Pfizer Q4 2023 Earnings Call Transcript

Quartr
Provided by Quartr
January 30, 2024

There are 24 speakers on the call.

Operator

Good day, everyone, and welcome to Pfizer's 4th Quarter 2023 Earnings Conference Call. Today's call is being recorded. At this time, I would like to turn the call over to Francesca DiMartino, Chief Investor Relations Officer and Senior Vice President. Please go ahead, ma'am.

Speaker 1

Good morning, and welcome to Pfizer's earnings call. I'm Francesca Di Martino, Chief Investor Relations Officer. On behalf of the Pfizer team, thank you for joining us. This call is being made available via audio webcast@visor.com. Earlier this morning, we released our results for the Q4 and full year 2023 via a press release that is available on our website atpfizer.com.

Speaker 1

I'm joined today by Doctor. Albert Bourla, Our Chairman and CEO and Dave Denton, our CFO. Albert and Dave have some prepared remarks, and we will then open the call for questions. Joining for the Q and A session, we also have Doctor. Chris Boshoff, EVP and Chief Oncology Officer Alexandre Germain, EVP and Chief International Commercial Officer Doctor.

Speaker 1

Michael Dolsten, Chief Scientific Officer and President of R and D Doug Linkler, EVP and General Counsel and Amir Malik, EVP and Chief U. S. Commercial Officer. Before we get started, I want to remind you that we will be making Forward looking statements and discussing certain non GAAP financial measures. I encourage you to read the disclaimers in our slide presentation, the press release we issued this morning and the disclosures in our SEC filings, which are all available on the IR website on pfizer.com.

Speaker 1

Forward looking statements on the With that, I will turn the call over to Albert.

Speaker 2

Thank you, Francesca. Good morning, everyone, and thank you for joining us. I'm pleased to discuss some of the highlights From the Q4 and full year 2023 and of course the compelling year we have ahead, I would like to begin with a few reflections On 2023. As you know, we missed our initial internal projections and Street expectations predominantly related to our COVID products, which affected Our stock price performance. Despite, however, this challenging year, there were a few great things that happened in 2023 that may have gotten lost amidst The missed expectations.

Speaker 2

1st, in 2023 Pfizer impacted the lives of more than 160,000,000 people approximately around the world. We believe there is no other company that can reach as many people as patients as Pfizer. If you multiply this with our brand equity and awareness, In terms of revenues from pharma only products, a marked improvement from our 4th position in 2019. Next, 2023 was a record year for FDA approvals with 9 new molecular entity approvals from Pfizer And many more approvals for new indications in already approved products, marking a very productive year of pipeline execution for Finally, we closed the season acquisition. In the current regulatory environment, being able Strategic efforts throughout 2023 created a strong foundation to support us.

Speaker 2

We are now focused From the advent of penicillin to the development of the COVID-nineteen vaccine, Pfizer has been at the forefront of medical and For the past 175 years, this year is our 175th anniversary That have not only changed patients' lives, but have changed history. Our strategy to continue to build on our proud history of innovation and commercial excellence is supported by the power and strength of our unmatched global scale and footprint Spanning commercial, financial, medical regulatory manufacturing and government relations. We have a clear view on how we will deliver operational, commercial and financial success across our business. Our confidence stems from the opportunity we have to bring additional focus to our business by executing 5 strategic priorities. We will get into each In more detail, but the 5 key priorities for Pfizer this year are: 1st of all, to achieve a world class oncology leadership To deliver the next wave of pipeline innovation, to maximize the performance of our new products, Expand margins by realigning our cost base, allocate capital to enhance shareholder value.

Speaker 2

I'm confident that Pfizer is well positioned to execute and that we can deliver meaningful value for our patients and our shareholders. Let's start with our first priority, which is to achieve a world class oncology leadership, which I believe we are in a strong position to do. As a reminder, 1 in 3 people will be diagnosed with cancer in their lifetime. Oncology represents one of the largest and fastest growing therapeutic areas. Completing the acquisition of Seadent doubled our oncology research and resources overnight and meaningfully expanded To immediately enhance Pfizer's top line growth and our combined portfolio provides the opportunity to lead janitorial cancers and be a leader in breast about our oncology platform at our Pfizer Oncology Innovation Day on February 29.

Speaker 2

As we build our leadership position, We have multiple potential key oncology catalysts in 2024, but we are acutely focused on. On the commercial side, the PADSEB launch in locally advanced metastatic bladder cancer in combination with pembroelizumab and the Xtandi launch in non metastatic castration sensitive prostate cancer. We are excited by the strength of our EV302 data and recent FDA approval as it represents an opportunity to broaden the reach of this potential practice changing platinum free regimen to even more patients in the frontline metastatic urothelial cancer setting. Essential, The recent approval doubles the addressable population, which had already doubled this path stream. We are also looking forward to Phase 3 data readouts from the test case graph in second line HR positive metastatic Breast cancer and BRAFTOVI in first line BRAFT colorectal cancer.

Speaker 2

We also plan to advance our late studies pipeline with Phase 3 starts of CDK4 in post CDK4six metastatic breast cancer and B6a In non small cell lung cancer, building on Pfizer's potential medicines, pipeline across breast cancer, genutrient cancer, hematology and CRC, our CDK4 inhibitor could be A compelling follow on to Ibrance. And finally, in the early stage pipeline, We look forward to initiating 1st in patient studies of 4 new ADC candidates this year, where we believe we have acquired The expertise to be a leader. Our second priority is to deliver the next wave of pipeline innovation with discovery and development across Our therapeutic areas outside of oncology, in vaccines, anti infectors, internal medicine, metabolic diseases and inflammation immunology. In 2024, we plan to continue to make meaningful investments in R and D. In FAST, Pfizer's R and D budget is one of the highest in the industry and supports our robust pipeline.

Speaker 2

We are pursuing cutting Ed science across modalities and platforms to deliver the next generation of potential breakthroughs. We are also leveraging AI and other digital across the value chain to increase speed and success rates. Starting first with our 4th generation PCV vaccine candidate, which recently entered the clinic and received FDA fast track designation. Building on our deep heritage with Prevra, we aim to solidify our leadership in the pneumococcal vaccine IPD and pneumococcal pneumonia in adults. Respiratory vaccine combinations are another area where we are poised Building upon our successful COVID vaccine, with the 1st generation standalone mRNA flu vaccine data demonstrated Relatively efficacy versus the recommended flu vaccine in 18 to 64 year olds, but did not meet success criteria for immunogenicity For the Bouygues strengths, our 2nd generation flu vaccine was tested in a Phase 2 COVID flu combination This new construct has now moved already into a Phase 3 COVID flu combination trial.

Speaker 2

Moving next to GBT-six zero one, our next generation and potentially best In class, HBS polymerization inhibitor represents a potential stepwise evolution over demonstrated multiple blood parameters approaching normal ranges with treatment suggesting GPT-six zero one may have the potential to deliver strong efficacy with the convenience of once We have consegravir, our GDF15 neutralizing antibody for cancer cachexia With Phase 2 data expected later this year, ponsecromab has the potential to be 1st in class And the 1st FDA approved treatment for cancer, KAKXIA, which accounts for 20%, 30% Of all cancer deaths, a significant statistic. Our 3rd priority It's of course to maximize the performance of our new products and core franchises through a relentless focus on execution to continue growing our top line. To do this, we are prioritizing and focusing while leveraging data to make changes quickly and Adapt. Our Pfizer U. S.

