Novartis - Earnings Call - Q1 2025
April 29, 2025
Transcript
Operator (participant)
Good morning and good afternoon, and welcome to the Novartis Q1 2025 results release conference call and live webcast. Please note that during the presentation, all participants will be in a listen-only mode, and the conference is being recorded. After the presentation, there will be an opportunity to ask questions by pressing star 11 at any time during the conference. Please limit yourself to one question and return to the queue for any follow-ups. A recording of the conference call, including the Q&A session, will be available on our website shortly after the call ends. With that, I would like to hand over to Ms. Sloan Simpson, Head of Investor Relations. Please go ahead, Madam.
Sloan Simpson (Head of Investor Relations)
Thank you, Heidi. Good morning and good afternoon, everyone, and welcome to our Q1 2025 earnings call. The information presented today contains forward-looking statements that involve known and unknown risks, uncertainties, and other factors. These may cause actual results to be materially different from any future results, performance, or achievements expressed or implied by such statements. For a description of some of these factors, please refer to the company's Form 20Fs and its most recent quarterly results on Form 6-K that respectively were filed with and furnished to the U.S. Securities and Exchange Commission. Before we get started, I just want to reiterate Heidi's guidance for our analysts. Please limit yourselves to one question at a time, and we'll cycle through the queue as many times as we can. With that, I will hand over to Vas.
Vasant Narasimhan (CEO)
Thank you, Sloan. Thank you, everyone, for joining today's conference call. If we could move forward to slide four, Novartis delivered double-digit sales growth in the quarter, a really strong start to the year. We had robust margin expansion, and that all supported an upgrade to our full year 2025 guidance, which Harry will go through in more detail. Sales were up 15%, core operating income up 27%, our core margin reached 42.1%, up 400 basis points. We also had important innovation highlights in the quarter, some of which I'll go through in detail in a moment. Pluvicto, Vafseo, and Fabhalta all achieved approvals in their relevant indications. We had a global submission for Remibrutinib in CSU, and our OAV101 IT gene therapy for patients with SMA older than two years of age had a positive readout and we're in process now of filing that globally.
Taken together, a very strong start to the year. Going into a little bit more detail, starting on slide five, we had strong growth momentum from all of our priority brands in the quarter. I think that really demonstrates the replacement power, which gives us confidence in our midterm guide of 5% plus and also our confidence that we have the levers that we need to continue to grow into the 2030s. You can see strong growth of 32% constant currency, excluding Entresto, the portfolio was up 38%. I wanted to go through on each of these key brands some of the key highlights. Moving to slide six. Kisqali grew 56% in constant currency, and that reflects our positioning globally, reflects our positioning as the preferred CDK4/6 inhibitor in both metastatic and early breast cancer.
You can see that the growth was strong both outside of the United States and in the U.S. I'll go through that in a bit more detail in a moment. In the central panel, you can see that our total brand NBRX now is market-leading, trending very strongly, really powered by the early breast cancer launch, which is leading to strong performance both in early breast cancer and in metastatic breast cancer. Now, turning to each region, in the U.S., we were up 87% in the quarter. We have a leading share in metastatic NBRX now at 48%. We are also now tied for TRX leadership, really demonstrating now those NBRXs are impacting our TRX growth. In early breast cancer, our NBRX grew 65%, and we've reached a 60% NBRX share.
What is important to note here is 56% of that volume we estimate is from the population that is exclusive to the Kisqali label. Now, outside of the U.S., we are still in the early stages of the early breast cancer launch. We were up 24% in constant currency. We are the metastatic breast cancer leader in 10 of our top countries with 46% share, our NBRX share at 35%, TRX share, and our early breast cancer indication has now improved in the EU plus nine other countries. I think you all will know we have strong guideline support with category one and NCCN guidelines, and we have also achieved very strong guidelines as well with ESMO. Overall, really pleased with the performance of Kisqali as it continues to grow towards our peak sales guidance of $8 billion plus. Now, moving to slide seven, Kisimpta grew 43% in constant currency.
It's outpacing both the B-cell and MS market. Our overall sales were robust both in the U.S. and ex-U.S. markets. In the U.S., 41% TRX growth. We're outpacing the B-cell and MS markets, as I mentioned, in the U.S. Outside of the U.S., we have leading NBRX share in eight out of ten major markets, really reflecting the ease of use of the medicine. We continue to generate further long-term data to support the profile of Kisimpta. Seven-year data was presented at AAN, which reinforced the benefit-risk profile of the medicine. As a reminder, we continue to believe the profile of Kisimpta with convenient at-home self-administration makes it the preferred medicine for patients who don't want to have IV administration at a doctor's office. I think that really positions us well outside the U.S. and in a large segment inside the U.S.
where there continues to be robust growth of B-cell therapies, which we plan to participate in. Now, moving to slide eight, Pluvicto grew 21% in quarter I. Most importantly for us, we laid the foundation, continue to lay the foundation for our pre-taxane launch with the PSMAfore population. When you look at some of the dynamics for Pluvicto, first, with the post-taxane setting, we have now leading NBRX share in the first-line VISION population setting, so post-taxane at 40%. This, I think, really demonstrates that we are getting strongly established in this post-taxane population. When you look at some of the momentum we're seeing, we're seeing that we are gaining traction in the community setting with 4,000 TRXs. That's 11% up from prior year. We also see overall, I'd say, encouraging signs that more and more community practices want to take on radioligand therapies.
Outside of the U.S., we see continuous growth driven primarily by European markets, which are increasingly adopting RLT and also with improved pricing that we're seeing in key markets, and now with expansion in over 20-plus countries. Most importantly for this brand, we had the March FDA approval of the PSMAfore population, the pre-taxane population. As a reminder, Pluvicto doubled the median PFS and had a very favorable safety profile versus a daily oral ARPI. The final OS analysis for the medicine when unadjusted for crossover was 0.91, but importantly, crossover adjusted was 0.59. That has been very well received in the community. We already have NCCN guideline support for the use of Pluvicto in this setting. We're also continuing to advance our Pluvicto lifecycle management efforts. The PSMAaddition readout is on track for the second half of 2025.
