I would now like to have the conference over to your speaker, Jacob Martin Wiborg Rode, Head of Investor Relations. Please go ahead.
Thank you. Welcome to this conference call regarding the changes to Novo Nordisk's executive leadership, as well as the lowering of the financial outlook for 2025 that we announced today. My name is Jacob Rohde, and I'm the Head of Investor Relations at Novo Nordisk. With me today, I have Helge Lund, Chair of the Board of Directors at Novo Nordisk; CEO of Novo Nordisk, Lars Fruergaard Jørgensen; Chief Financial Officer, Karsten Munk Knudsen; Executive Vice President, U.S. Operations, Dave 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 webcast 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 two. We'll 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, where Novo Nordisk today lowered the sales and operating profit expectations for 2025. The presentation will be followed by a Q&A session beginning in approximately 15 minutes. Please note that all sales and operating profit growth statements will be at 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. With that, over to you, Helge, for a review of the changes to Novo Nordisk's executive leadership.
Thank you, Jacob. Please turn to the next slide. In May of this year, it was announced that Lars Fruergaard Jørgensen 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 make 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, I/O 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 7th, 2025.
After 34 years of exceptional service, Lars Fruergaard Jørgensen 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 and the verse. 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 Kongsøye 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. On behalf of the Board, I look very much forward to working with Mike and the team to deliver the company's growth strategy. Now, over to Mike for a few words.
Thank you very much, Helge. It is 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 just makes the mandates ahead even more clear. We need to increase the sense of urgency and execute differently. We will 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 will 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. 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, Jacob.
Thank you, Mike. Please turn to the next slide. I would like to turn it over to Karsten for an update on Novo Nordisk's financial performance and outlook for 2025.
Thank you, Jacob. Please turn to the next slide. In the first six months of 2025, Novo Nordisk's 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 gross-to-net sales adjustments related to prior years of around DKK 3 billion related to the 340B U.S. rebate provision. Operating profit growth is positively impacted by the Ozoduranon impairment in the second quarter of 2024 of DKK 5.7 billion. This was partially countered by the incremental impact related to the acquisition of the three former Catalent manufacturing sites of around DKK 2.6 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%-14% at constant exchange rates. Given the current exchange rates versus the Danish kroner, sales growth reported in DKK is expected to be 4 percentage points lower than at constant exchange rates, primarily due to the depreciation of the U.S. 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 U.S. obesity markets, lower growth expectations for Ozempic in the U.S. GLP-1 market, as well as lower-than-expected penetration for Wegovy in select I/O markets. The lower growth expectation for Wegovy in the U.S. 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, Novo Nordisk 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 CAS channel is below expectations. Within the CAS 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 CAS 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 U.S., 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 U.S., the updated outlook is negatively impacted by competition in the U.S. market. Novo Nordisk continues to invest in commercial activities and label updates towards driving further market penetration of Ozempic. In addition, although Wegovy sales and international operations are growing at high rates and launches are progressing, the sales outlook is reflecting lower-than-expected penetration of Wegovy in select international operations markets due to slower market expansion and competition. With around 1 billion people living with obesity globally and only a few million on treatment, the outlook reflects a continued global rollout of Wegovy to more markets. Operating profit growth is now expected to be 10%-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 U.S. 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 the three former Catalent manufacturing sites. Novo Nordisk now expects net financial items for 2025 to amount to a gain of around DKK 3 billion. This is mainly driven by expected gains on hedge currencies, primarily the U.S. dollar, partially offset by interest expenses related to funding of the debt-financed Catalent transaction. The free cash flow is now expected to be DKK 35-45 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 U.S. and related cash flow implications amplified by the U.S. 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 6th, 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 U.S., 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'd like to congratulate Mike with the role as CEO. I am confident 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. Next slide, please. With that, we're now ready for the Q&A. We kindly ask 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're now ready to take the first question, please.
Thank you. As a reminder to ask a question, please press star one and one on your telephone and wait for your name to be announced. To withdraw your question, please press star one and one again. We are now going to proceed with our first question. The questions come from the line of Michael Novod from Nordea. Please ask your question.
Thank you very much, Michael Novod from Nordea in Copenhagen. 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 I/O versus U.S. 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.
