Creating Shared Value Through Socially Responsible Initiatives in the United States

The Blueprint for TheChange Blueprint Program for Change Program January 2012 03 January 2012

Creating shared value through socially responsible initiatives in the United States

We believe that a healthy economy, environment, and society are fundamental to long-term business growth. This is why we manage our business in accordance with the Triple Bottom Line principle and pursue business solutions that maximize value to business and society. This report details how this principle has contributed to our success in the United States.

DOLORES REISNER USADOLORES REISNER USADolores has type 2 diabetes Dolores has type 2 diabetes

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contents creating shared value

If we… We seek to The Triple Bottom Line: Creating shared value 3 address barriers to high-quality care for patients change diabetes A commitment to sustainable and those at risk of type 2 diabetes… and establish our growth have a positive societal impact in the communities presence in a Corporate social responsibility Our approach 4 we call home… holistic way, What is shared value? is not only a moral decision. partner with our stakeholders to help them reach addressing Put quite simply, shared value means what is good Evidence now shows that socially The challenge 6 their goals… patient, societal, for patients, our employees, and our communities responsible activities can help and stakeholder is good for us. companies gain a competitive needs. advantage in building a strong We could… The Novo Nordisk Way describes who we are, improve patients’ lives and help to reduce their where we want to go, and how we work.1 We reputation, earning the trust of Value to society 8 healthcare costs… believe that a healthy economy, environment and customers and investors, and create jobs and give back to the community… society are fundamental to long-term business attracting, engaging, and - Quality of care 8 build a committed workforce that enables the growth success.1 This is why we manage our business in retaining employees. of our business accordance with the Triple Bottom Line principle and pursue business solutions that generate value - Early diagnosis 12 to business, patients, and society. We would create shared value. - Prevention 14 By putting patient, societal, and stakeholder needs at When we consider the interests of our patients ADAM M. GRANT, Professor the center of our business, we build relationships. This and other stakeholders — providers, payers, and The Wharton School differentiates our company, opening doors for those we serve suppliers and other business partners who support University of Pennsylvania - Helping to build and for ourselves. our efforts to improve outcomes for people with sustainable communities 16 diabetes — we maximize value for both society and our company (Figure 1).

Our Triple Bottom Line principle carries a business We never compromise rationale. When we address societal issues, we Value to us 18 build an engaged workforce that creates synergies on quality and business ethics. with our partners. It helps us to build trust with - Culture and employee engagement 18 our customers by strengthening their value chain — potentially opening new opportunities for long-term business success. That’s shared value. the Novo Nordisk Way1 - Stakeholder support 20

Looking to the future 22 Shared value starts with the patient Figure 1

Methodology and definitions 24 Healthy people Value to society Value to us with diabetes Glossary 26 Limiting disease onset or achieving The most valuable patients are high quality care may improve the healthy people with diabetes who are lives of patients and reduce medical loyal to our products and services and nonmedical cost to society Reference list 27 Quality of care

Early diagnosis

Prevention

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If we… WeWe seekseek toto We seek toTheThe TripleTripleThe BottomBottom Triple Line:Line: Bottom Line: Creating shared value 3 address barriers to high-quality care for patients changechange diabetesdiabeteschange diabetesAA commitmentcommitment A commitment toto sustainablesustainable to sustainable and those at risk of type 2 diabetes… andand establishestablish ourandour establishgrowthgrowth our growth have a positive societal impact in the communities presencepresence inin aa presence in a CorporateCorporate Corporatesocialsocial responsibilityresponsibility social responsibility Our approach 4 we call home… holisticholistic way,way, holistic way,WhatWhat isis sharedsharedWhat value?value? is shared value? isis notnot onlyonly is aa notmoralmoral only decision.decision. a moral decision. partner with our stakeholders to help them reach addressingaddressing addressingPutPut quitequite simply,simply,Put shared sharedquite simply, valuevalue means meansshared what whatvalue isis means goodgood what is goodEvidenceEvidence nownowEvidence showsshows now thatthat shows sociallysocially that socially The challenge 6 their goals… patient,patient, societal,societal,patient, societal,forfor patients,patients, ourourfor employees,employees,patients, our andand employees, ourour communitiescommunities and our communitiesresponsibleresponsible responsible activitiesactivities cancan activities helphelp can help andand stakeholderstakeholderand stakeholderisis goodgood forfor us.us.is good for us. companiescompaniescompanies gaingain aa competitivecompetitive gain a competitive needs.needs. needs. advantageadvantageadvantage inin buildingbuilding in aa buildingstrongstrong a strong We could… TheThe NovoNovo NordiskNordiskThe NovoWayWay describes describesNordisk Way whowho describes wewe are,are, who we are, improve patients’ lives and help to reduce their wherewhere wewe wantwantwhere toto go,go, we andand want howhow to wewego, work. work.and how11 WeWe we work.1 We reputation,reputation,reputation, earningearning thethe earning trusttrust ofof the trust of Value to society 8 healthcare costs… believebelieve thatthat aa believehealthyhealthy that economy,economy, a healthy environmentenvironment economy, andandenvironment andcustomerscustomers customersandand investors,investors, and andandinvestors, and create jobs and give back to the community… societysociety areare fundamentalfundamentalsociety are totofundamental long-termlong-term businessbusinessto long-term business attracting,attracting,attracting, engaging,engaging, engaging,andand and - Quality of care 8 build a committed workforce that enables the growth success.success.11 ThisThis issuccess.is whywhy wewe1 This managemanage is why ourour we businessbusiness manage in inour business inretainingretaining employees.employees.retaining employees. of our business accordanceaccordance withwithaccordance thethe TripleTriple with BottomBottom the TripleLineLine principleprinciple Bottom Line principle andand pursuepursue businessbusinessand pursue solutionssolutions business thatthat solutions generategenerate thatvaluevalue generate value - Early diagnosis 12 toto business,business, patients,patients,to business, andand society.patients,society. and society. We would create shared value. - Prevention 14 By putting patient, societal, and stakeholder needs at WhenWhen wewe considerconsiderWhen thethe we interestsinterests consider of ofthe ourour interests patientspatients of our patients AADAMDAM M.M. GRANTGRANTADAM,, ProfessorProfessor M. GRANT , Professor the center of our business, we build relationships. This andand otherother stakeholdersstakeholdersand other ——stakeholders providers,providers, payers,payers,— providers, andand payers, and TheThe WhartonWharton SchoolTheSchool Wharton School differentiates our company, opening doors for those we serve supplierssuppliers andand othersuppliersother businessbusiness and other partnerspartners business whowho partnerssupportsupport who support UniversityUniversity ofof PennsylvaniaPennsylvaniaUniversity of Pennsylvania - Helping to build and for ourselves. ourour effortsefforts toto ourimproveimprove efforts outcomesoutcomes to improve forfor outcomespeoplepeople withwith for people with sustainable communities 16 diabetesdiabetes —— wewediabetes maximizemaximize — valuewevalue maximize forfor bothboth value societysociety for both society andand ourour companycompanyand (Figureour(Figure company 1).1). (Figure 1).

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Looking to the future 22 SharedShared valuevalueShared startsstarts value withwith thethestarts patientpatient with the patient FigureFigure 11 Figure 1

Methodology and definitions 24 HealthyHealthy Healthy peoplepeople people ValueValue toto societysocietyValue to society ValueValue toto usus Value to us withwith diabetesdiabeteswith diabetes Glossary 26 LimitingLimiting diseasedisease onsetonsetLimiting oror achievingachieving disease onset or achieving TheThe mostmost valuablevaluable patientsThepatients most areare valuable patients are highhigh qualityquality carecare maymayhigh improveimprove quality the thecare may improve the healthyhealthy peoplepeople withwithhealthy diabetesdiabetes people whowho arewithare diabetes who are liveslives ofof patientspatients andandlives reducereduce of patients medicalmedical and reduce medical loyalloyal toto ourour productsproductsloyal andand to servicesservices our products and services andand nonmedicalnonmedical costcostand toto nonmedical societysociety cost to society Reference list 27 QualityQuality Quality ofof carecare of care

EarlyEarly Early diagnosisdiagnosis diagnosis

PreventionPrevention Prevention

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v creating shared value in the United States v creating shared value in the United States 6 The challenge The challenge 7 The Blueprint for Change Program The Blueprint for Change Program

the challenge

Diabetes trends Type 2 diabetes is Diabetes and prediabetes prevelence in the United States Figure 5 Type 2 diabetes is Figure 8 present a a growing epidemic a complex condition Positive treatment outcomes require a focus on both products and services complex million people are living with diagnosed 3 challenge that Indisputably, type 2 diabetes is an epidemic. and undiagnosed diabetes The challenges of the type 2 diabetes 32 Patient value proposition requires If that weren’t enough, too few people with epidemic are multifaceted. million people interventions diabetes get adequate care. The result is a public 150 We know that prevention and quality care can help 140 on multiple health crisis that stretches healthcare budgets, 130 to reverse this crisis. People with diabetes who Disease Awareness 120 fronts. reduces business productivity, and robs people of 110 maintain near-normal blood glucose levels can 100 quality of life through loss of income and physical 90 gain, on average, 8 years of sight, 6 years free of Patient Advocacy 80 8 disabilities, such as blindness, kidney and heart 70 kidney disease, and 5 years of life. And yet, fewer disease, stroke, and amputation.4 60 than 4 in 10 people diagnosed with diabetes reach 50 Service and Community 40 recommended treatment targets.9 support 30 Fueled by poor lifestyle choices and escalating 20 10 5 Access to Healthcare obesity rates, the number of Americans diagnosed 0 Some risk factors for diabetes can be modified,

with diabetes has ballooned by more than 65% 2000 2010 2015 2025 though they present complex challenges 6 10,11 in the past decade. Over the same period, the Prediabetes (Figure 7). Because of this, tackling diabetes Access to Education Diagnosed number of people with prediabetes has risen Undiagnosed successfully depends on a holistic approach (Figure even more sharply. Moreover, it is believed that 8) that targets individuals, the healthcare system, one-third of Americans with diabetes are not social drivers, government, and public awareness. 7 6 medically diagnosed (Figure 5). Taken together, Total annual direct medical and indirect societal costs of diabetes Figure 6 these trends accelerate the economic stress that The pages that follow describe our response to diabetes places on society (Figure 6).6 billion is the increase this challenge. associated with diabetes $215 over the next 15 years Treatment Innovative Products $ billion

600

500 514 400

374 300 299 200

100

0 2010 2015 2025

ROSEBUD RESERVATION

The challenges of the type 2 diabetes epidemic are multifaceted Figure 7

Diabetes Challenges

Individual Healthcare Public Social Drivers Government Characteristics System Awareness

· Genetic · Screening · Education and · Legislation · Media coverage predisposition to · Quality of treatment social status · Food supply policies and availability diabetes · Patient compliance · Physical activity & · Taxation · Access to information · History of cost of physical · Social stigma gestational diabetes · HCP education activity · Funding and appropriations · Risk awareness · History of vascular · Patient support & · Level of alcohol intake education disease · Level of food literacy · Affordability · Age · Lifestyle interventions · Ethnicit y · Complexity of healthcare system

3. Saydah et al., 2004 4. Gold et al. 2007 5. Butland B., et al, 2009 6. Boyle J., et al., 2010 7. Shultz K., The global diabetes care market, Novo Nordisk Capital Markets Day, May 2011

v creating shared value in the United States v creating shared value in the United States 6 The challenge The challenge 7 The Blueprint for Change Program The Blueprint for Change Program the challenge

600

500 514 400

374 300 299 200

100

0 2010 2015 2025

ROSEBUD RESERVATION

The challenges of the type 2 diabetes epidemic are multifaceted Figure 7

Diabetes Challenges

Individual Healthcare Public Social Drivers Government Characteristics System Awareness

