Goldman Sachs 47th Annual Global Healthcare Conference

Okay, terrific. Good morning, everyone. Welcome to our 47th annual Global Healthcare Conference here in sunny Miami. Hopefully it stays that way. My name is Asad Heather. I'm the co-head of the Healthcare Research Business Unit at Goldman Sachs. I'm also the U.S. Pharma Analyst. I'm very pleased to open the conference with Dr. Albert Bula, CEO of Pfizer. He kicks off our conference every year, as you've been doing, Albert, very kindly over the past few years. Thank you very much for being with us. we have a lot to get through but maybe before I get into some of my specific questions Albert any high level opening remarks from your end

thank you for the opportunity I think I'm quite pleased with the way that we are executing in a strategy that I think is very solid right now since the changes that we did in our commercial model in the post COVID I think the word that stands out it is consistency in delivering consistency in delivering If you see 2024, 2025, and the first quarter of 2026, we beat the expectations of revenues or EPS, and in most cases, we beat them both. And that we did despite the fact that we were reducing cost dramatically, and we were able to reduce costs dramatically because we employed AI and very targeted transformational things of changing the business. The other thing that I will point out is that we were able to deliver these results in the face of a radically declining COVID business. COVID business in 24 was $12 billion, actually 11, then it went to six and a half, and this year we gave guidance by de-risking it at $5 billion, right? So despite that, we are doing well, and we are doing that well because the other parts of the business are performing very well. So that's on the financial front. But the thing that excites me the most is, of course, the progress that we had in the pipeline, but you've noticed also in a lot of your reports. I will start very quickly with oncology, which is the crown jewel of our R&D business right We had with thoracic cancer, with lornatinib, a new standard of care. I think it is probably the first thing that we see something like converting metastatic lung cancer into a chronic disease. We had seven years, and there is no medium survival risk yet. And there are people that there are many people that I have seen in the 10 years plus. We had in urophilia, with both PATCHEF, 56% improvement. We have with talazoparib, 56% improvement. We had in breast cancer with the new data that we presented for the CDK4. And I can go on and on with multiple lip myeloma on the oncology. On the vaccines front, also we had two significant successes. One is a readout of Lyme disease at 70-plus percent efficacy. We are optimistic that we will get registration for this product and that we'll become the first and only. Actually, there was one, not the first, but will be the only of the new generation of Lyme diseases over there. But also there was a significant success with the pediatric in Prevnar 25 that we are launching, and then we announced that we are going for PREMRA 35. We are hot of obesity ADA. I'm sure we will have a lot of discussions, but the highlight for me is that we presented data that support our positioning, that we will have a product in two years, that it is as good in efficacy as the current leading product, better than the current lacking product. It will be excellent tolerability and will be monthly. And then, of course, in immune inflammation, we present the data on the tri-specific. So with that, I will turn it to you.

So certainly a lot going on in terms of the rhythm of the business and the rhythm of the pipeline. But I guess maybe starting with a high-level question, you sort of alluded to this. You know, you've led this very significant structural transformation as you pivot from pandemic reliance on COVID-19 towards a more diversified portfolio focused on oncology and obesity and iron, et cetera, right? You've done about $70 billion of M&A over the last few years. You've done sizable cost reduction programs, overhauled the R&D structure. So, you know, maybe just talk to us about where we are in this arc, right? Is the substrate in place? So from here, it's going to now be about commercial and clinical execution, or is there potentially more to do in terms of potential transformational moves at an enterprise level?

