Yeah, whenever-
Yeah. Might as well.
Whenever suits you.
Okay. We'll kick off the next section. Thank you very much, everyone. It's Sachin Jain here from the European Pharma team. It's my pleasure to introduce GSK from the company. We've got Julie Brown, CFO, which is very timely just after the recent CMD, and we've also got IR folks at the front. So, we'll just do Q&A, I think, Julie, if that's all right. So we'll just kick off big picture. We're just on the back of the CMD where management team outlined a new strategy, new midterm targets, et c. So perhaps you could just precis that as an intro to this session.
Yeah, sure. Morning, everybody. I am delighted to be here, and thanks to Sachin for the invitation. We recently did a presentation at the end of July, and the work that led to that was really two major work streams. The first one was all about how could we accelerate growth, how could we accelerate the assets within the company? That was led by Luke, our new CEO, and it was called the Strategic Portfolio Review. On the other side, we were looking at how would we fund the acceleration.
So we were determined that it would be a self-funded situation, and we looked at how we could simplify the organization to drive that funding, which resulted in a funding saving of GBP 1.9 billion that we could then put on the right-hand side in terms of Strategic Portfolio Review. Through that work, we came to the conclusion we wanted to accelerate seven major assets across about 18 indications. Interestingly, there was a big emphasis there on the oncology portfolio and the opportunity that that gave us. So net-net, as I mentioned, it resulted in GBP 1.9 billion of savings.
We decided to say the majority of that would be funding the pipeline. But what we also said was there would be an element that would drop through to the margin in the years that people were concerned about, which are the years where we lose the dolutegravir patent in HIV, which is 2028- 2030. So it gave us the ability to say, through that period, our margin will be stable to improving. So the organization, I think we were really proud of the communication. We were pleased with the reaction to the market.
I can tell you now, when I was in the U.S. last week, working with the team in the U.S., we have got a lot of change going on in the organization. It has caused a level of energy around those projects, together with an energy around how we can simplify further and drive further productivity in the business. I think very importantly, we have built a track record now of being able to do this well. Over the last five years, if you think about the 2021- 2026 period, we have actually delivered strong top-line growth.
More than 7% sales growth is expected. More than 11% profit growth is expected during that period. This is all based on guidance for this year, and together with an improvement in our margin of over 500 basis points, at the same time is taking our R&D spend up significantly. So we have proven, I think, we can invest significantly in R&D, but still deliver productivity through the P&L.
Okay. Very good. I am going to kick off with some of the commonest questions I get asked on the big picture. Obviously, the target is greater than GBP 40 billion. Consensus, I think is in the mid-high- 30s, from memory. What do you think the biggest deltas are as you now look at it versus consensus?
Consensus is now at GBP 36.4 billion. Not that I count. But it is at GBP 36.4 billion. The biggest deltas, and to my mind, it is quite usual to have a gap sometimes between the company and the sell side. Because typically, and I have done extensive work on this when I was in one of my former companies. I was with AstraZeneca for a long time. Typically, the sell side pick the asset up when it reaches a certain degree of maturity, and it has got certain data behind it. This is quite a pattern. But the largest area, there are puts and takes across. I have got a chart in my mind.
There are puts and takes across the board, but the largest area of difference is oncology. There you have got a difference coming through with the ADC portfolio, Mo-Rez and Ris-Rez. We just had fantastic data on Ris-Rez just recently at World Lung. But that is one of the areas of difference. BLENREP is another area of difference. Together with small differences in products like Jemperli, and again, Jemperli, we have got endometrial cancer on the market.
We have got rectal cancer just read out, and we have also got colorectal coming, and we have got head and neck coming in 2028. Because of this, the recognition of the indication is not fully accepted until it comes through. I should emphasize, all our forecasts have got PTRS adjustments against them, so probability of technical and regulatory success.
So you've put-
Yeah.
...almost the entire delta to oncology. You sort of said puts and takes. Are there any assets where you think consensus is too optimistic that then drives the oncology delta even bigger, if that makes sense?
