諾和諾德 (NVO) 2025 Q3 法說會逐字稿

Welcome to this Novo Nordisk Earnings Call for the first nine months of 2025. My name is Jacob Rode, and I'm the Head of Investor Relations. With me today are CEO of Novo Nordisk, Mike Doustdar; Executive Vice President, Product and Portfolio Strategy, Ludovic Helfgott; Executive Vice President, US Operations, Dave Moore; Executive Vice President, Research and Development, and Chief Scientific Officer, Martin Holst Lange; and Chief Financial Officer, Karsten Knudsen. All speakers will be available for the Q&A session.

歡迎參加諾和諾德2025年前九個月的業績電話會議。我叫雅各‧羅德，我是投資人關係主管。今天與我一同出席的有：諾和諾德首席執行官邁克·杜斯達爾；產品和組合戰略執行副總裁盧多維克·赫爾夫戈特；美國運營執行副總裁戴夫·摩爾；研發執行副總裁兼首席科學官馬丁·霍爾斯特·蘭格；以及首席財務官卡斯滕·克努森。所有發言者都將參加問答環節。

Please note that the call is being webcasted live, and a recording will be made available on our website as well. The call is scheduled to last a little more than one hour.

請注意，本次通話將進行網路直播，錄音也將發佈在我們的網站上。通話預計持續一個多小時。

Please turn to the next slide. The presentation is structured as outlined on slide 2. Please note that all sales and operating profit growth statements will be at constant exchange rates unless otherwise specified. Next slide, please.

請翻到下一張投影片。簡報的結構如投影片 2 所示。請注意，除非另有說明，所有銷售額和營業利潤成長報表均採用固定匯率。請看下一張投影片。

We need to advise you that this call will contain forward-looking statements. These are subject to risks and uncertainties that could cause actual results to differ materially from expectations. For further information on risk factors, please see the company announcement for the first nine months of 2025 as well as the slides prepared for this presentation.

我們需要告知您，本次電話會議將包含前瞻性陳述。這些都存在風險和不確定性，可能導致實際結果與預期結果有重大差異。有關風險因素的更多信息，請參閱公司發布的 2025 年前九個月的公告以及為本次演示準備的幻燈片。

And with that, over to you, Mike, for an update on our strategic aspirations.

那麼，接下來就交給麥克，請你介紹我們的策略目標。

Thank you, Jacob. Next slide, please. In the first nine months of 2025, we delivered 15% sales growth and 10% operating profit growth. We've also narrowed our guidance range to 8% to 11% on sales and 4% to 7% for operating profit. This is because we expect lower growth for our GLP-1 treatment in diabetes and obesity. Karsten will get back to the guidance update later in the call.

謝謝你，雅各。請看下一張投影片。2025 年前九個月，我們的銷售額成長了 15%，營業利潤成長了 10%。我們也將銷售額成長預期範圍縮小至 8% 至 11%，營業利潤率預期範圍縮小至 4% 至 7%。這是因為我們預期 GLP-1 療法在糖尿病和肥胖症的成長會比較緩慢。卡斯滕稍後將在電話會議中再次談到指導意見更新。

Looking into the R&D in diabetes, Rybelsus is now approved in the US and EU with CV indications based on the SOUL trial. Within obesity and business development, we have progressed on a number of projects that Martin will come back to later. In rare disease, we have now submitted Mim8 for regulatory approval in both US and EU. We're now serving around 46 million people living with diabetes and obesity. This is around 3 million more people with our GLP-1 treatment compared to just 12 months ago.

著眼於糖尿病的研發，Rybelsus 目前已在美國和歐盟獲得批准，用於治療心血管疾病，這是基於 SOUL 試驗的結果。在肥胖症和商業發展方面，我們已經取得了一些進展，馬丁稍後會談到這些計畫。在罕見疾病領域，我們目前已向美國和歐盟提交了Mim8的監管審批申請。我們目前為約 4,600 萬名糖尿病和肥胖症患者提供服務。與 12 個月前相比，接受我們 GLP-1 治療的人數增加了約 300 萬人。

Furthermore, I would like to note that 2025 strategic aspirations is our current framework for reporting, and we look forward to updating this next year as the current strategic aspiration runs out. Next slide, please.

此外，我想指出，2025 年策略願景是我們目前的報告框架，我們期待在明年隨著當前策略願景的到期而對其進行更新。請看下一張投影片。

Since I became CEO, I have said several times that Novo Nordisk will sharpen its focus on core areas, specifically diabetes and obesity. I want to take a moment to explain how we have refined our strategy. For more than 100 years, we have been guided by a simple purpose: to identify and solve major unmet medical needs. This commitment is unchanged. There are many people who can benefit from expertise in diabetes and obesity, and we believe we can serve them better than anyone else. Going forward, we will concentrate on these areas where we can make the greatest difference.

自從我擔任執行長以來，我曾多次表示，諾和諾德將更加專注於核心領域，特別是糖尿病和肥胖症。我想花點時間解釋一下我們是如何改進我們的策略的。100多年來，我們始終秉持著一個簡單的目標：發現並解決尚未滿足的重大醫療需求。這項承諾不變。糖尿病和肥胖症的專業知識可以幫助到很多人，我們相信我們能夠比任何人都更好地為他們服務。展望未來，我們將集中精力在這些我們能夠發揮最大作用的領域。

Our strategy begins with patients at the center of everything we will do. Way more than 1 billion people are affected by diabetes or obesity. We will work tirelessly to develop products that help them live healthier, fuller lives. Some of these products will be developed internally. Others will be added to our portfolio through partnerships and acquisitions.

我們的策略以患者為中心，將患者放在我們一切工作的核心位置。全球有超過10億人患有糖尿病或肥胖症。我們將不懈努力，開發能夠幫助他們過更健康、更充實生活的產品。其中一些產品將由公司內部研發。我們將透過合作和收購，把其他公司納入我們的投資組合。

Many of these assets can address multiple unmet needs. We will explore those opportunities and expand indications where appropriate to serve our patients. Speaking of patients, it is a known fact that obesity and diabetes vary by individual and often comes with comorbidities that lack effective treatments. As with the Akero acquisition, Novo Nordisk will keep pursuing innovation with identification within research and then advancing those to development to address comorbidities within our core and the overlaps with those cores. We are now shaping our focus -- sharpening our focus.

這些資產中的許多都可以滿足多種未被滿足的需求。我們將探索這些機會，並在適當情況下擴大適應症，以便更好地服務我們的患者。說到患者，眾所周知，肥胖和糖尿病因人而異，而且常伴隨缺乏有效治療方法的併發症。與收購 Akero 一樣，諾和諾德將繼續透過研究發現創新，然後推進研發，以解決我們核心業務及其重疊領域的合併症問題。我們現在正在調整方向——更明確重點。

In the past, we spread our resources into areas a bit further away from our core. Think about stem cell research for Parkinson's disease. Therefore, during this last quarter, we have discontinued several noncore assets and redirected resources to areas aligned with our strength. We will intensify our commercial efforts to strengthen competitiveness. To meet evolving market dynamics and increasingly consumer-like behavior, we will, for example, expand telehealth capabilities across markets.

過去，我們將資源分散到離核心區域稍遠的地區。想想幹細胞研究在帕金森氏症治療的應用。因此，在上個季度，我們停止了多項非核心資產，並將資源重新分配到與我們優勢相符的領域。我們將加大商業投入，以增​​強競爭力。為了適應不斷變化的市場動態和日益消費者化的行為，我們將例如在各個市場擴大遠距醫療能力。

In short, we remain disciplined about where we will compete within diabetes, obesity, and related comorbidities in the years ahead. We will also continue our targeted research and commercial work in rare disease. And to support this strategy, we have launched a company-wide transformation, which I would like to give you an update on its progress right now. Please go to the next slide.

簡而言之，在未來幾年裡，我們將在糖尿病、肥胖症及相關併發症領域保持專注，明確我們的競爭方向。我們將繼續進行針對罕見疾病的專項研究和商業工作。為了支持這項策略，我們啟動了全公司範圍的轉型，我現在想向大家報告轉型的進展。請進入下一張投影片。

We previously announced a company-wide transformation designed to simplify our operating model, accelerate decision-making and reallocate capital and resource towards the highest growth opportunities in diabetes and obesity. This program supports our strategy to capture rising global demand and strengthening our competitive position in the increasingly consumer-like obesity market. As part of the plan, we expect a reduction of approximately 9,000 positions globally. While this decision was not taken lightly, it is expected to drive approximately DKK8 billion in annual savings by the end of 2026. Those savings will be redeployed to expand our diabetes and obesity franchises and fund strategic priorities.

我們先前宣布了一項公司範圍內的轉型計劃，旨在簡化我們的營運模式，加快決策速度，並將資本和資源重新分配到糖尿病和肥胖症領域最具成長潛力的領域。該計劃旨在支持我們抓住不斷增長的全球需求，並加強我們在日益以消費者為中心的肥胖症市場的競爭地位。作為該計劃的一部分，我們預計全球範圍內將裁減約 9000 個職位。雖然這項決定並非輕率做出，但預計到 2026 年底，每年將節省約 80 億丹麥克朗。節省下來的資金將重新用於擴大我們的糖尿病和肥胖症業務，並為策略重點項目提供資金。

We recognize the human impact of these changes and remain committed to responsible transition for affected colleagues. At the same time, we're confident this transformation will increase operational efficiency and strengthen our long-term future and enhance return for our shareholders.

我們認識到這些變化對員工的影響，並將繼續致力於為受影響的同事提供負責任的過渡方案。同時，我們相信此次轉型將提高營運效率，增強我們的長期發展前景，並提高股東回報。

I will now hand over to Ludovic for an update on our commercial execution for the first nine months of 2025.

現在我將把發言權交給 Ludovic，讓他報告一下我們 2025 年前九個月的商業執行情況。

Thank you very much, Mike, and please turn to the next slide. In the first nine months of 2025, our total sales increased by 15%. The sales growth was driven by both operating units. US operations grew 15%, and international operations grew 16%. Sales growth in the first nine months of 2025 was positively impacted by one-offs in the US of around DKK6 billion.

非常感謝你，麥克，請翻到下一張投影片。2025 年前九個月，我們的總銷售額成長了 15%。銷售成長是由兩個營運部門共同推動的。美國業務成長了 15%，國際業務成長了 16%。2025 年頭九個月的銷售成長受到美國約 60 億丹麥克朗一次性收入的正面影響。

Our GLP-1 sales in diabetes increased by 10%, driven by both operating units growing at the same rate. Insulin sales increased by 3%, driven by US operations growing 18%. The sales increase was positively impacted by gross to net adjustments related to prior years as well as channel and payer mix. This was partially countered by a decline in volume. International operations sales decreased 2%.

我們的 GLP-1 在糖尿病領域的銷售額成長了 10%，這主要得益於兩個營運部門以相同的速度成長。胰島素銷售額成長了 3%，其中美國業務成長了 18%。銷售額成長受到與往年相關的毛利淨利調整以及通路和付款方組合的正面影響。銷量下降部分抵消了這一影響。國際業務銷售額下降2%。

Obesity care sales increased 41%, driven by US operations growing 24% and international operations growing 83%. Our rare disease sales increased by 13%. This was driven by sales increase in the US of 14% and in international operations of 13%. Next slide, please.

肥胖症護理產品銷售額成長了 41%，其中美國業務成長了 24%，國際業務成長了 83%。我們的罕見疾病產品銷售額成長了13%。這主要得益於美國市場銷售額成長 14% 和國際業務銷售額成長 13%。請看下一張投影片。

Sales in international operations grew by 16% in the first nine months of 2025, driven by GLP-1 products. GLP-1 diabetes sales increased by 10%, driven by sales growth of Ozempic and Rybelsus. In Region China, GLP-1 diabetes sales decreased by 4%, which was negatively impacted by wholesaler inventory movements. Obesity care grew by 83% to DKK22.4 billion. Sales of Wegovy reached approximately DKK20 billion growing at 168%, driven by sales growth across all regions. Please go to next slide.

