Hello, and welcome to Novo Nordisk AS First 6 Months of 2021 Results Conference Call. Throughout the call, all participants will be in a listen only mode and afterwards there will be a question and answer session. Today, I'm pleased to present Lars Prouggaard Jorgensen, CEO, please go ahead with your meeting.
Thank you very much, and welcome to this Novo Nordisk earnings call for the 1st 6 months of 2021 And the outlook for the year. I'm Lars Roegard Jorgensen, the CEO of Novo Nordisk. I'd like to start by thanking you for your scheduling flexibility today As we decided to advance this earnings call as a consequence of our earlier than anticipated release of our results following an upgrade of both sales and With me today, I have our Chief Financial Officer, Carsten Munk Knudsen Executive Vice President and Head of Commercial Strategy and Corporate Affairs, Camilla Silvest Executive Vice President and Head of North America Operations, Doug Lange and finally Executive Vice President and Head of Development, Martin Holst Lange. All presenters will be available for the Q and A session. Today's earnings release and the slides for this call are available on our website, noornoise.com.
Please note that this call is being webcasted live and a recording will be made available on Novo Nordisk's website. The call is scheduled to last for 1 hour. Please turn to the next slide. The presentation is structured as outlined on Slide Please note that all shares, sales and operating profit growth statements will be at constant exchange rates unless otherwise specified. The Q and A session will begin in about 25 minutes.
Please turn to Slide 3. As always, I need to advise you that this conference call will contain forward looking statements. Such forward looking statements are subject to and uncertainty that could cause actual results to differ materially from expectations. For further information on the risk factors, Including the uncertainties around COVID-nineteen, please see the company announcement for the first half of twenty twenty one and the slides prepared for this presentation. Please turn to the next slide.
In the first half of twenty twenty one, Novo Nordisk has progressed on all four dimensions of our I would like to highlight a few today. As a company, we're continuously working on being the best for the world and have progressed within purpose and sustainability. Under our defeat diabetes strategy that focuses on prevention, access and affordability and innovation, We have expanded the Changing Diabetes in Children program by including Ghana as the 15th country. This will support our aspiration We're reaching 100,000 children and young people with type 1 diabetes in low resource settings by 2,030. An integrated part of being a sustainable business is to offer an inclusive and diverse working environment.
In Novo Nordisk, a number of initiatives have been launched The current share of women in leadership positions defined as Vice Presidents and above is 35%. To underline our commitment to accelerate progress and ensure leadership accountability, we are launching a global gender diversity target. Specifically, our aspiration is to achieve a minimum of 45% women and a minimum of 45% men in leadership positions by the end of 2025. Personally, I see this as an important step to create an inclusive culture with equal opportunities Martin will come back to key developments within R and D, but I wanted to touch upon a few. We have reached a very important milestone with the approval of Wegovy in the U.
S. To the benefit of people living with obesity. WIGOVI was made available to U. S. Patients in June 2021, and Doug will share more about the details of the launch later.
Furthermore, we expanded our pipeline within cardiovascular disease with the Heart Seed collaboration and acquisition of Protina's ATTR Amyloidis doses program. For commercial execution, we have progressed on all three strategic aspirations, Which Camilla and Doug will elaborate on later. Lastly, leaving the details to Carsten. We are pleased with the sales growth of 12% and operating profit growth of 9% in the first half of twenty twenty one, both measured at constant exchange rates. With that, I give the word to Camilla for an update on commercial execution.
Thank you, Lars, and please turn to Slide 5. In the first half of twenty twenty one, our total sales increased by 12%. This sales increase was driven by both operating units with international to growth with diabetes care sales growing 11% driven by GLP-one sales growth and broadly unchanged insulin sales. GLP-one sales increased 30%, driven by North America growing 24% and international operations growing 46%. The broadly unchanged insulin sales were driven by a 6% growth in international operations, partly offset by an 11% sales decline in North America.
The U. S. Sales declined by insulin sales declined by 11%, driven by a decline in volume and realized prices, the latter driven by channel and payer mix as well as rebate enhancements. Obesity Care sales grew 34% overall and now includes both Saxenda and Wegovy in the U. S.
In International Operations, Saxenda sales grew 44%, and in North America Operations, Obesity Care sales grew 27%. Biopharm sales increased by 7% driven by North America In line with our strategic aspirations of reaching 1 third of the diabetes value market by 2025, our growth of 11% is faster than the overall market, And hence, we have improved our market share by 0.5 percentage point to 29.6%. This increase reflects GLP-one growth of 30% and market share gains in both operating units. Currently, Ozempic has been launched in 62 countries Please turn to Slide 7. In International Operations, Diabetes Care sales increased by 13% in the first half of twenty twenty one, driven by all geographies.
The continued rollout of new generation insulins and focus on the GLP-one product portfolio have resulted in an increased diabetes market share in international operations, which is now 23.9%, reflecting an increase of 1.4 percentage points compared to 1 year ago. This is driven by share gains in both DLP1 and insulin. And in the last 12 months, our insulin volume market share has increased from 47% to 47.3%. Please turn to the next slide. Biopharm sales grew by 7% in the 1st 6 months of 2021.