Speaker 2

Commercial and our Pfizer International commercial organizations And expand REITs to drive growth over the next several years. To discuss a few examples, we continue to be very enthusiastic About the potential of Nurtec to help the more than 1,000,000,000 people living with migraines As access and prescriptions in the U. S. And globally continue to increase, we will continue to focus on direct to consumer marketing and reducing barriers to access and affordability for healthcare practitioners and patients. With Oxbridge, We will continue to educate healthcare practitioners and patients on the importance of proactively treating the underlying cause of sickle cell disease by reframing treatment goals to chronic proactive treatment.

Speaker 2

With Abrasive, we are focused on increasing overall RSV market growth and market share by establishing RSV vaccination as a year on discussion and Expanding our retail contracting and offerings. With Alexviorn, we are focused on educating healthcare practitioners in both Academic institutions and in the community are one of these building a new patient trial. Coming off the initial launch of Valsipity, We are focused on helping ensure patient access to Valsipti as a first line advanced therapy oral ops. With LITFULO, we continue to accelerate the consideration of advanced systemic treatments for appropriate alopecia and key blockbuster including Prevnar, Winterkel and Elix, while exploring further opportunities to advance a number of innovative combination regimens. We believe we are well positioned to bring our global commercial manufacturing and supply capabilities to accelerate current and future marketed products.

Speaker 2

We believe all these components support our growth potential through 2024 and drive growth potential into 2025. We plan to provide updates throughout the year on how we are And with that, I will turn the call over to Dave, who will discuss our financial performance, our initiative to realign our cost base and our capital allocation strategy to enhance shareholder value. Dave?

Speaker 3

Thank you, Robert, and good morning, everyone. As we enter 2024, we are clearly focused on a small number of critical priorities. These priorities include building a world class Our full year and our 4th quarter results, then I'll touch upon our capital allocation priorities. I'll finish this morning with a few comments on our 2024 guidance and the near term expectations that set this year as a foundational year to drive our growth potential in the latter half of the decade. For the full year 2023, we recorded revenues of $58,500,000,000 Achieving 7% operational growth, solidly in line with our expectations when excluding contributions from both The significant sales decline in our COVID products, including the $3,500,000,000 revenue reversal for PAXLOVID We're the primary driver of an overall 41% operational decrease year over year.

Speaker 3

And with the expectation that Seagen will be Growth contributor in 2024 and beyond, our full year and 4th quarter results include approximately $120,000,000 Inseegen product revenue after the close of the acquisition on December 14th. On the bottom line, we reported full year 2023 diluted EPS of $0.37 a share, a 93% year over year an adjusted diluted earnings per share of $1.84 down 72% versus LY. This decline is primarily due to a significant decrease in sales for both Comirnaty and Paxlovid, the impact The $3,500,000,000 reversal for PAXLOVID revenues in the 4th quarter related to an expected return of an estimated 6,500,000 unused EUA label treatment courses from the U. S. Government and finally, a non cash inventory write off and other charges of $5,600,000,000 recorded in the Q3 for PAXLOVID and to a lesser extent, commodity.

Speaker 3

Now turning to the quarter, I'd like to highlight that we delivered a solid 8% year over year operational revenue growth, Again, excluding commodity impacts, LOVID. Contributing to the strong performance were our newly approved RSV vaccine As well as Vindikale and Eliquis, partly offset by lower revenues from Ibrance and the Prevenar family. However, our Q4 results, both top and bottom line, continued to be significantly and negatively impacted by our COVID products on a year on year basis. Revenues declined 42% operationally, the results of a significant decrease in both Temuriti and Paxlovid sales. Adjusted cost of sales as a percentage of revenues increased by 12 percentage points, driven primarily by the $3,500,000,000 non cash PAXLOVID revenue reversal and to a much lesser extent unfavorable changes in sales mix.

Speaker 3

Overall, our adjusted operating expenses declined 10% compared to Q4 of last year. Adjusted SI and A expenses Increased 1% operationally in the quarter, primarily driven by the timing of marketing and promotional activities, including those related to recently launched and acquired products. And consistent with our strategy, we have been focused on reprioritizing our R and D Spending to enhance overall returns. Adjusted R and D expenses decreased 24% operationally, driven primarily by lower spending across both vaccine programs and certain acquired assets as well as lower compensation related expenses. Both our reported diluted loss per share of $0.60 and our adjusted diluted earnings per share of $0.10 for the quarter We're negatively impacted by the $3,500,000,000 Paxlovid revenue reversal, which dampened EPS by approximately $0.54 Continued declines in both commodity and Paxlovid sales also negatively affected our performance in the quarter.

Speaker 3

Foreign exchange movements had an immaterial impact compared to last year's Q4. As we are increasingly focused on prioritizing our investments To drive forward looking growth, our GAAP results include a $1,400,000,000 intangible asset impairment charge associated with etrasimod based on changes in development plans for additional indications and overall revenue expectations. But I will point out that this product is Still projected to contribute over $1,000,000,000 in peak annual sales. Additionally, we recorded a nearly $1,000,000,000 intangible asset 1st is growing our dividend, 2nd is reinvesting in the business, and finally is making share repurchases after delivering our balance sheet. For 2023, we returned $9,200,000,000 to shareholders via our quarterly dividend.

Speaker 3

We've invested $10,700,000,000 And finally, we've invested approximately $44,000,000,000 in completed business development transactions, Net of acquired cash, essentially for the acquisition of Seagen, our expectation is to maintain and grow our dividend, while delevering our capital structure With a gross leverage target of 3.25's time and a goal of to preserve our credit rating and access to Tier 1 commercial Upon achieving our delevering goals, we anticipate returning to a more balanced capital allocation strategy, inclusive of share repurchases. Now given that we issued our full year 2024 revenue and adjusted diluted earnings per share guidance on December 13, let me just hit a few of the highlights. We expect total company full year 'twenty four revenues to be in the range of $58,500,000,000 to $61,500,000,000 which reflects our expectation of strong contributions across our product portfolio. Importantly, excluding Primarity and PAXLOVID, We anticipate operational revenue growth of 8% to 10%. We remain confident on delivering at least $4,000,000,000 of net savings from our cost realignment program by the end of this year.

Speaker 3

We believe rightsizing the cost We expect adjusted diluted earnings per share to be in the range of $2.05 to $2.25 The CGen acquisition and again with the vast majority of this dilution resulting from the financing costs associated with the deal. Cycling into 2024, we have significantly invested in our business to fuel our long term growth And the foundation is set to deliver on our commitments to enhance long term shareholder value. We are acutely focused on driving near term

Speaker 2

Thank you. With that, let's start the Q and A session. Operator, please assemble the queue.

Operator

And our first question comes from Robin Karnauskas with Truist Securities.

