Novo Nordisk A S (NVO) Q3 2026 Earnings Call Transcript

Hi, and thank you for standing by. Welcome to the Q3 2026 Novo Earnings Conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 1 and 1 on your telephone. You will then hear an automated message advising your hand is Thank you. To withdraw your question, please press star 1 and 1 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Michael Novod, Head of Investor Relations. Please go ahead.

Thank you very much, Operator. Welcome to the Novo earnings call for the third quarter of 2026. My name is Michael Novod, and I'm the Head of Investor Relations at Novo. So, with me today I have... CEO, Mike Duster, EVP U.S. Operations, Jamie Millar, EVP International Operations, Emil Kongsoy-Larsen, EVP Research and Development and Chief Scientific Officer, Martin Holtz-Lange, and Chief Financial Officer, Karsten Knudsen. All speakers will be available for the Q&A session. Today's call is being webcasted live, and a recording will be made available on our website. The call is scheduled to last one hour. Next slide, please.

The presentation is structured as outlined on slide 2. Please stand by while the speakers reconnect. Please stand by while the speakers reconnect. And where we got disconnected?

Please continue.

All right, sorry for that. We'll try to start it from the get-go. On slide three, we need to advise you that this call will contain forward-looking statements. These are subject to risk and uncertainty that could cause actual results to differ materially from expectations. For further information on the risk factors, please see the company announcement for the third quarter of 2026 and the slides prepared for this presentation. With that, over to you, Mike, for an update on our 2030 ambitions.

Thank you very much, Michael. Next slide, please. Back in September, at our Capital Market Day, we set out our 2030 ambition to deliver mid-single-digit compounded annual sales growth in line with our industry peers from 2026 to 2030. Three commitments drove that ambition. We will grow and diversify our pipeline, we will drive sustainable growth, and we will deliver attractive returns to our shareholders. From this quarter onwards, we will hold ourselves accountable and report progress against each of them. On growing and diversifying our pipeline, we have initiated seven first human dose trials so far this year. In addition, we have ten ongoing Phase III programs. Martin will cover the key pipeline developments about those later on. In terms of driving sustainable growth, we are now reaching around 48 million people with our diabetes and obesity treatments. This is 2 million more than just a year ago. Especially within obesity, we are treating 5.6 million people, almost doubling during the past 12 months. Obesity sales grew by 22% in quarter three. Supported by continued GLP-1 volume growth across geographies, as well as the accelerated rollout of our innovative products, namely Vigovi Pill and Vigovi 7.2mg, also known as Vigovi HD. In terms of delivering attractive returns, we generated $32 billion DKK in adjusted operating profit and more than $28 billion DKK in free cash flow in Q3-2026. On the back of this strong quarter, we now expect adjusted sales growth of minus 2% to plus 2% and adjusted operating profit growth of minus 2% to plus 2%, both at CER. Carson will speak to the updated guidance later. Please turn to the next slide. The quarterly development clearly shows that we are at the growth recovery phase and that is progressing well. Following a Jets' sales decline of 2% in the fourth quarter of 2025 and 4% in the first quarter of 2026, we returned to 7% and 4% growth in the second and the third quarter, respectively. Additionally, we are happy to see that this quarter, both operating units, are in growth territory again. Behind this is a clear turnaround in patients' volumes. After a flat end to 2025 and a slight decline in the first quarter of 2026, we have now added 1.2 million patients in the second quarter and 1.3 million in the third, which is quite encouraging. What is promising is that growth comes from both obesity and diabetes. In obesity, we've added patients every single quarter, with 0.8 million in Q2 and 0.7 million in Q3. In diabetes, we have moved from losing 0.8 million patients in Q1 to adding 1 million patients in the past two quarters. In short, more patients are choosing novel treatments, and we are reaching them across both of our core therapy areas.

Next slide, please.

In the third quarter, the adjusted sales growth was driven by both operating units. U.S. operations grew 1%, while international operations grew 8%. Within IO, region UCAN remained the key growth area, delivering 18% growth. Across therapy areas, obesity continued to be the main growth driver. And with that, I'll pass it to you, Emil, for a closer look at I.O.

Thank you, Mike.

Please turn to the next slide.

Growth in I.O. continued to be driven by our GLP-1 portfolio in the third quarter. The total GLP-1 sales increasing by 8%. Obesity remains the key growth driver, delivering 24% growth, supported by continued volume uptake of Vigovi across regions. From a regional perspective, UCAN was the main growth contributor, with strong performance across both GLP-1 diabetes and obesity. However, performance in Canada was negatively impacted by lower realized prices following the loss of exclusivity for Simacrotide. We continue to be the GLP-1 volume leader in I.O. with a market share of 54%. We are supporting this position with the rollout of Vigoe pill, Vigoe 7.2 mg, and Osempic 2.0 mg. Please turn to the next slide. We continue to expand our oral obesity leadership across I.O. The pill has now been launched in seven markets, most recently in Mexico, France, Spain, and Poland, and with further launches planned during the fourth quarter. By first half of 2027, we now expect VigoiPill to be available in more than 20 markets. The market response in the UK and UAE is encouraging. While it is early days, we are seeing that VigoiPill is leading the oral obesity segment with around 90% market share in the UK and around 80% market share in the UAE in recent weeks. Six weeks into the launch in Germany, We've also seen solid uptake with approximately 100,000 packs sold, mainly driven by DLP1 naive patients, which suggest market expansion. While the UK market share development is encouraging, we're starting to see a normalization in the uptake, which naturally follows a bolus launch with pent-up demand. Our focus is now to further build the obesity market. We'll do this by driving continued GLP-1 naive patient initiations. Supporting patients throughout their treatment journey, ensuring clear switch guidance from injectables, and expanding subscription options that can improve affordability and retention. Overall, these early launches reinforce our confidence that Vigoe Pill can reach a broader group of people living with obesity and strengthen our leadership across I.O. With that, over to Jamie for an update on the U.S.

