AbbVie Inc. (ABBV) Earnings Call Transcript & Summary

Good morning, everybody, and welcome to Wednesday, 3rd day of the 44th Annual Goldman Sachs Healthcare Conference. Congratulations to all of you who have survived, hopefully, people are getting some decent sleep, not too much drama on the news front. My name is Chris Shibutani, along with my colleagues and the team and the Goldman research led by the pharma group by [ Dan Zimet ]. We are super pleased to have AbbVie here with us join in. So thank you so much on the team here presenting. We have Rob Michael, President and Vice Chair, I believe, right? Jeff Stewart, Chief Commercial Officer. And then Roopal Thakkar, who is Chief Medical Officer.

I always like to begin these things just making sure we understand who we're talking to and probably a lot of folks are pretty familiar with who you are, but a little thumbnail on sort of your professional journey, what brings you to where you are, that would be great. Sir, we will start with you, Rob.

Sure. Great to be here, Chris. Nice to meet you in person finally. So I started with Abbott 30 years ago actually, 20 years at Abbott, worked all over that company, diabetes care, diagnostics, nutrition, pharmaceuticals. Last 10 years with AbbVie since the beginning. I was the CFO for 4 years and currently responsible for commercial and financial operations.

Terrific. Jeff?

Yes. Thanks, Chris. So I've also like Rob worked for many, many years, 30-plus years, and almost exclusively in the commercial space. So sales, marketing, overall business strategy. And I have worked in Europe in different areas. And really, I approach business from the perspective of the stakeholders, the patients, the competition and really like to very much study human behavior and how teams work so that we can drive the business. That's been my primary thrust over the last 30 years.

Terrific. On the commercial front, never a dull moment, constantly changing, right? If you've seen stuff before, look out what's coming up next. And Roopal, go blue, I understand, right?

Yes, that's right. Thanks for having us. I've only been at Abbott, AbbVie for 20 years. So early development, clinical development and early days of Humira, a variety of indications, early days with Rinvoq, lifting that from Phase I into Phase II into Phase III. Regulatory affairs across all therapeutic areas, now development, regulatory and asset leadership.

You say it very calmly, obviously, it's a beast of a task. And clearly, the immunology franchise is tremendous. But you also lead me into the obvious discussion. Let's start the day right off, talking about the dynamics for Humira. I think ongoing progress through an unprecedented year. It's fascinating to see how things have happened so far this year. I think you guys have done a very good job of trying to keep us on pace with the kinds of insights that we could know when we could possibly know them. There's a constant dance between negotiations with payers, estimating really things that you also can't control and can't know like the pricing of the biosimilar dynamic. Perhaps talk through some of the issues that we are seeing come across in the headline. For instance, WACC price introductions of some of the biosimilars. There's been some characteristic kind of strategic entries with Amgen, doing kind of the 2 pricing version. Then we've seen Coherus with some headlines here. How should we think about with these headlines and the data points, what the pricing dynamic could look like with these biosimilar entries? Update us on your latest thoughts? And in particular, how this impacts your view in terms of what you think the revenue trajectory could go? I realize there's so many uncertainties, but we're struggling with that sometimes, too, as you can tell. Help us think about that?

Yes. Chris, maybe I'll start, and then Rob can make some highlights as well. So I would say that the marketplace in the first part of the year and the negotiations that we had last year leading up to it, is playing out really largely as we've anticipated. So no real surprises. If you remember what we said is that we would negotiate our pricing and concede pricing to maintain access, and that parity level access we were able to achieve that. So greater than 90% access. Now we studied very carefully the structure of the markets, in particular the -- of course, the immunology market. And we saw that there's basically 2 types of broad market segments. There's basically low WACC seekers, and then there's also rebate seekers depending on the mix of the market. And we knew that probably roughly 20% of the commercial market basically values a low list price. So it wasn't surprising to us when we saw Amgen's move. And we've also seen that in other areas. We've seen it in the diabetes space where you have high WACC, low WACC. You have biosimilars with high WACCs and low WACC because they're basically trying to customize the competitor's offering to the different market segments. It's not always easy to do. And I think as we've seen with this recent -- you mentioned Coherus, they clearly are moving towards this low WACC segment or about 20% of the market. So that is something that we anticipated. When we looked at the approach that we took for 2023, we knew that in the second part of the year, we would probably see more low WACC offerings. In this case, it was quite a low WACC offering. And it's the segment of the 20% that are maybe more attractive to basically think about that offering. So that's how we're seeing the marketplace evolve.

