Novo Nordisk A/S Q2 2025 Earnings Report

Novo Nordisk A/S EPS Results

• Actual EPS: $0.97
• Consensus EPS: $0.93
• Beat/Miss: Beat by +$0.04
• One Year Ago EPS: N/A

Novo Nordisk A/S Revenue Results

• Actual Revenue: $11.69 billion
• Expected Revenue: $77.51 billion
• Beat/Miss: Missed by -$65.82 billion
• YoY Revenue Growth: N/A

Novo Nordisk A/S Announcement Details

• Quarter: Q2 2025
• Date: 8/6/2025
• Time: Before Market Opens
• Conference Call Date: Wednesday, August 6, 2025
• Conference Call Time: 7:00AM ET

Novo Nordisk A/S (NYSE:NVO), together with its subsidiaries, engages in the research and development, manufacture, and distribution of pharmaceutical products in Europe, the Middle East, Africa, Mainland China, Hong Kong, Taiwan, North America, and internationally. It operates in two segments, Diabetes and Obesity Care, and Rare Disease. The Diabetes and Obesity care segment provides products for diabetes, obesity, cardiovascular, and other emerging therapy areas. The Rare Disease segment offers products in the areas of rare blood disorders, rare endocrine disorders, and hormone replacement therapy. The company also provides insulin pens, growth hormone pens, and injection needles. In addition, it offers smart solutions for diabetes treatment, such as smart insulin pens and Dose Check, an insulin dose guidance application. The company has a collaboration agreement with Aspen Pharmaceuticals to produce insulin products; and with Korro Bio, Inc. for the discovery and development of new genetic medicines to treat cardiometabolic diseases. Novo Nordisk A/S was founded in 1923 and is headquartered in Bagsvaerd, Denmark.

Novo Nordisk A/S Q2 2025 Earnings Call Transcript

Key Takeaways

• Negative Sentiment: In the first half of 2025, Novo Nordisk delivered 18% sales growth and 29% operating profit growth, but trimmed its 2025 outlook to 8–14% sales and 10–16% operating profit growth due to weaker-than-expected U.S. obesity and diabetes market dynamics.
• Positive Sentiment: Obesity care sales surged 58% globally (36% in the U.S., 125% internationally), supported by initiatives like the new NovoCare Pharmacy (≈10% of cash channel penetration) and Wegovy’s status as the sole covered GLP-1 on CVS’s national obesity formulary.
• Positive Sentiment: R&D momentum remains strong with Phase III launches for amicretin (AMACE) and CACILACEMA (REDEFINE 11), a positive EMA opinion for an Ozempic peripheral arterial disease label update, and an exclusive small-molecule obesity and diabetes collaboration with Septerna.
• Neutral Sentiment: Novo Nordisk expects to reach peak capital investments soon as new production capacity for API and fill-finish nears completion, which should support future demand for existing and upcoming GLP-1 and obesity treatments.
• Neutral Sentiment: Executive leadership changes include Mike Dukeslaar becoming CEO on August 7 and a unified R&D structure under new CSO Martin Langgett, aiming to sharpen focus on diabetes and obesity innovation and commercial execution.

Presentation

[Operator]

thank you for standing by. Welcome to the Q2 twenty twenty five Novo Nordisk Earnings Conference Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there'll be a question and answer session. There'll question Please be advised that today's conference is and being recorded.

[Operator]

I would now like to hand the conference over to your first speaker today, Jakob Roeder, Head of Investor Relations. Please go ahead.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you. Hello, everyone, and welcome to this Novo Nordisk earnings call for the 2025. My name is Jakob Roel, and I'm the Head of Investor Relations at Novo Nordisk. And with me today, I have CEO of Novo Nordisk, Lars Rocco Jansen Executive Vice President, Product and Portfolio Strategy, Ludovic Helfgard Executive Vice President, U. Operations, Dave Moore Executive Vice President and Head of Development, Martin Holzlage Chief Financial Officer, Karsten von Klusen and finally, Executive Vice President, International Operations as well as incoming CEO as of August 7, Mike Dukeslaar.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

All speakers will be available for the Q and A session. Today's announcement and the slides for this call are available on our website, novanoidis.com. Please note that the call is being webcasted live, and a recording will be made available on our website as well. The call is scheduled to last one hour. Please turn to the next slide.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

The presentation is structured as outlined on Slide two. Please note that all sales and operating profit growth statements will be at constant exchange rates unless otherwise specified. Next slide, please. We need to advise you that this call will contain forward looking statements. These are subject to risks and uncertainties that could cause actual results to differ materially from expectations.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

For further information on the risk factors, please see the company announcement for the first June 2025 as well as the slides prepared for this presentation. And with that, over to you Lars for an update on our strategic aspirations.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

Thank you, Jarrod. Next slide, please. In the first six months of twenty twenty five, we delivered 18% sales growth and 29% operating profit growth. As announced last week, Novo Nordisk has lowered the full year outlook for 2025 compared to the outlook issued in May. The change in sales outlook for 2025 is driven by lower growth expectations for 2025.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

This is related to lower growth expectations for Wegovy in The U. S. Obesity market, lower growth expectations for Ozempic in The U. S. GLP-one diabetes market as well as lower than expected penetration for Wegovy in select IO markets.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

Karsten will come back to this later in the call. I'd like to go through the performance highlights across our strategic aspirations before handing over the word to my colleagues. Starting with our focus on purposes of sustainability, we are now serving almost forty six million patients with our diabetes and obesity treatments. This is an increase of more than three point five million patients compared to the first six months of 2024. In R and D, Ozempic received a positive opinion by the EMA for the treatment of peripheral arterial disease in people living with type two diabetes.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

Within obesity, we announced that subcutaneous and oral amicretin for weight management will advance into Phase III clinical development. Further, we initiated a new Phase IIIb trial, REDEFINE 11. The trial lasts for eighty weeks and investigates further potential efficacy and safety of cachetema. Finally, we have entered an exclusive collaboration and license agreement with Septurna to discover and develop all small molecules for the treatment of obesity, type two diabetes and other cardiometabolic diseases. Now I'd like to turn over the word to Ludovic for an update on our commercial execution in the first June 2025.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

Thank you, Lars. And please turn to next slide. In the first June of twenty twenty five, our total sales increased by 18%. The sales growth was driven by both operating units. U.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

