Trung Huynh : Morning, all. Thanks for squeezing me in. Just one on Mounjaro U.S. pricing. So by our calculations, we think that 3Q ’23 the net price is around 440 per TRX. For the rest of the year do you think that net price can continue to go up and above the saving card price of 450 [ph]. Although payers willing to pay for this, or is this broadly capped now until that saving card ends? And for next year, can you just give us your thoughts on if net price can meaningfully keep increasing? Thanks.
Joe Fletcher: Thanks, Trung. Mike, do you want to make any comments around Mounjaro pricing?
Michael Mason: Yeah, no, I’d be happy to do that. I think maybe at a macro level, I would say that our gross to net for Mounjaro in Q3, that kind of normalized. Before then we had a number of saving card changes that that, made our gross to net rate dynamic. Our last and copay card change occurred late in Q2, so at the end of June. And so Q3 was a kind of a pure quarter, where we didn’t have any other copay card changes. And I would say that our Mounjaro rate normalized at that point, you know, going forward, I think what you’ll see is what you see normally for a product at this point in the lifecycle that as we pursue gaining access, there’ll probably be some pricing pressure related to that. But we don’t have any other coping card changes planned in the near future.
Joe Fletcher: Thanks, Mike. Paul, next question.
Operator: The next question is coming from Robyn Karnauskas. From Truist Securities. Robyn, your line is live.
Unidentified Analyst: Good morning. Thanks for taking our question. This is Nicole [indiscernible] on for Robyn. Going back to obesity, how are you thinking through the impact on Mounjaro if Ira [ph] stays and Wegovy and Ozembic prices decline in the 2026-20 27 time frame?
Joe Fletcher: Thanks, Nicole for the question. I think it’s very — if I heard you right, you’re thinking about IRA impacts to maybe semaglutide and potential impacts to Mounjaro. Mike, do you want to comment on that briefly?
Michael Mason: Yeah, and I’ll happy to do that, Obviously, it’s too early to really impact how IRA will have an impact and the impact will have another product within the class. I think what you know, what’s important for tirzepatide is it is the first dual acting incretin. And we do think it has a unique profile. And in head to head results in type 2 diabetes, it did show superior, both I1C and weight to semaglutide. And so at the end of the day, I think the profile of the product will carry the day. And obviously more to come on the IRA. As the first products go through the negotiation, we see the impact, but we’re confident in the profile of tirzepatide.
Joe Fletcher: Thank you Mike. Paul, I think we have two calls left in the queue. Why don’t we go through those two quickly, and then we’ll wrap up?
Operator: Certainly. The first one is a follow up from Seamus Fernandez from Guggenheim. Seamus, your line is live.
Seamus Fernandez: Oh, great. Thanks for the follow up question. So just in terms of how you’re thinking about the introduction of oral treatments, and the importance of pushing for what would be hopefully a maintenance type regimen. Is Lily looking at oral therapies as more of a maintenance regimen opportunity, or do you see a broader opportunity here, perhaps bringing in other mechanisms that perhaps could aid in pursuing, I guess, the ever elusive metabolic set point? Thanks.
Joe Fletcher: Dan, do you want to comment on that?
Daniel Skovronsky: Yeah, thanks, Seamus. Maybe to paraphrase Dave’s previous answers, it’s sort of in all of the above here, I think there’s great opportunities on the oral as a standalone therapy for initiation of therapy. Also, yes, for maintenance therapy globally. And also, yes, for potential combinations. You know, I point out the obvious fact that this is a GLP. One monotherapy. So we benchmark it against the best injectable GLP1 monotherapy. But I don’t expect as an oral it will achieve the same levels of efficacy we can see with dual agonism like tirzepatide. So the future certainly will hold combinations like that. Thank you.
Joe Fletcher: And the last question, Paul from the queue.
Operator: Certainly. The last question will be a follow up from Tim Anderson from Wolfe Research. Tim, your line is live.
Timothy Anderson: Thank you. What’s the latest thinking on the topic of get agonism versus antagonism. Tirzepatide is the former Amgen drug is the latter. I’ve never seen two drugs in any category that have a similar clinical effect but opposing underlying activity the biologic target. Amgen says get antagonism is the way to go supported by their genetic analyses. What is Lily saying? Have you looked similarly at genetic analyses to inform your view?
Joe Fletcher: Thank you, Tim, for the last question, Dan.
Daniel Skovronsky: Yeah, I’ll take that. I, of course, say we have now I think more data on GLP agonism than anyone in the world and starting with tirzepatide, of course, which is a combo GLP1 GIP agonist and the head to head study against a pure GLP1 agonist and you can see some profoundly different effects here looking at, for example, efficacy relative to tolerability. It looks like the GIP is boosting efficacy while also reducing the side effects that limit tolerability. So that was our initial evidence in human trials that involved well now tens of thousands of patients have been on tirzepatide in trials. And then we went out to sort of prove this point by creating a pure GIP 1 agonist that just agonizes GIP to see what that could do alone.
And again we saw a very highly tolerated drug consistent with what we understand about the mechanism of GIP 1 that probably could suppress actually nausea, vomiting that lead to weight loss. So, I think human data trumps everything here, and we’ve got a ton of that. So we’re pretty excited about gap agonism. I can’t really say what will happen with antagonism, but like you said, it’s pretty unusual to have opposing mechanisms both work in similar ways.
Joe Fletcher: Thanks, Dan for the last one, Dave.
David Ricks: Okay, thanks, Joe. We appreciate everyone’s participation in today’s earnings call and of course your ongoing interest in Eli Lilly and Company. As I said, it’s been a very productive year for Lilly so far, and we look forward to continuing this momentum through a busy end of year in fourth quarter. So thanks for dialing in today. Please follow up with the IR team if you have questions we did not address on the call. And hope everyone has a great rest of the week and rest of the day today. Take care.
Operator: Thank you. And ladies and gentlemen, this does conclude our conference for today. This conference will be made available for replay beginning at 1 pm today running through December 7 at midnight. You may access the replay system at any time by dialing 800-332-6854, and entering the access code 544467. International dialers can call 973-528-0005. Again, those numbers are 800-332-6854 and 973-528-0005 with the access code 544467. Thank you for your participation. You may now disconnect your lines.