And that really ties in with the guidance we gave. So we in the first half of the year, essentially were looking at 26%, 27% erosion -- the vast majority is price, very little volume. But we anticipate in the second half with 7 to 9 biosimilars coming in, we've also offered additional rebates in anticipation of that. So we expect more price erosion in the second half, but also volume coming from those WACC-sensitive accounts. So none of this really surprises us. If you do the math on our 37% guidance, erosion guidance for the year, you get to mid-40s for the second half, so that includes the stepped-up price as well as some level of volume erosion coming from those WACC-sensitive accounts. So I'd say from what you've seen so far is playing out as we expected.

We're always thinking on the forward. We're now almost halfway through the calendar 2023. We're approaching that seasonal time where we know that there's a lot of folks sitting down the table negotiating contracting, tends to be one of these elements that visibility is a little bit blurry, but special thanks to Liz and the IR team, their resilience in handling all the questions around. When are you going to know about this contracting dynamics? When are we going to know about the next season? But very logically, the Street is essentially now the center of gravity is really shifting towards 2024. I think previous comments have talked about volume being potentially more of a factor in the 2024 number, and this very logically treads into all sorts of things, which I don't want to go too far into as of yet in the discussion in terms of like trough EPS, which again, you guys have been very good and gracious about sort of like framing. But keeping it on the question of the Humira dynamics, talk about as we transition to 2024, and in particular, is it around 3Q earnings that we should start playing with, about like when are we going to know about the coverage sort of outlines for 2024. Help us understand when we should be pressure testing those questions.

Maybe, Chris, I could give some perspective on the timing on how things play out when you engage the payers in the United States. So typically, you start to engage the payers on the next year. This is for the commercial book of business because Medicare starts even earlier in terms of when the bids are due. But in the commercial book of business, let's say, with the large PBMs and large health plans, you start the negotiations in the late spring, okay? And sometimes the early spring depending on this. And you start to move and it starts to accelerate over the summertime period, and then typically into the early fall. Now typically, at that point, the large PBM start to put and publish their exclusionary lists, and which you've seen like which ones made it through the negotiations, which ones might get excluded, who's on the formularies. And I would say that we start to see that in the early fall, but immunology is a little bit different because if you look back over the patterns of the history, very often, they're still put as PBD. And we see that over the last cycles, particularly last year. And I would say that I think it's going to happen again this year. The deals don't really close until really the winter. So you don't really know your full set point until those deals are closed. And I would say over the last cycle with the biosimilars, and it will happen again this year, these are high stake negotiations, exactly how those formularies are going to be set. And so I think very similar to what we saw last year. We're not going to have the final visibility until later in the year in terms of how all that plays out. So I don't know, Rob, if you want to make any...

Yes. I think the way to think about it is on the second quarter call, we'll be able to give investors color on what we're seeing in the marketplace now that the 7 to 9 have entered the market. So we can give investors some comfort over the dynamics we're seeing for '23. We'll know the phasing prices. We'll have a good sense. And I think we can give some reassurance on what '23 looks like. But I think -- as you think about '24 as Jeff mentioned, the cycle of contracting would put us in a position where really that guidance wouldn't come until the fourth quarter call. I think we try to characterize the dynamic between price and volume to help investors model it as best as possible. This year, we've said, as I mentioned earlier, predominantly price. Next year, I would expect more of a balance between price and volume because you will have all the biosimilars on the market for a full year. So I would expect more volume erosion next year than you're seeing this year. But I'd say think of it as being more balanced. I wouldn't necessarily try to point to one versus the other in '24. I think the best way to think about it is a balance between price and volume, whereas this year was predominantly price.