There were three things that needed to be restored after COVID when we had the very big shock that we lost half of our average. One was the commercial model that I think it is up and running and I feel very, very comfortable that this commercial superpower that Pfizer traditionally had in the marketplace globally, not only in the U.S., But all over the world, it's restored, and it's like a oil machine. The second was on cost of goods in manufacturing. But with COVID, we had to do dramatic high investments that we're planning to absorb over many, many years. That, of course, changed because COVID business reduced dramatically. So we had to take significant drops. So if you see the margins now, whoops, are going up. And the third, which is the most important, was R&D. What was this R&D, the concern? With R&D, the concern was never productivity in terms of technical merit. I challenge you and everyone else to go and see the data. Right now, if you compare dollars in of Pfizer R&D in the last five years and products out, how many approvals we had, we are top, top, top quartile. When I say we are in the top end of the top quartile, if you see success rates in phase two, phase three, we are top quartile. But if you see dollars in, dollars out, we are mediocre. And that was what I needed to fix. It was a wrong choice of product that we brought to the market, either because we've chosen wrong or sometimes we were unlucky with what competition did. But I think it is our responsibility to do that better. The good news is that if it was a question for me to fix capabilities of R&D, that would be a long-term journey. years. If it is just to fix the focus or where we put, where we turn the cannons, I think it's much, much which is simpler and faster which is what we have done. And part

of that journey has been based on your BD strategy and the deals that you've done. I think just maybe high level on capital allocation you've got about $7 billion in M&A capacity that's left. Is that, by the way, after the Henry deal, is that still the number? Yes. Okay. So And that suggests about earlier stage deals potentially from here. So as you think about scenario planning, are there circumstances in which you think you might need to do something bigger? And if those circumstances were to arise, what levers do you have that you could shift around in terms of capital allocation priorities?

First of all, let me say that we can do something bigger if we want because we have a very big balance sheet. So it's not the seven billion cities if we want without diluting our stock position to do deals. That already we did $70 billion of capital deployments. That we did, as you said, three of the, actually 80, three of the deals represent 80% of the capital that we deployed. it. That was Sigen. Sigen is performing extremely well in terms of the in-line products. Just to remind you, this quarter we had 20 percent growth in the Sigen portfolio years after we did the acquisition. The second was BioHeaven, which was the migraine product. That, I remind you, this quarter was 42 percent growth. And the third was Metera, where we presented data And we are starting 10, we have already initiated a very big part of 10 pivotal studies, and we plan to compete very well. So I think that is doing very well. So right now, what we need is to execute on that and then complement it, not with bigger things, but with pipeline bolt-ons that will help us enhance our position, which is what you saw with the Innoven deal that we did in China. You saw it with the VGF PD-1, and you will see a lot of these things coming forward.

Maybe, Albert, just if we could talk a little bit about the external environment, the external operating environment for the industry. You know, you have the midterm elections coming up. You've got attempts to codify NFN. You've got some regulatory uncertainty as it relates to an FDL leadership vacuum. So I guess from your seat, what are you paying the most, you know, closest attention to in terms of just external forces? And I think, you know, you made some comments last week about drug pricing remaining and existential threat potentially to the industry. So I guess, you know, what did you mean by that? I mean, I thought maybe with MFN we were sort of done with that. Is there something in your line of vision that would suggest this could become a nettlesome kind of variable for us to all think about again?

What I said, and I truly believe it, is that it was an existential threat in 2025. And that was not only the price adjustments, a radical price adjustment in the U.S., but also was the tariffs. That's why most of my time in 2025 was allocated trying to resolve that for Pfizer and as a result for the industry. I think we did very, very well. I think the deal that we signed with the Trump administration put an end to both the tariffs threat, because we have until the end of the term a holiday of any tariffs, and on the MFN, which is prospective only for the new products, with Medicaid. That deal was excellent. Everyone did the exact same deal, and I'm very pleased and proud that we led the way. Now, in addition to this, which is the – by the way, I think always we had challenges in 25, I mean, with the FDA, with CDC, et cetera. I see tremendous steps towards the right direction. Things are going well, I would say, there. I think changes that we had in FDA are very positive. Changes that we had in CDC are very positive. The new director is an excellent scientist that brings confidence to all that science will prevail. So I think over there, I don't worry much. There are two things that I think are shaping this industry faster than what we thought. One is AI. AI will change dramatically the whole value chain generation, and as a result, will create, because of the disruption that will bring, new winners and losers. So it's not something trivial. The ranking will change, and people that are on top can go down, and people that are on the bottom can go up if they get it right or get it wrong. The second thing that is happening is the emergence of China as a scientific superpower. This is changing completely the equation. The geographies and the way that medical innovation is produced is radically different, and everyone needs to have a strategy how to tap in in this innovation but also how to compete in five years with the Chinese companies that, as I said, my competitor will not be Lilly or AstraZeneca but will be Chinese mega players at that time.

