towards kidney progression, either in terms of measurement of EGFR being reduced by more than 50%, EGFR going below 50 or patients going through dialysis or in transplant but also looking at mortality caused by kidney death and mortality caused by cardiovascular. That obviously is interesting. And based on that 5-point, primary endpoint. At DMC, a couple of weeks ago recommended us to close down the trial based on efficacy. And obviously, the last words based on efficacy is difficult. They could also have recommended us to close down the trial for futility.

在 SELECT 上，本著 SELECT 的精神，確實沒有透露太多，你也知道我們宣布我們將關閉流程試驗。這是腎臟科領域一項相當大的結果試驗，大約 3,500 名患者被隨機分配驅動磁鐵礦 1.0 毫克安慰劑。該試驗的主要終點是 5 個組成部分的複合終點，其中游離成分著眼於腎臟進展，要么是 EGFR 降低超過 50%，要么是 EGFR 低於 50，要么是正在接受透析或移植的患者還要關注腎臟死亡引起的死亡率和心血管死亡引起的死亡率。這顯然很有趣。並基於該 5 點主要終點。在 DMC，幾週前建議我們根據療效結束試驗。顯然，基於功效的最後一句話是困難的。他們也可以建議我們因徒勞而結束試驗。

So based on efficacy is good news. You will also see on the slide, the study was powered for a 20% difference between the semaglutide arm and the placebo arm on the primary endpoint. In the spirit of SELECT, we've given the same guidance to the DMC, the power is one thing. But if we are to stop on an interim analysis, we had to be absolutely sure. So the guidance for them to stop was substantially above 20% in terms of differential towards placebo. So you should expect something like that when you see the data. So incredibly exciting. My problem is your problem. I haven't seen the data and I'm not going to see the data for another couple of months. But as soon as we have them, we will share them with you. Just as a teaser, there will also maybe be a policy endpoint being disclosed on SELECT in a couple of days.

因此，基於功效是個好消息。您還將在幻燈片上看到，研究的主要終點是索馬魯肽組和安慰劑組之間存在 20% 的差異。本著 SELECT 的精神，我們給了 DMC 相同的指導，權力是一回事。但如果我們要停止進行中期分析，我們就必須絕對確定。因此，就與安慰劑的差異而言，他們停止戒菸的指導遠高於 20%。因此，當您看到數據時，您應該預料到類似的情況。非常令人興奮。我的問題就是你的問題。我還沒看到這些數據，而且接下來幾個月我也不會看到這些數據。但一旦我們有了它們，我們就會與您分享。作為一個預告片，幾天後可能還會在 SELECT 上揭露一個策略端點。

If we look at the broader R&D milestones, again, progress across the board in diabetes care. I may want to point out CagriSema. We've initiated the Phase III program for type-2 diabetes. As you know, we have a lot of aspirations and very high aspirations for CagriSema and obesity as well as in type 2 diabetes. And we are already finalized with the pivotal recruitment for the obesity program. So really, really happy days in the CagriSema world. IcoSema is going to be incredibly exciting. We have a combination of [IGT-once-weekly] insulin with semaglutide once weekly GLP-1 analog, that holds a tremendous potential from an efficacy and from a safety perspective in type-2 diabetes patients. And obviously, we are looking much forward to the readout of the pivotal trial in first half of next year.

如果我們再次審視更廣泛的研發里程碑，將會看到糖尿病照護領域的全面進展。我可能想指出CagriSema。我們已經啟動了針對第 2 型糖尿病的 III 期計畫。如你所知，我們對 CagriSema 和肥胖以及 2 型糖尿病有很多願望和非常高的願望。我們已經完成了肥胖計畫的關鍵招募工作。在 CagriSema 世界裡，日子真的非常非常快樂。 IcoSema 將會非常令人興奮。我們有[IGT-每週一次]胰島素與索馬魯肽每週一次的GLP-1類似物的組合，從療效和安全性的角度來看，該組合在2型糖尿病患者中具有巨大的潛力。顯然，我們非常期待明年上半年關鍵試驗的結果。

Then maybe I've already mentioned SELECT. There may be one additional thing to point out on the regulatory submission to the U.S. FDA and to the European authorities a couple of weeks ago, we're not going into details, and a couple of days ago, we received a message from the FDA that they have granted priority review for SELECT. I have gotten a question or 2 on whether that was based on using a voucher over the last couple of days and the answer is no. There was no use of voucher. This is basically based on the FDA criteria for what constitutes a priority review.

那也許我已經提到 SELECT。關於幾週前向美國 FDA 和歐洲當局提交的監管報告，可能還有一點需要指出，我們不做詳細介紹，幾天前，我們收到了 FDA 的一條消息他們已授予 SELECT 優先審查權。我收到了一兩個關於這是否基於過去幾天使用優惠券的問題，答案是否定的。沒有使用優惠券。這基本上是基於 FDA 關於優先審查的標準。

Subcutaneous and oral EM increasing we'll see data on oral EM increasing n a couple of months, but we are sufficiently confident but also enthusiastic around the concept of treating that we've also initiated subcutaneous dosing. And you will see us, if the data support our aspirations to fast progress the EM increasing project. In Rare Disease, we have our first approval in the RNA space based on nedosiran for primary hyperoxaluria, which is obviously very exciting from our prospective. And then I want to call out, obviously, in first half of next year, then we will see results from Mimi. So with that, back to you, Karsten.

皮下和口服 EM 增加，我們將在幾個月內看到口服 EM 增加的數據，但我們有足夠的信心，但也對治療概念充滿熱情，我們也開始了皮下給藥。如果數據支持我們快速推進新興市場成長項目的願望，您就會看到我們。在罕見疾病領域，我們在基於 nedosiran 的 RNA 領域首次獲得批准用於治療原發性高草酸尿症，從我們的前景來看，這顯然非常令人興奮。然後我想呼籲，顯然，在明年上半年，然後我們將看到咪咪的結果。那麼，回到你身上，卡斯滕。

Yes. Thank you, Martin. And this is just on the financial outlook for '23. So since we pre-released, there are no changes to what we released earlier. So we've increased our outlook for the full year. So now our top line growth outlook is between 32% and 38% sales growth for the year at constant exchange rates. So very, very high growth rate amongst the highest in the history of the company. Then we have adjusted for FX movements, compared to when we guided for the second quarter.