As a reminder, the PSMAaddition incidence is similar to that we see in the pre-taxane setting. Moving to slide nine, just a little bit more on our preparations for the PSMAforelaunch in the U.S. We have a strong foundation in place, 620 sites opened, large population now that we've expanded into. A prefilled syringe that's enabling broad adoption is now nationally launched. 50% of PSMAfore patients are treated by HCPs who have already prescribed in the VISION population. We're also continuing to increase and have increased our promotional spend. We've doubled our field force and are maintaining a very robust direct-to-consumer advertising campaign.
Now, in terms of the launch dynamics we expect to see, it would take about four to seven weeks of lead time for new patients to be treated for them to get the necessary scans as well as the necessary laboratory tests to be able to receive the medicine. We expect initial uptake to be driven by depth in our established accounts in the vision setting. We also expect to over time expand our breadth in the community and urology setting. As I mentioned, we also have the favorable NCCN guidelines. I think set up well, this will really be a second-half story. Really, in the next few months, we want to ensure we start to build the momentum that will allow this brand now to break through past the $2 billion mark and then forward to the $4 billion plus guidance that we've given.
Now, moving to slide 10, Leqvio grew 72% in the quarter, on track to achieve blockbuster status. We have this steady march upwards that we're very pleased with. We're seeing solid growth both in the U.S. and ex-U.S. We see a steady climb in monthly TRXs. It's 70% up versus prior year, and that's growth across all of the key channels we're targeting. We're also seeing increasing depth in the priority systems that we're trying to establish the medicine. That's up 51% versus prior year. We've also evolved our field operating model to better serve physicians and systems that would like to use Leqvio to manage their patients to goal for cholesterol lowering. Outside of the U.S., we're seeing robust growth across our key markets, 74% growth.
I would want to highlight the solid pricing and access we've secured in Japan, as well as the continued out-of-pocket expansion we're seeing in China, which I think bodes well for the future of this medicine in Asia. We know there's a significant runway ahead of us. Only about 2% of secondary prevention patients receive any advanced lipid-lowering therapy. There's increasing guideline recommendations that recommend these patients receive advanced lipid-lowering therapy. A big market opportunity and step-by-step, we're on track to fully realize the potential of this medicine. Now, moving to slide 11. Now, Scemblix, as you know, has established itself as a leader in the third-line plus setting. Now our focus has switched to really establishing the medicine in earlier lines given our recent approvals. In the third-line setting, we are up at 54% NBRX share.
We're three times higher than the next competitor, reflecting the excellent profile of Scemblix. Outside of the U.S., in key markets, 68% in Japan and 47% in Germany for NBRX share and an overall share of 47%. I think really well positioned now in the third-line setting. Our focus has shifted to driving our performance in earlier lines. We see continued momentum in the U.S. We have a very strong start building off the NCCN guidelines for a category one preferred recommendation. We have 54% of commercial lives covered now to label. We're seeing expanding prescriber drafts, 16% versus prior quarter, and a strong uptake in second line where we've already achieved 40% share and steady progress as well in first line where we have 10% NBRX share.
As a reminder, we are, of course, working against generic imatinib and generic second-generation TKIs, but we feel confident that step by step we'll continue to be able to take significant share from those medicines. Our early line approvals are on track globally. We have already approval in 10 countries, and our submission is now completed in Europe. Moving to slide 12 and turning to Cosentyx. Cosentyx grew 18% on the quarter. It was driven by both our launches in HS and IV, but also importantly, very good performance in our core indications. In the U.S., we saw strong demand growth, 29%, more than offsetting the expected impact of the Part D redesign. Our NBRX volume is outperforming the market in our core indications, 15% versus the market in psoriasis, 12% in the spondyloarthropathies.
We also have continued NBRX leadership in HS at 53%, even in the face of a new competitor entry. When you look at the IV formulation, we have 1,900 accounts using the medicine. That's a 13% growth. I think it's still early stages for the IV launch, but we're confident that step by step, now that we have the relevant reimbursement and support in place, the IV launch can also accelerate over the years to come. Outside the U.S., we delivered 15% volume growth, mainly in the core indications. We're the leading originator biologic now in Europe and China. We've also achieved HS reimbursement across our key markets. Taken together, we're confident in continued growth. We are on track to get the phase three readouts in both GCA and PMR, and we're also well prepared to launch in those indications when and if approved.
Now, moving to slide 13. Now turning to Entresto, which continues to have strong performance at 22% growth. You can see here on the quarter reaching over $2.2 billion in global sales. We expect continued growth in the U.S. up until LOE, and we continue to guide to a mid-2025 LOE, we can get into that in more detail on the call. In terms of outside the U.S., we have a very strong guideline position. We have balanced geographic sales with 50% of our sales outside of the U.S. We expect RDP protection in Europe to November 2026. Of course, we will continue to pursue other avenues to fully protect the medicine in Europe. June 2030 in Japan with possible additional protections as well. I would say that the hypertension indication is performing extremely well in China and Japan.
The possibility for that to drive our growth towards through the end of the decade is something we'll continue to remain focused on. Now, moving to slide 14. I did want to say a word about our renal portfolio. As you know, we've been building out a strong renal portfolio around the globe. We have the ongoing launch now of Fabhalta and the recent approval of Vafseo. When you look at Fabhalta, our IgAN, we've already seen 100% volume growth and 60% increase in writers versus the prior quarter. I think that reflects the excitement around the impact the medicine could have for these patients. We have over 90% of patients remaining on treatment out at five months. We have 68% commercial coverage to label. In C3G, while we're only approved in March, we already see positive signs over 2,000 physicians are REMS certified.
That is applicable across both indications. Now, Vafseo was approved by FDA in April. Once a day, non-steroidal oral treatment. What is exciting about this medicine is from an efficacy standpoint, it can be seamlessly added on to existing RAS inhibitors that a patient may be on without any discontinuation needed. Also importantly, there was no REMS for the label for hepatotoxicity or pregnancy. A nice clean label as well, which was the business case for this medicine. We really have now a safe, effective oral medicine to be given for the management of the endothelium in the kidney with this medicine. Overall, we are driving strong synergies across this portfolio, and our aspiration will be to continue to build out the strength of our renal pipeline to really ensure we can establish ourselves as a long-term renal leader. Now, moving to slide 15.
I didn't want to say a word about the OAV101 IT gene therapy readout that we had in the quarter. Looking at the left-hand part of the slide, you can see the primary endpoint was achieved in patients 2-18 years of age. I wanted to focus in on the patients 5-18 years of age, particularly given that Zolgensma has been in the market for some period of time. The treatment effect versus placebo of 2.45 is really very strong, and I think differentiating versus the competition and positions us well, we believe, to get both hopefully the approval and ultimately payer support for the use of this one-time therapy in patients 5-18 years of age. We are excited about the STEER and STRONG studies, the overall favorable safety profile we've been able to deliver with the medicine.