Speaker 4

Thank you guys for taking my question. So maybe I'm stupid on this question, but if I'm doing your math for your guidance of margins in low 70s for Fiscal year 'twenty four, by my math, the margins for other biopharma would have to drop about 60 to about 60% in order to balance out the other margins. Just help me understand your guidance and triangulate that with your top line and bottom line guidance and Triangulating that with your margin guidance. Thank you.

Speaker 3

Yes. So maybe this is Dave. Correct, our guidance for gross margin, although we don't provide it Specifically, we've given some color around the fact that it's approximately 70%. Obviously, our focus going forward is To improve our margin rate and more importantly improve our operating margin rate to the bottom line, I was as we look here at 2024, there's a few things that have compressed our margin rate. First is, as COVID Has declined year over year.

Speaker 3

That has served to, I'll say, delever, if you will, the P and L as COVID takes up And cover some fixed overhead, but importantly what's happening is we are in sourcing products that we've recently acquired. Those that in sourcing requires time before we get up to peak yield and performance, so that in the short term, Dampens gross margin rate, but has a trajectory to improve gross margin rate over time. And then secondly, we have new launches that are coming online Late in Q3 or late in the second half of twenty twenty three and moving into 'twenty four, again, those are not at performance yet that will ultimately improve gross margin rate as we cycle into later years. And then finally, I will say that over the last Several years, we have absorbed some amount of inflation within our cost of goods sold. That is an area of opportunity for us as we think about

Operator

Next, we have

Speaker 5

Maybe another kind of finance question here. Certainly R and D in 4Q was meaningfully below kind of where you guys set the guide there. How should we think about that? Does it just reflect sort of Cost cutting, was it just more of an artifact of the later integration of SGen? And clearly, you were reaffirming your guide, but Just maybe if you just sort of check that box for us that would be helpful.

Speaker 5

Thank you.

Speaker 3

Sure. Probably not much to read into that. Obviously R and D came in a little favorable than our previously, a part of this is the fact that we are very focused on our realigning our cost base, so consistent with the program. And then secondly, there probably is some timing that's dampening R and D in the Q4 that will slide into 2024 and into 2020 So there is some timing implications to that performance level. But I think importantly, back to my prepared remarks, Our focus is on delivering net savings of $4,000,000,000 and if you look through the end of 2023, about half of that we've achieved already.

Speaker 3

We're now focused on achieving the additional $2,000,000,000 or so as we cycle into 2024 and all eyes are on that Objective.

Speaker 2

Thank you, Dave. We have high confidence on the number that we gave. Let's move to the next question please.

Operator

Our next question will come from Louise Chen with Cantor. Louise, please make sure that you're unmuted.

Speaker 6

Hi, sorry, I was muted. So thanks for taking my question here. Wanted to ask you on your Prevnar franchise. First of all, for the 4th generation PCV, could you give more color on how it compares in And then just on the Prevnar order timing issue, was that U. S.

Speaker 6

Or ex U. S? Thank you.

Speaker 2

Thank you. Amir, why don't you take the Prevnar question and then maybe, Alexander, you can add a little bit color on The situation in the U. S. So what is the situation in Prevnar with the orders?

Speaker 7

Yes. So Luis, with regards to Prevnar, With the pediatric business, we often see some lumpiness in quarterly revenues given the timing and impact of CDC Order, so it's difficult to kind of map that all out quarter by quarter. So you should expect that on the pediatric business, but the pediatric business otherwise we're very happy With how our launch is progressing and the growth momentum that we see there. On the adult business, I think it's different in the sense that we We have a 96% market share that we closed the adult business with at the end of the year, but it's really important to keep in mind that versus the prior recommendation and we've worked through that catch up opportunity already. So the remaining patients are generally those that are aging into the 65 plus population as well as those with underlying medical conditions and those are harder to activate patients.

Speaker 7

So we expect that business to continue to face that smaller patient Population going forward and we also expect competition with B-one hundred and sixteen emerging that will make the adult market more competitive, but we see a lot of growth potential in the Alexander,

Speaker 2

how was the prevalent situation in the last quarter or in the year in international markets?

Speaker 8

Yes, Louise, good question. As you know, the majority of our ex U. S. Business is driven by tender. And of course, we booked the sales when we ship the product, which doesn't reflect utilization.

Speaker 8

And then

Speaker 2

the government schedule their campaign

Speaker 8

in their respective markets. And then the government scheduled their campaign in their respective markets. The reality is that we continue to have an IP exclusivity in 130 markets around the world. And at the same time, as we continue to progress both on the pediatric, as you saw last week, the CHMP positive opinion and now we're going to go into the final approval and then vaccine technical committees and pricing in all those markets, so that will take a bit of time. But at the same time, we see some Positive traction on the Allergan's franchise where we have launched in over 30 markets and we see some very good development With the recommendation of the Vaccine Technical Committee, to give you an example, we used to have very limited access on our PREML13 in countries like Germany France and UK and we just received the recommendation from the VTC in Germany that actually recommended usage Of PREV DAT20 in all adults over 60 as well as at risk population from 18 to 59, which we believe we have a significant growth opportunity Increasing vaccination in the adult population ex U.

Speaker 8

S.

Speaker 2

And Michael to conclude, what about the 4th generation, Prevnar?

Speaker 9

Yes. I'm very pleased that the 4th generation has entered clinical studies. It has from U. S. FDA indicating a unique product offering.

Speaker 9

And It includes some of the new technology we have developed that gives us really cutting edge toolbox, whether it's Chemistry carriers or reformulations. And of course, it relies on the unique Pfizer platform to have Potential prevention of both invasive disease, which is the smaller disease burden And pneumococcal disease, which causes more than 150,000 hospitalizations. And to the best of My knowledge, we are the only one that can address both of them. So we feel very good about that entry.

Speaker 2

Thank you, Michael. So summarize the Prevnar, which I know it is in the minds of all, let's start with the commercial front. In the U. S, Clearly, the adult opportunity, we have taken the cream basically of the catch up opportunity. This is happening once You are getting a recommendation from CDC for a catch up.

Speaker 2

This market, the pool of patients has been largely exhausted. We have already 96% markets out of that. So This is not the market, the adult Primarra to expect that will continue to see growth in the U. S. With the other very different story because our market share is now growing and we have Indications that will continue growing very strongly.

Speaker 2

So we expect in the U. S, the Prevnar situation to be a strong growth International, both we expect to see growth because the products have just been launched and then recommendations So there is a delay in international higher than usually there is in the U. S. So we expect to see growth in adult and in the pediatric. You want to reemphasize that we have basically exclusivity of Prevnar 13 in more than 100 countries, 100 and 13 countries in NII of tenders and we plan to convert that now to 2020.

Speaker 2

And then on the 4th generation, We are moving full speed. We think that our expertise will allow us to build a polyvalent vaccine that will really compete very, very Nice. Yes, for generation, and we'll do that successfully and fast. So that's the story. And let's move to the next question, please.

Operator

We have a question from Trung Nguyen with UBS.

Speaker 10

Hi, guys. Thanks for taking my question. Trung from UBS. 2, please. So in your prepared remarks, you noted you took a $1,400,000,000 impairment charge associated with etresimod.

Speaker 10

Can you add more color here what prompted that reevaluation? And any feedback of how that launch has gone? Secondly, on Abhryso, so Can you give us some color on how your contracting has evolved in 2024 versus 2023? And based on that, what's your market share do you think you can capture this year versus The 35% last year. Thank you.