3. Saydah et al., 2004 4. Gold et al. 2007 5. Butland B., et al, 2009 6. Boyle J., et al., 2010 7. Shultz K., The global diabetes care market, Novo Nordisk Capital Markets Day, May 2011

v creating shared value in the United States v creating shared value in the United States 8 Value to society . Quality of care Value to society . Quality of care 9 The Blueprint for Change Program The Blueprint for Change Program

value to society – quality of care

High-quality The goal of quality must be to help Recently, Novo Nordisk has placed a stronger Total healthcare cost reduction per patient per year Figure 9 care improves people achieve therapeutic targets emphasis on CE programs.1 through pharmacist education the health and of healthcare cost welfare of our What is quality of care? We offered CME and CE programs to more than can be reduced ($1,079) community. In large part, it depends on the context in which it 700,000 HCPs* in 2010 alone.1 7.2% Education, access, is used. This makes a consistent definition elusive. % and innovation Novo Nordisk launched DM Educate® as a web-based 100 100 are cornerstones education program for pharmacy students, and 1 in 98 in building a The World Health Organization has identified 6 10 US pharmacy students (11,000) have taken DM 7.2% 96 framework for dimensions of quality in healthcare. Healthcare, it Educate® electives. Since then, DM Educate® has 94 quality. says, must be effective, efficient, accessible, patient developed into a professional training program. It has 92 centered, equitable, and safe.12 We balance these helped more than 2,100 HCPs (primarily pharmacists) 92.8 dimensions through our Triple Bottom Line principle. become better acquainted with best practices that 90 increase the effectiveness of diabetes treatment.1

The objective of diabetes care is to ensure that patients achieve therapeutic targets. Today, most people with Studies show that pharmacist education improves 9 diabetes do not achieve those targets, and only 3% both clinical outcomes (0.4% improvement in The average % of patients with HbA1c <7% among Figure 10 Diabetes Recognition Program applicants 13 of insulin users receive optimal care. Our strategy for HbA1c) and economic outcomes (7.2% cost improving the quality of care for people with diabetes, reduction) for people with diabetes (Figure 9).15 more patients improve HbA1c levels then, contains several critical elements. Through the Pharmacist intervention improves adherence, provision of provider and patient education, access reduces diabetes-related complications, improves 21% HbA c <7.0% to care, and innovative treatments, Novo Nordisk health status, and has the potential to save 1 contributes to the quality equation. ROY AUMILLER $34 billion in health-system costs over the next 100 USA decade.16 80 Value of medical education Diabetes care specialist 60 55.1 Because greater knowledge among HCPs 40 14 33.8 correlates with better quality of care, Novo The National Committee for Quality Assurance 20

also provide tools for the successful initiation of the average percentage of patients whose HbA1c 75 insulin therapy in people with type 2 diabetes. was below 7% increased from 33.8% in 1999 to 55.1% in 2005 (Figure 10).18 Applicants’ per-patient We support the American College of healthcare costs dropped 10%-15% per year ($421 Endocrinology’s Endocrine University, held annually to $1,059, depending on measures achieved).18 at the Mayo Clinic. The curriculum enhances and expands educational experiences for endocrine fellows-in-training. Since 2003, Novo Nordisk By actively supporting programs that motivate has been a supporter and has provided nearly HCPs to improve the quality of care for people with $4 million in grants for this effort. In the past diabetes, we contribute to better patient outcomes decade, more than 2,000 endocrine fellows have and cost-efficient care. participated in the program.1

*An average HCP has been offered more than 1 education possibility.

Nordisk is a consistent supporter of patient- (NCQA) and the American Diabetes Association 0 centered, independent HCP education. In the (ADA) developed NCQA’s Diabetes Recognition 1999 2005 United States, Novo Nordisk provided $28 million Program (DRP) in 1997.17 Novo Nordisk has been 1 1 Saving per patient per year ($421 - $1,059) in educational grants in 2010 and 2011, and since a founding sponsor since 2004. This voluntary depending on measures achieved 2005 has supported more than 2,000 educational program recognizes PCPs, nurse practitioners, programs.1 Almost all educational activities and PCP assistants who consistently engage supported by Novo Nordisk are accredited for in such evidence-based practices as control of 10%-15% continuing medical education (CME) or continuing HbA1c, blood pressure, and LDL cholesterol; eye savings per patient per year education (CE). examinations; and assessment of kidney function, among others.17 % 100 Novo Nordisk-supported CME programs bridge 100 95 knowledge gaps among primary care practitioners 15% (PCPs) and endocrinologists. For PCPs, CME By April 2011, NCQA had recognized 9,700 90 programs focus on the progression of diabetes and clinicians17 for their provision of high-quality care 85 85 the physiological effects of insulin. These programs to people with diabetes. Among DRP applicants, 80 also provide tools for the successful initiation of the average percentage of patients whose HbA1c 75 insulin therapy in people with type 2 diabetes. was below 7% increased from 33.8% in 1999 to 55.1% in 2005 (Figure 10).18 Applicants’ per-patient We support the American College of healthcare costs dropped 10%-15% per year ($421 Endocrinology’s Endocrine University, held annually to $1,059, depending on measures achieved).18 at the Mayo Clinic. The curriculum enhances and expands educational experiences for endocrine fellows-in-training. Since 2003, Novo Nordisk By actively supporting programs that motivate has been a supporter and has provided nearly HCPs to improve the quality of care for people with $4 million in grants for this effort. In the past diabetes, we contribute to better patient outcomes decade, more than 2,000 endocrine fellows have and cost-efficient care. participated in the program.1

*An average HCP has been offered more than 1 education possibility.

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Value of access to care Figure 11 In the belief that there are further opportunities Figure 12 Number of patients In 2010, the Centers for Disease Control and to improve care for people with diabetes, we Prevention estimated that 59 million Americans are committed to supporting research also into — nearly 1 in 5 people — do not have health noninsulin products and services. leading insurance.19 Tragically, in 2009 it was estimated doubled in number of projects in pipeline, patent applications, that 45,000 Americans die every year because they growth in number of patients on We demonstrate this commitment to innovation phase 3 trials, and scientiﬁc citations Patient Assistance Program cannot afford the medical care they need.20 When through sponsorship of a grant program # of patients people with diabetes have to make choices between that supports new and established scientists’ We have the highest number of therapeutic protein their medication and other necessities of life, they 75,000 research into novel hypotheses in protein-based projects for diabetes in the R&D pipeline often skip treatments. Subsequently, they get sicker. 60,000 65,137 therapeutics and technologies for diabetes and # of protein projects 55,055 3 This not only reduces their own quality of life, it 45,000 obesity. In 2010, our Innovation Award Program 43,277 21 30,000 1 increases the overall societal costs of diabetes. 31,283 provided funding of $250,000 to $500,000 for 2 15,000 each of 10 projects. We view this as an investment 1 The Novo Nordisk Patient Assistance Program 0 in quality of care, and in the future, we plan to (PAP) provides medications at no charge to those 2007 2008 2009 2010 increase the number of awards to 20-25 annually. 0 who qualify. People who are uninsured and whose phase 1 phase 2 phase 3 Sanoﬁ® household income is at or below 200% of the Value provided through PAP Our board of directors has initiated 5 major Eli Lilly® Novo Nordisk® Federal Poverty Level are eligible to receive free innovation projects broadening access and million is the expected medications.1 All Novo Nordisk diabetes products savings to society in 2012 improving quality of care in vulnerable populations Insulin, GLP-1, and other NBEs 1 are available through this program. $5.5 (Future Field Force, Future Workplace, Googling We apply for most protein patents the Beta Cell, Base of the Pyramid, and Early # of patents $ million value of the products 1 80 PAP is a lifeline to thousands of people who 5.5 Origins of Health).

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medications. In 2010, PAP made treatment 4.5 Though we have made important strides in 40 4.0 accessible to more than 65,000 people without the the treatment of diabetes, there is still great 20 means to afford them — more than double the 3.5 potential for progress. Though insulin is effective 0 1 3.0 number of people served in 2007 (Figure 11). for achieving glycemic control, many HCPs Sanofi Eli Lilly Novo Nordisk Over that time, the volume of medication tripled 2.5 and patients are still reluctant to initiate insulin 2005 2006 2007 2008 2009 and the value of the medications distributed 2.0 therapy.22 Barriers to increased insulin go beyond 1.5 through this program rose from $1.9 million to HCPs’ concerns and include patients’ fear of 1.0 23 almost $4 million in 2010. By 2012, PAP’s direct 0.5 needles and hypoglycemia. Even modern insulin 2005-2010 We initiate most phase 3 trials cost savings to society is expected to rise to $5.5 0 still leaves room for improvement in duration million, with diabetes medications accounting for 2007 2008 2009 2010 2011 2012 of action, day-to-day variability, and the ability # of phase 3 trials 85% of the total1 (Figure 11). to mitigate hypoglycemia risk. The goal for the 100 93 75 Volume provided through PAP development of insulin formulations should be to 74 64 66 59 Value of innovation in diabetes treatments address these barriers to equitable treatment so 50 52 54 volume is The Novo Nordisk Way says “our key contribution expected to be that patients may enjoy a greater quality of life. 25 3434 36 is to discover and develop innovative biological provided by 2012 tripled 0 medicines and to make them accessible to patients GlaxoSmithKline®BoehringerPfizer® IngelheimAstraZeneca® Pharm.®Bistrol-MyersNovartis® Squibb®Merck® Sanofi Eli Lilly Novo Nordisk units in thousands (packages) 1 throughout the world.” As society grapples 2,000 with what has become a worldwide pandemic,