是的。謝謝你，馬丁。這只是 23 年的財務前景。因此，自從我們預發布以來，我們之前發布的內容沒有任何變化。因此，我們提高了全年的預期。因此，現在以固定匯率計算，我們的營收成長預期為 32% 至 38%。成長率非常非常高，是公司史上最高的成長率。然後，與我們第二季的指導相比，我們對外匯走勢進行了調整。

So stronger U.S. dollar yields lower negative impact on FX compared to what we've seen earlier. The offset to that is, of course, hedging and then net-net, a stronger cash flow linked to the stronger operating performance. And the step-up in cash flow is lower than what you'd expect from the operating performance. And that's a function of the fact that we've executed on a couple of business development opportunities, including the KBP transaction that we disclosed recently.

因此，與我們之前看到的相比，美元收益率走強對外匯的負面影響較小。當然，對此的抵消是對沖，然後是淨額，更強勁的現金流與更強勁的經營業績相關。而現金流的增幅低於您對經營業績的預期。這是因為我們已經執行了一些業務發展機會，包括我們最近揭露的 KBP 交易。

So that's the outlook for the year. And now we're ready to move into Q&A. And we have our Head of Investor Relations Daniel Bohsen to pick across the group for questions and answers. And I would be surprised if he doesn't give the first questions to our host.

這就是今年的展望。現在我們準備好進入問答環節。我們有投資者關係主管丹尼爾·博森 (Daniel Bohsen) 在整個團隊中進行提問和解答。如果他沒有向我們的主持人提出第一個問題，我會感到驚訝。

That is exactly correct Karsten. As always, we'll give the first question to the host. And let's stick with 1 question, and then we have a chance to do several rounds. So Richard, over to you.

卡斯滕說得完全正確。一如既往，我們將向主持人提出第一個問題。讓我們堅持做一個問題，然後我們有機會做幾輪。理查德，交給你了。

Okay. One question, please. Richard Vosser, JPMorgan. This year, we've seen margin expansion as the top line growth has outpaced the ability to invest. When we think about the future, how should we think about the speed of pipeline development and business development and whether that can keep pace with sales growth?

好的。請教一個問題。理查沃瑟，摩根大通。今年，由於收入成長超過了投資能力，我們看到了利潤率的擴張。當我們思考未來的時候，我們該如何思考管線開發和業務發展的速度，是否能夠跟上銷售的成長？

So Karsten, I think that's over to you.

卡斯滕，我想這件事就該由你來決定了。

Yes. So first of all, with this level of sales growth, and given the fact that we have paid for infrastructure, so to say, it's natural there to get the margin accretion, margin improvement. It's not a target in itself. It's just rational business logic. And of course, we run a rational business. Ultimately, what we want to do is, we want to pursue innovative-based growth. And we want to do that short, medium and long term. And that's why we really want to invest in our business to succeed on that. And that means that our resource allocation is really to invest in scaling supply investing in our commercial growth drivers. And here, right now, it's really about obesity market development. (inaudible) and GLP-1 penetration globally and then building a long-term growth opportunity through our R&D pipeline.

是的。因此，首先，隨著銷售成長水準的提高，並且考慮到我們已經支付了基礎設施費用，可以說，利潤率的增加、利潤率的提高是很自然的。它本身並不是一個目標。這只是理性的商業邏輯。當然，我們經營的是理性業務。最終，我們想要做的是追求創新成長。我們希望做到短期、中期和長期。這就是為什麼我們真的想投資我們的業務以取得成功。這意味著我們的資源配置實際上是投資於擴大供應投資，以推動我們的商業成長動力。此時此刻，真正的問題是肥胖市場的發展。 （聽不清楚）和 GLP-1 在全球的滲透，然後透過我們的研發管道建立長期成長機會。

And I think it really stands out with the R&D growing 40% on a year-to-date basis in terms of investments. And that is where you should see that as a function of strategic importance for the company to invest in the long term in the company, but also a rational approach that we believe that the investment opportunities, we have that they are creating a rational and attractive return for our shareholders. Otherwise, we wouldn't be doing it. So that's the approach.

我認為，今年迄今為止，研發投資成長了 40%，這一點確實很突出。這就是您應該看到的地方，作為對公司進行長期投資的戰略重要性功能，也是一種理性的方法，我們相信投資機會，我們擁有它們正在創造合理且有吸引力的投資機會為我們的股東帶來回報。否則，我們就不會這樣做。這就是方法。

How that then adds into margins. It's also a function of business development and the structure of our business development transactions. I would say our arching on business development, just to cover that one. Priority, first of all, strategic, it is about fit into our key therapy areas, diabetes, obesity, cardiovascular rebleeding as our top priorities. Then we need to see the scientific attractiveness and unmet needs and then we need to see the financial case. And then given the profile of our company, and our growth profile, then our preference is to go for early-stage assets because that's what really builds the long-term growth opportunity for the company. So net-net, high-growth yields margin improvement not being a target in itself because we want to invest for growth.

然後如何增加利潤。它也是業務發展和我們業務發展交易結構的函數。我想說的是我們對業務發展的關注，只是為了涵蓋這一點。優先級，首先是策略性的，它是關於適合我們的重點治療領域，糖尿病、肥胖、心血管再出血是我們的首要任務。然後我們需要看到科學吸引力和未滿足的需求，然後我們需要看到財務案例。然後考慮到我們公司的概況和成長概況，我們的偏好是選擇早期資產，因為這才是真正為公司創造長期成長機會的東西。因此，淨淨、高成長的收益率、利潤率改善本身並不是目標，因為我們希望投資成長。

We'll go to Charlie down there. Please state your name and organization. I forgot to say that before

我們去那裡找查理。請註明您的姓名和組織。我之前忘了說過

Charlie Marbert from Morgan Stanley. So you showed a slide yesterday on patient opportunities in different comorbidities. I've entered to your thoughts on which these you see is the most right for disruption from a GLP-1 perspective and where you see the biggest opportunity to drive high adoption?

摩根士丹利的查理·馬伯特。昨天您展示了一張關於不同合併症患者機會的幻燈片。我已經了解了您的想法，從 GLP-1 的角度來看，您認為哪些是最適合顛覆的，以及您認為哪些是推動高採用率的最大機會？

I don't know, Martin or Camilla, who wants to...

