Is it hard to acknowledge that we lost marketshare?

Um, it's not fun. It's 5 people that could have been on a GLP-1 that were losing weight, but at the same time protecting their heart, kidney and liver. Speed is a competitive advantage, but maybe more important than speed is clarity. What

role are GLP-1s playing in our lives five years from now?All right. Welcome to a new episode of Power Players. Really excited for my next guest, Novo Nordisk CEO Mike Dustar. Mike, good to see you, uh, in person. We're always used to talking to the company remote. You guys are overseas, so

good to be here. Thanks for having me.

Thanks for doing this. I can't believe it's been just over 1 year since you

got this job and 3 days. But

you're not new. You weren't new to the company.

No, I've been, I came as a 21-year-old, um, some 34 years ago. So, um, and, and did various different jobs. But yeah, I think, um,I actually never expected I'm going to sit at this chair, but um but it's been a fun one year and um and a challenging one, but, but an exciting one as well.

Did I read thatright that you started as an office clerk?

That's true. I was um working in the university at the at the reception of the university to pay for my college um courses and um and I was a little bit bored um and and and went to my graduate advisor.A little bit explaining how the whole thing is boring me and and surprisingly, he had just talked to someone else who knew about this company who needs an intern for summer making photocopies. There was no phone, there was no nothing. There was fax machines. So I, I went to the office of Novo Nordisky in Vienna.And walked in and I said, I heard that you guys need some help and I spent 3 months making photocopies, apparently some really good copies.

You just out of mymouth. I'm just going to ask you that. And you must have been really cracking those things out.

But, but you know, what, what attracted me to Novo from that very first day was, I was the youngest.Of course, the lowest level job. I was the most minority person in the office, but yet they brought me in and they treated me as an equal and that was really, really good and something that we are trying to retain all the way to here. I, I, I did the copying. The summer finished and I was really sad leaving that environment and atmosphere. But then I got lucky at um our receptionist basically broke her leg and she was going to be out for a few months and the copy machine was right next to the receptionist.So I raised my hand and I said, you know, can I, can I be the receptionist and um and and they gave me the job. I thought it was the biggest upgrade maybe to date because I got an office, a big telephone, um, and, and then continued doing that and eventually moved from there to finance department and then I was studying at nighttime.And I'm doing this um studying? I was studying marketing at American University in Vienna.

What was theNovo? I remember we, Yao Finance, I remember helping to write the story, awarded Novo, our Company of the Year award, maybe I think it was 3 years ago. And I remember at the time, um, we went into like the corporate culture. It's very different. What was Novo like back then and how are they? Talk to me a little about how they were so welcoming.

I, I, I think, you know, by the way, it's not so far from Novo today.Novo Nordisk unusually has gotten to this large size without a lot of mergers and acquisitions. Actually, there was one company called Nordisk. Eventually, a couple of brothers, um, employee number 2 and 3, they leave and and create a new company called Novo and for so many years, Novo and Nordisk, um, stemming from the same root competed with each other only for, um, in 1989 for the two companies to rejoin form Novo Nordisk. Why does that matter?It's a very homogeneous culture um that has been kept over years and years and years. Just, you know, I am the 6th CEO of the company in 103 years old, in 103 years. Um, yeah, I think there's like 12 popes or something during the same period. Um, so, so, so I would say it's a homogeneous culture around respect, care, integrity.UmPatient centricity, doing the right thing for for the customers and um and and then hopefully the money will follow. We were one of the first companies that talked about triple bottom line, that a stable and sustainable, durable business is not one that only thinks about finance and finance bottom line, financial bottom line.But one that thinks about the society, i.e. societal bottom line, and also the environment. So, and, and we need to be good at all three of those and the harmony between those three is eventually what gives us the license to operate over decades long.