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Tragically, in 2009 it was estimated doubled in number of projects in pipeline, patent applications, in number of projects in pipeline, patent applications, that 45,000 Americans die every year because they growth in number of patients on We demonstrate this commitment to innovation phase 3 trials, and scientific citations Patient Assistance Program cannot afford the medical care they need.20 When throughthrough sponsorshipsponsorship ofof aa grantgrant programprogram # of patients people with diabetes have to make choices between thatthat supportssupports newnew andand establishedestablished scientists’scientists’ We have the highest number of therapeutic protein their medication and other necessities of life, they 75,000 researchresearch intointo novelnovel hypotheseshypotheses inin protein-basedprotein-based projects for diabetes in the R&D pipeline often skip treatments. 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People who are uninsured and whose phasephase 11 phasephase 22 phasephase 33 Sanofi®Sanofi® household income is at or below 200% of the Value provided through PAP Our board of directors has initiated 5 major EliEli Lilly®Lilly® NovoNovo Nordisk®Nordisk® Federal Poverty Level are eligible to receive free innovationinnovation projectsprojects broadeningbroadening accessaccess andand million is the expected medications.1 All Novo Nordisk diabetes products savings to society in 2012 improvingimproving qualityquality ofof carecare inin vulnerablevulnerable populationspopulations Insulin,Insulin, GLP-1,GLP-1, andand otherother NBEsNBEs 1 are available through this program. $5.5 (Future(Future FieldField Force,Force, FutureFuture Workplace,Workplace, GooglingGoogling We apply for most protein patents thethe BetaBeta Cell,Cell, BaseBase ofof thethe Pyramid,Pyramid, andand EarlyEarly ## ofof patentspatents $ million value of the products 11 8080 PAP is a lifeline to thousands of people who 5.5 Origins of Health). have difficulty obtaining and affording their 5.0 6060 medications. 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TheThe goalgoal forfor thethe 100100 9393 7575 Volume provided through PAP development of insulin formulations should be to 7474 6464 6666 50 5959 Value of innovation in diabetes treatments address these barriers to equitable treatment so 50 5252 5454 volume is 36 The Novo Nordisk Way says “our key contribution expected to be thatthat patientspatients maymay enjoyenjoy aa greatergreater qualityquality ofof life.life. 2525 3434 3434 36 provided by 2012 is to discover and develop innovative biological 0 tripled 0 medicines and to make them accessible to patients GlaxoSmithKline®GlaxoSmithKline®BoehringerBoehringerPfizer®Pfizer® IngelheimIngelheimAstraZeneca®AstraZeneca® Pharm.®Pharm.®Bistrol-MyersBristol-MyersBistrol-MyersNovartis®Novartis® Squibb®SquibbSquibb®Merck®Merck® SanofiSanofi EliEli LillyLilly NovoNovo NordiskNordisk units in thousands (packages) 1 throughout the world.” As society grapples 2,000 with what has become a worldwide pandemic, ® the importance of providing innovative, safe, 1,500 and effective therapies for diabetes cannot be understated. 1,000 Across therapy areas, our scientific articles are cited most frequently In 2009 and 2010, the editors of R&D Directions 500 named our research and development pipeline ## ofof citationscitations 1 1212 as the industry’s best in diabetes care. 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OurOur activities activities DiabetesDiabetes isis aa gatewaygateway diseasedisease we believe we have contributed to a 16% increase thatthat support support —— aa gatewaygateway toto increasedincreased riskrisk ofof in diabetes screening rates since 2005 (Figure 13).27 earlyearly diabetes diabetes possiblepossible blindness,blindness, lossloss ofof detectiondetection can can kidneykidney function,function, heartheart disease,disease, Since then Novo Nordisk, together with a range My sister was in the hospital 29 havehave a a positive positive stroke,stroke, andand limblimb amputations.amputations.44 of stakeholders, developed the Ask.Screen.Know. times in the past year. She came impactimpact on on program to promote screening among Medicare to Nimesh [the pharmacist] and patients’patients’ lives lives and and EarlyEarly detection detection may may improve improve quality quality of of life life beneficiaries and others at risk who are eligible for he reworked all her meds and healthcarehealthcare costs. costs. andand may may reduce reduce costs costs the benefit. We also have been involved in screening she’s only been in the hospital DiabetesDiabetes is is also also an an insidious insidious disease. disease. But But evidenceevidence- activities like the Health Mart Healthy Living Tour, basedbased interventions interventions have have proven proven that that for for many many which offered free screening in selected cities once since she made the change high-riskhigh-risk individuals, individuals, diabetes diabetes and and its its costly costly across the United States. During this event, almost in January. complicationscomplications can can be be prevented. prevented. Targeted Targeted screening screening 3,500 people were screened; almost half of those isis a a cost-effective cost-effective method method for for early early diagnosis diagnosis2424 that that screened were at risk of developing diabetes.1 maymay halt halt progression progression from from prediabetes prediabetes to to type type 2 2 diabetesdiabetes to to its its myriad myriad complications. complications. By investing in these activities, we contribute to PATIENT, Riverwalk Health Mart Pharmacy better patient care, while building partnerships TheThe number number of of people people with with undiagnosed undiagnosed diabetes diabetes is is with and credibility among our stakeholders. believedbelieved to to be be on on the the rise, rise, carrying carrying an an unnecessary unnecessary burdenburden on on patients patients and and the the healthcare healthcare system. system. In In a a comprehensivecomprehensive health health economic economic study study published published in in thethe Lancet Lancet in in 2010, 2010,2424 various various diabetes diabetes screening screening Partnering with our communities strategiesstrategies for for early early diagnosis diagnosis reduced reduced the the incidence incidence of of Because Novo Nordisk is a myocardialmyocardial infarction infarction and and diabetes-related diabetes-related The Medicare Diabetes Screening Project has 2 ADRIADRI VAN VAN DER DER WIELEN WIELEN micromicro vascular vascular complications complications (for (for each, each, 3–9 3–9 events events simple goals: Make Medicare beneficiaries aware true partner in these community SouthSouth Africa Africa preventedprevented per per 1,000 1,000 people people screened) screened) compared compared that they can be screened for diabetes at no cost, efforts, my customers call me to OccupationalOccupational health health nurse nurse withwith no no screening. screening.2424 Screening Screening may may also also increase increase life life and motivate them to take advantage of the benefit. ask how they can get involved NetcareNetcare Pretoria Pretoria East East Hospital Hospital expectancy.expectancy.2424 and work with Novo Nordisk In Columbus, GA, Novo Nordisk partnered with and other members of our ForFor patients, patients, the the benefits benefits ofof screeningscreening areare evidentevident community leaders — the mayor, pastors, and OnOn national national level level FigureFigure 13 13 1 local coalitions. inin reducing reducing HbA HbA11cc sooner, sooner, potentially potentially preventing preventing others — to spread the word. The result? A spike complications.complications. Both Both the the United United Kingdom Kingdom Prospective Prospective in screening rates that outpaced national and utilizationutilization increase increase 27 DiabetesDiabetes Study Study and and the the Diabetes Diabetes Control Control and and ofof free free Medicare Medicare diabetes diabetes state averages (Figure 13). People at risk who ComplicationsComplications Trial Trial showed showed that that a a period period of of screeningscreening rates rates were screened learned what they could do to 16%16% DAYE BEXLEY untreateduntreated hyperglycemia, hyperglycemia, such such as as what what might might be be avoid the disease, and those who had been living expectedexpected in in a a person person with with undiagnosed undiagnosed diabetes, diabetes, with undiagnosed diabetes could be treated for it, Novo Nordisk senior account manager %% of of Medicare Medicare diabetes diabetes screening screening rates rates hashas lasting lasting effects effects on on cardiovascular cardiovascular morbidity morbidity and and 1616 potentially forestalling complications. who spearheaded a community effort in mortalitymortality — — even even if if blood blood glucose glucose levels levels are are later later 1414 Georgia to publicize Medicare screenings appropriatelyappropriately controlled. controlled.2525 1212 Novo Nordisk’s grassroots involvement in 1010 Columbus and elsewhere could offer inspiration to Target:Target: undiagnosed undiagnosed diabetes diabetes 88 policymakers and to communities to take action to Currently,Currently, Medicare Medicare supports supports diabetes diabetes screening screening in in 66 promote early detection of diabetes. 44 peoplepeople aged aged 65 65 or or older older who who have have hypertension. hypertension. 22

EvidenceEvidence suggests, suggests, however, however, that that screening screening people people 00 withwith other other risk risk factors factors — — obesity obesity and and ethnicity, ethnicity, 20052005 20062006 20072007 20082008 forfor instance instance — — may may be be an an effective effective way way to to help help to to ColumbusColumbus GeorgiaGeorgia identifyidentify more more people people with with diabetes. diabetes.2626 NationalNational Total Total

SinceSince 2006, 2006, Novo Novo Nordisk Nordisk has has actively actively promoted promoted screeningscreening activities. activities. (See (See “Partnering “Partnering with with our our communities”communities” on on the the next next page). page). In In 2005, 2005, only only 10%10% of of Medicare Medicare beneficiaries beneficiaries tooktook advantageadvantage ofof Medicare’s Medicare’s offer offer of of free free diabetes diabetes screening. screening.2727 ThroughThrough the the many many initiatives initiatives of of the the Medicare Medicare DiabetesDiabetes Screening Screening Project Project — — founded founded by by Novo Novo NordiskNordisk and and the the ADA ADA but but now now a a collaborative collaborative projectproject involving involving more more than than 20 20 organizations organizations — —

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

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Our activities Diabetes is a gateway disease we believe we have contributed to a 16% increase that support — a gateway to increased risk of in diabetes screening rates since 2005 (Figure 13).27 early diabetes possible blindness, loss of detection can kidney function, heart disease, Since then Novo Nordisk, together with a range My sister was in the hospital 29 have a positive stroke, and limb amputations.4 of stakeholders, developed the Ask.Screen.Know. times in the past year. She came impact on program to promote screening among Medicare to Nimesh [the pharmacist] and patients’ lives and Early detection may improve quality of life beneficiaries and others at risk who are eligible for he reworked all her meds and healthcare costs. and may reduce costs the benefit. We also have been involved in screening she’s only been in the hospital Diabetes is also an insidious disease. But evidence- activities like the Health Mart Healthy Living Tour, based interventions have proven that for many which offered free screening in selected cities once since she made the change high-risk individuals, diabetes and its costly across the United States. During this event, almost in January. complications can be prevented. Targeted screening 3,500 people were screened; almost half of those is a cost-effective method for early diagnosis24 that screened were at risk of developing diabetes.1 may halt progression from prediabetes to type 2 diabetes to its myriad complications. By investing in these activities, we contribute to PATIENT, Riverwalk Health Mart Pharmacy better patient care, while building partnerships The number of people with undiagnosed diabetes is with and credibility among our stakeholders. believed to be on the rise, carrying an unnecessary burden on patients and the healthcare system. In a comprehensive health economic study published in the Lancet in 2010,24 various diabetes screening Partnering with our communities strategies for early diagnosis reduced the incidence of Because Novo Nordisk is a myocardial infarction and diabetes-related The Medicare Diabetes Screening Project has 2 ADRI VAN DER WIELEN micro vascular complications (for each, 3–9 events simple goals: Make Medicare beneficiaries aware true partner in these community South Africa prevented per 1,000 people screened) compared that they can be screened for diabetes at no cost, efforts, my customers call me to Occupational health nurse with no screening.24 Screening may also increase life and motivate them to take advantage of the benefit. ask how they can get involved Netcare Pretoria East Hospital expectancy.24 and work with Novo Nordisk In Columbus, GA, Novo Nordisk partnered with and other members of our For patients, the benefits of screening are evident community leaders — the mayor, pastors, and On national level Figure 13 1 local coalitions. in reducing HbA1c sooner, potentially preventing others — to spread the word. The result? A spike complications. Both the United Kingdom Prospective in screening rates that outpaced national and utilization increase 27 Diabetes Study and the Diabetes Control and of free Medicare diabetes state averages (Figure 13). People at risk who Complications Trial showed that a period of screening rates were screened learned what they could do to 16% DAYE BEXLEY untreated hyperglycemia, such as what might be avoid the disease, and those who had been living expected in a person with undiagnosed diabetes, with undiagnosed diabetes could be treated for it, Novo Nordisk senior account manager % of Medicare diabetes screening rates has lasting effects on cardiovascular morbidity and 16 potentially forestalling complications. who spearheaded a community effort in mortality — even if blood glucose levels are later 14 Georgia to publicize Medicare screenings appropriately controlled.25 12 Novo Nordisk’s grassroots involvement in 10 Columbus and elsewhere could offer inspiration to Target: undiagnosed diabetes 8 policymakers and to communities to take action to Currently, Medicare supports diabetes screening in 6 promote early detection of diabetes. 4 people aged 65 or older who have hypertension. 2

Evidence suggests, however, that screening people 0 with other risk factors — obesity and ethnicity, 2005 2006 2007 2008 for instance — may be an effective way to help to Columbus Georgia identify more people with diabetes.26 National Total

Since 2006, Novo Nordisk has actively promoted screening activities. (See “Partnering with our communities” on the next page). In 2005, only 10% of Medicare beneficiaries took advantage of Medicare’s offer of free diabetes screening.27 Through the many initiatives of the Medicare Diabetes Screening Project — founded by Novo Nordisk and the ADA but now a collaborative project involving more than 20 organizations —