As I mentioned, we're on track for global regulatory submissions over the course of the first half of 2025. Now, moving to the next slide. Also from a clinical data standpoint, we did have long-term data on Remibrutinib in CSU, which we think further supports the differentiated profile of the medicine. Strong efficacy was maintained out to 52 weeks, even as the placebo group crossed over onto active 25 milligrams b.i.d. You can see that we had meaningful improvements in symptom control across all measures. I think really importantly, that symptom control starts as early as week one in a highly symptomatic disease where itch can lead to disruption in quality of life, in quality of sleep. Patients want something that will hopefully impact their disease very soon after initiating a therapy. We also had a very favorable safety profile in the data set, including balanced LFTs.
I can say that in our mid-cycle review, we did not receive any questions from the FDA with respect to the liver profile of the medicine. I think in CSU, that bodes well for the profile of Remibrutinib. We continue to achieve our key milestones. We had the New England Journal of Medicine publication. We have completed submissions now in the U.S., EU, and China. We have initiated a head-to-head study versus dupilumab with a readout expected in 2027, where we will focus very much on the speed of onset of action of Remibrutinib. We continue to advance a full range of indications. Our phase three in chronic inducible urticaria is ongoing and targeted for a 2026 submission. We have initiated our HS phase three study. We also have phase 2A B studies ongoing for food allergy with a readout expected in the second half of this year.
As you all know, at a higher dose, we also are looking at in neuroscience at relapsing MS as well as myasthenia gravis. The next milestone for us will be an FDA decision on CSU in the second half of the year. Moving to slide 17, taking it all together, we're on track for our innovation milestones for the year. We'll continue to keep you updated as we continue to get readouts. Importantly as well, the progress on our early and mid-stage pipeline, which we believe will generate the replacement power to enable us to grow strongly into the next decade. With that, I'll hand it over to Harry.
Harry Kirsch (CFO)
Thank you, Vas. Good morning. Good afternoon, everybody. I will now talk you through our financials for the first quarter, which reflect a very strong start to the year.
As always, my comments refer to growth rates in constant currencies unless otherwise noted. Starting on page number 19, net sales grew 15% in quarter one versus prior year and core operating income grew 27%. Our core margin was 42%, reflecting a 400 basis points improvement driven by the excellent sales growth and good cost management. Core earnings per share was $2.28, up 31%, and free cash flow was $3.4 billion. Just to note, gross-to-net favorability, mainly in the U.S., added about 2% points to growth in quarter one from gross-to-net true ups based on invoices related to prior quarters in 2024. The underlying growth in quarter I was still a very strong 13%. On the next slide, just a short focus on free cash flow, which was up 66% in U.S. dollars.
This is, of course, a continued area of focus for us. Our very strong ability to turn excellent cooperating income growth into great free cash flow provides, of course, ample capacity to reinvest in the business, pursue bolt-on deals, and return capital to shareholders via growing dividends and share buybacks. Speaking of capital allocation, next slide, please. We remain committed to our shareholder-friendly capital allocation strategy, which optimizes both investing in the business and returning capital to shareholders. We continue to invest in R&D and CapEx and pursue, of course, also value-creating bolt-on M&A and BD&L deals. For example, we recently announced a five-year, $23 billion investment into our U.S.-based manufacturing and R&D footprint. We also closed the acquisition of Anthos Therapeutics in April.
In terms of returning capital shareholders, we paid $7.8 billion in dividends in March and April of this year and continued our up to $15 billion share buyback in quarter one, which has approximately $2.7 billion left to be executed over the next months. Moving to slide 22. Our continued strong business momentum, combined with the gross-to-net favorability, mainly in the U.S., allowed us to raise our full-year guidance to the upper end of the prior provided range for both top and bottom line. We now expect sales to grow high single digit up from mid to high single digit. We expect cooperating income to grow low double digit up from high single to low double digit. Embedded in our guidance is the continued financial planning assumption that Tasigna, Promacta, and Entresto would have U.S. generic entries occurring mid of this year.
To complete our full-year guidance, please note that we continue to expect core net financial expenses to be around $1 billion and our core tax rate to be in the range of 16%-16.5%. No change versus what we said end of January. Now to my final slide already, where we have outlined details regarding the expected currency impact. If late April rates would prevail for the remainder of 2025, we would expect the full-year currency impact to be neutral on net sales and negative 2 percentage points on core operating income. As a reminder, we provide an estimated impact of exchange rates on our results on a monthly base on our website, which I hope is useful to you, especially in times of a bit more volatility lately. With that, back to Vas.
Vasant Narasimhan (CEO)
Thank you, Harry.
In conclusion, on slide 25, strong start to the year with double-digit sales growth, robust core margin expansion, strong core operating income growth, strong free cash flow generation. Given that strong start, we've upgraded our guidance for the full year. I think importantly, significant pipeline progress in quarter one. We had three new approvals in the span of three weeks that we believe can generate important growth for the company. We remain confident, even with the uncertainties of the geopolitical environment, in achieving our mid to long-term growth outlook as we've outlined previously. With that, I think we can open the volume for questions.
Operator (participant)
Thank you. As a reminder, to ask a question, you will need to press star one, on on your telephone and wait for your name to be announced. To withdraw your question, please press star one, one again.
We will take our first question. Your first question comes from the line of Simon Baker from Redburn Atlantic. Please go ahead. Your line is open.
Simon Baker (Research Analyst)
Thank you for taking my questions. Two, if I may, please. Firstly, on the issue of tariffs. Vas, most of your peers have led their quarterly presentations this time with tariffs and the impact and the correlation between where drugs are made, where they're sold. You chose not to. I just wondered if you could give us some thoughts on the tariff exposure as you see it now. Related to that, given it's a few weeks since it was published, I wonder if you could give us some feedback on your letter with Paul Hudson to the FT.
Then secondly, for Harry on the gross-to-net positive impact of 2 percentage points, could you give us any more color on precisely where that was disproportionately landing? I'm assuming it wasn't equally distributed across the portfolio. A little bit of color at the drug level would be very helpful there. Thanks so much.
