Eli Lilly and Company Q3 2024 Earnings Call Transcript

Quartr
Provided by Quartr
October 30, 2024

There are 18 speakers on the call.

Operator

Ladies and gentlemen, thank you for standing by, and welcome to the Lilly Q3 2024 Earnings Call. At this time, all participants are in a listen only mode. Later, we will be conducting a question and answer session and instructions will be given at that time. I would now like to turn the conference over to your host, Joe Fletcher, Senior Vice President of Investor Relations. Please go ahead.

Speaker 1

Thank you, Paul, and good morning, everybody. Thanks for joining us for Eli Lilly and Company's Q3 2024 earnings call. I'm Joe Fletcher, Senior Vice President of Investor Relations. And joining me on today's call are Dave Ricks, Lilly's Chair and CEO Doctor. Dan Skovronsky, Chief Scientific Officer and President of Lilly Immunology Lucas Montarsay, Chief Financial Officer Anne White, President of Lilly Neuroscience Ilya Juffa, President of Lilly International Jake Van Naarden, President of Lilly Oncology and Patrick Jonsson, President of Lilly Cardiometabolic Health and Lilly USA.

Speaker 1

We're also joined by Susan Hedgeland, Mikaela Irons, Mike Sprangeth and Lauren Zirke of the IR team. During this call, we anticipate making projections and forward looking statements based on our current expectations. Our actual results could differ materially due to several factors, including those listed on slide 4. Additional information concerning factors that could cause actual results to differ materially is contained in our latest Form 10 ks and subsequent filings with the SEC. The information we provide about our products and pipeline is for the benefit of the investment community.

Speaker 1

It's not intended to be promotional and is not sufficient for prescribing decisions. As we transition to our prepared remarks, please note that our commentary will focus on non GAAP financial measures. Now I'll turn the call over to Dave. Okay. Thanks, Joe.

Speaker 1

In Q3, Lilly continued to make progress across the business. We delivered strong revenue growth, we advanced and expanded our pipeline and we invested in new product launches and continued expanding manufacturing network. On Slide 5, you can see details of our financial performance and progress related to our strategic deliverables. Revenue grew 42% after excluding the impact of revenue from the Olanzapine portfolio, which we divested in Q3 2023. New product revenue grew by over $3,000,000,000 led by Manjaro and ZEPPOUN.

Speaker 1

U. S. Demand for Manjaro and ZEPHOUND has been strong and continues to grow as we expand both access and supply. U. S.

Speaker 1

Sequential quarter over quarter prescription volume growth was 25% in Q3. All doses are available for order from Lilly in both the wholesale channel and Lilly Direct Pharmacy Solutions. The launch of a single dose zepbound vials in the U. S. Exclusively through Lilly Direct's self pay channel further expanded supply and access in the quarter.

Speaker 1

And finally, we remain on track to exceed the production target of at least 1.5 times the saleable doses of Anchor Thin medicines in the second half of this year compared to the second half of last year. We continue to see strong performance across the balance of our portfolio in oncology, immunology and neuroscience. Excluding revenue from the Olanzapine portfolio, the non anchorton growth of the company was 17% in Q3. We achieved several key pipeline milestones this quarter, including the approval of EBLIS in the U. S.

Speaker 1

For the treatment of moderate to severe atopic dermatitis, the approval of Kisundla in Japan and Great Britain for the treatment of early symptomatic Alzheimer's disease, disclosure of positive 176 week data from the SIRMOUNT-one Phase 3 study of tirzepatide in adults with prediabetes and obesity or overweight. And the recent presentation of positive data from the Phase 3 trailblazer ALT-six study evaluating different dosing regimens for dasenomab. Our manufacturing expansion agenda remains a top priority. In September, we invested nearly $2,000,000,000 to increase our manufacturing footprint in Ireland. This brings the total commitments to build, upgrade and acquire manufacturing facilities announced since 2020 to more than $20,000,000,000 And beyond this $20,000,000,000 commitment, we also announced a separate $4,500,000,000 investment to develop the Lilly Medicine Foundry.

Speaker 1

This first of its kind facility will be dedicated to research and develop for manufacturing process design and to develop high quality investigational medicines for our clinical trials. It will be located in Lebanon, Indiana, a short drive from the corporate headquarters. This investment underscores our confidence in our pipeline and the urgency we bring to bring our medicines innovative medicines to patients around the world. In August, we closed the acquisition of Morphix Therapeutics adding oral integrin assets to our early phase immunology portfolio. And lastly, we returned over $1,600,000,000 to shareholders via dividends and share repurchases.

Speaker 1

On Slide 6, you'll see key events since our Q2 call, including the milestones I mentioned earlier and several other key updates. Last month, we appointed Lucas Montarce as Lilly's Executive Vice President and Chief Financial Officer. Lukas has 23 years of experience at Lilly and has worked with the executive team and the Board for a long time. So congratulations, Lukas. Now let me turn the call over to Lukas to review our Q3 financial results and provide an update on our 2024 financial guidance.

Speaker 2

Thanks, Dave. Slide 7 summarizes our financial performance in the Q3, which is highlighted by strong revenue growth across our new products as well as our non incretin medicines. As Dave mentioned, revenue grew 42% after excluding the impact of revenue from the olanzapine portfolio and was primarily driven by Moncharo and Zebbank. Revenue from our non incretin portfolio grew 17% after excluding the impact of revenue from the Olanzapine portfolio. Gross margin as a percentage of revenue increased to 82.2%.

Speaker 2

Gross margin primarily benefited from favorable product mix and higher realized prices, partially offset by the sale of rights for the Olanzapine portfolio in Q3 2023 and higher manufacturing costs. R and D expenses increased 13%, driven by continued investment in both our early and late stage portfolio. We recognized $2,800,000,000 of acquired IP R and D charges, primarily related to the acquisition of Morphic Therapeutics. Marketing, selling and administrative expenses increased 16%, primarily driven by promotional efforts supporting ongoing and future launches. Operating income increased to nearly $1,800,000,000 driven by higher revenue from new products, partially offset by operating expenses growth.

Speaker 2

The effective tax rate was 37.6%, reflecting the unfavorable impact of non deductible D, the underlying tax rate was consistent with previously provided guidance. We delivered earnings per share of $1.18 up from $0.10 in Q3 2023 and this includes a negative impact of $3.08 from acquired IP R and D charges. On Slide 9, we quantify the effect of price, rate and volume on revenue growth. U. S.