Thank you, Emil. Please turn to the next slide. Uptake of the Wagovi pill has continued to outpace the oral competitor in Q3, with Wagovi pill still capturing around 80% of NBRXs. This underpins the strong competitiveness of Wagovi pill. Since launch, we have seen more than 8 million cumulative prescriptions, which remains the strongest U.S. pharma launch by volume in over a decade, outside of vaccines. We see a long runway for the pill in the U.S., with current and incoming initiatives expected to drive more uptake into the new year. In Q3, Wagovi pill volumes grew around 20% versus Q2, and injectable Wagovi volumes grew around 10% sequentially, Q3 versus Q2. Part of the volume growth comes from the Bridge Program, where we see encouraging uptake over the last few months. Further, we continue to see the Wagovi franchise leading new-to-brand prescriptions with more than 50% market share. The breadth of the franchise is central to our approach. Wagovi Injectable, Wagovi High Dose, and Wagovi Pill allow us to serve different patient preferences and treatment needs while building on the established profile of semaglutide. Please turn to the next slide. Turning to diabetes, the transition from Rebelsis to Ozempic Pill is now complete, With new patients starting directly on the Ozempic brand. Since launch, weekly new-to-brand prescriptions for the oral franchise have more than doubled, demonstrating the strength of the Ozempic brand and the opportunity in the oral GLP-1 segment. Ozempic pill strengthens the franchise by giving patients and physicians an oral treatment option under a well-known and trusted brand. It also creates opportunities to engage additional prescribers to compete more effectively across channels. Importantly, more than 60% of Ozempic pill new to brand prescriptions are from people who are new to GLP-1 treatment. This indicates that the launch is helping to expand the treated market rather than only switching patients within the class. We will continue to build awareness, support the transition across commercial channels, and strengthen the combined Ozempic franchise. Over time, the oral and injectable offerings give us an opportunity to serve a broader range of people living with type 2 diabetes. We look forward to the potential FDA approval of a Zempic pill 25 milligrams by the end of the year, which will further strengthen our offering in diabetes with a highly competitive product profile. With that, I hand it over to Martin.

Thank you, Jamie.

Next slide, please.

During Q3, we continued to advance our pipeline. Starting with Cagrocema, we have continued to build the evidence base ahead of the potential launch. In type 2 diabetes, we completed the 60-week phase 3 reimagined 5 trial, a robust head-to-head study enrolling over 1,000 patients comparing Cagrocema 1mg of each component directly with Tsebutype 5mg. This is a very relevant comparison, as around 50% of global patients on disempatide are on the 5mg dose or less, thus doing a more or less like real-world evidence study. At 1mg of each component, Cagrysema demonstrated superior weight loss of 12.4%. Compared with 9.1% for placebo types, while delivering on-par non-inferior HbA1c reduction of around 1.7 percentage points. The results from Reimagine 5 will supplement the regulatory submission for Cagrosemma in type 2 diabetes. In obesity, we completed Redefine 9, which also added evidence on the lower maintenance dose of Cagrosemma. In the trial, Kagrysema confirmed a highly attractive weight loss profile, as the 1 mg dose of each component demonstrated 21% weight loss at 68 weeks. As NOVO expands its focus in women's health, as part of our broader consumer Rx ambition, we are building our understanding of how Kagrysema may address women's treatment needs across different stages of life. Women represent a large proportion of people receiving obesity medicines, and the menopause transition is associated with change in body composition, including bone, increased abdominal fat, and rise in cardiometabolic risk, making effective weight management particularly relevant. Two recent post hoc analyses of women in Redefine1 may help address this evidence. Overall, Cagre Sema was associated with an average weight loss of 25% in women. A separate analysis examining life stages, largely classified using age-based criteria, showed substantial weight loss across groups averaging 27%, 25%, and 23% respectively in premenopausal, perimenopausal, and postmenopausal women. Taken together, these data broadened the evidence base of CAR-Grysema and supported the potential for a more individualized treatment approach, recognizing that patients have different needs and may not necessarily require the highest dose. Lastly on CAR-Grysema, we conducted a Phase II trial in people with type 2 diabetes and painful diabetic peripheral neuropathy. The study in Kagusema reduced pain by 2.4%. Sorry, 2.4 points from a baseline on the PI NIRS score corresponding to approximately 38% reduction in pain on top of standard of care, with more than 53% of patients reaching at least a 30% reduction in pain. Based on these very encouraging results, we plan to initiate at phase 3.12. In the neuropathic pain across the portfolio during 2027. Turning back to the broader pipeline, we advanced oral sanagamtide into phase 3 in the AMAGE-9 trial. Oral sanagamtide brings GLP-1 and amylin dual agonism into a differentiated unimolecular oral treatment. AMAGE-9 is linked to the extensive subcutaneous AMAGE program. Through exposure response modeling and bridging data to support the planned regulatory submission of both oral and subcutaneous. We expect AMAGE 9 to read out in 2028. Within blood and endocrine disorders, we are excited to potentially launch denesimic in the European countries by the turn of this year, with a broader rollout in 2027. In the U.S., we are aiming to launch the Nesimic in the first half of 2027, pending regulatory decision. Next slide, please. Looking ahead, we are set to deliver important pipeline and regulatory milestones. Following the comprehensive pipeline update at our recent Capital Markets Day, I will focus today on the few key highlights. Starting with obesity, Amlin 355 recently advanced into Phase 2. with expected readout in the second half of 2020. The trial investigates both subcutaneous and all amlin 355 in around 170 patients with overweight and obesity. For the oil formulation, we see the potential to leverage the amlin biology to deliver a meaningful double-digit weight loss with potential fewer side effects. Continuing in the oral obesity space, we are anticipating the phase 1 results of the oral HDSL-5 inhibitor in the second half of 2027. HDSL-5 inhibition is a non-GFP1 oral small molecule approach with the potential to deliver double-digit weight loss alongside a differentiated tolerability profile and no need for dose titration. As a small molecule, it also offers the potential for high scalability. Cagrylentide, with its amylist-based biology, is expected to expand into a new patient pool and set a new standard for tolerability. Later this year, we expect to initiate phase 3 of the high dose of cagrylentide. Further, we anticipate phase 3 results of the Renew 1 and 2 programs around mid-2027. Lastly, within obesity, we anticipate phase 1-2 results for both of our tri-agonists in the first half of 2027. These include UBT251 targeting the receptors of GLP-1, GIP, and glucagon, and our internal triple molecule targeting GLP-1, GIP, and amna. Within liver disease, we submitted mass data for all semaglutide 25 mg in the U.S. The submission is based on part 1 of the ESSENCE trial investigating semaglutide 2.4 mg in mesh with moderate to advanced liver fibrosis. We are anticipating a U.S. decision in the first half of 2027. In addition, we are still anticipating phase 3 safety results from this synchrony real-world trial of afroxyformin in people living with mesh and fibrosis stages F1 to F4. The trial's primary endpoint is safety and tolerability. With that, over to you, Carlson.