Yeah. Thank you, Michael, and thank you, Jacob. With 18% growth in the first half of the year and the guidance range that we put out today with a midpoint of around 11%, the applied growth in the second half of this year is mid-single digits. Do bear in mind we have a tough comparator from last year linked to the gross-to-net adjustment of DKK 5 billion we did in the fourth quarter last year, which would take growth rate up from the mid-single digits to probably high single digits. In terms of growth contribution from a geography point of view, it is important to note that the lowering of outlook we are doing today is predominantly linked to performance of our U.S. business. It is a smaller piece that is related to a slower-than-planned penetration of Wegovy in I/O.
As a consequence, when we release our results next week, you'll see very healthy growth in I/O 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'll do that in conjunction with our full-year results come February. I will not go into further deliberations around 2026 for today.
Thank you for that, Karsten, very clear. Thank you also to you, Michael, for the question. With that, I believe we're ready for the next question, please.
We are now going to proceed with our next question. The questions come from the line of Sachin Jain from Bank of America. Please ask your question.
Hi there. Thanks for 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. For Wegovy, I guess you're citing the main issue being compounders. Any color on how many patients still do you think compounded versus a million prior? 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? I guess similar question on Ozempic, you have much looser commentary within the PR around path to growth. Come to main task, scripts on inflecting, assuming given a 5%-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.
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Good. Apologies for that. I'll give the question firstly on compounding, back to Karsten.
Yeah. Apologies for the technical glitch on our end. Specifically on compounding, at Q1 in May, we said our market research estimate was 1 million patients using compounded GLP-1 for obesity treatments. The FDA grace period for bulk compounding on the 503B ended on May 22, and our assumption was that would lead to increased patients using branded GLP-1s in the second half of this year. Unfortunately, our latest market research indicates that has not happened, and that's one of the assumptions that we have changed. The latest market research still indicates 1 million patients or more being on compounded GLP-1 for obesity in the U.S. marketplace.
Thanks for that, Karsten.
Your second question, Sachin, on Ozempic dynamics, I'll hand it over to you today.
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. With the current competitive dynamics, we're seeing 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. Secondly, we continue to see slower class growth of GLP-1 diabetes. 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 type. Thank you.
Thank you, Dave. I'll hand over to you, Karsten, for some final comments.
Yeah. Just adding on to my prior comments on compounded GLP-1s in the U.S. marketplace, it's important that this is something we don't take lightly. It's a key patient safety concern. Of course, we are active on many, many fronts in terms of improving patient safety and reducing compounding to what is legally allowed. We, amongst other things, are active in litigations, and we're working with regulators. 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 segments.
Thanks for that, Karsten. Also thank you to you, Dave. We are ready to move on to the next question, please.
Sure. We're now going to proceed with our next question. The questions come from the line of Harrison from UBS. Please ask your question.
Brilliant. Thank you very much for taking the question. Maybe can you just contextualize the bottom end of the guidance? It would imply that there is limited sequential growth in the second half for that bottom end. We have 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? 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 U.S. for the full year and going forward? Thank you.
Thanks for that, Harry. I'll give that procedure to you, Karsten.
Yeah. First of all, we have narrowed our range compared to the first quarter release back in May. Now we're guiding plus minus three 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. Of course, we are working hard each and every day to get the closest possible to the top end. 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 the gross-to-net estimates in the U.S.
Perfect. Thanks for that, Karsten. With that, I think we're ready to move to the next question.
We are now going to move to the next question. The questions come from the line of Martin Parkhøi from SEB. Please ask your question.
Yes, Martin Parkhøi 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 Novo Nordisk in order to prevent this situation that you're standing in today? 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 new products like Ozempic and CagriSema before we can see a real change to where you are today?
Thanks for that, Martin Parkhøi. I'll give that to you, Mike, reflecting on past challenges leading into the future also.
Yeah. 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. Predominantly, we do that by improving the commercial execution. We will focus more on some of the things that matter 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'll 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. We will invest competitively in finding 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. Thank you to you, Martin. With that, we're ready to move to the next question, please.
We are now going to proceed with our next question. The questions come from the line of Evan Seigerman from BMO Capital Markets. Please ask your question.