Got it. And then one of the headlines that came early in the course of the calendar year when we were thinking and bracing ourselves for this was this notion that actually Humira was positioned on formularies at parity. And that became kind of like one of these threshold levels of acknowledgment of sort of what the objectives were with your negotiation. How should we think about formulary positioning in 2024 comparable objective there or PBM is potentially thinking about giving a little more shelf space to the biosimilars?

Well, I think what we'll see is we'll see more biosimilars that are going to be added on to the formularies. Our objective really will remain the same, which will be -- we will basically position for parity. And there's a couple of reasons why we want to do that. First is from a patient perspective, it's highly disruptive to switch. They have to learn a new [ pen ]. They have to basically think about is it the same citrate buffers? Could you have a different experience? And we've seen that that's a big thing. It's a big thing for us as a manufacturer to have that patient continuity. So we would continue to have the objective, to Rob's point, to negotiate with appropriate standards for parity positions. Now some payers may take different positions and try to basically switch the Humira patients. For example, it might be in one of those low WACC leaning accounts, which, given HUMIRA's price point, they just may decide to take that move. Now they have to think through which biosimilar or two do I partner with? What is the profile of that biosimilar? Can I secure the right types of supply depending on how aggressive I want to be. So those are all elements of the calculus that take place during the negotiations certainly and also in the payer boardrooms in terms of the posture that they'll take going into '24.

And sometimes we think about this as being always on an annual basis, but there's some speculation -- actually, there's commentary about in some instances where you do a 2-year arc to your negotiations. Obviously, this particular product at this time represents many variables. And so give us a sense for maybe what portion that is generally true commercially, Jeff, but then in particular for this dynamic? And then there's also this sense that perhaps, well, midyear, the landscape really changes literally the cast of characters and the field of play could change. So within whatever was negotiated, is there sort of an escape clause or like a modification or behavioral change on any of the payers parts that's worth taking because of unexpected more disruptive type of change? So on the longer arc and on the shorter arc, lend your thoughts.

Yes, very important question. We've highlighted this before. Typically, what you see in the specialty brands with payers are annual contracts. So you negotiate over the summer into the fall, did you get the account or not. Now in some cases, we have negotiated and we think in very good faith with the payers 2-year contracts. And I think part of that is because as insurance companies, they're also thinking of their own flexibility in terms of how to navigate this very complex system. So many are 1 year, and many are 2 years. So there's a balance between the 2. We haven't said which ones and we won't say which ones are 2 because it's confidential information. And I would say, we negotiate those terms in very good faith, and we anticipate that they would hold. Now in any negotiation with the payers, there's typically clauses and other things that say, well, there could be out clauses or we could -- if the market substantially changes, for example, we may come back and try to renegotiate in good faith, et cetera. So this is all part of the very complex dynamic that we are living in with 9 biosimilars. It's been unprecedented. But we're confident that we have the right positioning and the right posture and the right terms with many of these payers going forward.

So in terms of the 2 years, I heard the word some. I heard the word many. How do I translate those, blink once if it's 20, twice if it's 30.

I think it's a reasonable balance between the 1 years and the 2 years on the commercial side.

Okay. Very interesting. Helpful. The immunology franchise, lots of planning behind it, a couple of next-generation franchises really steamrolling, doing quite well, Rinvoq, Skyrizi, let's transition to over there. Particularly for Rinvoq. I love immunology, just like each drug is a pipeline within a product across all these indications. Certainly, the mechanisms are fascinating, with Rinvoq in particular for the IBD opportunity. Talk to your expectations around how that is potentially going to be building. It's kind of crowded. There's a lot of cool mechanisms, novel mechanisms on the [ com ], et cetera. But one of the reasons I love immunology is that there's plenty of room for multiple players to do quite well, right? Probably because we don't understand the patients well enough, heterogeneity of populations, but nonetheless, Rinvoq, IBD. Talk to us how we should think? How you're feeling about it? What the outlook is?

