Good afternoon, everybody. I'm Chris Schott at J.P. Morgan, and it's my pleasure to be hosting this Fireside Chat today with Dave Ricks, Chairman and CEO of Eli Lilly. It's been a tremendous few years for the company. Obviously, we've got some big announcements today as well. So we're going to have Dave make some opening comments, and we're going to jump right into the conversation from there. So Dave, thanks for joining us today.
Thanks, Chris, and thanks for having us back at JPMorgan and for everyone interested here. I thought it made sense to just make some opening comments about this morning's announcement. So three things, I guess. First, you know it's always disappointing to miss your own expectations. We own that. That's our job to give good guidance to the street, and we aim to land within that guidance normally. That said, I think we're dealing with kind of a business here that is pretty unprecedented in our sector in terms of size and scale and growth rate. And we've learned a few things. So before I go into the detail of that, though, just to unpack 2024 a little bit, it was a remarkable year for the company. We ended the year $4 billion over our first-time guide. Growth rate on the year was 32%, on a pretty good base.
Exit growth rate in Q4 was 45%. So we are a rapidly growing large-scale company. We obviously rolled out Zepbound, and we're just now clocking a lap on that. So that's in the new growth rate, and that helped us dramatically during the year. But I want to point out that many other things went well, too. Mounjaro had a very strong year, growing share in diabetes. We're now the NBRX leader in GLP-1 in diabetes as we exit the year. The rest of the portfolio performed incredibly well as well, now annualizing at about $20 billion and growing in the mid-teens. And I think if you stripped away incretins and GLP-1s from the pharma sector, the balance of Lilly would probably be the biggest, fastest-growing big company in the sector.
We're very proud of that because long-term, it's important that we have balance and we work on important medicines and diseases other than obesity, so doing two things at once. We had many clinical readouts that are important, starting with Tirzepatide, of course. We had definitive readouts in sleep apnea, heart failure, diabetes prevention that are now going from, does weight loss, of course, we lose weight on the drug, patients lose weight, does it convert to long-term health benefit? The answer now, yes. Those are in submission review. Sleep apnea now approved. That was quite important. We had a number of other key clinical readouts and regulatory actions, maybe most notably on the regulatory side, the approval of Kisunla in Alzheimer's and now Ebglyss in atopic dermatitis. We started a number of studies, including the KRAS G12C program in cancer in phase three.
Overall, I feel great about the year. We also, final thing, is we did a big build-out in manufacturing for tirzepatide and hit our marks, hit our goal in the back half, which was to grow saleable units by 50% or more. And that's in the results we described today. Of course, as we sat there at the middle of the year, we made some assumptions that didn't fully transpire. But in Q4, maybe just to unpack that, really the miss from the midpoint of the guide can be explained by two things.
You can always isolate down to a number of things, but these are the biggest ones. The first is the diabetes GLP-1 market, which typically, and we've been in the diabetes segment for a long time, you see in many chronic conditions December really outperform the rest of the quarter. And this year, that didn't happen in GLP-1.
I think there could be a number of reasons for this. I'm just guessing. But we could speculate about whether the change in Part D, people didn't do two scripts in one month, or actually insurance edits are getting smarter about preventing that kind of thing to avoid deductible costs in the new year. Nonetheless, it happened, and we didn't predict it. We've rolled that into our future year. We did not push those sales into January, but we're not planning that in the future. The second thing is the stocking levels, which was a big discussion in the Q3 results, Chris. And we dropped about eight selling days in that quarter alone, which is getting to be a material number for us. And we had expected a couple of days of build-back at the end of the year because every year there's a couple of days of build-back.
That did not happen. And I think it's probably a function of a number of things, but overall, the economics in our distribution channel aren't great right now. And they're really preserving their working capital. And at the same time, patients have been sort of accustomed now to waiting a couple of days to get their script pulled down. We left the quarter in good supply position several weeks on each dose, filling every order we get. So that's not the issue. But nonetheless, disappointing to miss. Yet we look forward, and we celebrated a great year, and we look forward to a great 2025, which we put numbers out on today, 32% growth, $58-$61 billion. So super excited about 2025 and really proud of the accomplishments last year. Maybe just two things because graphics tell a story. It's our forward-looking statement.