我不知道，馬丁還是卡米拉，誰想…

I think it should be both of us. So I can start from the clinical perspective, we had to think this in, again, from our portfolio perspective because, obviously, there's a big, big potential for [Vion] and of itself, but actually, we see even bigger potential, for example, for CagriSema. I think we would be remiss, obviously not staying with obesity, huge potential, both in terms of volume but also in terms of the impact we can make to patients.

我想應該是我們兩個。因此，我可以從臨床角度開始，我們必須再次從我們的投資組合角度考慮這一點，因為顯然，[Vion] 及其本身俱有巨大的潛力，但實際上，我們看到了更大的潛力，對於例如，對於CagriSema。我認為我們是失職的，顯然不會停留在肥胖問題上，肥胖潛力巨大，無論是在數量上還是在我們對患者的影響方面。

The cardiovascular disease area. And this is both ASD, as we've seen it with SELECT. But I would encourage you to maybe also to look at some heart failure data when we see SELECT data on Saturday next. And this is where we potentially see a big upside with the GLP-1 analogs, including what we will see with CagriSema. There will be quite a number of additional disease areas and opportunities, but I think the big free will still be diabetes, obesity and cardiovascular disease.

心血管疾病領域。這都是 ASD，正如我們在 SELECT 中看到的那樣。但我鼓勵您在下週六看到 SELECT 數據時也看看一些心臟衰竭數據。這就是我們可能看到 GLP-1 類似物的巨大優勢的地方，包括我們將看到的 CagriSema。將會有相當多的額外疾病領域和機會，但我認為最大的自由仍然是糖尿病、肥胖和心血管疾病。

Exactly. So of course, we are aligned on that from a commercial point of view. The unmet need is very big in those areas. And when we are looking at sort of growth waves for the future, it's about building on indications both to semaglutide, but also to future compounds, and we take a proactive strategy on how to look at what are the potentials within those compounds what can they do? And of course, in related therapy areas to our core diabetes obesity cardiovascular. So maybe later, we will talk about flow. But when you look at renal opportunities, then, of course, we know that just an example, 40% of people living with type 2 diabetes, also have chronic kidney disease to some extent.

確切地。當然，從商業角度來看，我們在這一點上是一致的。這些領域未被滿足的需求非常大。當我們著眼於未來的某種成長浪潮時，我們不僅要建立索馬魯肽的適應症，還要建立未來化合物的適應症，我們採取積極主動的策略來研究這些化合物的潛力，它們可以發揮什麼作用。做？當然，在與我們的核心糖尿病肥胖心血管相關的治療領域。所以也許稍後我們會討論流量。但是，當您關注腎臟機會時，我們當然知道，這只是一個例子，40% 的 2 型糖尿病患者在某種程度上也患有慢性腎臟疾病。

And that just means that there is a big potential whereas had cardiovascular disease. So many of these cardiometabolic diseases are interrelated. And just to add from a commercial point of view, it means that by expanding, for example, the label on Ozempic, we can slowly from a commercial point of view, get access to target groups. Where we later then can focus in on the actual target group, for example, be that being the cardiovascular label on Ozempic, now us moving into cardiovascular disease. So that's the way we can stay focused on our core, but still expand to newer [peers].

這僅僅意味著患有心血管疾病的人有很大的潛力。許多心臟代謝疾病都是相互關聯的。從商業的角度來看，這意味著透過擴大，例如Ozempic的標籤，我們可以慢慢地從商業的角度接觸到目標群體。然後我們可以專注於實際的目標群體，例如，作為 Ozempic 的心血管標籤，現在我們進入心血管疾病領域。因此，這就是我們可以專注於我們的核心，但仍然擴展到更新的[同行]的方式。

We'll move over to Peter Verdult first and then Laura afterwards.

我們將首先前往 Peter Verdult，然後前往 Laura。

I've got a few, but I will stick to the rules, just 1 for now. It's not lost on us that Ozempic scripts are now declining. And judging by the incoming we're getting even today from multiple investors beginning to become concerned. So is this just a function of periodic supply constraints, utility management stepping up, something else. But can you -- I think people are looking for reassurance. It's basically a follow-up from yesterday's question, Karsten. How quickly can we reverse those deteriorating trends?

我有一些，但我會遵守規則，目前只有 1 個。我們並沒有忘記，Ozempic 腳本現在正在衰落。從我們今天收到的多位投資者的消息來看，他們已經開始感到擔憂。那麼，這是否只是周期性供應限制、公用事業管理加強或其他原因的結果。但你能——我認為人們正在尋求安慰。這基本上是昨天問題的後續，Karsten。我們能多快扭轉這些惡化趨勢？

I don't know, Karsten, supply and script in U.S. Can you comment on that?

我不知道，卡斯滕，美國的供應和腳本，你能對此發表評論嗎？

Yes, I can start out and then Camilla, you can add in also. So yes, you're correct. I'm always super careful not to forecast and guide on new-to-brand scripts because it is volatile in nature. I would say, when we look at the whole category, we have a category, the GLP-1 category, which is on an [MAT] basis growing 50% and it's a category that started out back in 2005. So really growing at this pace speaks to the benefits of the existing treatments. And then on the short-term dynamics, clearly, supply, and do bear in mind, when supply is tight, then companies talked from a novel perspective, then, of course, we adjust our commercial tactics also and adjustment to commercial tactics could be items like how much are we sampling in physician practices and how much are we doing in terms of DTC activity.

是的，我可以開始，然後卡米拉，你也可以加入。所以是的，你是對的。我總是非常小心，不要預測和指導新品牌腳本，因為它本質上是不穩定的。我想說，當我們審視整個類別時，我們有一個類別，即GLP-1 類別，它在[MAT] 的基礎上增長了50%，而且這個類別早在2005 年就開始了。所以在這個類別上確實在成長速度說明了現有治療方法的好處。然後就短期動態而言，顯然，供應，並且要記住，當供應緊張時，公司會從一個新穎的角度進行討論，那麼，當然，我們也會調整我們的商業策略，並且可以對商業策略進行調整例如我們在醫生實踐中進行了多少抽樣以及我們在 DTC 活動方面做了多少工作。

And of course, if that pressure is lower than at other periods that of course, has some impact on new starts. That's the logic of promotional tactics. And then finally, the promotional tactics also spills into social media. And we see social media also tapering off over the last few months. And then I would say, finally, in a fast-growing category, then, of course, payers are looking at really ensuring that it's the right patients that get reimbursed and stepping up there. What they call utilization management criteria really to ensure that they have proper documentation for the patients getting insurance coverage for ozempic. And it's not beyond the label, but it is just stricter requirements in terms of blood glucose, based on the right lab test, et cetera, that needs to be documented in the right way, according to a new standard in order to get insurance reimbursement. So those are the factors. And I'd say overall, we are very, very confident that the run rate for GLP-1 and obesity is very attractive for many years to come.

