Bristol-Myers Squibb Company (BMY) Earnings Call Transcript & Summary

All right. We're just right about at time. So let's get started. Welcome to day 3 of our Healthcare Conference. My name is Asad Haider, I'm the U.S. pharmaceutical analyst at Goldman Sachs. I'm very, very pleased and privileged to have the Bristol-Myers team over here, Chris Boerner, Chairman and CEO; and Adam Lenkowsky, Chief Commercial Officer. Chris and Adam, welcome, and thank you for being with us.

It's great to be here.

Thank you.

So I guess just let's start with a big picture question because this is something that we're really asking all of our companies just to sort of check the box and get it out of the way, and that has to do with the external operating environment, policy-related uncertainties that have been bearing down on the pharmaceutical sector. We've been hearing from companies all week on how some of the conversations with the administration have at least directionally been moving in the right direction, although caveated with the fact that it's still very early, and we don't know where this is all going to land. So maybe, Chris, just talk to us about how you're thinking about MFN in the context of your own conversations with -- and interactions with Washington, D.C., sort of what's the mood out there? And what are the range of outcomes that you think could happen?

Well, first of all, it's great to be here. We are obviously engaging with the administration. We've been engaging with the administration since January. And I'd say we're having constructive discussions. I'm obviously not going to get into the specifics of what we're discussing in our individual conversations. I don't think that would be appropriate. But if I just step back and say how I frame the conversations generally with the administration, I would say, if you go back and look at the executive order when the President announced the executive order on pricing, what did he say? There were a number of things that he focused on that we actually have a lot in common and agree with. First of all, he highlighted the fact that countries outside of the United States are not paying their fair share for research and medicines coming out of the U.S. We agree with that. And frankly, we applaud this administration as one of the first really in recent memory to say we're going to actually use the power of the presidency and tariff policy to begin to engage with this industry and try to make meaningful movement outside of the U.S. on pricing. So we agree there. He highlighted the fact that the U.S. system is very complicated. In fact, multiple times we talked about the role that middlemen play in the United States. And it's helpful as an aside to remember that $0.50 of every dollar paid for a branded medicine in the United States goes to somebody who wasn't involved in the highly risky endeavor of researching and developing that medicine. And so again, that's an area we have a strong alignment with. And as an industry and certainly as a company, we're going to continue to engage on ways, as we have been for years, to bring the cost of medicines for patients down in the U.S. So there's a lot of room for constructive engagement, the type of engagements we've been having. Having said that, we've also been very clear for some time that importing failed policies from outside of the U.S. is not something that we support. Policies from countries that have less access to innovation, that it takes longer to get where they ration medicines we don't think those are good policies for the U.S. And so we're going to continue to be direct on that regard as well. But so far, the engagements we've had with the administration have been constructive.

Should we be expecting any kind of an update this week on the 30-day mark?

Look, I don't think it's a useful exercise for me to try to predict what's going to happen when. What I would say is that conversations that we're having continue and those conversations are constructive at this point.

Okay. And maybe just to finish up on the external environment on tariffs, you put out an announcement via Stat News article on potential for $40 billion of U.S. manufacturing and R&D investment over the next 5 years. So maybe just double-click on the evolution of how that came about just given that it wasn't a discussion point on your earnings call just a couple of weeks earlier.

Well, obviously, we've been looking at investments across research and development, IT, manufacturing, which is what was included in that $40 billion projection of investments. And so some of those were things that had been on the table that we were considering. Some of those were things that, depending upon the policy evolution, would be additional investments. But that's the way we characterize it at the time. What I would say, if you just step back, as has always been the case at the company, we are going to make investment decisions, whether in terms of programs, resources or core infrastructure that reflects the needs of the business, the economic environment we have and certainly government policies. And so we felt comfortable that as we look forward 5 years, those are the types of investments we could predict in the U.S.