S. Operations grew 17%, and international operations has grown 19%. Sales growth in the first six months of twenty twenty five was positively impacted by gross to net sales adjustments related to prior years. Our GLP-one sales in diabetes increased by 10%, driven by U. S.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

Operations growing 9% and international operations growing 10%. Sales growth in The U. S. Includes an adjustment related to the 340B provision of around DKK 3,000,000,000 in the 2025. Incident sales increased by 4%, driven by U.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

S. Operations growing 17%. The sales increase was driven by gross to net adjustments related to prior years as well as channel and payer mix, partially countered by a decline in volume. International sales operation sales decreased 1%. Obesity care sales increased 58%, driven by U.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

S. Operations growing 36% and international operations growing 125. The volume of compounding GLP-1s in The U. S. Is estimated to have impacted the uptake of Wegovy prescriptions, as well as the growth of the branded obesity market during the 2025.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

Please turn to next slide. Our rare disease sales increased by 15%. This was driven by a sales increase in The US operations, 23%, and international operations, 10%. Sales of endocrine disorder products increased by 49%, driven by Norditropin and Segroya launch uptake across U. S.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

And international. As a reminder, in 2024, sales of Norditropin were negatively impacted by a reduction in manufacturing output, which has now improved. Red blood disorder sales increased by 6%, driven by an increased sales of NovoSeven and Lemo in The U. S. And higher hemophilia B and, ELEMO sales in international operations. And with that, I'll hand over to Dave.

[David Moore, EVP - US Operations at Novo Nordisk]

Thank you, Ludo. Please turn to the next slide. Sales of GLP-one diabetes care products in The US increased by 9% in the first six months of 2025. The sales increase was driven by continued uptake of Ozempic, partially countered by Victoza and Rybelsus. Ozempic sales in The US were positively impacted by gross to net sales adjustments related to prior years.

[David Moore, EVP - US Operations at Novo Nordisk]

The weekly Ozempic prescriptions are currently around 690,000 in standard units. While the full impact of the chronic kidney disease indication has yet to be fully realized, this indication allows us to reach an additional patient segment within the type two diabetes population. And we will continue to invest in commercial activities and label updates towards driving further market penetration. This includes Ozempic in the cash channel, which we anticipate launching later this year. Please go to the next slide.

[David Moore, EVP - US Operations at Novo Nordisk]

Wegovy sales increased by 37% in US operations in the first six months of twenty twenty five. The Wegovy sales growth was driven by increased volumes, partially countered by lower realized prices. And Wegovy has around 280,000 weekly prescriptions. As Ludo said, despite the expiration of the FDA grace period for mass compounding on May 22, Novo Nordisk market research shows that unsafe and unlawful mass compounding have continued. Multiple entities continue to market and sell compounded GLP-1s under the false guise of personalization, and it is estimated to be around one million patients are on compounded GLP-1s in The US.

[David Moore, EVP - US Operations at Novo Nordisk]

Novo Nordisk is working to prevent unlawful and unsafe compounding of semaglutide in The US while making sure patients have access to safe, legitimate semaglutide produced only by Novo Nordisk. As unsafe and unlawful mass compounding continues, the Wegovy penetration within the cash channel has been lower than expected. Novo Nordisk launched NovoCare Pharmacy in March 2025, and the penetration of Wegovy within the cash channel is now around 10% of total prescriptions. Novo Nordisk will continue to invest in the expansion of direct to patient initiatives, including Noble Care Pharmacy, as well as telehealth collaborations. Within the insured channel, Novo Nordisk expects a volume contribution from changes to the CVS national template formulary.

[David Moore, EVP - US Operations at Novo Nordisk]

This went into effect on 07/01/2025 where Wegovy is now the only GLP one medicine covered for obesity. Although compounding persists, we do see positive early indicators in recent weeks of prescription data that we believe is driven by CVS formulary decision, as well as recent commercial efforts. We remain focused on driving commercial execution, which includes refining our messaging, launching new initiatives, and pursuing additional indications over the course of this year. Our most recent Wegovy direct to consumer campaigns highlight real world evidence that was presented at the ADA meeting in June with additional campaigns planned for the second half of the year. Furthermore, we continue to anticipate a regulatory decision regarding the Begovy MATCH indication in the 2025. Now I will turn it over to you, Mike, for an update on international operations.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Thanks, Dave. Next slide, please. Sales in I O grew by 19% in the first six months of twenty twenty five, driven by GLP-one products. GLP-one diabetes sales increased 10%. This growth was negatively impacted by periodic supply movements.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Our GLP-one diabetes sales in region China was also lower than expected, mainly because of the wholesaler inventory movements and timing. Having said that, Obesity Care sales grew in IO by a very strong percentage. We grew the sales by 125% to DKK13.9 billion. And if you discount for Saxenda and look at the sales at Wegovy alone, we have now reached more than DKK12.2 billion growing at an impressive rate of 335% by all the regions. Please go to the next slide.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Novo Nordisk remains the market leader in IO with a total diabetes and obesity GLP-one volume market share of seventy one percent. Simply put, almost three fourth of people that use GLP-one products in IO are on a Novo Nordisk GLP-one product. With improved supply for both Ozempic and VIGOBI and connected to that increased investments and higher innovation higher activations of commercial activities, we will accelerate our launches and further advance our GLP-one leadership. Rybelsus is also available right now in 40 countries and will continue to gain market share in international operations. Meanwhile, Ozempic remains the leading GLP-one diabetes product within IO, having launched in around 80 markets.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

As supply has started to increase towards IO markets, we are now all in with our promotional activities to further expand the number of patients that we are reaching. That also includes an increased online presence and telehealth collaborations in our markets. We have now launched BIGOVI in around 35 countries, including more than 15 new launches just this year. Furthermore, we continue to drive innovation with VIGOVI, having submitted for regulatory approvals in Japan for the treatment of NASH in May, and a higher dose of VIGOBI with the submission of semaglutide seven point two milligram to the EMEA in July. The growth of VIGOBI in IO is very encouraging, but there are still millions of people with obesity who need our medications, and we need to get to them soon.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

We will continue rolling out VIGOVI in more countries during the second half of this year. Now over to you, Ludo.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

Thank you, Mike. That's right. And please turn to the next slide. As you've heard from Dave and Mike, there is much work to be done when it comes to reaching the millions of people worldwide living with diabetes and obesity. Over five fifty million people live with type one and type two diabetes globally, and over nine hundred million people live with obesity.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