This was driven by a 12% sales growth in North America operations and 4% sales Rare blood disorders grew by 11%, driven by uptake of launch products, Esperoct and VASYSIA ANOVA8 and ANOVA7. Specifically, hemophilia A products grew by 39%, hemophilia B sales by 30% Endovo 7 by 3%, where endocrine disorders grew by 2%, driven by new indications and global rollout of the next generation device for nodetropin. And now to Doug for an update on U. S. GLP-one and Obesity Care.
Thank you, Camilla. Please turn to the next slide. The U. S. GLP-one volume market growth is around 25%, Comparing Q2, 2021 to Q2, 2020, driven by once weekly injectable GLP-one as well as Rybelsus.
Novo Nordisk new to brand market share leadership is now 62.6%, driven by the continued uptake of Ozempic and Rybelsus. Furthermore, Ozepic has regained NBRx market share leadership within injectable GLP-1s in the first half of twenty twenty one. Measured on total scripts, Novo Nordisk remains the market leader with more than 50% market share. Please turn to Slide 10. In the U.
S, REVELTYSIS increased its volume market share both in terms of total scripts and new patient starts in the first half of twenty twenty one. This should be viewed in light of the 2 COVID-nineteen related commercial lockdowns in the U. S. With no face to face interaction between Novo Nordisk and the prescribers. Since mid May, our sales force has been fully back out in the field.
Importantly, Leading indicators such as prescriber breath, HCP awareness and sourcing from outside of the GLP-one class remain encouraging And we remain confident in the product and its long term potential. In addition, the launch trajectory is broadly progressing in line with the average performance of major SGLT2s that were all launched in a non COVID world. Outside the U. S, REVELTYSIS has now been launched in 17 countries with one key market being Japan, where REVELTYSIS has reached a 0.7% Modern OAD value market share. While underlying parameters are on track, it should be noted that there Continues to be COVID lockdowns in Japan, which makes it difficult for patients and the sales force to reach doctors.
Please go to the next slide. With the U. S. Approval of Wegovy in June, Obesity Care is now a portfolio consisting of 2 products. Globally, Obesity Care sales increased 34% with 27% growth in North American operations and 44% in international operations.
As we have touched upon throughout 2020 2021, Fewer patients have started treatment with Saxenda due to COVID-nineteen lockdowns and reduced access to health care providers. But thankfully, the situation has now started to improve. In the U. S, since the start of the year, We have seen positive momentum in new patient starts on Saxenda, which during the Q2 of this year were above pre COVID levels. The U.
S. Launch of Wegovy has been extraordinarily fast. Following a 6 month FDA review, Wegovy was approved on June 4, launched on June 10 and available to patients in pharmacies on June 18. Market access has progressed since launch and 2 national payers have unblocked Wegovy from their national formulary. The initial feedback from patients and prescribers has been encouraging.
5 weeks after launch, more than 8,000 will go via prescriptions have been filled and more than 50% of these are new to the anti obesity medication class. Now the overwhelming initial demand has put the supply chain under pressure, leading to temporary shortages for the starting dose, which is 0.25 milligram. Novo Nordisk is committed to ensuring that any patient who has started on Wegovy We'll be able to continue on the product and production plans are being adjusted to satisfy the current demand. Now over to you, Martin, for an update on R and D.
Thank you, Doug. Please turn to Slide 12. Now in the first half of twenty twenty one, we progressed our pipeline In diabetes, in obesity, in biopharm, as well as in other serious chronic diseases. Based on the significant unmet need of millions of people, As well as scientific evidence to the potential benefits of GLP-one based treatment of dementia, we initiated in May 2 Phase 3 trials, EVOQ and EVOQ plus investigating the efficacy and safety of oral semaglutide 14 milligram in early Alzheimer's disease. As discussed before, we have in real world data as well as in post hoc evaluations of our large scale RCTs seen the potential of clinically very meaningful impact of GLP-one treatment on the progress of dementia.
The mode of action is still being evaluated, Based on preclinical data, semaglutide is believed to work by reducing neuroinflammation as well as by impacting other pathways In the Alzheimer's pathophysiology, thus reducing neurodegeneration and slow the clinical decline in Alzheimer's disease. The duration of the two trials will be 3 years with a confirmatory readout after 2 years. There are 18.40 patients in each trial and therefore a total of approximately 3,700 patients will be randomized, The majority of whom be diagnosed with mild cognitive impairment or early dementia of the Alzheimer's type. In Evoque Plus, however, at least 20% of patients enrolled will have small vessel pathology. The primary endpoint for both trials is the change in the clinical dementia rating sum of VOXXY score after 2 years of treatment.
If successful, semaglutide has the unique potential to become the world's first oral disease modifying treatment For Alzheimer's disease with a very well established safety profile from across several indications. Please turn to the next slide. Within cardiovascular disease, Novo Nordisk strategic ambition is to have at least one dedicated compound to be launched between 2024 and 28. This should target either atherosclerotic cardiovascular disease or heart failure with a Highly innovative first to market products serving a significant unmet need. In support of this ambition, We've entered into a new stem cell R and D license agreement with HeartSheet and further acquired Prothena's ATTR amyloidosis program.
Let us start with the HeartSheet agreement. Novo Nordisk has entered into an exclusive worldwide collaboration as well as license agreement for the development, manufacturing and commercialization of Harte's lead asset, HS-one. HS-one is an investigational cell therapy using purified cardiomyocytes derived from induced pluripotent stem cells, which is currently under development by Heartseed for the treatment of heart failure. Hartzit expects to initiate a combined Phase III trial in Japan during the second half of this year. The collaboration very nicely complements our own stem cell technology platform.