But a lot of people want to know, okay, this Lilly's Q4 miss, say something about the incretin market. This is total prescriptions across all indications in the U.S. incretin market. Black line seems to be going up and to the right at an aggressive rate. We project that will continue, but I don't think there's a lot of a slowdown, although you can pick up a little bit of the wobble in December. I think that has more to do with payer dynamics than actual underlying demand. And there you see the total prescription share climbing five points on the year against Novo and super proud of that across all insulin forms. And then the other question might be, oh, is Lilly slowing? And just to remind you, we started with $41 billion first-time guide, exiting at $45. So a pretty big step up during the year.
Next year, growing at 32% off of 32% this year. So pretty good growth on growth. That's our story. Yeah. Thanks. 32% stuff, not the worst.
No. Just talk a little bit about the 2025 guidance approach, just given some of the dynamics we saw this year. How did you think about setting targets for this year?
You know, our approach has really not changed. I think what's been different is the scale of this business and the way it's growing, the consumer part of it, coupled with the stocking dynamics and so forth. It's just been a learning for us. It's not acting like other, I would say to our team's credit, the forecasters really nailed the rest of the portfolio. We don't have a problem with forecasting. It's just this market is quite different. By the way, I don't think our competitors have been immune to those kind of big moves and surprises. We don't like surprises. The street really doesn't like surprises. We'll try to avoid them. Just know we've rolled those learnings into our process. We always target, our approach to guidance is to give a range that we think will hit, not to gamify the expectations game too much.
But there are plenty of tailwinds in this number. There are things we don't know about that could go wrong, too. That's why we have a $3 billion range. And those tailwinds, what are they? The new indications, so sleep apnea launching. We expect heart failure this year as well. New markets, so expanding really to global rollout now as supply continues to improve, including big markets like China and Brazil and the rest of Europe. And potentially new access. And I think that's probably the most important KPI to watch, which is what is happening in the U.S. with reimbursement. We definitely see a difference in everything from ability to adopt, doctors' willingness to prescribe, and persistence when there's good insurance coverage. And I would forecast that that will improve this year. We've been, I think, conservative in our assumptions in this outlook, but we'll work hard on that.
I think that's the upside in the numbers.
Can I just go back to 4Q, just on the wholesaler levels? Where are we now in terms of how much inventory is out there?
Pretty lean. Normally, for parenteral products, you usually see about two weeks in the channel between us and the final customer, and now we're down to like 10, 11, so it's pretty lean.
Bigger picture question.
We've assumed we exit at that level next year.
Okay. Perfect. Bigger picture question, just to ask upfront. Within Lilly, is there any debate around demand for the Incretins at this point? I think that's one of the things that creeps in some of the conversations of the raising guidance and some of the pullback. Is this saying anything that we need to kind of be reconsidering the demand kind of part of the equation?
No. I mean, I think we're, first of all, we think we're in the early innings of this. There are limits on demands in each category. But I think the incretin story, tirzepatide's story, is going to be about unlocking new categories over and over again. And so remember, in 2006, we launched a GLP-1 for diabetes, and it's a pretty mature market. We do see in diabetes, GLP-1s continue to move earlier in therapy. And I think if we can get an indication for our diabetes prevention data, for instance, I mean, that's the earliest. That's the upside in diabetes. We're pretty saturated in second and third line use of these drugs. So that's the growth. So it's natural that diabetes will be a slower growing segment. Currently, it's like 60% of the volume, but maybe less than 20% of the opportunity.
On the other hand, weight loss per se is a growing market, very consumerized. Sleep apnea, it's about half the size of diabetes, and it's zero penetration. These other indications will come online. That's just in the U.S. And then we have the global version of that again and again. So we see a long runway to run on volume growth. Of course, there will be new medicines as well, which will spark interest and drive competition. That's okay. But our view is this is a, we've got at least a decade of growth ahead, and it will unfold chapter by chapter. It won't be a straight line up and to the right. That's disappointing for the forecasters. But this is a huge opportunity to improve human health and for Lilly to change ourselves and the rest of the industry.