In both cases, most of these people reside outside of The United States. Despite the prevalence of diabetes and obesity, more effort is required to help people get our innovative medicines. In diabetes, as an example, though a patient can have more than one prescription, only seven percent of total estimated prescriptions are of GLP-one. Furthermore, less than one percent of people with obesity globally are treated with branded anti obesity medications. This of course means that there is a vast unmet need that is yet to be addressed.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

Novo Nordisk will keep investing across the value chain. Our goal is to gradually expand the diabetes and obesity markets, reaching new patient groups and new physician segments. We also work to introduce new channels and treatments and reduce barriers to access so that our innovative treatments and devices can get of patients who need them. Please turn to next slide. As an example, and in continuation thereof, unlocking the full potential of the obesity market requires addressing diverse patient segments through a broad and strategically aligned portfolio of treatments.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

The obesity market today in magnitude of weight loss, and of course, we respond to that need. However, we will widen the scope of our medicines, and we ensure greater relevance across varying BMI categories and patient preferences. Our portfolio reflects this diversity, targeted at offering both subcutaneous and oral delivery, and addressing comorbidities associated with obesity. This includes atherosclerosis, heart failure matched with fibrosis, and osteoarthritis. With these differentiated treatment goals, whether patients desire rapid weight loss or rather gradual progress supported by tolerability and safety, Novo Nordisk remains focused on providing solutions to current and future segments.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

And now over to Martin for an update on R and D.

[Martin Lange, Executive VP - Development at Novo Nordisk]

Thank you, Ludo. Please turn to the next slide. I would like to start with a brief reminder of the amicretin Phase IbIIa data, which we presented at the ADA in addition to the next steps for the compound. The primary endpoint of the Phase IbIIa trial with subcutaneous amicretin in people with overweight or obesity was treatment emergent adverse events. Overall, the trial demonstrated that the safety profile for amicretin was consistent with incretin based therapies.

[Martin Lange, Executive VP - Development at Novo Nordisk]

The most common adverse events with amicretin were gastrointestinal, and the vast majority were mild to moderate in severity. People treated with amicretin in the dose dependent sorry, in the dose response part of the trial achieved an estimated body weight loss of 9.7, 16.2%, and 22% after a twelve week maintenance period. This was in the one point two five milligram, five milligram and twenty milligram doses respectively. In the multiple ascending dose part of the trial, people on the sixty milligram amicretin dose achieved an encouraging estimated body weight loss of 24.3% at thirty six weeks. Overall, we are very encouraged by the Phase IbIIa data speaking to the potential of amicretin, both on efficacy and on tolerability.

[Martin Lange, Executive VP - Development at Novo Nordisk]

After an end of Phase II discussions with the regulatory authorities, we are now looking forward to initiating a broad Phase III development program with amicretin for adults with overweight and obesity and associated comorbidities. Next slide, please. The comprehensive Phase III development program will be called AMACE and will start in the 2026. The program has decided to investigate the weight loss potential of envicretin while evaluating multiple maintenance doses, the subcutaneous and oral route of administration as well as several obesity related comorbidities. For example, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, knee osteoarthritis and obstructive sleep apnea, with the plans to investigate additional comorbidities as well.

[Martin Lange, Executive VP - Development at Novo Nordisk]

We're excited about the potential that amicretin holds, and the AMAZE program will be key to unlock this potential. Next slide, please. Turning to the upcoming R and D milestones, we are looking forward to the remainder of 2025 with a number of readouts and milestones. However, before speaking to these, I would like to highlight a few milestones from the past few months. Within obesity, we have initiated the REDEFINE 11 Phase III trial with Calcursema to investigate further weight loss potential by exploring dose re escalation and longer trial duration.

[Martin Lange, Executive VP - Development at Novo Nordisk]

Further, we have submitted semaglutide seven point two milligram for approval within the EU. Looking ahead, we also anticipate the internal triple GLP-onegip amylin Phase I readout that will gate for potential further development into Phases 1b and two. Within diabetes, as Lars noted, we received a positive EMA opinion regarding the Ozempic label update for treating peripheral arterial disease in people living with type two diabetes. This supports the accumulating evidence of cardiometabolic benefits for semaglutide one point zero milligram in people living with type two diabetes. Notably, semaglutide one point zero milligram has demonstrated a twenty four percent risk reduction in the risk of kidney related kidney disease related events in the FLOW trial and cardiovascular risk reduction of twenty six percent in the SUSPAIN six trial, which is unsurpassed in the incretin space.

[Martin Lange, Executive VP - Development at Novo Nordisk]

This seems to corroborate what we have been speaking to for the last couple of years, namely that semaglutide appears to be unique in driving the magnitude of cardiovascular benefits in the class. In addition in diabetes, we are awaiting the readout of the Re imagine Free trial investigating the potential of CAGNY RECEMA in diabetes. We also anticipate the Phase II results of the subcutaneous and oral amitretin in type two diabetes. Within Radixis, the FDA has now approved Althema as once daily prophylactic treatment to prevent or reduce the frequency of bleeding episodes. The label covers adult and children 12 years of age and older with hemophilia A or B without inhibitors.

[Martin Lange, Executive VP - Development at Novo Nordisk]

We also received a positive opinion in EMA for ALHEMO. Lastly, in rare disease, we expect to file MiMate for hemophilia A approval in The U. S. And in EU in the second half of this year. Within cardiovascular disease and emerging therapy areas, we are excited to have submitted the ESSENCE Part one data with once weekly semaglutide two point four milligram for regulatory approval in Japan for the treatment of MESH.

[Martin Lange, Executive VP - Development at Novo Nordisk]

We also anticipate a U. S. Decision on the Wegoe MESH indication later this quarter. In July, we successfully completed a Phase II trial with Korametuk, an antibody designed to deplete amyloid deposits in transthyretin amyloid cardiomyopathy. Detailed data expected to be shared at a medical conference later this year.