Further, We've acquired Prothena's broader ATTR amyloidosis program and the Phase 2 ready antibody PRX004 for the rare heart disease ATTR cardiomyopathy. More specifically, this is a rare type of heart condition characterized by a buildup of amyloid deposits in the cardiac tissue. This can cause both weakening and stiffening of the heart muscle. And it is an often fatal disease with a very significant unmet need. The asset PRX004 has an innovative mode of action with the potential to remove myocardial amyloid, preventing further progression and to reverse the course of the disease in ATTR cardiomyopathy.
Novo Nordisk expects to initiate a Phase 2 clinical trial in 2022, which is expected to be followed by a Phase 3 cardiovascular outcomes trial. These activities support an expansion of Novo Nordisk activities and commitment within cardiovascular disease And as to the ongoing activities within the cardiovascular space, such as our clinical development program for cetivekumab, oral PCSK9, as well as our major cardiovascular outcomes clients such as Select and Zoloft. Please go to the next slide. Turning to the high level RNG milestones, we start with the Q2 of 2021. Within diabetes, we resubmitted the label expansion for Ozempic 2.0 milligram for the treatment of diabetes to the FDA on May 28.
The standard review time by the FDA is 10 months. This resubmission followed the refusal to file letter received by the FDA on March 22. It's already been mentioned during this call, but within obesity, we've reached a very important milestone with the approval of Wegovy in the U. S. This was based on the results from the STEP program.
And building on that, in Q2, we completed the Phase II sorry, the Phase IIIb trials, Step 5 and step 8. Step 5 demonstrated a sustained weight loss of 16.7 percent over a period of full 2 years of treatment. Almost a little bit repetitive, but very consistently to the profile, Step 8 demonstrated a similar 17.1% statistically significant weight loss. This is to be compared to the 6.7% achieved for Saxenda.
In the
second half of twenty twenty one, we expect Phase 1 results for our glucose sensitive insulin As well as several trial initiations across all therapy areas such as the Phase 3 initiation of oral semaglutide in obesity and the CB outcomes trial for cilizavecamab in other serious chronic diseases. Towards the turn of the year, we expect a from the EU on somagnetide 2.4 milligram in obesity and Ozempic 2.0 milligram in diabetes. Within biopharm, we expect results from the Phase III program for somapacitan in growth hormone deficient children and results from cohorts of the ongoing combined Phase III trial with MiMID. With that, over to you, Karsten.
Thank you, Martin. Please turn to Slide 15. In the 1st 6 months of 2021, sales grew by 5% in Danish kroner and by 12 The gross margin declined to 83.0% compared to 84.1% in 2020. The decline reflects a negative currency impact of 0.7 percentage points, lower realized prices in the U. S.
And amortization of intangible assets related to the acquisition of Hemisphere Technologies in 2020. These factors were partly offset by positive product mix driven by increased GLP-one sales and continued productivity improvements. Sales and distribution costs increased by 8% in Danish kroner and 15% at constant exchange rates. The increase is driven by investments in our key strategic priorities, most notably launch activities and promotional spend for Rybulsus and Entosempic, Market development investments for obesity as well as sales force expansion in China. Research and development costs increased by 12% in Danish kroner and 15% at constant exchange rates.
The cost increase is driven by increased investments associated with more patients So, and Select. Furthermore, we increased our investments in our research platform technologies. Administration costs increased by 5% in Danish kroner and 8% at constant exchange rates, impacted by a low spend in the first half of 2020. Operating profit increased by 1% in Danish kroner and increased by 9 decreased by 1% in Danish kroner and increased by 9% at constant exchange rates. The negative currency impact on operating profit is partly offset by around DKK 1,000,000,000 in hedging gains under net financial items.
This compares to a loss of DKK 1,700,000,000 in 2020. The gains on hedge currencies primarily relate to the U. S. Dollar. Net profit increased by 10% and diluted earnings per share increased by 12% to DKK10.71.
Free cash flow was DKK 32.7 billion compared with DKK 30.3 billion in 2020. The increase reflects the higher net profit and the favorable impact from changes in working capital, further positively impacted by within timing of U. S. Rebate payments. Next slide, please.
A key priority for Novo Nordisk is to ensure attractive capital allocation to shareholders. And over the past 3 years, our average cash to earnings ratio has been around 80%. In May, the share repurchase program for 20 DKK 1,000,000,000 to a total of DKK 18,000,000,000. It should be noted that the program may be reduced in size if significant business development opportunities arise during 2021. For 2021, the Board of Directors Has decided to pay out an interim dividend of DKK 3.50 per share, which will be paid out in August this year.
This is an increase of 8% compared to the 2020 interim dividend. Novo Nordisk has consistently returned its free cash flow to investors through both share buybacks and dividends, with dividends per share increasing for 25 consecutive years. Finally, in Q2, we executed a 3 7 year euro bond issuance in an aggregate amount of €1,300,000,000 The 2 tranches were issued with a coupon of 0% and 0.125%, respectively. The euro bonds were issued under a €5,000,000,000 EMTN program. Please turn to the next slide.