It does. I wouldn't want to go into the specifics because the other difference is you get puts and takes of, say, GBP 500 million across the board. There are elements where the market is a little bit stronger. There are elements. It tends to be the newer products that are a bit slower to recognize. So consensus is a bit slower, for example, with some of the HIV innovation. It's also a bit slower with Excentia.
Okay.
We can talk about Excentia separately.
Well, I'll get to both of those, yeah.
Yeah.
I guess my question, I sort of left it open, but you'd think HIV cliff is roughly correctly modeled in consensus?
I don't want to be drawn into-
Okay, fine. Yeah, fine. We'll move on.
...into guiding by therapeutic area. I think we've come a long way-
Yeah.
...with HIV. I think the market was concerned that the patent expiry effectively started earlier than it did in material terms. I think we've established now, and the market consensus is much closer, that the material impact on HIV is 2029 and 2030 because we lose the Dovato patent in December 2029 and Juluca in July 2030. This is in the U.S. because the U.S. is the material point, and we've got a whole strategy around protecting that business.
Okay.
Yeah.
On from the top line, we'll do big picture margin, then I'll come back to specific products. So shape it, you sort of alluded to the bulk of the savings drop through in the 2028, 2029 period. But just perhaps you could just give us a sense of the shape of the margin. What I'm getting to there is the Nuvalent sort of comes in next year, bit of TRELEGY pressure, and then the savings. I think you've referenced this coming through more 2028, 2029. So do I think of that as more flattish or whatever wording is for next year and then an inflection 2028 or whatever color you can give?
Yeah, I think we've sort of decided not to guide the margin year- by- year. As you know, there are so many moving parts in a business. What we're confident of is that the savings just come from doing the internal work on this. We're absolutely confident these savings will come through. We are confident because of the amount of work that's gone on into the margin and the integrity of the margin going through it. Also the drivers of that in terms of, number one, the business is more and more moving to specialty, which means it's a very selected specialist sell, which means you get margin accretion coming through from specialty.
The specialty part of our business, it used to be when I joined in the beginning of 2023, we were 1/3 . We were 1/3 vaccines, 1/3 specialty, and 1/3 gen med. We're now just over 40% specialty. By 2031, we're going to be over 50% specialty. It gives you a natural lift to those margins. Secondly, we've got the Accelerate Growth program, as you say, when the savings will come through, GBP 1.9 billion coming through by 2029.
Then also on top of that, we've got this drive for productivity that we started a number of years ago, and you've seen the evidence through the margin accretion and through our SG&A to sales ratio coming down. That's where you'll see the bulk of the impact of the change in our business, is we're driving the SG&A down through productivity, and we're driving R&D up.
Okay. If I then move on to launches, especially the ones that are ongoing, BLENREP, Excentia. There was sort of a narrative of, you've obviously been clear on both that we're going to slow and take time and potentially inflection post J-code. Now, in the data we see, that's not particularly obvious.
Yeah.
The simple question I get is 2Q sales were, if combined, around 60 consensus. Next year is just shy of 800. That requires a lot of lifting from here. Just how do you think about how the curve inflects and the level of comfort, to the extent you want to comment to that consensus number next year?
Yeah. So if we take the two products, Excentia and BLENREP, we'll take them separately. I spent last week in the U.S. with the brand teams actually just talking about the overall position. So with Excentia, and I'll come back to your point about the J-code. Excentia is a six-month treatment for severe asthma. It's groundbreaking because it's a biologic, and it means basically that somebody is protected with just two injections a year, and it's got very good data underpinning it because it's a 72% reduction in exacerbations that cause hospitalization.
So fantastic data. So that's the good news. The bad news is, because it's six months, it means that there's a big outlay for the physician if they are wanting to prescribe it to a person. Therefore, there's a system in the U.S. called the buy and bill. The problem, therefore, before you've got the J-code, and it's interesting there was a lot of emphasis on the J-code, but it's not just the J-code, it's the administrative part of the J-code taking effect in the insurance system. That's happened just a couple of weeks ago.
Therefore, the J-code was July 1st. I think people thought it would be like this. It's not like that. But what's happened now is we would expect, having removed one of the largest barriers, and when we do physician-to-physician research, you find that the actual outlay, the initial economic outlay for Excentia was seen to be significant because it was six months rather than one. That's a big change. Therefore, now it goes into the administration. It goes into the health insurance plans. That barrier to actually prescribing it, knowing that the prescription can be fulfilled, is going to be very different as we go into the fourth quarter.