2025 年頭九個月，國際業務銷售額成長了 16%，主要得益於 GLP-1 產品的推動。GLP-1 糖尿病藥物銷售額成長了 10%，主要得益於 Ozempic 和 Rybelsus 的銷售成長。在中國地區，GLP-1 糖尿病藥物的銷售額下降了 4%，這受到了批發商庫存變動的負面影響。肥胖症治療支出成長了 83%，達到 224 億丹麥克朗。Wegovy 的銷售額達到約 200 億丹麥克朗，成長 168%，這主要得益於所有地區的銷售成長。請進入下一張投影片。

In the combined diabetes and obesity GLP-1 market, Novo Nordisk remains the market leader in international operations with a volume market share of 68%. Rybelsus is now available in more than 40 countries, and Ozempic continues to be the leading GLP-1 diabetes product within international operations have been launched in around 80 countries.

在糖尿病和肥胖症 GLP-1 市場中，諾和諾德在國際業務中仍保持市場領先地位，市佔率為 68%。Rybelsus 目前已在 40 多個國家上市，而 Ozempic 仍然是領先的 GLP-1 糖尿病產品，其國際業務已在約 80 個國家推出。

In obesity, Wegovy is now launched in more than 45 countries with more to come. Oral semaglutide 25-milligram or Wegovy in a pill has been submitted in the EU for potential launch in selected EU markets. The GLP-1 class growth of 35% in international operations is encouraging. And while competition in diabetes and obesity across international operations is intensifying, the unmet needs remain substantial.

在肥胖症領域，Wegovy 目前已在超過 45 個國家推出，未來也將涵蓋更多國家。口服司美格魯肽 25 毫克錠（Wegovy）已向歐盟提交申請，預計將在部分歐盟市場上市。GLP-1類藥物在國際業務中成長35%，令人鼓舞。儘管國際上在糖尿病和肥胖症領域的競爭日益激烈，但未滿足的需求仍然很大。

And with that, I would like to hand it over to Dave for an update on our US operations.

接下來，我將把發言權交給戴夫，請他報告我們在美國的業務進度。

Thank you, Ludovic. Please go to the next slide. Sales of GLP-1 diabetes care products in the US increased by 10% in the first nine months of 2025. The sales increase was driven by continued uptake of Ozempic, partially countered by Victoza and Rybelsus.

謝謝你，路德維克。請進入下一張投影片。2025 年頭九個月，美國 GLP-1 糖尿病照護產品的銷售額成長了 10%。銷售額的成長主要得益於 Ozempic 的持續暢銷，但 Victoza 和 Rybelsus 的銷量在一定程度上抵消了這一增長。

Ozempic sales in the US were positively impacted by gross to net sales adjustments and wholesaler stocking. Weekly Ozempic prescriptions are currently around 670,000 in standard units compared to 690,000 standard units in the second quarter of 2025.

美國的 Ozempic 銷售額受到毛利淨利利調整和批發商庫存增加的正面影響。目前每週 Ozempic 的處方量約為 67 萬個標準單位，而 2025 年第二季將達到 69 萬個標準單位。

The GLP-1 diabetes market grew around 10% in the third quarter of 2025 compared to the third quarter of 2024. In the US, we continue to invest in commercial activities and have recently launched Ozempic in our direct-to-patient cash offering. Please go to the next slide.

與 2024 年第三季相比，2025 年第三季 GLP-1 糖尿病市場成長了約 10%。在美國，我們繼續投資商業活動，最近透過直接面向患者的現金發行方式推出了 Ozempic。請進入下一張投影片。

Wegovy sales increased by 25% in the US operations in the first nine months of 2025. The Wegovy sales growth was driven by increased volumes, partially countered by lower realized prices. Wegovy has around 270,000 weekly prescriptions compared to 280,000 weekly prescriptions at the end of last quarter.

2025 年前九個月，Wegovy 在美國的銷售額成長了 25%。Wegovy 的銷售成長主要得益於銷售量增加，但部分被售價下降所抵銷。Wegovy 目前的每週處方量約為 27 萬份，而上一季末的每週處方量為 28 萬份。

In August, we announced that the US FDA approved Wegovy for the treatment of MASH. In US operations, we have established a sales force targeting US hepatologists and gastroenterologists while we work to build access in this segment.

8 月，我們宣布美國 FDA 批准 Wegovy 用於治療 MASH。在美國業務方面，我們已組建一支銷售團隊，目標客戶為美國肝病學家和胃腸病學家，同時我們也努力拓展在這個領域的市場。

Generally, we also continue to work on expanding access to safe and authentic Wegovy. Around 55 million people with obesity have Wegovy coverage in the US with more than 10 million people estimated to be covered with Medicaid. However, looking into 2026, several states have already announced changes to coverage for obesity medicines in response to budgetary concerns, which will affect Medicaid access to Wegovy.

總的來說，我們也持續努力擴大安全可靠的 Wegovy 的普及範圍。美國約有 5,500 萬名肥胖症患者享有 Wegovy 保險，另有超過 1,000 萬人估計享有 Medicaid 保險。然而，展望 2026 年，一些州已經宣布對肥胖症藥物的承保範圍進行調整，以應對預算問題，這將影響 Medicaid 獲得 Wegovy 的機會。

Regrettably, Novo Nordisk market research shows that compounding has continued to increase. Multiple entities continue to market and sell compounded GLP-1s and it is now estimated to be well above 1 million patients in the US that are currently on compounded GLP-1. Novo Nordisk launched NovoCare Pharmacy in March of 2025 and together with retail channel, total cash market is up around 10% of total Wegovy prescriptions.

遺憾的是，諾和諾德的市場調查顯示，複合成長仍在持續。許多實體繼續銷售複合 GLP-1 製劑，據估計，目前美國有超過 100 萬名患者正在接受複合 GLP-1 製劑治療。諾和諾德於 2025 年 3 月推出了 NovoCare Pharmacy，加上零售通路，現金市場總額佔 Wegovy 處方總量的約 10%。

Novo Nordisk will continue to invest in the expansion of direct-to-patient initiatives like the recently announced collaborations with GoodRx and Costco. We continue to anticipate a regulatory decision regarding Wegovy in a pill later this year, which then we will be ready to launch in early 2026.

諾和諾德將繼續投資擴大直接面向患者的舉措，例如最近宣布與 GoodRx 和 Costco 的合作。我們繼續期待今年稍後能就藥丸形式的 Wegovy 做出監管決定，屆時我們將準備好在 2026 年初推出該產品。

Now back to you, Ludovic.

現在把鏡頭交還給你，路德維克。

Thanks, Dave. Please turn to the next slide. Yesterday, we confirmed that we submitted an updated proposal to acquire Metsera to further strengthen our research and development portfolio in diabetes and obesity. As we said before, unlocking the full potential of the obesity market will require a broad and deep portfolio with different treatment options, formats, serving differentiation groups and their very different preferences.

謝謝你，戴夫。請翻到下一張投影片。昨天，我們確認已提交一份更新的收購 Metsera 的提案，以進一步加強我們在糖尿病和肥胖症領域的研發實力。正如我們之前所說，要充分發揮肥胖市場的潛力，需要一個廣泛而深入的產品組合，其中包含不同的治療方案、形式，服務於不同的群體及其截然不同的偏好。

Obesity treatment is still in its early stage. And in Novo Nordisk, we foresee future patient segments that, for example, could be categorized based on BMI, age, gender, lifestyle behaviors, and comorbidities.

肥胖症治療仍處於起步階段。在諾和諾德，我們預見未來的患者群體，例如可以根據 BMI、年齡、性別、生活方式行為和合併症進行分類。

We believe that Metsera's innovative pipeline would further enhance our opportunity to meet all these very different needs of all these very different groups. MET-097 is a potential best-in-class once-monthly GLP-1 treatment and MET-233 is a next-generation amylin asset. The pipeline of Metsera also includes a combination of the 2 mentioned above as well as innovative oral and injectable preclinical assets.

我們相信，Metsera 的創新產品線將進一步增強我們滿足所有這些不同群體的不同需求的機會。MET-097 是一種潛在的同類最佳的每月一次的 GLP-1 治療藥物，而 MET-233 是一種下一代胰淀素資產。Metsera 的產品線還包括上述兩種藥物的組合，以及創新的口服和注射用臨床前資產。

Furthermore, Metsera's institutional knowledge and capabilities around peptide engineering and synthesis, half-life extension technologies and oral peptide delivery nicely complements Novo Nordisk's core strength in research. The proposed deal structure includes an upfront payment of USD62.2 per share in cash, equal to an approximate enterprise value of USD6.7 billion. The cash consideration is paid at signing in exchange for non-voting preferred stock, representing 50% of Metsera's shared capital.

此外，Metsera 在勝肽工程和合成、半衰期延長技術和口服勝肽遞送方面的機構知識和能力，與 Novo Nordisk 在研究方面的核心優勢形成了很好的互補。擬議的交易結構包括每股 62.2 美元的現金預付款，相當於約 67 億美元的企業價值。簽約時支付現金對價，換取無投票權的優先股，佔 Metsera 股本的 50%。

In addition, up to USD2.8 billion in contingent value right CVRs will be issued upon the closing of the acquisition in exchange for the remaining shares. The CVRs are based on the achievement of certain clinical and regulatory milestones. In total, Metsera is eligible to receive up to USD10 billion or USD86.2 per share. Novo Nordisk believes that the proposal, including the structure of the transaction complies with all applicable laws and is in the best interest of patients, who will benefit from our commitment to innovation as well as Metsera's shareholders. The offer highlights Novo Nordisk's commitment to investing in the US and interest in continuing to grow the scale of its US investment.

此外，收購完成後，將發行高達 28 億美元的或有價值權 CVR，以換取剩餘股份。臨床價值聲明 (CVR) 是基於某些臨床和監管里程碑的實現而製定的。總計，Metsera 有資格獲得高達 100 億美元或每股 86.2 美元的資金。諾和諾德認為，該提案（包括交易結構）符合所有適用法律，符合患者的最大利益，患者將受益於我們對創新的承諾，同時也將使Metsera的股東受益。該提案凸顯了諾和諾德對投資美國的承諾，​​以及繼續擴大其在美國投資規模的意願。

Now over to you, Martin.

現在輪到你了，馬丁。

Thank you, Ludovic. Please turn to the next slide. As Mike described, we are intensifying our focus on key therapeutic areas such as diabetes and obesity, while continuing our commitment to related comorbidities as well as rare disease. The strategy aligns with our recent acquisition agreements of Akero and Omeros' zaltenibart assets. In early October, we announced the agreement to acquire Akero's efruxifermin, a once-weekly subcutaneous long-acting FGF21 analog with potential to be first to market in F4 and best in class. Efruxifermin complements a strategic position in Novo Nordisk MASH pipeline.

謝謝你，路德維克。請翻到下一張投影片。正如麥克所描述的那樣，我們正在加大對糖尿病和肥胖等關鍵治療領域的關注力度，同時繼續致力於相關合併症以及罕見疾病的研究。該策略與我們最近對 Akero 和 Omeros 的 zaltenibart 資產的收購協議相一致。10 月初，我們宣布了收購 Akero 的 efruxifermin 的協議，這是一種每週一次皮下注射的長效 FGF21 類似物，有望成為 F4 領域首個上市的產品，並且是同類最佳產品。Efruxifermin 完善了 Novo Nordisk 在 MASH 產品線中的戰略地位。

Current treatment options such as Wegovy, primarily target patients with F2 and F3 disease states. Consequently, there remains a significant unmet need in the F4 cirrhosis population, for which no approved therapies are currently available.