We now expect 2021 sales growth to be between 10% 13% at constant exchange rates. This is based on the performance seen in the first half of the year across therapies and geographies, including the strong initial Begovy uptake in the U. S, Increasing global obesity market growth, Ozempic growth acceleration as well as a reduced likelihood of a negative impact from volume based procurement in China in 2021. The guidance reflects Growth across therapy areas, but is mainly driven by GLP-one products Ozempic and Rybelsus as well as Obesity Care. Also embedded is intensifying competition within both Diabetes Care and Biopharm and continued pricing pressure mainly within Diabetes Care in the U.
S. Operating profit is now expected to grow between 9% 12%, reflecting the sales growth outlook and continued investments in current and future growth drivers. This includes the continued rollout of Ozempic and Rybelsus, the launch of BIGOVI and associated market development investments. Furthermore, additional resources are being allocated to R and D pipeline activities, such as the MANI Phase III clinical trial activities. Given the current exchange rates, most notably a strengthening of the U.
S. Dollar, we expect a less negative currency impact for the full year compared 3 months ago. Consequently, our reported sales and operating profit growth is now expected to be 4% 5% lower to be a gain of around DKK0.6 billion, mainly reflecting gains associated with foreign exchange hitting contracts. Capital expenditure is still expected to be around DKK 7,500,000,000 in 2021. Lastly, free cash flow is increased by DKK 2,000,000,000 and now expected to be between DKK 39,000,000,000 and DKK 44,000,000,000.
That covers the updated outlook for 2021. Now back to you, Lars, for final remarks.
Thank you, Carsten. Please turn to Slide 18. Firstly, we are proud of our progress within Purpose and Sustainability with the introduction of a concrete gender diversity target To continue to build an inclusive culture with equal opportunities in our Nordisk. We're also pleased with the sales growth in the 1st 6 months of 2021. Sales growth was driven by all geographical areas within International Operations as well as North America Operations and by all therapy areas, in particular our portfolio of GLP-one treatments.
The strong financial performance in the 1st 6 months of 2021 And the initial substantial demand for Wegovy has enabled us to raise our outlook range for the full year. We reached an important milestone with approval and very fast launch of Wegovy in the U. S. With encouraging initial feedback from both patients and prescribers. Finally, the license agreement with Heart Seed and the acquisition of Protina's ATTR amyloidosis program It's fully aligned with our ambition within cardiovascular disease.
We're now ready for the Q and A, where I kindly ask you to limit yourself to maximum of Two questions. Operator, we're now ready to take the first questions.
Thank you. Our first question is from Emmanuel Papadakisky from Deutsche Bank. Please go ahead.
Thanks for taking the question. Maybe I'll take 2 on Golgi please.
If you could just give us a little bit
of insight into what proportion Of the strong initial prescription uptake is free versus paid product and when you expect to phase out The form of that, I. E, the free products, and I'm not referring to the $25 copay support, just literally the product you're subsidizing. And the second question would be around your anticipation based on initial discussions for coverage rates in 2022. So we I think we had reasonably strong technical commercial insurance coverage rights, but a lot of opt outs, So less than half of that was effective. Are you expecting something similar on Wengovee?
Or do your initial discussions need you to believe that there'll be more from commercial employers and to what extent will that also involve utilization management
Thank you, Emmanuel. So I'll hand over to Doug the questions on How we see the split of the initial scripts on Wegovy, whether it's based on commercial access or It's support programs. And maybe Doug, you can talk a bit to how we are building access With the caveat that we're not at this call going in and guidance giving guidance on access or the like when it comes to 2022. So it's a bit about how we are progressing as we speak. So over to you, Doug.
Yes. Thank you, Lars, and thank you, Emmanuel, So for your first question, I would say it's roughly 50 in terms of where we're seeing coverage today and where we need to assist as an organization. Secondly, to your question on coverage, I think that we've been pleased initially with the work that the team has done, the receptivity from major PBMs as well as Local health plans and employers. As I stated in my opening, 2 major PBMs did unlock the blocking of Wegovy Early on, almost at launch, so that's a promising sign. And I think the receptivity and the feedback from the clinical conversations has been extremely strong.
We have communicated that we believe that we'd like to see Saxenda like access in 2022 moving on, and I'd these early indicators are a good sign that we're well on our way.
Thank you, Dirk, and thank you, Emmanuel. And next set of questions, please.
And our next question is from Matthew Weston from Credit Suisse. Please go ahead.
Thank you very much. Two questions for me, please. The first on Rybelsus. If we look at the U. S.
Prescription trends versus revenue, Doug, it would suggest a significant step down in revenue per unit. And I'd just be very interested to understand whether that's a re increase in rebating and patient support as the sales force comes Back online or has there been a significant change in mix in the U. S. Market? And how would you expect us how do you expect that to progress over the course Of the year?
And then secondly, a general question on guidance. You've significantly raised revenue expectations, but you've also Kept operating margin growth below sales. I realized that was the guidance in your previous setting because it was all about investing in R and D. Now that you've added incremental sales, I'd be very interested to know what you're spending the extra money on. Is it R and D or is it more incremental sales support for the launches?
Thank you.
Thank you, Matthew. So two questions, one on Rybelsus prescription and how do we see the revenue Per script, I think that looks okay, but Carsten can cover that. And also Carsten, you can cover the guidance that we are keeping intact, can say the ratio between top line and bottom line?
Yes. Matthew, thanks for these questions. So first of all, As to Rybelsus value prescription in the U. S, there are basically very limited changes to what we're reporting for the Q1. We are now at the tail end of some of the initial launch co pay programs.