[Martin Lange, Executive VP - Development at Novo Nordisk]

Following the successful completion of this Phase III trial, Corametuk in ATTR cardiomyopathy is expected to initiate Phase III during the course of 2025. Lastly, we look forward to the readout of the EVOQUE and EVOQUE plus Phase III trials in patients with early Alzheimer's disease towards the end of this year. While we are excited about the potential for semaglutide in Alzheimer's disease, we must also highlight that this is a high risk reward opportunity sorry, high risk, high reward opportunity. With that, over to you, Carsten.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Thank you, Martin. Please turn to the next slide. In the first six months of 2025, our sales grew by 16% in Danish kroner and by 18% at constant exchange rates, driven by both operating units. The gross margin decreased to 83.4% compared to 84.9% in 2024. The decrease mainly reflects amortizations and depreciations related to Catalent as well as costs related to ongoing capacity expansions.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

This is partially countered by a positive product mix driven by increased sales of GLP-one based treatments. Sales and distribution costs increased by 15% in both Danish kroner and at constant exchange rates. The increase in cost is driven by both U. S. Operations and international operations.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

In U. S. Operations, the cost increase is mainly driven by promotional activities related to VIGOVI and Ozempic, while in international operations, the increase is primarily related to BIGOVI launch and promotional activities. R and D costs decreased by 11% in both Danish kroner and at constant exchange rates. The decrease is driven by the impairment loss related to osiduranan of DKK five point seven billion and other impairments of intangible assets in 2024.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

This is partly countered by increasing investments within Obesity Care and reflecting increased late stage clinical trial activity as well as increased early research activities. Administration costs increased by 10% in Danish kroner and 11% at constant exchange rates. Operating profit increased by 25% measured in Danish kroner and by 29% at constant exchange rates, while EBITDA increased by 16% measured in Danish kroner and 19% at constant exchange rates. Net financial items showed a net loss of DKK 1,400,000,000.0 compared with a net loss of DKK $530,000,000 last year. This primarily reflects financing costs related to the funding of the Catalent transaction.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

The effective tax rate was 21.6% in the first six months of twenty twenty five compared to 20.6% in 2024. Net profit increased by 22% and diluted earnings per share increased by 23% to DKK 12.49. Free cash flow in the first six months of 2025 was 33,600,000,000.0 compared to DKK 41,300,000,000.0 in the first June of 2024. The reduction in free cash flow is driven by increased capital expenditures, partially countered by higher net cash generated from operating units. Capital expenditure in for property, plant and equipment was DKK 28,100,000,000.0 compared to DKK 18,900,000,000.0 in 2024.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

This was primarily driven by investments in additional capacity for API production and fill finished capacity for both current and future injectable and oral products. For 2025, the Board of Directors has decided to pay out an interim dividend of DKK 3.75 per share, an increase of 7% compared to August 2024. The interim dividend will be paid out in August. We have returned 36,500,000,000.0 to shareholders, mainly as dividends in the first June 2025. Please go to the next slide.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

The updated financial outlook for 2025 was announced last week, where the key highlights and drivers were described in the company announcement and investor call. Sales growth is now expected to be 8% to 14% at constant exchange rates, and operating profit growth is now expected to be 10% to 16% at constant exchange rates. Sales and operating profit growth reported in Danish kroner is now expected to be three and five percentage points lower than at constant exchange rates, respectively, based on exchange rates from 07/31/2025. The lower sales outlook for 2025 is driven by lower growth expectations for the 2025. This is related to lower growth expectations for VIGOVI in The U.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

S. Obesity market, for Ozempic in The U. S. GLP-one diabetes market as well as VIGOVI in select IO markets. The updated guidance reflects several efforts already underway, as mentioned by Mike and Dave.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Novo Nordisk expects net financial items to show a gain of around DKK 1,600,000,000.0. This is mainly driven by anticipated gains on hedge currencies, primarily the U. S. Dollar, partially offset by interest expenses related to funding of the debt financed Catalent transaction. The effective tax rate for 2025 is still expected to be between 2123%.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Capital expenditure is still expected to be around 65,000,000,000 in 2025, reflecting expansion of the global supply chain. In the coming years, the capital expenditure to sales ratio is still expected to be low double digits. Free cash flow is now expected to be 35,000,000,000 to 45,000,000,000, reflecting the lower than expected sales growth, mainly driven by lower volume growth of Th1 treatment in The U. S. That covers the remaining details on the outlook for 2025. Now back to you, Lars.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

Thank you, Karsten. Please turn to the next slide. The performance in the first six months of twenty twenty five with 18% sales growth reflects that nearly 46,000,000 people are now benefiting from our treatments. Further, we progressed our R and D pipeline, including initiating the CACILACEMA Phase IIIb trial, REDEFINE 11, in people living with overweight and obesity. We have reduced our full year outlook compared to the guiding issued in May.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

While we have had to adjust expectations for the 2025, the organization is clear on what it needs to do going forward. I'm confident that with Mike at the helm, Novo Nordisk is equipped to continue to unlock the potential to treat more people living with serious chronic diseases. It is with that I would like to share my gratitude to the Board, my team and all Novo Nordisk employees for allowing me to lead this incredible organization. I'll continue to follow Neuroscient, and I'm excited for the organization's next chapter. With that, I'd like to hand over to Mike for a final comment.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Thank you, Lars. Please turn to the next slide. As of tomorrow, August 7, I'm excited to be taking over as President and CEO of Novo Nordisk. As we shared last week, there have been additional changes to the executive management team that I would like to highlight now. Markus Schindler, Executive Vice President of Research and Early Development and Chief Scientific Officer is retiring after seven point five years at Novo Nordisk and four years in his current role.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Markus has been instrumental in discovering and advancing early scientific innovation across therapeutical areas and technologies. Novo Nordisk research and early development and development areas will be combined. The new research and development organization will be overseen by Martin Langgett, currently executive vice president of development. Martin has been appointed chief scientific officer and will resume responsibility for research and development starting tomorrow, August 7. As CSO and Head of Unified R and D Organization, Martin will leverage his deep scientific expertise, strong leadership, and long standing experience at Novo Nordisk to ensure efficiency and continued innovation.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

We'll be focused on raising the innovation bar within diabetes and obesity, bringing new and better medicines to patients with serious chronic diseases. Lastly, Emil Larsson, currently Senior Vice President of Europe and Canada region, will succeed me and assume the responsibility of Executive Vice President of International Operations. Emil currently leads Region UCAM, spanning 40 countries accounting for about 20% of Novo Nordisk global sales. I would like to congratulate Martin and Emil on their promotions and thank Marcus for his significant contributions and dedication to the company. Lastly, I would like to thank you, Lars, for your dedication and many years of service in Novo Nordisk.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

I consider it a privilege to have worked under you for so many years, and I appreciate your support in passing the responsibility over to me. Looking ahead, we must act with greater urgency building on your company's building on our company's strength while sharpening our focus on commercial execution and operational efficiency. By fostering innovation and making thoughtful investments, we will be having the greatest impact, and we can ensure steady progress together. With that, over to you, Jakob.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Mike. Next slide, please. With that, we are ready for the Q and A. Then we're ready for the first set of questions, please, operator.