Speaker 2

Revenue increased 46%, with volume growing 35%, driven by Sebban and Moncharo, partially offset by declines in Trulicity. Realized prices increased 11% in the U. S, primarily driven by Trulicity, Humalog and Verzeny. While Moncharo and Sedbon demand remains strong and growing, quarter by quarter revenue growth in 2024 has been impacted by supply and channel dynamics. As we highlighted in Q2, increasing supply led to higher shipments that allow us to fulfill the majority of wholesalers backorders, serving as a tailwind to sales.

Speaker 2

In Q3, we saw channel inventory decrease as wholesaler continue to navigate the complexities of high volume cold chain products across a dozen different dose and brand combinations. We estimate this inventory decrease impacted Q3 sales of Monjaro and Sedban by mid single digits as a percentage of aggregate used sales of these products. Europe revenue grew 39% in constant currency when excluding the impact of the divestiture of the Olanzapine portfolio. This growth was primarily driven by Monjaro, Verzenio and Jardiance. We continue to be pleased with the Monjaro equipment launches in Europe and are now launched in the U.

Speaker 2

K, Germany, Spain and most recently Italy. Revenue in the rest of the world grew 45% in constant currency, driven by volume growth of Monjaro and to a lesser extent strong performance of Verzenio and Jardiance. Moving to China, revenue increased 17% in constant currency. This increase was driven by volume growth of target and favorable pricing impacts for Humadol. Finally, Japan grew 17% in revenue in constant currency.

Speaker 2

Volume growth of 20% was driven by uptick of Monjaro, Bersenio and Jardiance. Slide 10 provides additional perspective of performance across our product categories. Monjaro sales were $3,100,000,000 globally, with almost $2,400,000,000 of net sales in the U. S. We continue to see solid uptake of Monjaro outside the U.

Speaker 2

S. With sales in Q3 totaling $728,000,000 Virsenio continued its growth trajectory with worldwide sales increasing 32%, driven by strong execution in the early breast cancer indication. JYPRC worldwide revenue was $81,000,000 When excluding the impact of Japan collaboration milestones recognized in Q2, JYPRGAA continued its sequential quarter over quarter growth trend, demonstrating sustained uptake in both the MCL and CLL patient population. Worldwide onboard revenue increased to $41,000,000 We are pleased with our progress gaining commercial access for Ombo in the U. S.

Speaker 2

As of January 2025, we will have first line access at 2 out of the 3 major PBMs. We were also excited to receive U. S. Approval for QESANLA and EPLIS in Q3. The QESANLA launch is underway and progressing, and the EPLIS launch began early this month.

Speaker 2

We are pleased to have already secured formulary access for Efiliz with 1 of the major PBMs. Worldwide Trulicity revenue declined 22%, driven by lower volume, partially offset by higher realized prices. Slide 11 provides an update on the U. S. Launch of ZEPTOWN.

Speaker 2

We continue to see strong growth trends leading to sales of over $1,200,000,000 We have broad formulary coverage for Zb1. As of October 1, Zb1 has approximately 87% access in the commercial segment and we are making ongoing progress expanding our employer opt ins. We are in the early days of launching single dose set band vials in the U. S. Exclusively through LilyDirect.

Speaker 2

2.5 and 5 milligram single dose vials are currently available to self pay patient at a 50% or greater discount compared to the list price of other incretin medicines for obesity. This offering helps even more adults living with obesity access Zebbond, including Medicare beneficiaries and those without 12, we provide an update on capital allocation. On Slide 13, you can see our updated guidance for the full year. We are updating our revenue guidance range to $45,400,000,000 to $46,000,000,000 The new midpoint range represents approximately 50% growth in Q4 2024 compared to the same quarter last year demonstrating a continuation of revenue growth acceleration. We are investing heavily in increasing supply of tirzepatide and have been carefully balancing our demand creation activities and launches into new markets with our production to support continuity of care for patients.

Speaker 2

In Q3, we continue to be prudent scaling up and demand generation activities. This is a driver for lowering the top end of the range. We continue to expect that we will exceed our goals to increase production of increasing soluble doses by at least 50% in the second half of twenty twenty four compared to the second half of twenty twenty three. Now with all the doses of Moncharo and Cepan available, we will accelerate demand activities and while there is a lag to flow through revenue, we expect to see the impact of these efforts in Q2 and into 2025. Lastly, we are also expect new Moncharo launches internationally to contribute to growing in Q4.

Speaker 2

Our expected ratio of gross margin less OpEx divided by revenue remains unchanged on both our reported and a non GAAP basis. Other income and expense is now expected to be in the range of $425,000,000 to $325,000,000 of expense on a reported basis and is unchanged on a non GAAP basis. We have updated our estimated effective tax rate to be approximately 17%, driven by the impact of non deductible IPR and D in Q3. EPS is now expected to be in the range of $12.05 to $12.55 on a reported basis and $13.02 to $13.52 on a non GAAP basis. Both ranges reflect the updated mentioned earlier, as well as acquire operating IPR and D charges through Q3 of approximately $3,100,000,000 Now, I will turn the call over to Dan to highlight our progress on R and

Speaker 3

D. Thanks, Lucas. Lilly R and D had another productive quarter. So let me begin by sharing some late phase updates, including some exciting Phase 3 data that we shared at recent medical congresses. Starting with neuroscience, yesterday at the Clinical Trials in Alzheimer's Disease Conference, we were pleased to share positive results from our Phase 3 trailblazer AL6 trial, which evaluated different dosing regimens for initiation of denitimab treatment to understand their effect on ARIA E.

Speaker 3

In this trial, we tested a modified titration, which shifted 1 bilodenemab from the first infusion to the 3rd, as shown on Slide 14. We designed this modified titration to achieve identical total dose of denenomab administered in the 1st 3 months as does our standard dosing regimen, but we hypothesized that the smoother increase in dose could result in less ARR. We are pleased to see in this trial that indeed by pharmacokinetic analysis, we achieved equivalent cumulative exposure between the modified titration and the standard dosing regimen. And as a result, we achieved similar levels of amyloid plaque removal and phospho tau-two seventeen reduction. Importantly, we also confirmed our hypothesis on ARIA and showed that the modified titration reduced the incidence of ARIA E to 14% compared to 24% for those receiving the standard dosing regimen.