Thank you, Martin. Please turn to the next slide. In the third quarter of 2026, our adjusted sales increased by 4%, reaching 79.2 billion Danish kroner. This was driven by continued GLP-1 volume growth across U.S. and I.O., primarily in obesity. Adjusted operating profit increased by 27%, driven by GLP-1 sales growth, and a favorable comparison base following approximately 9 billion Danish kroner of company-wide transformation costs recognized in the third quarter of 2025. This was partially offset by around 3.5 billion Danish kroner of one-time costs recognized in Q3 2026 within other operating expenses and R&D. For the first nine months of 2026, Novo has delivered better than expected sales and operating profits. As a result, we have raised our guidance again. The adjusted sales growth is now expected to be from minus 2% to plus 2% at CER. The improvement in the outlook is mainly driven by increased expectations for GLP-1 product sales. The outlook reflects expectations for sales growth within I.O. and expectations for sales decline within U.S. operations. In I.O., the outlook is based on current growth trends, including continued volume penetration from GLP-1 treatments and market expansion. Novo continues to roll out the Vigobi product portfolio in more markets during 2026, including the Vigobi pill. In U.S. operations, the outlook is based on current prescription trends for the injectable GLP-1 portfolio. Lower realized prices linked to investments in market access, amplified by the MFN agreement, are assumed. Uptake related to the launch of Vigo Vipil is reflected in the outlook based on a range of assumptions. Adjusted operating profit growth is now expected to be from minus 2% to plus 2% at constant exchange rates. The raised, adjusted operating profit growth outlook reflects the improved sales outlook. Combined with targeted investments in current and future growth opportunities within R&D and commercial. This is partially funded by reinvestment of savings from the company-wide transformation program started in 2025, as well as further optimization initiatives and disciplined resource allocation. Our key modeling considerations for 2026 are shown on the slide, including the improved free cash flow outlook, now expected between 60 and 70 billion Danish kroner. That was the outlook for 2026. Now over to you, Mike.

