Summary of the Americas Thematic Focus List Conference Call Industry and Company Overview - **Industry**: The thematic focus is on various sectors across North America and Latin America, particularly in technology, energy, healthcare, and education. - **Companies Featured**: The focus list includes notable companies such as Amazon, Microsoft, NVIDIA, Eli Lilly, and Walmart, among others. Key Themes for 2026 1. **Tech Diffusion**: Emphasizes the rapid adoption of AI technologies across various sectors, with significant implications for productivity and competitive dynamics [12][14]. 2. **The Future of Energy**: Focuses on the increasing demand for energy driven by AI infrastructure and the transition to renewable energy sources [12][17]. 3. **The Multipolar World**: Highlights the shift towards localized supply chains and national economic security, impacting multinational corporations [12][13]. 4. **Societal Shifts**: Explores the implications of demographic changes, AI-driven employment disruption, and evolving consumer preferences [12][18]. Americas Thematic Focus List - **List Composition**: The focus list includes 18 high-conviction stock ideas, with a target holding period of 12-18 months [9][20]. - **Key Companies on the List**: - **Amazon (AMZN)**: Positioned as a leader in AI infrastructure, with a projected 32% upside to a price target of $238.18 [23]. - **Microsoft (MSFT)**: Expected to capture significant AI spending, with a 42% upside to a price target of $456.66 [23]. - **Eli Lilly (LLY)**: A leader in the GLP-1 market, with a 25% upside to a price target of $1,032.97 [23]. - **Walmart (WMT)**: Leveraging AI for operational efficiency, with a 13% upside to a price target of $119.20 [23]. Methodology and Specifications - **Focus List Size**: 15-20 stocks, with equal weighting upon construction [21]. - **Sector Weights**: No fixed sector weights, aiming for diversification [21][22]. - **Regional Weights**: Targeting 80-85% in the USA and 15-20% in Latin America [28]. Important Insights and Data - **Amazon's Growth**: Amazon's custom silicon strategy has grown 150% sequentially, indicating strong demand for its AI capabilities [29]. - **Eli Lilly's Market Potential**: The global diabesity market is projected to exceed $150 billion by the early 2030s, with significant growth opportunities for Eli Lilly [39]. - **NVIDIA's Dominance**: NVIDIA is positioned to capture a significant share of the projected $3-4 trillion in annual AI infrastructure spending by the end of the decade [53]. - **Walmart's AI Strategy**: Walmart's AI initiatives have led to a 50% automation rate in its supply chain, significantly reducing delivery costs [68]. Conclusion The Americas Thematic Focus List presents a strategic overview of high-conviction investment opportunities across key sectors, driven by transformative themes such as technology diffusion and energy transition. The insights provided highlight the potential for significant growth and the evolving landscape of investment in the Americas.

Core Insights - The unmet need in India is significant, with nearly 100 million people living with obesity and diabetes who could benefit from tirzepatide [1] - Tirzepatide (Mounjaro) is the first therapy targeting both GIP and GLP-1 receptors, providing substantial efficacy in weight management and glucose control [2][11] - The company emphasizes the importance of education and awareness around obesity to combat stigma and promote appropriate treatment options [3][6] Product Strategy - The dual-action mechanism of tirzepatide distinguishes it from other treatments, achieving an average weight reduction of 20.2% compared to 13.7% for semaglutide [11] - The SURPASS-2 trial demonstrated that tirzepatide reduced HbA1c by up to 2.46 percentage points and body weight by up to 12.4 kg, outperforming semaglutide [11] - The company plans to maintain both vials and KwikPens in the market to cater to patient preferences and enhance adherence [17][24] Partnerships and Collaborations - Strategic partnerships with organizations like Apollo Clinic and Cipla are crucial for expanding access and building a robust obesity-care ecosystem [7][16] - The collaboration with Cipla for the second brand Yurpeak aims to extend tirzepatide's reach beyond major cities [7][16] Market Positioning and Pricing - The pricing strategy is based on the unique value and efficacy of tirzepatide, with no plans for generic versions in the near future [9][11] - The company acknowledges the diverse economic landscape in India and aims to reach a broad patient population [10] Investment and Manufacturing - A significant investment of over $1 billion is planned to enhance contract manufacturing capabilities in India, supporting the global supply chain [18][19] - The establishment of a technology and innovation site in Hyderabad is expected to drive growth and efficiency in drug development [20] Future Outlook - The company is exploring the potential of orforglipron, an investigational oral weight loss drug, to complement its injectable offerings [13][24] - There is a commitment to meeting the growing demand for GLP-1 drugs in India, with ongoing investments to increase production capacity [21][22]