[Operator]

Thank you. We will now go to the first question. And your first question today comes from the line of Michael Niedelkovich from TD Cowen. Please go ahead.

[Michael Nedelcovych, Director - Equity Research at TD Cowen]

Hi. Thank you for the questions. I have two. My first is on Wegovy's formulary position with CVS. The deal looks to already be having an impact on prescription volumes in The US.

[Michael Nedelcovych, Director - Equity Research at TD Cowen]

Lily has suggested that the sum total of lives covered that might be affected by the formulary update is roughly 200,000. Does that align with your thinking as well? And how many of those people do you expect will actually make the switch to Wegovy? So that's my first question. And my second question is on compounding.

[Michael Nedelcovych, Director - Equity Research at TD Cowen]

Our understanding is that the statutes that compounders use to support their marketing of so called personalized GLP-one dosing are not clearly defined and that a broad court decision may be needed to get this practice fully shut down across the country. One could even imagine the Supreme Court needing to weigh in. So my question is whether Novo has initiated any litigation that could possibly serve that purpose. Thank you.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Mike, for those two questions. I'll hand both of the message out to you, Dave, and we'll start with the question on the CVS pulmonary, please.

[David Moore, EVP - US Operations at Novo Nordisk]

Yes. Thank you, Mike, for the question. We are pleased, with what we're seeing so far, on the CVS formulary, conversion. That conversion is going according to plan at this point. We won't comment on the specific number of lives and what the actual percentage of conversion is, but to tell you that we are seeing things that are largely in line with what we expected and what was in the plans.

[David Moore, EVP - US Operations at Novo Nordisk]

On the compounding side, thank you for that question as well. You know, this is something that, as you heard in our remarks in the beginning of the call, this is a priority, for our company. This is a priority to protect patient safety. This is a priority to ensure that the laws are followed. And as we mentioned as of May 22, compounding is illegal in The US except for rare circumstances.

[David Moore, EVP - US Operations at Novo Nordisk]

And the APIs that are being imported into The US are illegal, and they are not coming from approved facilities. Not to comment directly on any litigation, but I will let you know that there is there is nothing categorically that is off the table. You saw earlier this week that we gave some more insight in terms of the legal actions that we are taking. And certainly, our viewpoints on that are broad. And we have updated or increased our recent dialogue, with FDA, and we will continue that ongoing dialogue.

[David Moore, EVP - US Operations at Novo Nordisk]

And we continue to think that there should be pressure that's put on these entities that are false advertising misleading patients with a legal API.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thanks a lot, Dave, and also thank you to you, Mike, for the set of questions. With that, we'll move on to the next set of questions, please.

[Operator]

Thank you. Your next question comes from the line of Peter Sedolt from BNP Paribas. Go ahead.

[Peter Verdult, MD - Pharmaceuticals Equity research at BNP Paribas]

Yes. Thank you. Peter Sedolt, BNP Paribas. Two for Mike, please. Just can we discuss China, Mike, before you move up to CEO just in a little more detail?

[Peter Verdult, MD - Pharmaceuticals Equity research at BNP Paribas]

Just interested to know why there's been so much destocking, in Q2 and how confident, you are about the the growth outlook in China given the arrival of generics and Magnatide next year. And then secondly, I just wanted to come back to a question posed to you on last week's call about the go forward strategy changes you intend to make. I mean, should we assume major changes in R and D focus? And kind of push you, what exactly you can do differently with respect to commercial strategy that hasn't already been tried by the company year to date? Thank you.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Pete. And for those two questions, I'll go to you, Mike.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Yes. Thanks very much, Pete. Let me start with China. Let me start by saying what it's not the reason for lower growth. We are not losing market share in China.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Actually, opposite, we're gaining market share. We're basically, as you know, a bit left alone. Competition is not yet present. So that is not the reason for the lower growth. As I've mentioned to us, the reason for the lower growth, I would say, is 1.5 things.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

The one thing is comparing it to last year where we basically, in anticipation of the Govi launches, built some large stocks. We now, of course, need to make that adjustment for this quarter. So it's a timely event, and that's what the definitions behind the sentence is. The half issue is that we need to accelerate the GLP-one market growth, both I would say still in diabetes, but certainly also in obesity. We know that from our diabetes leadership and being in China for a long time that you start somewhere in the center and you reach your customers, then you need to start going into the broader China in covering tier two and tier three and tier four.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

And, and and and we need to do that both offline as well as, of course, nowadays online. And that is, of course, what we are doing, and we're increasing investments and people behind our GLP one sales force, which gives me, of course, partially the the confidence for for for the future. I'm very I'm very confident for China's future. And and the reason I am is because it it has huge amount of unmet need and and populations that are within diabetes and obesity where we serve. Two hundred million people living with obesity, one hundred million people living with diabetes is what I get my confidence from.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

And and then we have some of the best people, the best team on the ground to to maximize on that.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thanks for that, Mike, for covering the the China question, and there was a follow-up question in terms of strategic building blocks.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

Yeah. So so I cannot give you much more than what I gave you last last week because because not much has changed, and I'm I'm still, you know, not the CEO. I have one more day to go. But I can repeat what I said last week, Pete. We're going to focus more.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

We're gonna focus more on diabetes and obesity as this is our main core and has always been. And I have a belief that when you focus on anything more, you increase the speed, increase the agility, and you get more out of that, you know, as as we go forward. I think I've been put into this position because because I execute and and and I outcompete my competition, at least in IO. I've done that, and I plan now to do more of that for the rest of the company. So execution, execution, execution is what we said also last time.

[Maziar Doustdar, Executive VP - International Operations at Novo Nordisk]

And then when I think about the future and the huge opportunities that we have, we need to be able to finance that and not fall behind the competition. To finance that, we need to reallocate and relook at our cost base and really put the money where the growth is. So So those are the three things I said last week, and they're still very valid today.

[Peter Verdult, MD - Pharmaceuticals Equity research at BNP Paribas]

Perfect. Thank you.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thanks a lot, Mike. And also thanks to you, Pete. Then we're ready for the next set of questions, please.

[Operator]

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

[Sachin Jain, Vice President at Bank of America]

Hi there. I have two questions, please. One for Dave and then one for Castle. So firstly, on the Wigavy recent TRx dynamics, you flagged in the presentation the NovoCare contribution. Just a follow-up to prior, any sense of how much the increased appetite of NovoCare is CVS versus remaining underlying growth?