當然，如果壓力低於其他時期，當然會對新的啟動產生一些影響。這就是促銷策略的邏輯。最後，促銷策略也蔓延到社群媒體。我們看到社群媒體在過去幾個月也逐漸減少。最後，我想說，在一個快速成長的類別中，付款人當然會真正確保正確的患者得到報銷並加強這一領域。他們所謂的利用管理標準實際上是為了確保他們為獲得臭氧保險的患者提供適當的文件。這並不超出標籤範圍，而只是在血糖方面有更嚴格的要求，基於正確的實驗室測試等，需要根據新標準以正確的方式記錄，以獲得保險報銷。這些就是因素。我想說，總的來說，我們非常非常有信心，GLP-1 和肥胖症的運作率在未來許多年都非常有吸引力。

Already with the next question.

已經有了下一個問題。

Laura Hindley from Berenberg. So my question is on the Logo rebate adjustment. Can you give us some guidance as to the absolute figure in Q3? How much of this was a rebate adjustment, so a true one-off versus a reflection of actually just more people paying out of pocket than you anticipated earlier in the year? And then what percentage of [gobindozempic] use is via insurers versus out-of-pocket in the U.S?

來自貝倫貝格的勞拉辛德利。所以我的問題是關於Logo返利的調整。您能給我們一些關於第三季絕對數字的指導嗎？其中有多少是回扣調整，所以這是真正的一次性調整，還是反映實際上自付費用的人數比您今年早些時候預期的要多？那麼在美國，透過保險公司和自付費用的 [gobindozempic] 使用比例是多少？

Karsten, over to you also on that one.

卡斯滕，這一點也交給你了。

So yes, we had a favourable rebate adjustment to go in in the third quarter. And it's important to note that for launch products or young products, you don't have a lot of experience in terms of exactly what channels and what payers and hence, what rebate rates are being paid on those products. So there's no magic in the fact that their rebate adjustments for a product like Wegovy. And so that's the starting point. And it turned out different compared to our expectations, not because of some specific actions in the markets, but just due to the fact that we had provided for more in rebates than what it turned out, when we got the actual rebate claims in from the PBMs.

所以，是的，我們在第三季進行了有利的回扣調整。值得注意的是，對於推出的產品或新產品，您在確切了解哪些管道和哪些付款人以及因此為這些產品支付多少折扣率方面沒有太多經驗。因此，他們對像 Wegovy 這樣的產品進行回扣調整這一事實並沒有什麼神奇之處。這就是起點。結果與我們的預期不同，不是因為市場上的一些具體行動，而只是因為我們提供的回扣比我們從實際收到的實際回扣索賠中得到的結果要多。PBM。

In terms of channel mix, et cetera, I'd say, one driver was a non-rebated business, which is a composite of different factors. So it's not only pharmacy cash and the non-rebate was around 10%, as we're looking at it. Yes, I think that's as detailed as we'll go today on this topic.

在通路組合等方面，我想說，一個驅動因素是非回扣業務，這是不同因素的綜合體。因此，這不僅僅是藥房現金，正如我們所看到的，非回扣約為 10%。是的，我認為這就是我們今天討論這個主題的詳細內容。

We'll move to Richard.

我們將搬到理查德那裡。

Richard Parkes from BNB Paribas. On Lilly's call yesterday, they were asked about stay time and they said they've looked at experience Wegovy and they didn't think that, that was a good guide going forward given your supply constraints, which kind of implies that maybe stay time that you've been seeing hasn't been as good as you might be hoping. And he's the one thing on your call yesterday, didn't sound that confident about. And I know the answer is likely to be supplier disruption, but is there any comfort that you can give to investors that, that what you're seeing currently is due to restricted supply rather than patient behaviour?

法國巴黎銀行的理查‧帕克斯。在 Lilly 昨天的電話中，他們被問及停留時間，他們說他們已經查看了 Wegovy 的經驗，但他們認為，考慮到供應限制，這是一個很好的指導，這意味著可能停留時間您所看到的情況並不像您希望的那麼好。昨天你打電話時，他是唯一一個聽起來不太有信心的人。我知道答案可能是供應商中斷，但是您是否可以向投資者提供任何安慰，您目前看到的情況是由於供應受限而不是患者行為造成的？

Camilla over to your state time insights we can share.

卡米拉向我們分享您對州時間的見解。

Thanks a lot. So definitely, we've had some disruptions with Wegovy, and it's too early days to give you the exact stay time. But of course, anecdotal evidence is very strong in terms of patient appreciation of being on Wegovy. And we know from Denmark, for example, just to give you some insights that the majority of the patients actually continues to stay on the product. Also, this was launched in the beginning of the year. At this point, the majority of the patient continues to stay on the product. So we also know that daytime also often is impacted by the drop-off in the first few weeks, and that can be for many different reasons. It can be either not picking up at the pharmacy access, not really working out or, of course, people dropping out because of other types of issues or no share or other things.

多謝。可以肯定的是，我們與 Wegovy 發生了一些中斷，現在為您提供確切的停留時間還為時過早。當然，就患者對 Wegovy 的評價而言，軼事證據非常有力。例如，我們從丹麥了解到，只是為了向您提供一些見解，即大多數患者實際上仍在繼續使用該產品。此外，該項目於今年年初推出。此時，大多數患者繼續使用該產品。因此，我們也知道，白天也經常受到前幾週下降的影響，這可能有許多不同的原因。它可能是在藥房沒有接受，沒有真正鍛煉，或者，當然，人們因為其他類型的問題或沒有分享或其他事情而退出。

But it's mainly within the first few weeks. And then from there, we know that people are more likely to stay on. So the real exact number of stay time, we will only know in a while from now, but we will continue to describe that as good as we can from our eWorld evidence data to you. But no doubt that we expect a much longer stay time on Wegovy than what we've seen on Saxenda in the past.