Guys, thank you so much for taking my question, providing the updates today. As we think about kind of the go-forward for your businesses, how would you characterize the competitive dynamics in the U.S.? 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 U.S. dynamics.
Thanks for the question, Evan. Overall, we believe there's still substantial growth opportunity in the U.S. for GLP-1s. This is in both diabetes and in obesity. 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. 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 a medicine that is not safe for patients. We take it seriously, and we have stepped up our dialogue recently with the FDA.
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. 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 guided in May, which is still overly due to compounding. We have seen our cash business move from 4% early in the year to now 12%. That is an encouraging sign that there's an opportunity to meet patients where they are and have a cash offering.
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. 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. Before going to the next questions, just hand 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. 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 what 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 are 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.
We are increasing our online presence and telehealth partnership, so we also open up that channel besides, of course, the other channels that we have had. 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 Rybelsus to that number, then we are closer to three-fourths. I would say we are very serious on upholding that and defending that as we go forward.
Thanks for that, Mike. Also, thanks again to you, Evan, for the question. With that, we are now ready to move to the next one, please.
We are now going to move to our next question. The questions come from the line of Richard Vosser from JPMorgan. Please ask your question.
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. Could you give us an idea how to think on pricing going forward in the U.S.? 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, etc., coming through in the second half? Thanks very much.
Thanks for those two, Richard. Dave, both of you, Karsten, firstly on the high-level pricing and then on gross-to-net adjustments.
Thank you for those questions, Richard. In terms of high-level pricing, then it's important to say that the lowering of guidance that we're doing today compared to what we issued back in May is volume-driven. There are no major changes to pricing compared to what we announced last time. On top of that, when we look at pricing between the different brands, I would say there are no major changes to what we've been discussing on Ozempic as a general trend. 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. A continued gradual decline on ARP, which, of course, is enabling reaching many, many more patients in the U.S. marketplace.
In terms of gross-to-net dynamics and the part B redesign, I would say for part C redesign first, this is relatively smaller, in fact, to our numbers. It's more like a spacing across the year of a few percentage points that we're discussing. 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. Pending that and just the general test of time will be kind of the deciding factor to how we deal with the partial recognition that we have under 340B.
Thank you, Karsten. Thank you also to you, Richard. With that, we're then ready to take the next question, please.
We are now going to proceed with the next question. The questions come from the line of Mike Nedelcovych from TD Cowen. Please ask your question.
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 mature late-stage pipeline opportunities. 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 to you, Mike.
Yeah. 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. What I can say today is we are going to focus on the two issues I touched upon earlier on. One of it was progressing the pipeline and the innovation. We need to basically do that better and faster. That does not exclude external innovation as well as, of course, seeing what we can do internally. That is where I leave it for now.
Thank you, Mike. We are ready to move to the next question, please.
Sure. We are now going to take our next question. The questions come from the line of Thibault Boutherin from Morgan Stanley. Please ask your question.
Thank you. The question is on the dynamics in international markets with Wegovy. You mentioned the growth through launches in new geographies, but also competition in some select markets. When we look at some IQVIA data in Europe on markets like U.K., Germany, Spain, we see very, very strong traction for Mounjaro and maybe a bit more limited updates for Wegovy. If you could give a bit more details on the dynamics you see in these countries, was there still any supply gating here and how you think you can reverse that in this key developed market, XUS?
Thank you, Thibault. Thanks a lot for that. I think it goes to you, Mike, on competitive dynamics in international operations.
Yes. I think you're correct. If you handpick just a handful of markets, you will probably find that in those handful of markets, and amongst which the ones you mentioned, we are right now not the leading player. That's something, of course, we'd like to change. 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. We'll allude to this more next week. In other markets where we start with 100% market share and Mounjaro joins, I think they should get their fair share, but not more than that in market share.
In general, I would say we are seeing in some of the markets where we were trading behind quite a bit of movement related to our acceleration, but we also have said that most of the product supply source I/O will be coming in in the second half of the year. That also you need to kind of be aware of.
Thank you, Mike. Thank you to you, Thibault, for the question. We are ready to take the next question, please.
We are now going to proceed with the next question. The next questions come from the line of James Quigley from Goldman Sachs. Please ask your question.