目前的治療方案，如 Wegovy，主要針對 F2 和 F3 疾病狀態的患者。因此，F4 肝硬化患者族群仍存在巨大的未滿足需求，目前尚無核准的治療方法。

The Phase 2 data for efruxifermin are encouraging across F2 to F4. Specifically, the SYMMETRY Phase 2B trial demonstrates that after 96 weeks of treatment, 29% of F4 patients show improvement of at least 1 fibrosis stage with no worsening of MASH and 42% achieved MASH resolution with fibrosis -- without fibrosis worsening. This is the first Phase 2 trial to show statistically significant fibrosis regression in F4 patients for an FGF21 analog.

efruxifermin 的 2 期臨床試驗數據在 F2 至 F4 階段均表現令人鼓舞。具體來說，SYMMETRY 2B 期試驗表明，經過 96 週的治療，29% 的 F4 患者至少改善了 1 個纖維化階段，且 MASH 沒有惡化；42% 的患者實現了 MASH 消退，纖維化也沒有惡化。這是第一個在 F4 患者中，使用 FGF21 類似物顯示出具有統計意義的纖維化消退的 2 期試驗。

Efruxifermin is currently in the Phase 3 SYNCHRONY program with pivotal readouts in the coming years and expected launch by the end of this decade. As a result, efruxifermin has the potential to be first-in-class FGF21 analog targeting the F4 population as well as playing a role in F2 and F3 patients, including people who are not responsive to existing treatments.

Efruxifermin 目前處於 SYNCHRONY 3 期臨床試驗階段，關鍵性結果將在未來幾年公佈，預計將在本世紀末上市。因此，efruxifermin 有可能成為第一個針對 F4 族群的 FGF21 類似物，同時也能在 F2 和 F3 患者中發揮作用，包括對現有治療無反應的患者。

We look forward to leveraging our capabilities to further optimize the SYNCHRONY program trials, assess the potential combinations with our current GLP-1-based portfolio, and explore opportunities for additional indications such as alcohol liver disease.

我們期待利用我們的能力進一步優化 SYNCHRONY 項目試驗，評估與我們目前基於 GLP-1 的產品組合的潛在組合，並探索其他適應症（如酒精性肝病）的機會。

Also in October, we announced the agreement to acquire the clinical stage MASP-3 inhibitor zaltenibart from Omeros for rare blood and kidney disorders. This action aligns with the rare disease strategy with a key focus on rare blood disorders.

同樣在 10 月份，我們宣布了從 Omeros 收購處於臨床階段的 MASP-3 抑制劑 zaltenibart 的協議，該藥物用於治療罕見的血液和腎臟疾病。此舉符合罕見疾病策略，重點在於罕見血液疾病。

Zaltenibart is currently in Phase 2 for the acquired rare blood disease paroxysmal nocturnal hemoglobinuria or PNH. Plans are in place to begin a global Phase 3 program for zaltenibart in PNH. The molecule holds big potential in a number of additional indications within rare disease and kidney disorders, which will be evaluated at a later point in time. We believe our extensive expertise in the development, manufacturing and commercialization of medicines within these fields makes us well positioned to advance these assets, optimize the value of their innovation and ensure they reach the patients in need of these treatments in a very timely fashion. Please turn to the next slide.

Zaltenibart 目前處於治療罕見後天性血液疾病陣發性睡眠性血紅素尿症 (PNH) 的 II 期臨床試驗階段。目前已製定計劃，啟動針對 PNH 的 zaltenibart 的全球 3 期臨床試驗項目。該分子在罕見疾病和腎臟疾病等多種其他適應症方面具有巨大潛力，這些潛力將在以後進行評估。我們相信，我們在這些領域藥物的開發、生產和商業化方面的豐富專業知識，使我們能夠更好地推進這些資產，優化其創新價值，並確保及時將藥物送到需要這些治療的患者手中。請翻到下一張投影片。

Looking towards our internal pipeline, we recently published a sub-analysis of REDEFINE 1, focusing on cagrilintide. In the trial, cagrilintide achieved 11.8% weight loss at 68 weeks, assuming full treatment adherence. About one in three patients on cagrilintide lost at least 15% of their body weight. Overall, cagrilintide was very well tolerated. The most common side effects were gastrointestinal of nature. And the discontinuation rate due to gastrointestinal adverse events was 1.3%.

展望我們的內部研發管線，我們最近發布了 REDEFINE 1 的子分析，重點關注卡格里林肽。試驗中，假設患者完全堅持治療，卡格里林肽在 68 週時可使體重減輕 11.8%。在接受卡格里林肽治療的患者中，約有三分之一體重減輕了至少 15%。總體而言，卡格里林肽的耐受性非常好。最常見的副作用是胃腸道方面的。因胃腸道不良事件導致的停藥率為 1.3%。

Obesity is a global challenge that requires continued scientific innovation. More treatment options also focusing on tolerability are needed to meet their diverse individual needs and preferences. We are very encouraged by the first Phase 3 data for cagrilintide from REDEFINE 1, and we look forward to studying it further in Phase 3, the so-called RENEW program.

肥胖是一個全球性挑戰，需要持續的科學創新。需要更多注重耐受性的治療方案來滿足他們多樣化的個別需求和偏好。我們對 REDEFINE 1 中 cagrilintide 的首個 3 期數據感到非常鼓舞，並期待在 3 期（即所謂的 RENEW 計劃）中對其進行進一步研究。

RENEW 1 and RENEW 2 will assess the 2.4 milligram dose in people with obesity with and without type 2 diabetes, respectively. Both trials have already been initiated and additional studies evaluating higher doses of cagrilintide are anticipated in the beginning of first half of 2026. Please turn to the next slide.

RENEW 1 和 RENEW 2 將分別評估 2.4 毫克劑量對患有第 2 型糖尿病和未患有第 2 型糖尿病的肥胖族群的效果。這兩項試驗均已啟動，預計將於 2026 年上半年初開展更多評估更高劑量卡格里林肽的研究。請翻到下一張投影片。

Turning to the upcoming R&D milestones. We're looking forward to the remainder of 2025 with a number of readouts and milestones. In the first half of 2026, we anticipate the readout of the REIMAGINE 3, which is the first of three pivotal trials for CagriSema and people with type 2 diabetes. REIMAGINE 3 is a smaller study with CagriSema as an add on to basal insulin.

接下來展望即將到來的研發里程碑。我們期待在 2025 年剩餘的時間裡，能夠公佈一系列數據並實現多個里程碑。我們預計將在 2026 年上半年公佈 REIMAGINE 3 的結果，這是 CagriSema 治療 2 型糖尿病患者的三個關鍵性試驗中的第一項。REIMAGINE 3 是一項規模較小的研究，將 CagriSema 作為基礎胰島素的附加療法。

REIMAGINE 2 is the largest study, which will provide comparison to semaglutide and will read out in the first quarter of 2026. We also look forward to the Phase 2 results of the subcutaneous and oral amycretin in type 2 diabetes in Q4 this year.

REIMAGINE 2 是規模最大的研究，將與索馬魯肽進行比較，並將於 2026 年第一季公佈結果。我們也期待今年第四季皮下和口服阿米克林治療第 2 型糖尿病的 2 期臨床試驗結果。

Within obesity, we completed the Phase 1 trial with our internal GLP-1/GIP/amylin triagonist. The study assessed the safety, tolerability, pharmacokinetics, and pharmacodynamics of the triagonist in the trial. All multiple doses tested appear to have a safe and well-tolerated profile. The result of this study allowed progression to a Phase 1B/2 trial in individuals with overweight obesity, which was initiated in October of 2025.

在肥胖症領域，我們完成了我們自主研發的 GLP-1/GIP/胰淀素三激動劑的 1 期試驗。該研究評估了試驗中三種激動劑的安全性、耐受性、藥物動力學和藥效學。所有測試的多劑量組均顯示出安全性和良好的耐受性。這項研究的結果使得針對超重肥胖個體的 1B/2 期試驗得以推進，該試驗於 2025 年 10 月啟動。

Looking forward, we expect the FDA decision regarding the new drug application for the Wegovy pill by the end of this year. Further, the submission of CagriSema as well as the readout of the REDEFINE 4 trial remains on track for the first quarter of 2026.

展望未來，我們預計FDA將在今年年底前對Wegovy藥丸的新藥申請做出決定。此外，CagriSema 的提交以及 REDEFINE 4 試驗的結果公佈仍按計劃在 2026 年第一季度進行。

Within rare disease, we have filed Mim8 as once monthly, once every two weeks and once weekly prophylaxis treatment to prevent or reduce the frequency of bleeding episodes in people with hemophilia A with and without inhibitors for regulatory approval in the US and in EU.

在罕見疾病領域，我們已向美國和歐盟提交了 Mim8 的上市申請，該藥物可作為每月一次、每兩週一次和每週一次的預防性治療藥物，用於預防或減少患有 A 型血友病（伴或不伴抑製劑）患者的出血發作頻率。

Finally, we anticipate the results of the evoke trials in patients with early Alzheimer's disease later this year. While there are a number of high unmet need for the treatment of Alzheimer's disease, it is important to remind you that this represents a high-risk opportunity. And as the very final remark, while it is not on the slide, I would be remiss if I don't mention that the first readout of ziltivekimab is anticipated to read out in the second half of 2026.

最後，我們期待今年稍後能獲得早期阿茲海默症患者誘發試驗的結果。雖然阿茲海默症治療方面存在許多未被滿足的迫切需求，但重要的是要提醒您，這代表著一個高風險的機會。最後，雖然投影片上沒有提到，但我還是要提一下，預計 ziltivekimab 的首次讀數將在 2026 年下半年公佈。

With that, over to you, Karsten.

那麼，接下來就交給你了，卡斯騰。

Thank you, Martin. Please turn to the next slide. In the first nine months of 2025, our sales grew by 12% in Danish kroner and by 15% at constant exchange rates, driven by both operating units. In the third quarter, DKK9 billion in costs related to the restructuring was booked. The gross margin decreased to 81.0% compared to 84.6% in 2024. The decline in gross margin mainly reflects impact of around DKK3 billion from the one-off restructuring costs and impairments related to a few production assets.

謝謝你，馬丁。請翻到下一張投影片。2025 年頭九個月，我們的銷售額以丹麥克朗計算成長了 12%，以固定匯率計算成長了 15%，這主要得益於兩個營運部門的共同努力。第三季計入了與重組相關的 90 億丹麥克朗成本。毛利率從 2024 年的 84.6% 下降至 81.0%。毛利率下降主要反映了約 30 億丹麥克朗的一次性重組成本以及與少數生產資產相關的減損的影響。

Further cost of goods sold are impacted by amortization and depreciations related to Catalent as well as costs related to ongoing capacity expansions.

銷售成本也會受到與 Catalent 相關的攤銷和折舊以及與持續產能擴張相關的成本的影響。

Sales and distribution costs increased by 12% in Danish kroner and by 15% at constant exchange rates. The increase in costs is driven by both US operations and international operations and is primarily related to Wegovy. S&D costs are impacted by one-off restructuring costs of around DKK2 billion.

銷售和分銷成本以丹麥克朗計算上漲了 12%，以固定匯率計算上漲了 15%。成本增加是由美國業務和國際業務共同推動的，主要與 Wegovy 有關。銷售和分銷成本受到約 20 億丹麥克朗的一次性重組成本的影響。

Research and development costs increased by 9% in Danish kroner and by 10% at constant exchange rates. This reflects increased R&D activity across the early and late-stage portfolio, particularly within obesity care. R&D costs are impacted by one-off restructuring costs of around DKK4 billion and impairments related to the closure of early non-core projects to free up resources for projects in core therapy areas. This is partially countered by the impairment loss related to ocedurenone of DKK5.7 billion and other impairments of intangible assets in 2024.