Perfect. Let's shift to just capital allocation and obviously starting with the BioNTech partnership. Congratulations on the deal, very exciting. Clearly, a lot of excitement about the PD-L1 VEGF bispecific as a potential new frontier in oncology. So I guess, just talk us through how you landed on this asset specifically. And the price tag. And maybe just talk us through, help us understand the deal structure and the reason for the staged payments that you've structured into this deal? And how do you think about quantifying the size of the opportunity given the total consideration of the deal could be up to about $11 billion.

Yes. Well, let me start and then Adam, you should chime in. Look, we've been following this target and the science related to this for some amount of time. And what do we know about it? We know the data that's emerged across companies, including BioNTech, is quite exciting and that there's a real potential here if the data continue to evolve, that this is going to have a meaningful impact on a number of difficult-to-treat tumors. And those include tumors like lung cancer and triple-negative breast cancer, just to name two. And so we felt that as this evolved, when you look at the overall dynamics at play and notably, the number of potential competitors who could be in this space, was an area that we felt we wanted to try to get into, but we wanted to be in a position to be first or second. And that really framed how we thought about the opportunity here, and that's precisely what we have with the partnership that we announced at ASCO. This is an exciting target. BioNTech has a great scientific perspective here. We applaud them for getting in early on this asset. And we're very excited to have -- it's a 50-50 co-commercialization, co-development arrangement. And I think there's real synergies between these two companies. And I think we have a real potential to be first or second across multiple tumors, and that provides a significant opportunity not only for the company but to help a lot of patients. But Adam?

Yes, just adding on to that. We're very excited about this partnership. We had said that business development was a top priority for the company. And we have now almost a 2-decade experience and leadership in the immuno-oncology space. And so this is a great strategic fit for our company. and I think a good strategic fit as well for BioNTech. So we're excited to work urgently to bring this market, as Chris said, to be first or second is critical. It's obviously a key learning from the experience we've had with Opdivo, and that's what this opportunity will bring. In terms of the deal structure, as you know, it was a $1.5 billion upfront with $2 billion in milestone payments, so roughly $3.5 billion upfront up to $11 billion, and that $11 billion really is largely around sales milestones and regulatory milestones. So if we get to an $11 billion outcome, we're going to be thrilled, because we will deliver, but we hope to deliver with this asset, and that's transforming the cancer landscape with BNT327. As far as the opportunity here, we have a broad CDP that we are working on with BioNTech. You've got a number of Phase III studies in flight today. So we're going to leverage our commercial and development capabilities that we've built for -- now for years to accelerate those studies. We think we have an opportunity to grow what today is about a $50 billion landscape with novel, novel combinations, looking at not just areas like Chris mentioned, in lung cancer and vesting standard of care, but also expanding beyond tumors that we've seen that are immunosensitive today.

On the point of being first or second in oncology. You've made this point a few times, Chris, that is of the value of sort of being ahead. And you've talked about this acceleration strategy with the BioNTech compound. Maybe just do you see scope to potentially leapfrog where ivonescimab is?

Well, obviously, we're going to move as quickly as we can. And we think there's a real opportunity across multiple tumors for us to be either in a first position. And if we're not in a first position, to be second, we're going to do everything we can to prosecute these programs with high quality, but also recognize that this is a highly competitive space. And we genuinely believe, and this is based on the experience we've had with Opdivo and KEYTRUDA in the IO space that the vast majority of the value that will accrue in this class is going to go to those agents that are either in the first or second position. What we've seen in IO, and we would see no reason it would be different here, especially in light of the number of players potentially in this space. So it's interesting to note the day we announced the deal, that morning, the teams got together and began working through exactly how we were going to help accelerate ongoing programs and initiate the programs that we've agreed to as part of our clinical development plan.

I just want to spend one more minute on this, just given how topical it is. And Adam, for you, just given that these drugs are going to be launching in a world of biosimilar, Opdivo and Keytruda, I mean, what's the level of differentiation that needs to be seen both from a regulatory and FDA perspective as well as from a payer perspective?

