諾和諾德 (NVO) 2025 Q2 法說會逐字稿

Welcome to this conference call regarding the changes to Novo Nordisk executive leadership as well as the lowering of the financial outlook for 2025 that we announced today.

My name is Jacob Rode and I'm the Head of Investor Relations at Novo Nordisk. With me today I have Helge Lund, Chair of the Board of Directors of Novo Nordisk; CEO of Novo Nordisk, Lars Fruergaard Joergensen; Chief Financial Officer, Karsten Munk Knudsen; Executive Vice President, US Operations, David Moore; and finally Executive Vice President, International Operations, and incoming CEO as of August 7, Mike Doustdar. All speakers will be available for the Q&A.

Today's announcements are available on our website, novonordisk.com. Please note that the call is being webcasted live and a recording will be made available on our website too. The call is scheduled to last for a maximum of 45 minutes. Next slide, please.

The presentation is structured as outlined on slide 2. We will briefly cover both of today's announcements First, Helge will cover the appointment of Mike Doustdar as new president and CEO of Novo Nordisk, as well as other executive-level changes briefly. Following that, Karsten will review the update to the financial outlook when Novo Nordisk today lowered the sales and operating profit expectations for 2025. The presentation will be followed by Q&A sessions beginning in approximately 15 minutes. Please note that all sales and operating profit growth statements will be a constant exchange rate unless otherwise specified. Please turn to the next slide.

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

And with that, over to you, Helge, for a review of the changes to the Nordisk executive leadership.

Thank you, Jacob. Please turn to the next slide. In May of this year, it was announced that Lars Fruergaard Joergensen would step down from his role as CEO of Novo Nordisk by mutual agreement with the Novo Nordisk Board. Following this announcement, we accelerated our ongoing succession process with Lars continuing as the CEO to support a smooth transition to new leadership. Please go to the next slide.

Earlier today, we announced that Lars will be succeeded by Mike Doustdar as President and CEO of Novo Nordisk. This announcement comes after a comprehensive search process which included both external and internal candidates. The Board believes that Mike's leadership, strategic vision, and commercial execution experience makes him best suited to lead the company through the current market challenges while maximizing future opportunities.

Mike has been Executive Vice President and Head of International Operations since 2015 where he has consistently demonstrated his abilities to create value and drive growth. Under his leadership over the past decade, IO has more than doubled sales and grown to an organization of nearly 20,000 employees, serving around 35 million patients.

Given his leadership of international operations and his role on executive management since 2015, Mike has an extensive understanding of the company, its culture, its strengths, and also areas of opportunity. As CEO, Mike will be focused on strengthening the company's global leadership in diabetes and obesity, enhancing commercial execution, and driving greater efficiency across the company. Mike is an outstanding leader and truly committed to Novo Nordisk, our purpose, and the patients we serve. He will take up the position as President and CEO from August 7, 2025.

After 34 years of exceptional service, Lars Fruergaard Joergensen leaves Novo Nordisk with our deepest gratitude. His visionary leadership and steadfast commitment have driven the company's remarkable growth and global impact, earning him widespread respect throughout the pharmaceutical industry. On behalf of the Board and all employees, we extend our sincere thanks and best wishes for his future endeavors. And a special thank you to Lars for ensuring a smooth handover to Mike.

In addition to the CEO announcement, we announced today that Novo Nordisk Research and Early Development and the Development function will be merged into one, appointing Martin Holst Lange as the Chief Scientific Officer and EVP for the full R&D function. In addition, Emil Kongshoj Larsen will succeed Mike in the role as Executive Vice President for International Operations. Also, these changes will be effective as of August 7, 2025, so we have a full team in place. And on behalf of the Board, I look very much forward to working with Mike and the team to deliver the company's growth strategy.

So now over to Mike for a few words.

Thank you very much, Helge. It's really a privilege to get this job. Let me start by thanking Lars for your leadership and support over so many years. I also want to thank you, Helge, and the entire Board for their unanimous support. I really appreciate that.

Now, the fact that my announcement comes right after the guidance update, well, it just makes the mandate ahead even more clear. We need to increase the sense of urgency and execute differently. But we'll do that by building on the core strength that makes this company so unique.

I take this job very seriously. You can expect me to be a CEO that combines strategic clarity with operational urgency. Soon, I'll be working closely with my management team, the Board, and the entire organization to move forward. We will sharpen our focus and move faster. We will operate more efficiently. We will advance our pipeline and keep pushing the boundaries of innovation, and we will invest to accelerate growth and deliver shareholder value. That is my promise to you. I'm looking forward to working with my team after we close Q2, and I'm eager to meet the investor community as soon as possible.