Vasant Narasimhan (CEO)
Thank you, Simon. First on tariffs, I think as Harry noted and we noted earlier today as well, our guidance fully accounts for any potential tariffs that we've modeled or scenarios that we expect in this year and in the medium-term guidance. We've taken, I think, appropriate actions with inventory levels and in terms of managing our supply chain to enable us to feel comfortable we can manage it this year and in the medium term.
As you also saw with our $23 billion investment, our goal in the coming years is to have 100% of our key U.S. products fully produced end-to-end in the U.S. We are on track to do that. We think it is manageable and not something that we need to highlight with respect to our financial outlook. Hence, we do not place a lot of emphasis on it. This is something we have been working on since January, and we feel good about where we are. Now, with respect to the letter on EU properly rewarding innovation, we believe there is an opportunity right now, given the deliberations at the European Commission on how to maintain a competitive environment for the biopharmaceutical industry to hopefully make the Commission consider doing something more proactive to ensure that we have a better environment in Europe.
Clearly, prices in Europe have continued to decline, no longer reflecting the innovation that we deliver. The combination of capping market growth, penalizing new indications, low prices at launch has really led to 30% of medicines not being launched in Europe or being delayed in Europe. That number will only grow over time. As an industry, I think this is something we're taking up. We've put forward three ideas on how we could potentially address the situation, maybe other ideas as well. We are hopeful that the European Commission will take it up and will stay determined to educate policymakers at the country level and at the Commission level to really address the situation. Now, with respect to gross-to-net, Harry?
Harry Kirsch (CFO)
Yeah, thank you. Thanks, Simon, for the question. Obviously, we continue to monitor.
As you know, this is due to invoices we get six to nine months late sometimes. We try to always be in the midpoint based on latest information we get. Again, we got a bit lower Medicaid utilization and more favorable channel mix, which gives prior period adjustment. I mentioned the two points of impact, but of course, also informs us about future. Also, when we come to the upgrade, it's not only the prior period gross-to-nets, it's also a better revenue deduction outlook for a year to go, if you will, for the future, as well as continued very good brand performance. I think Cascard and many see fantastic performance there. In terms of, it's really across many brands. I don't want to call out one brand. It's not distorting growth rates very much.
It's in this range of 1%-4% or something like that. It's not worth mentioning a single product. It's quite broad-based.
Vasant Narasimhan (CEO)
Thank you, Simon. Just as a reminder, if the colleagues on the call could limit yourself to one question, thank you very much. Next question, operator.
Thank you. We will take the next question. Your next question comes from the line of Graham Parry from Bank of America. Please go ahead. Your line is open.
Graham Parry (Senior European Pharmaceuticals/Healthcare Equity Analyst)
Great. Thanks for taking my question. It's just following from tariffs, actually, Vas. Your guidance, your midterm guidance focuses on revenue and margin. Obviously, Novartis is one of the companies that has a lower global tax rate because of the booking of profits in Switzerland, it looks like from the reporting accounts, which is 16.5%. That's obviously quite a long way below U.S. corporate tax rates.
When you're talking about factoring this into your guidance, is that also factoring in the potential for any actions on transfer pricing or IP patent boxes, etc., which would impact on tax rate as well? Thank you.
Vasant Narasimhan (CEO)
Harry?
Harry Kirsch (CFO)
Yeah, Graham. We feel very confident in our tax rate, in our tax planning, in our transfer pricing. All of that is very robust. From that standpoint, we are at the moment in the 16%-16.5% range. This already includes pillar two, 15% minimum in, for example, Switzerland. All of that we feel is very robust. Of course, I do not want to talk about others, but overall, all of this is also OECD conform. From that standpoint, I believe that our tax rate will be in that range of 16%-17% as a core tax rate.
Vasant Narasimhan (CEO)
I think, Graham, of course, we do not know.
We're monitoring the situation. If the government were to, the U.S. government were to take more extreme actions, we'd, of course, have to reevaluate. Based on everything we're hearing, we believe we can manage the policies that have been put forward thus far and feel confident in the position we have.
Harry Kirsch (CFO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Emmanuel Papadakis from Deutsche Bank. Please go ahead. Your line is open.
Emmanuel Papadakis (Analyst)
Thank you very much for taking my question. Maybe a question on Leqvio. Just firstly, a clarification. I think you mentioned, Vas, earlier, $4 billion ultimate peak sales ambition. If I recall correctly, last year, you provided us with a $5 billion number. I just want to confirm if that had changed or that was just a typo.
Just talk to us a little bit about the confidence on the H2 PSMA 4 inflection. Is that really based on confidence that you're going to transcend this community referrals bottleneck? Is it actually expanding the number of sites that will be capable of administering therapy? If you could provide a little bit more color there, that would be extremely helpful. Thank you.
Harry Kirsch (CFO)
Yeah, thank you, man. My apologies. It is still $5 billion plus. I misspoke. With respect to Pluvicto and the dynamics that we're seeing, I think within the academic centers and large integrated health centers that already are well set up, we expect to see rapid uptake. I mean, these accounts, these are accounts that are familiar with the medicine. They have capacity. They do need to staff up, but we believe that that's within their reach.
Those are the accounts where we expect to see initial rapid uptake of the medicine. That will drive, I think, the second-half performance. I think to reach the full potential within the PSMA 4 population and the PSMA addition population, we're going to have to continue to expand not only the number of centers, but getting many of those centers to increase the volume of patients that they're seeing. We would estimate of the centers that we've gotten set up, about half of those centers are using Pluvicto at a target rate in terms of the number of patients they're actually processing through their clinic. The remaining 300, we need to get up. We need to get up to a higher level of utilization. We also need to expand the number of sites.
That's going to be some combination of getting comfort with use of the medicine. Hence, we roll out the prefilled syringe use with referral networks and adequate capacity as well for the imaging, which we're working through as well. We have reorganized our field force to enable easier referrals, but also to hopefully better align with where imaging capacity is. I think that'll be really important as well. Of course, continuing to promote the medicine to patients and physicians so they understand the strong data set that we have. I mentioned the unadjusted OS and the adjusted OS, both of which I think have given confidence to experts that the medicine has the opportunity to have a significant impact on these patients. Each one of those activities is ongoing.
I think this is important for us not only, obviously, because of Pluvicto, but also given the broader radioligand therapy portfolio that we're developing. We're now entering the clinic with multiple RLTs in rapid succession, targets such as FAP, fibroblast activation protein, targets like HER2, B7H3, DLL3, all of these targets now entering the clinic. For those medicines to be successful, we know we need to build out this community capacity. Hence, a big focus for the company to figure this out.