Thank you, Carson. Next slide, please. As we close yet another strong quarter above expectations and another guidance raised, I would also like us to take a moment and focus on what comes next. I've been at Novo for more than 30 years, and I can truthfully say that few things energize this organization, like new launches. The coming period will bring two exciting potential launches, Freehemgo and Cagrysema. Let me start on the left side with Freehemgo. People living with hemophilia have been asked to accept the tradeoff between good protection and a heavy treatment burden for way too long. Freehemgo is designed to remove that exact trade-off. The Frontier program demonstrated durable bleeding protections with the flexibility and the convenience of a once-weekly, once-every-second week, or once-monthly injection in a simple, safe, and easy-to-use device. That means more time living and less time managing a disease. Our job now is to make switching from today's standard of care seamless, safe, and the preferred choice for patients and doctors. That is exactly why I am excited to roll out FreeHemGo globally during 2027, pending approval. Turning to Kagrisema. Here, our job is simple. We need to get it to patients fast across channels. We are preparing as we speak. So, we can go from approval to launch as quickly as possible. We will use NovoCare and our partners to reach consumers directly and make the customer experience as seamless and as simple as possible. So, to sum up, we have delivered a strong quarter, raised our guidance again, and introduced a new strategy, culture, and a brand for Novo. Across the organizations, we're focusing on turning our innovation into successful launches that makes a meaningful difference for patients and society. I'm excited about what lies ahead for Novo and look forward to sharing our progress quarter after quarter. Next slide, please. Before we open for Q&A, I would like to say a few words about the change in our executive management. As announced earlier today, our CFO Carsten is leaving Novo after 27 years with the company. Throughout his career, Carsten has made a lasting contribution to Novo, most notably over the past nine years as CFO. He has been a trusted colleague and a highly respected leader, known for his integrity and sound judgment and genuine commitment to patients and our people. On behalf of the entire Board of Directors, Executive Management, and all of our employees, thank you, Karsten, for your many years of dedication. We wish you every success in the future. At the same time, I am excited to welcome Luigi LaCorte as our incoming CFO. Luigi joins us from Galderma as CFO, and he brings more than 30 years of international financial leadership experience across healthcare and consumer businesses. Karsten will remain with the company until the end of this year to ensure a smooth transition and therefore return to Q&A now. I would like, before doing that though, give the word to you, Karsten, for a few words.

Thank you for your kind words, Mike. As Mike mentioned, this will be my last conference call as CFO at Novo. It has been a privilege to serve this company and to engage with all of you. Your questions, challenges, and insights have consistently made us sharper, and I have truly valued our open and constructive dialogue over the years. I leave with great confidence in our strategy, our strong financial foundation, and above all, the people who drive NOVA forward every day. Thank you all for your trust and support over the years, and with that, let's open up a Q&A. Over to you, Michael.

Thank you, Karsten. Thank you, Mike. Next slide, please. For that, we're now ready for the Q&A, where I kindly ask all participants to limit her or himself to one or maximum two questions, including sub-questions. Operator, we're now ready to take the first question.

Thank you. As a reminder, to ask a question, you'll need to press star 1 and 1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1 and 1 again. Our first question comes from the line of Peter Verdalt from BNP Paribas. Please go ahead. Your line is open.

Yeah, thank you. Pete Badol from BNP Paraba. I rarely do this on a public conference call, but I will make an exception this time for Carson to say thanks for all the interactions over the years and best wishes on your next career chapter. On to the questions, two for you, Mike. Just firstly, on the upcoming Kagri Summer approval, is the probability of Kagri Summer having some sort of halo effect of a Wego V containing brand name high, medium, or low? And then secondly, I realize you're not going to provide any official guidance ahead of a CFO change, but a frequent question we get from investors is whether Novo can return to revenue growth in 27. I know there are many moving parts, but I just wanted to kick the tires with you on your confidence that a positive growth number could feature in any guidance range you provide in February, given what you're seeing across IO markets with the pill and post the exempt pill launch. Thank you.

Thank you very much, Pete. So, that was sort of one and a half question. So, both questions for Mike around. First, Kakvizema and sort of the halo, and then secondly, pushes and pulls to 27, although we don't guide to 27.

So, thanks, Pete. To answer your question on Catricema, The brand name ends with SEMA, so there's semaglutide in there, but there is more than SEMA inside, which actually makes us incredibly excited. I think the introduction of Amelin as the first company to do that gives us a huge opportunity to build on. The credibility that semaglutide has had for so many years, and the Vigobi, of course, brand, but go beyond that. I would say, you know, it's medium. It's not high, it's not low, it's medium, because we actually think that this is much, much more than semaglutide on the back of amylin being mixed with it. On the 2027... I think you are correct. As usual, we're not going to guide, but let me go out of my way and provide even more building blocks for next year. So maybe you can do your own math. I think the starting point, of course, is that we are nicely positioned. In a growing GLP-1 market with a good runway and still quite a bit of unmet need, as we have been able to show this year with our volume optics, both on the injectable side as well as the pill. We start 2027 with the current runway and how we will end December. We just guided a midpoint of 0%. For the first nine months, we will monitor how October, November, and December will also look like. And that's how really we build our own budget as well as, of course, the guidance to you. Now, as usual, we'll have some pushes and some pulls, some pluses and minuses. Let me give you three plus and three minus. The pluses for us next year is the continued Vigobi pill. The third uptake in U.S. and I.O. I don't foresee why should that completely change, and how well we've done both in U.S. and in I.O. does not change just because January comes after December. The other plus is we have seen a good uptake in U.S. bridge program. That program started mid this year, so you need to annualize it when you make your calculation for next year. Then the third... Positive element, I would say, is the two launches I just spoke about. Cagre Sema, Free Hemgo are two launches where we plan to introduce Cagre Sema in the U.S., Free Hemgo in both sides of the Atlantic, and hopefully both of those will prove to be fantastic launches. On the negative side, I would say we've talked about the LOE this year in international operations and the early LOE markets. We have seen some of that already, more of it in Q3 than we saw in Q2. And next year, I would say annualize that and see how that goes. Then the continued headwind that you currently see in China, minus 2% that we just showed. It's not going to go away just because Christmas turns into, again, a new year. And in addition, in China, we have lots of exclusivity next year, which you need to take into consideration. And then last, maybe not least, you see some favorable growth to net in 2026. That we should, maybe under normal circumstances, not expect to the same degree next year. I don't know that. So those are the pluses and the minuses as far as I can go. And then we will, of course, guide with all of this in mind in 2027 at the full year announcement.