Speaker 3

As well, lower frequency of symptomatic ARIA E, lower radiographic severity of all categories of ARIA E and lower ARIA E in APOE4 genotype carriers was observed using the modified titration as compared to the standard dosing regimen. We plan to submit a supplemental BLA to the FDA in the coming weeks for this modified titration. Our efforts on remternitug continue to progress and we're starting a Phase 3 efficacy study of HER2DOGEN focused on preclinical stages of disease, similar to our ongoing TRAILBLAZER ALS3 trial for denitumab, where we are trying to reduce the risk of progression symptomatic Alzheimer's disease. In this upcoming Phase 3 registrational trial called TRAIL Runner 3, we are evaluating a fixed duration of monthly subcutaneous administration of rinceratuck, offering what we see as a potentially convenient option for this earlier patient population. We'll share more details about the study design of TRAIL RUNNER 3 tomorrow at CTAD.

Speaker 3

Turning to cardiometabolic health. Last month, we shared data from our remaining Phase 3 studies for our weekly basal insulin called insulin excitura alpha. As a reminder, the sutora Phase 3 consists of 5 global registration studies, 4 of which are in adults with Type 2 diabetes and 1 is in adults with Type 1 diabetes. We are pleased that each study met its primary endpoint of non inferior A1c reduction versus insulin glargine or insulin degludec, which are the most frequently used daily basal insulins. In the studies evaluating the Epsitura in people with type 2 diabetes, the results demonstrated that Epsitura achieved meaningful A1C reduction with relatively low hypoglycemia rates.

Speaker 3

We were particularly excited with the results for QUINT-one in which Episitora was administered via fixed doses using a single use auto injector. In this 52 week study in people with type 2 diabetes, Episitora lowered participants A1C by 1.31% compared to 1.27% for insulin glargine. This impressive A1C reduction was achieved in low hypoglycemia rates. Actually, Escitora had approximately 40% lower rates of severe or clinically significant hypoglycemia than the daily insulin glargine. These data highlight the power of an easier to use dose form of a weekly insulin for people who are just initiating basal insulin therapy for the first time.

Speaker 3

We look forward to discussing the results from the QUINT Phase 3 program with global regulatory agencies. It has also been a productive quarter for our late phase incretin programs. First, as shown on Slide 15, we shared positive 176 week data from the SURMOUNT-one Phase 3 study of tirzepatide in adults with pre diabetes and obesity or overweight, which demonstrated a remarkable 94% reduction in the risk of developing Type 2 diabetes. This is the longest duration tirzepatide data to date and we are highly encouraged to see that patients on a 15 milligram dose achieved sustained weight loss of nearly 23% during the more than 3 year treatment period and that this weight loss was accompanied by a significant reduction in risk of developing diabetes. We look forward to sharing the detailed results next week at Obesity Week.

Speaker 3

These results add to compelling data showing the benefit of the combined pharmacology of dual GIP and GLP-one receptor agonism in several obesity related complications, including type 2 diabetes, metabolic dysfunction associated steatohepatitis or MASH, moderate to severe obstructive sleep apnea and heart failure. We are working quickly to bring tirzepatide to more adults living with obesity and its complications and we are pleased to share that we expect U. S. Regulatory action for tirzepatide in adults with obesity and obstructive sleep apnea yet this year. And that we will submit for U.

Speaker 3

S. Approval tirzepatide in adults with obesity and heart failure with preserved ejection fraction before the end of this year. Another avenue to advance patient care is the maintenance of body weight reductions. We're conducting 2 Phase 3b weight loss maintenance trials. The first is surmount maintain, which compares either tirzepatide 5 milligrams or tirzepatide maximum tolerated dose to placebo.

Speaker 3

The second is attain maintain, which evaluates our oral GLP-one or for glipron versus placebo after tirzepatide or semaglutide in participants who complete surmount 5, the 3b head to head study of tirzepatide versus semaglutide. We look forward to sharing the top line data readout for SERGIO5 later this year. Next in oncology, the Phase 3 EMBER 3 study evaluating our oral SERD in luminescent in patients with second line ER positive HER2 negative metastatic breast cancer was positive. The study evaluated 3 arms, imlanesterant as a monotherapy, investigator's choice of endocrine therapy monotherapy and imelinesterin in combination with abemaciglib. Based on the results from this trial, we expect to submit an NDA to the FDA by year end and we look forward to sharing detailed results at an upcoming medical meeting.

Speaker 3

The Phase 3 portion of the olorosib first line KRAS G12C lung cancer study is now underway. The first Phase 3 trial for this class of medicines in newly diagnosed locally advanced or metastatic lung cancer regardless of PD L1 expression. This comes after recently defining the dose of the medicine in combination with standard of care regimens in consultation with the FDA under Project Optimus. We continue to believe we could have a leading agent in this class and look forward to execution of the late stage program. Finally, in immunology, we're cited by the recent U.

Speaker 3

S. FDA approval of lebrikizumab as Eblis for adults and children 12 years and older with moderate to severe atopic dermatitis. Eblis provides a new first line biologic treatment that targets a main cause of eczema inflammation that offers significant early skin clearance and itch relief with convenient once monthly maintenance dosing following the initial phase of treatment. We recently shared compelling long term data showing that lebrikizumab provides sustained disease control for up to 3 years in more than 80% of patients with moderate to severe atopic dermatitis who responded to EPCUS treatment at 16 weeks. We've also initiated 2 Phase 3 studies of leprikizumab in adults with perennial allergic rhinitis and chronic rhinosinusitis with nasal polyps.

Speaker 3

As we continue to expand our immunology portfolio to help more patients, we're conducting 2 Phase 3 studies evaluating etsikizumab and tirzepatide together in patients with obesity or overweight and either psoriatic arthritis or moderate to severe plaque psoriasis. Obesity is associated with an increased risk of developing autoimmune diseases and can negatively impact disease outcomes. Taltz has already demonstrated strong efficacy in treating psoriatic arthritis and plaque psoriasis and we are excited to see the potential for additional benefits for patients when combined with the significant and sustained weight loss offered by ZEPALC. Slide 16 shows select pipeline opportunities as of October 28 and Slide 17 shows potential key events for the year. I've already covered our late phase progress, so now I quickly cover updates for the early phase pipeline.