Emmanuel Papadakis (Analyst)
Very helpful. Thank you.
Harry Kirsch (CFO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Florent Cespedes from Bernstein. Please go ahead. Your line is open.
Florent Cespedes (Senior Analyst)
Good afternoon. Thank you very much for taking my question. Just a quick follow-up on Pluvicto.
In the U.S., when you said that 50% of the sellers are not using Pluvicto at a target rate, what's the main pushback from these sellers? Is it just they need more convenience? So prefilled syringe would help, or other any color on this front would be helpful. Thank you.
Vasant Narasimhan (CEO)
Yeah, I think it's a combination of things, Florent. I think one is, of course, once you have a patient treated, to ensure you have adequate reimbursement and then see the process ultimately work. I think second, continuing to educate on the staffing needs and to be ahead of the curve in order to get patients treated. I think the referral networks and making sure the referral networks are operative so that patients are referred to locations where Pluvicto is available. I think these are all surmountable challenges.
I think we've already made tremendous progress each six-month period in terms of expanding the reach of the medicine. I remember a few quarters ago, we were at 100 or 150 centers now providing the medicine. Now we're at multiples higher than that. I think we're getting there step by step. Of course, for each account, it is a puzzle that we need to solve. We've mapped that out geographically. We were reorienting our field force to match to that mapping. We just have to, I think, stay consistent. When I look at corollaries, you think about how long it took chemotherapy long ago to ultimately roll out. I mean, we know these things take time, but once you establish them into the standard of care, they stick.
That's the mindset we're taking, consistent investment over time to make it stick, given the portfolio that we have that we're bringing forward. Next question, operator.
Florent Cespedes (Senior Analyst)
Thank you very much. Very clear.
Operator (participant)
Thank you. Your next question comes from the line of Peter Verdult from BNP Paribas, Exane. Please go ahead. Your line is open.
Emmanuel Papadakis (Analyst)
Yeah, thanks, Peter Verdult. Thanks, Exane. Just one question for you, Vas, on ianalumab in Sjögren's. I mean, the feedback from the docs is positive, but we know that there are no systemic treatment options to offer patients. It just seems from the feedback we're getting that replicating that phase two data you presented earlier will be enough to get the community excited. Just wanted to check in on your latest thoughts ahead of that readout and how you're seeing the commercial opportunity.
If we were to compare it to something like Cosentyx and HS, do you see Sjögren's, ianalumab being that sort of similar size or even bigger? Thanks.
Vasant Narasimhan (CEO)
Yeah, I think we see ianalumab being a very significant medicine if successful. I think clearly with Sjögren's having no approved systemic therapies and given the size of the patient population, there's an opportunity here to create a significant medicine. We haven't guided to specific numbers yet, but I think certainly a multi-billion dollar potential medicine is what we would expect in just the Sjögren's indication. Now, I think that, I think, goes without saying that this will be a challenge with respect to, one, when you look at this disease, it's a heterogeneous disease. Hence, the endpoint here, the ESSDAI endpoint, is a challenging endpoint.
We've done everything we can in the design of the study to ensure that we control for placebo effects, that we power appropriately, we have the appropriate statistical analysis hierarchy, that we've included FDA-requested patient-reported outcomes, which I think will also be important for physicians. We've done all of the steps needed to really give ourselves the best chance. I think also it's going to be important to have impact not only on composite endpoints like ESSDAI, but also very specific areas that patients care about: saliva production, fatigue, etc. I think each one of these elements of the story have to ultimately tie together. I think the opportunity then is significant given that we're targeting patients here with systemic manifestations of the disease. Patients that clearly are having this impact their daily life.
If we can demonstrate that we move the needle for patient quality of life, we would expect a very significant medicine. We are excited about the readout. Hopefully, we can replicate what we saw in phase two B, but we fully also acknowledge that this is a high-risk study that we have to deliver on. Thank you. Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Richard Vosser from JP Morgan. Please go ahead. Your line is open.
Richard Vosser (Managing Director and Senior Analyst)
Hi. Thanks for taking my question. A question on Scemblix, please. The growth on prescriptions is very stunning, but revenue growth is a bit below that. Just wondering whether you are having to rebate more heavily to generate first-line volume, or if we could see an uptick later on this year in terms of Scemblix more towards the prescriptions. Thanks very much.
Harry Kirsch (CFO)
Yeah, we've looked into this a bit. I think one of the things we're seeing is when we look at the IQVIA data set versus what our internal data sets would show. Our internal data sets would show 73% TRX growth of Scemblix versus prior year. That ties to the 75% net sales growth, so very much in line. We know IQVIA is showing a higher number. We think this might have to do with the nature of a rare disease product that's not flowing fully through only the pharmacy, but also through a specialty distribution chain. I think that's the key difference. It has more to do with channel than anything underlying the performance. I think most important for us is that we're seeing strong growth in the second-line and first-line indications. We have the reimbursement in place. We have the NCCN guidelines.
We think the growth should accelerate in the first and second line. We think this medicine, as you know, has a very significant potential that we plan to fully realize.
Richard Vosser (Managing Director and Senior Analyst)
Thank you, Richard. Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of James Quigley from Goldman Sachs. Please go ahead. Your line is open.
James Quigley (Senior Analyst)
Great. Thank you for taking my question. I have a question on Pelacarsen and competitiveness. Last month, Lilly put out phase two data demonstrating a 94% reduction in LP(a) at the highest dose with a 180-day administration interval. The phase III will clearly come after Horizon. We need to see that to really sort of see where the competitive landscape will move.
With data emerging for competitors with longer dosing intervals, how does this impact your view on the competitiveness and/or your launch strategy for Pelacarsen and assume positive Horizon data? Does this also increase the need to accelerate development of your own six-monthly or longer-acting LP(a) option? Thank you.
Vasant Narasimhan (CEO)
Yeah, thanks, James. Certainly, we're watching the competitive landscape, but our core focus right now is to deliver on the phase three trial and then accelerate towards a launch and hopefully establish ourselves as the first-in-class therapy and building on our global cardiovascular presence with the monthly dosing, really get a broad base of patients on therapy. We acknowledge the fact there could be competitors coming down the line with quarterly dosing, and we'll see what the clinical data ultimately shows for that medicine, and then six-monthly dosing, as you mentioned, later in the decade.