Speaker 2

Thank you very much. Why don't we take Dave the impairment question and then I will move to

Speaker 3

Yes. So on etrasimod, keep in mind that this product we still anticipate to be over $1,000,000,000 in peak sales. As you know, there are multiple indications attributed to this medicine. And financially, As you look at that medication, there were additional indications that met the financial criteria for an So with that.

Speaker 2

Thank you very much. So, Amir, maybe about etrasimod commercially, how the launch is doing in the appraisal of Prisma?

Speaker 8

Sure.

Speaker 7

So I'll start with etrasimod So just in terms of the product's value proposition, we think this is a very promising oral option For moderate to severe UC patients, it's got strong efficacy that patients and physicians that we've exposed this to. They want to start Transitioning from conventional therapy to advanced therapy and it gives them an option also to maintain once a day oral routine, which many Already on instead of beginning with an injection or infusion. So about 80% of those patients that haven't progressed to an advanced therapy prefer an oral option, but only about 10% of those patients actually get one. So there's a very clear need here that valsivity can help us fit And the benefit risk profile for Valsivity is also very, very strong. So we approved we received approval At the end of last year, and so we invested efforts in building HCP and patient awareness on the label and on the value proposition.

Speaker 7

But I just want to remind you that with any immuno inflammatory product, it takes time to get broad national access And that is where our focus is right now is ensuring that we secure valsifiti access as a first line advanced therapy oral option and that's going to take some Time to put in place. And when we have that in place, we see upside momentum from the launch.

Speaker 2

What about the Brismo?

Speaker 7

On a BRISBO, I'll comment briefly on the adult and then on the maternal. On the adult vaccine, I think the market was clearly ahead of everyone's expectations and not limited by shared decision making versus a routine recommendation. We would like to do better than the 30 some percent share that you referred to as well. So we're very focused going forward on retail contracting for the 'twenty four, 'twenty five season. But I will also mention that we are doing that with real thoughtfulness on ensuring that we secure profitable share in those contracts And also differentiating using our maternal indication.

Speaker 7

We also see opportunities in the non retail setting where for example And we're going to also focus on new opportunities that we're currently studying with the Frisbo, Adults age 18 and older with underlying medical conditions as well as a new packing presentation to better fit our customer needs. So We see momentum there. And on the maternal side, we're only a few months in, but we're encouraged by what we're seeing as the first Vaccine to prevent infants from birth to 6 months when they are the most vulnerable. More than 65% of women prefer to get The maternal vaccine versus having their infant immunized with a monoclonal antibody. And we think that the label provides us opportunity grow that segment as well.

Speaker 2

Thank you, Amir. Next question please.

Operator

Our next question comes from Terence Flynn with Morgan Stanley.

Speaker 11

Great. Thanks for taking the questions. 2 for me. I guess the first one is just Commernati Rest of World was ahead of consensus expectations this quarter. Just wondering if there are any one time benefits in that number, if that's a fair go forward sales level to think about Through 2026 given the existing EU contract?

Speaker 11

And then the second was, I noticed that Danigliperon wasn't mentioned in The PR or the prepared remarks, just wondering if that once daily PK trial completed yet and what the next steps are there? Thank you.

Speaker 2

Thank you very much. Maybe very quickly on the time, we didn't mention because we don't have anything to say more. So that's the only thing. There is a program, which is composed with a lot of experiments that we're doing now In terms of moving it to once daily and we will speak only when we have data. We don't want to become now the focus again of another Earnings call.

Speaker 2

That being said, I'm moving it to Alexander to discuss about Comirnaty in the rest of the world outside the U. S. What are the dynamics over that?

Speaker 8

That's right. There are several elements playing out on the Comminati franchise. First, what we see is restriction on vaccination guidelines, So versus the previous years, we see that the guidelines are really focusing on the older population as well as the at risk population. But we have, as you know, already signed several contracts with the European Commission, Canada, UK and Australia. And following the approval in August last We started to execute on a contract with the European countries.

Speaker 8

As a matter of fact, some countries have decided to Advance some of their order in 2024 into 2023 so that they can execute their vaccination campaign properly. The other trend that we see is that actually we don't see major vaccination upticks in the future year. We that's what we have seen in 2023, 2024 campaign is really the type of vaccination we will see And that will be carry on the next few years. The only area where there is a potential Future growth in terms of vaccination uptake is if we can increase our co administration with the flu vaccines where in All our key markets, the rate of vaccination in flu is actually higher than it is for community. So we believe that there is potentially The last point that I want to say is, as you see that the community sales pattern is evolving towards a seasonal pattern.

Speaker 8

So you saw you have a very strong Q4 like you expect in flu vaccination type of markets. And that's what we see also to be expected in 2024. And actually, as I was reading some of your models in the financial community, I think there is some confusion that we will have a higher Q1, Q2, which I believe will be more towards the 2nd part of the year, but of course in line with the guidance.

Speaker 2

Thank you very much, Alexander. Next question please.

Operator

Our next question will come from Umer Raffat with Evercore ISI.

Speaker 12

Thanks for taking my question. Albert, so I was looking at SEC filings from Cervel and they disclosed that Pfizer was open putting out a bid on Cerevel after Phase 3 data, which would have been in 2024. Meaning, I also noticed that you were saying you're not open to a back in 2024 and deleveraging remains a top priority. So I just want to balance those 2, especially also in the context of where the stock stands.

Speaker 2

Look, I will ask Dave to speak about it. But the fact that we are looking everything And we are engaging in everything, doesn't mean that that's our obligation. We are doing all the work. It doesn't mean that our This will deviate of the capital allocation strategy, but we have just articulated and that is number one priority is our dividend and the ground dividend. Then it's a year of execution.

Speaker 2

We try to deleverage, as David said. And then once we bring our deleverage to the levels that we are aspiring, We will start also moving into serve by box and of course M and A, Which means that for 'twenty four, we will see everything in existence because we never say never The business development opportunities could come. But our strategy, it is that you will not see anything major in business development In terms of dollars. David, did I say it well? I said it well.

Speaker 2

I said it well. Correct. Thank you very much. You are a good teacher. Thank you.

Speaker 2

And the other question from there, I think that was it, right? Yes. Thank you, Omar. Thank you very much. Let's go to the next question please.

Operator

Next, we have Tim Anderson with Wolfe Research.

Speaker 13

Thank you. Maybe for Amir. So Eliquis is the biggest drug on the initial list of 10 drugs for IRA. CMS has until February 1st To provide you the initial proposed negotiated price, so that's 2 days away. So two questions here.

Speaker 13

Can you confirm you haven't already received that initial proposal yet? And second question, can we expect that at some point between now and September 1, Which is the deadline that they have to make the final price public that you'll give some investors some sort of directional information on how Those discussions are going or we're going to be kind of in the dark until September 1?

Speaker 2

So Amit, are you planning to give light to Timur? Yes.

Speaker 7

So Tim, as you can appreciate, this whole price setting authority in Medicare, this is new and pharma companies obviously In Part D, that will begin in January 1, 2026. And also as I'm sure you can appreciate, we're not going to comment on an ongoing price process and negotiation.