以丹麥克朗計算，研發成本成長了 9%；以固定匯率計算，成長了 10%。這反映出早期和後期產品組合的研發活動增加，尤其是在肥胖症治療領域。研發成本受到一次性重組成本（約 40 億丹麥克朗）以及因關閉早期非核心計畫而產生的減損的影響，關閉非核心計畫是為了騰出資源用於核心治療領域的計畫。但這部分被 2024 年與奧塞杜酮相關的 57 億丹麥克朗減損損失和其他無形資產減損所抵銷。

Operating profit increased by 5% measured in Danish kroner and by 10% at constant exchange rates. Operating profit adjusted for costs related to the restructuring increased by 16% measured in Danish kroner and 21% at constant exchange rates. Net profit increased by 4% and diluted earnings per share increased by 4% to DKK16.99.

以丹麥克朗計算，營業利潤成長了 5%；以固定匯率計算，營業利益成長了 10%。經重組相關成本調整後的營業利潤以丹麥克朗計算成長了 16%，以固定匯率計算成長了 21%。淨利成長 4%，稀釋後每股收益成長 4% 至 16.99 丹麥克朗。

Free cash flow in the first nine months of 2020 was DKK63.9 billion compared to DKK71.8 billion in the first nine months of 2024, driven by increased capital expenditures. And finally, in the first nine months of 2025, we have returned DKK53 billion to shareholders, mainly through dividend payments. Please go to the next slide.

2020 年頭九個月的自由現金流為 639 億丹麥克朗，而 2024 年頭九個月的自由現金流為 718 億丹麥克朗，這主要得益於資本支出的增加。最後，在 2025 年的前九個月，我們已向股東返還了 530 億丹麥克朗，主要透過股利支付。請進入下一張投影片。

For 2025, sales growth is now expected to be 8% to 11% at constant exchange rates. The new range reflects lower expectations for sales growth of our GLP-1 treatments in diabetes and obesity. Given the current exchange rate versus the Danish kroner, sales growth reported in Danish kroner is expected to be around 4 percentage points lower than constant exchange rate growth.

預計到 2025 年，以固定匯率計算，銷售額成長率將達到 8% 至 11%。新系列產品反映了我們對糖尿病和肥胖症 GLP-1 治療藥物銷售成長的預期降低。鑑於目前的丹麥克朗匯率，以丹麥克朗計價的銷售成長率預計將比以固定匯率計算的成長率低約 4 個百分點。

In international operations, the updated outlook reflects current growth trends driven by GLP-1 penetration in diabetes and obesity, partially offset by intensifying competition within both diabetes and obesity. In US operations, the outlook is based on current prescription trends for Wegovy and Ozempic as well as intensifying competition and pricing pressure within both diabetes and obesity.

在國際業務方面，更新後的展望反映了目前由 GLP-1 在糖尿病和肥胖症領域的滲透所推動的成長趨勢，但糖尿病和肥胖症領域日益激烈的競爭部分抵消了這一趨勢。在美國業務方面，前景是基於 Wegovy 和 Ozempic 目前的處方趨勢，以及糖尿病和肥胖症領域日益激烈的競爭和價格壓力。

Operating profit is now expected to be 4% to 7% at constant exchange rates, negatively impacted by DKK8 billion in restructuring costs. Given the current exchange rates versus Danish kroner, growth reported in Danish kroner is expected to be around 6 percentage points lower than at constant exchange rates. The narrowing of the guidance range mainly reflects the lower sales growth outlook and costs related to the agreed acquisition of Akero and Omeros, partially countered by reduced spending.

受 80 億丹麥克朗重組成本的負面影響，以固定匯率計算，營業利潤預計為 4% 至 7%。鑑於目前的丹麥克朗匯率，以丹麥克朗計價的經濟成長預計將比以固定匯率計算的成長率低約 6 個百分點。業績指引範圍的收窄主要反映了銷售成長前景的下調以及與收購 Akero 和 Omeros 相關的成本，但部分被支出減少所抵銷。

Novo Nordisk expects net financial items to show a gain of around DKK2.6 billion, driven by gains on hedged currencies, whereas capital expenditure is now expected to be around DKK60 billion driven by adjustments to expansion plans. Free cash flow is now expected to be DKK20 million to DKK30 billion, reflecting lower-than-expected trade receivables in the US and reduction in capital expenditure. Furthermore, the free cash flow guidance assumed an impact from the acquisition of Akero contingent on final timing of closing. Potential financial impacts related to the potential acquisition of Metsera has not been included.

諾和諾德預計淨財務項目收益約 26 億丹麥克朗，主要得益於對沖貨幣收益；而資本支出預計約為 600 億丹麥克朗，主要得益於擴張計畫的調整。由於美國貿易應收款低於預期以及資本支出減少，預計自由現金流為 2,000 萬至 300 億丹麥克朗。此外，自由現金流預期假設收購 Akero 的影響取決於最終交割時間。尚未計入與潛在收購 Metsera 相關的潛在財務影響。

For the coming years, Novo Nordisk has previously informed that the compound patent expiry of semaglutide molecule in certain countries in international operations is expected to have an estimated negative low single-digit impact on global sales growth in 2026. In 2026, the agreed acquisition of Akero is expected to lead to increased R&D costs with an estimated negative impact on full-year operating profit growth of around 3 percentage points depending on the timing of closing.

諾和諾德先前曾表示，未來幾年，由於司美格魯肽分子在某些國家的國際業務專利到期，預計到 2026 年，將對全球銷售成長產生約個位數的負面影響。預計 2026 年對 Akero 的收購將導致研發成本增加，並可能對全年營業利潤成長產生約 3 個百分點的負面影響，具體取決於交易完成的時間。

Lastly, Novo Nordisk accepted the Inflation Reduction Act maximum fair price, MFP, for Ozempic, Rybelsus, and Wegovy in Medicare Part D for 2027. The estimated direct impact of semaglutide MFP in Medicare Part D had it been introduced first of January 2025, would have been a negative low single-digit impact on global sales growth for the full year of 2025. The MFPs for semaglutide will be effective as of 1st of January 2027 in Medicare Part D in the US.

最後，諾和諾德接受了《通貨膨脹降低法案》規定的 Ozempic、Rybelsus 和 Wegovy 在 2027 年醫療保險 D 部分中的最高公平價格 (MFP)。如果 semaglutide MFP 於 2025 年 1 月首次在 Medicare Part D 中推出，預計其直接影響將對 2025 年全年全球銷售成長產生個位數的負向影響。索瑪魯肽的醫療保險計劃（MFP）將於 2027 年 1 月 1 日起在美國的醫療保險 D 部分生效。

That covers the remaining details on the outlook for 2025. Now back to you, Mike.

以上涵蓋了2025年展望的剩餘細節。現在把鏡頭交還給你，麥克。

Thank you, Karsten. Please turn to the next slide. It's been a busy and productive quarter. Throughout the first nine months of 2025, we delivered 15% sales growth, and nearly 46 million people are now benefiting from our treatments. We have also advanced our R&D pipeline, launched a company-wide transformation program, and announced a few strategically aligned R&D acquisitions and agreements.

謝謝你，卡斯滕。請翻到下一張投影片。這是一個忙碌而富有成效的季度。2025 年前九個月，我們的銷售額成長了 15%，近 4,600 萬人正在受惠於我們的治療。我們也推動了研發管線，啟動了全公司範圍的轉型計劃，並宣布了一些具有戰略意義的研發收購和協議。

With that, back to you, Jacob.

那麼，雅各布，把鏡頭交還給你。

Thank you, Mike. Next slide, please. And with that, we are now ready for the Q&A, please. (Event Instructions) So with that, operator, let's take the first question, please.

謝謝你，麥克。請看下一張投影片。那麼，現在我們準備進入問答環節。（事件說明）那麼，操作員，我們來回答第一個問題吧。

(Operator Instructions) Carsten Lønborg Madsen, Danske Bank.

（操作員指示）Carsten Länborg Madsen，丹斯克銀行。

I think I'll start -- I have two. I'll start out with sort of a relatively basic question for Mike now that it's the first time you have your sort of a real quarterly conference call here. If we look at your roadshow presentation, you can see that in the combined obesity and diabetes market, the GLP-1 market, you lost 9 percentage points global market share over the last 12 months. That's quite a massive loss of share.

我想我會先開始——我有兩個。既然這是你們第一次召開真正的季度電話會議，那我就先問一個比較基本的問題吧。如果我們看一下您的路演簡報，您會發現，在肥胖症和糖尿病合併市場以及 GLP-1 市場中，您在過去 12 個月中失去了 9 個百分點的全球市場份額。這是相當大的市佔率損失。

We obviously knew about this trend. But still, when you look at what you can actually do in terms of strategic initiatives to turn this around, what is it the intangible initiatives that you are thinking about implementing? You tried pricing in US in Q3. It doesn't really seem to have a sort of a big delta effect on your momentum in the US market. So maybe if you could give some examples.

我們當然知道這種趨勢。但是，當你審視自己能夠採取哪些策略措施來扭轉局面時，你正在考慮實施哪些無形措施？你們在第三季嘗試了美國定價策略。它似乎不會對你在美國市場的動能產生很大的影響。所以，或許您可以舉一些例子。

And question two is for Karsten. The acquisitions you have done or are planning to do will lead to sort of a quite significant cash outflow, especially if you get the Metsera. So if you have Akero, Metsera, you have CapEx, you also need to pay dividends next year, I assume. Is there anything you can talk about the capital planning, capital allocation and also how high in the hierarchy is the dividend payout ratio in terms of being extremely important for our investors, of course?

第二個問題是問卡斯滕的。你已經完成或計劃進行的收購將會導致相當大的現金流出，特別是如果你收購了 Metsera。所以，如果你擁有 Akero、Metsera，有資本支出，我猜你明年還需要支付股息。您能否談談資本規劃、資本配置，以及股利支付率在我們的投資人眼中有多重要？當然，這對投資者來說至關重要。

Very good. Thanks for those two questions. On the first one on market share development and perhaps market growth also will turn to you, Mike.

非常好。謝謝您提出的這兩個問題。關於市場佔有率發展以及市場成長的第一個問題，恐怕也要問你了，麥克。

Thank you very much, Carsten. So as someone who has been part of the commercial organization for so long, then I would not lie and say I don't like losing market share. But our job right now is to focus the company's strategy around diabetes and obesity predominantly because we see a huge expansion potential as we go forward.

非常感謝你，卡斯滕。所以，作為一個在商業機構工作了這麼久的人，我不會撒謊說我不喜歡失去市場份額。但我們現在的工作重點是圍繞糖尿病和肥胖症來制定公司策略，因為我們看到了未來巨大的擴張潛力。

We are expanding our pipeline through our own activities as well as, of course, acquisitions. We are getting our costs under control to invest and really make sure that no stone is unturned and we're really putting most of our efforts at this point in expanding the markets. There are millions and millions of diabetes and obesity patients out there, including in the US that are not getting their treatments.

我們正在透過自身業務拓展以及收購來擴大產品線。我們正在控製成本，以便進行投資，確保萬無一失，目前我們正將大部分精力投入拓展市場。世界上有數以百萬計的糖尿病和肥胖症患者，包括美國在內，他們沒有得到治療。

Launching new products like our Wegovy pill is one way to go get there. Other ways is through increasing our commercial partnerships. You have seen Costco, Walmart, GoodRx, LifeMD, Ro, all of those are ways for us to expand the market and really make sure that through that we succeed and have a successful future. But it does take time for those measures to take effect. It's a marathon, as I have said a number of times now, not a sprint.

推出像我們 Wegovy 藥丸這樣的新產品是實現這一目標的途徑之一。另一種方法是透過增加我們的商業合作夥伴關係。你們已經看到了 Costco、沃爾瑪、GoodRx、LifeMD、Ro，所有這些都是我們拓展市場、確保我們成功並擁有美好未來的途徑。但這些措施需要時間才能生效。正如我多次說過的那樣，這是一場馬拉松，而不是短跑。

Thank you, Mike. And for the second question on capital allocation, we'll turn to you, Karsten.