Great. Hopefully, you can hear me. Thank you for taking my questions. We've got a question on the total U.S. market for obesity. How is that developing? When we look at IQVIA trend 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. When you think about that, plus the most recent data you have on compounding, what's the total market doing? How is that volume opportunity unlocked? What is Novo doing in order to take steps to unlock the total market opportunity? Obviously, the share of the compounders is a key growth driver. From a total obesity perspective going forward in terms of patients, how is that progressing? How are Novo going to unlock that opportunity?
Thanks for that question. That goes to you, Dave, on efforts to further expand the market in the U.S.
Yeah. Thanks very much, James. I appreciate the question. There's still a tremendous opportunity in the U.S. 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. As Karsten mentioned earlier, we estimate that's about 30% of the market, around 1 million patients. I'll come back to what we're doing to curtail compounding. 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. The NBRX is now up to 42%.
We continue to compete for patients on an ongoing basis. 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 U.S. living with MASH, 80% of them have obesity, over 40% of them have type 2 diabetes, it gives us an encouraging opportunity ahead. 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. 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 U.S., 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. We have an ongoing effort on the legal side. We have issued over 120 lawsuits. We've issued 1,000 cease and desist letters. We're starting to see some of the effects of those efforts where compounding has been shut down. Importantly, we must have regulatory action. We must have enforcement from the FDA. As I mentioned earlier, we have stepped up that dialogue. We will continue to around the importation of illicit API, as well as compounding that takes place with fake API.
That will give us an opportunity to convert those patients back to branded Wegovy. As Karsten mentioned, it just has not developed yet because we have not 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.
We are now going to take our next question. The questions come from the line of Emily Field from Barclays. Please ask your question.
Hi. Thanks for taking my question. I just wanted to kind of dig into these efforts to limit compounding. The company's been very consistent in this message around safety, but for better or for worse, that's not really resonating with whatever the subsegment of American patients. In the prior answer, Dave, you mentioned the lawsuits and the cease and desist letters. Have you filed suit against Hims? 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 deep. 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. Thank you, Emily. I'll give that to you, Dave, to expand on previous answer.
Yeah, absolutely. Happy to expand on that. We will not rule out anything categorically. All legal actions, as well as efforts that we can take with the government, as well as taking legal action. No ruling any of that out. We cannot comment on specific lawsuits. We would not do that. We would not comment on legal strategies either. Certainly pursuing all angles to ensure that we get this back to a branded market. We believe in our brands. We believe in the opportunity and are confident in our ability to compete in a branded pharmaceutical market.
Very clear. Thanks for that, Dave. Then we're ready for the final question, please.
Sure. We are now going to proceed with one final question. The questions come from the line of Carsten Lomberg Madsen from Danske Bank. Please ask your question.
All right. Thank you very much. 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're actually able to supply semaglutide to, 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 based on the balance sheet or how you're thinking about this.
Thanks for that, Carsten. I'll turn that over to you. Do you, Karsten, have a question?
Yeah. Thank you for that question. In this context, it's important to remember what we heard from both Mike and Dave before around the significant unmet needs in both diabetes and obesity and the portfolio that we're working with. As you know, in diabetes, when we look at international operations, we're looking at a penetration of only around 7% of scripts being on a GLP-1 compared to 19% or so in the U.S. A very significant runway, especially in IO, but also in the U.S. in the diabetes GLP-1 penetration. That runway is even bigger on the obesity side. I'll say on top of that, as I said in the beginning, this is predominantly a U.S. shortfall. The volume split between IO and U.S. is like 90/10 or something like that.
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. Also, do bear in mind that the factories we're building, they're of course for the inline products that are on the market today. The factories, they're built based on technologies that we expect to be able to apply for our pipeline products also. Here I'm thinking of products like CagriSema and amycretin, to mention a few. At this point, no indications of any potential write-downs.
Thank you, Karsten. Very clear. With that, we are concluding the Q&A session. Thank you for participating. Feel free to contact investor relations in regards to follow-up. Before handing off, I will 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 management. It is 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. We 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. Thank you.
This concludes today's conference call. Thank you all for participating. You may now disconnect your lines. Thank you.