And that's a great segue into my next two high-level questions, which are exactly that. I think you made some comments a couple of weeks ago saying that AI and China are the last things you think about before you go to bed. So, you know, maybe just double-click on your vision for AI as it relates to the transformation of the organization. You've highlighted it as a key strategic priority. But I guess the question that we often get from equity investors, Albert, is, you know, when are we going to see tangible benefits in terms of quantifiable metrics on, you know, how AI is helping the pharma industry? So how would you respond to that?

First of all, I have to say that when it comes to Pfizer, the investor have seen some tangible benefits from the deployment of AI because all this cost reduction without touching the top line, it is because exactly we didn't just cut, but we transformed productivity to the next level by employing AI. But still it is scratching the surface right now. I think when in our planning, if things goes well, we will start seeing the benefits in year 28 in a big way, because we have right now, in the second half of 26, scaling up big time, a lot of really scaling up, and making decisions towards the end of this year for things that we will do in 2017 and things we will not do. All the plots are in place. If things work, I think by the end of 27, we will have a very different Pfizer organization that will be an AI native to the degree that it can, and that should provide the benefits in 2028.

Maybe just then going from there.

That's ready for the growth period that starts post-2028. On the cost line, do you think? Actually, the efficiency and the cost reduction because of AI, it is the least valuable thing. It's going to be significant, but it's the least valuable thing. I think the commercial model is changing dramatically with AI. So you can gain significant market share if you know how to deal with the big models. Physicians are getting all their information. So things will change dramatically. So if you get it right, you can have significant wins in the top line as well.

Let's talk a little bit more about China. It obviously is a big theme in the sector. You know, you talked a little bit about it already. It remains a very fertile and dynamic source of innovation. You know, in your words, Albert, they're doing things at half the cost at three times the speed. You know, you've been active there. You've done a number of deals, most recently with Innovent, as you mentioned. So, you know, just update us on the developments you're seeing from a broad industry perspective and, you know, balancing this tension between doing these partnerships and deals versus what you said, China's emergence as a superpower in clinical development that, you know, could be your competitors in 2020.

Yes, that has consequences. Right now, it is positive consequences. Right now there is a lot of new science that is generated and you can tap into it and develop it. They can't do global development yet, so they need you, and there is another offering of excellent science right now. So the first part of our strategy is how to tap into that opportunity and maximize it. But there is a second thing on the consequences, which is negative, which is they will emerge eventually as a global competitor. They will start developing global capabilities, and we have seen that playbook with batteries. We have seen that with EVs. So it's no doubt in my mind. So that's why I said that they will come as our main competitors in end of the decade, by the year 2030. Now, what does this mean for us? They are introducing a different league of competition. If you compare Lilly and AstraZeneca and Merck and us, someone is better here, someone is better there, but we are all within a margin in the same league, the same category some year someone wins, COVID we won, Lilly won now in obesity, so that will keep changing, right? They come with a different league. Half the cost, three, four times the speed, is a new norm that they will introduce in this competition. So if you want to be able to compete, you need to do exactly that. You need to be able, one, to have your cost, secondly, to improve dramatically your speed, and third, to be able to invest significant amounts in innovation. Those are the three things that you need to do. And that's where Pfizer is going. When I say the last thing I think is AI and China when I go to bed, and the first thing when I wake up in the morning because I dream about it while I'm sleeping, it is how to deploy AI, transform the company into an AI-native company that will triple our speed and half our cost. And triple our speed, I mean, in producing innovation, right? So way more innovation, much faster.