謝謝你，麥克。關於資本配置的第二個問題，我們請你來回答，卡斯滕。

Yeah. Thank you for the capital allocation question. We have a clearly articulated capital allocation framework, which is invest in the business, provided attractive return, pay out dividend in a consistent manner, do pipeline additions through BD and M&A and finally, if excess cash, do share buyback. So that's our framework, which has remained unchanged for quite a while.

是的。感謝您提出的關於資本配置的問題。我們制定了明確的資本配置框架，即投資於業務，以獲得可觀的回報，持續支付股息，透過業務拓展和併購增加業務儲備，最後，如果現金過剩，則進行股票回購。這就是我們的框架，這個框架已經相當長一段時間沒有改變了。

And with that, I'm saying that we do have a consistent approach on dividend and have no intention of changing that. The starting point is clearly to convert our earnings into cash flow, which we focus on each and every day. And then looking at value-generating opportunities, both organically and inorganically as in the case with Akero as an example.

因此，我想說的是，我們在分紅方面一直秉持一貫的方針，並且沒有改變的打算。很顯然，我們的首要任務是將收益轉化為現金流，這也是我們每天努力的方向。然後，著眼於創造價值的機會，包括有機增長和非有機增長，例如 Akero 的案例。

So I hope that's clear. Back to you, Jacob.

希望這一點很清楚。雅各布，該你了。

Thank you, Karsten. And also thanks to you, Carsten, for the two questions. With that, operator, let's turn to the next set of questions, please.

謝謝你，卡斯滕。也要感謝你，卡斯滕，提出了這兩個問題。那麼，操作員，我們就開始下一輪問題吧。

Peter Verdult, BNP Paribas.

Peter Verdult，法國巴黎銀行。

Two questions, please, for Mike and Martin. Mike, don't shoot the messenger, but there are many people that view your pursuit of Metsera as an implicit signal that the -- or your confidence in the internal pipeline has waned over the past 12 months. My question is, where do you see the clinical differentiation between the assets you're looking to acquire versus a cagri, CagriSema and amycretin. Is it just the multi-dosing angle? Or are there other factors at play?

請問我有兩個問題要問麥克和馬丁。麥克，別怪我，但很多人認為你對 Metsera 的追求，暗示著——或者說你對內部人才培養體系的信心在過去 12 個月裡有所減弱。我的問題是，您認為您正在尋求收購的資產與 Cagri、CagriSema 和 Amycretin 之間的臨床差異在哪裡？只是多劑量給藥的角度問題嗎？或者還有其他因素在起作用？

And then secondly, and this is a very simple question. But we've heard overnight from our network that Novo has been contacted by FTC for information relating to Metsera, I know you're not going to go into any details, but can you at least confirm if this is actually the case? Thank you.

其次，這是一個非常簡單的問題。但我們昨晚從我們的管道獲悉，Novo公司已被聯邦貿易委員會聯繫，要求提供有關Metsera的資訊。我知道您不會透露任何細節，但您至少可以確認這是否屬實嗎？謝謝。

Thank you, Pete. And on the first question, on Metsera, we'll turn to you first, Mike, and then Martin, you can add on the different assets.

謝謝你，皮特。關於第一個問題，關於 Metsera，我們先請你回答，Mike，然後 Martin，你可以補充不同的資產。

Thanks very much, Pete. I would say, Pete, that I am very excited about our own pipeline. I think we have a fantastic pipeline. But when you have an ambition to go to hundreds of millions of people and treat them, then no pipeline is broad enough. So we have been looking at Metsera for a long time. We are very excited about these assets. The proposal to acquire Metsera really supports our long-term strategy. And it's mainly because these assets are differentiated and complemented to our products and portfolio. That's why we are doing it.

非常感謝，皮特。皮特，我想說，我對我們自己的管道項目感到非常興奮。我認為我們擁有非常棒的人才儲備。但是，當你的目標是為數億人提供治療時，任何管道都不夠寬廣。我們關注Metsera已經很久了。我們對這些資產感到非常興奮。收購 Metsera 的提議確實符合我們的長期策略。這主要是因為這些資產與我們的產品和投資組合具有差異化和互補性。這就是我們這樣做的原因。

I'll pass it on to Martin, who can more easily explain you the differentiation to our own assets. But I would say it works very complementary to what we have.

我會把它轉交給馬丁，他能更容易地向你解釋這與我們自身資產的差異。但我認為它與我們現有的系統非常互補。

I can only echo that. What we are looking for is complementary to our pipeline. You've heard us speak to many, many times, obesity is not just one disease, it's many different diseases with many different presentations. Different patients coming in with different age, different BMI, different behaviors, different needs, different body composition, and different comorbidities. They have different focus areas.

我完全同意。我們正在尋找與我們現有產品線互補的產品。你們已經聽我們說過很多很多次了，肥胖不是一種疾病，而是多種不同疾病的組合，表現形式也多種多樣。不同的患者年齡不同，BMI不同，行為不同，需求不同，身體組成不同，合併症也不同。他們的關注領域各不相同。

And for us to really serve the full palette of patients suffering for obesity and their comorbidities, we need a diversified pipeline. What we've seen is differentiation and complementarity. And when we see that, then if we can progress that with diligence and in [assumption], then obviously, we're interested.

為了真正服務所有患有肥胖症及其併發症的患者，我們需要多元化的產品線。我們看到的是差異化和互補性。如果我們看到這一點，並且能夠以勤奮和[假設]的態度推進此事，那麼顯然，我們會對此感興趣。

Thank you, Mike, and thank you, Martin. And then on the second question, the FTC, we'll turn to you, Karsten.

謝謝你，麥克，也謝謝你，馬丁。接下來，關於第二個問題，即聯邦貿易委員會（FTC），我們請卡斯滕回答。

Yeah. So the short answer is that at this point, we don't want to get into any details around the process. It's still TBD where everything lands out. We note that Metsera board assessed our to be superior, and that's what we can relate to.

是的。所以簡而言之，目前我們不想深入探討過程的任何細節。最終結果如何，目前尚未確定。我們注意到 Metsera 董事會認為我們的產品更勝一籌，這一點我們深有同感。

And then I can say as part of this due diligence, as with any other due diligence, we do comprehensive homework in terms of living up to all laws and regulations in order for the deal to close. We always do that, and we did that here also with the assistance and channels of external experts. So we are confident that this deal can close according to regulations.

然後我可以說，作為盡職調查的一部分，就像任何其他盡職調查一樣，我們會進行全面的功課，確保遵守所有法律法規，以便完成交易。我們一直都是這樣做的，這次我們也藉助外部專家的幫助和管道做到了這一點。因此我們有信心這筆交易能夠按照規定完成。

Thank you, Pete, for those two deal questions. Let's turn to the next set of questions, please.

謝謝你，皮特，問了這兩個關於交易的問題。請讓我們來看下一組問題。

Florent Cespedes, Bernstein.

弗洛朗·塞斯佩德斯，伯恩斯坦。

One question, a follow-up. About Medicare, maybe could you share with us your view on Medicare, on one hand, the opportunity if there is a broader coverage of people with obesity on this channel. And the second, about the potential risk or the IRA -- the next step on IRA, you gave some color on the press release about that. So any comments about this opportunity and risk on Medicare would be great.

一個問題，一個後續問題。關於醫療保險，您能否與我們分享您對醫療保險的看法？一方面，如果這個管道能夠更廣泛地涵蓋肥胖者，這會帶來怎樣的機會？第二點是關於 IRA 的潛在風險——關於 IRA 的下一步，您在新聞稿中對此做了一些說明。所以，任何關於醫療保險方面的機會和風險的評論都將不勝感激。

Thank you, Florent, for those two questions. For both of those, we'll turn to you, Dave, on Medicare potential and then on IRA.

弗洛倫特，謝謝你提出的這兩個問題。關於這兩個問題，戴夫，我們先請你談談醫療保險的潛力，然後再談談個人退休帳戶（IRA）。

Thanks for the question, Florent. The Medicare opportunity is very important to us and something we've been pursuing since we launched into obesity over a decade ago. And we know that there's roughly 30 million people of Medicare age that are suffering from obesity, and that is something that we feel is really important that those individuals have access to anti-obesity medicines. We can't speculate on what the potential is and how many of those patients will be able to reach, but we do see this as a very important development for us.

謝謝你的提問，弗洛倫特。醫療保險機會對我們來說非常重要，自從十多年前我們開始關注肥胖問題以來，我們就一直在追求這個機會。我們知道，大約有 3000 萬符合醫療保險年齡的人患有肥胖症，我們認為讓這些人能夠獲得抗肥胖藥物是一件非常重要的事情。我們無法預測其潛力以及有多少患者能夠受益，但我們確實認為這對我們來說是一個非常重要的進展。

Regarding your second question about IRA, as Karsten mentioned, we gave an understanding of the expected impact in the company announcement as well. And it's not something that we are able to comment on. We are under strict confidentiality with CMS, and CMS will be making the announcement of what those prices are at some point in the near future.

關於您提出的第二個問題，即 IRA，正如 Karsten 所提到的，我們也在公司公告中說明了預期影響。對此我們無法置評。我們與CMS簽訂了嚴格的保密協議，CMS將在不久的將來公佈這些價格。

Thank you, Dave, and also thanks to you, Florent. And let's move to the next set of questions in line, please.

謝謝你，戴夫，也謝謝你，弗洛倫特。接下來，我們進入下一組問題。

Martin Parkhoi, SEB.

Martin Parkhoi，SEB。

Two questions. I have to come a little bit back to the question that's getting from Carsten because I think he was a little bit kind to you, Mike, with respect to market share loss because if we look at the your old area IO and look at reported sales, then Lilly have actually done a sprint. Two years ago, you had a market share of 80% on all GLP-1 sales on reported numbers. And today, you are at 50%. So can you talk a little bit about what has gone, not wrong for you, but what have they done right in IO to basically capture so much more share than you? Is it commercial execution in IO across the countries? Or is just due to product superiority? Why can they sprint and you cannot?

兩個問題。我必須稍微回到卡斯滕提出的問題上來，因為我認為他對你有點客氣了，麥克，關於市場佔有率損失的問題。因為如果我們看看你以前的區域IO，再看看報告的銷售額，那麼禮來實際上已經取得了飛躍式增長。兩年前，根據公佈的數據，你們在所有 GLP-1 銷售額中佔據了 80% 的市場。今天，你的進度是 50%。那麼，您能否談談發生了什麼事？不是說您那邊出了什麼問題，而是他們在IO方面做對了什麼，才能獲得比您多得多的市場份額？IO在各國的商業執行如何？還是只是因為產品性能更優？為什麼他們能衝刺而你卻不能？

And then second question is just on device strategy. A bit of a setback for Wegovy FlexTouch in US, you had argued for that to be an important part of flexibility in the consumer channel. What are you -- going to '26, are your device strategy overall also with respect to launch of products in vials and in which market would that be relevant?

第二個問題是關於設備策略的。對於 Wegovy FlexTouch 在美國來說，這算是一個小小的挫折，你們曾經認為這是消費者通路彈性的重要組成部分。到 2026 年，你們的整體設備策略是否也包括推出小瓶裝產品？如果是，這將在哪些市場中適用？

Thank you, Martin. On the first question on IO, I'll turn it over to you, Mike.

謝謝你，馬丁。關於IO的第一個問題，我把問題交給你，Mike。

Yeah. Thanks very much. So a couple of different ways to answer your question, Martin. There are markets that we are clearly competing well and gaining market share within IO and there are markets that we are losing. So it is market dynamics that dictates IO and averages sometimes cloud the picture.

是的。非常感謝。馬丁，你的問題可以用幾種不同的方式回答。在某些市場，我們顯然表現出色，並在 IO 領域獲得了市場份額；而在其他市場，我們正在失去市場份額。因此，是市場動態決定了IO，而平均值有時會掩蓋真相。

In certain markets, take China as an example, the market is not growing as much as we had anticipated. We have said it in the past. It's predominantly because we have never launched a previous version of obesity drugs in that market. At the same time, we have seen in the same market that we're losing in the online battle to our competitor, predominantly because obesity drugs or Wegovy is not allowed to be sold online, while if you have a mega brand, then it's a very different picture. So that's, I would say, for China.