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 Rohde, and I'm the Head of Investor Relations at Novo Nordisk. With me today, I have: Helge Lund, Chair of the Board of Directors at Novo Nordisk; CEO of Novo Nordisk, Lars Fruergaard Jørgensen; Chief Financial Officer, Karsten Munk Knudsen; Executive Vice President, U.S. Operations, Dave 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 webcast 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 two. 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, where Novo Nordisk today lowered the sales and operating profit expectations for 2025. The presentation will be followed by a Q&A session beginning in approximately 15 minutes. Please note that all sales and operating profit growth statements will be at 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. With that, over to you, Helge, for a review of the changes to Novo Nordisk Executive Leadership.
Thank you, Jacob. Please turn to the next slide. In May of this year, it was announced that Lars Fruergaard Jørgensen 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 make 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, I/O 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 in 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 Jørgensen 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 and the years. A special thank you to Lars for ensuring a smooth handover to Mike.
In addition to the CEO announcement, we announced today that 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 Kongsøe 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. On behalf of the Board, I look very much forward to working with Mike and the team to deliver the company's growth strategy. 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. The fact that my announcement comes right after the guidance update just makes the mandate ahead even more clear. We need to increase the sense of urgency and execute differently. We will 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. 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, Jacob.
Thank you, Mike. Please turn to the next slide. I would like to turn it over to Karsten for an update on Novo Nordisk's financial performance and outlook for 2025.
Thank you, Jacob. Please turn to the next slide. In the first six months of 2025, Novo Nordisk's 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 gross-to-net sales adjustments related to prior years of around DKK 3 billion, related to the 340B U.S. rebate provision. Operating profit growth is positively impacted by the Ozoduranon impairment in the second quarter of 2024 of DKK 5.7 billion.
This was partially countered by the incremental impact related to the acquisition of the three former Catalent manufacturing sites of around DKK 2.6 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%-14% at constant exchange rates. Given the current exchange rates versus the Danish kroner, sales growth reported in DKK is expected to be 4 percentage points lower than at constant exchange rates, primarily due to the depreciation of the U.S. 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 U.S. obesity markets, lower growth expectations for Ozempic in the U.S. GLP-1 market, as well as lower-than-expected penetration for Wegovy in select international operations markets. The lower growth expectations for Wegovy in the U.S. 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, Novo Nordisk 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.
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 CAS channel is below expectations. Within the CAS 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 CAS 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.
Nordisk is starting to see some positive indicators reflected in the latest NBRX data in the U.S., and we continue to engage in additional commercial activities. Further, we continue to expect a regulatory decision around the Wegovy MASH 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 U.S., the updated outlook is negatively impacted by competition in the U.S. 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 its international operations are growing at high rates and launches are progressing, the sales outlook is reflecting lower-than-expected penetration of Wegovy in select I/O markets due to slower market expansion and competition.
With around 1 billion people living with obesity globally and only a few million on treatment, the outlook reflects a continued global rollout of Wegovy to more markets. Operating profit growth is now expected to be 10%-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 U.S. 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 the three former Catalent manufacturing sites. Novo Nordisk now expects net financial items for 2025 to amount to a gain of around DKK 3 billion.
This is mainly driven by expected gains on hedge currencies, primarily the U.S. dollar, partially offset by interest expenses related to funding of the debt-financed Catalent transaction. The free cash flow is now expected to be DKK 35 billion-DKK 45 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 U.S. and related cash flow implications amplified by the U.S. 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 o ver 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 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. Next slide, please. With that, we are now ready for the Q&A. We kindly ask 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.
Thank you. As a reminder to ask a question, please press star one and one on your telephone and wait for your name to be announced. To withdraw your question, please press star one and one again. We are now going to proceed with our first question. The questions come from the line of Michael Novod from Nordea. Please ask your question.
Thank you very much, Michael Novod from Nordea in Copenhagen. 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 I/O versus U.S. for the second half, and also what kind of implications that could have for 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.
Yeah. Thank you, Michael, and thank you, Jacob. With 18% growth in the first half of the year and the guidance range that we put out today with a midpoint of around 11%, the applied growth in the second half of this year is mid-single digits. Do bear in mind we have a tough comparator from last year linked to the gross-to-net adjustment of DKK 5 billion we did in the fourth quarter last year, which would take growth rate up from the mid-single digits to probably high single digits. In terms of growth contribution from a geography point of view, it is important to note that the lowering of outlook we are doing today is predominantly linked to performance of our U.S. business.