We feel confident that Pelacarsen can have a very significant outlook with its current profile. I would note as well, when we look at the recently published study that the investigators published on the baseline characteristics of the Horizon study, you see a situation where the median level of LPA was around 108. We had 80% of patients above 90. I think that shows that we've enrolled a high-risk patient population in the study, which hopefully gives confidence that if the modeled performance of the drug ultimately and the modeled impact of LPA reductions ultimately bears out, we have a good chance to win on the study when it fully reads out. I would say as well, we do have multiple efforts ongoing to get to less frequently dosed SIRNAs or ASOs.
Those could be as far out as out to one year is certainly the goal we're trying to get to annual dosing. So we would have the opportunity to establish ourselves in the market with a month-monthly dose therapy and then life cycle managed into a much less frequently dosed medicine that we'll be looking to hopefully bring to market at the end of the decade or the early part of the 2030s.
James Quigley (Senior Analyst)
Thank you.
Vasant Narasimhan (CEO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Thibault Boutherin from Morgan Stanley. Please go ahead. Your line is open.
Thank you very much. I just have a question on the new phase three study you started with Kisimpta and the new dosing regimen. Is it extending injection interval? Is it exploring higher dose for more efficacy? Because it's quite late in the life cycle of the drug.
I'm just trying to understand the goal here. Could it be something potentially helping with IP duration, for example?
Vasant Narasimhan (CEO)
Yeah, thanks, Tebow. This is an effort for us to increase the dosing interval of Kisimpta before the end of the life cycle of the medicine. I think when we look now at the competitiveness of Kisimpta, given the situation with competitors not fully achieving their goals, I think we have an opportunity to continue to extend this franchise longer. We're looking at infrequent dosing. We also have other internal efforts ongoing because we believe that Kisimpta can be a mainstay of B-cell therapy for an extended period of time, given its convenience at home dosing, which is, I think, convenient for patients around the globe. We continue to pursue a BTK inhibitor, Remibrutinib, as well in MS.
We, of course, are cognizant of the fact that we do have four studies that have not shown an impact on RMS to date from competitor products. We would characterize that as still a high-risk opportunity. Given the overall competitive landscape, we want to ensure now that we fully life cycle Kisimpta. We currently do not believe we would face biosimilars in the United States until the early part of the 2030s. We believe there is time to develop these alternative formulations. Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Matthew Weston from UBS. Please go ahead. Your line is open.
Matthew Weston (Pharmaceutical Research Analyst)
Thank you. It is a question for Harry, please. Harry, in the Q4 slide deck earlier this year, there was a very prominent slide on the first half, second half dynamics in the year, especially around profitability. It is absent in today's slides.
Is that because you're expecting less of a sharp contrast in first half, second half? Now you've seen the launch of Kisqali and continued growth of Kisimpta, or is it just that you decided not to include it today?
Harry Kirsch (CFO)
We just wanted to see if you notice. No. Kidding. No, thank you, Matthew. Obviously, the one-time effect of the gross-to-net for prior period, that is reflected in the current quarter. There are a couple of other effects that give us further confidence and contribute to the overall full-year upgrade. One is that with this, there should be also better gross-to-net going forward. We adjusted our assumptions. We always learn every quarter. Of course, we are fully modeled in and accrued for the Medicare Part D redesign, which you already see part of Q1.
The other contributor is, of course, very good growth performance overall. Clearly, I see both half one being better than what we outlook, but also half two, where half two I mentioned low to mid single digit. We now would see the half two to be in the mid single digit range given these two improvements of more favorable gross to net ongoing as well as better than expected performance on some brands. I hope that answers your question, but we can happily add that slide back if this is very helpful. We continue to see if our mid-year assumption for the three to be genericized brands in the U.S. as a financial planning assumption plays out or if we would have updates for you. Of course, the moment we would know, we would inform you.
Therefore, for the time being, we recommend that that continues to be the financial planning assumption for everybody.
Vasant Narasimhan (CEO)
Thanks, Harry. Thanks, Matthew. Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Kerry Holford from Berenberg. Please go ahead. Your line is open.
Kerry Holford (Managing Director and Senior Equity Research Analyst)
Thank you for taking the question. On Uncertain (possibly 'The PTC plan' or 'Branaplam'), please. Are you still on track to release phase two data in the first half of this year? Do you see the potential to file and secure an approval in Huntington's on that data alone, or should we assume a phase III study is likely to be required? Thank you.
Harry Kirsch (CFO)
Yeah, thanks, Kerry. As you know, Uncertain (possibly 'The PTC plan' or 'Branaplam') is currently being the phase two study is being conducted by PTC. We do expect the readout in the first half of this year.
I think when we see the data, we'll have a better sense of if on top of mutant Huntington protein reduction, we also see improvements in clinical endpoints, which would be, I think, needed for us to be able to file with FDA. I think based on the data, we'll work with our partners at PTC to determine what's the right approach, whether to file off of that phase III or to move forward to conduct a pivotal phase three study. Stay tuned. I think we'll obviously know more once we have a look at the data. Of course, we're staying abreast of the evolving kind of mindset within FDA and certainly what other competitors are doing as well. We'll see how the data unfolds.
Vasant Narasimhan (CEO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Seamus Christopher Fernandez from Guggenheim.
Vasant Narasimhan (CEO)
Please go ahead. Your line is open.
Seamus Fernandez (Senior Managing Director and Senior Analyst)
Hi. Thank you for taking the question. So really just wanted to ask about value-creating bolt-ons and areas of focus for BD, in particular, if you see opportunities for life cycle management via BD around your hypertension and heart failure portfolio, particularly given the upcoming loss of Entresto in the U.S., but the robust opportunity for Entresto in overseas markets. Thanks so much.
Harry Kirsch (CFO)
Yeah, thanks, Seamus. So nothing specific to say. I mean, we feel very good about our cardiovascular pipeline overall. We have, of course, Entresto, Leqvio, pelacarsen. We have our entire renal portfolio. We recently did the Anthos acquisition to get abelacimab, the monoclonal antibody for anticoagulation into the portfolio. We have a broad range of siRNAs targeting cholesterol lowering, targeting Lp(a) lowering, targeting hypertension lowering in-house as well. All of those programs are proceeding and also an antiarrhythmics portfolio.