How did you, you know, I think back to your story is very unique and I, I would compare it to uh former Walmart CEO Doug Millen, who started loading trucks in the back room. That's where he started at the company and look, I mean ultimately went on to lead.This giant company like Walmart and you know, hearing your story, how do you advance? How do you go fromOffice clerk to all these other spots from finance to leading overseas. Is this as simple as putting your hand up and saying yes to everything? No,

I would say a couple of things. Um, there were a number of times I didn't put my hands up and then I was trusted with jobs I got, which I'm very thankful. I, I think there's a couple of things. One, and, and, and this just reflects my own story. So, so it's not to say it's always the same, same path. But, um, I would say, um, I always focused.On my current job. I never wanted the next job, including the one I'm sitting in today.Um, youFeel blessed, you look outside and see how many people don't have what you have, and you say be thankful and just do a good job and earn your, you know, um, salary. Um, then the, the second thing was.By doing that,You also have to sometimes be lucky and happy that someone, a boss typically sees that and gives you the the chance and the promotion that instead of you all the time asking it.Um, and then the other thing I, I, I, I think has helped me is regardless of what I was doing, I was putting the benefits of the company as a whole and not, was not territorial per se. You know, I always felt like that my biggest risk is when the company fails and someone calls you and says, I'm sorry, as a company we're not doing well, you're doing great, but you have to be laid off. So, so I'll do my utmost to make sure.That my boss succeeds, my boss's boss succeeds, and ultimately the company succeeds, regardless of how low I was. And, and, and I do think that helped. And and then I've been really blessed by having phenomenal people, not being afraid of hiring people that are smarter than yourself, thinking that actually if they do a good job, you'll look good.Um, and, and then up until today, I, I am so happy that I work for a company that I walk at different corners of it that could be research, manufacturing, or the commercial organization and the back office people. There are incredible people with incredible energy, stamina, and sense of purpose that, that basically, you know, think.We're doing this for a purpose above and beyond just a salary and and that that is really good.

Is one of your superpowers that you brought to this CEO role that you had extensive and of course to do extensive knowledge of the overseas operations.

It's a good question. Um, I told a couple of investors actually just a day or two ago, um, that when I got the job a year ago,At least in the Danish media, there was a lot of articles about me being the first non-Danish CEO and what does that mean?I never thought about it that way. I actually feel like I've been so much and so long with Danes and Denmark that that I, you know, I I'm probably more Danes than people give me credit for it. But um, but I did think.Um, while that is not, you know, it should not be unusual. I mean, take a look at the CEO of, of, of Google, of Microsoft, of Novartis. I mean, they're they're all foreigners. What I thought is actually quite unusual is that they gave me the job after 34 years not having worked in headquarters. You find me one CEO of any company of a certain size.That has been appointed internally and has never worked at that company's headquarter. I do not think you will find a single one.Um,

so you were likean insider but an outsider at the sametime.

I think that was the reason. I think they wanted an insider, but an outsider because I think you probably you can reflect on it that every company's headquarters is somehow has a bit of a different nuance to it than when you're out there with the customers, with the competitors, um, and then and basically smelling the flowers on, on, on daily basis. I think the company felt at this moment.We could benefit from someone who comes in, does not change the DNA of the company, but brings in the speed, customer centricity that exists more likely.On the on the boundary of the circle rather than the center of it. And that's what I have, you know, tried to do.

You know, this is uh, of course, Novo is a much larger company than uh dating back to 1992. It's it's a larger company. So that, that first day, CEO officially, what do you do on day one? And what were your 1st 90 days like?

SoGetting into the job, I, um.First, it was, it was a daunting task, and, and I think I, um, I certainly didn't want to mess it up as the first non-De. um, but I also reflected what can I actually do that I haven't been doing or thinking about.Um, the last 30+ years. I, I was a member of the executive team. I was running international operations for 10 years in many ways in the room when some of the decisions that were made for good or bad. So what am I going to do different? I, um, I felt like, you know, I need to bring commercial execution.And speedTo the operation through the value chain. I, um, I think when you live in a world that's moving really fast, and I think we will agree that it is moving really fast compared to 92.Um, speed is a competitive advantage.But maybe more important than speed, I also learned throughout the last year.Is clarityI have come across many people in the company that can run incredibly fast.When it's clear to them where they're running, thoughts, which direction they need to go. So when you give them the direction, people can really run fast and that clarity is something I've been trying to bring. Try to explain how we can first and foremost turn some of the lost market share around.But also what is coming next. Ozempic was great. Vigovi is fantastic. What happens next? Build a future for decades long after I'm gone.Um, and, and do that across the value chain, regardless if you're a scientist, a manufacturing person or a supporter of whatever function that you may have is what I've been trying to do and I've been incredibly, um, it's, it's, it's one year, it's early innings still, but I've been really happy with what I see.