Core Insights - Mounjaro has rapidly become the highest-selling drug in India, with total sales reaching Rs 450 crore by October, significantly outperforming its competitor Wegovy, which only achieved Rs 28 crore since its launch in June [3][21][22] - The drug's success is attributed to effective marketing strategies, superior patient experience, and timely market entry, as it was launched three months ahead of Wegovy [2][10][21] - Globally, Mounjaro's sales have reached $24.8 billion year-to-date, surpassing Merck's Keytruda [6][21] Sales Performance - Mounjaro's cumulative sales in India were Rs 235 crore by September, indicating strong market acceptance since its launch [3][21] - The drug's sales are driven by direct sourcing from allied specialties, which has led to higher actual sales than reported prescriptions [9][22] Marketing Strategy - Eli Lilly's decision to launch Mounjaro in vials rather than waiting for pen supplies allowed for a cost-effective trial for patients, enhancing initial uptake [10][11][12] - The repositioning of Mounjaro as a weight-loss therapy rather than a diabetes drug has improved its acceptance among consumers in India [17][22] Competitive Landscape - Mounjaro has a weight-loss efficacy of 20-22%, compared to Wegovy's 16-18%, contributing to its competitive edge [16][22] - Executional gaps in Novo Nordisk's rollout of Wegovy, including frequent changes in salesforce and limited local partnerships, have hindered its market penetration [18][19][22] Future Outlook - Experts predict that Mounjaro's growth may plateau with the anticipated entry of cheaper generics of semaglutide (Wegovy) into the Indian market by early 2026 [19][20][22] - While Mounjaro currently leads in market share, the long-term impact of generics and the stronger cardiovascular data associated with semaglutide may influence prescribing trends [20][22]

Core Insights - Eli Lilly is making a significant investment of over $1 billion to enhance its contract manufacturing capabilities in India, aiming to expand its global supply chains and improve access to innovative medicines for patients worldwide [1][10] - The company has committed more than $55 billion since 2020 to build, expand, and acquire facilities globally, indicating a strong focus on growth and capability building [5][10] - Lilly is preparing to launch an oral version of its experimental weight loss drug orforglipron, which is part of its strategy to expand its diabetes and weight loss portfolio [7][10] Investment and Manufacturing Expansion - The investment in India is part of a broader strategy to scale up manufacturing and supply capabilities to meet the growing global demand for Lilly's medicines [6][10] - A new manufacturing and quality hub is planned to be established in Hyderabad, which will enhance technical capabilities and oversight for Lilly's contract manufacturing network in India [9][10] - The company is focusing on potential new medicines for diabetes, obesity, Alzheimer's disease, cancer, and autoimmune conditions, preparing for future medicine developments [5][10] Market Focus - India is identified as a key region for Lilly's weight loss and diabetes portfolio, with the anti-obesity drug market in India valued at approximately ₹752 crore [7][10] - Regulatory submissions for chronic weight management and obesity are expected by the end of this year, with potential approvals in many countries anticipated in the second half of 2026 [8][10]