Maybe, Chris, I'll have Roopal who was really involved in the development of those agents because as you highlighted, the performance and the profile of Rinvoq in IBD is exceptional, and we're seeing fantastic market performance, which I'll get into, but maybe Roopal can frame for the group exactly what we've been looking at from a clinical and performance perspective.

Yes. So sticking with -- thanks, Jeff. Sticking with Rinvoq, what we're seeing with the profile there, as you were talking about different mechanisms, this particular mechanism in Crohn's and ulcerative colitis is driving efficacy as high as we've ever seen, which is very gratifying for someone who worked in the early days in IBD with Humira, we're able to easily beat those levels of efficacy around clinician remission. For example, in ulcerative colitis, we're seeing 52-week remission rate of 50%; endoscopic improvement, 60%. And then what's really emerging is also being very important is steroid-free remission of 70%. So these numbers are unprecedented in the ulcerative colitis space. And I think what Jeff can speak to is depending on the jurisdiction, some patients maybe taking it after an anti-TNF or a biologic. But in Crohn's and UC, 60%, 70%, 80% of the patients have already seen an anti-TNF. So it's already a very strong setup for these patients looking for very high levels of efficacy, mucosal healing and then getting them off very rapidly off of steroids and that leads to a very, very good, strong profile for clinicians.

And if you think of a couple of things that I think are important for investors is that Rinvoq will be the only JAK inhibitor that will be approved for Crohn's disease, which is the biggest of the 2 segments. So the performance is just simply exceptional, and we've got it approved now across Europe and recently just in the United States. When we look at Rinvoq's launch trajectories around the world, they're very, very strong. I mean, if you think of the historical launches in UC that are more recent, like the STELARA launch or the Entyvio launch, we're significantly beating all of those ramp analogs, even in the United States where we have a post-TNF label. So it's really an exceptional medicine, and it's also very important I think that investors understand that we've got cousins on the other side with Skyrizi. So the ability for our commercial teams to bring 2 very innovative medicines with essentially very often the same teams to the same gastroenterologist is a very unique AbbVie setup for IBD as you highlighted.

And what's the thumbnail on how you're positioning both of these products with the GI folks?

Well, in terms of the positioning, it depends on the territory. So for example, in the U.S., where we have a post-TNF label, it's actually very simple for the representatives to highlight starting off with Skyrizi as a very powerful and convenient frontline agent. And then if patients are able to get into trouble or they've already been too exposed to a TNF, which is about 75% of the market, you have Rinvoq sitting there in terms of a frontline and later line, let's say, co-positioning standard. In Europe and other countries where you don't have a TNF step label, in that case, we position them with the first principle is both of the agents have something very unique, which is this incredible endoscopic improvement. So it just cleans the gut from the inflammation at levels not seen with the other competitive set. So once the teams align with that with the gastroenterologist, it's kind of like dealers choice. You can go with Skyrizi, which is a very convenient injectable once every 2 months or so, or you can take a very potent daily medication with Rinvoq. And so we have that type of discussion with the gastroenterologists around the world, and it's going to work very, very well.

Yes. No, two strong athletes in the field there. And then you're actually showing some muscle by doing the head-to-head versus STELARA. What's the importance of the result of that trial in terms of achieving your guidance?

I think it is important. I mean if you think of where we are today, we are right now for Skyrizi in the U.S., which is the first launch, we are just behind STELARA in terms of in-play share in really only a matter of 8 or 9 months. This is very substantial. So when you think of what we've been able to do with Skyrizi in the cousin therapeutic area of psoriasis, we've had 4 head-to-head trials at least, and we have another one on the way. So we were able to defeat Humira, STELARA, Cosentyx and one other. I mean it's quite -- Otezla even. And so it makes it just much more relevant to the prescriber, okay, that they just see actually, sometimes they see placebo-controlled study. When you have very trusted representatives and medical affairs personnel going in and saying, we just flat out beat the current standard, it's very powerful in terms of your share momentum, which we anticipate that will ramp even faster in the fourth quarter. And I think the second thing it helps us really to inoculate ourselves against ultimately a biosimilar, because there will be biosimilar STELARA in '25, '26 and beyond, we think across many of the territories. So it helps with that positioning as well for the physicians and the payers. The strength of Skyrizi and Rinvoq are all about differentiation. And so it just adds the body of evidence, not only with prescribers, but also with payers as well. And so it puts us in a very strong position given the head-to-head, the profiles of both drugs is very strong.