Okay. So J-code happened, but it still needs to work through the administrative system-
Through the administrative.
...which has just happened.
Yes.
We should see an inflection fourth quarter.
Yes. The administrative system piece was a couple of weeks ago, then it has got to go from there into the insurer, into the plans.
Got it.
Whether it is Entero or United or whoever it may be, going through into the plans. That is only then, is the physician assured of getting the reimbursement.
Can I touch on two other topics? Payer coverage, the last time I think you commented was running at like 50%. I think I had asked the question at one of the breakfasts that typically needs to be north of 70% to see physicians comfortable enough to prescribe.
Yeah.
Where are you with payer coverage?
Yeah. I think this is a topic that we definitely will cover at Q3. It is moving as we speak, and like I say, I was in the U.S. last week. I think let us pick it up as part of the Q3.
Okay.
Because literally, the contracting piece is critical. Now you've got the administration and you've got the J-code.
So that unlocks payers if I-
Unlocks payers.
Okay.
It unlocks payers.
Okay.
Yeah, no question.
The third bit was the bridge program.
Did you want to talk about BLENREP or
Yeah, I'll just do the bridge program on Excentia, then we'll go to BLENREP.
Okay. We had an access program running. In this period in particular, it was required because of the reimbursement piece. That's gone well. It would go well because it's an access program. The key thing is, once you've got the insurance coverage in place and the reimbursement in place, it's actually then moving those patients from the access program into commercial. Because you're dealing with a six month, six month is fantastic, but it's also got some disadvantages. You've got to wait until the next dose is ready before you're doing it.
Okay.
Yeah.
Very clear. So some update at 3Q, payer coverage, bridge program-
Yeah.
...path into 2027.
The team are very comfortable with how it's moving. We've got a fantastic guy in the U.S. who's in charge of this area, and I left feeling optimistic, but understanding much better about the dynamic in the U.S. market.
Okay. Let's do BLENREP then.
BLENREP is different. BLENREP is different because with BLENREP, we always said we would go slow to go big. So BLENREP has got a history, as we all know. The benefit of BLENREP is it has got fantastic data for those who are not so familiar with it. It halves the risk of death from multiple myeloma, and it triples progression-free survival. The data is fantastic. It is going into an area of the market that currently is quite unmet because 70% of the patients in the U.S. are community. They are treated in the community.
Most of the other therapies that have got that level of efficacy that I spoke about at the beginning, you need to be hospitalized to be able to have the treatment, CAR-Ts and bispecifics. BLENREP is a 30-minute infusion that can be dealt with in the community. A very different situation. There is an unmet medical need. The problem with BLENREP is it has got eye side effects, and the reason, therefore, it has to be very carefully monitored. In the U.S., before each dose, the eyes have got to be checked.
We found through the trials, DREAMM-7 and DREAMM-8, that there is a resolution of the eye effect as long as you elongate the dose. But the physician and the patient have to understand that the efficacy is not lost if you elongate the dose. So it has got to be managed very carefully. We really wanted to ensure that it was almost a white glove treatment with physicians and with patients also understanding this and basically managing this situation because you have got to connect the physician, say yourself, with the eye professional, say Constantin on the front row, and the two of you have got to work together before you can carry on with the dosing.
Net-net, we wanted to deliberately do this, and also, we feel that physician- to- physician conveying the experience is an important part of the uptake. We never thought this would be big soon. We thought it would be big over time. The other important factor with the U.S. is we've got registrations now in over 50 countries. The U.S. is the only country where it's a third-line label. Everywhere else, it's a second-line label, which means it follows on from DARZALEX, from J &J.
The advantage in most of the countries is you're going in much earlier. You probably saw the nice data that BLENREP's got a leading share in second line in the U.K., which was the first country we launched in. The U.S. isn't going to be in that position because it's going in third line. That means the patients are usually older, frailer, more difficult to get a positive experience than it is in second line. So net-net, we'll go slow to go big.