Core Insights - Eli Lilly and Company is recognized as one of the best pharmaceutical stocks, particularly excelling in obesity treatments and expanding its global presence [1] Group 1: Product Development and Market Expansion - The obesity drug franchise, led by Mounjaro (tirzepatide), has rapidly expanded beyond the U.S. to regions including Europe, Asia, the Middle East, Mexico, Brazil, India, and China [2] - New clinical trial data indicates that Orforglipron, an oral GLP-1 agonist, has outperformed Novo Nordisk's Rybelsus in blood sugar control and weight loss for type 2 diabetes patients [3] Group 2: Manufacturing and Investment - Eli Lilly announced a $5 billion facility near Richmond, Virginia, focused on bioconjugates and monoclonal antibodies, as part of a broader $27 billion investment plan for four U.S. plants [4] - This investment is aimed at enhancing capabilities in next-generation oncology and autoimmune therapies [4] Group 3: Regulatory Approvals and Acquisitions - The Alzheimer's drug donanemab (Kisunla) has received an FDA-approved dosing schedule and positive feedback from European regulators [5] - The acquisition of Verve Therapeutics for $1.3 billion is expected to strengthen Eli Lilly's innovation capabilities [5] Group 4: Pricing Strategy and Policy Impact - Eli Lilly introduced a flat-rate $499 monthly pricing model for Zepbound, aimed at improving affordability [6] - Upcoming U.S. policy changes, including Medicaid coverage for GLP-1 weight-loss drugs in 2026 and Medicare in 2027, could further enhance demand [6]

Core Insights - Eli Lilly plans to build a new $6.5 billion manufacturing facility in Houston, Texas, focusing on small molecule synthetic medicines [1][2] - The facility will create 4,615 jobs, including 615 high-wage positions and 4,000 construction jobs [2][4] - The site will manufacture orforglipron, Lilly's first oral GLP-1 receptor agonist, expected to be submitted for regulatory approval for obesity by the end of the year [3][4] Company Expansion - The Houston site is Lilly's eighth U.S. manufacturing facility announced since 2020 and is part of a broader strategy to enhance domestic production capabilities [1][4] - The facility will utilize advanced technologies such as machine learning, AI, and digital automation to improve operational efficiency [6][8] - Lilly aims to collaborate with local universities to build a skilled workforce in Texas [6][8] Economic Impact - The investment is expected to stimulate the local economy, with an estimated four dollars in local economic activity generated for every dollar spent by Lilly [5] - The expansion will not only create jobs directly but also support related sectors such as supply chain and logistics [5][6] Strategic Importance - The new facility will enhance Lilly's ability to produce critical medicines at scale, ensuring faster access to treatments for patients [4][8] - The selection of Generation Park for the facility was based on various factors, including workforce potential and local incentives [8]

Core Insights - Eli Lilly's Mounjaro (tirzepatide) demonstrated significant efficacy in treating type 2 diabetes in children and adolescents, meeting primary and secondary endpoints in the SURPASS-PEDS trial [1][2][5] - The trial results indicate a promising opportunity for improving long-term health outcomes for young patients with type 2 diabetes [2][5] Summary by Sections Trial Results - Mounjaro achieved a 2.2% reduction in A1C from a baseline of 8.05% at 30 weeks, significantly outperforming placebo [2][3] - 86.1% of participants on the 10 mg dose reached the target A1C of 6.5% [2][3] - The 10 mg dose also resulted in an average BMI reduction of 11.2% at 30 weeks, with improvements sustained through 52 weeks [2][3] Safety Profile - The safety and tolerability of Mounjaro were consistent with previous adult studies, with common adverse events including diarrhea (25%), nausea (22%), and vomiting (16%) [5] - No severe hypoglycemia episodes were reported, and the rate of Level 2 hypoglycemia was 15.4% in Mounjaro groups compared to 5.9% in placebo [5] Regulatory and Market Implications - Eli Lilly has submitted the SURPASS-PEDS results to global regulatory agencies for an expanded indication for Mounjaro [6] - The increasing prevalence of type 2 diabetes in children highlights the need for effective treatment options, positioning Mounjaro as a potential solution in an underserved market [5] Background on Mounjaro - Mounjaro is a GIP/GLP-1 dual receptor agonist that aids in glycemic control and weight management by decreasing calorie intake and improving insulin sensitivity [7][8] - It is already approved for adults with type 2 diabetes and obesity, with ongoing studies for chronic kidney disease and obesity-related morbidity/mortality [7][8]