You know, as someone that has, you know, been in the company for a while, was on the executive team, um, major player in international operations. Is it hard toAcknowledge that like you just did, we lost market share, especially at a company as proud as Novo.

I would say um it's not fun. It's um it's, it's not fun for two reasons. One,You proudly want, you, you're very proud of your products. You would want as many people as you can on those medications. You're also convicted, uh, convinced that um,That you have the better product. Maybe you're subjective, but I am convinced we have the better products. Um, so, so you would want as many people.On those products as possible, market share loss for me is not a numerical, graphical.Picture, it's 5 people that could have been on a GLP-1 that were losing weight, but at the same time protecting their heart, kidney and liver.That todayAre on a competing drug that is making them lose weight, but doesn't have the liver, kidney, and um and and and the cardiovascular benefits that would have otherwise have happened. That makes me sad a bit. And then you feel like it is what it is, we need to now look forward rather than backwards, what went wrong, we improve what went right, we'll continue to do. So, so, so that's a little bit how I look at it, um, I would say. On the other hand,As a publicly traded company, when you, your market uh cap goes down, you think aboutThe people that you've lost their money, they could be institutional, rich institutions thatAlso matters, but it could also be back home in Denmark, an individual who whose pension was connected to a fund that was connected to our share and now is suffering from that as well. That's also something that I take incredibly serious. It's not because of the financial element of it per se only, but we would like to leave a world better behind for that pensioners or for that patient.Um, and, and all of those comes with, um, the headwinds that we have seen a bit.

How do you?How do you regain market share?

By, by doing a couple of things. First, we work in an industry where innovation is, is, um, is, is your future fuel.We need to continue innovating. I am incredibly proud of what Novo Nordisk has done with the introduction of the GLP1s and um and and giving a voice to a billion people who are suffering from obesity and no one cared for my company to basically way before there was money, way before there was financial benefits, come in, innovate.And provide these medications and attract a number of competitors into um into the space to, to echo your voice, um, is a very proud moment that I would love to set the platform and the and the foundation for it to continue over a number of decades to come. So, so we can, we can, we can continue this, this success. What I um.What I think we basically need to do short term.I become better in execution. That's where I bring in to the, to the to the business as a as a muscle memory. To think about the product at hand, to think about how we can um tell our story of why this product is better.More assertively.To segment and target the right audience for our products. For some people, our product might not be the best. That's fine. Go after basically in an honest way, those that um that that can can see the benefits in this and quarter by quarter continue the energy and the pace and the speed.To show a bit of a moment and and gain the trust back of the society while your other team is innovating for the next generation of products to come.

Why do you thinkYou know, some of your competitors have been able to take market share. How do you convince the population out there that your product is better?