Okay. Is it fair, I'm not putting words in your mouth, but Excentia, good level of comfort that we get there, 2027, payers, administrative. BLENREP sounds like it's tracking as you thought, but consensus may have got the shape wrong short term.
No, I'm not saying that, actually. I'm not saying that. As you say, in aggregate across the two. No, I'm not saying that consensus has got it wrong.
Okay.
Don't take that message. Just, I guess, recognize the dynamic underpinning it.
Okay.
About why you don't go up in a way that some products do.
Okay.
It's a different characterization of the product.
Very clear. I'll move on to some other launches, if I may. Hep B.
Yeah.
Around the corner.
Yes.
We had a physician survey. Tough to model. Where's the level of excitement?
Yes.
Targeting. I think Nina's talked to sort of five or six states which there's particularly amenable. Just any updated thoughts on how you're thinking about that launch, pricing, cadence?
Yes. It's interesting, this one, because when I first joined and people were asking Tony what he was most excited about in our pipeline, this is almost four years ago, his answer was bepirovirsen. It tells you something, that he was excited about it all those years ago. The reason as we know is that it's basically giving 19%, one in five people, a functional cure, and it's reducing surface antigen for a further. So net-net, you've got 49% of people benefiting from this. Together it's taking the surface antigen level down to a level that should not cause liver cancer.
So it's got very good data. I think as Nina mentioned, the commercial opportunity is in three countries, China, the U.S., and Japan. We've now got approval in Japan, and the pricing negotiations are ongoing. So net-net, we feel we're in a strong position in Japan. China, the population affected by hep B is huge. It's like 75 million, and in China there's a lot of stigma associated with the disease.
In the U.S., the other countries have comprehensive testing for hep B. In the U.S., it's not across the board, and so therefore we find there are certain states in America, usually the California, the West Coast, together with Florida, together with some in the South actually, in the southern states. So those are the major states where it's most prevalent and where we believe there's an opportunity. We're excited about it just because key opinion leaders, and you may have seen some of the calls, I'm sure you joined.
They said this was transformational, and it is transformational because previously these people were on NUCs and the functional cure rate was a single-digit low percentage, and they felt like they got flu all the time that they were on them. With bepirovirsen, they take it for six months, and then basically for one in five people, it leads to a functional cure, and halfway through the treatment they get a good readout about whether they will be the one in five or not. Net-net, we're hugely excited. Again, I was with the U.S. team that are leading the charge on this. The excitement is phenomenal. Really, and we've got, again, a very relatively new appointment on this team. Yeah.
Okay. I'll do China first. China approval from memory is mid-next year.
We're expecting it to be, yes.
How long do you think you want me to the payer dynamics in China to get this going? Because obviously you referenced it as a huge opportunity.
Yeah.
Should we be thinking about China as a 2027 or more into 2028 sort of dynamic?
Yeah. As you say, and you've done a model also on this. Probably bepirovirsen is one of the harder products to actually model for us as well as probably for you guys. I think it depends on, obviously, you've got reimbursement and you've got access points, but you've also got how the testing works, how the follow-through works, and just people have often asked us, "Are you dealing with a bolus or are you dealing with an even growth with this one?"
You could be dealing with a bolus because those patients who are already on some form of-- They're diagnosed, they've been tested, they're on some form of treatment. There's likely to be a high rate of switch of those people. But in terms of guiding on each year and guiding on by country, I can't really get drawn into that. It's a really hard call. Yeah.
When you meet with the U.S. team, do they give you a sense within your five, six, seven states, how they sense the size of that bolus? I've got KOL feedback, but just interested in what your team say on that.
At the moment, we call it the plan. We do the plan internally at the moment. There's not a single case.
Right.
There is not a single case on this one. I think it is hard.
Okay.
Yeah. For new launches, you would normally deal with a windsock around it, depending on a whole series of factors. We did the same with Excentia, actually. This one is difficult.
It is even broader.
It is even broader. It is for the dynamics because of the dynamics we have talked about. Yeah.
Okay. Last one, I think at the CMD, Nina alluded to hep C-type pricing, not exactly, but what is your payer reception to that, if you have had the conversations? Because again, our KOL feedback is the functional cure rates are a lot lower than hep C, and therefore a bit of surprise on that pricing, but obviously you must have had those combos, so any color you can give there?