[Sachin Jain, Vice President at Bank of America]

I'm just trying to get a sense of how much more CVS has to go and what the growth rate looks like once the CVS bolus is done? That's the first question. The second question is, I guess, a repeat of a question for Castle from last week. I understand. So it's on 26 pushes and pulls, you like to price some high level.

[Sachin Jain, Vice President at Bank of America]

I know you didn't last week, but if consensus has corrected dramatically, obviously, big share price, wonder whether you wanted to assess whether you think we collectively are thinking about this correctly. Consensus has fallen out at about nine to 10% sales in EBIT growth.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank Sachin, those two questions. I'll give the first one to you, Dave. I think you covered part of it firstly, but on CVS and then also NovoCare, please.

[David Moore, EVP - US Operations at Novo Nordisk]

Yes. Thanks, Sachin. It's still early days with respect to CVS and the conversion. We have a couple of data points, in July. So most of those, obviously show up in first case in MBRX.

[David Moore, EVP - US Operations at Novo Nordisk]

And as I mentioned, we're seeing that largely in line, but there's still data points to come, right, and some time to go. The increases that we are seeing in our uptick, they are partly due to CVS, but they're also partly due to our other commercial efforts. As I had mentioned, in the previous quarter, we have a new campaign that we launched and focused on the weight loss of Wegovy as primary message. So it's a mix of both. And then with respect to Noble Care Pharmacy, we will continue to expand that channel.

[David Moore, EVP - US Operations at Novo Nordisk]

It is a focus for us. Certainly, the early days of Noble Care Pharmacy have been impacted by the continuation of compounding, But we think there's a real opportunity to continue to expand that channel. We are encouraged in terms of what we're seeing in our overall cash business. And we think there's certainly an opportunity to partner with more organizations, telehealth included, and other entities to expand the cash channel. And as I mentioned, we will we will in the second half of the year, be offering another product, which is Ozempic in NovoCare Pharmacy as well. Thanks, Sachin.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Dave. And then the question second question on looking ahead and pushes and pulls. I'll turn to you, Kastner.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Thank you for that question, Sachin. And I'd just like to take us back to the starting point around what we're pursuing as a company. And we're pursuing innovation based growth and what we see in terms of unmet need. As Ludo covered in the prepared remarks, we're looking into two significant markets in diabetes and obesity, where our penetration with our current portfolio of products is still very, very low. And what you saw in our reporting today, you saw 19% growth in international operations.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

It's a big portfolio of markets. And we are not even done in terms of rolling out in all markets with VIGOVI as an example. And GLP-one penetration in diabetes is also very low on a global scale. So we believe that we have a substantial volume opportunity with our current portfolio, and that's what we'll be continuing to drive on the basis of what we're delivering this year. And then like any year, there are pushes and pulls between new launches like autism, obesity in The U.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

S, build of new channels, cash channels in The U. S. And elsewhere. And of course, then there are a few headwinds also LOE in a few select markets in IO. And to kind of size that in rough terms, as we've also done historically on specific items of discretionary nature, Then our assessment on LOE in the specific IO markets in terms of impact to group growth next year is to the tune of low single digits of group sales.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

So that's what we're looking into next year, but clearly focused on driving growth with our portfolio and then continued FIGOVI launches as well as oral sema in The U. S.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Karsten. And also thanks to you, Sachin. With that, we're ready to move on to the next set of questions, please.

[Operator]

You. Your next question comes from the line of Michael Novod from Nordea. Please go ahead.

[Michael Novod, Managing Director at Nordea Markets]

Thank you very much. Michael Novod from Nordea. Maybe you can comment a bit on how you stand in terms of capacity also for accelerating IO also going into next year because, of course, there has been lack of capacity. But how are you positioned now? And also in the same question, obviously, how well positioned do you believe you are for a sort of an expansive launch of oral semo twenty five milligrams for obesity?

[Michael Novod, Managing Director at Nordea Markets]

And then just lastly, a small note to Rybelsus. We've seen you sort of comment on a deprioritization. Is that something that we should just factor in will mean that Rybelsus will be more sort of flattish going forward?

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Michael. On the first question on capacity, I'll turn that over to you, Carsten.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Yes. Michael, thank you for that question. I think the best forward looking indicator on capacity you can get is our current run rate. And when you look at BIGOVI in IO year to date compared to last year, it's up four times. So we are scaling really fast in terms of both the in market penetration and number of launches.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

And as to number of launches, if you just take over the last roughly six months, then we started the year in around 20 markets, and now we're in around 35 markets and still counting. So the pace of launches is high in sales operations, and you should expect that to continue to be the case. And then for capacity on the oral sema for obesity, you should expect us to launch that come next year in The U. S. In a non supply restricted way.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Carsten. Very clear. And on the second question on Rybelsus mainly in The U. S, I'll turn it over to you, Dave.

[David Moore, EVP - US Operations at Novo Nordisk]

Yeah. Thank you for that question. Yeah, I think you have it right, Michael. The priority, certainly is is continuing to expand with Ozempic and the type two diabetes market. The priority, is with Wegovy in the obesity market.

[David Moore, EVP - US Operations at Novo Nordisk]

And as Carson mentioned, you know, with the NASH launch coming up as well as, the oral sema for obesity. So so I I think the the terms of, you know, flattish trends with Rybelsus, is really just a signal in terms of, you know, where our priorities are. This is on our commercial, investments and execution, in Ozempic and Wegovy. Okay. Thank you very much.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Dave, and thanks to you, Michael. With that, we're ready to go to the next question, please.

[Operator]

Thank you. Your next question comes from the line of Evan Seigerman from BMO Capital Markets. Please go ahead.

[Evan Seigerman, MD & Senior Research Analyst at BMO Capital Markets]

Hi, guys. Thank you so much for taking my question. I wanted to touch on one of your development assets. We noticed you discontinued your development of Sulfiram and NASH. Can you walk us through kind of the rationale and what you saw in that trial to drive this decision? And do you still have interest in the FGF21 target? You.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Hi, Ewen. Thanks for that. On the question on sulfurmin and FGF21, I'll turn that to you, Martin.