It's a great question. I mean I see this market shifting twice, if you will. I think the first shift that we're about to see is the shift in formulation. And so as you know, we've launched Opdivo Qvantig, and we expect to see additional subcutaneous formulations moving. We've talked about shifting roughly 30% to 40% of our current IV business over to Opdivo Qvantig by 2028. And so we'll see a significant portion of the business, I think, today in PD-1, PD-L1s moving from IV to Subq, leaving less for biosimilar encroachment. I think the second piece, though, is when we see the data that reads out from PD-1, PD-L1 VEGF and the superiority that will be necessary in order to get into the marketplace, again, beating standard of care in the oncology landscape is important, particularly when you look at overall survival, and we've seen a significant PFS benefit already across a host of tumors. So I think when that comes to pass, we will see fairly rapid conversion over to these new modalities, and we're excited that, as Chris mentioned and I mentioned being first or second is so critical in order to maximize the opportunity I think we have at hand.

Okay. Perfect. And then maybe just staying high level, big picture. Back to you, Chris, just on the broader M&A and BD strategy in the context of the economics of this deal, M&A was obviously framed as a top priority on your first quarter call. So maybe just give us an updated ranking of capital allocation priorities as well as maybe any comments on just your firepower.

Yes. Well, I mean, BD continues to be an important priority for the company. It's -- we've always sourced innovation at Bristol, both internally and externally, and that's going to continue to be the case. In terms of the areas we're interested in, I would say we continue to be focused on our core therapeutic areas. This is certainly a great example of that. Oncology is an area we know well. We know the IO space having brought IO to market and the only company to have three distinct targets in IO. And so we would be looking to do things that make strategic sense like the BioNTech deal. We'd be looking for opportunities for us to certainly continue to drive value for the company and for shareholders. That's a prerequisite, of course. The science needs to [indiscernible] and then the only thing that we have added to that criteria list is to say we're looking for opportunities to accelerate growth as we exit this decade. That continues to be the North Star for how we're thinking about rewiring the company and focusing our efforts. And so we're going to look for those opportunities as well. But business development remains a top priority, and we have the ability thanks to the fact that we've been very financially disciplined over the last number of years, we've got financial capacity to engage where it makes sense.

Any numbers around that in terms of quantification?

Look, I think the way we look at it is we've got the financial horsepower to be able to engage in deals that make sense for the company, and those could be anything from partnerships like the one we announced with BioNTech to potentially M&A, but nothing beyond that. Our focus continues to be really focused on driving the business we have today, prosecuting the pipeline that we have and where it makes sense, bring in additional opportunities to grow the company.

And then on the cost cut side, Chris, this is another sort of operational efficiencies is something else that we've been championing. And so I guess in the context of the $40 billion in manufacturing commitment and now this deal with BioNTech, just frame to us how this all fits into the broader kind of cost-cutting calculus.

Yes. Well, look, the announcement that we made this year of $2 billion in efficiencies, those were independent of the thinking around this opportunity, and those are still very much on track. We'll be able to deliver on that. And remember, when we announced that, part of that was a financial exercise. But really, I would step back and frame that more broadly, which is to say we are in the process of rewiring the company and that means becoming a much more operationally efficient company to be much more disciplined in how we operate and ultimately to become more agile as an organization. If you look at kind of the world that we're in, in biopharma, it's one where the level of competition is going to be increasing. You can expect that over time, I think there's going to be a higher premium placed on the organizations that are financially disciplined in how they operate. And we're getting ahead of that, and this is a perfect opportunity for us to do it. And so that's how we think about the $2 billion. With respect to the financials on this deal, we obviously have non-IP R&D that we'll have a charge against and then we'll talk about the additional financials of this deal when we get into the Q2 call.