但主要是在最初幾週內。從那時起，我們知道人們更有可能留下來。因此，真正確切的停留時間，我們要過一​​段時間才能知道，但我們將繼續根據 eWorld 證據數據向您盡可能詳細地描述這一點。但毫無疑問，我們預計 Wegovy 上的停留時間比我們過去在 Saxenda 上看到的要長得多。

So we are ready for the next question. We have one in here.

我們準備好回答下一個問題了。我們這裡有一個。

This is (inaudible) from (inaudible). I have 1 question, if I may. So the question is about the Treat Obesity Act. So it would be great if you could share your thoughts with us. Do you think is it that or as we have heard? Or if not, what do you expect action?

這是（聽不清楚）來自（聽不清楚）。如果可以的話，我有 1 個問題。所以問題是關於《治療肥胖法》的。因此，如果您能與我們分享您的想法，那就太好了。您認為是這樣還是像我們聽到的？或者如果沒有，您期望採取什麼行動？

Camilla, over to you again.

卡米拉，又輪到你了。

So no, we don't think the Treat and Reduce Obesity Act in the U.S. is that it does require bipartisan change in regulation for it to be enabled. And of course, over time, it will be important to have also that group of patients enrolled on obesity treatment, which is today not allowed in that segment. Having said that, I want to also reiterate that, today, we have access to 15 million Americans that have access to Wegovy in the commercial segment. And we also have a number of states that provide access to Wegovy via the Medicaid. So the most poor people, I think around 14 states that keep access this way.

因此，我們不認為美國的《治療和減少肥胖法案》確實需要兩黨改變監管才能使其得以實施。當然，隨著時間的推移，讓這群患者參與肥胖症治療也很重要，而目前該領域不允許這樣做。話雖如此，我還想重申，今天，我們有 1500 萬美國人可以在商業領域使用 Wegovy。我們還有一些州透過醫療補助提供 Wegovy 服務。因此，我認為大約有 14 個州以這種方式保留最貧窮的人口。

So we do have, compared to the less than 1 million people on Wegovy today, there is significant access even in the commercial segment and in the segment for the most poor people. So of course, Medicare Part D is important, and we continue to work towards that. But there is already a very big access. That means that in the U.S., that means that 80% of people are paying no more than $25. That’s great.

因此，與目前 Wegovy 上的不到 100 萬人相比，我們確實擁有大量的訪問權限，即使在商業領域和最貧困人口的領域也是如此。當然，醫療保險 D 部分很重要，我們將繼續為此努力。但已經有一個非常大的存取權限了。這意味著在美國，80% 的人支付的費用不超過 25 美元。那太好了。

So we'll move to Peter Welford.

所以我們將轉向彼得·韋爾福德。

Can I ask a question on CagriSema, please. Just with regards to the Phase III trials in obesity are fully enrolled. Can you just talk a little bit about, firstly, when you can go to regulators with those data or you also require data from, I think, the sort of shared cardiovascular study this part of the type 2 diabetes program, to be able to just a bit for obesity. I guess I'm not sure what the hazard ratio sort of requirements are necessary for obesity versus diabetes drug approvals for FDA. And is there any reason why you think with CagriSema with those data, we should expect a bigger disparity, I guess, between obesity and diabetes versus what we see with semaglutide alone in the 2 different indications as far as how the drug performs relatively for the sort of weight loss HPMC and reductions?

我可以問一個關於 CagriSema 的問題嗎？就肥胖症而言，III 期試驗已全數入組。您能否簡單談談，首先，您何時可以向監管機構提供這些數據，或者您還需要來自 2 型糖尿病計劃這一部分的共享心血管研究的數據，以便能夠有點適合肥胖。我想我不確定 FDA 批准肥胖症與糖尿病藥物所需的風險比要求是什麼。您是否有任何理由認為使用CagriSema 的這些數據，我猜我們應該預期肥胖和糖尿病之間與我們在兩種不同適應症中單獨使用索馬魯肽所看到的更大差異，就藥物相對於糖尿病的表現而言HPMC 的減肥減量有哪些？

Yes. Martin, that's one for you.

是的。馬丁，那是給你的。

Yes, absolutely. So first of all, we will acquire data from redefined free, which is the cardiovascular outcomes trial that is covering both diabetes and obesity for regulatory submission. That is actually not on time critical test in the way that we designed the program. So at the end of the day, you should still expect to see when we see readouts of redefine 1 and 2, we'll also be able to do the regulatory submissions thereafter. When it comes to differentiation, we've discussed the weight loss. The weight loss potential of CagriSema is big. We're currently assuming at least 25%, which is obviously in a non-diabetes population, really good.

是的，一點沒錯。因此，首先，我們將從重新定義的免費中獲取數據，這是一項涵蓋糖尿病和肥胖症的心血管結果試驗，以供監管提交。這實際上不是我們設計程式的方式的時間關鍵測試。因此，最終，您仍然應該期待看到我們看到重新定義 1 和 2 的讀數，此後我們也將能夠進行監管提交。當談到差異化時，我們討論了減肥。 CagriSema 的減肥潛力很大。我們目前假設至少有 25%，這顯然是在非糖尿病族群中，非常好。

When it comes to diabetes, we've seen superiority over semaglutide or glycemic control to the tune of 0.4 percentage points. That is in a really short study. And the way that (inaudible) act, we can actually expect to see an even bigger differential with longer treatment. Obviously, we had to show that in Phase III, but that would be our expectation. I think the big differentiator in diabetes will actually be on weight loss. Our current assessment is we will see at least 20% weight loss with CagriSema in type 2 diabetes. And that is without comparison, the best and most differentiated that we've seen comparing to anything else out there.

當談到糖尿病時，我們發現它比索馬魯肽或血糖控制有 0.4 個百分點的優越性。這是一項非常簡短的研究。從（聽不清楚）的作用方式來看，我們實際上可以預期在更長的治療時間內會看到更大的差異。顯然，我們必須在第三階段證明這一點，但這將是我們的期望。我認為糖尿病的最大差異實際上在於減肥。我們目前的評估是，使用 CagriSema 治療 2 型糖尿病患者的體重將減輕至少 20%。這是沒有比較的，是我們所見過的與其他任何東西相比的最好和最有區別的。

We'll go to Emily.