Now back to you, Jcob.

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

Thank you, Jacob. Please turn to the next slide. In the first six months of 2025, Novo Nordisk sales increased by 18% and operating profit increased by 29%, both at constant exchange rates. Sales growth in the first six months of 2025 was positively impacted by growth to net sales adjustments related to prior years of around DKK3 billion related to the 340B US rebate provision.

Operating profit growth is positively impacted by the ocedurenone impairment in the second quarter of 2024 of DKK5.7 billion. This was partially countered by the incremental impact related to the acquisition of the three former Catalent manufacturing sites of around DKK2.6 billion in 2025. Please go to the next slide.

As announced earlier today, Novo Nordisk has lowered the full-year outlook for 2025 compared to the outlook issued in May of this year. For 2025, the range for sales growth is now expected to be 8% to 14% at constant exchange rates. Given the current exchange rates versus the Danish kroner, sales growth reported in DKK is expected to be 4% lower than at constant exchange rates, primarily due to the depreciation of the US dollar to the Danish kroner exchange rate.

The change in sales outlook for 2025 is driven by lower growth expectations for the second half of 2025. This is related to lower growth expectations for Wegovy in the US obesity markets, lower growth expectations for Ozempic in the US Glp-1 market, as well as lower than expected penetration for Wegovy in select IO markets. The lower growth expectation for Wegovy in the US obesity market reflects the persistent use of compounded GLP-1 along with slower market expansion and competition.

Despite the expiry of the FDA grace period for mass compounding on May 22, 2025, non-Nordic market research shows that the unsafe and unlawful mass compounding has continued, and that multiple providers continue to market and sell compounded GLP-1s under the false guise of personalization. Novo Nordisk is pursuing multiple strategies, including litigation, to protect patients from knockoff semaglutide.

Novo Nordisk is deeply concerned that without aggressive intervention by federal and state regulators and law enforcement, patients will continue to be exposed to the significant risk posed by knockoff semaglutide drugs made by illicit foreign active pharmaceutical ingredients.

As unsafe and unlawful mass compounding continues, the Wegovy penetration in the cash channel is below expectations. Within the cash channel, Wegovy prescriptions via NovoCare Pharmacy, including telehealth collaborations, are currently around 11,000 total weekly prescriptions. This is in addition to around 20,000 weekly prescriptions in the retail cash channel. Novo Nordisk will continue to invest in the expansion of direct-to-patient initiatives such as NovoCare Pharmacy and further collaborations with the telehealth organizations.

The sales outlook also reflects lower-than-expected penetration of Wegovy in the insured channel. This is due to lower market expansion and competitive dynamics despite the initiation of new commercial activities for Wegovy in the first half of 2025.

Novo Nordisk is starting to see some positive indicators reflected in the latest NBRx data in the US and we continue to engage in additional commercial activities. Further, we continue to expect a regulatory decision around the Wegovy mass indication during the second half of 2025. Moreover, Novo Nordisk expects a positive volume contribution from the changes to the CVS National Template Formulary. where Wegovy is now the only GLP-1 medicine covered for obesity as of July 1.

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

Operating profit growth is now expected to be 10% to 16% at constant exchange rates. Given the current exchange rates versus the Danish kroner, growth reported in DKK is expected to be 7 percentage points lower than at constant exchange rates. This is primarily due to the depreciation of the US dollar to Danish kroner exchange rate.

The updated expectation for operating profit growth reflects the lower sales growth outlook, partially countered by reduced spending. This includes a negative mid-single-digit operating profit growth impact related to the acquisition of three former Catalent manufacturing sites.

Novo Nordisk now expects net financial items for 2025 to amount to a gain of around DKK3 billion. This is mainly driven by expected gains on hedge currencies, primarily the US dollar, partially offset by interest expenses related to funding of the debt-financed Catalent transaction.

The free cash flow is now expected to be DKK35 billion to DKK45 billion, reflecting the lower-than-planned expected sales growth. The lower growth is mainly driven by lower volume growth of GLP-1 based treatments in the US and related cash flow implications amplified by the US gross-to-net system. Novo Nordisk's full disclosure of the financial results for the first six months of 2025 will be published on August 6, where more information will be available.

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

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

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

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

Operator, we are now ready to take the first question, please.

(Operator Instructions) Michael Novod, Nordea.

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

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

Thank you, Michael, and thank you, Jacob. So with 80% growth in the first half of the year and the guidance range that we put out today, with a midpoint of around 11%. Then the applied growth in the second half of this year is mid-single digits. Do bear in mind we have a tough comparison from last year linked to the gross net adjustment of DKK5 billion we did in the fourth quarter last year, which would take a growth rate up from the mid-single digits to probably high single digits.