在某些市場，例如中國，市場成長速度不如我們預期。我們以前說過。這主要是因為我們之前從未在該市場推出任何版本的減肥藥。同時，我們發現，在同一市場中，我們在與競爭對手的線上競爭中處於劣勢，這主要是因為減肥藥或 Wegovy 不允許在線銷售，而如果你擁有一個超級品牌，情況就完全不同了。所以，我想說，這就是中國的情況。

If you take a look at some of the European markets, take UK as an example. We have seen how our share of growth over a period of one quarter has now bypassed on initiation our competitors' numbers. So this is a dynamic market that changes. And it is really to be seen on a longer horizon and not quarter by quarter.

如果你看看一些歐洲市場，以英國為例。我們已經看到，在一個季度內，我們的成長份額已經超過了競爭對手的份額。這是一個瞬息萬變的動態市場。而且，這確實需要從更長遠的角度來看待，而不是按季度來看。

We still have a patient base more than -- two times more than our competitor in international operations. The volume strategy and the future potential of international is still incredibly attractive for us. But we came to this market with a very high level of market share, 100% on our own. So losing market share is something that we had anticipated. And as our competitor comes and as we go also into next year, it will not just be Eli Lilly, but also in some of the markets, other players as we lose LOE. So we have to look at this longer term. And when we do look at it longer term, I am incredibly optimistic for the volumes and the level of unmet need that exists in international operations.

在國際業務方面，我們的患者群體仍然是競爭對手的兩倍以上。國際市場的規模化策略及其未來潛力對我們來說仍然極具吸引力。但當我們進入這個市場時，憑藉自身實力，已經取得了非常高的市佔率。所以，失去市佔率是我們預料之中的事。隨著競爭對手的出現，以及我們進入明年，不僅會有禮來公司，而且在某些市場，隨著我們失去 LOE，還會有其他公司面臨挑戰。所以我們必須從長遠角度來看這個問題。從長遠來看，我對國際業務的規模和未滿足的需求水準非常樂觀。

Thank you, Mike. And let's move to Dave for the device question, please.

謝謝你，麥克。接下來請Dave回答關於裝置的問題。

Thank you, Martin. Yeah. As you mentioned, it's a setback to receive the CRL on Wegovy FlexTouch. Looking into 2026, we are looking at other presentations. This includes vials. It includes other devices that we're thinking about entering into the market, which would lead to more optionality, especially as we continue to grow in the cash channel as well.

謝謝你，馬丁。是的。正如您所提到的，收到 Wegovy FlexTouch 的 CRL 確實是一個挫折。展望 2026 年，我們正在考慮其他方案。這包括小瓶。它還包括我們正在考慮進入市場的其他設備，這將帶來更多選擇，尤其是在我們繼續拓展現金管道的情況下。

On the FlexTouch specifically, we are in active dialogue with FDA and working through the CRL, but can't comment on any specific time lines yet at this point.

關於 FlexTouch，我們正在與 FDA 積極溝通，並處理 CRL，但目前還無法就具體時間表發表評論。

Thank you, Dave. Thank you, Martin, for the set of two questions. And let's move to the next question, please.

謝謝你，戴夫。謝謝馬丁提出的這兩個問題。我們進入下一個問題吧。

Sachin Jain, Bank of America.

Sachin Jain，美國銀行。

I have two questions please, one commercial, one financial. Commercial on Wegovy pill, just wondering if you could talk about how you're scenario planning around orforglipron pricing given some news overnight and given your API restrictability, your ability to compete on price? And any further color you can give on launch cadence as we think about that launch?

我有兩個問題，一個是商業問題，一個是財務問題。關於 Wegovy 藥片的廣告，我想請教一下，鑑於昨晚的一些新聞以及貴公司 API 的限制，貴公司是如何制定 orforglipron 定價方案的？貴公司在價格方面是否有競爭力？關於產品發布節奏，您還有什麼其他資訊可以補充嗎？

And then second one for Karsten, I'm sure you're expecting the question, but the last couple of years, you've given some high-level color on year forward sort of you'd be willing to just share moving parts as we think about '26. A lot of factors there, gross to net in the base, certain IO patents, Akero, consensus sitting at roughly 7% sales, low teens EBIT, so just any high-level thoughts.

第二個問題問卡斯滕，我相信你預料到了這個問題，但過去幾年，你對未來一年的發展方向進行了一些高層次的展望，你是否願意分享一下我們在思考 2026 年時的一些進展。有很多因素需要考慮，例如毛利潤與淨利潤的比率、某些 IO 專利、Akero、市場普遍預期銷售額約為 7%、息稅前利潤在 10% 左右，所以只是一些高層次的想法。

Thank you, Sachin. The first question on oral sema, let's go to you, Dave, in terms of preparedness. Of course, for competitive reasons, we cannot go into any details, but the high-level picture, Dave.

謝謝你，薩欽。關於口腔黏膜炎的第一個問題，Dave，讓我們來問問你，關於準備工作方面。當然，出於競爭原因，我們不能透露任何細節，但戴夫，大致情況就是這樣。

Yeah. Thanks a lot, Sachin. We're incredibly excited as we move closer to the approval date of the Wegovy pill. I think this is a big step forward in terms of expanding the market and for those individuals that align better with taking a pill for their obesity. We can't comment on specific pricing, of course. But what I would say is we are going to have the Wegovy pill available in all channels.

是的。非常感謝，薩欽。隨著 Wegovy 藥丸獲批日期的臨近，我們感到無比興奮。我認為這對擴大市場而言是一大進步，對於那些更願意服用藥物來控制肥胖的人來說也是如此。我們當然無法對具體價格發表評論。但我想說的是，我們將透過所有管道提供 Wegovy 藥丸。

And this is different from previous launches because we will have the ability to focus on Medicaid, Medicare and commercial, but also have a cash offering available through all of our different telehealth partnerships as well as our own NovoCare Pharmacy and the retail partnerships that we've aligned as well. This is a new way to launch for us. And we're also thinking about the competitiveness. This is a competitive profile with respect to efficacy and tolerability, and we're really looking forward to bringing this to people living with obesity in the US.

這與以往的推出有所不同，因為我們將能夠專注於醫療補助、醫療保險和商業保險，同時還可以透過我們所有的遠距醫療合作夥伴關係、我們自己的 NovoCare 藥局以及我們已達成合作的零售合作夥伴提供現金支付服務。這是我們全新的產品發布方式。我們也在考慮競爭力問題。就療效和耐受性而言，這是一個具有競爭力的指標，我們非常期待將它帶給美國的肥胖症患者。

Thank you, Dave. That's very clear. And the second question, we'll turn it to you, Karsten.

謝謝你，戴夫。這一點很清楚。第二個問題，就交給你來回答吧，卡斯滕。

Yeah. Thank you for that question, Sachin. And I think you actually already captured some of the key elements going into your own question. So the starting point is we do not guide for next year today. We'll come back to guide for next year at a later point in time as we normally do. What I can say is, as always, current momentum is the foundation for future trends in the business. Not saying everything continues, but current momentum is where we start.

是的。謝謝你的提問，薩欽。我認為你其實已經抓住了你問題中的一些關鍵要素。所以，出發點是我們今天不為明年做規劃。我們將像往常一樣，在稍後某個時候再來發布明年的指導方針。我可以肯定地說，一如既往，當前的勢頭是未來商業趨勢的基礎。並非說一切都會繼續下去，但我們是從目前的勢頭開始的。

Then we have a few specific items worth calling out in relation to next year's growth rates. One is this year, we have some gross to net favorability, I would estimate it to around 2 percentage point on group sales growth this year that will not repeat into next year. So that needs to be factored into a growth rate. Then loss of exclusivity in certain IO markets. We've been calling that out for quite some time, including in our release that will have an estimated negative impact of low single digits on next year's sales growth on group sales.

接下來，我們有一些與明年成長率相關的具體事項值得一提。第一點是今年，我們有一些毛利淨利好因素，我估計今年集團銷售成長將達到 2 個百分點左右，但這種情況不會延續到明年。所以，這就需要計入成長率。然後在某些IO市場失去獨家經營權。我們已經指出這一點很長時間了，包括在我們的新聞稿中，預計這將對明年集團銷售額的成長產生個位數百分比的負面影響。

Then on sales, Dave was covering the Wegovy pill, which, of course, is our main launch into next year and upon regulatory approval by the FDA. And then the final discretionary factor to call out is Akero and the step-up in R&D costs associated with that transaction pending closing expected later this year. That will have a 3% negative impact on operating profit growth in 2026.

在銷售方面，Dave 介紹了 Wegovy 藥丸，這當然是我們明年的主要產品，前提是獲得 FDA 的監管批准。最後需要指出的酌情因素是 Akero 以及與該交易相關的研發成本的增加，預計該交易將於今年稍後完成。這將對 2026 年的營業利潤成長產生 3% 的負面影響。

Thank you, Karsten, and thank you to you, Sachin, for those two questions. Now let's move to the next one in line and those set of questions, please.

謝謝卡斯滕，也謝謝薩欽提出的兩個問題。現在我們來看下一組問題。

Mike Nedelcovych, TD Cowen.

邁克·內德爾科維奇，TD Cowen。

I have two. My first is actually a follow-up on Metsera. Martin, can you articulate what specifically about the Metsera agents is differentiated from Novo's own pipeline candidates other than the potential for once monthly dosing? In response to the previous question, you've restated that Metsera is differentiated and complementary, but I'm wondering what public data lead you to that conclusion or if those data are not public, can you confirm that? That's my first question.

我有兩個。我的第一篇文章其實是對 Metsera 的後續報導。Martin，除了每月一次給藥的可能性之外，你能否具體說明一下 Metsera 的藥物與 Novo 自己的在研藥物有哪些區別？針對先前的問題，您重申了 Metsera 具有差異化和互補性，但我想知道是什麼公開數據讓您得出這個結論，或者如果這些數據不是公開的，您能否確認一下？這是我的第一個問題。

And then my second question is on the evoke trials. We are now less than a month away from the CTAD presentation. So I'm assuming that Novo has the data in-house and is simply cleaning them up before top line release ahead of the presentation. So my question is, if it is an unequivocally negative result, would Novo cancel its CTAD presentation?

我的第二個問題是關於誘發試驗的。距離 CTAD 會議報告會還有不到一個月的時間。所以我推測 Novo 公司內部已經掌握了這些數據，只是在發表會之前先對數據進行清理，以便發布最終結果。所以我的問題是，如果結果明確為陰性，諾和諾德會取消在CTAD上的演講嗎？

Thank you, Mike, for those two questions. Now let's start with the first one on revisiting Metsera and the view on differentiation from your side, Martin.

謝謝你，麥克，問了這兩個問題。現在讓我們從第一個問題開始，重新審視 Metsera 以及 Martin 你對差異化的看法。

Yeah. Thank you very much for the question. I don't want to go into specifics, but maybe just to iterate what we're looking at, where we look for complementarity to our pipeline. It's data on efficacy, and those can be differentiated at many levels. It's data on safety and tolerability, a little bit of the same consideration.

是的。非常感謝您的提問。我不想贅述細節，但或許可以重申我們正在關注的內容，即我們尋找與我們現有流程互補的產品。這是關於療效的數據，而療效數據可以從許多層面進行區分。這是關於安全性和耐受性的數據，兩者在某種程度上是相同的考慮因素。

Its scalability. And then obviously, in this case, the dose in frequency. We, on more than one parameter, see complementarity to our pipeline. And therefore, this is an effective proposition for us.