Perfect. All right. Let's move to the product side and zoom in on some of the key products. Adam, Cobenfy, obviously, it's something that's very topical. Right now, people are focused -- investors are focused on sort of that launch. It's experienced a bit of a clinical setback with the ARISE study. And as we look at scripts, now deep into the second quarter, they do -- and our excess certainly seem to be moderating to some extent. So why is that? And has there been any impact from ARISE in terms of what you're seeing with prescribing with neuropsych specialists on the ground?

Yes. Let me just take the second piece first and just maybe take that off the table around ARISE. So obviously, ARISE study right out wasn't quite the results that we hoped for. But there were certainly some meaningful and notable results that came from this study. Clearly, a significant portion of patients in that study derive benefit there was -- have been nothing approved in the adjunctive space to date. And so we're continuing to interrogate that study. The safety profile looks very good. And so we want to better understand that study and why some of the patients did not respond versus the patients who had a robust response. And so when I think about the impact in the landscape today, has zero impact. The awareness of that study is very low with the community psychiatrists, the only physicians who really are aware of that study to date has been the investigators. And so they are asking the same questions, and we're working with them to better understand the results of the study. So the ARISE study has no bearing on the uptake of the brand in the short term, or in the long term. We did not describe any sales to an adjunctive use of the product. That said, as Cobenfy is a critically important product for the organization in the near term and in the long term. The launch is tracking against our expectations. When I think about what's going well with the launch, number one, we've surpassed 30,000 TRxs to date. That's ahead of any recently launched [indiscernible]. What I look at and look for from a week-to-week basis is how we're doing in driving and increasing the number of prescribers. Driving breadth of prescribing is the most important factor for any launch because you need to have a broad base, and so we're tracking ahead of our own expectations as well as external analogs. And the feedback from physicians has also been very positive to date, particularly around the efficacy profile and most notably, the cognitive benefits that excited us about the asset, and how unique that product is in the marketplace, where there's been nothing for 3 decades in the space. That said, it's going to take time to continue to increase the number of prescribers drive breadth and depth of prescribing getting doctors to break that inertia and that kind of habit of using age, generic D2 in the marketplace. We've got a very robust plan in place right now in the field organization. We'll be upsizing our teams in the near future as well to make sure we've got the right reach and frequency. The other question that we typically get now is around how do you switch? What's the best way to switch? So we've got a study in place right now to help inform physicians on what's the best way to switch and manage some of the adverse events that could manifest with using two products at once. And -- but the feedback that we've heard from the prescribers, the feedback we've heard from KOLs and most importantly for patients have been very positive. So our focus is continuing to accelerate the launch, which still is in the early innings and we feel very good about, where we're going to be at the end of this year.

Are you still confident in the ramp you've talked about in the second half of the year?

We do. We've got good access now in place. We're going to continue to drive commercial access. Getting more and more successes, getting more physicians to write. Yes, we do believe we'll see strong uptake in the back end of the year.

And then I guess, looking forward to the ADEPT trial in ADP, how are you thinking about that opportunity in all Alzheimer's psychosis? And any update on timing and any sort of high-level framing on what would constitute success in that trial? What does it need to hit?

Well, as you know, we have 3 studies in Alzheimer's disease psychosis, ADEPT-1, ADEPT-2 and ADEPT-4. And so three shots on goal here. Clearly, this is an important opportunity for patients and for the company. It's a very sizable opportunity, about 6 million patients with Alzheimer's disease, about half of those suffer from hallucinations and delusions. So we look forward to the readout of ADEPT-2 in the back end of this year, but also gives us a lot of encouragement around these readouts, is what we've seen from the open-label study from ADEPT-1. And so we're very excited about what we're seeing around reduction in hallucinations and delusions. We look forward to sharing those data over the coming months, but gives us increased confidence around the three studies that we have in Alzheimer's psychosis. Remember, we're also starting 7 new Phase III studies. A number of them are in the Alzheimer's domain, Alzheimer's agitation, Alzheimer's cognition beyond Alzheimer's psychosis as well as bipolar disorder, irritability associated with autism as well as a new formulation, which will be an LAI that we'll launch in the back end of the decade. So we essentially have the opportunity to have a data readout every single year from now to the end of the decade. And we believe that this will be a meaningful contributor to growth for the company in the back end of decade and beyond.