We were a little bit ahead of our time. When we came with um Ozempic and Vigovi to the market. For Vigovi, our slogan was Beyond weight.We told the world that um how much weight you lose is secondary to the gain that you get from um risk reduction of your heart attack, stroke.Kidney disease, liver diseases, and so on and so forth.We still believe in that, butThe world was not ready for it as much as we thought they wanted the magnitude of weight loss.As the primary reason.When you come 2nd to market as our competitor did, it's easier to look at the flaws.And uh and improve and adjust it. We have a lot of respect for um Eli Lilly and we have competed with one another for 100 years and we've made each other better over any given decade. They did something and we looked and we learned and did it better. We did something, they learned and made it better. So they brought a product to the market um that provided 21, 22% weight loss.While the current version of ours at the time was 15, 16%. And people felt a 21% weight loss, that's the next generation of the product and it's the better version of it. So, that's the one I want and um and that led into our market loss.Meanwhile, what we did after I got the job, we decided to introduce actually the higher dose of VOV, VOV HD we call it, VOV high dose. That's a 7.2 mg of the same product, bringing the weight efficacy exactly on par with our competitor. Now, we have a bigger license.To speak to heart, kidney, liver, because all of a sudden people see those benefits as an add-on, almost a freebie.And um and then we're seeing, it's early start of an attraction and um and um and a dialogue that why should I actually not get the product that does the weight loss, in addition, gives me the health benefits. So it's it's a learning, frankly speaking. And then what we have done incredibly well, we have introduced this in a pill format.And the VigoV pill today takes 9 out of 10 patients that want a pill. One only goes to my competitors, competing pill.And, and, and a lot of the learnings has gone into that launch that we just did, um, a very efficacious drug, 17% weight loss, plus all the benefits of the cardiovascular benefits that I just mentioned.Um, and lack of restrictions that the competing product has. So, so if you're on the competing product, you have to, for example, think about your birth control pill. You have to think about the statins that you're taking or maybe the hypertension drugs that you're taking, and it's quite complicated for people to be aware of all those different restrictions. With my product, you don't have any of those restrictions. So we have created a situation where 6 months into the launch,We just announced 5 million prescriptions. To put that in perspective for you, that's the best product launch of any pharmaceutical company to date in volume. So, it's, it's, you know, it's hard work, but I'm, I'm optimistic today.

I think

it

was, was one of these Goldman notes I was reading. They acknowledge, I mean, the numbers, the uptake on the pill has been, has been strong, but I think some of the industry, they want to see more uptake. Are there, are there barriers that you're seeing?Holding back the pill because to me it seems like a really good piece of innovation.

Look, I think most people, including probably Goldman will tell you 90% market share is a pretty good one. where I think sometimes the market is always right, but where the market sometimes is, is, is they're too impatient. Um, obviously the uptake, if you can continue like this.Brings with it a very bright future, no doubt about it. One can do the math on that. Um, 6 months into it.The numbers are what they are. You could not do what you usually are able to do in 2356 years into 6 months. But uh I would say, um, as I tell the investors, I work together with um 70,000 other people out there, incredibly hard, quarter by quarter to improve the results and gain some trust back. But we're building the company for decades to come.And we are patient, perhaps sometimes more than the market in terms of we're in the right track, we're doing the right thing at the right speed. Let's just not get tired and continue.

Where do you see?What role are GLP-1s playing in our lives five years from now?

Much bigger than we think today and much and not much different than what has happened today compared to 5 years back. These products were meant initially to treat diabetes.Um, and then of course, people saw the weight loss reductions and they became a product of choice for obesity treatment.As millions of people have started to use them, you can read and see patient testaments about many other improvements, conditions. People take these products and they say, my skin feels better. They um they all of a sudden their alcohol addiction also goes away together with the food noise that they used to have. Um, they're seeing a lot of benefits related to fertility, pre-menopausal.Um, symptoms that they used to have. So, it's a vast area that one can imagine can be helped and supported by this. The, the, the theory and the, the explanation behind it that they are.Having um benefits for inflammation, they're reducing the level of the inflammation in the body and we do know that inflammation is the cause of many, many other conditions. Of course, in our own case, as I mentioned, we did some vast clinical studies proving that even before you lose weight, so if you take VigoV, 2 weeks after it, you have not lost weight yet.Your heart starts to show improvement. The risk of the heart attack, the risk of stroke, kidney diseases, fatty liver starts to improve irregardless, regardless of the magnitude of the weight loss.So, so that's quite powerful and speaks toThe molecule. I also have to say, I think 5 years from now, there'll be much better understandings that GLP-1s are not GLP-1s, that amylins are not amylins, that GIP is not GIP. They all do something similar, reduce weight to some extent.But that's where maybe the similarity ends. We've seen our competitor has tried really hard to get some of the cardiovascular benefits that we have into their label. They did a, you know, a fantastic long um trial, but unfortunately they were not able to prove the same way. It has something to do with the secret sauce of the molecule.And and I think right now, everyone treats these categories as GLP one, just another peptide.There will be much better understanding of the differences and nuances of these differences and why we should use certain ones for this condition and other ones for other conditions,