I'm going to move to zoom in on some business-specific aspects, But before I do that, I just want to see if there's any questions, big picture, high level from the audience. Okay, Albert, let's maybe start double-clicking on just the business. You know, just in terms of current business trends, just a word maybe just given the revenue beat in the first quarter that you saw commentary from Dave on the earnings call suggesting upside pressure to 2026 guidance. I think the words that were used is that the philosophy is not to raise guidance in the first quarter, but the levers seem to be in place. So just, you know, level set us on current trends.

Look, I think the quarter was very strong. You know, we never raised guidance in the first quarter because, you know, it's first quarter, and I was tempted this time because it was very strong. But if you ask me, do I think that we have a significant upside probably in the non-COVID business? Yes, because this is the part of the business that did extremely well, not the COVID, right? And do I think that we have de-risked COVID? I hope, because from six and a half, which was the lowest ever, we gave a guidance of five. But still, I keep a reservation. I want to see how COVID will evolve. COVID has two components, the vaccine and the treatment. The vaccine, I don't think, will be very variable. I think it will come as we predicted it, because people, vaccinations are at the lower level. This is what we calculated, and I don't think that will change much. However, the treatment, it is highly correlated with the level of infections. Not that much the vaccine, but the treatment is absolutely correlated with the level of infection. So if we don't have COVID wave and infections, the impacts will go lower than last year. If we have a high wave in August, September of COVID, then we'll have much higher than last year. So there is this uncertainty there. But the other part of the business is doing very, very well.

And then maybe just on the long-term guidance, your increased confidence that starting in 2029, Pfizer is going to enter a five-year period of high single-digit revenue CAGR. So maybe just walk us through how you get there. There still seems to be a modicum of investor skepticism around that.

I'm highly convinced about that, and this is not a vision statement. I want to do that. It is a bottom-up. And how we do that, it is we have the in-line products that were easier to predict, I remind you that our new launches and business development business grew 22% this quarter at $3 billion, right? So that's already $12 billion annualized business that is growing exponentially. So we have that piece, and then, of course, we have the in-line products. Then we have the LOEs, that they are also easy to predict and certain. We know how the products respond with archetypes, so we know exactly how that will go. And then we have the pipeline. And the pipeline, there are multiple products, and they are all risk-adjusted when we do the bottom-up. If it was five products, you know, you can say that you can be lucky or you can be unlucky. But if it is 15, then the statistics should work. So the probabilities of success, some will fail, some will succeed, but should come to these numbers. So when we see that number, I have high certainty that starting in 29, we will have high single-digit growth on the top line.

So let's, you know, that's a great segue then to maybe start talking a little bit more about the pipeline. You know, maybe just most recent developments coming off of ADA, Pfizer had a notable presence with detailed data for barobenetide showing efficacy that's on par with the currently marketed GLP-1s, manageable tolerability, no new safety signals in the context of low investor expectations that was an incremental positive. And you're moving this program into 10 phase three trials. So just, you know, and, you know, you're sort of highlighting the convenience of monthly dosing. So help us understand how you're thinking about the commercial opportunity where you're going to come to the market with the weekly first as a sort of a bridge into the monthly that comes later, and by the time you, you know, at that time there's also potentially going to be more competition, maybe Amgen's Maritide, maybe higher efficacy agents, so just maybe help frame those dynamics for us.