The way we -- if I step back and look at the transaction to get Cobenfy, what did we assume? We assume that we would have a meaningful opportunity in schizophrenia and that we would have a meaningful opportunity starting in Alzheimer's disease with the initial indication in psychosis. But our interest in that space actually goes even further back to the original work that was done [indiscernible] by Lilly, where they saw a benefit in Alzheimer's. There were some toxicities in the brilliance of what Karuna did was combining trospium, finding the right engineering to be able to engineer out some of those toxicities. But also keep and preserve the benefits that we're seeing back in the '90s from that Lilly work. What we see with the end market today, we've got a very strong launch off the bat. We've got very good feedback from physicians in terms of what they're seeing on positive symptoms, negative symptoms. And as Adam mentioned, the cognitive benefits, which again, aligns to what we saw in that early Lilly data and what we have now is a number of programs that either will begin reading out or that we'll be initiating to ensure that we can maximize the opportunity beyond schizophrenia. But we're incredibly excited about the potential that we have with Cobenfy and it's a nice opportunity for us to reenter the neuropsych space. And of course, we've got a neurodegeneration portfolio that's a bit earlier on in the pipeline.

Okay. Let's maybe shift to Opdivo Qvantig. I guess maybe just starting with sort of this debate about potential inclusion of SC form, Subq formulations and IRA negotiations for the latest CMS update. So what's Bristol's position on that? And what would be the impact if Qvantig is included along with Opdivo in the negotiation?

Thanks for the question. So we're in the midst of the commentary period right now. And we feel very strong about the clinical benefits that Opdivo Qvantig brings to physicians and physician practices to patients and to the entire health care ecosystem. So we feel strongly that Opdivo Qvantig should be excluded from the IRA negotiation. So I'm not going to speculate on the results of that. But what I can tell you is that we look forward to sharing the commentary, and also working with the administration to clearly demonstrate the benefits that Opdivo Qvantig brings to patients and physicians.

Are they clinically different?

In terms of the two?

Yes.

Look, I think one of the things that we're really excited about and hearing back from physicians early on is, number one, the ability to administer in office in a 3-minute infusion versus a 30-minute infusion, saving time for physicians, nurses and ultimately, using the product in the community where we see about 80% of the business. In terms of the safety profile, safety profile has been excellent in the real-world setting. And we're also seeing efficacy that at least on par with what we see with the IV. So we have shared this, it's part of our commentary, along with other data that we have in-house. I know Halozyme, who have been our partners in this formulation has also shared their commentary. These are dual moieties. So again, very separate mechanism here that we see with the IV. So again, we feel good about the arguments we're putting forward.

I think the -- if you step back and look at it, you've got real physician benefit, you've got real practice benefit, real patient benefit, most importantly, the FDA has weighed in this being a distinct product. And let's remember, if you look across multiple companies, there's a lot of innovation taking place in this space precisely because of the benefit it brings to patients and practices. And I think, we're making it very clear the dampening of innovation that would take place if you ended up seeing the type of proposal that was put forward here, and we're going to be aggressive in how we communicate that to the administration.

Just before we leave that topic, Adam, any updated thoughts on the launch now midway through the year? And what gives you confidence that the J-Code in GI is actually going to lead to an inflection?