Speaker 3

Starting again with neuroscience, we recently initiated a Phase 2 study of an epiregulin antibody in chronic neuropathic pain associated with distal sensory polyneuropathy. We had previously shown this molecule in Phase 1 of the pipeline as an undisclosed mechanism in pain. We also have begun Phase 1 studies on 2 new neurodegeneration assets, an alpha synuclein directed siRNA and a tau directed siRNA. Earlier this morning at CTAD, we disclosed detailed results from our Phase 2 study of seperoblastat, our oral oclic nakase anti tau agent. While neither does slow clinical decline in early symptomatic Alzheimer's disease, biomarker data suggests potential impacts on tau pathology, brain volume and neuro inflammation.

Speaker 3

Safety

Speaker 4

follow ups

Speaker 3

for the study are ongoing. Turning to cardiometabolic health. In the coming days, we will initiate a Phase 2 study of Alora Lintide, our long acting amylin receptor agonist for chronic weight management in combination with tirzepatide in patients with Type 2 diabetes and the Phase 2 study of bimagramab alone or in combination with tirzepatide for chronic weight management in participants without type 2 diabetes. We will also be advancing volenrelaxin, our long actingrelaxin molecule into Phase 2 in adults with chronic kidney disease. We removed the Phase 1 APOC3 siRNA asset in cardiovascular disease as it did not meet our bar for continuing clinical development.

Speaker 3

In oncology, 2024 continues to be a very productive year for new clinical starts. Since the last call, we advanced 3 new molecules into Phase 1 studies. Our oral SMARCA-two or BRM inhibitor, our KRAS G12D inhibitor and our pan KRAS inhibitor. These three initiations bring the total new clinical starts in oncology in 2024 to 7 exceeding the goal we shared earlier this year to put at least 5 new potential medicines in the clinic. And we've done that across 3 different modalities, emblematic of our strategy to utilize therapeutic modality diversification to combat treatment resistance and improve patient outcomes.

Speaker 3

We expect this new slate of clinical programs will set us up for an exciting 2025 as we look to see which programs deliver differentiated and important early clinical data sets for patients. Finally, in early stage immunology, we're also excited to initiate several new Phase 2 studies. First, we moved DC-eight fifty three, an oral IL-seventeen inhibitor from the Dice Therapeutics acquisition into Phase II in adults with moderate to severe plaque psoriasis. And we removed DC-eight zero six from the pipeline in favor of 853, which is a more potent molecule. 2nd, we are initiating a Phase 2 study combining eltrecobart and mirikizumab in adults with moderately to severely active ulcerative colitis.

Speaker 3

In addition, we are terminating the Phase 2b study of parisolumab in rheumatoid arthritis due to the overall benefit risk profile of the molecule in this study. Finally, after welcoming our Morphet colleagues to Lilly in August, our pipeline now reflects the oral alpha-four beta-seven integrin inhibitor, MORF-fifty seven in Phase 2 for moderate to severe ulcerative colitis and moderate to severe Crohn's disease. Q3 was an exceptionally productive quarter for Lilly R and D and we're pleased with our important progress we're making for patients across all of our therapeutic areas. Now I'll turn the call back to Dave for closing remarks.

Speaker 1

Okay. Thanks, Dan. Before taking questions, let me briefly summarize our progress in the quarter. We had strong revenue growth across both Manjaro and ZEPOUND as well as our oncology, immunology and neurosciences medicines. Significant advancements in our pipeline included approval of Eviglitz for moderate to severe atopic dermatitis in the U.

Speaker 1

S, Kizumma for early symptomatic Alzheimer's disease in Japan and Great Britain and positive data disclosures for Phase 3 studies of tirzepatide and denonumab. We are confident in Lilly's bright future. We have now launched in major geographies the cohort of medicines that we expect will serve as the driver of our growth through the balance of this decade. That is Manjaro, Japerca, Amvyle, ZEPOUND, Kisumla and Eblis. We expect these products together with our already launched products will contribute to strong growth of the company in 2025.

Speaker 1

In addition, we plan to continue to scale R and D and step up our investment across manufacturing and commercial to support the successful launches of these medicines to help even more patients next year. So now I'll turn the call over to Joe to moderate the Q and A session. Thanks, Dave. We'd like to take questions from as many callers as possible and conclude our call in timely manner. So consistent with prior quarters, we'll respond to one question per caller, so I ask that you limit to 1 question per caller as we will end the call at 11 am.

Speaker 1

If you have more than one question, you can reenter the queue and we'll get to your question if time allows. So Paul, please provide the instructions for the Q and A session and then we're ready for the first caller.

Operator

Caller. And the first question today is coming from Chris Schott from JPMorgan. Chris, your line is live.

Speaker 5

Great. Thanks so much. Just to kick off the questions, can you just help bridge a bit from the 3Q sales we just saw reported to the 4Q implied results? It's obviously a substantial step up in sales. It sounds like part of this is you're now accelerating demand generation efforts given the improved capacity.

Speaker 5

But I was just hoping to get a little bit more color on exactly what those efforts are and how quickly you expect those programs can translate to an acceleration in prescriptions? Thank you.

Speaker 1

Thanks, Chris, for the question. I'll maybe hand over to Patrick since I'm guessing a lot of the question is around tirzepatide related, but let Lucas jump in as needed. Patrick?

Speaker 4

Thank you very much, Chris. I think it's first important to emphasize that the overall performance and health of both Mondjaro and ZEPHOUND was very strong. And we saw a slightly accelerated growth in Q3 of more than 25%. And also the market, the underlying market for both Type 2 and obesity continues to grow. We took a more prudent approach than we anticipated in Q3, pretty much driven by the need to deliver a good consumer experience.

Speaker 4

That has been one of our triggers for any investments based upon the experience we faced in the first half of the year when a lot of the calls to our customer service center was about supply, actually more than 20%. We are now down to more than less than 1% of those being supply related. So what we are doing right now is that we are investing heavily in our DTC efforts, which we haven't done in the past, both supply allows us to invest strongly there, but it's not a demand issue. And similarly, we're fully leaning in on all the HCP promotional efforts, also providing samples in the marketplace to providers. We remain very confident based upon the underlying trend in the marketplace today and also the growth of both ZEPHOUND and Mojaro in terms of TRx, MBRx and TRx that we are after a good few for.

Speaker 2

Maybe just to add to that. Thank you, Chris for the question. When you look at the midpoint that I mentioned 50% growth that we expect for the Q4 compared with the 42% is at a step up of 8%. When you remove the channel dynamics that we alluded in Q2, the step up of growth is very consistent throughout the quarters. So the acceleration and the drivers are the ones that Patrick mentioned.