I think. Is there a next, you know, I look at the, I really, I didn't realize about the shot and GLP one until I really started covering Novo years ago. Then the pill. Is there another breakthrough innovation like that as it pertains to GLP one? So,

so, so I think um right now, of course, as you see with our competitors product, they are mixing um,Uh, the GLP-1 with something else called GIP, we are, um, hopefully soon introducing, uh, a new drug, it's called Carisema that takes semaglatite, so the molecule of VOV and adds amylin to it.That will give you some additional benefits from the biology of amylin. There are in the works already products that have 3 different things inside, so GLP, GIP, glucagon, our competitor is working on that. We have our own version of that. We have a version again with amylin, GIP GLP-1. This combination therapies hitting various different receptors seems to actually have additive benefits.And um and then there's a lot of, um, I would say scientific activities around those.

I'm going to try to make this tie in. So I talked to a lot of food executives and and they tell me, we have not seen an impact yet. They sell snacks, hotdogs, whatever it is. We have not seen an impact yet of GLP ones. What are they missing? Because uh you are selling these products. I see more people than I know taking them. And I think a lot of those folks are underestimating the long-term impact.

Yeah. So, so, so again, it's a little bit like the question on the market.That they they could be right, but there's a timing effect here. Today, um, we have around 110 million people suffering from obesity in the United States. Um, approximately 1520 million of those are on our GLP-1, um, and our competitors' GLP1s and all the compounders and what have you that exists. So, a small fraction of the people, globally, I would say.We have 25 million, you know, um, individuals that are maybe are on a GLP-1 product.25 million people are a lot of people from a medicine point of view and something that became available just a few years back. But compared to all the people who eat unhealthy food and you know, compared to the number of the customers, those CEOs that you speak to, still a fraction.That could be the reason why this is, this is, this is not yet showing itself up. It's quite interesting because um when uh when Ozempic was doing as it was, it was impacting the airlines. Yeah, the airlines were getting, you know, their, their, their share price um positively impacted by the notion thatThey're carrying less weight and less fuel and um no, absolutely not. Come on. So when you think about how many people fly per day, and you think, you think about how many people are on these products, it's a long way before, you know, we, we will, we will help. But the market likes um to, to take, you know, their hand from one stock to another and and do their work and then I think there were other, other things at at play.Um,

I'm sure you're watching the, the peptides debate in the United States and I look, I know folks in my universe that have to take these, um.At what point did it become mainstream? I, I still feel as though there's like a, you know, black market for these things. There's no other way to put it. Like I can't go to like, let's say Amazon per se and buy safe

peptides. And thank God for that, by the way. Yes, yes. I'm not

saying,yeah, I'm yeah, yes,

exactly. That's correct. No, but, um, but, but let me, let me tell you, so it's quite funny. You talked about my tenure at Novo 34 years and so on for pretty much, you know, um, all of that starting from when I was photocopying, um.I would tell people we are the biggest peptide company in the world back then and then people had no clue what peptide is. So, so Novo is one of the first peptide companies in the world because insulin, which we created um um and and and started selling, we didn't create the insulin, but we started selling it 103 years ago, was one of the first peptides.Today, we are the only company in the world that has a peptide in a pill, by the way. So, so we go with pill is the only peptide in a pill. Also why it's powerful. Coming back to all the other pills, they're small molecules, they're chemically induced, and that's also why that they are not, you know, at this point reaching the potency of Vigovi pill. But um,There are so many of these peptides out there that unlike VOV pill, unlike our insulins, are not tested. They have not gone through clinical trials. At best, maybe there are some animal studies and people have seen how they have behaved in a rat or a mouse, but not a human.It's really good that our industry is regulated.Because medicines can have severe side effects. Medicine, you know, can kill if misused.So this is not like going and buying a fake Gucci bag. It has serious consequences.