Yes. We are relatively comfortable with the comment around pricing. I think it is because the data is so phenomenally different from how people are currently being treated. Previously, the treatment with NUCs, the side effects were so serious, and the benefit was so low. This is probably why key opinion leaders say this could be transformational against, I think it is something like 75% of liver cancers are caused by hep B. Again, transformational for people, transformational for healthcare systems. Yeah.
Move on to the next set of launches. Nuvalent assets.
Yes.
Just I think one's come, one's pending. I think your commentary has roughly been consensus is in roughly the right place, but again, excitement launch PrEP, et c, as we think about into next year.
Yeah. The oncology team in the U.S. at the moment are on fire because of the Nuvalent. We met some of the members of the Nuvalent team as well. We were delighted obviously with Jideytro, as zidesamtinib, because its approval was ahead of its PDUFA date. We are very well prepared for the launch. It's underway. Patient recruitment is going strongly. Yeah. Our U.S. head and the team are, I think, really proud of that one. We've got neladalkib, which is, of the two, the larger opportunity. Neladalkib initially will go into second line.
The PDUFA date is towards the end of November. Again, all the preparation is going extremely well for the launch, including recruitment ahead and everything else. So yeah, neladalkib is looking very positive. Again, the data from neladalkib is, as you know, it's a fourth generation ALK. The data is very compelling when you compare it with current lines of therapy. [Lorlatinib] it's got a much more tolerable profile to [lazertinib] These are young patients in the 40 to 50 age group, usually females.
They want to be able to work, they want to be able to go out and do things. Unfortunately, the side effects of some of the competitor products have not enabled them to do so because it can lead to psychosis, and it can lead to serious weight gain. So net-net, we feel very proud of the profile of neladalkib. The big opportunity for neladalkib further down the track is the first-line indication, which comes a number of years later, and the trials are ongoing associated with that. So yeah, we're very pleased.
Since you mentioned, I was going to ask you, but you said a number of years later. Front line, you haven't really given a lot of color on timelines. I asked the question-
Yeah.
...CMD 35% study recruited felt a little bit slow to me. That feels like 2028, 2029 read. Is that roughly correct? We should be thinking about that inflection towards the end of your forecast period?
We see it in that sort of timeframe. The recruitment's going really well. I'm not sure when you got your last data set.
CMD.
Okay. It's a couple of months now.
Yeah.
Yeah. No. Obviously, I was in the U.S.
Yeah.
Ben not give all the information that we're going to give at Q3.
I feel free.
At Q3. But the recruitment, it's a good sign. I think because of the side effects of current, you've got two things going on, efficacy on the one hand, and neladalkib is still going strong. It's 84 months overall survival. Some of the competitor products are so much less than that. They've got a more tolerable profile, but they're dealing with much shorter. The one that, obviously lorlatinib, has got a longer duration of effect. The problem though is the side effects are serious. So you've got a combination here with neladalkib of tolerability and efficacy. That should be a winning formula. So again, we-
We should think about some update on patient recruitment at 3Q.
Yeah.
The timeline is towards the end of your forecast view.
I wouldn't say, because if we go to the end of 2031, we're seeing 2029.
Yeah.
Yeah.
Okay.
We think the uptake on that should be very strong because the market conditions and the market competition is relatively weak compared with the profile we've got.
Very clear.
Yeah. We're excited about neladalkib .
I've gone through a lot. Sorry.
To your point, the centers are up and running together with the patient recruitment is quick, which is a very good sign of a successful product when you've got strong uptake.
Okay.
Yeah.
As we have gone through a lot of launches and positive drivers into next year, perhaps I could touch on or perhaps you could list for where you think some of the headwinds we should think about. I have my list, which is TRELEGY , IRA, vaccines, annualizations from the bolus. Just if you could comment on those two and anything else we should think about for 2027.
Yeah, I think for 2027, the major headwind comes from TRELEGY . I think in terms of step down because we have got the pricing impact through going into the IRA. We factored that in, and we have known it has been coming for quite some time, and we factored it in very early on. Actually, it was slightly better than we anticipated originally when we were guiding a few years ago. So TRELEGY I would definitely call that out.