我們要去艾蜜莉那裡。

Emily Field from Barclays. Just a follow-up question to your earlier answer talking about the excitement around the cardiovascular benefits of semaglutide. Where do you currently stand on running primary convention studies particularly in light of those being run by your competitor and now SELECT now and really gone through it.

巴克萊銀行的艾米麗·菲爾德。只是您之前回答的一個後續問題，談論了索馬魯肽對心血管益處的興奮。您目前在進行主要會議研究方面處於什麼位置，特別是考慮到您的競爭對手正在進行的研究，現在選擇並真正進行了研究。

I think in the diabetes space, it makes sense and we're actually also doing a primary prevention study for Ozempic, as we speak. The event rate, and the nature of cardiovascular outcomes price, you're dependent or events when it comes to both the sample size or the size of the study and also the duration of the study.

我認為在糖尿病領域，這是有道理的，正如我們所說，我們實際上也在為 Ozempic 進行一級預防研究。事件發生率以及心血管結果的性質，在涉及樣本量或研究規模以及研究持續時間時，您所依賴的事件或事件。

The event rate in obesity for cardiovascular events is low. So it requires bigger trials, and it requires potentially longer trials. All it requires that you define events composite of events that may not be acceptable from a regulatory perspective. Typically, from a regulatory perspective, you have to look at 3.8%. And that basically means that depending on your purpose, if you have a clear regulatory purpose, you also have to either expect a very, very big differential or you have to make out probably large sample size. We don't expect to pursue primary prevention for Wegovy, but we would not rule it out when it comes to CagriSema, some of our other offerings in our pipeline.

肥胖導致心血管事件的發生率較低。因此，它需要更大的試驗，而且可能需要更長的試驗。它要求您定義從監管角度來看可能不可接受的事件組合。通常，從監管角度來看，您必須考慮 3.8%。這基本上意味著，根據您的目的，如果您有明確的監管目的，您還必須預期會有非常非常大的差異，或者您必須找出可能很大的樣本量。我們不期望為 Wegovy 尋求初級預防，但當涉及到 CagriSema（我們正在開發的其​​他一些產品）時，我們不會排除這種可能性。

So we'll take the question here, and then we'll ...

所以我們將在這裡提出這個問題，然後我們......

It's Colin White from UBS. I was just wondering, ahead of the HA, if you could give any perspectives on the commercial regular importance of the benefit of each component of the miss that we might see?

我是瑞銀集團的柯林懷特。我只是想知道，在 HA 之前，您是否可以對我們可能看到的失誤的每個組成部分的利益的商業常規重要性提出任何看法？

So the commercial part, I would need to Camilla, but on the only thing that we have disclosed is that all of the individual components were contributing to the primary endpoint. And again, the individual components, myocardium infraction stroke and cardiovascular risk. We've not said to what extent, and we've not said, if they are equally distributed. The only thing that we mean by that is they are all on the right side of Unity and they are all supporting the assessment of the primary endpoint. So in a position to previous outcome studies where you may have seen one of the components going in the other direction, you don't see that here. But again, you'll have to wait until Saturday to see that.

因此，在商業部分，我需要卡米拉，但我們唯一披露的是，所有單獨的組件都對主要終點做出了貢獻。再次，心肌梗塞、中風和心血管風險的個體組成。我們沒有說到什麼程度，也沒有說他們是否平均分配。我們唯一的意思是，它們都站在 Unity 的右側，並且都支援主要終點的評估。因此，在先前的結果研究中，您可能已經看到其中一個組成部分朝另一個方向發展，但在這裡您看不到這一點。但同樣，你必須等到週六才能看到這一點。

Camilla, commercial perspective on SELECT.

卡米拉，對 SELECT 的商業視角。

Yes. On the commercial perspective, we already see now just with the top line results out that there is keen interest from payers and policymakers to understand what does this mean and to enter into discussions on reimbursement of Wegovy. So it's clear that this is a landmark trial that provides a lot of evidence and data for us also going forward, understanding much more about obesity. So there are many aspects of this data set that is relevant for payers and policymakers, always at this point before the release.

是的。從商業角度來看，我們現在已經看到，從頂線結果來看，付款人和政策制定者都非常有興趣了解這意味著什麼，並就 Wegovy 的報銷進行討論。很明顯，這是一項具有里程碑意義的試驗，為我們提供了大量的證據和數據，讓我們進一步了解肥胖。因此，該資料集的許多方面都與付款人和政策制定者相關，並且總是在發布之前的此時。

And Peter, was so unusual discipline before with only 1 question. So you'll get another 1 now.

而彼得，以前只有 1 個問題，紀律非常不尋常。所以你現在會得到另一個 1。

I'll try to stay disciplined. Peter of Citi Group. Just taking a breather from GLP-1, maybe Camila. The outlook for the interesting franchise globally. I mean VBP in China is ended, but I don't know, it's more coming, big reset in the U.S. this year, ICOS. So my question is, do you still believe, you got a lot of crisis when you launched Tresiba saying it deserved the premium and didn't get anywhere. What's your mindset going into the icosema launch? And just high level, how are you thinking about the outlook for insulin going forward?

我會努力保持紀律。花旗集團的彼得.也許卡蜜拉只是從 GLP-1 喘口氣。全球有趣特許經營的前景。我的意思是，中國的 VBP 已經結束了，但我不知道，今年美國還會有更大的重置，ICOS。所以我的問題是，你是否仍然相信，當你推出 Tresiba 時，你遇到了很多危機，說它值得溢價，但沒有取得任何進展。您對於 icosema 的推出有何想法？高層，您如何看待胰島素的未來前景？

Yes. So icosema and icodec provides a great offering to patients. It's a once-weekly treatment has never been seen before. Everyone can imagine that a once-weekly injection, we've seen it even in GLP-1 that that's much small advantageous than once daily. Then actually, now we've talked a lot about scaling and supply. There's also just having to ship for once weekly treatment instead of a once daily treatment, is also an advantage for us. We are, of course, looking at from a supply point of view, how can we make sure that we can utilize the presentations that we have in a much smarter way, and there once weekly is just an added benefit as well. And then finally, I want to say also we only hold approximately 33%, 34% market share in the basal segment. So there is an opportunity for us to also take share in that segment with the first one will be insulin.