I think we, of course, are looking across the opportunities out from a bolt-on standpoint, but no particular focus on cardiovascular medicines at this time.
Vasant Narasimhan (CEO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Steve Scala from TD Securities. Please go ahead. Your line is open.
Steve Scala (Pharmaceuticals at TD Cowen)
Thank you so much. Novartis has among the fewest manufacturing plants in the U.S. in the industry, but did announce the $23 billion program to expand the U.S. footprint. The question is, how much of that $23 billion build-out to the footprint will be complete by 2028? It seems that such a profound pivot could be a less than ideal decision if the views in the U.S. were different in four years. If instead it was an inevitable pivot, regardless of the U.S. president, then why didn't it start sooner?
Related to this, you said Novartis can manage plans put forward in the U.S. so far. Does that include most favored nation legislation? Thank you.
Harry Kirsch (CFO)
Thanks, Steve. On point one, I think we would acknowledge, I think we could have done this earlier. I mean, this is a strategic decision to say that the U.S. is our most important single market from a growth and revenue standpoint. We want to be in a position to be able to produce all of our key medicines end-to-end in the U.S. I think we are right. We should have recognized it sooner, but now we have recognized. I think independent of who is president, it is prudent for us to be able to have our supply chain stable inside the United States.
We do have a number of medicines already fully produced in the U.S.: Zolgensma and our Leqvio, Kisimpta, our gene therapies, Pluvicto. In the other relevant therapies, we believe within this period of time, we can get the necessary manufacturing plants up and running, given our footprint that we already have in certain locations to manage this. It is a strategic decision independent of the president to make sure that we have that capacity inside the United States. Now, in terms of most favored nations, of course, I think if this policy, which I think would be devastating to the industry, was ultimately put forward in any kind of meaningful way, it would cause, I think, all companies to have to relook at their long-term, medium to long-term outlook. It goes without saying.
I think it's really important that we keep advocating that the United States should not import European price controls and the European anti-innovation or challenging innovation environment into the United States. I don't think that will serve patients well, serve healthcare systems well, and the biotechnology ecosystem well. That's certainly what we're advocating for. Rather, the focus should be to correct the imbalances that have occurred in Europe over the last decades and hopefully get a better environment in Europe that's more competitive with the United States.
Vasant Narasimhan (CEO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Graham Parry from Bank of America. Please go ahead. Your line is open.
Graham Parry (Senior European Pharmaceuticals/Healthcare Equity Analyst)
Great. Thanks for taking my follow-up. Excuse me. First one was just on Pluvicto and PSMA addition.
Just wondered, when you get the PFS primary endpoint read, roughly what proportion of overall survival events you think you'd have and whether that would be sufficient for filing, just given you needed more OS data on PSMAfore? Actually, just wanted to follow up on Harry's comment on Entresto. I think, because Vas, I think you were quoted on the wires this morning saying expect generic Entresto in July. Harry still refers to that as a modeling assumption. Could we still see some flex in that? Is there potential for a 918 patent ruling or a settlement there that could see this bumped into 2026 in the scenarios that you see? Thank you.
Vasant Narasimhan (CEO)
Yes. Thanks, Graham. First on Pluvicto PSMA addition.
At the time of the RPFS output, difficult to say exactly, but we would expect OS events in the range of 40-60%, something in that range overall. I think our view is that we would maintain the study blind and then with a small group review the data set with FDA to ensure that FDA felt like the OS is sufficient at that point in time, assuming the study is positive for us to take it forward. If they inform us it's not the case, then we'll maintain the study blind so as not to inadvertently change the rate of crossover in the study. That's the approach we're currently taking on PSMA addition. Now, with respect to Entresto, there are multiple cases ongoing. We have two generic filers that we have not settled with.
We do have the ongoing patent litigation on the amorphous complex patent, which is pending. We have the ongoing trade dress litigation as well with MSN. We have the ongoing litigation with the FDA on whether the approvals are valid. All of these litigations are ongoing. At any point in time, any of those litigations could shift our perspective on the mid-2025 LOE. I think until we hear from any of those cases, the most prudent course for us is to maintain a mid-2025 LOE. If it changes, of course, we'll immediately update the markets and then update our outlook accordingly.
Graham Parry (Senior European Pharmaceuticals/Healthcare Equity Analyst)
Okay. Just to be clear, that's based on litigation outcomes as opposed to settlement that you're referring to potential for it to move?
Vasant Narasimhan (CEO)
It could be litigation outcome or settlement. All of the above are things we're working on.
Graham Parry (Senior European Pharmaceuticals/Healthcare Equity Analyst)
Thank you.
Vasant Narasimhan (CEO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of James Quigley from Goldman Sachs. Please go ahead. Your line is open.
James Quigley (Senior Analyst)
Hello. Just a quick follow-up for me, given that European pricing has been mentioned a couple of times. What is the politician's view on this at the moment? Is it seen as a problem, or do you have some support from some European politicians about addressing the innovation and balance that you see between Europe and the U.S.? Have any negotiations or discussions started, or are we still at a standing start, and hence the reason for your letter? Thank you.
Vasant Narasimhan (CEO)
Yeah, thanks, James.
There is a letter from FPI to the European Commission, which I think has been published, which has been published publicly, which I think outlines some of the topics, but not the specific recommendations that Paul and I put forward in the FT. I think that was a response to a request from the European Commission to understand how the innovation environment in Europe can ensure that they retain their leading biotechnology sector, biotechnology manufacturing, biopharmaceutical R&D. I think a lot of the focus right now is in streamlining regulations, which are welcome, streamlining and improving regulatory data protection also welcome, strengthening overall support for the biotech ecosystem, venture capital, et cetera, all welcome as well.
I think we as an industry, and at least some of the CEOs, strongly believe that this also should be an opportunity to rethink the overall approach to valuing innovation in the European Commission, in the European community. I think that's what we're trying to focus on. I can't really comment on whether or not that is being viewed as something that will be taken up by the Commission. That's not something they've communicated back to us, but it's certainly something we're advocating for both at the Commission level and with individual countries around Europe as well.
Graham Parry (Senior European Pharmaceuticals/Healthcare Equity Analyst)
Thank you.
Vasant Narasimhan (CEO)
Next question.
Operator (participant)
Thank you. Your next question comes from the line of T-Bow Bodwin from Morgan Stanley. Please go ahead. Your line is open.