We saw them run out here in the middle of the second quarter. So that's The only change visavis Rybelsus value per script. Then we have a competitive Copay program vis a vis the oil competition down to $10 per script and we have a Like pricing from there, so pretty much nothing new from Q1. In terms of investments with With the increased sales outlook, then of course that's something that we carefully consider and I would put it In rather simple buckets, so first of all, we continue to invest in our TF1 portfolio between Rybulsus Endozempic, both in the U. S.
But also on a global basis. Then secondly, our Obesity franchise with the market development required clearly is a focus area of investments on a global scale. This is This is a market that we have to build on our own. So clearly, a lot of investments going into both building internal capabilities, but also working a lot On market development at large. Thirdly, if we invest in specific emerging markets based on growth And portfolio in those markets.
And then finally, I would say, as I've been commenting on before, Clearly, we have a strategy to increase our R and D to sales ratio gradually over You also see in the patient numbers and the portfolio that Martin was talking to.
Thank you, Carsten. Thank you, Matthew. Next set of questions, please.
And our next question is from Vimal Kapadia from Bernstein. Please go ahead.
Great. Thanks so much for taking my questions. I will Mark Kapadia from Bernstein. So just first On ribosus, I just wanted to know what's Novo's preference in terms of volumes between ribosus and Ozempic, given that Ozempic seems to Have a higher net price, but a shorter IP duration and does not have the same level of lifecycle management as Rybalsis. So just curious, Given Ozempic seems to be beating market expectations, but RISE PRIBALISSE seems to be coming in a little bit lower.
And then my second question, I just want to ask about the broader And if I look at volumes over the last 5 years in the U. S, we actually see flat absolute volumes in for AOMs. So I'm just curious how you're thinking about market volume growth from here. Do you expect WEGOVI to drive market growth? And to what extent do you think that they can do that over the majority of volumes actually come from generic products on the market?
I appreciate the initial volumes Just fifty-fifty like you outlined in your slides, but just curious how you think that will play out moving forward? Thanks.
Thank you, Wimal. So first, Camilla, if you can talk to a bit whether we have a preference for 1 or the other, Rebersource versus Symptec, in terms of driving growth. And then Doug can talk to What we see in terms of obesity market growth in the U. S?
Yes. Thank you, Lars. So Since we had the approval of Rybelsus, it has always long been our strategy to expand into the OAD market. And from the PIONEER program, we saw that Rybelsus It's the most efficacious OAD. So our plans and strategies are to expand the use of DLP1 Being in the injectable segment and being in the OAD segment where we historically have never been present.
So that's basically the strategy that we've been following and that we are executing on.
Thank you, Camille. That's very clear. And I think we're seeing some good success. So Doug, what can you say about your expectations To your busy market growth in the U. S.
Thanks. I appreciate the question. So what I would say is, as I said in my opening comment that we did See in the Q2, Saxenda coming back and then additionally and importantly, Wegovy adding to the growth of the category. And importantly, we saw within that over 60% of that coming from naive patients. So the expectation is that, we'll go over it will continue to add to the class and its
growth. Thanks, Doug. And when we compare to IO, we can see that there's a very, very nice uptick in the obesity market in IO. And obviously, we are not even close to getting Wegovy on the market there. So I think it's a very strong sign that a 44% growth in IO It is a sign that the obesity market is back, and you could say that it's maybe coming back even stronger because during the lockdown And many people have developed an even larger need for obesity medicines.
So we're quite confident and bold on the future Growth of the obesity market globally. Thank you, Wimal. Next set of questions, please.
And our next Question is from Steve Scala from Cowen. Please go ahead.
Thank you so much. 21, wegovy. First, curious if Versus your expectations, more physicians have prescribed Legovy so far or among the physicians who have prescribed it, You are seeing more prescriptions per physician than expected. So the former might suggest a bigger opportunity, The latter might suggest quicker saturation. And then secondly, have commercial insurers mandated any stopping or discontinuation Conditions on Wegovy use.
Thank
you. Thank you, Steve. So Two questions on Wegovy. So the first one to kind of birth or death in terms of the prescriber universe And then whether there are any, say, conditions to how commercial plants can join the WIGOVI campaign. So Doug, can you talk to that please?
Yes. Thanks, Steve, for the question. So For us, what's critically important is both breadth, so the number of prescribers as well as depth and those prescribers prescribing more. So we're hard at work at both of those. And I'd say it's early days to tell.
We're 5, 6 weeks into the launch. What we have been pleased with We've seen 8,000 prescriptions in less than a month. If you compare that to Saxenda that took approximately 4 years to achieve that. So I think that it's a combination of both. As far as your payer question, right now we're seeing The same traditional components on Saxenda in the payer community as we are with Wegovy.
But we're working very hard to have this Treated like a standard listed product, we think that's critically important, not only for patients, but the overall success of the brand. So that's where we're hard at work. And again, early indications are good Receptivity of the PBMs.
Thank you, Doug. Thank you, Steve. Next set of questions, please.
And our next question is from Peter Verdult from Citi. Please go ahead.
Thank you, Peter Verdult, Citi. Just a quick clarification for Doug and then my two questions. Just very quickly, Doug, when do you expect the supply situation on the start of those Filmicore V2 result? Just a very quick clarification. Just on the two questions, maybe for Carsten.