Speaker 2

Yes. It's very difficult, Tim, to comment on these things because they are ongoing. So it's very inappropriate and absolutely could complicate things. I understand, There is a need for people to understand because that's an important product and we will try as soon as possible and practical Be able to provide the level of details that we are looking at everybody's looking so that they can model it properly. Thank you very much.

Speaker 2

Let's move to the next question please.

Operator

Our next question will come from Andrew Baum with Citi.

Speaker 14

Many thanks. A couple of First to Amir, under your new leadership and commercial focus, What key products would you guide us to of recent launches that we should look for in terms of acceleration of rollout Trajectory and it doesn't have to be recently launched established ones as well. And then second to Michael, you just share a little bit more information about your next generation PCV vaccine, specifically how many serotypes? And I'm assuming that given it's a new technology, you will lose the ability to grandfather the Pneumonia claim from the CAPRETA trial into the profile, is it matures? If you could confirm, that would be great.

Speaker 2

Thank you very much, Andrew. Your assumption, I don't think it is correct, but Michael will answer to that. But let's first go to Amir To basically give us a view how you see in 2024 the priorities of the commercial execution in the U. S?

Speaker 7

Yes. So Andrew, I'll take a step back and let me start by saying I've been very excited by this role and this And also to do it with the team that we've built, which is a mix of both seasoned Pfizer leaders As well as experienced leaders from outside of Pfizer. I mean, my focus and we can talk about specific products, we've touched on many of them already. My focus overall is on execution excellence. So in our primary care and specialty care portfolio, we have a lot of great brands.

Speaker 7

We have Some really enduring franchises, Glinda, Eliquis, Prevnar, I spent quite a bit of time talking about that. Our Focus there is to defend and grow where we can and we do see some opportunities. And we also have to acknowledge that we have some brands that have great So in a situation like that, my focus is principally, let's really prioritize the actions that can grow each of the brands and talk about the individual launches. There's a lot of operational focus on blocking and tackling, including contracting. And then when we look at our main resources, we have our field force, our advertising and promotion dollars and our medical capabilities, just prioritizing exactly where we That is what I'm focused on with me and my management team.

Speaker 7

And as I mentioned, we see opportunities in some of the franchises and defending and growing our share, but then also in a number of our launches. And Albert mentioned in his opening remarks what we hope and expect to do with Abrasco, with Nurtec, with Ludulo, Sabineco. Those are all brands that we're going to continue to focus on, including some of our recent acquisitions like OXBRIDA as well.

Speaker 2

Thank you, Amit. Andrew, let me take the liberty to also the other commercial leaders to comment a little bit on their priorities because that will give you better sense of the whole picture. Alexandre, in international, as You're taking over. What are your key priorities?

Speaker 8

Thanks for the question, Albert, and the opportunity to share my priorities. My main focus is really to focus on the area where we can generate material growth with improved return on investment. This is My mantra, how we're going to do that? My top four market in the order, China, Japan, Germany and France represent 40% of our international division. So it's quite concentrated.

Speaker 8

Those Those four markets will report directly to me so that we can have the resources and support the country to execute on their plan at best and to generate the most growth. Our top 15 countries represent 70% of our total international. So it's again quite concentrated. What I'm actually doing currently In each of those markets, we are selecting drivers of growth. What are the key in line and the key new products where we can have material impact With improved investment.

Speaker 8

So I'll give you an example. Of course, it's going to be different from one country to the other because the archetype and the dynamic of this market are different. So last week I was in Japan and so for instance Vindiquel, JAK DUSY's rate is half the JAK DUSY's rate that we have in the U. And in France, so we reviewed last week the plan to go and catch those increased on the execution. In Germany, Eliquis has a very strong Eliquis franchise.

Speaker 8

We believe we have growth to untapped And I'm next week in Germany to actually review the plan on the Ediquis precisely. And we'll do the same thing on the new product. And it's going to be for instance, LOBRENNA in China. As you know, lung cancer in China is unfortunately affecting a large proportion of the population. And as a matter Fact, the proportion of the lung cancer that can benefit from LOBRENNA in the worldwide communities were 1.7%.

Speaker 8

In China, it's actually 7%. So we believe we have a huge opportunity. What we're doing is actually developing a plan last week when I was visiting China To quickly get LOBRENNA to those patients that could benefit from the clinical outcome. So this is really what I'm doing in each of our No, 15 countries. Then frankly, the rest of the year will be simply tracking our execution, tracking all the metrics Both from activities, medical activities and KPIs for each of our key products.

Speaker 2

Thank you. And then maybe Chris also on the commercial front, How do you think of the oncology in the U. S. Of all?

Speaker 15

Thank you, Andrew, Albert. Our biggest priority right now is obviously continuity of the business. We've done a lot of work during the last 9 months during integration planning, and we don't want to miss a beat and is now moving towards flawless With immediate priorities, obviously, the path set launch for advanced metastatic bladder cancer from the EB-three zero two study, The launch of Xtandi in non metastatic castration sensitive prostate cancer from the IMbark trial, the early launch, and also focus On access and awareness during 2024 for ALRxVIO in late line multiple myeloma and for Talzena, Up to 25% of patients with metastatic aspiration resistant prostate cancer would be eligible in the U. S. From the TALIPR2 indication.

Speaker 2

Thank you, Chris. And then let's go to Michael Dostin. If you can make some comments on the next generation as much as you can share about sales. Yes. I think we have

Speaker 9

a very strong position with good momentum in the PCB conjugate. And I think, Alexander, you mentioned just the Positive recommendation we got for PCBs 20 in Europe. Now we're building on that unique platform. And as And to the best of our knowledge, the Pfizer platform with a new 4th generation As was with the 3rd generation, we'll be the only one that can carry that claim based on, as you said, the original Now the new generation will contain more serotypes, has applicability for adult and Possibly pediatric as we have done with all of ours. And it also will include improvement on existing serotypes to altogether Get a very good increased coverage versus the PCV20.

Speaker 9

And I do think we are the one that really can continue this Expansion of more serotypes by unique communication, chemistry, carriers and recombinations. And I am cautious To abandon enoceritide, whether you work on infant and adults, as the characterization what caused disease, For example, pneumonia is not very well described. So maintaining the coverage as we have uniquely And it's not really happening with other product. It's a unique differentiation. So I feel very good about the 4th

Speaker 2

Thank you, Michael. Let's go to the next question please.

Operator

Our next question will come from Geoff Meacham with Bank of America.

Speaker 7

Good morning, everyone. Thanks so much for the question. Albert, the oncology franchise following CGM, I We'll probably be one of your bigger growth drivers for Pfizer going forward. The question is, is there an intermediate or long term target as Revenue that you're looking to achieve for this segment? And then are there technologies beyond ADCs that you think could be additive to the pipeline?

Speaker 7

Thank you.

Speaker 2

Yes. In a very general and then I will ask Chris to comment a little bit on the technologies that we are having here. I can't say how much Oncology will contribute, but clearly, we have given expectations about Cision and we say that we expect it to be a $10,000,000,000 by year 2,030 from 3.1% what we gave guidance in the 2024. Actually we feel very good about the EUR10 billion, the more data coming. When we gave the EUR10 billion, we weren't aware of some of the readouts that follow That projection.