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

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Slowing Slowing NordiskNordisk valuesvalues [that][that] encourageencourage several years — first through the National General Legislation patients’onsetonset of of diabetes livesdiabetes and Earlyitsits spread spread detection will will require require may lifestyle improvelifestyle changes, changes, quality including includingof life societysociety toto changechange behaviorbehavior toto Changing Diabetes® Program (2005) and, later, Minorities & Disparities healthcareandand reduce reduce costs. andhealthierhealthier may diets reducediets and and costs more more physical physical activity. activity. This This is is the Diabetes Advocacy AllianceTM (DAA) (2010). preventprevent diabetesdiabetes ratesrates fromfrom NDPP & National Coord. healthcarehealthcare costs. costs. Diabetesaa societal societal is change. change.also an insidiousFostering Fostering disease. that that kind kind But of ofevidence- change change Collectively, these initiatives have focused on increasing.increasing. Gestational basedisis an an ongoing ongoinginterventions process process have that that proven requires requires that scientific forscientific many driving federal policy change through stakeholder Type 1 high-riskevidence,evidence, individuals, financial financial incentives, diabetesincentives, and andand its supportivecostlysupportive engagement. complicationshealthhealth policies policies can that that be increase increaseprevented. awareness awareness Targeted of ofscreening the the isdiabetesdiabetes a cost-effective burden burden and methodand elevate elevate for earlyits its place place diagnosis on on the the24 that Our early public policy efforts were grounded maynationalnational halt agenda. progressionagenda. from prediabetes to type 2 in science and involved building an evidence diabetes to its myriad complications. NovoNovo Nordisk Nordisk employee employee base of more than 10 peer-reviewed papers TypeType 2 2 diabetes diabetes may may be be preventable. preventable. Numerous Numerous conveying the economic impact of diabetes and its 1 Thestudiesstudies number have have ofshown shown people that that with lifestyle lifestyle undiagnosed changes changes diabetes could could is complications. This contributed to the enactment As a company with a passion believedpreventprevent hundreds tohundreds be on the of of thousands rise,thousands carrying of of an new new unnecessary cases cases of of of several diabetes-related proposals. Notably, we burdendiabetes,diabetes, on and andpatients could could and remove remove the healthcare hundreds hundreds system. of of millions millions In a of of were the only pharmaceutical company to support for helping people in need … comprehensivedollarsdollars in in spending spending health on on economicdiabetes diabetes care carestudy (See (See published “Impact “Impact in of of the creation of the National Diabetes Prevention it feels good to know that you thediabetesdiabetes Lancet prevention, prevention, in 2010,24 by variousby the the numbers” numbers”diabetes screening on on next next page). page). Program and the Prevention and Public Health are making a difference in the strategies for early diagnosis reduced the incidence of Fund1 (Figure 14). More recent coalition-based world. myocardialSomeSome such such infarctioninterventions interventions and diabetes-relatedare are achievable, achievable, efforts have focused on the need for screening ADRI VAN DER WIELEN microinin expensive, expensive, vascular and complicationsand decidedly decidedly (forlow-tech. low-tech. each, 3–9For For instance,events instance, and prevention, and on how lifestyle change can South Africa preventedaa UnitedHealth UnitedHealth per 1,000 Group Group people analysis, analysis, screened) found found compared that that a a 5% 5% reduce the prevalence and costs of diabetes. Occupational health nurse withreductionreduction no screening. in in body body24 weight weightScreening could could may reduce reduce also increase prediabetes prediabetes life Netcare Pretoria East Hospital prevalenceexpectancy.prevalence by24 by about about 10 10 million million people people by by 2020 20201616 These activities have strengthened our reputation Novo Nordisk sales force employee —— or or about about 1 1 in in 8 8 people people with with prediabetes. prediabetes. and company culture, which we consider to be key For patients, the benefits of screening are evident enablers of continued success. On national level Figure 13 EveninEven reducing a a more more HbA conservative conservative1c sooner, potentially1% 1% reduction reduction preventing in in body body masscomplications.mass index index could could Both prevent prevent the United more more Kingdom than than 2 2 million Prospectivemillion utilization increase casesDiabetescases of of diabetes Studydiabetes and onset. onset. the Diabetes A A 1% 1% reduction reductionControl and is is roughly roughly of free Medicare diabetes Impact of diabetes prevention, equivalentComplicationsequivalent to to a Triala 2-pound 2-pound showed weight weight that a loss. periodloss.2828 Sustaining Sustainingof 16% screening rates by the numbers thisuntreatedthis reduction reduction hyperglycemia, would would require require such a aas net net what 20-calorie 20-calorie might be reductionexpectedreduction in per per a person day day for for with 3 3 years years undiagnosed — — a a goal goal diabetes, that that could could 1 case of diabetes prevented per 7 persons % of Medicare diabetes screening rates 26 behasbe obtained lastingobtained effects simply simply on by bycardiovascular consuming consuming 1 1morbidity less less nondiet, nondiet, and 16 treated for 3 years with life-style intervention 12-ouncemortality12-ounce — soda soda even per per if bloodweek. week. glucose levels are later 14 appropriately controlled.25 12 8% reduction in the share of people who move 10 from prediabetes to diabetes by 2020, using Target:InIn a a country country undiagnosed where where 68% 68% diabetes of of the the adult adult population population 8 lifestyle-intervention methods employed in the Currently,isis overweight overweight Medicare2828 and and supportswhere where 1.9 1.9 diabetes million million screening new new adult adult in 6 Diabetes Prevention Program16 4 peoplecasescases of ofaged diabetes diabetes 65 or are olderare diagnosed diagnosed who have each each hypertension. year, year,2929 the the 2

possibilitiesEvidencepossibilities suggests, that that come come however, with with thesethat these screening interventions interventions people 0 11 years that lifestyle-change interventions can arewithare significant. significant.other risk factors In In a a country country— obesity strugglingstruggling and ethnicity, toto containcontain 2005 2006 2007 2008 delay the onset of type 2 diabetes31 healthcareforhealthcare instance costs, —costs, may these these be an interventions interventions effective way have have to help the the to Columbus Georgia potentialidentifypotential more to to reduce reducepeople diabetes-related diabetes-relatedwith diabetes.26 expenditures expenditures National Total 330,000 diabetes cases prevented per year significantlysignificantly forfor patients,patients, payers,payers, andand employers.employers. if 1 in 2 people with prediabetes makes lifestyle Since 2006, Novo Nordisk has actively promoted changes6 screening activities. (See “Partnering with our communities” on the next page). In 2005, only 300 billion dollars saved by 2025 if 1 in 2 people 10% of Medicare beneficiaries took advantage with prediabetes makes lifestyle changes6 of Medicare’s offer of free diabetes screening.27 Through the many initiatives of the Medicare Diabetes Screening Project — founded by Novo Nordisk and the ADA but now a collaborative project involving more than 20 organizations —

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v creating shared value in the United States v creating shared value in the United States 14 Value to society . Prevention Value to society . Prevention 15 The Blueprint for Change Program The Blueprint for Change Program value to society - prevention

By engaging In diabetes, the power of Making prevention a priority Lobbying activities within diabetes care Figure 14 in diabetes prevention is clear Since 2006, Novo Nordisk has engaged in prevention and activities intended to make diabetes a public policy we actively engage in public policy activities 30 awareness efforts, Some epidemics can’t be prevented. Some can. We should partner with our local priority (Figure 14). We have been working to put Novo Nordisk Eli Lilly Sanoﬁ Takeda® we contribute to In the United States and worldwide, the diabetes communities to adopt Novo diabetes on the national health policy agenda for Care & Prevention efforts to limit the epidemic is growing at an alarming rate. Slowing Nordisk values [that] encourage several years — first through the National General Legislation onset of diabetes its spread will require lifestyle changes, including society to change behavior to Changing Diabetes® Program (2005) and, later, Minorities & Disparities and reduce healthier diets and more physical activity. This is the Diabetes Advocacy AllianceTM (DAA) (2010). prevent diabetes rates from NDPP & National Coord. healthcare costs. a societal change. Fostering that kind of change Collectively, these initiatives have focused on increasing. Gestational is an ongoing process that requires scientific driving federal policy change through stakeholder Type 1 evidence, financial incentives, and supportive engagement. health policies that increase awareness of the diabetes burden and elevate its place on the Our early public policy efforts were grounded national agenda. in science and involved building an evidence Novo Nordisk employee base of more than 10 peer-reviewed papers Type 2 diabetes may be preventable. Numerous conveying the economic impact of diabetes and its 1 studies have shown that lifestyle changes could complications. This contributed to the enactment As a company with a passion prevent hundreds of thousands of new cases of of several diabetes-related proposals. Notably, we diabetes, and could remove hundreds of millions of were the only pharmaceutical company to support for helping people in need … dollars in spending on diabetes care (See “Impact of the creation of the National Diabetes Prevention it feels good to know that you diabetes prevention, by the numbers” on next page). Program and the Prevention and Public Health are making a difference in the Fund1 (Figure 14). More recent coalition-based world. Some such interventions are achievable, efforts have focused on the need for screening in expensive, and decidedly low-tech. For instance, and prevention, and on how lifestyle change can a UnitedHealth Group analysis, found that a 5% reduce the prevalence and costs of diabetes. reduction in body weight could reduce prediabetes prevalence by about 10 million people by 202016 These activities have strengthened our reputation Novo Nordisk sales force employee — or about 1 in 8 people with prediabetes. and company culture, which we consider to be key enablers of continued success. Even a more conservative 1% reduction in body mass index could prevent more than 2 million cases of diabetes onset. A 1% reduction is roughly Impact of diabetes prevention, equivalent to a 2-pound weight loss.28 Sustaining by the numbers this reduction would require a net 20-calorie reduction per day for 3 years — a goal that could 1 case of diabetes prevented per 7 persons be obtained simply by consuming 1 less nondiet, treated for 3 years with life-style intervention26 12-ounce soda per week. 8% reduction in the share of people who move from prediabetes to diabetes by 2020, using In a country where 68% of the adult population lifestyle-intervention methods employed in the is overweight28 and where 1.9 million new adult Diabetes Prevention Program16 cases of diabetes are diagnosed each year,29 the possibilities that come with these interventions 11 years that lifestyle-change interventions can are significant. In a country struggling to contain delay the onset of type 2 diabetes31 healthcare costs, these interventions have the potential to reduce diabetes-related expenditures 330,000 diabetes cases prevented per year significantly for patients, payers, and employers. if 1 in 2 people with prediabetes makes lifestyle changes6

300 billion dollars saved by 2025 if 1 in 2 people with prediabetes makes lifestyle changes6

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v creating shared value in the United States v creating shared value in the United States 16 Value to society . Helping to build sustainable communities Value to society . Helping to build sustainable communities17 17 The Blueprint for Change Program The Blueprint for Change Program value to society – helping to build sustainable communities

Through job As its name implies, shared value Figure 15 Volunteer activities creation, grants, involves putting communities and The volunteer spirit is pervasive at Novo Nordisk. and community stakeholders at the center of our jobs created These activities are driven by the social awareness involvement, we business. 11,200 team (SAT) and by individuals. The SAT is a Working at local diabetes camps bring our business cross-functional team of employees who are for Novo Nordisk makes me and the people Here are some of the many ways Novo Nordisk has thousands job committed to making a difference through social realize how important our jobs as 12 we affect closer lived up to its commitment to the Triple Bottom interaction within Novo Nordisk, social awareness ambassadors really are — we’re together. Line and creating shared value. 10 within our local community, and involvement 1 helping patents with diabetes 8 within the diabetes community. live better lives. Job generation 6 A growing business creates jobs, both within The SAT reviews activity funding and goodwill 4 and beyond its walls. In the United States, the from management. These activities have included 2 number of people who work for Novo Nordisk has food, toy, and clothing drives, benefitting increased 200%1 since 2002 — even as the overall 0 vulnerable populations, such as the native 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Novo Nordisk sales force employee number of jobs within the pharmaceutical industry Americans, homeless people, and disadvantaged Employee re-spending 32 Supplier jobs decreased by 6%. Our internal job creation Direct jobs children. Other activities include annual has a ripple effect among our business partners “lend-a-hand-a-day” in Camp Nejeda, a camp and in our communities; in 2010 alone, roughly in New Jersey for more than 300 children with two-thirds of the 11,200 jobs we created in the diabetes, sponsored by an annual $50,000 grant United States were within our supply chain, and and insulin donations from Novo Nordisk.1 another third resulted from employee spending.33 Since 2000, the number of jobs Novo Nordisk Engaging in Triple Bottom The Diabetes Sales Force has carried out numerous has created in the United States has grown at a Line activities shows that we volunteer Triple Bottom Line initiatives, including compound annual rate of 30% (Figure 15).1 ADA Step Out walks, fundraising events, diabetes as a company care about the awareness days, celebrity speaker events, Community investment community at large and that we community health fairs, community education We are committed to making a difference in the really “walk the walk” … taking events, and disaster relief programs. Almost communities where our employees live and work. steps that make a difference. 90% of Novo Nordisk’s sales force is involved in To live up to this commitment, Novo Nordisk volunteer Triple Bottom Line activities, and 80% provides grants that help local organizations build invest their personal time. In 2010 and 2011, our sustainable communities and to provide access to sales force spent more than 18,000 hours (2,290 basic health and humanitarian services. The nature days) on volunteer activities that create value in of these investments ranges from grants to local Novo Nordisk sales force employee our communities.1 ALEX DE LA ROSA, DAVID GARCIA, and IAN SMITH healthcare organizations to a joint project with USA Aetna in which Novo Nordisk provided diabetes Diabetes care specialists education materials in Spanish and English to HCPs serving Latino populations.1 Three Novo Nordisk Representatives partnered with Habitat for Humanity in the rebuilding efforts for Together with Wells Fargo, we set up a $3 million the Tornado victims in Birmingham, AL. Native American Health Initiative (2010) to provide diabetes education and prevention on the Rosebud Reservation in South Dakota.1 This program addresses severe health disparities among Native Americans, a population that historically has high diabetes rates.