From whatyou see out there is this, is this safe?

They havenot been tested. So, so the the answer from from my side is I have no clue and for sure I don't want to take the risk on myself.Maybe they have benefits, maybe they have risks, maybe they don't, but why would you take such a big gamble and bet?With your body, with your health, um, I see, of course, a lot of people are influenced by influencers and others. I want the people to think a little bit more, not just about the benefits of them, which the influencers often talked about, talk about, but also the risks and outweigh the risks versus the benefits. I would not think for me.This is worth it. Now, well I think that sometimes in the future, some of these, you know, molecules and some of these peptides should be tested properly by um by companies and go through um FDA and regulations that we are obliged to to to to deliver to. Absolutely, that's fine. If there's a market for it, if there's a need, let's test them. Let's, you know, file them, let's, you know, put the safe version of them out there.But let's not, you know, gamble with our

safety. That'sreally, um, it's well said. Um, Lastly, you know, early next decade.What is it like the patent cliff comes home to Novo. Is there a way to just prevent going off that cliff and just staying full steam ahead? Like, do you have to have, do you have to make an acquisition? Do you have to have a breakthrough new product? How do you overcome that? Yeah,

a couple of different things I would say. First, I would like to see a future after patent cliff where majority of semaglatite sold is sold by Novo Nordisk. Today, Novo.Is the biggest generic insulin maker in the world. While, just this week actually, we launched our most innovative insulin, weekly insulin called a weekly here in in US. I'm very proud of this um this this um this strategy that we're able to bring innovation at higher prices um to to the market ahead of everyone else, but at the same time be there for the masses.With the generic size, more affordable versions of the, you know, of the of the same molecules. So, so, so that I hope we can also replicate when it comes to GLP ones. I do think we have the manufacturing capabilities and the know-how and the brand recognition that hopefully allows us to continue that. But that is the so-called volume part of the game.That is something we need to do for societal um responsibility rather than necessarily generating a lot of um um financial benefits from it. What we need to do is at the same time, continue innovating, continue bringing um different types of medications at different price points and and and make sure that we are covering that gap. And that's exactly what we're working at. As I mentioned, we'll be the first company with the amylin biology next year coming to the market again, first.Um, we currently have, um, versions of the drug that is only actually, um, Amylin has less efficacy, but much, much lower side effects. There's a group of people, at least in my own family, that says I don't want to lose 30, 40, 50 pounds. I want to lose 10 pounds, but I also don't want the nausea. I don't want the vomiting.That's a perfect group for that drug. We have the so-called triple agonists, so GLP, GIP, and glucagon and GLP, GIP, amylin, so two different products that before the end of the decade, hopefully will come to the market, high efficacy and different types of populations again. We have a drug I'm incredibly proud of. If it makes it to the market, I will be very happy. It's called efroxiformin.And this is a drug for people that have fatty liver, late stage fatty liver.For these people, the option is unfortunately death or liver transplant. If the data shows, as we hope it will.Then uh they might not need to get a liver transplant. That the molecule helps their liver go back to, you know, uh previous um uh status.How wonderful would that be, right? Um, and then of course we have outside of obesity in our diabetes franchises, in our rare blood disorders.Also a number of exciting um pipeline products. That's what we have. At the same time, I tell my team,We don't have a monopoly of good ideas.So, let's be humble and see who who else has something that's either better than what we have ourselves to fill the gap or earlier than us can be launched. So, so, so we're also looking into partnerships, acquisitions and trying to basically see where else we could um um um complement.All the good things we have on our own.

Good to see you settle into this role. Uh, I think your story is absolutely phenomenal. Look forward to following your CEO journey now. Thank you for doing this. Thanks

for having me here. I appreciate

it. All right, that's it for the latest episode of Power Players.