Speaker 2

So we feel very, very good about that. Now I have to say that the Pfizer pipeline In oncology, I think was also among the strongest in our entire therapeutic area. So I think the combination in general It's giving us, let's say, a lot of strength. But Chris, why don't you comment a little bit about how you see the R and D evolution of oncology, the platforms we So we are going to base your strategies.

Speaker 15

Thank you. So with the modalities we want to focus on for now are those We see we have significant strength and capabilities, including with medicinal chemistry, our protein engineering, as well as our strength in cancer biology. We therefore want to focus on small molecules, especially from our La Jolla site, bispecifics, both La Jolla and the new Seattle site and ADCs in Seattle, so Small Molecules Biologics. As you know, we do have an interest also in allogeneic CAR T cells With the formation of Allogene, the company we still follow and have a significant interest in, but for now focusing on those three modalities where we see significant opportunities Combinations, for example, doing small molecules, ADCs, but also potentially in the future between ADCs and bispecific.

Speaker 2

Thank you. Thank you, Chris. Next question please.

Operator

Our next question comes from Mohit Bansal with Wells Fargo?

Speaker 16

Great. Thank you very much for taking my question. Maybe a question on Nurtec, The trends in market share as well as pricing, just wanted to make sure that is there a significant price delta between MerTech price versus Says the competitor price, I mean, the discounts that they are offering given that your competitor has multiple offerings in the headache market. And if there is a delta, do you expect this to grow or decline over 2024 on pricing? Thank you.

Speaker 2

Thank you, Mohit, very much. Amir, about Nurtec and In general, the migraine front size?

Speaker 7

Yes. So Mohit, thanks for the question. So we were encouraged by Q4 for Nurtec and I'll also include some comments on ZAP spread as part of my response. We were up more than 30% versus the prior year and over 20% versus the prior quarter. And there's a few things that are encouraging.

Speaker 7

Nurtec continues to be the number one prescribed CGRP. So we have leading TRx volume and share. Interestingly, more than 90% of new prescribers in the category, many of whom were primary care physicians, are prescribing Nurtec. And our PILs for Rx has also over the last several quarters been steadily riding. So we continue to see Opportunity and there's a few things to keep in mind.

Speaker 7

One is that there's still a lot of unmet need. Albert referred to it in Written remarks, but there's a lot of patients undiagnosed, very few get an Rx therapy. Oral CGRPs are still only less than 20% of the Rx market. But as you point out, this is also a very competitive category with Helixa and Uroldi. And I won't comment Specifically on their pricing strategies versus ours and GTN's play a role in all of it.

Speaker 7

But our focus for Neurotech, 1, I think we want to be sharper and more competitive in our patient engagement and activation. 2, we have an opportunity with our field To focus on both the most relevant CGRP writers and as I said PCPs. PCPs write 2 thirds Of triptans, but only about a little over a third of CGRP. So there's an opportunity there. And then patient And experience, there's an opportunity to really reduce the friction there.

Speaker 7

And I will also mention ZAS spread because with an intranasal, we think we Can have a very nice complement to an oral for either rapid pain relief and there's also unmet need for patients that have nausea and vomiting from the use of an oral. So We want to continue to invest and grow in our Neurotech and Zasberg franchise.

Speaker 2

Thank you, Amir. Next question please.

Operator

Our next Question comes from Steve Scala with TD Cowen.

Speaker 17

Thank you. Two questions. First on Danubeletron, I know Pfizer Doesn't want to provide an update, but clearly the company has greater insight than we do into how the once daily version is performing in the Phase 1 PK Trial. So I'd like to ask how would you characterize that performance so far? In the absence of any visibility, it's kind of hard for us To be confident in the outlook for this program.

Speaker 17

2nd question is a new weight loss agent was added to Phase 1 designated 6,016. Can you tell us what the mechanism is, please? Thank you very much.

Speaker 2

Yes. Steve, I'm going to disappoint you because you are asking things that we have said. We are not willing to disclose at this stage for multiple reasons. Clearly, on Danube, we have more information than The answer is very normal with everything that we are doing because we're having a very complicated, as I said, multiple experiments planned right now. Because we don't have new data, we're not going to comment on that.

Speaker 2

And on the new weight loss molecule also, we said that Unfortunately, we are not disclosed the mechanism of action. The reason is because, first of all, it's too early and we don't want to take competition. There's nothing So I'm sorry to disappoint you, but there is not much to offer at this stage. Hopefully, as we said, midyear is where we expect More information on that. Let's go to the next question please.

Operator

Next, we have David Risinger with Leerink Partners.

Speaker 18

Thanks very much and thanks for all the updates. So I have two questions, please. First is for Dave. Could you please discuss the 2024 gross margin prospects in some detail? I think on the last call, you had discussed Potentially a low 70% gross margin, but if you can comment on that in more detail that would be helpful.

Speaker 18

And the second question is for Michael. If daniaglutron once daily does have a profile that you're looking 4, would the company then conduct the Phase 2a dose ranging study to assess the efficacy and tolerability In order to decide on a dose to advance Phase 2b or Phase 3? Thank you.

Speaker 2

Thanks, Dave. Very quickly, Michael, resolve Daniel, and then we'll go through the day.

Speaker 9

Yes. You heard Albert say that we are Running a number of clinical experiments to gather insight in that molecule and we have a second Pfizer have always been open to consider different types of clinical study design. And in general, we tend to move into directly whenever data is supportive, if there is a large safety database Into Phase 3 with a leading phase, but we have to look at each program by program. So when we have all the data, We will be able to share with you.

Speaker 2

Yes. Let's go to the gross margin where we can share a little bit more information.

Speaker 3

So David, this is Dave Denton. I'll be very Brief here. Obviously, as you indicated, our 2024 gross margin expectations are in the low 70s As we discussed previously, as you know, as we cycle into 'twenty four, there's a few things that are happening as I indicated earlier. One is, As COVID comes down, we're kind of deleveraging as COVID had absorbed a lot of fixed overhead. So that's compressing gross margins.

Speaker 3

Secondly, we're in the process of in sourcing many of the acquired products over the last couple of years. And as we in source, the short term effect of that It's dampening on gross margin because there's an opportunity to improve gross margins as yields improve over time. And then finally, or 2 things Finally here is new launches have that same characteristic as we launch a new product, yields and performance are not at Peak performance, that will be an opportunity for us going forward. And then finally, we have absorbed some inflation over time that it's an opportunity for us to take out over the next several periods. So again, an opportunity for us to enhance performance over time, but again, we're in this roughly low 70s for 2024 is our expectation.

Speaker 2

And David, let me add a little bit more color here. But the Commernati and Xplovitz are big products, but they are manufactured in the same facilities, but They are separate facilities, so they are not affecting the margins of the other products. So the margins were really absorbing in those facilities when you had such a huge Volume production and value production, of course, the margins were seriously Those products were seriously taking a lot of the overhead. Now as we are reducing our expectations for COVID into very realistic, we think, targets. This doesn't mean that we have eliminated our capacity to produce more if The demand is there because that would be not responsible, first of all, from public health perspective, But also from our investors' money perspective.