Thank you. Your press release mentioned a litigation with a drug manufacturer for a generic of Lutathera.
Just if you could help us understand what generic would look like with radioligands in terms of type of price discounts, any challenges a potential generic maker could face in terms of penetration, supply challenges, these kinds of things.
Vasant Narasimhan (CEO)
Yeah. First, I think on generics and RLT, this is not something where there is, we believe, an adequate or clear regulatory standard. While one topic is, does any proposed generic infringe on our IP, which is what the litigation is referring to? Separate from that, we have filed citizens' petitions, and continue to advocate with regulators around the world to clarify what is expected of a radioligand therapy and that it should absolutely be held to the standard of ensuring patients and the tumor is receiving an equivalent dose of radiation to ensure efficacy and appropriate safety. That is all, I think, also ongoing.
A third question is the supply chain, and can a potential generic manufacturer produce the medicine in a way that does not also infringe on our patents in terms of production and know-how in terms of production, but also in a way that reliably provides these medicines to patients, given that you have a four-day, three- to five-day window, depending on the medicine, to actually get it to physicians? As we have learned, it is absolutely critical to be on time and full. Novartis right now is 99.9% on time and full for our radioligand therapy business. That is the standard I think physicians expect and that any generic company would also have to meet. I think those are the three levels of the ongoing discussion.
I think it'll take years to resolve, but it'll be important because these standards will ultimately be what defines the sector in the longer run.
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Matthew Weston from UBS. Please go ahead. Your line is open.
Matthew Weston (Pharmaceutical Research Analyst)
Thank you. I'd love to go back to Graham's question on tax. Harry, on the Astra call, Pascal was prepared to say that he believes Astra pays a fair amount of tax in the U.S. relative to the sales booked in the U.S. and the total tax paid by the company. There's been a lot of discussion in the past as to how Novartis pays tax in the U.S., some of it before your time. I’d just be interested if you're comfortable saying the same thing from a Novartis perspective.
Vasant Narasimhan (CEO)
Thank you, Matthew. Harry.
Sloan Simpson (Head of Investor Relations)
Of course, we pay in every jurisdiction we do business our fair and proper amount of taxes. By the way, we do not have any offshore balance sheet structure. From that standpoint, we are very confident in our tax planning and very robust.
Harry Kirsch (CFO)
Perfect. Many thanks indeed.
Vasant Narasimhan (CEO)
Thanks, Matthew. Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Graham Parry from Bank of America. Please go ahead. Your line is open.
Graham Parry (Senior European Pharmaceuticals/Healthcare Equity Analyst)
Great. Thanks. Last one, I promise. I just wanted to follow up, actually, Vas, on your to qualify the comment you said about MFN being devastating for the industry is, I think, the word you used if it was implemented.
When you say devastating, are you talking about MFN being imposed across both government and commercial setting, or do you see that just imposition across Medicare, Medicaid would actually have that level of impact? I think that's an important clarifica
Vasant Narasimhan (CEO)
tion. Thank you. Yeah, absolutely. Look, of course, the devil's in the details with these things. I think MFN, if it's as previously conceived, is limited to Part B drugs. For Novartis, highly manageable. If it's MFN in Medicare Part B and Part D, but we no longer have to pay rebates and a number of other discounts disappear, manageable. If it's Medicare Part B, Part D with the spillover into Medicaid, the spillover into 340B pricing and all of the other problems, definitely painful. If it spills over into the private market, devastating. I mean, I think all of this, of course, is something to look at.
Here I speak about the industry, I think, broadly as well. I mean, of course, for Novartis, given our relative exposure to the U.S. and relative exposure to Medicare, if this policy ultimately were to come into place, we're well positioned, relatively speaking. That still does not mean that we would in any way want this to happen, obviously, given the damage it would do to our ability to invest in R&D, invest in manufacturing, invest in a future pipeline of medicines for patients around the globe. It would definitely have a significant impact. Certainly, it depends on the details of what ultimately is conceived.
Graham Parry (Senior European Pharmaceuticals/Healthcare Equity Analyst)
Thank you.
Vasant Narasimhan (CEO)
Next question, operator.
Operator (participant)
Thank you. Your next question comes from the line of Florent Cespedes from Bernstein. Please go ahead. Your line is open.
Florent Cespedes (Senior Analyst)
Good afternoon. Thank you very much for taking my follow-up question.
First, a big picture question on IRA. Could we have your thoughts about the difference in exclusivity between small molecule and large molecules, the 9 years versus 13 years? Do you see any, let's say, possible happy endings or more favorable trend on this front? Any color would be great. Thank you.
Vasant Narasimhan (CEO)
I think it was very promising, and I think a good sign that in the president's executive order that there was support for moving the small molecule 9 years to 13 years. That's something the industry has made our top priority from a legislative standpoint. We have the pay force to enable this to happen. It is our absolute focus that in any reconciliation bill that's taken forward, that the correction of 9 and 13 is part of that reconciliation bill.
I think we have good bipartisan support both in the House and Senate to make that happen. I think we know that with respect to these kinds of bills, it really comes down to the very final language on the last day. We can never be sure. I think all signs are positive that we have an opportunity to get this fixed, which would really, I think, enable us to sustain small molecule drug innovation into the future. I'm hopeful. I'm hopeful at this point that we could make something happen. I think while on that, I think we continue to also advocate, of course, on PBM reform. I think there was a good bill that nearly passed in December, and we continue to hope that can happen. We continue to advocate for fixing the 340B system as well.
That may not happen legislatively, but we continue to pursue all avenues to ensure that there's no abuse of the 340B system. There was an important report put out by the Senate Health Committee, I think, that highlights the problems in the current system. Hopefully, step by step, we get to a place where that program is also put into its proper context of actually helping patients and clinics in low-income communities and disadvantaged rural communities get the support they need without the abuse that we're seeing around the country. Those would be the three, I think, big legislative priorities for the industry and for Novartis. Great.
Florent Cespedes (Senior Analyst)
Thank you very much.
Vasant Narasimhan (CEO)
I think we have one more question, maybe.
Operator (participant)
Once again, if you wish to ask a question, please press star one and one on your telephone. No. All right. Very good. Thank you all very much.
Vasant Narasimhan (CEO)
Thank you for joining today's call. We'll look forward to keeping you up to speed on all happenings at Novartis, and we wish you a great day.
Operator (participant)
This concludes today's conference call. Thank you for participating. You may now disconnect.