Can you just give us some sort of ballpark quantification What the uplift was for guidance this year from VDP insulin in China not coming to pass in 2021 And any sort of intel or insight you can give us about potential scope and breadth of VUP plans for 2022 In light of the recent meeting with the government and industry payers. And then for Martin, just a quick update on the key outcome studies, Select, Sol, Flow, just any comments I realize these trials are live, so you can't give us too much, but Anything you could say about event rates, whether they're running in line, ahead or behind schedule? Thank you.
So thank you, Pete. I will deal with the Supply issue because that's not really on the DUC's responsibility. So it's clear we have seen a very, very strong uptake of Wegovy. And I think we have to admit it's stronger than what we had planned for. So when you launch, you're obviously in a ramp up phase for manufacturing.
So we have some bottlenecks right now. But you can rest assured that we're working hard to make sure that we can ramp up manufacturing as fast as possible. And these are standard, say, Manufacturing processes that we know how to handle very well, so we know what needs to be done to get the supply back on track. And as Doug mentioned, our key concern is, of course, to make sure that those who start on treatment can continue on treatment. On BBP in China, Karsten, you can talk a bit to how it's baked into the guidance, but I can just say that there was recently a consultation meeting in China with the authorities where manufacturers Based on that, we now believe it's less likely that there'll be an impact this year.
If an insulin VBP is implemented, which we believe will eventually happen, it's Probably not going to take place before 2022. And if you put a bit of caveats around it, had it been easy to do, most likely it would be done. So I think I've commented before that the experience that is already in the market is in the small molecule space. And if you want to do a VPP for biologic and not least a lifesaving medicine like an insulin, This is not a trivial thing to do to secure both volumes and quality of those volumes. So for now, we think it's unlikely for this year.
And if it happens, it could be next year. So Karsten, you can talk to how we have baked that into the guidance we have given.
Yes, absolutely. And thanks for that question, Pete. So based on what Lars just explained around the status of EVP, That was part of enabling us to narrow the breadth of our guidance range for our top line and lift the floor. But of course, the Key driver behind us lifting the oral range was what we have just discussed in terms of our performance in within obesity Both wegovy and the oral obesity market growth as well as the acceleration in GLP-one and the strong biopharm performance in the first half.
Thanks, Karsten. And since I think this was actually 2 questions, margin very shortly on status on the outcome trials.
Thanks very much, Pete. Things are going well. We managed to secure recruitment of all three Trials on time. In fact, Select and Flow were a little bit ahead of time. And what we see right now is despite of COVID-nineteen, Really good retention in all trials.
So more than 95% of patients still being in trial. We can't really speak to the event rate, But maybe just saying that what we see right now is very close to what we anticipated when initiating the trials.
Thank you, Martin. Good to hear that is well on track. Thank you, Pete, for the two questions. And on to next set of questions, please.
Our next question is from Martin Parcoy from Danske Bank. Please go ahead.
Yes. Martin Parcoy, Danske Bank actually also on the go. We all the two questions. Just on the supply side, Lars or Carter, whoever, You say that you, of course, prioritize to make sure that the patients which already on the drug can continue. Does that mean that we can what should we think about script count because we have an enormous growth in script over the last 5 weeks?
Can you know new scripts actually or new brands stalled because you can actually not have supply to start new patients now? Or how should we see the dynamics? And then secondly, maybe this is on to Doug. I guess that A lot of the demand for the cohort has been driven by patients seeing About this new one to drugs in media and stuff like that, are there a risk that it's not the right patients, they're not the patients that you actually like to have to make sure that this is will be a strong long term upside of the drug. And also maybe you can talk a little bit because we also saw many years ago that Contrave actually had a quite nice start, not to the magnitude like this, but It died out.
So how many are there risks that you're actually not getting the right patients on board?
Thank you, Martin. I'll start on the supply. So we have seen here initially That we were out of the start dose, the low dose, but of course, manufacturing is running constantly. So yes, we can start new patients. But the initial uptake we have seen is significantly higher than what we had planned for.
And It's not it's always quite common that when you launch a new product, you are ramping up manufacturing as you launch and we're doing that. So We will eventually be able to cover the full demand, but it's not that we cannot start new patients For the rest of the year, so don't need to worry about that. You're right that there's a lot of excitement around Wegovy. And Doug, What can you talk to the type of patients we get in? Obviously, it's early days, but what is your intelligence from the field?
Thanks, Lars. And Martin, thank you for the question. Let me first start by saying, we have a there's a when we think about an unmet need in the 650,000,000 patients in the world With 100,000,000 patients in the U. S, they need help and they've been in a lot of ways maybe waiting for a drug like this. So There's certainly a significant patient pool.
I would say it's early days. When we look at the patient level data that we see it with Saxenda, Typically, the patients are aged between 4060 with a BMI of 35 or less with comorbidities. So, I think there is a significant unmet need and now is the right time to unlock the potential.
And who are the main prescribers? Primary, indoors, weight loss centers?
Yes. So what we're seeing and again, this is really based on what we've For Sexend and anticipate is that the primary care physician, the interim medicine, nurse practitioners, PAs, That's going to be the bulk of the prescrib writers that we're going to see in this space right now. It's less about specialty as comparatively as we would see in say diabetes, But based on what we see in Saxenda, what we anticipate is PCP and NPs.
Okay. Thank you.
Thank you, Doug. Thank you, Martin. It's clearly Exciting times, and I think we've all been talking to that we go is the first time there's a real solution to the problem being obesity. And I think the sign we see from the market is that, that's well understood and there is a significant demand for this. So we're very encouraged with what we see.