All right. Thank you, Mike. And to the brand name for KWC, they will come in due time. Next question, please.

Thank you. And our next question comes from the line of Sachin Jain from Bank of America. Please go ahead. Your line is open.

Hi there. Thanks for having my questions. One for Jamie, one for Emil. For Jamie, on the U.S. Wig-Ovi pill script trend, thank you for commenting sequential growth. On your data, how much of that growth is the bridge program? Our data suggests the bulk is Medicare, and that's sequentially slowing. In fact, you can comment to that, and any color on white X Medicare trends are flattish, if that's correct. For Emil, you commented on UK normalizing just after an updated pack number relative to the $65,000 per week you gave at the CMD. And perhaps I can just squeeze in a clarification from Mike. When you talk about current momentum continuing, I was a little bit confused in the answer to Pete's question. Is the midpoint a guide 0% best proxy or the recent 2Q, 3Q growth rate at mid-single digits? Thank you.

Thank you, Sachin. So we'll stick with the two first questions that's already beyond the number one. So first, one question to Jamie on bridge and then a question to Emil on uptake in IO. Yeah, thanks, Sachin.

Relative to bridge, latest weekly data, we're seeing about 60,000 TRXs across injectable and oral in terms of bridge. So the sequential growth of 20% in the quarter is largely, but not exclusively, bridge volume. For the whole category, if you look May to October and eliminate the contribution of the bridge, The whole category is relatively flat, consistent with the seasonality that you see in that period outside of the consumer activation that we see in the wellness period that starts here in the fourth quarter and really peaks at the beginning of the year with New Year's resolutions and a recommitment to health, if you will.

Yeah, on the UK, we are still very pleased with 90% market share, despite a competitor launch, of course, is very strong. In terms of how we fare versus what we shared at Capital Markets Day, We back then talked about 65,000 packs weekly sales. Now we are probably around 60. So despite a competitor launch, super strong, and also with the seasonality at the moment being a bit low, we move into November, December, that's typically peak, where the online providers also invest heavily. I think what you should also take note of, which we really are keenly focusing on, is of course that this is not cannibalizing our injectable business. That's perhaps what I'm most pleased about. This is really adding to our overall market share, so we are still faring more than 10% at this point higher than we did prior to the launch overall, so very positive. Now the focus, of course, is to build the segment, the class. That's probably up to us, given our overall leadership with 90%, so we are focusing on subscription models, proving very successful for the providers who offer that. Focusing on clear switch guidance in the UK, there are a lot of people with obesity who have tried a GLP-1, so if they've been on an injectable, we want to work with the private providers to ensure they start on the right dose. So there's a lot of, you know, the long haul of building the segment, but so far, we really see good synergistic effects between injectable and the pill, and that's perhaps what we are really celebrating at the moment.

Thank you. Very clear, Emil and Jamie. Next question, please.

Thank you. And our next question comes from the line of Simon Baker from Rothschild & Co. Redburn. Please go ahead. Your line is open.

Thanks so much for taking my questions, and let me echo Pete's comments earlier and wish you the very best of the future, Carsten. So on Wagovi, I wonder if you could give us an update on the impact of the subscription program. Is that affecting the capture rate of scripts that we're seeing? Because we kind of have to assume it's constant, but maybe it isn't. And then secondly, on Wigovi high dose, you hopefully told us that it's 5% of total Wigovi scripts in the US, but I wonder if you could give us any more color, both within and outside the US, on where that's coming from. Are these predominantly titrations up from Wigovi? Thank you very much, Simon.

So, questions for Jamie to start with, and then maybe we can add a bit of color, at least on initial expectations.

Yeah, so first question related to capture rate. Low capture, relative low capture rates from IQVIA are not isolated simply to the subscription model. We have a much more extensive ecosystem of partners. For Wagovi than our competitor, and those partners don't report to IQVIA in absolute terms. So we've consistently seen a lower capture rate for Wagovi pill than the competitive oral product. So not explained specifically by the subscription model. In terms of Wagovi high-dose, the 7.2 milligram, as you stated, about 20,000 prescriptions a week, 5% of total volume. If you look at the injectable business, both Lily's and ours, about 15% of the TRXs are in the highest dose, so there is still opportunity to move Wagovi HD further. 80% Your specific question, 80% of Wagovi high-dose is titration from 2.4 milligrams. So those 20,000 scripts a week are scripts that otherwise would have been lost to the Wagovi franchise.

Thanks so much. Yeah, I mean... We talk a lot about the Vigoi pill, but of course, year to date, it really is Vigoi Indectables that has been driving our growth in IO with a very, very strong volume uptake and I would say very disciplined pricing where we've not given up. So just to give you a sense that volume growth year to date has for Vigoi Indectables been close to 70%, so very, very meaningful. That's, of course, why the high dose launches 7.2, we call them an IO, a top priority. We've promised more than 30 launches by the end of the year, and we'll get there. We've had three so far. The one where we have the most meaningful experience from is the UK. We launched back early June, and today, around 5% of our injectable patients have already started on a high dose. That's pretty good, and we, of course, keep supporting that. We, over time, will also look at, of course, how can we facilitate patients who have maxed out on the GOI pill, 25 milligram, and also offer them an even more efficacious treatment with 7.2. So we give a lot of priority to this, just launched in Germany, Poland, and the rollout continues these very weeks. Great. Thank you very much. Next question, please.