[Martin Lange, Executive VP - Development at Novo Nordisk]

Yes, absolutely. Thank you for the question. I think you've heard me talk to you before, we do not progress assets that are not differentiated in a meaningful way. We conducted a trial comparing salfermin or FTR-twenty one, both in monotherapy to semaglutide, but also in combination with semaglutide. And we did not see from an efficacy perspective a dramatic improvement, neither in monotherapy nor in combination above and beyond what we know already now semaglutide can do in F2 and F3 and actually also in F4.

[Martin Lange, Executive VP - Development at Novo Nordisk]

This largely speaks to the power of semaglutide. We have some very strong data in MESTA currently under FDA review. As you know, FDA granted priority review because of the data package. And we expect the readout of that this quarter. Semaglutide is difficult to beat in this space.

[Martin Lange, Executive VP - Development at Novo Nordisk]

It doesn't mean that we are necessarily done with the FTAr21 biology, But specifically, in a head to head comparison, it just didn't substantially differentiate from somatostatin.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Martin, and thank you for the question, Evan. Let's move on to the next set of questions, please.

[Operator]

Thank you. Your next question comes from Richard Foster from JPMorgan. Please go ahead.

[Richard Vosser, Managing Director at JP Morgan]

Hi, thanks for taking my questions. One question just to follow-up on pricing. We talked a lot about volume in the second half, but just the thoughts on the price, a little bit more on that color. I know we covered it last week, but price around Wegovy and Ozempic in the second half and into 26 as well. And then secondly, on the just wondering if I could get your thoughts on SURPASS CVOT and how you think that will impact the competitive dynamics in the diameters market with Ozempic? Thanks very much.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thanks a lot, Richard, for those two questions. First, on the pricing question, I'll turn it over to you first, Garten.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Yes. Thank you for that question, Richard. And as we've said consistently, then do be careful in terms of working too much with the pricing on a quarterly basis. There are fluctuations with the inventories at wholesalers, gross to net and the likes. So what I would say is that directionally, when we talk about the Gobi pricing, then the price erosion is more skewed towards the second half of the year linked to the fact that we're building the cash channel and hence, there's a channel mix element to it.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

And then we are also investing in reducing friction in the access we have in place in the insured channel, so patients can get better access to reimbursed VIGOVI in The U. S. Marketplace. So more skewed to the second half in terms of price erosion, but of course, something we do in a very disciplined, thoughtful manner.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Absolutely. Thanks, Karsten. And on the second question on competitive trial, I'll turn it over to you first, Maarten, and then you add if anything, Lule, afterwards.

[Martin Lange, Executive VP - Development at Novo Nordisk]

Yes, absolutely. Thank you for the question. Of course, we've only seen headline data, so it's difficult to go into details. Looking at the headline, however, it was clear that based on the primary analysis, tirzepatide was inferior sorry, non inferior to dulaglutide, which means basically it did not demonstrate a benefit versus dulaglutide. Dulaglutide that in the REWIND study demonstrated a twelve percent CV risk reduction versus placebo.

[Martin Lange, Executive VP - Development at Novo Nordisk]

Despite of a better weight loss and better glycemic control. I remind you that semaglutide by comparison through SUSPANE six has shown a twenty six percent CV risk reduction, which is to date unsurpassed in the incretin space. This does seem to confirm that semaglutide stands out on the magnitude of CV benefit among the incretin based drugs. And it also a little bit appears to be driven by more than just weight loss. So for CV benefit, for also other comorbidities, appears to stand out at this point. Ludovic, any comment from you?

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

Absolutely. I think you're right. I think that we have with semaglutide an agent here that has an unsurpassed CV profile. And of course, as we discussed earlier on, as this market is expanding, we're gonna have to target new populations, new groups of patients, new physicians. And it's extremely important to make sure that for those patients for which beyond the weight, the comorbidities are important in their journey, we make sure that the quality of the CV quality and CV profile of semaglutide are being heard.

[Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk]

And that's true with the endocrinologist, the GPs, the cardiologist. It's also true for those patients who decide maybe to learn by themselves which product they want to get. And we have to make sure that this profile is known and renowned for what it gives. I think it's actually very interesting and a validation of what I think Martin was saying all along, not all GLP-1s are the same.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Perfect. Thank you, Ludo. And also thank you to you, Martin, as well for the question, Richard. Let's turn to the next set of questions, please.

[Operator]

Thank you. Your next question comes from the line of Martin Pacoi from SEB. Please go ahead.

[Martin Parkhøi, Head - Equity Research at SEB]

Yes. Martin Pacoi, SEB. Also two questions. Carsten, first, a question on you on CapEx. Now there's a little bit less growth in Novo, then it turns more to a value case.

[Martin Parkhøi, Head - Equity Research at SEB]

And then it would be interesting to hear your more long term thoughts on cash flow development. And that's, of course, CapEx, which are very high right now. When should we actually expect a more maintenance level? And what kind of level are we actually looking at very long term? And then the second question, Justin, Dave, also on the all the Govio launch, and maybe you already touched a little bit about it.

[Martin Parkhøi, Head - Equity Research at SEB]

But now there's a U. S. Decision in Q4 according to your table. And how will that immediately be launched in the cash channel? And how important do you actually think that could change the trend of the uptake in the cash channel?

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Hi, Martin. Thanks for those questions. For the first one on the CapEx part, we'll give that go, Carsten.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Yes. So thanks for that question, Martin. And the level of CapEx we're pursuing is directly a function of the opportunity we see in unmet need I was talking to before in both diabetes and obesity as well as our other assets that we're investing into. So I would say in terms of CapEx at risk, I do believe that we're investing in the core of the company and to the long term, both marketed assets as well as pipeline assets. And then in terms of the shape of the CapEx curve and how to get to a maintenance level and the magnitude of that.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Then I would say that we're actually starting to see some of our bigger CapEx project announcements in API getting very, very close to delivering to market and to regulatory approval. So of course, that then ties into the spending of those projects coming down. So but then we have still finished projects that are slightly delayed compared to that. So I would say we are fairly close to the peak. And then as we conclude on the assets, then you'll see a gradual decline.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

I won't guarantee from next year, but we're getting close to it at least. And then for the maintenance level of CapEx, then at least what we've seen historically, then the maintenance level has been around 5% to sales CapEx to sales. And now we're in the low double digits. But of course, hopefully, CapEx will be higher in the case of growth outlook and pipeline coming to fruition. But I would say on our peptide fillfinish platform, with what we have going now, we will be able to cater to many millions of patients in the coming decades.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

So we have a solid installed footprint in place there.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thanks a lot, Carsten. That was question one on the CapEx part. And for the second question, oral VIGOBI in The U. S, let's turn that to you, Dave, please.