It's a smaller piece that is related to a slower-than-planned penetration of Wegovy in I/O. As a consequence, when we release our results next week, you will see very healthy growth in I/O 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. I will not go into further deliberations around 2026 for today.
Thank you for that, Karsten, very clear. Thank you also to you, Michael, for the question. With that, I believe we are ready for the next question, please.
We are now going to proceed with our next question. The questions come from the line of Sachin Jain from Bank of America. Please ask your question.
Hi there. Thanks for 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. For Wegovy, I guess you're citing the main issue being compounders. Any color on how many patients still do you think compounded versus a million prior? 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 time frame? I guess similar question on Ozempic, you have much looser commentary within the PR around path to growth. Comments remain, so our scripts aren't inflecting, assuming given a 5-10% 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. Specifically on compounding, at Q1 in May, we said that our market research estimate was 1 million patients using compounded GLP-1 for obesity treatments. The FDA grace period for bulk compounding on the 503B 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. The latest market research still indicates 1 million patients or more being on compounded GLP-1 for obesity in the U.S. marketplace.
Thanks for that, Karsten. Thank you for that, Karsten. Your second question, Sachin, on Ozempic dynamics, I'll hand it over to you today.
Thank you for the question, Sachin. Yes.
In regards to your question about Ozempic, we are seeing a flattish TRX development currently. We are seeing approximately 690,000 TRXs per week on par with competition. With the current competitive dynamics, we are capturing about 40% of the NBRX, and we do see patients switching from Ozempic to the competitor product as well. We have not seen a solid pickup from our newly approved indication in chronic kidney disease, although we do hear positive comments from clinicians. We have not seen that materialize into prescriptions as of yet. Secondly, we continue to see slower class growth of GLP-1 diabetes. To some degree, there is 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. I'll just hand over to you, Karsten, for some final comments.
Yeah. Just adding on to my prior comments on compounded GLP-1s in the U.S. marketplace, it's important that this is something we do not take lightly. It's a key patient safety concern. Of course, we are active on many, many fronts in terms of improving patient safety and reducing compounding to what is legally allowed. We, amongst other things, are active in litigations, and we're working with regulators. 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 segments.
Thanks for that, Karsten. Also thank you to you, Dave. We're ready to move on to the next question, please.
Sure. We're now going to proceed with our next question. The questions come from the line of Harry from UBS. Please ask your question.
Brilliant. Thank you very much for taking the question. Maybe can you just contextualize the bottom end of the guidance? 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? 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 U.S. for the full year and going forward? Thank you.
Thanks for that, Harry. I'll get that question through to you, Karsten.
Yeah.
First of all, we have narrowed our range compared to the first quarter release back in May. Now we are guiding plus minus three to the midpoint. It is not like we have a specific scenario taking us to the floor. It is an assessment of the risk profile that we are looking at that can take us both to the top end and to the low end of the range. Of course, we are working hard each and every day to get the closest possible to the top end. Really, the uncertainty factors to this are related to, I would say, the fairly usual uncertainty factors around performance of Ozempic and Wegovy, and then the classic uncertainties around the gross-to-net estimates in the U.S.
Perfect. Thanks for that, Karsten. With that, I think we are ready to move to the next question.
We are now going to move to the next question. The questions come from the line of Martin Parkhøi from SEB. Please ask your question. Yes, Martin Parkhøi 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 Novo Nordisk in order to prevent this situation that you're standing in today? 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 Ozempic and CagriSema before we can see a real change to where you are to
day? Thanks for that, Martin Parkhøi. I'll give that to you, Mike, reflecting on past challenges leading into the future also.
Yeah. 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 matter 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'll 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. We will invest competitively in finding 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. Thank you to you, Martin. With that, we're ready to move to the next question, please.
We are now going to proceed with our next question. The questions come from the line of Evan David Seigerman from BMO Capital Markets. Please ask your question.
Thank you so much for taking my question, providing the updates today.
As we think about kind of the go-forward for your businesses, how would you characterize the competitive dynamics in the U.S.? 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 U.S. dynamics.