Thank you. And our next question comes from the line of Martin Parkhoi from SEB. Please go ahead. Your line is open.

Yes, good afternoon. Martin Parker for ACB with two questions. Just a question for Martin Lange with respect to expectations ahead of the phase 1 slash 2 readout in obesity of the two tri-agonists. I'm not expecting you to give some kind of indication of where you see the weight loss. I would more like to get you to get some expectations of how we should view the adverse events profile going on to this, because there has been some noise when new orders come out with the Phase 2 results and high level of adverse events. How have the trials on the triagon has been set up with respect to this? Just to control expectations. And then, secondly, maybe that is for Emil. We can see in the U.S. that the Osempic pill rebranding has been quite a success so far. Does that make any sense also to do that in some of the I.O. markets where Osempic also is a high household name?

Great. Thank you, Martin. First question to Martin around triples, reading out, and then to Emil on the IO question.

Yeah, thanks very much, Martin. So, first of all, I just want to clarify. Where we typically see adverse events rates being captured in a very rigorous way is in phase one, because basically we follow the patients very, very closely there. I think that is what you are referring to also because most of these trials are built with technicalities around how we capture the rates, but also how we want to drive the dose escalation in a meaningful way. So, those are a little bit technical, but also a little bit artificial. What we will see read out of is proper phase two trials, and here we actually expect to see the, I would say, The expected adverse event profile and tolerability profile of these two drugs, you've actually seen some readouts from phase two, albeit in Chinese patients from UBT251. It looks very, very attractive with low adverse event rates and low withdrawal rates. We cannot fully expect to see that in a global study, but our aspiration is to have adverse events in line with what we've seen with GOI and with other GLP-1 incretin-based therapies. And actually, for the triple, we potentially expect to see either inline and potentially even a more attractive safety profile and tolerability profile because the GIP component will come to its own right here.

Yeah, on OsempicPill in IO, we have definitely taken note of the success that Jamie and team have delivered in the US. That's good inspiration. You'll be the first to hear if we end up concluding that it's a good product for IO as well. At the moment, our focus is the 2.0 launches. We've come late to that in IO, launched in 13 markets year to date, 20 by the end of the year. And so far, we have good results. We shared the results from Germany and the Netherlands. To early launch markets, but a number of other markets are also proving promising here. So that's our focus. They will already reinforce the OcemPic brand at a moment where, for your building blocks for next year, we, of course, are facing increasing competition, particularly in reimbursed markets across IO from a well-known competitor to you all. So it will be key to reinforce OcemPic first with 2.0.

Thank you very much, Emilio. Thank you very much, Martin. And then just to kind of ask again to limit yourself to one question, so as many as possible can get to ask a question. Next question, operator.

Thank you. And our next question comes from the line of Matthew Weston from UBS. Please go ahead. Your line is open.

Thank you. I'm going to actually ask Sachin's question, Mike. Is the positive growth exit rate in the second half of 26 the best proxy for 27? Or is the full year's 0% average at the midpoint of guidance that you referenced earlier the best baseline for next year? And if I can slip in one because I managed to get to slide 83, if Ruxifurmin looks like you have no plans to launch until 2030 when you get the F4 data, can you confirm no plans to go early with F3? Thank you.

Yep. So the way that it works, we look at the totality of this year. We look at the pluses and the minuses that we had this year. And we look at quarter by quarter, frankly speaking, and then we look at the exact same thing for next year. I told you that on some notes, we see positive results for next year. I think the bridge program is a great example of that. We've had half of that. We're happy with it. Let's do that for the full year next year. On the other hand, LOE, International Operations, is exactly the opposite of that. So I would not give you numbers again. Today, we're not guiding. But what I do tell you is that right now, we've guided 0% midterm for the first nine months. So that's basically how we're going to look at this going forward. On the afroxyformin question, we have to follow the data. We will look at the data for F2, F3, F4, and then make a decision. I don't know if Martin wants to add any more to that.

I think it's important to call out that F4 is where we see the big unmet need. We already have a drug on the market for F2 and F3. It's called pregoid. And therefore, to Mike's point, we'll be guided by the data as we see them.

Thank you very much. Thank you, Matthew. Next question, please.

Thank you. And our next question comes from the line of Richard Vosser from JPMorgan. Please go ahead. Your line is open.

Hi, thanks for taking my questions. One on a ZENPIC, please. Maybe you could talk about the underlying price dynamics this quarter throughout this year, whether there's any impact from lower 340B rebates throwing through to better prices, and how you're thinking about that into next year. I noticed you didn't mention IRA next year. I know we talked about that last quarter, but is that still a headwind in terms of price, or are there price benefits that offset that next year? And then the second question, maybe you could just talk about that oral rollout. I think 12 or so incremental markets in the first half of 27. Maybe you could talk about the relative opportunity of those markets relative to the UK and how, you know, early days, France, Poland, Mexico, et cetera, are going and their relative opportunity. Thanks very much.