Speaker 2

So that's why so far we maintain all this capacity, although the revenues are down. So there is a significant The second thing that David said, keep in mind, all basically our new acquisitions that brought so many new products, they were from More relevant to the conference, they didn't really have their own manufacturing. So these were all outsourced. And outsourced, of course, is way more expensive than when You are able to bring it. There are plans for everything in shops, but in manufacturing that takes 3 years, right, to be able to And then last but not least, we have this proportional amount of new launches and those new launches Are coming with a very big cost when you build infrastructure or something new to be developed.

Speaker 2

But of course, You build it for your peak revenues, but of course, you start with very low revenues and then those are going up. So as the infrastructure is there, But then higher revenue for these new products are coming. It's always the case with new products, but margins are expected. So it's not something that Gross margins, you can't see it in months, you see it in years, the improvement. But clearly, this is an area that we know Why it's happening, what's happening and how we can improve it.

Speaker 2

So let's go on to the next question.

Operator

Our next question comes from Chris Schott with JPMorgan.

Speaker 19

Great. Thanks so much for the question. And maybe just for Dave and Albert, Kind of building on mid to longer term margin piece of the equation, it sounds like we should think about margin recovery as a gradual process Versus a snapback, is that fair? And I guess kind of the bigger picture question I was asking is just how do we think about reasonable longer term margins, maybe not giving specific timelines, but Can we think about kind of like mid to high 30% operating margins is still a reasonable target for Pfizer or just kind of factoring in some of the dynamics we're seeing now? Do we need to kind of rethink where margins can go over time?

Speaker 19

Thank you.

Speaker 3

No, I think you're absolutely correct. Mid to high 30s is a reasonable target for us with a slight caveat in The sense that the vaccine program, Comirovy, it has a shared, as you know, gross margin level with our partner. And so that's dampening to gross margins and Operating profit, so I'll say slightly mix adjusted for that product. And then from a progression standpoint, yes, you could think about this as a gradual, Steady improvement story over the next several periods.

Speaker 2

Thank you. Next question please.

Operator

Our next question comes from Rajesh Kumar with HSBC.

Speaker 20

Hi there. Good afternoon. Just on the medium term margin profile, thank you for the color you've provided. If you think about the growth aspirations you have, does that require you sacrificing Margins. So if you were to say hit the top end of your growth profile would Looking at mid-30s gross margin or lower or what is the balance there?

Speaker 20

And the second one, you briefly touched on your capital allocation priorities earlier. Obviously, cost cutting and Deleveraging is a priority for 2024. In the medium term, which are the therapy areas where You would deploy more capital after 2024 deleveraging exercise done? Thank you.

Speaker 2

David, why don't you take it?

Speaker 3

Yes. So maybe on the margin discussion is, obviously, what we've said is, have Pretty substantially in our business over the past couple of years. So largely the investment phase, at least from a business development standpoint, is behind us. We have worked to invest to improve performance going forward, but the big dollars are already invested now as execution story and a continued improvement story. So you should expect that to occur over the next several periods.

Speaker 3

Obviously, the higher the revenue, the better performance because you get to leverage your fixed costs. So clearly, The higher those revenue targets and achievement happen, the better improvement from a margin And then from a capital allocation perspective, I think you said it right. We are at the moment Focused on executing our plan, focused on supporting our dividend growth over time, But importantly, beginning to delever as we cycle into the operation of the sinking assets. And then from a priority standpoint, Clearly, we've made a significant investment in oncology. You should expect to us to put the investment thesis

Speaker 2

And I would add that following the oncology, we're clearly We have right now the biggest part of our R and D expenses and we have a significant also part of our S and A expenses. The other areas that we are putting a lot of emphasis when it comes to research, clearly vaccines, it's a crown jewel and we plan to have In internal medicines, our metabolic franchise, it is an area that we are very excited. Obesity is part of that. We do believe that obesity It's a big market and is growing. And we do believe that Pfizer has the capabilities that allows us We are in that area.

Speaker 2

So that's an area that we will continue investing. Immuno inflammation will have significant investments

Speaker 15

is the

Speaker 2

other area. And of course, we have We're among the fewest that they have antiviral and the effective steel investment. So Those are the areas that we will be putting money. Oncology, number 1, then vaccines, metabolic diseases, immuno inflammation and the virus are the ones But we are continuing to invest. Next question.

Operator

Next, we have Carey Holford with Berenberg.

Speaker 21

Thank you. Just a couple of pipeline questions for me, please. Firstly, on RSV, Can we expect you to announce the data for Abbrizo following that 3rd season in Q2? And then also on the 2 Phase III starts, you've highlighted today B6A in lung, CDK4 in breast. When can we expect Phase 3 data readouts for these 2 products?

Speaker 21

Thank you.

Speaker 2

I'm not sure what was your question on RSV?

Speaker 21

And to understand whether you're going to publish the data from The following the 3rd season, 3rd week of season of IFRS.

Speaker 2

Yes. I got it. Thank you. Why don't you take that, Michael, on the Abrisco and then Chris?

Speaker 9

We continue to accumulate important RSV data and expansion of how this important I think can be used. So you should expect This part of the year, likely Q2, that we share more from our clinical trials, including full second season, But also expansion in traditional age groups, as you can note on cleantrile.gov, we have active trials, And we think that will very nicely allow high risk groups across a large HSPAM to be addressed.

Speaker 2

Thank you, Michael. And then Chris?

Speaker 15

Thank you very much for the question. So the immediate readouts for this year, second half twenty twenty four will be vetegastrant in 2nd line, hormone receptor positive metastatic breast cancer, the VERITEC-two study, also second half twenty twenty four. We expect or anticipate results from breakwater, very important indication, up to 12% of colorectal cancer with BRAFTOVI in first line BRAF CRC. The new study starting right now is CDK4, B6A and decitamab in Phase III programs and then also I hope later this EZH2, those will appear in clinicaltrials dot gov as primary completion dates beyond 20252026, but obviously there The interim results with earlier results.

Speaker 2

Thank you very much guys for answering Kerry's question. Let's go to the next question please.

Operator

Our next question comes from Chris Shibutani with Goldman Sachs.

Speaker 22

Thank you very much. Two questions, if I may. Amir, with your prior role, you had talked about a $25,000,000,000 in revenues by 2,030 that the company was looking To deliver based upon M and A, we have the impairment with Arena. Is there an update for that? And now that you're in the role of U.

Speaker 22

S. Steve, commercial officer, non oncology, non COVID, what would be on your wish list in your current seat in terms of where you feel An opportunity to expand those revenues, potentially to business development that could work to hit that $25,000,000,000 target by 2,030. Then secondly, with the M and A activity across the industry, investors are always paying attention to what's going on with the TC, having passed through this gauntlet with Cgen last year, is there anything you can comment about to help us think about how regulators Thinking about the M and A environment in terms of particularly size of deal or any other dimension that you think is worth Being aware of that might have been your observation from your experience in 2023? Thank you.

Speaker 2

Thank you very much. Amir, why don't you take the question? By the way, let me clarify that Amir's possibility includes COVID revenue. So go ahead, Amir.