I think in terms of obviously the major other point is that some of the products now that have been driving a lot of growth become harder to lap the higher base. You see that with SHINGRIX to some degree. Having said that, there is a big opportunity with SHINGRIX still because we are only 12% penetrated in the rest of the world versus 45% in the U.S. So there is still growth opportunities with some of these products, but you are just on a much higher base.
I do not think there is anything else to call out because there are also growth drivers coming through Excentia, BLENREP. Nucala COPD has grown very strongly, and one of the benefits we found with launching Nucala in COPD, which again has got good data, is the halo effect then on severe asthma. It also has a benefit. So yeah, I do not think there is anything else major. We start to see some HIV erosion coming in, but it is in smaller markets. But it is not eroding HIV overall. It is just a downward pressure.
Patterns.
Patterns.
Yeah. Okay.
Yeah. Patterns.
Any other of the specialty products you would call out base effects? No.
No, I do not think so. No major. Yeah. It is-
I might have missed it, but have you guided to the TRELEGY IRA impact?
We haven't given the specifics of it. Important to remember with TRELEGY, it's one of our highest rebated products. Sometimes people look at the list prices and say, "Okay, we're dealing with a major issue." It's got a very significant RAR on it. Net-net, we haven't given the specifics of it, no.
I'll ask the question, you answer it as you will. Novo, basically on Ozempic, which is heavily rebated, saying IRA is going to be no deviation to historic pricing. The average IRA price cut is like 20%-25%. Should we be thinking about that sort of top to tail for TRELEGY next year?
I won't
Okay
I won't be-
Chucking it all.
...drawing any further on it.
I tried.
Yeah.
If we-
It's all in the forecast. It's all in the guidance. It's all in forecast.
Yeah. Okay. If we move on now, I'll do the South Side CFO question, if I may. I would ask it on the third quarter bit. We've sort of done the top line pushes and pulls for next year.
Yeah.
One of the, and you referenced in your intro, one of the hallmarks of your tenure, or at least recent years, has been the operational financial leverage. I'm less clear and just interested as to how that plays for 2027. Nuvalent, both margin impact and net financial impact. I'll ask the question, answer it as you will, but should we be thinking that pattern continues next year with operational financial leverage or is it a bit tougher given what we know is coming?
It definitely, well, I suppose, it gets tougher as you drive productivity through the organization. You see we've done quite a lot of that already. You've seen I've been putting pressure on SG&A to drive productivity, to invest in R&D. We've been doing it for a number of years. The reason, the major tailwind now is the program that we recently announced, which gives us the GBP 1.9 billion. It ramps up, 2028, 2029 are the big, more significant years. It doesn't give you a massive lift, and we're not dropping any of that through in 2027.
So what we deliver in 2027 in terms of leverage doesn't come through the program we just announced. It's more about just productivity. I won't guide on the specific margin in a particular year. What I can say, though, is there's no reason to see us dropping that margin. We believe that when we guided a number of years ago, that we would be more than a 30% margin by 2026. We are on track to be, then we re-guided to say more than 31% margin by 2026. We are on track to deliver that. We have made commitments to the market. We will deliver.
I will move on to some competitive aspects, if that is okay, on the top line. Two, just I am interested in. You mentioned Nucala COPD, and if you are with the U.S. team, reimbursement takes time, but AstraZeneca had some interesting data, PDUFA for first quarter. Just interested if that is coming up in conversation as to potentially impact Nucala.
Yeah, it certainly comes up in conversation. Our view is AstraZeneca had some good data for sure, and they have got the benefit of being able to go across the eosinophil range. Nucala got a good label, as you know, for COPD because we were able to go quite a lot lower at 150+ . The Nucala uptake, as you probably saw from the chart at Q2, has been extremely strong in terms of, compared with Dupixent. We continue to see that with Nucala.