Yes. Really pleased with what we're seeing in the early days of the launch. As I talked about, we are seeing good uptick in the community, roughly 80% of the prescribers in the community as we had expected. We are seeing good breadth of accounts adopting Opdivo Qvantig, making that a preferred formulation in their respective either community practice or even in the academic centers. The patient feedback has really been strong in feeling that they're not tethered to an IV, some of the quotes we've got back from patients is I don't feel like I have cancer because I can go out and do the things I want to do. And then the other -- the last piece I'd mentioned is kind of the breadth of tumors that the product has been used across. It's not just 1 or 2. We're seeing use across a host of tumor types. So we're encouraged with what we're seeing today. As you mentioned, it is not the J-Code, we expect July 1. And what that will do is really, I think, inflect the business when you give that greater certainty of reimbursement to community oncologists. And so every new Part B oncolytic launches with a temporary J-Code. So come July 1, we should have our permanent J-Code in place, and we expect to see that really take off post July 1.

Okay. Perfect. Let's talk about Camzyos. That tracked very well in the first quarter. You doubled sales versus the prior quarter. I know it's early. But what can you tell us about how that launch has been progressing? And I guess, longer term going into next year, how are you thinking about the emerging competition?

Yes. So pleased with the performance of Camzyos. We have established a very robust set of patients who've been prescribed Camzyos since launch. Roughly 15,000 patients have been prescribed the product. Similarly to how I described Cobenfy is the feedback from and physicians has been truly remarkable. Patients are going to be on this product for many, many years, just because they're feeling great. They're doing things now that they have been unable to achieve before they were on their treatment. So as we're gathering more patients quarter after quarter, as you know, back in March, we had a label update to loosen the burden of echo restrictions, moving that from -- to every [ Q 6 ] months here. So it's -- that has already started to bear fruit in terms of allowing physicians to treat more patients in the COEs. We've also started to see patients being treated more frequently in the community cardiology offices, which is a core part of our strategy as well as seeing the diagnosis rates start to increase. So all those factors have been contributing to a very strong performance over the last several years for Camzyos. As it relates to the competition, we've been preparing for the competition for quite some time. We'll be prepared when it comes to market. We expect that to happen sometime late this year or early next year. But we feel really good about the position that we have and the leadership that we've had now for multiple decades in the cardiology space, starting with Plavix to Eliquis to Camzyos and hopefully with milvexian data readout. So feel great about where we are with Camzyos, it's going to be a very big product for the company.

Great. Let's maybe shift to cell therapy. Breyanzi and Abecma. Just help us mark-to-market the state of the uptake there is there growing availability and sort of branching out beyond centers of excellence? And what innings are we in this for these products specifically?

Yes. Again, I think we're still in the relatively early innings. When you look at where we were with Breyanzi at the launch to where we are today, I think it's almost unrecognizable quite frankly. I mean our supply team has done a phenomenal job. It certainly has been a complex journey, but where we are today, we have significant supply, adequate supply to treat the patients in the United States, and we're expanding more broadly outside of the U.S. We showed in Q1 150% growth versus prior year. And as you probably know, we have surpassed YESCARTA as the #1 CD19 directed CAR-T in the United States. And so our strategy is continuing to drive market share leadership within these CAR-T centers of excellence as well as because of the unique and differentiated adverse event profile that Breyanzi brings to patients, allowing patients to be treated in the outpatient setting. And we see now about 40% of the use in the outpatient setting. There's a lot of interest that we're starting to hear from some of the large oncology practices about wanting to use Breyanzi in the outpatient setting. And as you know, last year, we also had a number of indications added to. So we've got the breadth of indications that are greater than the competition there. So we're starting to see not just leadership in LBCL, but in areas like second, third line follicular lymphoma in CLL. We presented data in marginal zone lymphoma. Mantle cell lymphoma is indicated in the U.S. today. So we feel great about where we are with cell therapy and the leadership we have there and where we're headed with our best-in-class product in Breyanzi.

And then my last question on the growth portfolio, and then I do want to talk about the pipeline is just quickly on Reblozyl. Obviously, that's been a great growth product. But what keeps the momentum going? I mean, is it new indications? Is it market growth? Or is it something else?