Speaker 7

Okay. So Chris, there's a lot in what you asked. Firstly, on the $25,000,000,000 goal that we put out there, I'll just remind that we guided to $20,000,000 for what we Plan on getting to by 2,030 for the deals that we had done. And I would also just remind you that the $25,000,000,000 was a 2,030 goal. So there is Lots of time between now and 2,030 to achieve that goal consistent with our capital allocation Priorities that Dave described.

Speaker 7

On your second question, I mean to be honest, yes, everyone's got a wish list, but my focus is on exactly what I describe Right now and what we've talked about as a management team, which is delivering value from our launches and delivering value from the deals that we've done. So that's where my focus is. Now lastly, in terms of the FTC, it's not appropriate for us to comment on what the FTC is going to do or not But what I can say is that we feel very good about how we have operated with all regulators and in all regulatory bodies across the world to get done All the deals that we did and I think that just speaks to our patient centric approach and our collaborative nature with regulators.

Speaker 2

Thank you. Next question please.

Operator

Next, we have Akash Tewari with Jefferies.

Speaker 22

Fair point on the prepared comments with the impairment charge and kind of the moving parts between adult pediatric and international. Consensus has modest top line growth over the next few years for entire franchise, is that a reasonable expectation for investors given the increased competition for Merck and the U. S. Pool shrinking? And then do you have an internal view on what the AATIP recommendation will be regarding Prevnar and VB-one hundred and sixteen?

Speaker 22

Thank you.

Speaker 2

Look, Amir, why don't you take the is it the Prevnar expectations? We don't comment on what the expectations of the Street are, right? So are we and I think we gave a very good, let's It's a high level trajectory how we see this market. In the U. S, the adult opportunity, It is mainly as always in with the adult, a catch up opportunity.

Speaker 2

So when you come, you have a pool of all the people that are eligible, That some of them would choose to make the vaccine. Usually, that happens in the 1st year and maybe a little bit then on the 2nd year. We have exhausted, I think this opportunity with a 96% market share. So right now, I don't think that we will see in the U. S.

Speaker 2

In the adult Huge opportunity. Merit competition is coming into that. So this is not a very big growth area for Because as I said, this is not where we plan to do it. It's huge when you launch it, then very quickly goes down because then it is So I asked the people what they are really graduate, they are going into this cohort in terms of age. The big opportunity is the pediatric Because it is 4 doses, it's not 1.

Speaker 2

And because it is a huge cohort every year, way bigger the Newborns then people that are becoming 65 in the gut. So that's how we should see. So There is nothing much to add into that. Next question please.

Operator

Thank you. Our last question will come from Evan Seigerman with BMO Capital Markets.

Speaker 2

Evan, you are welcome.

Speaker 16

Hi, guys. Thank you so much.

Speaker 23

Thank you, Albert. I appreciate it. Two questions from me. One, when you think about the additional $25,000,000,000 revenues by 2,030. Now that Seagen is part of this business, where are we in getting to that metric?

Speaker 23

And then my second question is really on OxBrid on sickle When you bought the asset, you really you noted that you plan to speed up the distribution of the drug to parts of the world most impacted by The disease, we haven't really seen much OUS, given recent competitive approvals of cash Jebi in the Middle East. How do you think about the OUS opportunity in context of the competitive updates there? So Cgen and then thinking about some Oxbridge

Speaker 2

On the season, maybe I can take it because that's an easy answer. From season, we expect Get 10,000,000,000 by year 2030. That was a number that we put out there when we announced the acquisition. Since then, Few things that have reinforced our confidence in this number have occurred. The first one, it is that ADC became the hottest thing On the M and A activity, everybody wants an ADC which Basically, our big bet was in this technology.

Speaker 2

So looks like there is an overall consensus Among investors, companies, analysts that this is a technology that will deliver a lot. So that give us a lot of comfort That happened after we announced. The second thing that also happened after we announced this $10,000,000,000 was That Seadrill came out with significant readouts of significant products and that were beyond But also what you don't see, but we see, they are advancing a lot of stuff that some of them we will show you on the 28th 29th February. So also it was a bet in the technology and the bet in the company. We feel that we did very well in both.

Speaker 2

So the 10,000,000,000 €10,000,000,000 of the €25,000,000,000 But we remain we don't change it, but we remain confident that we can make it. Then, of in addition to that, there was an additional €10,000,000,000 for all the other things that we have done and this €5,000,000,000 that we could execute. Now On Oxbridge, how Oxbridge is doing, Amir?

Speaker 7

Yes. So Evan, with regards to Oxbridge, and then I'll comment on the We're pleased with the U. S. Performance. The Q4 was up 30 Over the prior year and 14% over the prior quarter.

Speaker 7

The prescription trends are very solid. We've made a lot of investments in customer facing teams since we made that acquisition. So we like the momentum that we're seeing in the U. S. And we expect to Seymour, right now, the rest of the world is a very small part of Xtrider revenue and that is something that will take Time to develop and we'll obviously look at that appropriately.

Speaker 7

And as you think about the GBT acquisition, it's important to look at But I also would remind you that we're also very excited about GBT601, which we Expect can bring a lot of value in addition to Ausprita. Some of it will if it's Successful from a clinical and regulatory perspective. Some sales will be cannibalized, but there will also be room for Uxpira in the market to continue to grow. So when you look at the combination of the momentum in the U. S, an opportunity that's yet to be developed outside the U.

Speaker 7

S. And 601 where we presented great data at ASH In December, we think that there is a lot of value to be gained from this acquisition.

Speaker 2

Yes. And I will add, it is the same exactly with the GBT acquisition. When We did the acquisition. We announced our projections for year 2,030. Since then, things have improved in terms of our confidence to deliver These numbers and I'm not talking only that Oxbridge is performing exactly as we thought it would, but the most important upside is that we had data, but we didn't have when we made the acquisition on 601 that has the potential to become a transformative therapy in the sickle cell and really, really brings to the next is a step change If that thing if the Phase 3, let's say, reconfirms the Phase 2 results.

Speaker 2

So also over there, I think what we announced, we feel now we're more confident, but we should be able to achieve and hopefully exceed. So with that, I think it's time to the call, in summary, we are optimistic about the year ahead. We have defined our 5 key priorities that I have assembled a team that I have picked that I believe are the absolutely right leaders to execute. And I know that the whole world was impressed with the way that we executed our COVID Strategies, how we were able to execute on the R and D front, on the manufacturing front and on the commercial front with 2 Products, vaccine with the highest market share and with a product in oral antiviral, We plan to repeat the same execution excellence level as we are building oncology leadership, As we are progressing the next wave of our pipeline, as we are maximizing the performance of all these new launches that have happened, As we execute our cost realignment program starting this year with SI and A, but also which you will see the results, but also of course the program to The gross margin that you won't see results now because it takes long, but we started now as we speak and laser focus in maximizing value for shareholders with the way The team is there to make sure that this will happen, and I think We should meet again in 3 months and we will see how we are progressing against those stated goals.

Speaker 2

Thank you very much. Bye bye.

Operator

Thank you, ladies and gentlemen. This does conclude today's Pfizer's 4th Quarter 2023 Earnings Conference Call. We appreciate your participation and you may disconnect at this time.

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