Overall, in 2010 and 2011, Novo Nordisk awarded more than 2,000 grants worth approximately $46 million1 — all dedicated to critical education and local community issues and needs.

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v v v creating shared value in the United States v creating creatingsharedcreating value shared shared in value thevalue United in in the the States United United States States 16 Value to society . Helping to build sustainable communities Value to societyValueValue to to. Helpingsociety society to . .Helping Helpingbuild sustainable to to build build sustainable sustainable communities17 communities communities171717 1717 The Blueprint for Change Program The BlueprintTheThe Blueprint forBlueprint Change for for Program Change Change Program Program value to society – helping to build sustainable communities

Through job As its name implies, shared value Figure 15 VolunteerVolunteerVolunteer activities activities activities creation, grants, involves putting communities and The volunteerTheThe volunteer volunteerspirit is pervasive spirit spirit is is pervasive pervasiveat Novo Nordisk.at at Novo Novo Nordisk. Nordisk. and community stakeholders at the center of our jobs created These activitiesTheseThese activities areactivities driven are are by driven driventhe social by by the theawareness social social awareness awareness involvement, we business. 11,200 team (SAT)teamteam and (SAT) (SAT) by individuals. and and by by individuals. individuals. The SAT Theis The a SAT SAT is is a a WorkingWorkingWorking at local atat diabetes locallocal diabetesdiabetes camps campscamps bring our business cross-functionalcross-functionalcross-functional team of employeesteam team of of employees employees who are who who are are for Novoforfor Nordisk NovoNovo NordiskNordisk makes makesmemakes meme and the people Here are some of the many ways Novo Nordisk has thousands job committedcommittedcommitted to making to to a making makingdifference a a difference difference through socialthrough through social social realizerealize realizehow important howhow importantimportant our jobs ourour as jobsjobs asas 12 we affect closer lived up to its commitment to the Triple Bottom interactioninteractioninteraction within Novo within within Nordisk, Novo Novo Nordisk, socialNordisk, awareness social social awareness awareness ambassadorsambassadorsambassadors really are reallyreally — we’reareare —— we’rewe’re together. Line and creating shared value. 10 within ourwithinwithin local ourcommunity,our local local community, community, and involvement and and involvement involvement 1 11 helpinghelpinghelping patents patentspatents with diabetes withwith diabetesdiabetes 8 within thewithinwithin diabetes the the diabetes community.diabetes community. community. live betterlivelive betterlives.better lives.lives. Job generation 6 A growing business creates jobs, both within The SAT ThereviewsThe SAT SAT activityreviews reviews funding activity activity andfunding funding goodwill and and goodwillgoodwill 4 and beyond its walls. In the United States, the from management.fromfrom management. management. These activities These These activities haveactivities included have have included included 2 number of people who work for Novo Nordisk has food, toy,food,food, and clothingtoy, toy, and and drives,clothing clothing benefitting drives, drives, benefitting benefitting increased 200%1 since 2002 — even as the overall 0 vulnerablevulnerablevulnerable populations, populations, populations, such as the such such native as as the the native native 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Novo NordiskNovoNovo salesNordisk Nordisk force sales sales employee force force employee employee number of jobs within the pharmaceutical industry Americans,Americans,Americans, homeless homeless homelesspeople, and people, people, disadvantaged and and disadvantaged disadvantaged Employee re-spending 32 Supplier jobs decreased by 6%. Our internal job creation Direct jobs children. children.Otherchildren. activities Other Other activities includeactivities annual include include annual annual has a ripple effect among our business partners “lend-a-hand-a-day”“lend-a-hand-a-day”“lend-a-hand-a-day” in Camp in Nejeda,in Camp Camp aNejeda, Nejeda,camp a a camp camp and in our communities; in 2010 alone, roughly in New Jerseyinin New New for Jersey Jerseymore for thanfor more more 300 than thanchildren 300 300 withchildren children with with two-thirds of the 11,200 jobs we created in the diabetes,diabetes, diabetes,sponsored sponsored sponsored by an annual by by an an $50,000 annual annual $50,000 grant$50,000 grant grant United States were within our supply chain, and and insulinandand donations insulin insulin donations donations from Novo from from Nordisk. Novo Novo1 Nordisk. Nordisk.11 another third resulted from employee spending.33 Since 2000, the number of jobs Novo Nordisk Engaging in Triple Bottom The DiabetesTheThe DiabetesSalesDiabetes Force Sales Sales has Force Forcecarried has has out carried carried numerous out out numerous numerous has created in the United States has grown at a Line activities shows that we volunteervolunteer volunteerTriple Bottom Triple Triple Line Bottom Bottom initiatives, Line Line initiatives, initiatives, including including including compound annual rate of 30% (Figure 15).1 ADA StepADAADA Out Step walks,Step Out Out fundraising walks, walks, fundraising fundraising events, diabetes events, events, diabetes diabetes as a company care about the awarenessawarenessawareness days, celebrity days, days, celebrity speakercelebrity events,speaker speaker events, events, Community investment community at large and that we communitycommunitycommunity health fairs, health health community fairs, fairs, community community education education education We are committed to making a difference in the really “walk the walk” … taking events, andevents,events, disaster and and reliefdisaster disaster programs. relief relief programs. programs. Almost Almost Almost communities where our employees live and work. steps that make a difference. 90% of Novo90%90% Nordisk’sof of Novo Novo Nordisk’s Nordisk’ssales force sales sales is involved force force is is involved ininvolved in in To live up to this commitment, Novo Nordisk volunteervolunteer volunteerTriple Bottom Triple Triple Line Bottom Bottom activities, Line Line activities, activities,and 80% and and 80% 80% provides grants that help local organizations build invest theirinvestinvest personal their their personal time.personal In 2010time. time. andIn In 2010 20102011, and and our 2011, 2011, our our sustainable communities and to provide access to sales forcesalessales spent force force more spent spent than more more 18,000 than than hours 18,000 18,000 (2,290 hours hours (2,290 (2,290 basic health and humanitarian services. The nature days) on days)volunteerdays) on on volunteer volunteeractivities activitiesthatactivities create that that value create create in value value in in of these investments ranges from grants to local Novo Nordisk sales force employee our communities.ourour communities. communities.1 11 ALEX DE ALEXLAALEX ROSA, DE DE LA LADAVID ROSA, ROSA, GARCIA, DAVID DAVID GARCIA,andGARCIA, IAN SMITHand and IAN IAN SMITH SMITH healthcare organizations to a joint project with USA USA USA Aetna in which Novo Nordisk provided diabetes Diabetes DiabetescareDiabetes specialists care care specialists specialists education materials in Spanish and English to HCPs serving Latino populations.1 Three NovoThreeThree Nordisk Novo Novo RepresentativesNordisk Nordisk Representatives Representatives partnered partnered partnered with with with Habitat forHabitatHabitat Humanity for for Humanity Humanity in the rebuilding in in the the rebuilding rebuilding efforts for efforts efforts for for Together with Wells Fargo, we set up a $3 million the Tornadothethe victimsTornado Tornado in victims victimsBirmingham, in in Birmingham, Birmingham, AL. AL. AL. Native American Health Initiative (2010) to provide diabetes education and prevention on the Rosebud Reservation in South Dakota.1 This program addresses severe health disparities among Native Americans, a population that historically has high diabetes rates.

Overall, in 2010 and 2011, Novo Nordisk awarded more than 2,000 grants worth approximately $46 million1 — all dedicated to critical education and local community issues and needs.

15. http://www.ncqa.org/tabid/139/Default.aspx15.15. http://www.ncqa.org/tabid/139/Default.aspx http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP,16.16. NCQA2011 NCQA - -DRP, DRP, 2011 2011 17. NCQA – DPP,17.17. NCQA 1999-2005NCQA – – DPP, DPP, 1999-2005 1999-2005

v creating shared value in the United States v creating shared value in the United States 18 Value to us . Culture and employee engagement Value to us . Culture and employee engagement 19 The Blueprint for Change Program The Blueprint for Change Program value to us – culture and employee engagement

part of our fabric as a company, they weave a in 2005 to 3.4% in 2010, allowing us to retain a 4 4.3 strong corporate culture. This, in turn, energizes a Novo Nordisk diabetes highly qualified work force.1 3.8 2 workforce with the will to champion the company sales force employee 0 — secure in the knowledge that Novo Nordisk is We care about our employees S&P 500 Russell 3000 “100 Best” “100 Best” committed to not only its success as a company, As part of our strategy for fostering employee Buy and Hold Reset Annually but to their own success as well. engagement, we have also paid close attention eVoice scores are equally high for the US employees and Figure 16 managers showing high alignment and unity about how we to employees’ needs — as evidenced by having do business in our company In general, our employees believe that the culture been named in 2010 to the “Working Mother 100 Average rating Figure 18 within Novo Nordisk is strongly aligned with the score in eVoice Best Companies” list; 3 times by the Dave Thomas Our Triple Bottom Line initiatives have a positive spirit of our Triple Bottom Line principle and that Foundation as one of the “100 Best Adoption- contribution to our culture and engagement the company creates an attractive place to work. 4+ Friendly Workplaces” since 2007; and 4 times impact from Triple Bottom Line Employee satisfaction and engagement scores, Novo Nordisk eVoice results (2006-2010) to “Conceive Magazine’s 50 Best Fertility- and To a very great extent which are measured through annual eVoice 5 Adoption- Friendly Companies” rankings since surveys, have been high since 2006 (Figure 16).1 2007.1 To a great 4 extent

believe that a sound reputation contributes positively Nordisk (Figure 18). The survey showed that field Culture Employee Innovation Regulatory Reputation Employees compliance to overall performance and strong stakeholder and home office employees have a similar opinion engagement

Managers Environmental Talent attraction Talent Relationships with

support. about the contribution of the Triple Bottom Line, partners healthcare suggesting a uniform and strong company culture. Among “100 Best Companies to Work for” External stakeholders have also recognized our corporate culture. In the United States, Novo Nordisk has made the Fortune “100 Best The founders of Novo Nordisk Companies to Work for” list 3 times since 2009 understood that the company If employees see how the and the “Best Places to Work in New Jersey” list Novo Nordisk Way guides our 1 should survive on its ability to 6 times since 2005. The Great Place to Work activities, then we are being true Institute, which creates the Fortune list, surveys challenge and empower the employees on 5 key attributes: credibility, respect, employees. This has created a to the Triple Bottom Line and fairness, pride, and camaraderie.34 culture where the principle of developing our Novo Nordisk sustainability is transformed Way culture all at the same time. into daily actions. Novo Nordisk is the employees, and their engagement in the mission is crucial. Novo Nordisk employee