Right. On the capacity front, I think you're talking about a 60% kind of step up year-over-year, first half of 2025. Just talk a little bit about what's driving that piece of it and maybe just help level set us over the next few years, how we think about Lilly's capacity build-out.
Yeah. And here again, it's early innings. We're projecting to ship or have saleable doses to ship 1.6 times first half of last year, 2024. So that gives you a sense of both the phasing through the year to our guidance, but also the specific tirzepatide numbers. That's a good improvement, and it's faster than any quarter we've had so far. So you're beginning to see that CapEx deployment, which has been pretty big bolus over the last three years, $23 billion, begin to hit the playing field. But it's still quite early. Of the big sites we've built, greenfield sites we've expanded into, really only the Research Triangle Park site is contributing to the 2024 number. We do expect the Concord site, the sister site in North Carolina, to ramp up in 2025. So we'll have both those engines running.
In addition to that, there's a number of other nodes, including the Kenosha site we bought, along with a number of other nodes inside our existing capacity that will be coming online next year. So yeah, that's looking strong. Of course, I say all that with the caveat that regulatory uncertainty, these things need to be approved, and there's a lot of technical challenges here, and things can go wrong. But we feel good about the 60%. We don't give the full year because of those uncertainties. But sometime before we get to July 1st, we'll give an indication how we feel about the second half.
I guess on the demand generation side, is Lilly at this point, so you're thinking this is kind of like full push ahead, or are you still balancing?
It's still metered, to be honest, and I think that's confusing because people want an on-off switch. In the U.S. market, we did begin that process, and different segments of the pharma industry respond differently to different stimulus, so we started in a pretty modest way to see what would happen. We saw good response, but just to give a sense of proportionality versus big primary care drugs that competitors advertise, we're a fraction of what they spent in Q4 because we didn't want to hit the gas or tap the gas and have the thing run away from us again, get in supply problems. It's a priority for me, for everyone in the company, to make sure that the patients already on our medicine can fulfill them. That's something we've crossed that line before. We don't want to go back.
We have a diverse supply chain to fulfill that demand. When we see signs of trouble there, we will pull back. I think it's a long-term business we're in. Loyalty matters. The doctors hate that experience because it wastes their time. So we're not doing that again. So we'll be careful feathering in the promotion. But in the U.S., it's pretty modest now. You can expect us to step that up based on our learning so far. And as the supply picture is clear, additionally, ex-U.S., we can launch and we can begin to promote. And that's another lever to manage the supply-demand equation. If it was full on, we would launch everywhere tomorrow in our premium device. And that's not what we're doing. So it's still metered. But between coverage and new indications and our ability to control those things, we feel good.
We can drive this thing between that corridor of not disappointing customers at the same time, aggressive growth, 60% saleable units.
Absolutely. You mentioned access. Just update of where we are in terms of access and how much more should we expect in terms of build?
I think it's a key one, right? We did see good improvement last year. We started the year below 50%. This is both for Lilly and Novo of commercial lives opting in. Remember, there's two steps here. There's the insurance part on the formulary not. That's true for all drugs. And we're close to 90% for Zepbound and over 90% for Mounjaro. But on the opt-in side, not true for Mounjaro, but true for Zepbound, we have this toggle of I want to pay for obesity drugs or not. That was a little less than 50% last year at this conference. Now it's over 50%. We see it incrementally growing. And I think that will continue, particularly as these proof points on clinical benefit continue to read out. Remembering that the decision, this opt-in really applies only to the weight loss without comorbidity population.