Thank you, Richard. First question to Jamie, and then the second question to Emil.

Yep, thanks for the question, Richard, on Ozempic growth to net trends. So as we've guided before, suggested 10% to 15% price erosion on an annual basis is the way to think about it. There's so much fluctuation, variability, quarter to quarter. Obviously, in the quarter, we saw... Significantly, you know, better range than the 10 to 15, but year-to-date in over a 12-month period, we still feel 10 to 15 percent is reasonable. The payer pressure on net prices in the type 2 diabetes category remain and will continue, so that's our best judgment there.

To me? Yeah, on the rollout in IO, of course, I'm very pleased with our manufacturing colleagues because they keep upping the output. And you noticed at Capital Markets Day, we promised 20 markets by end of next year. Now we promised by end of first half. So that's, of course, incredibly positive. We also back then shared that this would correspond to two thirds of the market potential. So we reached that earlier, of course. And then across the markets, you know, I've learned to be rather humble, predicting potential in this space. But of course, you could say. Markets with a low penetration and a propensity to tablets such as Mexico. That is a, relatively speaking, bigger market expansion opportunity versus a Danish market, for instance, that's more mature with a 10% treatment rate. So there's something about where are we on treatment rates, what is the propensity to online and tablets altogether. But overall, of course, we see it as a hugely important opportunity. And in the early innings, it will still be Europe driving the majority. Then, of course, we'll see, and that's what we will learn next year. In markets that have gone LOE, what does the fact that this will be a premium offering from a pricing perspective mean to the volumes we can secure there? And we'll keep you posted on those learnings as we move into next year. Great. Thank you.

Thanks. Next question, please.

And our next question comes from the line of Michael Lugten from Jefferies. Please go ahead. Your line is open.

Thank you. I'll stick to one, and Carsten, thank you so much for the interactions over the years. The question is just a follow-up on your commentary, Jamie, on the bridge contribution to the franchise. Do I understand correctly that without bridge, you wouldn't have grown the GLP-1 franchise, and what does that mean as bridge starts to annualize? Thank you.

Thank you very much, Michael. A question to Jamie on bridge in the U.S.

Without the bridge contribution, there's less growth than the 20% sequential growth that we talked about. Bridge is definitely creating an inflection in the category, and without bridge, the AOM category, not just NOVA, but the category, looks relatively flat in the May to October timeframe, reflecting the seasonality.

Great. Thank you, Jamie. Thanks, Michael. Next question, please.

Thank you. And our next question comes from the line of James Quigley from Goldman Sachs. Please go ahead. Your line is open.

Great. Thank you for taking my questions. And also, thank you, Carsten, for your help over the years and best of luck in the future. Maybe one for you, Carsten. So on the upgraded guidance range for 2026, the implied range for Q4 is super wide. I think it's a 12 billion DKK swing. So what are the key factors we need to consider there? And then as we look into next year, with the growth to net is quite high this year, how should we treat that as we're thinking for 27? Is that an unwind or is that a new base from which sales need to grow from? And then secondly, quickly for Jamie, on the Cagri Samba launch in the U.S., as you prepare for the launch, how are you thinking about market segmentation? Which patients or consumers will the initial marketing campaign target? It sounded a little like older women from Martin's comments, but will you have sufficient data for the launch here, and what is the best analog we should look at as we start to model the launch? Thank you.

Thank you very much. First question to Karsten on Year2Go in 2026, and then over to Jamie on KV7.

Yeah, James, thanks for the nice words. And specifically to a question on implied growth and guidance ranges, then I'll just say, as to the guidance ranges, the breadth we have here at Q3 is completely customary, you know, at this point in time. And the reason why we have this breath is that we are navigating a rapidly growing category with a certain degree of volatility. So that's why we keep it a little bit wider compared to the heydays when it was pure insulin and extremely linear. So that's really the reason there. And in terms of implied growth, it's important to note that while we're growing 2% year-to-date and we have a midpoint of zero, then we do have a tough comparator in the fourth quarter due to U.S. growth to net last year of $3 billion in the fourth quarter. And then LOE, mainly in Canada, Emil spoke to also having a bigger impact in the fourth quarter compared to the first nine months. So, those are really the two biggest ticket items impacting the fourth quarter and the implied growth there. Great. What's your name, Jimmy?

Yeah, and as for segmentation, it's absolutely the right question, but you'll understand and appreciate if I don't graphically describe our launch strategy. But that said, I'll make two points. One. I'm super excited about Cagrosemma and expanding the optionality for physicians and for patients. Increasingly, as more competitors come into the category, having a portfolio of singlets, doublets, triplets over time is going to be really important from a competitive standpoint. And as you described, as the Information data emerges on Cagrosema. There is a nice profile that is emerging in terms of the efficacy of the product, even at lower doses, as Martin described, and the patient population perimenopausal women, where we recently announced the 25% weight loss seen in the study. So thank you for your question, and we're super excited about the launch coming up. Thank you. Thank you very much.

Next question, please.

Thank you. And our next question comes from the line of Martin Brenno from Nordia. Please go ahead. Your line is open.