LARS REBIEN SØRENSEN President and CEO Novo Nordisk A/S

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

A great place to Triple Bottom Line strengthens Companies on the Fortune “100 Best” list, 1998-2010 Figure 17 work energizes company culture and employee reward investors better than other companies. employees to The average annual return of the “100 Best Reset more can be earned engagement by investing in “100 Best” contribute to its People who work for Novo Annually” portfolio, from 1998 to 2010, was success. What does our way of doing business — Nordisk accept the challenge 7%-points greater than that of the Standard & 7% balancing financial, social, and environmental to live the values. Poors 500 (Figure 17). Moreover, companies on % decisions — mean for our employees? the list have, on average, lower employee turnover 10 11.1 Our people are crucial to our success. When the than their industry peers.35 In the United States, 8 6.7 values inherent in Triple Bottom Line become our unwanted turnover rate has fallen from 7.3% 6 part of our fabric as a company, they weave a in 2005 to 3.4% in 2010, allowing us to retain a 4 4.3 strong corporate culture. This, in turn, energizes a Novo Nordisk diabetes highly qualified work force.1 3.8 2 workforce with the will to champion the company sales force employee 0 — secure in the knowledge that Novo Nordisk is We care about our employees S&P 500 Russell 3000 “100 Best” “100 Best” committed to not only its success as a company, As part of our strategy for fostering employee Buy and Hold Reset Annually but to their own success as well. engagement, we have also paid close attention eVoice scores are equally high for the US employees and Figure 16 managers showing high alignment and unity about how we to employees’ needs — as evidenced by having do business in our company In general, our employees believe that the culture been named in 2010 to the “Working Mother 100 Average rating Figure 18 within Novo Nordisk is strongly aligned with the score in eVoice Best Companies” list; 3 times by the Dave Thomas Our Triple Bottom Line initiatives have a positive spirit of our Triple Bottom Line principle and that Foundation as one of the “100 Best Adoption- contribution to our culture and engagement the company creates an attractive place to work. 4+ Friendly Workplaces” since 2007; and 4 times impact from Triple Bottom Line Employee satisfaction and engagement scores, Novo Nordisk eVoice results (2006-2010) to “Conceive Magazine’s 50 Best Fertility- and To a very great extent which are measured through annual eVoice 5 Adoption- Friendly Companies” rankings since surveys, have been high since 2006 (Figure 16).1 2007.1 To a great 4 extent

To a moderate In a survey of US employees conducted for this case 3 According to an internal survey in July 2011, our extent 2 To a small study, 80% expressed that our Triple Bottom Line employees are committed to the Triple Bottom Line extent principle has a significant positive impact on our 1 principle1 and believe that it contributes positively Not at all 1 company’s reputation. What’s more, those surveyed 0 to the value we create for society and Novo 2006 2007 2008 2009 2010 1 impact believe that a sound reputation contributes positively Nordisk (Figure 18). The survey showed that field Culture Employee Innovation Regulatory Reputation Employees compliance to overall performance and strong stakeholder and home office employees have a similar opinion engagement

Managers Environmental Talent attraction Talent Relationships with

LARS REBIEN SØRENSEN President and CEO Novo Nordisk A/S

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v v v v creatingcreatingcreatingcreating shared sharedshared value shared valuevalue in valuethe inin theUnitedthe in UnitedtheUnited States United StatesStates States v creating shared value in the United States 20 2020 20 ValueValueValue to Valueus toto . Stakeholder usus to .. StakeholderStakeholderus . Stakeholder support supportsupport support Value to us . Stakeholder support 21 The TheBlueprintThe BlueprintTheBlueprint Blueprint for Change forfor Change Changefor ProgramChange ProgramProgram Program The Blueprint for Change Program

valuevaluevaluevalue to toto us to usus – us stakeholder–– stakeholder–stakeholder stakeholder support supportsupport support

What’sWhat’sWhat’s goodWhat’s goodgood for good forfor forThe TheThe TripleThe TripleTriple TripleBottum BottumBottum Bottum Line LineLine helps Line helpshelps helpsus us us us Brand GoalBrandBrand Score Goal GoalBrand (Novo Score Score Goal Nordisk(Novo (NovoScore Nordisk (NovoNordisk vs Eli LillyNordisk vs vs Eli Eliand Lilly Lilly vsSanofi) Eliand and Lilly Sanofi) Sanofi) and Sanofi) Figure Figure19Figure 19 Figure19 19 Increased market potential Insulin market development Figure 21 our patientsourour patientsourpatients andpatients andand andto buildtoto buildtobuild win-winbuild win-winwin-win win-win relationships relationshipsrelationships relationships Our efforts to improve quality of care and to highhigh highreputation high reputationreputation reputation annual outgrowth of the insulin our customersourour customersourcustomers customers develop innovative treatments poise us for market resulting in 100% higher is goodisis goodgood foris good our forfor our ourfor our ReputationReputationReputationReputation and andandtrust and trusttrust trust score scorescore score long-term business success. Helping patients to index growth after 10 years 9 99 9 5% business.business.business.business. In business,InIn business,business,In business, success successsuccess oftensuccess oftenoften hinges often hingeshinges not hinges notonlynot only notonlyon the only onon the theon the achieve treatment goals and to stay adherent to index 8 88 8 valuevaluevalue of valueyour ofof your your products,of your products,products, products, but butonbut the onbuton valuethe theon valuethevalue of valueyour ofof your your of your medication therapy not only has an impact on 300 7 77 7 wordwordword as wordwell. asas well.well. Weas well. striveWeWe striveWestrive not strive notjustnot justfornotjust innovation, forjustfor innovation, innovation,for innovation, their quality of life; it has the potential to drive 280 6 66 6 260 but buttobut be tobutto recognized bebe to recognizedrecognized be recognized as a asasleader aa asleaderleader ain leader our inin ourindustry.our in industry.ourindustry. industry. 5 55 5 sales volume and help us sustain long-term 240 WhenWhenWhen ourWhen ouractionsour actionsouractions matchactions matchmatch our match ourwordsour wordsourwords about words aboutabout our about ourour our 4 44 4 business growth. 220 TripleTripleTriple BottomTriple BottomBottom LineBottom LineLineprinciple, Line principle,principle, principle, we build wewe build buildwe customer build customercustomer customer 3 33 3 200 relationshipsrelationshipsrelationshipsrelationships that that thatcontribute that contributecontribute contribute to our toto ourreputationour to reputationourreputation reputation 2 22 2 Our emphasis on Triple Bottom Line may be 180 1 11 1 — and,—— and, and,in— turn, and, inin turn,turn, ourin turn, oursuccess.our success.oursuccess. success. reflected on the company growth, which has 160 0 00 0 outperformed that of the market (Figure 21). 140 -1 -1-1 -1 For severalForFor severalseveralFor years, several years,years, we years, have wewe have have wemeasured have measuredmeasured measured how how howwe how wewe we Whereas a decade ago our insulin market share 120 -2 -2-2 -2 2 100 are perceivedareare perceivedperceivedare perceived externally externallyexternally externally through throughthrough throughour ourbrandour brandourbrand goal brand goal goal goal 2006 20062006 20062007 20072007 20072008 20082008 20082009 20092009 20092010 20102010 2010 was 25%, today it is 42%. 2000 2002 2004 2006 2008 2010 score.score.score. Brandscore. BrandBrand goal Brand goal goalscores goal scoresscores are scores based areare basedbasedare on based questions onon questions questionson questions Novo NordiskNovoNovo Nordisk vsNordiskNovo Eli Lilly Nordiskvs vs Eli Eli Lilly Lilly vs Eli Lilly Novo NordiskNovoNovo Nordisk vsNordiskNovo Sanofi Nordiskvs vs Sanofi Sanofi vs Sanofi Insulin Market thatthat thatmeasure that measuremeasure measure perception perceptionperception perception of leadership ofof leadershipleadership of leadership as a asas aa as a Novo Nordisk diabetesdiabetesdiabetes diabetescare care carecompany, care company,company, company, leadership leadershipleadership leadership in the inin fightthethe in fightthefight fight againstagainstagainst diabetes,against diabetes,diabetes, diabetes, and andleadershipand andleadershipleadership leadership within withinwithin type within type type1 type 11 1 and andtypeand andtype type2 diabetes. type 22 diabetes.diabetes. 2 diabetes. Among AmongAmong patients,Among patients,patients, patients, PCPs, PCPs,PCPs, and PCPs, andand and NumberNumberNumber of modernNumber of of modern modern insulin of modern insulin sciptsinsulin insciptsinsulin scipts relation in inscipts relation relation to thein relation to to the the to the Figure Figure20Figure 20 Figure20 20 secondarysecondarysecondarysecondary care care carerespondents, care respondents,respondents, respondents, our ourscoreour scoreourscore outranks score outranksoutranks outranks level oflevel levelsatisfaction of oflevel satisfaction satisfaction of (general satisfaction (general (general practitioners) (general practitioners) practitioners) practitioners) 36 3636 36 our ourpeerour peerour peerdiabetes peer diabetesdiabetes diabetescompanies companiescompanies companies (Figure (Figure(Figure 19). (Figure 19).19). 19). numbernumbernumber ofnumber modern ofof modernmodern of insulinmodern insulininsulin scripts insulin scriptsscripts scripts in relationinin relationrelationin torelation the toto level thethe to level leveltheof satisfaction level ofof satisfactionsatisfaction of satisfaction HealthyHealthyHealthy patientsHealthy patientspatients patientsand andhighand andhigh highcustomer high customercustomer customer satisfaction satisfactionsatisfaction satisfaction createcreatecreate brandcreate brandbrand loyalty. brand loyalty.loyalty. This loyalty. ThisThisis evident This isis evidentevident is fromevident fromfrom a from aa a # of modern## of of modern moderninsulin# of modernscriptsinsulin insulin perscripts scriptsinsulin competitor per perscripts competitor competitor per competitor 1.6 1.61.6 1.6 cross-analysiscross-analysiscross-analysiscross-analysis of our ofof our2011our of 2011our2011 customer 2011 customercustomer customer satisfaction satisfactionsatisfaction satisfaction 1.4 1.41.4 1.4 surveysurveysurvey withsurvey with withinsulin with insulininsulin prescribing insulin prescribingprescribing prescribing rates; rates;rates; the rates; resultsthethe resultstheresults results 1.2 1.21.2 1.2 1.21 1.211.21 1.21 suggestsuggestsuggest asuggest correlation aa correlationcorrelation a correlation between betweenbetween between high high highprescribing high prescribingprescribing prescribing 1.0 1.01.0 1.0 0.8 0.80.8 0.8 0.93 0.930.93 0.93 and andhighand andhigh highPCP high PCPPCPsatisfaction PCPsatisfactionsatisfaction satisfaction with with withthe with companythethe companythecompany company 0.6 0.60.6 0.6 (Figure(Figure(Figure 20).(Figure 1 20). 20).In another1 1 20). InIn anotheranother1 In anotherstudy studystudy it wasstudy itit waswasfound it wasfoundfound that found that that that 0.4 0.40.4 0.4 0.2 0.20.2 0.2 0.3 0.30.3 0.3 two-thirdstwo-thirdstwo-thirdstwo-thirds of PCPs ofof PCPsPCPs saidof PCPs saidsaidour said ourTripleour TripleourTriple Bottom Triple BottomBottom LineBottom Line Line Line 0.2 0.20.2 0.2 0.0 0.00.0 0.0 1 11 1 principleprincipleprincipleprinciple is unique, isis unique,unique, is believable,unique, believable,believable, believable, and andmotivating.and andmotivating.motivating. motivating. Basal (long-acting)BasalBasal (long-acting) (long-acting)Basal (long-acting) Bolus (fast-acting)BolusBolus (fast-acting) (fast-acting)Bolus (fast-acting)