Yes, how I see it, we come with a weekly, but the monthly will follow very fast, so it's not that it's going to come after two years, right? It's going to come in months after the week. Then the second one, it is that we will start by trying to get new patients that they want to start into this GLP-1 class, and they would prefer us because they can get the same benefits, but they will get it with a monthly injection. So that's something that we will try to compete, and I understand it's against a very entrenched, let's say, competitor, which is Lilly, but also I emphasize multiple times that when When it comes to commercial capabilities, Pfizer is not Novo Nordisk. So we really got it a little bit easy with them in the competition. Now, on a very big opportunity, it is the switch studies that we are doing. When you reach your plateau with the GLP-1, we know that people either are getting off and most of them are getting significant weight back, or they don't like that they have to do constantly weekly injections for the rest of their lives. The switch studies, we have just to prove, not that we are better, we just have to prove that we are not inferior when they switch, so that people will not gain weight, because now we are talking at a plateau situation, and when they switch two hours, compared to if they continue to the Lilly or any other weekly option that exists over there. And I think we will achieve significant number of switches just because of this convenience. So that's in the beginning. In 2008 we are launching, and this is how we see it commercially. I remind all that we have two major innovations. One of them certainly we will present this year. One, it is the amylin, amylin monotherapy and amylin combination that we expect to achieve very high levels of weight reduction. We still haven't seen the whole gam of the data. But what you will see this year probably will be 24, 28 weeks of weight loss, both in monotherapy and in combination. And that will be our answer to the high level of weight loss or to using lower doses to achieve the same, but with very, very benign profile. And then the third innovation that is coming, It is we are having seen already data, because we are working, on every quarter injection of GLP-1 that so far looks promising, early days, but the pharmacokinetics that we see are very positive.

So I guess just on the Amlin combo, do you feel like that is the added efficacy that you could potentially see with that is needed to drive meaningful market share?

And you need options because the market is having different segments. So the very high weight loss, it is for those that only need, which is the very high BMI. It's not for the masses, right? For the masses, they want something that is comparable to 15 to 20, 20 percent, 20 plus, which is the current offerings from semaglutide to terzetta pipe. But we believe they want it in a convenient way, which is coming now. Also, you spoke a little bit about the competition from Abvi that also could come as the monthly. Because when it comes to monthly, Lilly or Novo, I haven't seen anything that they have. Amgen, you mean? Amgen, not Abvi. Lilly or Novo, they don't have anything on the monthly. So it is only Amgen that has something in the monthly. I haven't seen data much from the Amgen. So, it's not fair to make general statements, but what I have, from what I have seen, the two weaknesses, it is one, the dose that they need to use is very high. Don't forget that our injection, even in the high dose, the 9.6 milligram, is half a ml subcutaneous. When you try to put the dose from Amgem, you need two and a half at least. So it's very inconvenient, I think, an injection of two-and-a-half subcutaneous. The second is they need to fix their tolerability profile, which is very big. So maybe they will fix both of that, and then they will compete with us. But so far, I feel very confident that we have the better product.

What can you tell us, Albert, on how you're thinking about pricing dynamics evolving in that period, just particularly with Baro Benetide's significant COGS and API advantage that provides a significant scalability advantage over competitors. So how should we help us sort of frame that for us?

One, it is the scalability that you said. When you are a factor of 10 to 40 or 50 in terms of syringes that you need and in terms of API that you need, you understand that the very high level of investments that we receive at Novo or Lilly are doing in manufacturing capacity are not really needed from us, actually. All are planning for very high volumes of these products with marginal improvements in our current manufacturing network, which is very, very big in the U.S., we should be able to do it. So the capex that we need to invest in order to make that happen is not as high as with everybody else. Now, the pricing of the product, I think we saw prices going down in the U.S. That was in line when we did the Metzera deal with what we were expecting. What came as a positive on that was that we had the Medicare volumes that we didn't expect when we did the deal. But the big surprise for all of us was international markets. In international markets, the obesity is taking off very rapidly. It's completely out of pocket, the business. There is nowhere almost or very little reimbursement of this market. There is a huge difference when you launch a product in Europe. Usually, after the approval, you need from six months the first country, a year plus most countries, and then two years the lagers to get approval. So, reimbursement. You have approval, but you don't have reimbursement. When it is cash market, it is the next day. But you go and you sell. So, that's one. Also, the prices that we have seen in Germany, in France, they are high prices that they are of the market. So, with all of that in mind, there were some – I think we will continue with the pricing like that. And clearly, as you said, we have the cost of goods advantage.