And Rob, you leave me to one of the two controversies that came out of the first quarter. One was this notion that there's a little bit of a disconnect between Street expectations for what the trajectory of both of these drugs, which have been very strong. So it's a question of sort of like cadence and relative strength there. And secondly, during the Q&A and the earnings call, what became topical and very much sort of top of mind was this notion of the pricing dynamic for both of these products. So can you address both of those issues, maybe perhaps starting with the latter question on the pricing dynamics that we can understand what you meant to relay in terms of how we should think about the pricing outlook for both of these products given the strength of the profiles, but given the complex dynamics across the space for the payers?

Yes, I'd say we fully expect the dynamics for -- in our guidance, right, we expected -- we knew about the high single-digit price headwind this year because we added 7 indications across Rinvoq and Skyrizi, and got very rapid access. We're talking about within 60 days getting a point where patients can access those medicines with those new indications. And so we rapidly gained access. We had that, I would call it, a 1-year step up or if you want to call it step-down on price, but that is not the go-forward assumption. We were trying to make sure that was clear to investors. I think where things went wrong, we'll say, in the first quarter was when you look at just sell-side consensus and the expectations, the full year was okay. The full year, the growth rates were right in line with our guidance. So there wasn't a disconnect there. That was around, we'll call it, the mid-40s revenue growth for both Skyrizi and Rinvoq on a full year basis. But the first quarter we had some analysts modeling 80% to 90% growth, greater than prescription growth in the first quarter. And so we printed a number that was ahead of our guidance. We did a little bit better on demand. It was consistent on price. And yet the reaction was we missed expectations because sell-side models had very significant growth for some reason, the first quarter, not for the full year. And so when we look at it, we stand behind this year's guidance. We stand behind the '25 and '27 guidance. I think there was just a disconnect in terms of the way the numbers were modeled. But the price dynamic we saw this year was a function of having an unprecedented number of new indications added to formularies in the last 12 months.

So then if I -- to be clear, make sure I understand you used the word, that won't be the case on the forward. So as we anticipate and model beyond 2023 into '24 and beyond in terms of what we think of the potential for pricing headwinds, you would say that, that is less. Can you quantify the magnitude? Should we see a gradual diminution because they're -- you're right, there's many material sizable indications that have come on. There's still exploration of additional indications, some of which are a bit more niche. But how should we think about that progression?

If you think about the overall, the growth of Skyrizi and Rinvoq, so last year, $3 billion; this year, based on our guidance, $3.5 billion. You are on trajectory to deliver that kind of growth and to exceed -- to get to that $17.5 billion in 2025. So we're on pace to deliver that. It is predominantly -- it's going to be volume growth. It's really about driving share and driving volume growth. I think we haven't been specific about price. What I will tell you is don't expect high single digits. I would -- if you want to model it closer to the industry averages that would be reasonable. But I would say count on us to deliver the volume growth without the type of price headwind we saw this year.

Okay. Great. Let's return to a foundational issue, which is the '24 earnings. [ 10 70 ]was the lower end of the range provided with the expectation that, that would be truly the floor in terms of the trough year, a lot of things going into that. And you've articulated previously that's separate from the Humira dynamic and the clear revenue drivers in immunology, I think it's the aesthetics, in particular, the BOTOX, the Allergan franchise is very much a part of that, dominant leadership here. Subject to macroeconomic environment conditions on a global basis, really, right, I mean, very important markets, et cetera, in China. The guidance has been that you expect to be relatively stable, the stabilization that you talked about in the back half of the year. As we sit here in mid-June, with your finger on the pulse, give us a sense for your incremental levels of confidence in the outlook of the aesthetics business since that seems to be relevant part of the calculus for '24.