是的。因此，icosema 和 icodec 為患者提供了很好的產品。這是以前從未見過的每週一次的治療方法。每個人都可以想像，每週注射一次，我們甚至在 GLP-1 中也看到了，這比每天注射一次的優勢要小得多。實際上，現在我們已經討論了很多關於擴展和供應的問題。而且只需每週一次的治療而不是每天一次的治療，這對我們來說也是一個優勢。當然，我們從供應的角度來看，如何確保我們能夠以更明智的方式利用我們擁有的演示文稿，每週一次也只是一個額外的好處。最後，我還想說，我們在基礎細分市場只佔有約 33%、34% 的市佔率。因此，我們也有機會在該領域佔有一席之地，第一個領域將是胰島素。

We have a question down here.

我們在這裡有一個問題。

Raj Sharma from HSBC. Just thinking forward, if we look ahead in, say, towards end of '24, you would have your -- potentially your competitor would have launched their obesity product by then. They clearly are preparing various strategies, to have less of a supply issue as you had, you are expanding your capacity. What point do you think the supply becomes less of an issue for the overall GLP market. And how does the competitive pricing model work from that point?

來自匯豐銀行的拉傑夏爾馬 (Raj Sharma)。展望未來，如果我們展望未來，比如說，到 24 年底，您的競爭對手可能會在那時推出他們的肥胖產品。他們顯然正在準備各種策略，為了減少像你們那樣的供應問題，你們正在擴大產能。您認為什麼時候供應對於整個 GLP 市場不再是一個問題？從那時起，競爭性定價模式將如何運作？

Karsten, considerations on supply.

卡斯滕，供應的考量。

Yes. Could you just repeat, was it for the obesity market or the obesity and diabetes?

是的。您能再說一遍，是為了肥胖市場還是為了肥胖和糖尿病？

GLP-1 market

GLP-1市場

The GLP-1 market. And thank you for taking a slightly longer perspective because I think that's the right approach on this one. So the starting point is we see just based on the demand, we see now and we've seen for the last number of years, that GLP-1s are making a difference for patients and prescribers. So this is not a push market. Really, this is about the market really understanding the benefits of GLP-1 treatments on a number of parameters, A1c, weight, cardiovascular risk reduction. So we have checked that box. And then it's really about market penetration.

GLP-1 市場。感謝您採取更長遠的視角，因為我認為這是解決此問題的正確方法。因此，我們的出發點是，我們根據需求看到，我們現在和過去幾年都看到，GLP-1 正在為患者和處方者帶來改變。所以這不是一個推動市場。事實上，這關係到市場真正了解 GLP-1 治療對許多參數（A1c、體重、降低心血管風險）的益處。所以我們已經勾選了該框。這其實與市場滲透率有關。

And when we look at the runway for GLP-1s, we've been talking about in diabetes at only around 5% of global diabetes scripts are for TF1 today. So the runway is very, very sizable, both in magnitude and in duration. And I say when I travel the Novo world and talk to our GMs, they are really pulling to get more Ozempic and the step-up opportunity in their local businesses is very significant. So that's the strategic premise.

當我們審視 GLP-1 的跑道時，我們一直在談論糖尿病，目前全球糖尿病腳本中只有約 5% 是針對 TF1 的。因此，無論是規模還是持續時間，跑道都非常非常大。我說，當我走訪 Novo 世界並與我們的總經理交談時，他們確實在努力獲得更多的 Ozempic，而且他們當地業務的提昇機會非常重要。這就是戰略前提。

And given the market structure, there are 2 companies that are scaling into this market. So I do believe that that space for both in this market. Now I'm just talking diabetes because it makes it a little bit simpler. So long runway and plenty of space for 2 companies to scale globally. And then again, in obesity and just to give you some hard numbers to get the sense of it, more than 800 million people in the world living with obesity, according to WHO today.

鑑於市場結構，有兩家公司正在進軍該市場。所以我確實相信這個市場上兩者都有空間。現在我只談論糖尿病，因為它使它變得更簡單一些。如此長的跑道和充足的空間可供兩家公司在全球擴張。再說一遍，在肥胖方面，根據世界衛生組織今天的數據，世界上有超過 8 億人患有肥胖症，只是為了給你一些確切的數字來理解它。

And Camilla spoke to the U.S. setting more than 100 million people in the U.S. with obesity, 50 million with these people in the U.S. with Wegovy reimbursement and treatment of less than 1 million today. So this is a volume-based market expansion strategy with ample space for more than 1 company. So that's why it is not the classic well-defined market where companies are fighting for share. This is about building the markets. So I would be less concerned about tough price competition for a number of years and more focus on global volume penetration and volume development because the incumbents in the market, they're going to scale significantly over the coming years and hence, less focus on price competition. And then you can say, when are you out of supply constraints, and then I'd say, given the global magnitude of the opportunity, without knowing a competitor supply capacities, then I do believe it will be a number of years, several years, before this market is unconstrained on a global basis.

卡蜜拉對美國表示，美國有超過 1 億人患有肥胖症，而這些人在美國有 5,000 萬人，而如今接受 Wegovy 報銷和治療的人數還不到 100 萬人。因此，這是一種基於數量的市場擴張策略，為超過一家公司提供了充足的空間。這就是為什麼它不是典型的公司爭奪份額的明確市場。這是關於建立市場。因此，我不太擔心多年來激烈的價格競爭，而是更關注全球銷售滲透和銷售發展，因為市場上的現有企業將在未來幾年大幅擴大規模，因此不太關注價格競賽。然後你可以說，你什麼時候擺脫供應限制，然後我會說，考慮到全球機會的規模，在不知道競爭對手的供應能力的情況下，那麼我確實相信這將是幾年，幾年，在此市場在全球範圍內不受限制之前。

We have room for a few more questions. We'll take the last one here before.

我們還可以再問幾個問題。我們先在這裡拿最後一張。

Martial Descoutures from Deutsche Bank. So as you're now basically moving into cardiology with SELECT and so on, just if you can give us an update on the guidelines? And when do you expect those to get updated? And how important is this eventually. But also as you're venturing into cardiology, has it the way that you look at cardiological therapeutic areas, such as hypertension, cholesterol lowering, (inaudible) and so on? Has your view of those change how you look at it from a competitive perspective, just would be keen to understand that.