For sleep apnea, we would expect most insurance plans to automatically opt-in patients. There may be a PA or other thing, but that should expand access now in commercial. And for the government, they've come down on it and said, we will pay for this in Part D. I think there's a six-month latency typically on their decisions, but middle of the year, we'll start to see that kick in. And that's a good improvement. Each one of those new indications should see a step up in access. And then we have policy levers, which at the end of December, the Biden administration promulgated a regulation that would propose to cover obesity medications as a chronic disease in Part D per se. So that's all of it at once. That needs to be finalized by the Trump administration. We'll see what happens there.
But if that occurred in 2026, that would be a pretty significant step up and probably has a very significant spillover into commercial markets as well.
On the access piece, over time, obviously, the goal is to get that as broad as possible. Is that also a metered approach in the near term as you balance, I guess, like price versus demand?
Yeah. There's no sense in discounting our way to a lot of volume we can't fulfill. So we're pretty disciplined on that. I think you can see in your notes, I read the price points are pretty stable. And I think that's something that we have a lot of discipline around. We put a lot of research and effort into these medicines. We're not in a hurry to discount them away. And there's a huge development program behind them on all these other indications. So I think that's stable for the time being.
Okay. Excellent. Maybe just one last question on Mounjaro, Zepbound, just pricing for this year. I think you mentioned stable. Is there a reason to be, I guess, more cautious on pricing in the near term for any trend break from what we've been seeing from your perspective?
I don't think so. I think if there was an opportunity to dramatically step up access for, say, tens of millions of people, whether it be in a population not covered now, like say DOD, or maybe DOD is already covered, actually, but something like that, yeah, then we can look at discounts in those kinds of segments. But no, I think steady as she goes.
Duration is another topic, I think, that comes up a lot. How are you finding through your education process and just physicians getting comfortable with this, how is the duration piece of the equation playing out as relative to your expectations?
Yeah, I think it's a confusing thing. One, because for modeling purposes, everyone wants to say, let's add up all the customers in the TAM, make a calculation of how many will get these medicines, and then multiply that by how many months they'll be on the, that's like a spreadsheet modeling. That's not actually, that really doesn't matter in a world where there is a limit on supply and there's a lot of demand and the coverage is poor. So the people with coverage tend to be very persistent on the drugs. Those who are buying out of pocket are less persistent. So when you look at the average, it's not that meaningful. It's not behaving like a chronic care market that's insured. But I think that's our destination is most of this will be insured and it'll look like other chronic care markets.
Plus one thing, which is I think most drugs we take chronically, our doctor says they're good for us. We can maybe see lab values every 90 days that are improving. But otherwise, we feel the same or a little bit worse. I think when people take Zepbound or Mounjaro, they feel better and they feel better fast. People like to be on these medications. And all you have to do is read social media when there's a shortage or whatever. People get furious about it. So I would project that persistency on our medications will be longer than the average chronic drug. And that maintenance is the big unanswered question there, what happens when I get to target weight. But of course, we're working on that with clinical programs to address that question. But I'm pretty bullish long term on a pretty long duration therapy.
It will never be as long as you think. I think the average in the U.S. for chronic therapy is like seven, eight months. So I think it'll be longer than that.
Yeah. Excellent. Maybe one bigger picture and then we'll jump into some pipeline. The international piece of the Incretin market, I know we're in the infancy of the launches there. But when you think about the market over time, how large of a percent of the business is coming ex-US for something like this?
Yeah. I think a significant portion. For one, about 10% of the volume opportunities in the U.S. and 90% outside. There's probably a price step down. And the bigger markets we go to, there will be a price step down. So there's a mixed effect thing there. But we barely launched internationally. I mean, we're just, we launched in the Gulf around the time in the U.S. and we've got high share and a good penetration. U.K. also, just launched in Germany middle of last year and that's gone well. But the rest of Europe's still going, rolling out now. Canada, Australia just getting going. So we don't know. But if it gets to the U.S. kind of usage rate and share, and there's no reason to believe it won't, that's a big market. And guessing at a ratio, I don't know.
But you've got nine times the volume and something less on price.
Yeah. Big markets. Pivoting to pipeline, orforglipron, big update coming this year. Just latest thoughts in terms of confidence in that asset and maybe just to help us frame out where you see that fitting in kind of the broader treatment paradigm relative to a Zepbound or a Mounjaro.