It is performing very strongly. And together with that, as I mentioned, what we are finding increasingly is you have got, Nucala has got a very extensive label now. It has been on the market for a while, and it has got nasal polyps, severe asthma, HES, and EGPA, multiple indications. And what we find with the population is they have got comorbidities. So it is much easier for the doctor. Because COPD is a very heterogeneous disease, it is much easier for the doctor to have something that is more comprehensive. It really is. It is one of the reasons that we decided to accelerate Excentia indications. As you know, instead of rolling them out year by year, we went for-
Four there.
...four or five in one. Effectively, we got EGPA readout coming up with Excentia. The reason for that is this comorbid argument. AstraZeneca have got a very good label for COPD, but it is one in multiple, and that is, I think, the big difference.
Very clear. The second one I have, and I have spoken to Deborah lots about this, is the lenacapavir. I know the once weekly from Gilead and Merck. I understand her message on reasons for protection, so we won't go over that. What I am more interested in as a CFO is you have to think about the puts and takes. How do you think about that into next year and in potential impact to Dovato growth in particular?
Yes. Like you say, we watch the competitors like hawks. I think the reason we feel strong about HIV is, as you probably know from this, you got evidence from patients, and you've got evidence from physicians. The evidence from patients when we've done assessments of what they prefer, the patient voice is huge in the U.S. They prefer long-acting injectables. When I first joined the business, I thought, "Why?
Why would you prefer a long-acting injectable over a tablet?" They prefer them because they know they're safe with them and the frequency of the injection, and the stigma associated with having HIV is significant. So 90% in the SOLAR study, this is patients, preferred long-acting injectables. Then physicians preferred them, and the data monitoring committee stopped that trial in LATITUDE because the data was so strong with long-acting injectables because they know they've got the protection.
We've got two months on the market. We've got a readout, importantly, for prevention this year for four months. We've got a readout next year for the next one in terms of treatment. Therefore, we feel in a strong position because the preference is long-acting injectables. It's great that there's innovation, but we believe injectables are better than orals.
Okay.
Yeah.
Last topic, BD.
Yeah.
Guardrails of what you want to do. Every time I see Luke, he's like, "I want to do more and quicker and bigger." I'm paraphrasing obviously, but just how would you talk to the urgency of continuing to add assets within the organization?
I wouldn't necessarily call it urgency. I would call it, in my experience for sure, the best science is never just internal. The best science, you've got to keep your mind open, and you've got to be reviewing both all the time. We have this SPR group, the people who review the pipeline every two weeks. We have a BD meeting, we had one yesterday, every month. We're looking at the best science in the industry and the BD team and the scouting team.
There's a lot going on in China, as you can imagine at the moment. We do a lot of work on terms of. Then we're looking together with the internals. I wouldn't say it was sort of urgent. I would say it was wise. I would say it was the right way to run a business. We've got a healthy balance sheet. Post the Nuvalent acquisition, on a pro forma basis, we're just shy of 2x net debt to EBITDA.
We've got a healthy balance sheet, and we drive productivity through the P&L to be able to absorb more and build the pipeline. You've seen what we've just recently done. We've gone from 10 phase III starts that we announced at the beginning of the year to 20. In fact, it's 21 now because we just announced mRNA over the last couple of weeks. I think it's a sign of a dynamic company.
That 2x , what sort of headroom does that give you for deal size as it sits?
It gives us reasonable. First of all, we've still got, even after Nuvalent, reasonable deal size for the rest of this year. Very importantly, we've guided more than GBP 10 billion of CGFO, cash generated from operations, for this year. The company generates, we've been able to generate capacity to be able to do the Nuvalent deal, and we've continued to do that because one of the other things I'm focused on is the conversion of profit to cash, which has improved a lot if you look at the data over the last few years, because I've got a team focused on just that conversion.
Last one, just because I'll get out. Is the next, how do I say? Are you focused on a more Nuvalent-type larger deal, or have you sort of done that and we're sort of back to the smaller, earlier-stage stuff?
It's entirely dependent. I've got the list in my mind as I'm answering this question. Entirely dependent on where we won't be driven by late or early. It'll be driven by the quality of the asset. Yeah. It'll be the quality of the asset that will win through.
Perfect.
Yeah.
Right. We're up on time, Julie, so we've covered a lot of ground there. So thank you very much.
Thank you.
Enjoy the rest of the day, and great session. Thank you.