來自德意志銀行的 Martial Descoutures。您現在基本上正在透過 SELECT 等進入心臟病學領域，您能否給我們提供有關指南的最新資訊？您預計這些內容什麼時候會更新？這最終是多麼重要。但當您涉足心臟病學時，您是否也以這種方式看待心臟病治療領域，例如高血壓、降低膽固醇（聽不清楚）等？您對這些的看法是否會改變您從競爭角度看待它的方式，我很想了解這一點。

So I sense a couple of questions, but if we do brief answers, then let's try to check Martin. So the medical guidelines and afterwards, Camilla, our strategy in CBD.

所以我感覺到有幾個問題，但如果我們做簡短的回答，那麼讓我們試著檢查一下馬丁。所以醫療指南，然後，卡米拉，我們在 CBD 的策略。

So medical guidelines, once we have the SELECT data out, we'll be working with the key opinion leaders who write the guidelines and who own the guidelines to see if we can see an update of the diabetes guidelines, the obesity guidelines, but certainly also guidelines within cardiovascular potentially, for example, either based on SELECT, but potentially also on loow of kidney guideline. So that's the approach that we usually take you already now see GLP-1 being mentioned in the diabetes and some obviously guidelines. And obviously, based on SELECT, we aim to expand that.

因此，醫療指南，一旦我們有了選擇的數據，我們將與編寫指南和擁有指南的關鍵意見領袖合作，看看我們是否可以看到糖尿病指南、肥胖指南的更新，但當然例如，心血管內的指南也可能基於SELECT，但也可能基於腎臟指南。這就是我們通常採用的方法，您現在已經看到糖尿病中提到的 GLP-1 以及一些明顯的指南。顯然，我們的目標是在 SELECT 的基礎上擴展。

And from a commercial point of view, of course, as I spoke to before, so we are addressing the cardiovascular disease area from 2 angles, 1 with specific cardiovascular assets, (inaudible) and others that we have in our pipeline, and we are also expanding and approaching from diabetes and obesity with label expansions in those patient segments. So it's a 2-way approach to get to that therapy area. That also means from a sort of pure cost point of view, we can derisk some of the expansions that we need to do to enter into the cardiology segment.

當然，從商業角度來看，正如我之前所說，我們正在從兩個角度解決心血管疾病領域的問題，1 特定的心血管資產（聽不清楚）以及我們正在開發的其​​他資產，我們正在糖尿病和肥胖症也隨著這些患者群體的標籤擴展而擴大和接近。因此，這是到達該治療區域的兩種方式。這也意味著從純粹的成本角度來看，我們可以避免進入心臟病學領域所需的一些擴張。

And I think we'll take the last question before we wrap up, and then management will stay around a little longer. But Richard, as the host, I think you will get the last question.

我想我們會在結束之前回答最後一個問題，然後管理層會停留更長時間。但是理查德，作為主持人，我想你會得到最後一個問題。

We haven't talked sales forces for ages. So an icodec is launching maybe next year. So, what do you need in terms of sales forces at the moment? Do they need to step up to for an insulin relaunch, if you like? How should we think about that? And maybe DTC as well? Does that restart next year?

我們已經很久沒有談論銷售人員了。所以 icodec 可能會在明年推出。那麼，您目前需要什麼銷售人員呢？如果你願意的話，他們是否需要重新啟動胰島素？我們該如何思考這個問題？也許還有 DTC？明年會重新開始嗎？

Camilla, sales force strategy is what you can say at this point in time?

卡米拉，現在可以說一下銷售隊伍策略嗎？

Now going into specific segments. We, of course, want to make sure that we are competitive in every segment that we operate in that goes for GLP-1 insulin and other spaces, and we will also be there for icodec when we launch there. At the moment, we are also, of course, spending a lot of time with our reps trying to explain some of the periodic out-of-stock situation that there can be, but also in obesity to talk about the -- what is obesity, why does it need to be treated and so on. And then finally, I would say there's also a moment in time now where we actually can experiment a little bit more with more digital solutions for the future, which I think everyone here understands that there is a high demand for our GLP-1 products at the moment. So it gives us a little bit of leeway to test out a few things in the marketing and sales area that we can benefit later on from when the competition maybe get more intensified.

現在進入具體部分。當然，我們希望確保我們在 GLP-1 胰島素和其他領域運作的每個領域都具有競爭力，當我們推出 icodec 時，我們也將在那裡。當然，目前我們也花了很多時間與我們的代表一起試圖解釋一些可能出現的周期性缺貨情況，但也在肥胖方面談論什麼是肥胖，為什麼需要治療等等。最後，我想說，現在我們實際上可以對未來更多的數位解決方案進行更多試驗，我想這裡的每個人都明白，我們的 GLP-1 產品的需求很高。此時此刻。因此，它給了我們一點餘地來測試行銷和銷售領域的一些東西，當競爭可能變得更加激烈時，我們可以從中受益。

This concludes the Q&A. But Karsten, any final words from your side before we close the call?

問答到此結束。但是卡斯滕，在我們結束通話之前您還有什麼想說的嗎？

Thanks, Daniel, and thanks to the audience and the ones listening in from remote for listening into our Q3 call. 33% sales growth in the first 9 months is remarkable in a Novo setting, and I think also in an industrial setting. It's a sign of the innovation we've brought to market really meet patient needs I spoke about how many patients were reaching 40 million in diabetes. So we're on an innovation-based growth strategy delivering this year, setting out for attractive growth also in the years to come. So we are happy to come back with our full year results and guidance for ’24 come late January. And then just like on a final note, just to remind you that we have a Capital Markets Day coming up in March to go deeper in a number of our business topic. So I hope to see many of you there in person or virtually.

謝謝丹尼爾，也感謝觀眾和遠端收聽我們第三季電話會議的人。前 9 個月 33% 的銷售額成長在 Novo 環境中非常引人注目，我認為在工業環境中也是如此。這是我們推向市場的創新真正滿足患者需求的標誌。我談到了有多少糖尿病患者已達到 4000 萬。因此，我們今年將實施基於創新的成長策略，並在未來幾年實現有吸引力的成長。因此，我們很高興能在 1 月下旬帶來全年業績和 24 月業績指引。最後，我想提醒您，我們將在三月舉辦資本市場日，以深入探討我們的一些業務主題。因此，我希望能親自或虛擬地見到你們中的許多人。

So with that, have a great rest of the Friday and thank you for listening in.

那麼，週五好好休息一下，感謝您的收聽。