Yeah. I mean, year-over-year, it's interesting to think about your J.P. Morgan last year versus now. And I think if you liked Lilly's pipeline story in incretins' last year, you should like it a little better now. And that one main reason is our orforglipron upon us. I think we expect data mid-year on that. And really there, I think we're pretty confident on the weight loss and HbA1c profile. Tolerability will probably look like, both of those will probably look like high-dose injectable SEMA. But the key question is, is there some off-target safety or some other problem with oral medications, which can happen. I mean, there's an empirical part to this with chemistry that is difficult to predict. So far, behaved well in our studies. We published those. Everyone can look at them. But super exciting, I think, for a couple of reasons.
There is a meaningful segment of people who prefer oral medications, and a lot of the friction in the supply chain we've discussed with stocking and availability, and we've kind of normalized the U.S. now where if I go to a mainline drug store, I'm pretty much expecting to be told, we'll take your prescription and we'll call you in four or five days, and I think with orals, that won't happen. It'll be fill as expected, like every other oral medication, so that's good for the consumer experience. I think the other thing is scale, and here we're using totally different assets that are already existing, either in our plants or others, and we can imagine a scale that is multiples above the total injectable market today.
So I think we should expect, if the drug is successful, to be able to launch probably first in the U.S., then Europe, then Japan, etc., with no limit on supply. And should we be able to position the drug appropriately as a first-line treatment and on formularies, I think that's a big asset for us. That's super exciting. Reminder too, we have data a little bit behind that for our triple-acting retatrutide, which is a three-way, three mode of action, incretin adding now glucagon to GIP and GLP. And those studies are accrued and we're waiting for the final data. But sometime in 2026, we'll get that. And here the promise is really the opposite of orforglipron, which is sort of GLP for all kind of for the masses.
This will be really for people who need more weight loss, for more severe conditions that have comorbidities associated with obesity, and really help people who have high BMIs get to target weight. Remembering, if you have a BMI of 40, which is a lot of people, even tirzepatide, you're going to lose 25% of your body weight. You're still BMI is 30. You're still overweight. So we need solutions for those people too. And I think those are probably the next two big readouts in the whole industry. And they're both in Lilly's portfolio.
Do you remind us on or for Orforglipron when we can think about data and probably once we see that data, how quickly can that get filed with FDA?
So again, we'll see data in Q2, setting expectations as they should maybe later in Q2. The stats team would want me to do that. I think Lilly's now in a motion where we literally file within a few weeks, typically. And it's a great opportunity for us. So we'll work as fast as we can.
On Retatrutide, has your view changed at all, I guess, in light of the CagriSema data we've seen of, I guess, on that higher end of the market for efficacy?
Yeah. Thanks for the question. I mean, there were two important competitor readouts at the end of last year. I think it's one thing about Incretins, starting with GLP-1s, but now GIP and amylin and probably glucagon is they've been really easy to translate animal signal to early human, early human to scale trials. I don't think we've had too many surprises. So magic doesn't happen and disappointment is unlikely. And I think that with high-dose GLP-1, we see mid-teens weight loss and good A1C control with dual-acting medicines. tirzepatide, of course, is first. CagriSema is a dual-acting mechanism. You see a step up from there on both those metrics, meaningful step up. I think there's a difference in tolerability probably between those two medicines, mostly because GIP is not only synergistic with GLP, but it also is tolerizing to nausea and GI side effects, whereas Amylin probably is not.
I would expect triple-acting to have a step up above that. We've launched the first dual-acting mechanism. We'll launch the first triple-acting mechanism and hopefully Orforglipron will work out and we'll have a very strong, easy to make, easy to access oral medication for sort of that base market, which is those that need 15% weight loss.
And then maybe just last one, bigger picture. How do you think about Lilly's kind of incretin portfolio looking at, let's say, 10, 15 years?