[David Moore, EVP - US Operations at Novo Nordisk]

Yes. Thank you for the question, Martin. We are, anticipating, the approval, as you mentioned, towards the 2025. We are excited about this potential approval and launch. And as you can imagine at this point, Martin, all of the typical launch readiness activities, are fully underway, and are building momentum.

[David Moore, EVP - US Operations at Novo Nordisk]

I won't comment on exact timing launch, but but certainly expect that we will launch the product as close to approval as possible, and having the organization ready to do that. No specific comments on pricing strategy. However, since you mentioned it, having a cash channel option, exists, and, and that's different, in the way that we thought about launching products, previously. Launching Noble Care Pharmacy is a very long term view from our perspective, and we think obesity products certainly lend themselves to the cash channel. So it's an option that we have, and we certainly, you know, look forward to making sure that we can meet patients, you know, wherever they are in terms of their access needs, whether that's through insurance or or or other forms that we can make available to them. Thank you.

[Martin Parkhøi, Head - Equity Research at SEB]

Thank you both.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you for that, Dave. You for that, Dave. And with that, we are approaching the turn of the hour. So we're ready for the last set of questions, please.

[Operator]

Thank you. Your final questions for today come from the line of Emmanuel Papadakis from Deutsche Bank. Please go ahead.

[Emmanuel Papadakis, MD & Pan-Euro Pharmaceuticals Equity Analyst at Deutsche Bank]

Thank you for taking the questions. Maybe I'll come back to guidance, if I may, for the second half of this year even, let alone next year. So now that we actually have the full set of Q2 results, perhaps you could just enlighten us on what set of assumptions would lead us to arrive at the bottom end of the range for this year in particular? What assumptions did you make around the outlook for Ozempic and Wegovy in H2 led you to believe we may have zero group revenue growth in H2 and a high single digit decline? And then maybe a question on R and D for Martin.

[Emmanuel Papadakis, MD & Pan-Euro Pharmaceuticals Equity Analyst at Deutsche Bank]

Thanks for the CAGRICEMMA single chamber update. You talked about further clinical development next year, it's unclear, would a simple bridging stress study be enough to then bring that to the market, or would you actually require a full phase three? And would successful development here enable you to make use of all your existing installed single chamber device manufacturing capacity for Ozempic and Wegovy? Would you actually require additional investments in new facilities for that device? Thank

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

you, Emmanuel, for those two questions. On the first one, on guidance, clearly go to you, Carsten.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

Yes. Thank you for that, Emmanuel. And let me be clear. So our guidance, we didn't build it for the low end. So clearly, we are closer to the center in terms of our base case, which is based on the trends we are seeing in terms of script numbers as well as the run rate in IO markets and launches there.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

And now you have the product and geography splits to beyond what you had last week. So that's our base case. And of course, everyone at Novo, we are pushing to deliver at least that and hopefully even more than that. And then the reason why we have the guidance range and the low range is basically to cater for unforeseen events beyond what the trends we're seeing right now. And these events could be, for instance, gross to net adjustments in The U.

[Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk]

S, given that we have a rebate provision of more than DKK 100,000,000,000, if you look in our reporting this quarter. So just the forecast uncertainty on that number, positive or negative, move the numbers up or down in the range. And then as we've seen, the obesity market is somewhat volatile. So we can have a scenario where trends are stronger and we can have a scenario where trends are softer. And that's basically what the way we constructed our guidance range.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Carsten, for answering on question one in terms of guidance. For the second one on cabozyma co formulation, that goes to you, Martin.

[Martin Lange, Executive VP - Development at Novo Nordisk]

Yes. Thank you very much for the question. So you're absolutely right. We have established pharmacology equivalence, which is obviously very gratifying. We do not expect to need to do a full Phase III program, but we do have to establish what we call clinical equivalent, showing a little bit of the same efficacy and safety potential as we see for the dual chamber device.

[Martin Lange, Executive VP - Development at Novo Nordisk]

So that is in progress. From a manufacturing perspective, I guess, could say this does not require new build to finish.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Thank you, Martin. Thank you, Karsten. And also, thank you to you, Emmanuel. And with that final question, that concludes our Q and A session. I would like to thank you for participating and urge you to contact Investor Relations in case of any follow-up questions.

[Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk]

Before formally closing the call, I would like to hand over to you Lars for your final remarks.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

Yes. Thank you, Jarek. Let me just reiterate that we don't take our guidance reduction light. We treat that with utmost seriousness. We have strong conviction in our ability to drive commercial execution and get to many more patients that are currently treated than what is treated with our products today.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

And but we also acknowledge that we need to show that in real heart data, and we look forward to doing that over the coming period of time. We're also excited about the pipeline readouts we have for the rest of the year and also looking into next year. And finally, I would like to again congratulate Mike with his appointment. I'm confident that with Mike and the team we have set, we have the execution power needed to deliver on our expectations. And final remark, thank you all in the investment community for the many interactions we've had over the years.

[Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk]

I have truly appreciated your challenging questions and support over the years, and I wish all the best of luck as I leave the company as of today. With that, we will close the call. And again, thank you all for your attention. Bye bye.

[Operator]

Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect.

Participants

Analysts

• Jacob Martin Wiborg Rode, Head - IR at Novo Nordisk
• Lars Fruergaard Jørgensen, President & CEO at Novo Nordisk
• Ludovic Helfgott, EVP - Product & Portfolio Strategy at Novo Nordisk
• David Moore, EVP - US Operations at Novo Nordisk
• Maziar Doustdar, Executive VP - International Operations at Novo Nordisk
• Martin Lange, Executive VP - Development at Novo Nordisk
• Karsten Knudsen, EVP, CFO & Member of the Management Board at Novo Nordisk
• Michael Nedelcovych, Director - Equity Research at TD Cowen
• Peter Verdult, MD - Pharmaceuticals Equity research at BNP Paribas
• Sachin Jain, Vice President at Bank of America
• Michael Novod, Managing Director at Nordea Markets
• Evan Seigerman, MD & Senior Research Analyst at BMO Capital Markets
• Richard Vosser, Managing Director at JP Morgan
• Martin Parkhøi, Head - Equity Research at SEB
• Emmanuel Papadakis, MD & Pan-Euro Pharmaceuticals Equity Analyst at Deutsche Bank