Thanks for the question, Evan. Overall, we believe there's still substantial growth opportunity in the U.S. for GLP-1s. This is in both diabetes and in obesity. 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.
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 a medicine that is not safe for patients. We take it seriously. We have stepped up our dialogue recently with FDA. 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. 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. We have seen our cash business move from 4% early in the year to now 12%. That is an encouraging sign that there is an opportunity to meet patients where they are and have a cash offering. 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. 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. Before going to the next questions, just hand 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. We are increasing our online presence and telehealth partnership, so we also open up that channel besides, of course, the other channels that we have had. 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 Rybelsus to that number, then we're closer to three-fourths. I would say we are very serious on upholding that and defending that as we go forward.
Thanks for that, Mike. Also thanks again to you, Evan, for the question. With that, we are now ready to move to the next one, please.
We are now going to move to our next question. The questions come from the line of Richard Vosser from JPMorgan. Please ask your question.
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. Could you give us an idea how to think on pricing going forward in the US? 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, etc., coming through in the second half?
Thanks very much.
Thanks for those two, Richard. Dave, both of you, Karsten, firstly on the high-level pricing and then on growth and adjustments.
Thank you for those questions, Richard. In terms of high-level pricing, it is important to say that the lowering of guidance that we are doing today compared to what we issued back in May is volume-driven. There are no major changes to pricing compared to what we announced last time. On top of that, when we look at pricing between the different brands, I would say there are no major changes to what we have been discussing on Ozempic as a general trend. For Wegovy, what we have been saying is that as we expand the market and reach more patients, the market should expect that the average pricing should go down gradually over time, linked to channel dynamics and reaching more patients.
A continued gradual decline on ARP, which, of course, is enabling reaching many, many more patients in the U.S. marketplace. In terms of gross-to-net dynamics and the Part D redesign, I would say for Part D redesign first, this is a relatively smaller impact to our numbers. It is more like a spacing across the year of the few percentage points that we are discussing. Beyond that, on an annual basis, no major change on that front. As to 340B, we are still awaiting at least one key legal clarification in terms of interpretation of the rules in place. Pending that and just the general test of time will be kind of the deciding factor to how we deal with the partial 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.
We are now going to proceed with the next question. The questions come from the line of Mike Nedelcovych from TD Cowen. Please ask your question.
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 mature late-stage pipeline opportunities. 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 to you, Mike.
Yeah. 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.
What I can say today is we are going to focus on the two issues I touched upon earlier on. One of it was progressing the pipeline and the innovation. We need to basically do that better and faster. That does not exclude external innovation as well as, of course, seeing what we can do internally. That is where I leave it for now.
Thank you, Mike. We are ready to move to the next question, please.
Sure. We are now going to take our next question. The questions come from the line of Thibault Boutherin from Morgan Stanley. Please ask your question.
Thank you. The question is on the dynamics in international markets with Wegovy. You mentioned the growth through launches in new geographies, but also competition in some select markets.
When we look at some IQVIA data in Europe on markets like U.K., Germany, Spain, we see very, very strong traction for Mounjaro and maybe a bit more limited updates for Wegovy. If you could give a bit more details on the dynamics you see in these countries, was there still any supply gating here and how you think you can reverse that in this key developed market, XUS?
Thank you, Thibault. Thanks a lot for that. I think it goes to you, Mike, on competitive dynamics in international operations.
Yes. I think you're correct. If you handpick just a handful of markets, then you will probably find that in those handful of markets and amongst which the ones you mentioned, then we are right now not the leading player. That's something, of course, we'd like to change.
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. We will allude to this more next week. In other markets where we start with 100% market share and Mounjaro joins, I think they should get their fair share, but not more than that in market share. 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. We also have said that most of the product supply source IO will be coming in in the second half of the year.
That also you need to kind of be aware of.
Thank you, Mike. Thank you to you, Thibault, for the question. We are ready to take the next question, please.
We are now going to proceed with the next question. The next questions come from the line of James Quigley from Goldman Sachs. Please ask your question.
Great. Hopefully, you can hear me. Thank you for taking my questions. We've got a question on the total U.S. market for obesity. How is that developing? When we look at IQVIA trend since sort of last week of May, thereabouts, the prescriptions have been around 670,000 between you and Zepp, and obviously, the share has been shifting between that. When you think about that, plus the most recent data you have on compounding, what's the total market doing?