In terms of growth contribution from a geography point of view, then it's important to note that the lowering of outlook we're doing today is predominantly linked to a performance of our US business. It's a smaller piece that is related to a slower than planned penetration of Wegovy IO and as a consequence, when we release our results next week, you will see very healthy growth in IO in the first half of this year and we expect that to continue into the second half of this year.

As to implications into 2026, of course we will not guide for 2026 today. We will do that in conjunction with our full year results come February. So I will not go into further deliberations around 2026 for today.

Thank you for that Karsten, very clear. And thank you also to you Michael for the question. With that, I believe we are ready for the next question please.

Sachin Jain, Bank of America.

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

And I guess a similar question on Ozempic, you have much looser commentary within the PR around path to growth. Comps remain tough, scripts are inflecting. Assuming given a 5% to 10% price decline, fair to think that Ozempic is now trending towards sales declines from here. Thank you.

Thank you for that question, Sachin. On compounding, I'll give it first to Karsten.

Yeah, thank you, Sachin. So specifically on compounding, at Q1 in May, we said our market research estimate was 1 million patients using compounded GLP-1 for obesity treatments. Then the FDA grace period for bulk compounding on the 503 ended on May 22, and our assumption was that that would lead to increased patients using branded GLP-1s in the second half of this year. Unfortunately, our latest market research indicates that that has not happened, and that's one of the assumptions that we have changed. So the latest market research still indicates 1 million patients or more being on compounded GLP-1 obese in the US market.

Thanks for that, Karsten. And your second question, Sachin, on Ozempic dynamics. I'll hand it over to Dave.

Thank you for the question, Sachin. Yes, in regards to your question about Ozempic, we are seeing a flattish TRx development currently. We're seeing approximately 690,000 TRxs per week on par with competition. But the current competitive dynamics, we see we're capturing about 40% of the NBRx, and we do see patients switching from Ozempic to the competitor product as well. We haven't seen a solid pickup from our newly approved indication in chronic kidney disease, although we do hear positive comments from clinicians. We haven't seen that materialize into prescriptions as of yet.

And then secondly, we continue to see slower class growth of GLP-1 diabetes. And to some degree, there's also an impact from compounding, meaning if someone is coming in and looking for Ozempic branded product, it is possible that they would end up on a compounded semaglutide. Thank you.

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

Yeah, so just adding on to my prior comments on compounded yield points in the US marketplace, it's important that this is something we don't take lightly. It's a key patient safety concern. And, of course, we are active on many, many fronts in terms of improving patient safety and reducing compounding to what is legally allowed. So we, amongst other things, are active in litigation and we're working with regulators. And, of course, we are hopeful that this can, over time, lead to a reduction in compounding and hence a potential inflow of additional patients into the branded sector.

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

Harry Septhon, UBS.

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

Thanks for that, Harry, and I'll get that procedure with you, Karsten.

Yeah, so first of all, we have narrowed our range compared to the first quarter release back in May, so now we are cutting plus minus, 3 to the midpoint. It's not like we have a specific scenario taking us to the floor. It's an assessment of the risk profile that we're looking at that can take us both to the top end and to the low end of the range. And, of course, we are working hard each and every day to get the closest possible to the top end.

So really, the uncertainty factors to this is related to, I would say, the fairly usual uncertainty factors around performance of Ozempic and Wegovy, and then the classic uncertainties around growth to net estimates in the US.

Perfect. Thanks for that, Karsten. And with that, I think we're ready to move to the next question.

Martin Parkhoi, SEB.

Yes, Martin Parkhoi from SEB. Just a question to Mike. Now as a new CEO, but you have of course also been there your entire career. If we look back over the last two years, what would you have done differently in order to prevent this situation that you're standing in today?

And what do you see as the main catalyst to see a rebound in growth over the next two or three years? Can it be driven by improved commercial execution or do we need a new product like Oral Sema and CagriSema before we can see a real change to where you are today.

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

Thanks very much. Martin, I would say in the tumble of high growth, we sometimes can overlook things, and that's probably a bit what has happened. As we go forward, my promise is that we're going to accelerate the growth and the shareholder value creations by predominantly two big things.

One, we need to progress our pipeline and the innovation that helps us mid- and longer-term, but also short-term, get more out of what we have, the assets that we have, and predominantly we do that by improving the commercial execution. We will focus more on some of the things that matters most in terms of that growth. I have no doubt we're going to be faster and become more clear in our decision-making, reducing the white space in various different processes that we have.