Yeah, it's so exciting. I think it's so exciting for a few reasons. First, like all big markets, it'll begin to fragment. And that's, I think, a normal thing. And patients and doctors will seek medications more tailored to their situation. We've talked about several now. So it's just beginning, but right now it's like a two-asset market. So that will change. And we want to participate broadly in that fragmentation. One version of that is like profile of the drug. What's the experience? What's the weight loss profile? What's the trajectory of weight loss, fast, slow? What's my tolerability to side effects? Some people really can't tolerate even low-dose GLP now. And there may be solutions that are much more tolerable, but have less dynamic weight loss, slower or whatever. What about maintenance? That's another asset profile that's quite interesting.
So I think that's all going to play out in the next five, six years. By the way, we have beyond Retatrutide and Orforglipron, we have nine other weight loss programs in the clinic, NMEs. I don't think anyone is close to that. And so we're well positioned to take advantage of those textures in the market that will develop. The other big fragmentation, which we're also very excited about investing significantly behind, particularly this year, is moving beyond the metabolic health story. Of course, Sema and tirzepatide have done a lot of large-scale trials, cardiovascular trials, MASH, all the things we just discussed, really looking at the direct effect on metabolism of weight loss. And that's sort of an intuitive thing. Of course, it started with diabetes. That's important because those are leading killers around the world and obesity is a driver of those.
But we also notice now, of course, these other effects, effects on inflammation. And there's some interesting data that semaglutide has published. And we loaded into our Retatrutide a pretty big joint endpoint set of endpoints on low back and knee. And I think that's super exciting because that's acute and it's disabling for people who have obesity and those conditions. And so that's, I think, a new chapter. There might be other inflammatory diseases we could exploit. We're doing some studies along with Taltz and other inflammatory diseases we have, like inflammatory bowel disease, that could be quite interesting. And then neuroscience is the other thing we're quite excited about because this clearly affects the desire cycle. And we've talked about starting studies this year in a number of dependencies. Alcohol and tobacco seem pretty straightforward. What about opioids and others?
I think we should do that and see if something's there because that's such a huge public health problem.
Yeah. Right. Obviously, incretin obesity has been a huge part of the story. Stocks had great performance over the last few years. As I just think about the company evolving over time, how do you think about balancing what's obviously one of the biggest growth opportunities the industry has ever seen versus not becoming too dependent on any one category or any one product? So just talk a little bit about just how you feel like Lilly's balancing kind of that dynamic as you think about where the company is in 15 or 20 years versus where we are in three or four years.
Yeah. I spend a lot of time thinking about that. I mean, I think, first of all, we have to do multiple things at once and we have to own that and take that on. The first thing is fully delivering on what's in front of us already with obesity and tirzepatide and the two follow-on products we've been talking about today. That's a generational opportunity for any medicine company and we need to take advantage of it. I think we are in the pole position in every conceivable way. I didn't mention, of course, we ran a head-to-head against Wegovy and beat them handily of almost 50% more weight loss with tirzepatide. This is ours to take advantage of, but in taking advantage of it, I mean, help lots of people around the planet at scale and change our company for a long time. Have to do that.
That's manufacturing, build out, all those clinical studies. The second thing is, I think, to really balance that in the midterm with the oncology, immunology, and neuroscience portfolio. Here we have great opportunities and are executing extremely well. We talked about the size of that, $20 billion, growing high- to mid-teens%. And we see upside to that business and lots of opportunities to invest. Will that be in an absolute sense anything like the step-ups we can expect in obesity? Maybe not. But every other drug company is operating in that world and we should be the best one you could invest in, the best one patients can count on. And we're focused on those diseases. I think we're good at those things. That needs to continue and probably has more duration because it's diversified by itself. It's three separate things.
The third category is what do we do with the capital? And it's likely that we will generate a lot of cash flow and we can choose to reinvest that. There's a long list of companies. Maybe you could put Lilly in the early 2000s on this list or even the Prozac years that generate those kinds of excess returns. And then we look back and we say, what do we do with that? And so we have ideas about that. I can tell you we're happy with our BD motion now, which for all the biotechs in the room, there was a lot of small deals, some even below the radar completely that build early-stage pipeline strength. We can add value. We like to take the risk with people. We can shape the development plans. We can do the big things Big Pharma does well, extremely well.