Next set of questions, please.
Our next question is from Karsten Lundborg from SEB. Please go ahead.
Thank you very much. I will just jump a little bit into the GLP-1 diabetes segment. What we saw here in Q2 was that you Significantly also your sort of market share gain trajectory in the U. S. Market and you had a very, very strong quarter in terms of market share gains.
And it came after a
period where maybe Lilly had put a little bit
of pressure on you with the high dose Trulicity launch. What have you changed? Have you changed anything in your message or your go to market strategy for, in particular, Ozempic because it seems to be Ozempic that's the driving force. And then secondly, on what's your expectations for timing of U. S.
Interchangeable version of NovoLog? And what do you think will happen once such a product hits the market?
Thanks.
Thank you, Carsten. And I think the first question on U. S. Tier 1 dynamics, clearly, very, very strong performance. I think we have all long been very Excited about Ozempic.
But Doug, can you share anything about any change in tactics or anything? Or is it just pull through? And then secondly, I don't know timing about interchangeability on NOLOC, whether you have overview of that?
Thanks, Carson for the question. And what I would say is, if you just remember, we started to phase in our sales reps In mid February and then got them fully back in the field by May. So there was a component of us reentering into the market. I would also suggest that somaglutide has become a well known molecule. Ozempic itself is highly recognized.
It's excellent efficacy. You think back to the numbers of patients in the SUSTAIN program, 80% of them reaching HbA1c of less than 7%. So It's a great product. And I think that we haven't necessarily changed our strategy. We're still deploying what we've communicated is semi synergy, which is to be effective And successful with both Ozempic and Rybelsus in the category.
Okay. And on the second question on interchangeability in the U. S, I think our perspective is that to a large degree, we already See that the market seen from a manufacturer's point of view is a market that works like an interchangeable market in the way PBMs buy from us. It might not be fully the benefit of that might not fully be going to the patients. But in terms of the contracting we do, That is largely of an interchangeable nature.
Thank you, Doug, and thank you, Carsten. So we take your next set of questions, please.
And our next question is from Michael Novot from Nordea Markets. Please go ahead.
Yes, thanks a lot. Two questions as well. So Perhaps on NovoSeven first. So how should we sort of foresee growth going forward? It seems you have been able to completely stabilize it.
And if you First half year, you're up around 19% in the U. S. So are we through this Market share erosion from HEMLIBRA and what should we expect going forward? And then secondly, to Rybelsus Dynamics In IO, we see a quarter over quarter decline in sales. Is that due to the aforementioned lockdowns in Japan still going on?
What is sort of the drivers of this? So is it just that you don't really get the traction that you wish for with the Belsys in IO?
Yes. Thank you, Michael. Yes, indeed, no 7 performance is very strong in a rather competitive arena. So Carsten, can you talk a bit To how we see growth there. And then Camille, you can touch upon Rebelsa's performance in International Operations where, yes, I think we have seen a lot of Pandemic activity going on.
But first, Carsten? Yes.
Michael, I fully concur. We were very satisfied with the 3% growth in the first half for NovoSeven after a number of years Where the branch has been significantly under competitive pressures. I'd say there are a couple of aspects to it. So first of all, Then as you know, the demand for NovoSeven is somewhat stochastic in nature linked to the number of bleeds and surgeries and so And we did see some significant events in the Q2 in the U. S.
Positively impacting U. S. Sales. And on top of that, without having a firm data on it, then of course with the society And Healthcare Systems opening up, one could speculate that increased activity levels could lead to increased bleeding episodes requiring NovoSeven treatments. As to the commercial impact on the brand, then We are not fully through that set of emerging markets that have yet To launch competition, but to a large extent, we are through it in some of the more developed markets.
Thank you, Carsten. And Camilla, on reversals performance in IO?
Yes. So on reversals in IO, we are continuing We see increasing market share performance in key countries, but it is, of course, in the light of COVID-nineteen that continues to impact especially EU countries And also Japan. We've owned in 17 countries. And Japan being the country with the biggest potential has been impacted by multiple states of emergencies, and that, of course, impacts our ability with the sales force to reach our customers. Nevertheless, the underlying parameters such as number of actively prescribing physicians and source of business and also launch upticks Does look good and encouraging.
And as in the U. S, we also in the rest of the world continuing to expand the number of prescribers and of course, The number of scripts, what we call depth for the prescriber as well.
Thank you, Camilla, and thank you, Michael. Next set of questions, please.
Our next question is from Sachin Zhang from Bank of America. Go ahead.
Hi, it's
Tatch and Jane, Bank of America. Just 2 on with GOVI, please. I'm just trying to try and get the excitement on scripts into numbers to the extent you're able to. So firstly, Is it fair to assume that the biggest single element of the sales guide raise is Wegovia of the various factors that you've listed Implying we're going to be sales of sort of DKK 1,500,000,000 to DKK 2,000,000,000 for this year. And then secondly, again, Doug, you mentioned that scripts have matched Saxenda within 8 weeks.
And if that is converted to paid drug into next year, is it fair to think that you could potentially achieve your midterm obesity aspiration of doubling sales by 2022 itself. Thank you.
Thank you, Sachin. So we are not going into speculations about 2020 2 as of yet, but we have limited amount of recovery sales in the books so far, Carsten. But what can you tell us about What we are seeing without going into guidance on individual brands?