How is that volume opportunity unlocked? What is Novo doing in order to take steps to unlock the total market opportunity? Obviously, the share of the compounders is a key growth driver. From a total obesity perspective going forward in terms of patients, how is that progressing? How are Novo going to unlock that opportunity?
Thanks for that question. That goes to you, Dave, on efforts to further expand the market in the U.S.
Yeah. Thanks very much, James. I appreciate the question. There is still a tremendous opportunity in the U.S. market, as you mentioned. Over 100 million people living with obesity. You have 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. As Karsten mentioned earlier, we estimate that is about 30% of the market, around 1 million patients. I will come back to what we are doing to curtail compounding. In terms of the in-market growth, we are encouraged with early signs that we are seeing. We are seeing Wegovy come in as of late, around 275,000 prescriptions per week. The NBRX is now up to 42%. We continue to compete for patients on an ongoing basis. 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 U.S. living with MASH, 80% of them have obesity, over 40% of them have type 2 diabetes, it gives us an encouraging opportunity ahead.
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. 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. We have an ongoing effort on the legal side. We have issued over 120 lawsuits. We have issued 1,000 cease and desist letters.
We're starting to see some of the effects of those efforts where compounding has been shut down. Importantly, we must have regulatory action. We must have enforcement from the FDA. As I mentioned earlier, we have stepped up that dialogue. We will continue to around the importation of illicit API, as well as compounding that takes place with fake API. That will give us an opportunity to convert those patients back to branded Wegovy. As Karsten mentioned, it just has not developed yet because we have not 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.
We are now going to take our next question. The questions come from the line of Emily Field from Barclays. Please ask your question.
Hi. Thanks for taking my question.
I just wanted to kind of dig into these efforts to limit compounding. The company's been very consistent in this message around safety, but for better or for worse, it's not really resonating with whatever the subsegment of American patients. In the prior answer, Dave, you mentioned the lawsuits and the cease and desist letters. Have you filed suit against Hims? 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 deep. 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.
Thank you, Emily. I'll give that to you, Dave, to expand on previous answer. Yeah, absolutely.
Happy to expand on that. We will not rule out anything categorically. All legal actions, as well as efforts that we can take with the government, as well as taking legal action. No ruling any of that out. We cannot comment on specific lawsuits. We would not do that. We would not comment on legal strategies either. Certainly pursuing all angles to ensure that we get this back to a branded market. We believe in our brands. We believe in the opportunity and are confident in our ability to compete in a branded pharmaceutical market.
Very clear. Thanks for that, Dave. We are ready for the final question, please.
Sure. We are now going to proceed with one final question. The questions come from the line of Carsten Lomberg Madsen from Danske Bank. Please ask your question.
All right. Thank you very much.
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're actually able to supply sumatriptan to, I was wondering whether you could share some thoughts about what will happen in case that you're not even close to maximizing on the production of sumatriptan, whether there could be a sort of a write-down of your asset based on the balance sheet or how you're thinking about this.
Thanks for that, Karsten. I'll turn that over to you. Do you, Karsten, have a CapEx program?
Yeah. Thank you for that question.
In this context, it's important to remember what we heard from both Mike and Dave before around the significant unmet needs in both diabetes and obesity and the portfolio that we're working with. As you know, in diabetes, when we look at international operations, we're looking at a penetration of only around 7% of scripts being on a GLP-1 compared to 19% or so in the U.S. A very significant runway, especially in IO, but also in the U.S. in the diabetes GLP-1 penetration. That runway is even bigger on the obesity side. I'd say on top of that, as I said in the beginning, this is predominantly a U.S. shortfall. The volume split between IO and U.S. is like 90/10 or something like that.
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. Also, do bear in mind that the factories we're building, they're, of course, for the inline products that are on the market today. The factories, they're built based on technologies that we expect to be able to apply for our pipeline products also. Here I'm thinking of products like CagriSema and amycretin, to mention a few. At this point, no indications of any potential write-downs.
Thank you, Karsten. Very clear. With that, we are concluding the Q&A session. Thank you for participating. 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 management. It is 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. We 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. Thank you.