Yes. It's the new indications that we are -- we have launched. Now we launched the COMMANDS first-line study now going on, I mean, 2 years ago come this August. And so what we have been seeing very consistently is market share increases the first-line RS negative. We very quickly were able to get over a 70% market share in the RS positive, but that represents about 25% of the potential. The large piece of that business is in the RS negative. And so that's been the team's focus in growing in the RS negative largely the EPO less than 200, where the untapped opportunity has been rapid switch where it's being used in a second line post ESA. So that also has contributed to the growth. Plus, we're starting to launch more broadly outside of the United States. We've got broad label in Europe and some of the broadest labels in Japan where the indication is not just in transfusion dependent, but also in non-transfusion dependent. And we also will be launching in China as well. We've got exciting opportunities to grow there. So taken together, we expect to see continued growth for Reblozyl over the next several years and into the 2030s.

Okay. Perfect. Let's maybe spend the last few minutes just talking about the pipeline. You flagged over a dozen upcoming pipeline milestones in the next 12 to 24 months. So just maybe rank the top 2 to 3 for us in order of your level of confidence on excitement as it relates to the opportunity and more importantly, the impact to your business.

Maybe Adam can start and then I'll...

Yes. So I've been with the company, Asad, as you know, for over 2 decades, and we've never had the pipeline that we have today and the number of readouts that are really right in front of us. So you can start to see with our growth portfolio that we've talked about, coupled with the pipeline, what the future of the company is going to look like. In fact, we talk about 10, 30, 30, which 10 new products potentially new indications launched by 2030. So really exciting opportunities. I'll start. I mean, for me, I'm going to start with Cobenfy because I'm really excited about what the opportunities that Cobenfy can bring and the robust growth that we expect there in these 7 new studies from Alzheimer's disease to bipolar disorder all the way to autism. Of course, we still have significant growth yet to achieve in schizophrenia. The other asset that I'll mention is milvexian. So we're excited about the 2 data readouts we expect next year in ACS and secondary stroke prevention. And then in 2027, a readout in atrial fibrillation. So that is really important for the company growth and sustained leadership in cardiovascular. We're very pleased with what we've seen to date. When we look at the blinded data from AFib, we've seen nothing like what Bayer had seen in their study. So we expect to see a low bleed rate a rate that's comparable to Eliquis, but also lower events. So we're excited for those important data readouts. I don't know, Chris, if you have...

Yes. I mean I would just start with milvexian and I think Adam's covered Cobenfy. Remember, in atrial fibrillation, about 40% of patients are either not getting or underdosed with respect to a Factor Xa. So there's a lot of opportunity in that opportunity. And so I would start with milvexian and then I would say, let's remember, we've got [indiscernible] that will read out in multiple myeloma in the coming year or so. And those are going to be potentially large opportunities as oral therapies with the potential to be partially replacing of where we were with Revlimid and Pomalyst. [indiscernible] that I'll throw in there, which we have not been talking a lot about is golcadomide. I actually started my career in lymphoma. And if you look at the mainstay of diffuse large B-cell lymphoma, it's still a Rituxan-based therapy. And we have an opportunity with golcadomide given the data that we've seen so far in early line lymphoma to, again, be a transformative therapy there. So that's exciting. And then last but not least in an over at time is earlier data, but the opportunity we have with next-generation CD19 NEX-T, particularly in the data we're seeing in lupus. It's incredibly exciting. And obviously, that continues to hold out. We think we have a transformative therapy there. starting in lupus, but potentially in other autoimmune diseases. So there's a lot happening, as you've said, and as we've reiterated, we're at the beginning of a wave of potential assets that along with the business we have today is going to really shape the company looks like as we exit this decade.

Terrific. Thank you both very much. Great conversation, covered a lot. Really appreciate having you both here.

Great. Thank you.

Thank you.