Low satisfactionLowLow satisfaction satisfactionLow satisfaction High satisfactionHighHigh satisfaction satisfactionHigh satisfaction

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v creating shared value in the United States v creating shared value in the United States 20 Value to us . Stakeholder support Value to us . Stakeholder support 21 The Blueprint for Change Program The Blueprint for Change Program value to us – stakeholder support

What’s good for The Triple Bottum Line helps us Brand Goal Score (Novo Nordisk vs Eli Lilly and Sanoﬁ) Figure 19 Increased market potential Insulin market development Figure 21 our patients and to build win-win relationships Our efforts to improve quality of care and to high reputation annual outgrowth of the insulin our customers develop innovative treatments poise us for market resulting in 100% higher is good for our Reputation and trust score long-term business success. Helping patients to index growth after 10 years 9 5% business. In business, success often hinges not only on the achieve treatment goals and to stay adherent to index 8 value of your products, but on the value of your medication therapy not only has an impact on 300 7 word as well. We strive not just for innovation, their quality of life; it has the potential to drive 280 6 260 but to be recognized as a leader in our industry. 5 sales volume and help us sustain long-term 240 When our actions match our words about our 4 business growth. 220 Triple Bottom Line principle, we build customer 3 200 relationships that contribute to our reputation 2 Our emphasis on Triple Bottom Line may be 180 1 — and, in turn, our success. reflected on the company growth, which has 160 0 outperformed that of the market (Figure 21). 140 -1 For several years, we have measured how we Whereas a decade ago our insulin market share 120 -2 2 100 are perceived externally through our brand goal 2006 2007 2008 2009 2010 was 25%, today it is 42%. 2000 2002 2004 2006 2008 2010 score. Brand goal scores are based on questions Novo Nordisk vs Eli Lilly Novo Nordisk vs Sanoﬁ Insulin Market that measure perception of leadership as a Novo Nordisk diabetes care company, leadership in the fight against diabetes, and leadership within type 1 and type 2 diabetes. Among patients, PCPs, and Number of modern insulin scipts in relation to the Figure 20 secondary care respondents, our score outranks level of satisfaction (general practitioners) 36 our peer diabetes companies (Figure 19). number of modern insulin scripts in relation to the level of satisfaction Healthy patients and high customer satisfaction create brand loyalty. This is evident from a # of modern insulin scripts per competitor 1.6 cross-analysis of our 2011 customer satisfaction 1.4 survey with insulin prescribing rates; the results 1.2 1.21 suggest a correlation between high prescribing 1.0 0.8 0.93 and high PCP satisfaction with the company 0.6 (Figure 20).1 In another study it was found that 0.4 0.2 0.3 two-thirds of PCPs said our Triple Bottom Line 0.2 0.0 1 principle is unique, believable, and motivating. Basal (long-acting) Bolus (fast-acting)

Low satisfaction High satisfaction

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v creating shared value in the United States v creating shared value in the United States 22 Looking to the future Looking to the future 23 The Blueprint for Change Program The Blueprint for Change Program

looking to the future

What’s good for Challenges ahead Figure 22 Diabetes prevalence continues to rise. Novo Figure 23 our patients and We believe that maximizing shared value requires maximizing shared value creation Nordisk must work together with multiple overview of employee suggestions for improvement our customers a conscious balance of choices. To maximize value stakeholders to address this and to expand efforts is good for our creation, we must continuously invest with an eye to prevent, detect, and improve quality of diabetes “Create more awareness “Even more focus on about Triple Bottom Line when Diabetes Prevention – we business. toward 3 things: societal issues that are aligned with care. This recognition necessitates an increased decisions are taken; make it an could be National explicit part of the discussion“ Sponsors of the our business strategy; the right internal capabilities focus on our commitment to the Triple Bottom YMCA implementation of the Diabetes to enable success; and leveraging the Triple Bottom Line and the need to induce sustainable change. Prevention Program“ Invest in addressing Line principle as a competitive advantage. These societal issues that Every day, we must make difficult choices and activities are interdependent: without investing are aligned with our challenge ourselves to consider the following: business strategy in addressing societal issues, we would be unable 92 suggestions to leverage the Triple Bottom Line principle, and How do we enable a focus on targeted screening for addressing without the engagement, support, and skills of our for people with prediabetes and obesity? societal issues employees, we would be unable to create shared value activities and programs. How should we weigh our investments between Invest in how Invest in the to leverage Triple building capabilities, new Triple Bottom Line Our employees have contributed greatly to this right internal Bottom Line initiatives, and leveraging them to create shared capabilities as a competitive Blueprint report. In doing so, they shed light on advantage value? 71 136 suggestions on suggestions on internal perceptions of the Triple Bottom Line how to build right how to better principle and what we can do to create even How may public and private partnerships, such internal capabilities leverage Triple Bottom Line greater value for society and to our business as the Diabetes Advocacy AlianceTM, create (Figures 22 and 23). Suggestions include better sustainable shared value? communication about and awareness of our Triple Bottom Line principle to internal and external How do we address business challenges while stakeholders, and a stronger focus on being balancing stakeholders’ interests? “More communication of Triple Bottom Line to the public, I was attracted to Novo Nordisk primarily for the Triple Bottom environmentally conscious and socially responsible. Line/environmental aspect. I think more/unambiguous communication All of these suggestions will be taken into account How do we balance innovation with the need for of this approach to the public is a win-win for all“ in future business planning. greater access to care?

We challenge our peers, policymakers, and society to consider the same.

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

We challenge our peers, policymakers, and society to consider the same.

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v creating shared value in the United States v creating shared value in the United States 24 Methodology and definitions Methodology and definitions 25 The Blueprint for Change Program The Blueprint for Change Program

methodology and definitions

Assessing value creation in the United States The Blueprint for Change case is built on extensive This case study is 1 of a series in our Blueprint field and desk research, including 28 qualitative for Change Program. We create value for interviews, a comprehensive employee survey, business and society as described in Figure 24, economic simulations and information gathered by maximizing the upsides, and minimizing the from news, announcements, and annual reports downsides. “Maximizing the upsides” includes for the past 10 years. Both the US management early detection of diabetes, improving quality of team and key employees at Novo Nordisk were life, and treatment possibilities for our patients interviewed for the report. and at the same time building reputation, trust, employee engagement, stakeholder support, The comprehensive employee survey was an and increasing market potential. “Minimizing the anonymous survey of all Novo Nordisk US downsides” includes reduction of diabetes costs, employees. The intent of the survey was to limiting diabetes onset, and other examples of risk understand how employees believe Triple Bottom mitigation for our business and society. Initiatives Line is perceived to create value. Three areas that address societal issues within the need for formed the basis of the survey: (1) value to society; prevention, early detection, and improved quality (2) value to Novo Nordisk; and (3) enablers and of care have had a central focus of this Blueprint personal input. We received 720 responses, which for Change case. accounts for 20% of US employees.1

At the end of the US Blueprint for Change case, we The assessment of societal value creation is challenge ourselves, our peers, policymakers, and based on analysis of several initiatives and health society to consider what we should do to enhance economic analyses. The selection of these value creation, and how we all should come initiatives is guided by input from key members of together to address the diabetes epidemic in the the US management team. The initiatives analyzed United States. are those that are perceived to bring most value to society while also having a direct or indirect business rationale. We have intended this to be a balanced report on our business impact.

The study was conducted by Novo Nordisk. For further information on methodology, please Slide no 12 Figure 24 contact Ole Kjerkegaard Nielsen.

shared value creation Academic reviewers of this Blueprint for Change case:

Associate Professor, Adam M. Grant, Shared value creation Figure 24 University of Pennsylvania Wharton Business School

MaximizeMaximize upside upside MinimizeMinimize downside downside Associate Professor, Jette Steen Knudsen, Copenhagen Business School

Research Fellow, Stacie Rabinowitz, TangibleTangible IntangibleIntangible CostCost RiskRisk ValueValue ValueValue Harvard Business School Institute for Strategy and Competitiveness

Financially responsibleFinancially responsible

Patients Socially Environmentally responsible responsible

Socially Environmentally Developed by Novodeveloped Nordisk by and Accentureresponsible Accenture and Novo Nordisk responsible

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

The study was conducted by Novo Nordisk. For further information on methodology, please Slide no 12 Figure 24 contact Ole Kjerkegaard Nielsen. shared value creation Academic reviewers of this Blueprint for Change case:

Associate Professor, Adam M. Grant, Shared value creation Figure 24 University of Pennsylvania Wharton Business School

MaximizeMaximize upside upside MinimizeMinimize downside downside Associate Professor, Jette Steen Knudsen, Copenhagen Business School

Research Fellow, Stacie Rabinowitz, TangibleTangible IntangibleIntangible CostCost RiskRisk ValueValue ValueValue Harvard Business School Institute for Strategy and Competitiveness

Financially responsibleFinancially responsible

Patients Socially Environmentally responsible responsible

Socially Environmentally Developed by Novodeveloped Nordisk by and Accentureresponsible Accenture and Novo Nordisk responsible

15. http://www.ncqa.org/tabid/139/Default.aspx 16. NCQA - DRP, 2011 17. NCQA – DPP, 1999-2005

v creating shared value in the United States v creating shared value in the United States 26 Glossary Reference list 27 The Blueprint for Change Program The Blueprint for Change Program