Speaker 2

Maybe just to add to that, OUS as well, we continue to advance and gate new countries that we are going to be launching Monjaro as well that will drive that part of that growth acceleration in the Q4. Thanks. Paul, next question.

Operator

The next question will be from Geoff Meacham from Citigroup. Geoff, your line is live.

Speaker 5

Hey, guys. Thanks for the question. I guess related to that, I just want to dig into the 3Q volatility. Dave, you mentioned the script demand sequentially. I guess, so given that, why would you see such a big drawdown this quarter?

Speaker 5

I guess investors are trying to figure out if the sequential trends are perhaps a leading indicator of a moderation demand or if it's just the lumpiness of the rollout in excess? Thanks.

Speaker 6

Dave, you want to fill that?

Speaker 1

Yes. Maybe just kind of a macro thing you're asking there. But I think, first of all, there is a lot of lumpiness in channel stocking. I think all the sell side analysts on this call have probably struggled with that as we have. As you know, in Q1, we can recall that we had a number of our dosage forms on back order and we pretty much reached a nadir of supply and wholesalers that was restocked in Q2 and then we saw a drawdown in Q3.

Speaker 1

I think what we really don't control and don't attempt to, but is a reality is that downstream customers from Lilly wholesalers and retailers are making their own decisions about which of the 12 different dosage forms they want to stock and at what level. There are some physical constraints to that, cold chain capacity is constrained and there are financial constraints, working capital that they're managing to. Those are their decisions to maintain their customer service levels. I think what we've done is sort of move our set point of how much stock we want to have on hand before we go initiate demand stimulating activities, which we had more or less pause from a jar on the first half and never started for ZEP bound, remembering we launched in December of last year. So I think in market data, you guys can all read and you see, Jeff, yourself, and we do see acceleration of both brands in Q3 over Q2 in actual consumption.

Speaker 1

And our estimate is that will continue or accelerate as we add U. S. Stimulation to that demand, which as Patrick said, we're going to begin doing here really mid November in earnest. Ex US demand is another factor that affects sales and that too we moved out launches by about a quarter just to make sure we had enough buffer that so when customers wanted a prescription, they could get it filled reliably. And I think that's an important thing for us to keep that trust going forward.

Speaker 1

So at a macro level, is there a demand problem here? No, actually. Is there a supply problem? No, although if we had unlimited demand, there would be. So we're carefully gating those two things together As we escalate supply in Q4, which, as I mentioned, we're going to beat the 50% growth number.

Speaker 1

You'll see us grow our demand stimulation as well. And I think that's really about Q4, but even more about Q1 of 20 25 and continuing acceleration there. So business is super healthy. We feel good about where we are. Obviously, there was some choppiness this quarter, but I think underlying growth here is as strong as we would have hoped.

Speaker 1

Thanks, Dave. Paul, next question?

Operator

The next question will be from Evan Seigerman from BMO Capital. Evan, your line is live.

Speaker 5

Hi, guys. Thank you so much

Speaker 7

for the question and Joe congrats on your new job. I want to touch on compounding. Given the headlines, do you believe that compounded drugs are impacting demand? And secondarily, how do you frame kind of the FDA's waffling on the shortage list as it relates to compounding? It seems that this has been a hot button issue.

Speaker 7

I'd love your perspective. Thank you so much.

Speaker 1

Thanks, Evan. Yes, hot topic indeed. Maybe in terms of talking about whether there's a financial impact, we see that. I'll have let Patrick field that and then maybe the broader question around the FDA. I'll let Dave chime in.

Speaker 1

So, Patrick?

Speaker 4

Well, thank you very much, Evan. I think as we all know, that is not one reliable source when it comes to quantifying the compounding market. We also know that it's a pig and mainly cash and there are probably reasons to believe that some of those patients are off label. So from our perspective, we actually don't estimate

Speaker 1

there to

Speaker 4

be a huge financial impact of compounding on our business. And our major concern here has been driven by safety, but thousands of people in the U. S. Are getting medicine that is not approved by the FDA for quality, safety or efficacy purposes. So that has been our concern and we are mainly leaning in now as we said earlier to drive demand in the U.

Speaker 4

S. Marketplace for patients with obesity and type 2 diabetes.

Speaker 1

Yes. I mean, I can't really speculate too much what's going through the FDA's mind, but I think other commentators have mentioned that the longer this goes on, the more risk they have to their own regulatory framework. And so my guess is the FDA is concerned about that and they want to win this case, and they're putting their ducks in a row to do so. There is an alternate, I guess, perspective that they don't care, but I think they do care. The other thing I'll say is we work closely with the FDA to approve new capacities.

Speaker 1

And it's important to note here, do more with them and we communicate this to them directly. They're not hearing anything here. They haven't heard from you already. But we have invested massively in parenteral filling capacity and API capacity. And a big part of the delivery schedule for that, which can take 2.5 to 4 years is actually the regulatory process itself.

Speaker 1

So it's difficult to think about a world where the workaround to that is to unleash unregulated product. The workaround should be to collaborate with the companies to speed up legitimate product delivery and we would embrace that discussion fully.

Speaker 3

We have

Speaker 1

a lot of things in queue now with the FDA or about to be that could speed up what already is an impressive production ramp. We would welcome that opportunity. Thanks, Bo. The next

Operator

question will be from Seamus Fernandez from Guggenheim. Seamus, your line is live.

Speaker 8

Thanks. My question is actually on how you feel the compounding situation could be resolved by the availability of an oral small molecule that can be provided at substantial scale. It seems like this is the easiest and most straightforward answer to the compounding crisis. Once that occurs, does it make sense with that availability regardless of product that the agency would move to resolve the crisis? Or is this a product by product situation such that if Novo can't get their house in order, in that context that we'll end up with having this compounding issue just draw out over time?

Speaker 8

Thanks.

Speaker 1

Thanks, Seamus. Yes, I'll hand back to Dave. Although, I mean, if you're referring to our, of course, our oral GLP-one non peptide agonist or forglipron, I mean, that's still a ways away from the Phase 3 turning over and then ultimately coming to market. But Dave, maybe what would you add to your prior comments?

Speaker 2

Yes.

Speaker 1

Well, I mean in the long run, of course, there's a potential 1,000,000,000 customers on the planet. And I think we've said, I've said that probably the only way that a big chunk of those are served well is with the oral products because of the production system efficiencies there versus parenteral filling of proteins. So it's important. Of course, we're in the lead there and we want to see our foregone be successful, but we need the data and then submission and launch would put that sometime something like a little less than 2 years from now. But first of all, I wouldn't characterize compounding as a crisis.