它的可擴展性。然後很明顯，在這種情況下，劑量和頻率也需要考慮。我們從多個方面都看到了與我們現有流程的互補性。因此，這對我們來說是一個有效的方案。

On evoke, I do want to iterate, we do not know the data in-house in this room. If we did, we would actually had to issue a corporate announcement immediately. So no knowledge amongst any of us in this room. Our starting point is to disclose data, good or bad. So we currently aim to present whatever data that we will have at CTAD in the beginning of December.

關於 evoke，我確實想進行迭代，但我們在這個房間裡並不了解內部數據。如果真是這樣，我們就必須立即發佈公司公告。所以，在座各位對此都一無所知。我們的出發點是公開數據，無論好壞。因此，我們目前的目標是在 12 月初的 CTAD 會議上展示我們掌握的所有數據。

Thanks, Martin. That's very clear. And also thank you to you, Mike, for both of those questions. Now let's move to next question, please.

謝謝你，馬丁。這一點很清楚。還有，謝謝你，麥克，問了這兩個問題。現在我們進入下一個問題。

Harry Sephton, UBS.

瑞銀集團的哈里·塞普頓。

Two on the US, please. So just in light of the agreed IRA direct negotiation discounts on semaglutide. And also some of the press reports yesterday on potential obesity Medicare coverage. I don't want you to comment directly, but it appears you'll end up with significantly different prices for your products across different channels. So I wanted to get your thoughts on how you expect that you're able to maintain this segmented pricing by channel? Or should we assume that all prices gradually trend towards the lowest level?

請給我兩份美國版。因此，僅就 IRA 直接談判對索馬魯肽達成的折扣協議而言。昨天還有一些新聞報導提到，肥胖症可能會被納入醫療保險的覆蓋範圍。我不想讓你直接評論，但看起來你的產品在不同管道的定價最終會有很大差異。所以我想了解一下您認為如何才能維持這種按管道劃分的定價模式？或者我們應該假設所有價格都逐漸趨向最低水準？

And then the second one on the US, just on the current US market trends. Can you discuss how you're currently thinking about the levers to improve access and commercial insurance coverage on Wegovy and Ozempic going into next year? Or do you expect that the majority of the 2026 US growth is really going to come from the launch of the Wegovy pill? Thank you.

第二部分是關於美國的，只關注美國當前的市場趨勢。您能否談談您目前考慮如何改善明年 Wegovy 和 Ozempic 的交通便利性和商業保險覆蓋範圍？或者您認為 2026 年美國經濟成長的大部分將真正來自 Wegovy 藥丸的上市？謝謝。

Thank you, Harry. Noted two questions here. I'll send both to you, Dave. The first one on the pricing dynamics and then subsequently on the current access picture. Over to you, Dave.

謝謝你，哈里。這裡有兩個問題。我會把這兩樣都寄給你，戴夫。首先分析定價動態，然後分析目前的准入狀況。接下來該你了，戴夫。

Yeah. Thank you much. As we mentioned, we can't discuss any of the specifics around IRA or MFN, but we do appreciate the question. And the fact that historically, we have been able to maintain different prices in different channels, given that be Medicaid, Medicare or commercial and now are increasingly expanding cash channel. Of course, we can't speculate what that will mean in the future. But historically, we have been able to maintain the differentiation between those markets and the access that comes with it.

是的。非常感謝。正如我們之前提到的，我們不能討論有關 IRA 或 MFN 的任何具體細節，但我們感謝您的提問。而且，從歷史上看，我們一直能夠在不同的管道（無論是醫療補助、醫療保險還是商業管道）中維持不同的價格，現在我們正在不斷擴大現金管道。當然，我們無法推測這在未來意味著什麼。但從歷史上看，我們一直能夠維持這些市場之間的差異化以及隨之而來的進入機會。

To your second question around the trends in terms of the quality of access, it's something that continues to be really important for us as sometimes receiving an obesity medication can be a challenge because of the friction that exists in the marketplace. So we are continuing to push for and invest in improved access. It's a clear priority for us. This includes both our cash offerings. It's also what we do with payers.

關於您提出的第二個問題，即獲取藥物品質的趨勢，這對我們來說仍然非常重要，因為有時獲得肥胖藥物可能是一個挑戰，因為市場上存在摩擦。因此，我們將繼續努力並投資改善醫療服務取得途徑。這顯然是我們的首要任務。這包括我們的現金發行方案。這也是我們對付款方所做的事情。

But we haven't seen a large uptake yet in terms of that opportunity, but it's something that we're going to continue to push for in 2026 access. We don't really expect the access to be largely changed in 2026, but we do know that each of the payers or Medicaid, as we mentioned earlier, have budget constraints and there could potentially be some loss of coverage as well.

但就這一機會而言，我們還沒有看到很大的普及，但這是我們將在 2026 年繼續努力爭取實現的。我們並不認為 2026 年的醫療服務取得方式會發生太大變化，但我們知道，正如我們之前提到的，每個支付方或醫療補助計劃都有預算限制，因此也可能出現一些醫療服務覆蓋範圍的喪失。

Thank you, Dave, for those two. And also thanks to you, Harry. Let's move to the next question, please.

謝謝你，戴夫，謝謝你提供的這兩個資訊。還有，謝謝你，哈利。我們進入下一個問題吧。

Emmanuel Papadakis, Deutsche Bank.

伊曼紐爾‧帕帕達基斯，德意志銀行。

A few follow-ups, perhaps. Maybe taking a step back on US commercial channel trends and obesity. Excuse the background noise. Wegovy scripts are pretty much flat since July despite the NASH launch. Even Zepbound has seen most of the growth coming from the cash channel. So talk us through what you think the obstacles actually are to better penetration in that commercial channel? Is it on the demand side due to product profile, lack of demand beyond the motivated minority? Or is the barrier really on the access side, for example, as you referenced potentially insurance companies making it difficult for patients to actually get on or main on therapy?

或許還需要一些後續問題。或許應該重新檢視美國商業通路的發展趨勢和肥胖問題。請忽略背景噪音。儘管推出了 NASH，但自 7 月以來 Wegovy 的腳本數量基本上持平。就連 Zepbound 的大部分成長也來自現金管道。那麼請您詳細談談，您認為在該商業管道中實現更好滲透的真正障礙是什麼？是產品定位導致的需求不足，還是除了少數有購買意願的消費者之外，其他消費者的需求量不夠？或者，真正的障礙是否在於進入方面，例如，正如您所提到的，保險公司可能會讓患者難以真正開始或堅持治療？

Maybe a follow-up on Metsera, the deal structure and the risk associated with that. Can you just help us understand your comfort with the risk around the way you are structuring your offer? It seems there's a reasonable chance you could end up with 50% of the company you don't control to its ultimate benefit preventing someone else from owning them. So why are you comfortable with that possibility? Or how do you expect to avoid it?

或許可以跟進報道 Metsera 的情況，包括交易結構以及相關的風險。您能否幫我們了解一下，您對目前這種報價方式所帶來的風險的承受能力如何？似乎很有可能你最終會擁有你所不控制的公司 50% 的股份，而這最終有利於公司，並阻止其他人擁有這些股份。那你為什麼能接受這種可能性呢？或者你打算如何避免這種情況？

And then just a quick clarification on the Medicare access discussions. What would be upper limit discount you're contemplating be? Would that be in line with the MSP or this would be something in addition to that? Thank you.

最後，我想就醫療保險准入的討論做一個簡單的澄清。您考慮的最高折扣是多少？這是否符合MSP的要求，還是說這是MSP以外的額外內容？謝謝。

Thank you, Emmanuel. I noted two questions there. On the first one on the Wegovy scriptions, I'll turn it to you, Dave. And on the second one afterwards, on the deal structure, I'll turn to you, Ludovic. But first, over to you, Dave.

謝謝你，伊曼紐。我在那裡記下了兩個問題。關於韋戈維手稿的第一條，我把機會交給你，戴夫。接下來第二個問題，也就是交易結構，我會問你，路德維克。但首先，請看你的發言，戴夫。

Yeah. Thank you, Emmanuel. As we mentioned earlier, the quality of access remains a focus point and certainly a challenge in the reimbursed channel. Of course, we've got that combined with intense competition. And we also mentioned that the compounding is continuing to increase as well.

是的。謝謝你，伊曼紐。正如我們之前提到的，准入品質仍然是一個重點，而且在報銷管道中確實是一個挑戰。當然，我們還面臨激烈的競爭。我們也提到，複利效應也持續增強。

So that focus and investment in the quality of access, we do think is an important factor with respect to expanding the market. And in addition, you'll continue to see our efforts in expanding the cash channel through more partnerships and certainly having our product offerings available in that channel as well.

因此，我們認為，重視並投資於高品質的准入條件是擴大市場的重要因素。此外，您還會看到我們繼續努力透過更多合作來拓展現金管道，當然，我們的產品也會在該管道上線。

Thank you. And now I'll hand over to you Ludovic.

謝謝。現在我把麥克風交給你，路德維克。

Thanks for the question, Emmanuel. Well, I think everything stems from, I guess, what you feel is an excitement for the portfolio of Metsera. We really believe in the assets. We believe in the team. And we believe that the deal structure that we have now, which, by the way, as Karsten said, has been vetted and discussed with external councils and experts. And believe that it's in line with all legal standards, boils down to the quality of the asset and the data that we -- and the confidence we have in the data that we have.

謝謝你的提問，伊曼紐。嗯，我想這一切都源自於你對 Metsera 產品組合的興奮之情。我們非常看好這些資產。我們相信團隊。我們相信，我們現在所擁有的交易結構，正如卡斯滕所說，已經過外部委員會和專家的審查和討論。並且相信它符合所有法律標準，歸根結底取決於資產的品質和我們擁有的數據——以及我們對我們所擁有數據的信心。

So of course, we know when you get into such acquisition that this deal will be reviewed, but we're comfortable that even the 50% of the shares that we would have in our pocket would be actually worth a lot if the product stands out to be the way we think it is, products with an edge, by the way, because as you said, Martin, it's a convention of product. So in all cases, as it boils down to science, we believe that we have a good value proposition. Of course, we would prefer at the end to have that in our portfolio from an operational perspective, but the value there, we believe is really, really high in all scenarios.

當然，我們知道進行這樣的收購後，這筆交易將會被審查，但我們相信，即使我們只持有 50% 的股份，如果產品像我們預期的那樣脫穎而出，具有優勢，那麼這筆交易實際上也會很有價值。順便說一句，正如你所說，馬丁，這是產品的慣例。因此，歸根結底，從科學的角度來看，我們相信我們擁有良好的價值主張。當然，從營運角度來看，我們最終還是希望將它納入我們的投資組合，但我們相信，在任何情況下，它的價值都非常非常高。

Thank you, Ludovic. And now let's turn to the last two questions. For the second last question. Please go ahead, operator.

謝謝你，路德維克。現在我們來看最後兩個問題。倒數第二個問題。請開始吧，接線生。

Richard Vosser, JPMorgan.

理查沃瑟，摩根大通。

First question, Mike, you alluded to more telehealth involvement, particularly in the US. I think the prior arrangements, particularly with Hims, have faced challenges, given they continue to bulk compound. So there's been some discussion around continuing or new agreements with Hims, but also the wider involvement of the telehealth. So I wondered what was different this time and whether there's any evidence of any increased pressure around from the FDA or legal pressure to remove the compounders and what could change on that front.

第一個問題，麥克，你提到了遠距醫療將得到更廣泛的應用，尤其是在美國。我認為之前的安排，特別是與 Hims 的合作安排，面臨挑戰，因為他們仍在大量生產化合物。因此，圍繞著與 Hims 繼續合作或達成新協議，以及遠距醫療的更廣泛參與，已經進行了一些討論。所以我想知道這次有什麼不同，是否有任何證據表明來自 FDA 的壓力或法律壓力加大了要求移除配藥商的壓力，以及這方面可能會發生什麼變化。

And then the second question, just you mentioned a couple of times about coverage, maybe even getting a little bit worse in Medicaid and maybe even the commercial payers, the barriers staying high. Well, in that case, how should we think about the pricing? Normally, we think about increased rebate levels and increased pricing should remove barriers to get more reimbursement. So how should we think about that going into '26? Thanks very much.