Yes, Cien. As I was covering before, then Obesity Care at large is one of the key drivers for us upping Our guidance for the full year and that is the combination of Vicovy and the overall market growth benefiting Saxenda both in the U. S. And in International Operations. So, we go with part of it, but only one segment.
So, the Two main chunks of the upgrade is Obesity Care and acceleration of our GLP-1 business.
Thank you, Carsten. So we'll take the final set of questions.
And our next question is from Seamus Fernandez from Guggenheim Curtis, please go ahead.
All right, great. Thanks for the question. So a couple of questions. First on the select trial And the current obesity market uptake and opening up of access. Just hoping in the past, you've Generally commented that the select trial would be critically important.
I think one investor earlier this week characterized it as biblically important to a real opening up of the obesity market. Just wondering how you're feeling given the strong early launch of Wegovy Relative to the importance of a successful select trial. And then incremental to the select trial opportunity, I don't think we've had many questions on AM833 and the acceleration of your combination program there. Just hoping, you could provide a little bit of context of the pace of a switch there Potentially and how quickly you would want to drive patients to that? Is it optimized for obesity?
Or do you really view that combination As a preferred diabetes plus obesity and NASH market opportunity product. Thanks.
So thank you. If I start by giving it a shot on how we see the importance of Select and then Martin you can cover The second question. So we have when we have spoken to the obesity opportunity, we have spoken about the importance of mobilizing No, patients living with obesity, the importance of getting physicians to prescribe and the importance of getting payers To reimburse. And you can see the based on the initial signs we see here, we do see that patients are Mobilized, we do see that physicians are willing to prescribe. And based on what Doug mentioned in terms of 2 national Payers having removed block, we also see that there's a willingness to pay for it.
So I think it's I think we're off to a very exciting start and it seems like the profile of the product and the Market build activities we have done is resonating well, and I think that's quite encouraging. Margin on Hey, Amit. Do you feel?
Yes. Very briefly, Cagrulintide between France to be combined with semaglutide and we've shared Data showing that with the combination of cabrelentate and semaglutide, we can see an approximately 17% weight loss, but in a matter of 20 weeks and with a safety profile that is comparable to that of semaglutide in monotherapy. Obviously, that has made us very excited and we intend to initiate Phase 3 already Next year. I think the question was more about the positioning of the combination product towards semaglutide and maybe that's too
Thank you, Martin. And let's since we are on a good role, take one final question.
And our next question is from Keo Park from Goldman Sachs. Please go ahead.
Hi. Thank you for fitting me in. Two questions, if I may, please. First one, Doug, as we think about the launch for Vicobee ex U. S, If my memory is correct, kind of the Saxenda launch ex U.
S. Was actually more successful than the Saxenda launch in the U. S. So as we think about Vika, we launched ex U. S, is there a reason why that might be different?
Or should we expect a similar enthusiasm to the Vika we launched ex U. S? That's question number 1. And then question number 2, Carsten, you kind of made an oblique reference to the risk to the Stock buyback in the event that you were to pursue a sizable transaction. You're clearly raising your free cash flow guidance.
You have done a couple of transactions, but your balance sheet capacity is still meaningful. So I'm just wondering kind of if What is the size of transaction that might need you to rethink your stock buyback? And is that something we should We anticipating over the course of the next few months. Thank you.
Thank you, Keyur. So On WeGoi ex U. S, we have plans to get European approval by turn of the year. It's a bit early for us to start speculating on how it might look like. I think it's a quite dynamic position that In IO, it's typically out of pocket paid, whereas in the U.
S, it's reimbursement. And Clearly now in the U. S, it seems like we are now hitting a weight loss profile where it becomes meaningful for payers to reimburse. And I can only project that individuals who are paying out of pocket today When they see the profile of Wegovy at a similar pricing, there is a very robust demand for that also outside of the U. S.
So again, Encouraging prospects based on the profile of the product and the price point we have set. You raised a good point in terms of Capital location in the context of deals, so Carsten, can you talk a bit to that? You have Introduced debt financing in Novo Nordisk at a 0% coupon, which obviously is an attractive Great. So what can you tell about that?
Yes. Thank you, Lars. Thank you, Kjell. Yes. So first of all, It's interesting how to finance the company.
It was 40 years ago that we actually listed on the New York Stock Exchange at a PE at around 15 And now we are issuing bonds at a 0 coupon this year. So just to wind back, we basically have 3 core pieces to our toolbox in terms of capital allocations. So we have the cash we have on our balance sheet. Then we have adjustments to our share buyback and then we have debt leverage. Of course, there are additional means, but that's kind of 3 core tools we use.
And what you saw last year, Just to baseline us and that is that the Covidien transaction we did last year with an upfront of $725,000,000 That we're actually able to finance through our financial reserves or the cash on balance sheet without impacting our share buyback or raising debts, Well, the MSV acquisition at $1,800,000,000 in real estate is mainly linked and financed from the bond issuance we just did. So we are very focused on continuing to provide an attractive capital return to our shareholders And thereby, continuing our track record on increasing dividends for now 25 years, but also continuing our share buyback program. So Of course, it depends on the exact deal and so on how we finance it between three means and the magnitude of the deal.
Thank you, Carsten. Thank you, Keyur. With that, we'll close the call. So thanks a lot for dialing in and have a great day and a great evening wherever you are. Thank you very much.