Speaker 1

It certainly isn't one for us. I think the problem is people are being harmed and duped, right? And so that's kind of what we like to see stop. But as Patrick said, we don't really see a financial impact on Lilly of compounding. I think that as an industry, we should probably be worried that if this grows and is allowed to continue, then it sort of creates this backdoor generic world.

Speaker 1

But as I said, I think the FDA wants to stop that for good reasons, for public safety reasons, and they'll do that. At the end of the day, FDA use this as a product by product analysis. And right now tirzepatide is not in shortage and therefore for mass compounding should not be permitted. There's a stay etcetera in the court, but we think that should be the state there. As it relates to semaglutide, you'll have to ask Nova that, although we're working hard to help Novo with their supply problem by reducing demand for semaglutide and increasing empertocepaglutide.

Speaker 1

So maybe it will resolve that way. Thanks, Dave. Paul? Next question.

Operator

The next question will be from Mohit Bansal from Wells Fargo. Mohit, your line is live.

Speaker 9

Great. Thank you very much for taking my question. Maybe if I can ask the demand question and supply question differently. So, Lal, you will be starting some demand generation activities in the later half of the year later part of the year. How are you thinking about the access side of it?

Speaker 9

Do you think that there is some convergence between access, demand generation and supply into 2025? Because we are hearing that some of the payers are restricting it even more now. So we'd love to understand your thoughts on access side given that you are probably you have done the negotiations at this point.

Speaker 1

Thanks, Mohit. I'll hand over to Patrick to talk about maybe access updates and go forward.

Speaker 4

Maybe just a few comments with Vonjaro, but the price moving into SEDAR. I think with Vonjaro, we have really good access and it's 93%. And I think we're pretty much where we need to be across commercial and Medicare. In terms of ZEPOUND, I think we've made progress in record time here, close to 90% commercial access and we continue to see improvement in terms of employer soft in. You're correct, Mahesh, we had stories about some employers opting out, but the major trend is actually in favor of opting in to the anti obesity medications.

Speaker 4

So we are definitely north of the 50%. And I think we will have some new data in the 1st part of 2026 since both of the employees are making those decisions effective oneone in the new year to come. So I think we are very, very optimistic in that part of our business. But we're also continuing to make progress in terms of access for Medicaid. And just since we connected last time, we have gained 6 incremental states for Medicaid and most recently effective tenone with California and Massachusetts.

Speaker 4

So big states are now covering more than 30,000,000 lives and we expect to continue to make progress in that space. And lastly, I would just emphasize the potential approval here of obstructive sleep apnea. The approval of obstructive sleep apnea will help us with employer opt in, but we know that outcome studies are critical to convince employers. But on top of that, it also opens up the door for access in Medicare. And with the decision that CMS announced back in April this year, we are confident that we will gain access also for OSA in Medicare.

Speaker 4

So I think we have many reasons to be excited about the outlook for 2025, driven by improved access across the commercial America space as well as the investments we have done with Mediate Direct.

Speaker 1

Thanks, Patrick. And Mohit, even though you didn't ask about OUS access and I don't allow multipart questions, maybe I'll see if Ilya wants to chime in and talk a little bit about OUS access progress to date and what we see going forward. Ilya, do you want to would you like to chime in on that?

Speaker 10

Sure. Overall, we have seen significant progress on our launches OUS. We have both access for Type 2 diabetes. We're in some of the markets like U. K, Germany and Japan and we're seeing some good progression of our share in those markets where we're already seeing leading share of market in new patient starts in those places.

Speaker 10

Of course, we need to continue to develop access in other markets. And then on the chronically management side, we feel good about the prospects of adding countries to drive access. At the same time, there's also developed self pay markets like the U. K, UAE and Saudi. We're already seeing significant progression of our share and penetration where we actually have leading share of market in TRx in these markets.

Speaker 10

And we continue to focus on both developing the self pay, but also increasing access for both Type 2 diabetes and chronic weight management over time. And that will be gradual as we enter new markets.

Speaker 1

Thanks, Ilya. Paul, next question.

Operator

Next question will be from Terence Flynn from Morgan Stanley. Terence, your line is live.

Speaker 1

Great. Thanks for taking the question. I was just wondering, I know you've already framed out kind of where supply would be for the second half of this year. Again, as we look out to 2025, can you give us an early read on how your supply capacity efforts have been progressing and how we should think about the

Speaker 2

amount

Speaker 1

of new capacity, especially on the auto injector side that you can bring on for 2025? Thank you. I can start, Lucas jump in. I mean, we'll have a chance to lay out that as we did this year in our guidance call in early February. But qualitatively, you can see the flow of our investment and CapEx into the space.

Speaker 1

And you could kind of go backwards 3 years or so and expect the capacities we announced then to be coming on full line in that timeframe and then rolling that forward. So, of course, we made announcement this year and those are a couple of years away from having full impact. But if you go back to 2021, 2022, 2023, we are working hard to bring those online and expect good growth next year. So, I think Lucas mentioned we're seeing acceleration in demand, but that means acceleration in supply during this year. And we expect strong growth on the total for next year and we'll lay out the details we get into the guide.

Speaker 1

Colin, do you have anything else to add to that Lucas?

Speaker 2

Maybe just one comment from my side, when we talk about more so from the demand perspective, I think in the U. S. In particular, the proxy that we alluded to on the growth that we see across both the Motaro and ZEP bound in TRx of that 25% sequential quarter on quarter is a good proxy to start basically trending out into next year, more so to provide more perspective from the market side and the demand side and the manufacturing.

Speaker 1

Thanks both. Paul, next question.

Operator

Next question will be from Umer Raffat from Evercore ISI. Umer, your line is live.

Speaker 6

Hi guys, thanks for taking my question. Maybe just to spend one more minute on the inventory dynamic in the quarter. I'm trying to think out loud, could the launch of Cash Pay single vial option via Lilly Direct have impacted channels interest in filling out their inventory given how the launch is going? And or were there any changes in your incentives or fees to the distributors that could have impacted it? Thank you very much.

Speaker 1

Thanks. I'll let Patrick quickly handle that.