We will bring the performance culture that I'm very well aware of from my part of the world and try to do that across the whole organization. And then we will invest competitively in the areas where we really need to invest, and we will try to find efficiency and savings in the so-called less important areas.

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

Evan Seigerman, BMO Capital Market.

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

Hi, Evan. Thanks for those questions. Dave, I'll turn it over to you on US dynamics.

Thanks for the question, Evan. Overall, we believe there's still substantial growth opportunity in the US for GLP-1s. This is in both diabetes and in obesity. And we do have to continue to execute on the roadmap that we've presented earlier in the year, and as Mike said, with a focus and a sense of urgency around commercial execution. And let me just comment on a few areas and put a finer point to it.

The first, it is compounding, as you mentioned. And we have to continue to be aggressive and push avenues to limit unlawful compounding. You could say in a way we're competing against compounding with a fake alternative of our medicine that is not safe for patients. We take it seriously. We have stepped up our dialogue recently with FDA. And you may have seen last week there were some letters from congressional leaders asking FDA to move on the illicit importation of API coming in from around the world, which is not even approved for use from where it's coming from. It has to stop.

Secondly, as you mentioned, we do continue to expand in other channels. And right now, the expansion of the cash channel is important. We are encouraged with some of the signs that we have seen, but it is still not picked up to our expectation that we got it in May, which is still overly due to compounding. But we have seen our cash business move from 4% early in the year to now 12%. And that is an encouraging sign that there's an opportunity to meet patients where they are and have a cash offering.

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

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

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

I would say in international operations, of course, next week we will release the full numbers. But what you will see is that we are having a fantastic growth right now with Wegovy on the back of many, many more launches than was originally planned. It is true that we are falling a bit short of our own ambition and plans that we made earlier on, but the numbers will hopefully satisfy you that this is going very, very well.

Besides, of course, expanding the footprint on Wegovy across the world, we're also, as alluded to some time ago at the last quarter, we have restarted our Ozempic promotions across the world, and that should give us, in addition to Wegovy, an extra bit of growth.

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

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

Richard Vosser, JPMorgan.

Hi, thanks for taking my question. I just wanted to go back on a question on the pricing dynamics in the US. With the pickup in CVS, I think the guidance, certainly at the bottom end, and probably the middle implies continued price erosion, I think, certainly for Wegovy and some of the brands. So could you give us an idea how to think on pricing going forward in the US?

And also, just on gross-to-net, we've seen substantial 340B benefits in the first half this year. What's to stop more benefits from 340B and part of the redesign, et cetera, coming through in the second half. Thanks very much.

Thanks for those two, Richard. We'll go to you, Karsten, firstly on the high-level pricing and then on gross net adjustments.

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

Then on top of that, when we look at pricing between the different brands, I would say that there are no major changes to what we've been discussing on Ozempic, as a general trend. And then for Wegovy, what we've been saying is that as we expand the market and reach more patients, the market should expect that the average pricing to go down gradually over time, linked to channel dynamics and reaching more patients. So a continued gradually decline on ARP, which of course is enabling reaching many, many more patients in US marketplace.

Then in terms of gross-to-net dynamics and Part D redesign, I'll say for Part D redesign first, this is a relatively smaller impact to our numbers. It's more like a spacing across the year of the few percentage points that we're discussing. But beyond that, on an annual basis, no major change on that front.

As to 340B, we're still awaiting at least one key legal clarification in terms of interpretation of the rules in place. So pending that and just the general test of time will be kind of the deciding factor to how we deal with the partial income recognition that we have under 340B.

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

Mike Nedelcovych, TD Cowen.

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

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

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

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

Thibault Boutherin, Morgan Stanley.

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

Thanks a lot for that. I think it goes to you, Mike, on complexity dynamics in international operations.

Yeah. Thibault, thanks for that. So I think you're correct. If you handpick just a handful of markets, then you will probably find that in those handful of markets amongst which the ones you mentioned, then we are right now not the leading player. And that's something, of course, we'd like to change. But if you actually do look at the rest of the IQVIA data, you will see that in a lion's share of markets, we are upholding those leadership.

We are having, of course, in a number of markets, take China as an example, a bit of a retraction of the market size, and we'll allude to this more next week. And in other markets where we start with 100% market share and Mounjaro joins, then I think they should get their fair share, but not more than that, in market share.

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

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

James Quigley, Goldman Sachs.

Great, hopefully you can hear me. Thank you for taking my questions. I've got a question on the total US market for obesity. So how is that developing? When we look at IQVIA trends since sort of last week of May thereabouts, the prescriptions have been around about 670,000 between you and Zepbound. Obviously, the share has been shifting between that. But when you think about that, plus the most recent data you have on compounding, what's the total market doing? And how is that volume opportunity unlocked and what is Novo doing in order to take steps to unlock the total market opportunity? Obviously, the share of the compound is a key growth driver, but from a total obesity perspective going forward in terms of patients, how is that progressing and how are Novo going to unlock that opportunity?