glossary reference list

1. Data on file. Novo Nordisk, 2011. CE: HCP: 2. IMS Data, 2010. Provided by Insights & Forecasting department, Novo Nordisk, on May 10, 2011. Continuing Education for pharmacists, nurses, Healthcare professional. 3. Zimmett P, Alberti K, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782-787. registered dieticians, certified diabetes educators, 4. Saydah S, Fradkin J, Cowie C. Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes. JAMA. 2004;291:335-342. and case managers. Innovation: 5. Pan L, Freedman D, Gillespie C, Park S, Sherry B. Incidences of obesity and extreme obesity among US adults: findings from the 2009 Behavioral Risk Product innovation and treatment innovation Factor Surveillance System. Population Health Metrics. 2011;9:56. CME: within diabetes care, solving current and future 6. Institute for Alternative Futures. Diabetes 2025 Forecasts, 2011 United States’ Diabetes Crisis: Today and Future Trends. Institute for Alternative Futures, 2011. Continuing Medical Education for PCPs, PCP challenges while spurring other new innovations. 7. Boyle J, Thompson T, Gregg E, Barker L, Williamson D. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of assistants, and nurse practitioners. incidence, mortality, and prediabetes prevalence. Population Health Metric. 2010;8:29. Medicare Diabetes Screening Project: 8. National Committee for Quality Assurance. The State of Health Care Quality Reform; The Quality Agenda and Resource Use. NCQA, 2010. 9. National Institute of Health. Most People with Diabetes Do Not Meet Treatment Goals. National Institute of Health. Maryland, 2004. Compound Annual Growth Rate (CAGR): Novo Nordisk/American Diabetes Association 10. Butland B, Jebb S, Kopelman P, eds. Foresight Tackling Obesities: Future Choices – Project report. Government Office for Science. The year-over-year growth rate of an investment program to help reduce the burden of diabetes on Department of Innovation Universities and Skills, 2007. over a specified period of time. older adults through early detection and treatment 11. Gold M, Briefel R. Study of federal spending on diabetes: an opportunity for change. Mathematica Policy Research, Inc. Washington, 2007. 12. World Health Organization. Dimensions of quality in health care. http://www.wpro.who.int/health_topics/quality_patient_safety/. of diabetes and through primary prevention or Accessed on October 2011. Diabetes Advocacy AllianceTM: delay of onset. 13. Beckles G, Engelgau M, Narayan V, eds. Population-Based Assessment of the Level of Care Among Adults With Diabetes in the US 1998. A coalition that is committed to helping improve Diabetes Care. 1998;21:1432-1438. 14. Shuval S, Linn S, Brezis M, Shadmi E, eds. Association between primary care physicians’ evidence-based medicine knowledge and quality of care. diabetes prevention, detection, and care by aligning National Changing Diabetes® Program: Inter J Qual Health Care. 2010;22(1):16-23. key diabetes stakeholders around diabetes-related Brings together innovators in diabetes education, 15. Fera T, Bluml B, Ellis W. Diabetes ten city challenge: final economic and clinical results. J Am Pharm Assoc. 2009;49:e52-e60. policy and legislative efforts. Members include treatment, reimbursement, and policy to shift 16. UnitedHealth®. Center for Health Reform & Modernization. The United States of Diabetes: Challenges and opportunities in the decade ahead. UnitedHealth® Working paper 5; 2011. Novo Nordisk, the American Association of attitudes and change the way patients and HCPs 17. National Committee for Quality Assurance. Diabetes Recognition Program (DRP). NCQA, 2011. Clinical Endocrinologists, American Association of think about diabetes. 18. National Committee for Quality Assurance. Physician Recognition Programs. MAKING THE CASE A Powerful Change Agent to Improve Quality and Diabetes Educators, American Clinical Laboratory Affordability. NCQA, 2009. 19. Centers for Disease Control and Prevention. Vital Signs: Health Insurance Coverage and Health Care Utilization — United States, 2006–2009 and Association, American Diabetes Association, National Committee for Quality January–March 2010. Morbidity and Mortality Weekly Report. Early release. Vol.59. CDC, 2010. American Optometric Association, Medicare Assurance (NCQA): 20. Heavey S. Study links 45,000 US deaths to lack of insurance. Reuters. Sep 17, 2009. Diabetes Screening Project, Results for Life Lab A private, not-for-profit organization dedicated to http://www.reuters.com/article/2009/09/17/us-usa-healthcare-deaths-idUSTRE58G6W520090917. 21. Sipkoff M. Pharmacists can help patients who can’t afford diabetes meds. Voice of Pharmacists. 2004. Testing: Better Health, Improved Outcomes, The improving healthcare quality through programs http://drugtopics.modernmedicine.com/drugtopics/article/articleDetail.jsp?id=129078. Endocrine Society, and Vision Service Plan. that measure healthcare delivery and recognize 22. Hayes R, Fitzgerald J, Jacober J. Primary care physician beliefs about insulin initiation in patients with type 2 diabetes. high-performing HCPs. Int J Clin Pract. 2008;62(6):860-868. 23. Korytkowski M, Niskanen L, Asakura T. FlexPen®: Addressing Issues of Confidence and Convenience in Insulin Delivery. Diabetes Recognition Program: Clin Thes. 2005;27(Suppl B):S89-S100. This National Committee for Quality Assurance Novo Nordisk Way: 24. Kahn R, Alperin P, Eddy D, eds. Age at initiation and frequency of screening to detect type 2 diabetes: a cost-effectiveness analysis. program provides HCPs with tools to support Describes who we are, where we want to go, and Lancet. 2010;375:1365-74. 25. Murray P, Chune G, Raghavan V. Legacy Effects from DCCT and UKPDS: What They Mean and Implications for Future Diabetes Trials. the delivery and recognition of consistent high how we work. Curr Atheroscler Rep. 2010;12:432-439. quality care. This voluntary program is designed to 26. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. recognize PCPs and other HCPs who use evidence- Triple Bottom Line: N Engl J Med. 2002;346:393-403. 27. Centers for Medicare & Medicaid Services. https://www.cms.gov/PrevntionGenInfo/20_prevserv.asp, Accessed on June 2011. based measures to provide quality care to their Our business principle of balancing financial, 28. Wang C, McPherson K, Marsh T, Gortmaker S, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. patients with diabetes. social, and environmental considerations. Lancet. 2011;378:815-25. 29. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. CDC 2011. 30. Quarterly Lobby Disclosure Act Reports, QI-QIV 2010. http://soprweb.senate.gov/index.cfm?event=selectfields. Analyzed by Federal Government Affairs, DM Educate®: Reset annually: Novo Nordisk Inc. Accessed on June 2011. A comprehensive diabetes management course Liquidating the portfolio at the end of the year and 31. Herman W, Hoerger T, Brandle M. The Cost-Effectiveness of Lifestyle Modification or Metformin in Preventing Type 2 Diabetes in Adults with Impaired packaged as multiple web-based diabetes using the proceeds to invest in the new list of “100 Glucose Tolerance. Ann Intern Med. 2005;142(5):323-332. 32. US Bureau of Labour Statistics. Employment, Hours, and Earnings from the Current Employment Statistics survey (National). educational modules. Courses are available in Best” is repeated for all years. US Bureau of Labour Statistics, 2010. 2 formats, for schools of pharmacy or for HCPs 33. Calculation based on: Bivens J. Updated Employment Multipliers for the US Economy (2003). Working paper 268. Economic Policy Institute, 2003. for CE credit. Shared value: 34. Great Place to Work® Trust Index© 2010 Scores & 2010 Benchmark Novo Nordisk Inc. Great Place to Work® Institute, 2010. 35. Cipoletti J. Novo Nordisk Inc. Trust Index© Scores Interpretation. Great Place to Work® Institute, Inc. February 23, 2011. About realizing synergies between business and 36. Brand reputation tracker 2010, United States report – External Benchmark Study. Reputation Institute, 2010. GLP-1: society. Glucagon-like peptide, widely viewed as an important emerging treatment for diabetes and obesity. S&P 500: One of the most commonly used benchmarks of

HbA1c: the overall stock market. Glycated hemoglobin, the average plasma glucose concentration over prolonged periods of time.

Healthy people with diabetes: Patients who not only achieve treatment targets but also those who receive ongoing, high-quality diabetes care.

v creating shared value in the United States v creating shared value in the United States 26 Glossary Reference list 27 The Blueprint for Change Program The Blueprint for Change Program glossary reference list

HbA1c: the overall stock market. Glycated hemoglobin, the average plasma glucose concentration over prolonged periods of time.

Healthy people with diabetes: Patients who not only achieve treatment targets but also those who receive ongoing, high-quality diabetes care. About the Blueprint for ChangeAbout Program the Blueprint for Change Program

By definition, a blueprint is a guide or planBy definition, that gives instructionsa blueprint is a guide or planGet that givesin instructionstouch Get in touch about how to build or create a new structure.about Basedhow to on build a common or create a new structure. Based on a common methodology, the Novo Nordisk Blueprintmethodology, for Change Programthe Novo Nordisk Blueprint for Change Program aims at assessing and communicating howaims our at Tripleassessing Bottom and Line communicating howQuestions our Triple Bottomregarding Line this case: Questions regarding this case: business principle delivers value to businessbusiness and society. principle All delivers topics value to business and society. All topics in the program explore our approach to insustainability the program and explore related our approach to sustainabilityLori Moore and related Lori Moore value creation that: value creation that: HR – Comm. & Public Affairs CommunicationsHR – Comm. & Public & Public Affairs Affairs +1 609-919-7991 +1 609-919-7991 Goes beyond — or seeks to go beyond —Goes traditional beyond challenges— or seeks to go beyond —[email protected] traditional challenges [email protected] of incremental improvement, compliance, of andincremental accountability improvement, compliance, and accountability

Drives — or has potential to drive — genuine Drives market — or has potential to drive — genuineQuestions market regarding the Questions regarding the transformation through innovative partnerships, transformation products, through innovative partnerships,Blueprint products, for Change Program: Blueprint for Change Program: and practices and practices Ole Kjerkegaard Nielsen Ole Kjerkegaard Nielsen Delivers ethical robustness and transparency Delivers throughout ethical robustness and transparencyGlobal throughout Triple Bottom Line ManagementGlobal Triple Bottom Line Management the value chain the value chain +45 30 79 22 20 +45 30 79 22 20 [email protected] [email protected] Our intent is not to present a solution. Rather,Our intent each is paper not to presents present a solution. Rather, each paper presents work in progress; therefore, these presentationswork in progress;also identify therefore, key these presentations also identify key challenges ahead challenges ahead

For more information, visit For more information, visit novonordisk.com/sustainability/How-we-manage/blueprints.aspnovonordisk.com/sustainability/How-we-manage/blueprints.asp

About Novo Nordisk About Novo Nordisk

Novo Nordisk is a global healthcare companyNovo with Nordisk 88 years is a global of innovation healthcare and company leadership with in 88diabetes years ofcare. innovation The company and leadership also has in diabetes care. The company also has leading positions within hemophilia care,leading growth positions hormone within therapy, hemophilia and hormone care, growthreplacement hormone therapy. therapy, Headquartered and hormone in Denmark, replacement therapy. Headquartered in Denmark, Novo Nordisk employs approximately 32,000Novo employees Nordisk employs in 74 countries, approximately and markets 32,000 itsemployees products in in 74 179 countries, countries. and Novo markets Nordisk’s its products in 179 countries. Novo Nordisk’s B shares are listed on NASDAQ OMX CopenhagenB shares are (Novo-B). listed on Its NASDAQ ADRs are OMX listed Copenhagen on the New (Novo-B).York Stock Its Exchange ADRs are (NVO). listed onNovo the New York Stock Exchange (NVO). Novo Nordisk strives to conduct its activities in Nordiska financially, strives environmentally,to conduct its activities and socially in a financially,responsible environmentally,way. The strategic and commitment socially responsible to way. The strategic commitment to corporate sustainability has brought the companycorporate onto sustainability center stage has asbrought a leading the playercompany in today’s onto center business stage environment, as a leading recognized player in today’s business environment, recognized for its integrated reporting, stakeholder engagement,for its integrated and reporting, consistently stakeholder high sustainability engagement, performance. and consistently Novo Nordisk high sustainability is listed in the performance. Novo Nordisk is listed in the 2010/2011 Dow Jones Sustainability Indices2010/2011 with a gold Dow class Jones rating. Sustainability For more Indicesinformation, with a visit gold novonordisk.com/sustainability. class rating. For more information, visit novonordisk.com/sustainability.

Diabetes Advocacy Alliance™ and DAWN™ are trademarks andDiabetes Changing Advocacy Diabetes® Alliance™ and DMand Educate®DAWN™ are trademarksregistered trademarks and Changing of Novo Diabetes® Nordisk and A/S. DM Educate® are registered trademarks of Novo Nordisk A/S.

AstraZeneca® is a registered trademark owned by the AstraZenecaAstraZeneca® group is of a companies.registered trademark Bistrol-Myers owned Squibb® by the is AstraZenecaa registered trademarkgroup of companies. owned by Bistrol-MyersBristol-Myers Squibb®Squibb. Boehringeris a registered trademark owned by Bristol-Myers Squibb. Boehringer Ingelheim Pharmaceuticals® is a registered trademark ownedIngelheim by Boehringer Pharmaceuticals® Ingelheim Pharmaceuticals,is a registered trademark Inc. GlaxoSmithKline® owned by Boehringer is a registered Ingelheim trademark Pharmaceuticals, owned by GlaxoSmithKlineInc. GlaxoSmithKline® group. is a registered trademark owned by GlaxoSmithKline group. Lilly® is a registered trademark owned by Eli Lilly & Co. Merck®Lilly® is is a a registered registered trademark trademark owned owned by by Merck Eli Lilly & & Co., Co. Inc. Merck® Novartis® is a registered is a registered trademark trademark owned of byNovartis Merck AG.& Co., Pfizer® Inc. Novartis® is a registered is a registered trademark of Novartis AG. Pfizer® is a registered trademark owned by Pfizer Inc. Sanofi® is a registered trademarktrademark used owned for byNon-Medicated Pfizer Inc. Sanofi® Skin Care is aPreparations registered trademark and owned used by Sanofi-Aventis,for Non-Medicated Sanofi-Synthelabo. Skin Care Preparations Takeda® and is aowned registered by Sanofi-Aventis, Sanofi-Synthelabo. Takeda® is a registered trademark of Takeda Pharmaceutical Company Limited. trademark of Takeda Pharmaceutical Company Limited.