Speaker 4

Well, overall, we launched the Lilly Direct self pay file just a month ago. Not we are pleased with the uptake, but we also realized that it takes some time for health care system to adopt the self pay in their EMR systems. But so far, I would say that the impact of TRx has been quite limited and would be defined as being at the low single digit level. We expect Lillet RX self pay, though, to be a very important channel to grow new therapy starts moving forward, but not significant in Q3.

Speaker 1

I think the short answer to both your question is no and no. We didn't change our terms and I don't think we see any change in retail stocking of the auto injector because the vials are filled. Thanks, Umer. Paul, next question.

Operator

The next question will be from Steve Scala from TD Cowen. Steve, your line is live.

Speaker 11

Thank you so much. For a product with a seemingly unlimited market opportunity, what appears to be great market awareness and persistent supply shortages, DTC for ZEPTOWN really shouldn't be necessary, particularly now. DTC, in my experience, usually signals concern about patient volumes, awareness or competition. So the question is if DTC were not instituted, what would be the trajectory of ZEPBOUND over the next say 12 months? Would consensus be achieved?

Speaker 11

And if competition is the concern, are you getting ahead of Cagressema data due out soon? Thank you.

Speaker 1

That's a lot to unpack, Steve. I don't think we're going to speculate around a hypothetical demand curve, but maybe I think Patrick kind of touched on this in his first answer with regard to why we're doing DTC now, maybe just reiterate that point or briefly Patrick around.

Speaker 4

Yes. You know what, I think we are comparing a very different market, the first half of twenty twenty five versus the second half of twenty twenty five. We've faced some significant supply constraints and it wouldn't be responsible for us at that point in time to drive any major DTC investments and just provide consumers with a bad experience at the pharmacy level. We have much more confidence now in terms of the supply moving forward and this is not a demand issue problem. It's actually just a supply opportunity and we want to drive up that consumer awareness.

Speaker 4

So why we're doing extremely well, we just need to have in mind that the penetration in terms of obesity is just at the low single digit level 4% to 5%. And there is still a huge stigma. So whatever we can do here to drive patient activation is going to serve us very well moving forward.

Speaker 1

I would just add that actually unaided awareness for ZEPTOWN, although we're everyone on this call is highly aware of the brand name, is actually not very hot. And then we launched the drug almost a year ago and have done no advertising. So I think it is time to introduce the brand and so people are aware of that when they speak to their doctor. Great. Thank you.

Speaker 1

Paul, next question.

Operator

The next question will be from Dave Risinger from Leerink. Dave, your line is live.

Speaker 12

Yes, thanks very much. A number of my questions have been asked. So with respect to parisolumab, I'm hoping that you could just provide a little bit more color. You mentioned that it was dropped due to the benefit risk ratio, but did you see any specific safety problems? And what is your view of the opportunity to develop another PD-one agonist for INI disease in the future?

Speaker 12

Thank you.

Speaker 1

Thanks, Dave. And I was getting worried that Dan wouldn't get a chance to speak on the Q and A. So maybe I'll hand this over to Dan for his thoughts.

Speaker 3

Good. Thanks for your concern, Joe. Thanks for the good question, Dave. Yes, I mean, paracetamol was a really interesting mechanism for us and we were excited when we saw the Phase 2a data. It was a small number of patients, but had a relatively profound effect on RA symptoms, particularly in patients who had failed a previous biologic.

Speaker 3

So we sought out to replicate that in a larger Phase 2b study. Unfortunately, when we came to the end of that study, the benefit risk that we've seen in the Phase 2a study was not fully borne out in Phase 2b. So just based on the overall profile, which includes both the efficacy and the safety of the drug, we decided not to pursue that. As to your question on the follow on PD-one agonist, we don't have one that we're pursuing right now. So that's what I'll

Speaker 4

say about that.

Speaker 3

And I think, of course, we'll look forward to presenting this whole data package at a future meeting. Thanks, Steve.

Speaker 1

Thanks, Dan. Paul, next question.

Operator

The next question will be from Kerry Halford from Berenberg. Kerry, your line is live.

Speaker 13

Thank you very much. Kerry Halford from Berenberg. My question actually on the ZENIO, please. So your competitor in this space, Novartis, Kisqali, recently received a broad approval in early breast cancer, which obviously includes a high risk patient group. So I would just be interested to hear you speak about your expectations for market share evolution in that space, how you protect your position with VISENIO in a high risk setting?

Speaker 13

And then also if you can talk to the impact of IRA that you expect on that brand as you move through Part D reform next year And whether or not you expect the drug to be on the negotiation list for 2027? Thank you.

Speaker 1

Thanks, Carrie. Sort of a 2 part question, but I'm excited to ask Jake to chime in and maybe talk about presenting on the potential Kaskali impact as well as IRA. Jake?

Speaker 14

Yes, happy to take it. Thanks for the question. Our position and expectation here around market share with respect to the adjuvant setting for PROSENIO versus Kisqali hasn't really changed sort of preapproval versus now. I think we have a very robust clinical data package with a lot of follow-up on our data set, which is critically important for prescribers and a 2 year regimen where patients can finish their adjuvant therapy and move on with their life, hopefully remaining recurrence free. That's a pretty compelling proposition.

Speaker 14

It has been and I think is recognized as such in a variety of treatment guidelines that for the high risk population, the Monarch E patient population, prefer Verzenio over Kynsgalya standard of care. That's those expert guidelines have weighed in over the past couple of months. I don't expect that to change materially. Of course, with a new market entrant, the percentage of patients in this setting who get any CDK4six inhibitor as adjuvant therapy could go up and that would benefit us. And I expect that there will be some patients for whom KYSALI is a more appropriate choice, but I don't expect it to be a significant shift in our overall market dynamics.

Speaker 14

And of course, the node negative population is not where we're indicated and not where we're used and that's a story for them to tell. On the second part of your question around Part D reform, it will have an impact. Of course, there's a push and pull here on the amount we have to contribute for catastrophic coverage being a downside and of course, the co pay cap out of pocket cap on patients, particularly in Medicare, where that could be a tailwind on the brand. I think it's hard to know exactly where that will net out. It probably nets out sort of in the neutral range.

Speaker 14

I don't think it will end up being a headwind or a tailwind sort of in it in totality, but we have to see how that shakes out. On the last part of your question around negotiation list, I don't want to speculate on that. I don't think we have enough information yet given the evolving nature of all of the different medicines that could be up for negotiation to actually say one way or another which ones will be there just yet.

Speaker 1

Thank you, Jake. I know we're running short on time. So Paul, maybe just 2 or 3 more questions. Next question?