But staying in our lane and starting early, that's been good for us. But let's be honest, there's a finite number of those things. And we're operating at a level that's pretty high already. I was mentioning to you off backstage, I mean, we've done like 100 deals in the last three and a half years. That's a lot of deals. We could do more. We will do more, but will that consume all the capital? Maybe not. I think we're also interested in ideas, not BD ideas, but organic ideas that could make a bigger difference, but are maybe hard projects, but also projects that are likely to translate. An example of this is the work we're doing in Alzheimer's prevention. That's a hard project and it will take a long time, but what could be more important than preventing neurodegenerative conditions?
We're in a good position to fund those studies, do the studies in advance to get confident in the translation and do them. Another one, Lp(a), a number of people in the industry are on that, but we're the only one doing a primary prevention version of those studies. And I think that's a big bet on the future. And I think those are the kinds of things we should be doing that could create growth and revenue, but also massive planet-wide impact on health into the 2030s, 2040s. That's our thought process on what to do with the.
I think Lilly seems in a pretty good position to be able to make those investments.
Yeah. I think that's exciting.
I guess coming back to the BD piece, you mentioned 100 deals over a short period of time. Can you keep scaling at that level or, at some point, is there just too many projects, too many assets, and you might lose focus?
I mean, it creates operational complexity for sure, and we do need to grow our BD and Alliance group and we will. That's actually not the pinch point. The pinch point is actually shared resources with our own programs, and so when you bring in things and it's lumpy, it's not planned in the year, that stresses things. But literally people rally to the cause. I think we'll digest that. Probably the rate limiter is the amount of funded ideas in the VC universe that are saleable, that have data and are of the quality that we're willing to transact, and we may be getting close to that. I mean, we're a meaningful percentage of the total transactions, so what are we doing about that? I think we're heavily investing in early-stage ideas.
We have this program, Catalyze 360, I talked about last year, which is I think really exciting because it's more of a kind of a scale-up incubation idea. So if they aren't available today to transact with, can we grow some into that space and get to know them in the process? We've made some interesting early-stage investments. Like last week, we built a $500 million fund with A16Z, looking at everything from real biotech to picks and shovels ideas to new models to find growth in biopharma. So we're open to those things as well. We can plant seeds and see what happens. We have a pretty good run now where we don't expect patent expirations to meaningfully affect our company, and we're focused on long-term growth.
Last question on the BD front. Does larger M&A make sense for Lilly? I know it's something historically the company hasn't done, but to the extent you found an innovative business where you could maybe apply your capital and your focus, would you look at that or do you stay with the sweet spot of these earlier-stage deals?
More the second. I mean, we have an obligation to be prudent with our money and look at everything and we do. Often we learn and say, "That's interesting. No thanks." So it's hard to think of one that fits what you're talking about. But hypothetically, it's possible, but it's not our focus. Our focus is first, like I said, nail the opportunity in front of us, which is profound, build out the rest of the portfolio, a lot of BD happening in those other three areas, oncology and immunology in particular. Maybe neuroscience will blossom a bit in the BD space.
And then look for these sort of blue ocean opportunities where we can invest with high probability, but it takes a lot of convicted capital to do it over a long period of time and make a real difference in human health and be able to play that out over time. If there's something that drops in, of course, we'll have balance sheet capacity to do it. It would really have to be better than Lilly because the other choice is to buy back our own stock. And we don't want to buy something and dilute our effectiveness.
On the rest of the portfolio, I guess also the cash flow the business generates, I think you mentioned these examples of being able to make these longer-term bets in some of these big markets. Are there other opportunities to, I guess, create competitive advantage just given the cash flow from the incretin piece of the business to maybe fund, whether it's sales and marketing, kind of the way you think about portfolios differently in the other verticals?