We agree on the international market. We just took a damn forecast higher for that market.

And keep in mind that Pfizer is probably among all the players the strongest commercial machine internationally. There is no one that has international commercial infrastructure like Pfizer has in every single country, basically.

Let's maybe, Albert, pivot to oncology. Sigvidotin specifically, that is a readout that's getting a lot of attention given its imminence and the importance of this readout, you know, phase three, second line, non-small cell lung cancer. So maybe just level set us on your expectations both for this trial and the first line trial that's going to read out after this one, given that, you know, many investors are seeing this as highly consequential for broader sentiment.

Yes, and they are right. This is, if it is positive, could be a very, very big opportunity because it comes to the lung cancer, which is the number one killer in terms of cancers, and it is the largest market right now. There are two studies, as you said. One is second line, and the other is first line. The potential of the first line is bigger than the potential of the second line, of course. Second line is now. First line is in a year. Second line, it is monotherapy. First line, it is combination therapy. of success in monotherapy is lower than probability of success in combination therapy. I think combination therapy has pretty much the risk through the PADCEF, and we see how the vedotin operates in conjunction with PD-1s, and we feel very, very good about the probability of that success. When it comes to the second line, which is against monotherapy, no ADC so far was able to be successful. So the bar is much higher, and we will wait to see the results.

And the second-line trial is still on track for a mid-year readout?

Do you think the protocol amendment de-risked that trial at all? The protocol amendment was just because we wanted to provide more alpha power to the overall survival. So basically it gives a little bit of a push to have a successful study, because that is really what, instead of vetting, if we miss overall survival, we can get progression-free survival. We said, let's go all in for overall survival, and we moved all the alpha there.

Maybe just sticking with oncology, another big-picture theme coming out of ASCO was just PD-1 VEGF by specifics. We saw new OS data from Summit and the keys of Ivanesimab as well as Phase II data from your old 440 program. So I guess high level, you know, how does Pfizer view the Ivanesimab read through to the class, broadly speaking, and your own program? And then anything you want to highlight regarding 4404?

For us, it's a very, very big program with, again, eight phase three studies. And it is high promising opportunities. The first time that you have a class that is challenging the dominance of the previous king, which was the PD-1s, the K-trudas that is going to go. We didn't have anything that could come better or close to K-truda, and now we have. Now, in our case, we have presented a small number of patients' data, right? So it's not that we have an extensive... But the data that we have seen are best in class. I will give you a comparison. First of all, we all know you can do cross-trial comparisons, but it is important to understand the magnitude, if the whole thing holds, right? But we had in the enriched PD-L1 population, I'm taking the maximum of the efficacy of all three, we had 77% response rate in our own. Keytruda has demonstrated 45%, right, in this enriched 50% population. And that's their highest, right? Also our highest. And Summit demonstrated 60%. So 45, 60, 75. And the same superiority we have seen in the overall survival duration. So I'm very optimistic that the class could do well and we can be first in class. Now, for us, this class has also a strategic advantage. because it's not only that we go for the monotherapies of the PD-1 VGF, but we go for the combination therapies with our SIGEN ADC line. As you know, and I spoke about it, we have high synergistic effects when we use the dotting, which is the payload of the SIGEN ADCs. It is the same in PADCEF. It is the same in SV in combination with PD-1s. So the studies that we are doing right now will be in combination with PD-1 and ADCs. So we see this synergistic effect, so we go all in in this group.

Certainly looking forward to hearing more about that progress. Albert, thank you very much for your time with Wright at about the hour. I really appreciate all your candid conversation, and thank you for being with us.

Thank you very much.