Operator

The next question will be from Chris Shibutani from Goldman Sachs. Chris, your line is live.

Speaker 15

Great. Thank you very much. Luca, welcome to these calls. Just curious, there's a little bit of a tension point between the thought of what the operating margins and I know Lilly uses very unique and specific precise calculus for that. With most people longer term forecasting at least amongst the sell side approaching high 40s percent and I believe some of your commentary suggested that perhaps that would not be where you would aim for.

Speaker 15

Can you just maybe clarify for us your view, your take on where you think the operating margin trajectory would go under your purview?

Speaker 1

Lucas, go ahead.

Speaker 2

Yes. Sorry. Thank you, Chris, for your question. And thank you for quoting me about this new ratio, the gross margin minus OpEx divided by revenue is quite a lengthy ratio. But just going to your question, in the short run, you see that we have grown our ratio in the last few quarters as we have been having this cycle of significant growth trajectory and we are starting to ramp up our investment both in SG and A and R and D.

Speaker 2

That effect will continue for sure for getting into the Q4 of the year that is including as part of our guidance. And what we expect to see moving into 2025 going into your question is, we do expect to ramp up our demand generation activities in SG and A that will pay down into 2025 as well as we will scale our R and D. We talk about some of the

Speaker 10

assets

Speaker 2

on our portfolio that moves into Phase 2 and Phase 3 that will continue to play out as we ramp up those investments to drive long term sustainable growth. So I would expect that in the short term, we continue to see some operating margin expansion on this ratio. In long term, again, we will continue to expand and drive sustainable growth that will then basically justify the investments that we do in SG and A and R and D.

Speaker 1

Thanks, Lucas. Next question?

Operator

The next question will be from Trung Huynh from UBS. Trung, your line is live.

Speaker 16

Hi, guys. Thanks for squeezing me in. So in your PR, you note favorable changes to estimates for rebates and discounts for Monjaro. If you ex on our numbers, if you ex out mid single digit destock, it does look like price has gone up for the year for that product. Also, ZEP bound pricing looks pretty stable.

Speaker 16

So perhaps can you just talk about what you see in pricing evolution for the rest of the year, but also next year as you'll have potentially sleep apnea and HF on the label, which may mean that you go into more government settings? Thank you.

Speaker 1

Lucas, if you'd like to talk kind of high level on any net pricing dynamics worth sharing?

Speaker 2

Yes, sure. And thank you for the questions. Going back to the Moncharo so far in the year, we kind of signaled throughout the year that once we were sunsetting last year, the co pay program that we had that we will see that basically tailwind on the price year on year comparison that played out as what we expected. And the sunset of course takes again a little bit of time to see that playing out. So you see a little bit of that spillover effect getting into Q3.

Speaker 2

Getting into Q4, we don't expect to see major dynamics on that and what we you're starting to see basically in Q3 is what we project into the Q4 of the year. Maybe getting into the strategy for sleep apnea indication, any comments that you would like to add, Patrick, on that front?

Speaker 4

No, I would just say in terms of step down, we are still very early on in launch. And I think you clarified the stability in pricing Q3 over Q2, Luca. What we need to have in mind is that we will continue to increase access. We will see launches outside of U. S.

Speaker 4

As well now with QuickFam being approved. That also can impact the global net pricing dynamics moving forward.

Speaker 1

Thanks both. Maybe last question Paul and then we'll wrap up.

Operator

The final question today will be from Courtney Breen from Bernstein. Courtney, your line is live.

Speaker 17

Hi, there. Thank you so much for the question and for squeezing me in. Coming back to obesity and perhaps looking a little longer term, you spoke to the ATTAIN, Maintain trial off the back of SIRMOUNT5. I know that for a focal point, this is placebo controlled. And so I just wanted to kind of get your thoughts on kind of that being the comparator.

Speaker 17

For us, kind of that being the comparator suggests that this is about kind of duration of treatment, expansion to patients, which would really be an expansion of the total market rather than kind of displacement of necessarily another obesity product. Can you just talk a little bit about or focal point and kind of the future of how this could expand the market?

Speaker 1

Thanks, Courtney, for the question on ORFO. Maybe I'll hand it to Patrick to talk about that and some of the commercial potential commercial strategy and the ATHENA maintain trial. Thank you for noticing that. Patrick,

Speaker 7

would you go, Patrick?

Speaker 4

Thank you very much, Courtney. We are looking forward to the readouts of the Orkfo Phase III trials next year 2025. But I think overall, we see a significant opportunity here. It's going to be the 1st oral if we deliver on the lines that we saw on Phase II with an efficacy along the lines of an injectable, along the lines of semaglutide. So I think that will really position us to escape globally.

Speaker 4

We are avoiding the cold chain requirements, etcetera. But also in the U. S, we see an opportunity to further penetrate because we know that even if the experience with the auto injector once you have tried it is really good, we know that there is a needle there in the marketplace that probably impacts 20% to 25% of the population. So I think there is a huge opportunity to expand. When you refer particularly to the attain, maintain, I think there is an obligation on our side to really better understand how can you best keep patients on treatment for a longer period of time knowing that obesity is a chronic disease.

Speaker 4

That's why we are leaning in on some of mine maintained to see what is the lowest efficacious dose that you can keep patients on during a longer time. And similarly, with attain, maintain. We don't expect a major shift on a by clinicians from injectables to autos. But I think this is one alternative to continue treat patients for the periods they need to be on medication, which is a chronic disease and we are doing whatever we can to improve adherence and improve patient outcomes.

Speaker 1

Great. All right. Thank you, Patrick. And I think we're wrapping up, Dave. Okay, great.

Speaker 1

Well, thanks for joining us today, everyone. I want to end the call by just thanking Joe Fletcher, who is moving on from his role as Head of IR to a new role, critical role of CFO of Manufacturing. I think you'll all agree Joe did a great job in representing Lilly to the Street over the last many years. And we welcome Mike Sippar into the role, returning to IR actually after various rotations in the business and it will be an exciting time ahead with Mike as your main point of contact. So thank you all for joining us today.

Speaker 1

And as usual, if you have follow-up questions, please give us a call at the IR team and look forward to seeing everyone on the road over the coming months. 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 p. M. Today running through December 4 at midnight.

Operator

You may access the replay system at any time by dialing 800-332-6854 and entering the access code 9,87,290.

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Earnings Conference Call
Eli Lilly and Company Q3 2024
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