Sure, sure. So I'll break it up between, I'll say, China and the U.S. In China, what we saw was an earlier recovery than we initially anticipated. When we gave the guidance, we said we would see the market recover from COVID in the middle of the year. We saw a very robust recovery. If you go back to December, January, we look at our market recovery index, it was in the 40% to 50% range, and then it bounced back very strongly thereafter. And we saw essentially the market recover by the end of the first quarter. And so we've seen an acceleration there. That has been a source of upside and drove a part of the beat and the raise that we delivered in the first quarter. In the U.S., it's been more stable. And so we look at things like consumer confidence, real personal consumption, Google searches. In the first couple of months of the year, the Google searches were up significantly. We saw it pull back a little bit in March and April. We've seen it recover and start to increase again in May. And so I'd say the metrics that we look at for the U.S. are, I'd say, stable. It is -- we had a good first quarter. We're trending well now. I think depending on -- it's difficult to predict the economy, but I think we took a prudent position on no recovery this year. What you will see, though, is the growth, you're lapping that impact. We had very robust growth from May of last year. I mean, we're starting to lap that impact. So that decline, you're going to lap, and then you'll see more stability. And then I would think about it as, if we see an earlier market recovery this year, that will be a source of upside because we've assumed market recovery next year.

And you kind of helped educate folks and segment the aesthetics business a little bit in terms of the neurotoxin side and the filler side, and educated us all in terms of the notion that the filler side is kind of like a bigger total invoice at the end of the day, potentially longer intervals between and some ability to change that. Update us on your thoughts on the neurotoxin dynamic, the filler dynamic, and what kind of cadence of recovery should they be in synchrony? Is there going to be a lag effect between one of the two segments?

They do behave differently. You would expect to see similar to when we saw the decline you saw it more for fillers, and it was really more a price point issue, right? So you would also expect to see the recovery come sooner for toxins as well. I mean they didn't decline as much. And so they'll get back to growth, I think, quicker. But that dynamic -- I think that's a good way to think about it. We're pleased with the performance of both, but certainly, given the different price points, you would expect to see a faster recovery for toxins versus fillers. And you're seeing that play out. And as we look at the market, there was a steeper decline in the market growth for fillers versus toxins as a result of that.

And as I think people think about the resilience and like -- just a simply fantastic market, the underpinning drivers are always going to survive through the end of time kind of thing. And I'm not sure that you can talk to this Roopal but in terms of thinking about innovation and what could come next. People are always trying to figure out what could come next. When you have a franchise such as BOTOX, right, it's not the 800. It's the 900-pound gorilla. And you have other players coming up with sort of different feature benefits, for instance, DAXXIFY from Revance. There's even folks looking at shorter duration stuff. Where is the innovation and growth to keep you on edge? And how do you see any potential competitive incursions clearly on market segments, but talk about innovation and competitive dynamics.

Yes. I think on innovation, you mentioned a couple of the aspects that we're certainly working on as well. So one of them is around short-acting and having a short-acting toxin that people can use and have sort of ready to go. If there's -- if it's a reunion season and you only got a couple of days, something like this could be a great profile that we can see ramp-up efficacy in the matter of hours to a couple of days, peak at around a week and then be gone. And then it's also important for patients that aren't exactly sure how it's going to turn out if their first attempt at a neurotoxin. So this gives you that confidence that you'll see it right away. And if you're not sure about it, it will also go away. But then once they like it, then we have the installed BOTOX already...

And when might be able to expect such an offering? Is there a timeline?

That's right. Probably around 2026 or so is kind of what we're planning for right now for something like that. That's our BoNTE molecule. We're also working on a long-acting toxin further in the decade. And that's going to be very important because it has to be a truly long-acting toxin. There may be others that claim to be long-acting, but if there's a mismatch between setting expectations with the patient early on and then not delivering on those expectations, many of these practices could be at risk for ultimately losing those patients. So that's why it's very important to get that right. So we're also studying that as well for that segment of patients where it can be important. I think where we're at now when you're around this 3- to 4-month cadence with the BOTOX, it's sort of expected, it's known. And many patients come in not just for one treatment, but a variety of treatments that can be offered. So sometimes it's great for practices to be able to see these patients 3 or 4 times a year. So there's also benefit to that. So setting expectations and achieving expectations are critical. We're also looking at around 2025 in China an approval for masseter with toxin. This is a prominence here on the side of the jaw. That's a very important desire or need in Asia. So that's another innovation in the U.S., hopefully, end of next year, early 2025. Platysma, people may not know what that is, but you'll see...