That question goes to you, Dave, on efforts to further expand the market in the US.

Yeah, thanks very much, James. I appreciate the question. There's still a tremendous opportunity in the US market, as you mentioned. Over 100 million people living with obesity. You've heard from us before that we now have coverage with over 55 million people where employers have opted in to be able to receive Wegovy for a low and reasonable copay. In terms of the market development and the script trends, we do continue to see Wegovy impacted by compounding. And as Karsten mentioned earlier, we estimate that's about 30% of the market, around 1 million patients. And I'll come back to what we're doing to curtail compounding.

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

First is our own supply of safe approved Wegovy. It's important to note that we have supply of Wegovy on the injectable side to treat all patients in the US, those that are seeking branded medications and those that are on fake compounded and wish to transition over. We also have commercial and medical affairs activities. We continue to raise the awareness of compounding, the safeties, the substandard, and the uncontrolled manufacturing. And we have an ongoing effort on the legal side.

We have issued over 120 lawsuits. We've issued 1,000 cease and desist letters. And we're starting to see some of the effects of those efforts where compounding has been shut down. But importantly, we must have regulatory action. We must have enforcement from FDA. And as I mentioned earlier, we have stepped up that dialogue, and we will continue to around the importation of illicit API as well as compounding that takes place with fake API. And that will give us an opportunity to convert those patients back to branded Wegovy. As Karsten mentioned, just has not developed yet because we haven't seen that market reduced yet to this date. Thank you.

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

Emily Field Barclays. Please ask your question.

Hi. Thanks for taking my question. I just wanted to kind of dig into these efforts to limit compounding. Your company is very consistent in this message around safety, but for better or for worse, it's not really resonating with whatever the sub-segment of American patients. So in the prior answer, Dave, you mentioned the lawsuits and the cease-and-desist letters. But have you filed suit against HIMSS? Can you see preliminary injunctions as part of these lawsuits? Given that we're off the drug shortage list, we all expected compounding to come down following this May 22 grace period date, so I guess I sort of was wondering, what is within the company's purview to get more aggressive in getting this to stop and defend your IP and defend your product? Thank you.

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

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

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

Carston Lonborg Madsen, Danske Bank.

All right. Thank you very much. So when considering the turmoil and the challenges we have here, and also the huge CapEx program you have been running where you never really have told us exactly how much supply and how many patients you are actually able to supply semaglutide to. Then I was wondering whether you could share some thoughts about what will happen in case that you are not even close to maximizing on the production of semaglutide, whether there could be a sort of a write-down of your asset base on the balance sheet, or how you're thinking about this.

Thanks for that, Carston. I'll turn that over to you, Karsten.

Yeah, thank you for that question. And in this context, it's important to remember what we heard from both Mike and Dave before around the significant unmet needs in both guidance and obesity and the portfolio that we're working with.

So as you know, in diabetes, when we look at the internet corporations, we're looking at a penetration of only around 7% of Scripps being on a GLP-1 compared to 19 or so in the US. So a very significant runway, especially in IO, but also in US in the diabetes GLP-1 penetration. And that runway is even bigger on the obesity side.

And then I say on top of that, as I said in the beginning, this is predominantly a US shortfall, and the volume split between IO and US is like 9 to 10 or something like that. So we believe that we will have good use of the factories that we're putting in place and we're building right now in terms of what we're going to deliver.

And then also do bear in mind that the factories we're building, they are of course for the inline products that are on the market today, but the factories, they are based on technologies that we expect to be able to apply for pipeline products also. And here I'm thinking of products like CagriSema and the (inaudible) to mention a few. So at this point, there are no indications of any potential write downs.

Thank you, Karsten. Very clear. And with that, we are concluding the Q&A session. Thank you for participating, and feel free to contact Investor Relations in regards to follow-up.

Before handing off, I'll give it to you, Helge, for some final comments.

Thank you, Jacob. I would like to once again say thank you to Lars for his service as president and CEO of Novo Nordisk. Congratulations to Mike in his new role. The Board looks forward to working with Mike and the executive. It's an important moment in time for Novo Nordisk.

I also want to say that a reduction in guidance is a matter we approach with utmost seriousness. Nonetheless, Novo Nordisk has launched a variety of strategic investment and commercial initiatives, and they are already observing positive early indicators that support the company's revised outlook and progress towards our mission to treat more patients with serious chronic diseases. So, thank you.