Hi, Mike, Karsten, and Michael. Thank you for taking my questions. I just have two left, please. First question would be whether you can provide a bit of color on how you see the price dynamics heading into 2027. Just what's the main building blocks that we need to be aware of when we do our modeling? And second question is on the Vigovic pill. Now you're committing to rolling out the Vigovic pill a bit faster than what you indicated just less than two months ago. Can you just help us understand what's been the main driver behind this assumption and whether you still see some upside to this accelerated rollout that you are now promising here? Thank you.

Thank you very much, Martin. So, some high-level comments from Jamie on the U.S., and then over to Emil on accelerating to go repealing IO.

Yeah, I apologize if a bit repetitive, but on the Ozempic side, you know, as we've suggested, that 10 to 15 price degradation trend is... Kind of our experience and what we would, you know, suggest, not guiding, but that trend continues. And then on the Wagovi side, we've, again, seen 30-35% in the quarter, again, with the variability, a little on the high end, but we expect, you know, that or a little better, you know, moving forward. Just to clean up maybe one question that was asked before that I missed. It has been answered previously. Because of the Ozempic trend, MFP pricing, we don't expect to have an incremental negative, you know, consequence, because that's been the trajectory we've been on. So someone asked that before, and I didn't cover it. Thanks, Jamie.

Yeah, on the acceleration, it is really back to, of course, manufacturing. Stepping up, producing above what the lines are expected to be able to deliver. I've been visiting myself to cheer on the teams, and they're really doing a great job working 24-7. Another aspect is regulatory. We've actually taken some learnings. Somehow we also rolled out. We go injectable very quickly, working with multi-country packs, etc. So great work to also optimize. That simply means you can have launch batches serving more countries and hence speed up productivity in manufacturing. So that's helped. You saw maybe also the breaking news of the day. Australia, we got approval. Also great local regulatory work. So another front loading there. So it's a combination of manufacturing, regulatory work, and really close collaboration.

Thanks, Jimmy. Thanks, Martin. Next question, please.

Thank you. And our next question comes from the line of Seamus Fernandez from Guggenheim Securities. Please go ahead. Your line is open.

Thanks very much for the question. So my question is just kind of going back to that, the comment about the sequential growth. From March, basically being flat, and the contribution of the Medicare Bridge Program being the main accelerator, you know, that speaks to, I think, to some degree, a cautionary tale for payers potentially lowering the price or helping to lower the price of treatment. And I guess the big question is, is how do you get commercial pay to really step in and start to? Reveal the benefits, the medical benefits that we all know GLP-1s actually have given several, appear to have pulled back from supporting the obesity opportunity. Thanks so much.

Thanks, Amos. So to Jamie on that question regarding dynamics in the U.S. pay market.

Yeah, it's a great question. It's a simple question with a difficult answer, but the reticence on behalf of the downstream payers, employers, government, private payers, is increasingly about the volume concern side of the equation. Price keeps coming down, net prices, competitions working in that sense. Our list prices will also come down, 1-1-27 as previously announced, but how payers control the cost trend that they see, which is the price times volume equation, is the challenge. We're engaged daily with employers, third-party payers, PVMs on their behalf to try and manage the volume in a unique and different way so that they can manage the cost trend. But you're right, whether it's... Pepsi, Starbucks, other large employers, when they see the cost trend, they move against despite the clinical and economic benefit long-term of medical cost offsets that have been demonstrated in the market. So we continue to fight that battle and seek greater access for the category, by the way. Again, not unique to Novo. This is a categorical issue and opportunity that we're working on.

All right. Thank you very much. Last question, please.

Thank you. And our last question comes from the line of Kerry Holford from Berenberg. Please go ahead. Your line is open.

Thank you for taking my questions. And thank you again also to Carsten for the many years of interactions. I will finish again on bridge. Just linking to that question in a way with regard to commercial opt-ins. As the Duff now settles after the U.S. returns today, Jamie, I wonder if you can comment on your expectations for the Medicare bridge, let's say the Medicare coverage extending beyond the end of bridge, which I know that you'd come to an end at the end of next year. If that appetite is not there to provide access more broadly, how do you see it playing out within the Medicare channel?

Thanks, Kerry. Last question to Jamie around the dynamics, again, on Bridge and also how it's all panning out in the U.S.

Yeah, it's difficult to predict what the political environment is going to look like at the end of 27, but as the 28 presidential elections... You know, come into play. Health care continues to be, you know, a dominant topic for U.S. citizens. Family insurance premiums have increased 28 percent over the last five years. So health care costs, you know, are a continued issue for both parties. I think as more and more seniors. Enjoy this coverage for GLP-1s, for weight loss. That will put pressure politically on continuation of the program. The benefit of this demonstration project is to document eligibility, inclusion, cost, and outcomes so that they can make a determination. Obviously, we'll continue to work with the administration, with CMS, with both parties, too. Continue this access opportunity for seniors who are finding it beneficial and affordable. Great.

Thank you very much, Jamie, and thanks, Carrie. So this concludes the Q&A session, and before we end it completely, I also would be remiss. Even though there's been a lot of thank yous, I also need to say thank you very much to you, Carsten, both from being an analyst on the sell side and most recently internally as my direct boss and leader. So thank you very much and best of luck going forward. Thank you. That was it. Thank you for participating and feel free to contact Investor Relations regarding any follow-up questions you may have. Thank you very much.

This concludes today's conference call. Thank you for participating. You may now disconnect. Speakers, please stand by.