[ Shaving ] muscle.

You've seen that, right? And you also see how that may occlude the profile of the rest of the chin and jaw. So that one, the data are looking also very strong, so we should see that...

The portfolio of diversification continue to expand kind of the future benefit...

A little more [indiscernible] side of the fact that the key to growth -- I mean, these are markets with very low penetration rate. So it's really a market expansion story. The investment we're putting in, consumer activation, injector training. We always focused on innovation that will drive long-term growth. But really, the key is the market expansion. And that's where we have a tremendous amount of confidence. We understand there's always going to be a competitive dynamic. But it doesn't knock us off that trajectory to drive that long term greater than $9 billion of revenue in 2029. It's really more of a market expansion story with innovation, supplementing it.

Got it. As the clock is winding down, I realized that I've not necessarily addressing some very important parts of your business segment, particularly heme-onc side, the CNS, but perhaps we'll cover those to an extent with a question to you, Rob, particularly about business development. And I'll frame it from the standpoint that once we get past whatever tail stabilization for Humira, be it '25, '26. The Street is certainly expecting that there's going to be a very strong growth trajectory. And part of that seems to be just with any pharma company's equipment, doing business development. So to you, Rob, as we think about areas of particular focus or interest or opportunity. And I know you've articulated that it's kind of different for each business. But how should we think about things? And I want to also ask you to comment in particular because, for instance, immunology, you have such a bulky presence there. And there are some folks over at the FTC who are paying attention to folks who have bulky presences, et cetera. We also know that Prometheus was a bit of an auction, and you guys had a bid in there as well. So I think talk to the business development objective in terms of how important that would be to driving that post-Humira growth? And where we should be aware of where you're paying attention to?

Well, it's important to keep in mind that we do not need business development to deliver on the high single-digit growth outlook that we've delivered. So we can choose to do nothing. And with the portfolio we have today and the pipeline we have today can deliver that. So I want to make sure that's clear to investors. We're not looking to BD to help us achieve that. We're looking to it is more about thinking about that growth in the next decade. So you think about more early to mid-stage opportunities in immunology. Skyrizi and Rinvoq will deliver robust growth for the next decade. So we have a lot of runway. But if we can find a new mechanism that can advance standard of care and drive growth in the next decade, we have the financial flexibility to pursue it. That would be an example. I would point to in psychiatry, we have a very nice footprint there. If there is a next-generation asset that can really help us with mood and anxiety disorders, that will be of interest to us. If you look at oncology, we have a platform with ADCs and immuno-onc, but if we have a next-generation ADC or immuno-onc agent that can help us drive that longer-term growth, that would be an interesting opportunity for us. In eye care, we are really focused on glaucoma and retinal disease. If you look at just the REGENXBIO gene therapy as an example, there are technologies that we can identify that can advance standard of care in those disease areas, those would be things we'd be interested in. So we have plenty of financial flexibility given the rapid debt paydown. And that's what we were trying to communicate to investors. It's not that we're going to run out and do something large. We're not planning on that. We're looking -- we're more focused on that longer-term growth given the portfolio we have today, but we've done a nice job of deleveraging. We have more financial flexibility. And so -- and we've demonstrated tremendous amount of value generation with the deals we've executed, Allergan is a great example of that.

Terrific answers, lots of content there. Can't wait to reread the transcript here, buckle-up folks. I think there's a lot of ingredients that will go into this growth calculation, not just at the end of the decade, but as we've articulated into the 2030s. So we're out of time. Appreciate you coming all the way over here and bringing an entire crew. Kudos to the IR team led by Liz. Thank you very much Rob, Jeff and Roopal.

Thank you, Chris.

Thank you.

Thank you.