I think the portfolio part in particular and some of my third bucket ideas fit into that, like taking Kisunla and before really having a launch or even with phase 2 data, starting a prevention study. I think we can take a little more risk there or another KRAS G12C. So there's a few in the market. People are working on this. The breadth of the program we're starting, which includes adjuvant non-small cell lung cancer at the get-go, is an unusual move for us. It's also consistent with the incentives of IRA now to go early and hard. But I think Lilly's in a unique position to use income statement capacity in a way that others might say, "Ooh, let's step into that risk." That can create advantage if it works. Now, if it doesn't work, we've got a different conversation happening.
So we need to be prudent and smart about that. That's the primary one. Of course, if we need to flex commercial muscle, we will. But long-term, as we've talked about in the past, Chris, I think SG&A as a percent of the company will shrink. It will not grow nearly as fast as sales because we're finding a lot of efficiency and communication with digital channels. And mostly we operate in four therapeutic areas. We don't need to add manpower to go to market with what we have.
Maybe just last topic here, new administration coming in. What are you most focused on? How are you thinking about the dynamics for the sector heading into the Trump administration?
Yeah. New day. I think Tuesday will be the most optimistic we'll be. But things will change. And the administration themselves will have competing priorities. And let's face it, there's a lot of tensions in their agenda now. We see that playing out between the visa debate, for instance. So I think they'll have to wrestle those out and we'll see what they really care about. But for the industry, I think there's two industry-wide ones we need to stay laser-focused on. And then for Lilly, there's a third. The first is really making sure that in the legislative package that comes next and in administrative actions, if appropriate, we can create more transparency and efficiency in how drugs get paid for and distributed in America.
So we know the supply chain, PBMs are not transparent enough and we should be able to pass through more of that savings directly to consumers. Right now, we have reverse insurance in our country where people who have sickness and use medicines fund those that don't. We think that should change. That's top priority. Second is fixing the IRA, which is really about the 9 to 13 Rule primarily. So two years ago, that went down and every day since then, venture capital and large pharma have allocated capital away from small molecule chemistry projects and discounted their value in the market. And as a result, we'll have fewer small molecule generics in the future as a country. And I think that's a terrible outcome because that's the most efficient, cheapest thing going in healthcare.
It also blocks off an avenue of science to solve important problems like tissue penetration in the brain and so forth. So that's number two. And the third is expanding obesity coverage for the country, which I think with MAHA, that's what we're about. We want to make America healthy again. We didn't call it that, but that is what we do every day. And obesity is fundamentally a prevention play. And there's lots of great scientific evidence that shows, while diet and exercise is very effective at prevention of obesity, it is rather ineffective at treatment. And we know that because we use it as a control arm in our studies and you lose 2% of your body weight over a year and a half versus 22%. It's quite different.
So if there's common ground there, we'd love to work with the administration to expand really quite broadly access to these medications, find a way to pay for them, although I think the ROI will be measured in months once they get this done and really change the trajectory of health in America and the cost curve for Medicare. I think there's a strong story there. We'll work on that too.
In your announcements for Lilly, do you find the new administration receptive to these ideas or how's the dialogue been to the extent you can comment on it?
Well, they've been receptive to talk. And I think that's a bit of a change from the last four years. I don't think everything the Biden administration did was misintended, but it certainly lacked a lot of industry input. And so then you get these mistakes and no one really wins in that world. I think these folks understand because a lot of them are coming back the second time. And it's just sort of the nature of the president to interact with business and get a lot of inputs before deciding what to do. And I think that's quite healthy and useful. I think the flip side might be, what is the agenda and what's the ability to execute it?
That said, I think some of the people around the incoming president are quite smart and good, Chief of Staff and others that will guide him to say, "Let's do one thing at a time. Let's do it well. Let's knock out some early wins. Let's do things that'll be both popular and good for the long-term health of America." And I think a lot of that comes back to the things I just mentioned. Transparency in pricing, discount, go directly to patients, obesity coverage. I mean, these would be enormously popular and successful policies.
Excellent. Well, I think just about time to really appreciate the comments.