And then on pricing, if we do our value per script calculation, there was a huge jump from Q2 to Q3 and that you’ve called out gross to net adjustments, we know that commercial mix has improved, but just making sure, is this a sort of high watermark, a one-off in terms of value prescription, how should– in terms of base lining and thinking going forward, can we use the value per script in Q3 as a baseline or is it artificially high? Thank you.
Daniel Bohsen: Thanks Pete. Karsten, supply going into ’24 and the value per script.
Karsten Munk Knudsen: Yes. Pete. Thank you. Thank you for those — my favorite subjects. So I would say, first of all with the guidance for the full year, this year that has a midpoint of 35% sales growth at constant change rates, at least in the Novo setting it feels like we have released the handbrake and moving at very high pace in terms of growth rates, at least it’s the highest in the history of the company. But that said and extrapolations into ’24, I would say first of all, we clearly prudent growth strategy based on innovation, we have shown that we have the innovation platforms, especially in Ozempic and Wegovy, which would drive growth this year and clearly also next year. So — so not teaching you how to extrapolate.
But if you extrapolate our implied Q4 sales growth based on our guidance then you actually get to a sales growth number next year in the double-digits, which is actually not that far away from where consensus is currently. So I do believe that we’re scaling very fast. And then specifically on Wegovy and any handbreaks there, then what I would say as to 2024 is that in 2024 we will be delivering significant step up in volumes to the US market, compared to 2023, as we did from ’22 to ’23. And then to your pricing questions, as we’ve said on numerous occasions, the appropriate way of looking at net realized pricing in the US is to look at the year-to-date numbers. So most contracts are contracted on an annual basis and the tricky part is a lag effect between when a script is written and then we received the repay claims from the payers.
And there’s just a lag effect of several months and that’s why in reality Q3 is the first point, where we see how the channel payer tool is falling out for 2023. So I wouldn’t use Q3 in isolation for anything forecasting wise, I would recommend you to use year-to-date Q3 as a starting point. Thank you.
Peter Verdult: Very clear, thank you.
Daniel Bohsen: Thank you, Karsten. Thanks, Pete. We are ready for the next question.
Operator: Thank you. Your next question comes from the line of Mark Purcell from Morgan Stanley. Please go ahead.
Mark Purcell: Yes, thanks very much for taking my questions. The first one on GLP-1 and higher doses, clearly starting higher doses trials for semaglutide, you have 8 miligram and 16 milligrams coming through by the end of this year. Can you help me understand your expectations there and the importance of increasing your dose where the pivotal trial at 7.2 milligram will read out late next year? And then secondly in terms of the pen platform leverage, we estimate that about $100 million GLP-1 pen units going to be sold by Novo in 2023 for GLP-1 that is, the majority is the FlexTouch platform with a 3-ml platform, so will you use those two platforms to launch, Wegovy in US? And if not, why not.
Daniel Bohsen: Martin, the first question for you, GLP-1 higher-dose considerations.
Martin Holst Lange: Yeah, absolutely. Thank you for that question. So you’re absolutely right. We are investigating 8 milligram and 16 milligram in diabetes. But we’re also investigating 7.2 milligram in obesity. The purpose is obviously to assess whether we, we can achieve even higher efficacy without compromising on safety. Our model suggest, in particular in the obesity space that a higher dose could potentially be associated with an even greater weight loss without having to compromise on safety and being diligent we want to assess this.
Daniel Bohsen: Thank you, Martin. And if I understood your question correct, Mark, then the question was whether we will leverage our FlexTouch platform also to launch Wegovy in the US in the FlexTouch device, but last maybe to you any strategic considerations on our device platforms?
Lars Fruergaard Jorgensen: Yeah, Mark, thanks for the question. I just say that we have a situation today where we have a number of device platforms — the company won using outside vendor and technology. So that gives us flexibility and it’s actually part of fuelling the growth today that we can flex this. So I’ll not go into specifics speculation about what we use of device per market, but we see that it’s a strength that we can flex between different presentations and we see today that is really the figures of the molecule that drives that, so that gives quite some flexibility in how we go to market country by country and strategic flexibility on our side. Thank you.
Daniel Bohsen: Thank you, Lars. Next question please.
Operator: Thank you. Your next question comes from the line of Emily Field from Barclays. Please go ahead.
Emily Field: Hi. Thanks for taking my question. I’ll ask two. One just on the STEP 9 osteoarthritis study, I believe that this is not large enough to be added to the Wegovy label. So if this were to be a positive study, what would be your next steps plans? And then just on anti-obesity medications and muscle loss, we’ve seen competitors more explicitly make efforts in R&D for compounds that could preserves lean mass over fat mass and overall weight loss. I was wondering if you could just give an update on where you stand on that within your R&D portfolio? Thank you.
Daniel Bohsen: Thank you, Emily. Martin, two for you.
Martin Holst Lange: So specifically on the osteoarthritis trial, you are right, it’s not the biggest trial. I think it’s too early to speculate whether that will have an impact on the label. It’s very, very clear that for us it’s also guiding for future clinical activity and specifically maybe for Cagrisema Amycretin or our GLP-1/GIP combinations. So it has actually two potential both to serve for information specifically for Wegovy, but also to guide us for future activities.
Daniel Bohsen: And the second one, Martin, obesity and research and development focus on muscle loss.
Martin Holst Lange: Yeah. I think this is a relevant point. It’s also a focus of ours. With current treatments, specifically Wegovy and Saxenda we actually see a reasonable preservation of lean body mass given the broader weight loss. But it has to be a focus area, and you will probably see also in our pipeline. Without going into details maybe even quite to assets that could lead to a preservation of lean mass.
Daniel Bohsen: Thank you, Martin. Thank you, Emily. We are ready for the next question.
Operator: Thank you. Your next question comes from the line of Simon Baker from Redburn. Please go ahead.