第二個問題，你剛剛提到過幾次關於保險覆蓋範圍的問題，醫療補助計劃甚至商業保險的覆蓋範圍可能還會進一步惡化，門檻仍然很高。那麼，在這種情況下，我們該如何考慮定價問題呢？通常情況下，我們認為提高回扣水準和提高價格應該可以消除獲得更多報銷的障礙。那麼，我們該如何看待2026年呢？非常感謝。

Thanks, Richard. On the first one, I'll turn to you, Mike, on the telehealth.

謝謝你，理查。第一個問題，我先請你來談談遠距醫療，麥克。

Yeah. A couple of comments on that, Richard. There's been no increased pressure to answer your question directly. But what we have been quite consistent with regards to the illicit API that is coming from China and being used by compounders, we find -- since these are not FDA approved, their safety is questionable. And as a pharma company, we don't basically like that. That hasn't changed at all.

是的。理查德，關於這一點我有幾點要補充。並沒有人施加額外的壓力讓我直接回答你的問題。但是，對於來自中國並被配藥師使用的非法原料藥，我們一直持相當一致的看法，即由於這些原料藥未經FDA批准，其安全性值得懷疑。作為一家製藥公司，我們基本上不喜歡這樣。這一點絲毫沒有改變。

We also have been saying that we need to increase our access and we need to find ways to get to many more patients. The cash channel and eHealth is definitely an attractive way to go about it. In that context, we're having dialogue and discussions with multiple players on how we could actually increase our access and then we will see with who we should go into partnership. We've made a number of those partnerships available. So we talked about Costco.

我們也一直在說，我們需要擴大服務範圍，我們需要找到方法去接觸更多的病人。現金管道和電子健康無疑是實現這一目標的一種很有吸引力的方式。在此背景下，我們正在與多個參與者進行對話和討論，探討如何才能真正增加我們的市場准入，然後我們將看看應該與哪些參與者建立合作夥伴關係。我們已經開放了其中一些合作關係。於是我們聊起了好市多。

We have talked about EMed. We have talked about Walmart. And ongoing dialogues with many, many more are ongoing in pursuit of our market expansion that I spoke to earlier on.

我們已經討論過急診醫學。我們已經討論過沃爾瑪了。我們正與許多其他公司進行持續對話，以拓展我之前提到的市場。

Thank you, Mike. That's clear. And for the second one, let's move to you again, Dave, please.

謝謝你，麥克。這一點很清楚。第二個問題，我們還是請你來回答，戴夫。

Yeah. Thanks very much, Richard. We continue to have dynamics that we've discussed in the past, continued pressure, both in GLP-1 as well as in obesity with respect to price as we look to unlock more volumes. But I think it's -- I do want to reiterate that the quality of access is a clear priority for us. We are working with payers to make sure that the experience is one that patients are able to receive their medicine more seamlessly. That means lower utilization management, right? That means less of a prior authorization criteria. When we say we're investing in quality of access, that's really what we mean. And that's the focused conversation that we're having with payers.

是的。非常感謝，理查德。我們繼續面臨過去討論過的動態，在 GLP-1 和肥胖症領域，價格方面持續存在壓力，因為我們希望釋放更多銷售量。但我認為——我確實想重申，保證用戶存取品質是我們工作的首要任務。我們正與支付方合作，確保患者能夠更順暢地獲得所需藥物。這意味著降低利用率管理，對嗎？這意味著可以放寬事先審批標準。當我們說我們投資於提高網路存取品質時，這就是我們真正的意思。這就是我們正在與支付方進行的重點對話。

In 2026, we don't really expect a large difference in terms of access in the commercial channel. As we mentioned, there may be some in Medicaid. But when we look at the commercial opportunity, I think it is important to note that we haven't been making progress in terms of the access. We continue to believe that the CVS opportunity remains there, and that will -- we will see Wegovy as the exclusive brand at AOM, at CVS in 2026 as well.

到 2026 年，我們預計商業通路的准入方面不會有太大差異。正如我們所提到的，其中一些可能包含在醫療補助計劃中。但從商業機會的角度來看，我認為需要指出的是，我們在進入方面並沒有取得進展。我們仍然相信 CVS 的機會仍然存在，而且——我們將在 2026 年看到 Wegovy 成為 AOM 和 CVS 的獨家品牌。

Thanks a lot, Dave. That's clear. And let's move to the final question before I hand over to you, Mike, for closing. So final question, please.

非常感謝，戴夫。這一點很清楚。在把發言權交給你，麥克，請你來做總結之前，我們先來看最後一個問題。最後一個問題。

James Quigley, Goldman Sachs.

James Quigley，高盛集團。

I've got two left, please. So firstly, on REDEFINE 4, how important is this into demonstrating differentiation from a physician and a marketing perspective versus Zepbound? Have you thought any more about how Zepbound could behave in a flexible dosing scenario versus other trials and real-world data? And can you confirm that you still look to launch CagriSema if REDEFINE 4 shows no statistically significant difference? And second one, can you talk through the launch preparations for Wegovy in ex US?

我還剩兩份，謝謝。首先，在 REDEFINE 4 中，從醫生和行銷的角度來看，這點對於展現與 Zepbound 的差異化有多重要？您是否進一步思考過 Zepbound 在彈性給藥方案下的表現與其他試驗和真實世界數據相比會如何？如果 REDEFINE 4 沒有顯示出統計上的顯著差異，您能否確認您仍計劃推出 CagriSema？第二個問題，您能否談談 Wegovy 在美國以外的發布準備？

I mean, you've highlighted in the release and in the comments that you could look to launch in select countries versus previously when it's likely to be mainly focused in the US. So what's happened such that you consider also launching in the ex US? And how do you balance this with US launch processes and pricing, et cetera, as we head into an MFN world?

我的意思是，你在新聞稿和評論中都強調，你們可能會選擇在特定國家/地區推出產品，而此前可能主要集中在美國。是什麼原因讓您考慮在美國以外的地區推出產品？隨著我們邁入最惠國待遇時代，您如何平衡這一點與美國的上市流程和定價等因素？

Thanks, James. That's two. One on the REDEFINE 4 and one on the orals sema in IO. But on the REDEFINE one, I'll turn it to you first, Martin.

謝謝你，詹姆斯。那是兩個。一個在 REDEFINE 4 上，一個在 IO 的口語 sema 上。但關於 REDEFINE 這個問題，我先問你，馬丁。

Yeah, REDEFINE 4. As you well know, we've taken some learnings from REDEFINE 1 more specifically that we needed to do a lumber study. So we amended the REDEFINE 4 study. That being said, our base case has always been non-inferiority with an upside of superiority. In the case of non-inferiority on weight loss, we still see a potential for upside on gastrointestinal side effects and tolerability.

是的，REDEFINE 4。如您所知，我們從 REDEFINE 1 中吸取了一些經驗教訓，更具體地說，我們需要進行木材研究。因此，我們對 REDEFINE 4 研究進行了修訂。也就是說，我們的基本目標始終是不遜色，並且有超越的可能。即使減肥效果不遜於其他療法，我們仍然看到在胃腸道副作用和耐受性方面存在改進的潛力。

But also we do believe that the CV benefits that we know from semaglutide could also potentially pan out and will read out from REDEFINE 3, thus clearly differentiate CagriSema vis-a-vis potential competitors. But I do want to iterate, there is still the potential for superiority upside. But obviously in an amended study, that should be taken with a little bit of a risk.

但我們也相信，我們從索馬魯肽中了解到的心血管益處也可能得到證實，並將在 REDEFINE 3 中得到體現，從而將 CagriSema 與潛在的競爭對手明顯區分開來。但我確實想重申一下，仍然存在提升空間。但顯然，在修改後的研究中，這樣做應該要承擔一定的風險。

Thank you, Martin. And let's turn to you, Ludovic, for the second one, please.

謝謝你，馬丁。接下來，請路德維克回答第二個問題。

Absolutely. So let's take a step back. The real focus and the priority of our Wegovy pill launch is the US and will remain the US in 2026. As you rightly read, we are indeed opening -- we've filed, and we are opening the option to launch in selected markets in the course of 2026, depending, of course, on how things are ramping up, and we are definitely ready to -- in this market to be able to make the -- the best and the most of the Wegovy pill.

絕對地。所以讓我們退後一步。我們Wegovy藥丸上市的真正重點和優先事項是美國，並且在2026年仍將是美國。正如您所看到的，我們確實正在開放——我們已經提交了申請，並且我們正在考慮在 2026 年期間在選定的市場推出產品，當然，這取決於情況的發展，我們絕對準備好——在這個市場中，能夠做到最好，充分利用 Wegovy 藥丸。

By the way, we're also very quickly transferring some knowledge from the telehealth channels, for instance, in the US into some higher markets. We are very active right now as we speak in many markets across the world, not just in Europe, but also in Australia, for instance, or in other part of the world where we believe that we really are gaining progress on the telehealth side. So again, we're accelerating our overall experience curve on the telehealth and that will be -- we believe will be proven very helpful at the time we launch the Wegovy pill.

順便說一句，我們也正在迅速地將一些知識從遠距醫療管道（例如美國的管道）轉移到一些更高端的市場。我們現在在全球許多市場都非常活躍，不僅在歐洲，例如澳大利亞，以及我們認為在遠距醫療方面真正取得進展的世界其他地區。所以，我們正在加快遠距醫療的整體經驗積累，我們相信，這將在我們推出 Wegovy 藥丸時證明非常有幫助。

It's also not worthy to say that the IO market are also markets where we have some of the nicest experience in Rybelsus in Europe and elsewhere, which means that we can also leverage our experience in the oral markets that have been successful for Rybelsus to build even quicker position with the Wegovy pill. So priority to the US, but fully ready to take on some selected markets in IO when time comes.

值得一提的是，IO 市場也是我們在歐洲和其他地區 Rybelsus 取得最佳業績的市場之一，這意味著我們還可以利用 Rybelsus 在口服市場的成功經驗，更快地憑藉 Wegovy 藥丸建立市場地位。因此，我們的首要任務是美國市場，但時機成熟時，我們也完全準備好進軍印度洋-義大利的一些特定市場。

Thanks, Ludovic. And with that, let's conclude the Q&A session. Thank you for participating, and please feel free to ask in the Investor Relations for any follow-up questions if that's case. Before we finally round off, I'll just turn it over to you, Mike, for some final remarks.

謝謝你，路德維克。問答環節到此結束。感謝您的參與，如有任何後續問題，請隨時聯繫投資者關係部門。在最後結束之前，我把麥克風交給你，麥克，請你做些最後的總結發言。

Thank you, Jacob. Thank you to everyone for calling in. Before closing, I did want to make a few remarks. Although we have narrowed the full-year outlook for this year and see currently competitive headwind, the unmet need is huge. The volume opportunity longer term in our core area is enormous.

謝謝你，雅各。感謝大家的來電。在結束之前，我還有幾點要補充。儘管我們縮小了今年的全年展望範圍，並且目前面臨競爭逆風，但未滿足的需求仍然巨大。從長遠來看，我們核心領域的銷售成長機會龐大。

We are sharpening our focus on diabetes, obesity, and associated comorbidities in order to address this unmet need. This is our home turf, and this is for us to drive the commercial execution and raise the innovation bar to treat many more patients and treat them better than ever before, and we will not stop until we do that. Thank you.

為了滿足這未被滿足的需求，我們將更加關注糖尿病、肥胖症及相關併發症。這是我們的主場，我們將在這裡推動商業執行，提高創新標準，治療更多患者，並比以往任何時候都更好地治療他們，我們將不懈努力，直到實現這一目標。謝謝。