Core Viewpoint - Eli Lilly plans to significantly increase the list price of its weight-loss and type 2 diabetes drug Mounjaro in the UK, reflecting heightened competition in the obesity drug market, particularly with Novo Nordisk [1][2]. Pricing Strategy - Starting in September, the highest monthly dose of Mounjaro will see a price increase from £122 to £330, marking a 170% rise to align with prices in other European markets [1]. - Bank of America Securities reported that Eli Lilly intends to double GLP-1 drug prices in the UK, although the specific customers affected remain unclear [2]. Market Context - Similar price adjustments are anticipated in other European markets, where GLP-1 manufacturers typically lack formal pricing agreements with governments, resulting in out-of-pocket costs for patients [3]. - The pricing strategy aligns with a "most favored nation" (MFN) pricing concept discussed recently, aiming to raise drug prices outside the U.S. while lowering them domestically [3][4]. Company Initiatives - Eli Lilly has initiated pricing strategies, including the "Lilly Direct" direct-to-consumer channel for Zepbound and other medications, which aims to bypass pharmacy benefit managers [5]. - While direct-to-consumer initiatives may enhance access, they are expected to have minimal impact on profit and loss, particularly for obesity drugs [6]. Investor Sentiment - Investors in the obesity sector are increasingly anxious due to the competitive landscape, with Novo Nordisk's lead diminishing and Eli Lilly's stock volatility [7]. - Bank of America maintains a Buy rating for Eli Lilly, projecting a price target of $900, citing strong growth potential at a reasonable valuation [7]. Stock Performance - Eli Lilly's stock was trading higher by 0.85% at $690.27 as of the last check [8].

Market Overview - Major tech-heavy indices experienced declines, with the S&P 500 and Nasdaq 100 down 0.3% and 0.6% respectively, influenced by cautious investor sentiment ahead of the Trump-Putin meeting and a dip in consumer confidence [1] - The Dow Jones outperformed, rising 0.2% to surpass the 45,000-point mark, driven by a rally in pharmaceutical stocks [2] Company Performance - Intel Corp. (INTC) saw a significant increase of 7% as reports emerged that the U.S. administration is considering taking a stake in the company to enhance domestic chip manufacturing, marking a 26% rise for the week, the largest weekly gain since January 1975 [2] - UnitedHealth Group Inc. (UNH) was the standout performer, surging 14% after Berkshire Hathaway disclosed its purchase of shares, recovering from a previous decline of over 40% year-to-date [3][10] - The Health Care Select Sector SPDR Fund (XLV) outperformed the market, increasing by 1.88%, with notable gains in pharmaceutical stocks such as Centene Corp. (CNC) up 6.2%, Moderna Inc. (MRNA) up 6.63%, and Molina Healthcare Inc. (MOH) up 4.88% [10] Economic Indicators - Retail sales for July increased by 0.5% month-over-month, aligning with forecasts, but consumer sentiment dropped to 58.6 in August from 61.7 in July, missing expectations [4] - Inflation expectations rose, with the one-year outlook increasing to 4.9% from 4.5% and the five-year measure rising to 3.9% from 3.4% [4]

Core Insights - Mounjaro (tirzepatide) demonstrated non-inferiority to Trulicity (dulaglutide) in reducing major adverse cardiovascular events (MACE-3) with an 8% lower rate of such events [1][2] - Mounjaro showed a 16% reduction in all-cause mortality compared to Trulicity, indicating broader health benefits [1][2] - The SURPASS-CVOT trial is the largest and longest study of tirzepatide, involving over 13,000 participants across 30 countries [1][6] Group 1: Trial Results - Mounjaro achieved a hazard ratio of 0.92 for MACE-3 events, meeting the criteria for non-inferiority [2][3] - The trial reported a 39% reduction in all-cause mortality when comparing Mounjaro to a hypothetical placebo [2][3] - Mounjaro also showed a significant improvement in estimated glomerular filtration rate (eGFR) decline in patients with chronic kidney disease, with a treatment difference of 3.54 mL/min/1.73 m² at 36 months [2][3] Group 2: Efficacy and Safety - Mounjaro led to greater reductions in A1C levels and body weight compared to Trulicity, with a treatment difference of -0.83% in A1C and -7.1% in body weight [4][5] - The most common adverse events for both Mounjaro and Trulicity were gastrointestinal-related, with 13.3% of Mounjaro participants discontinuing treatment due to adverse events compared to 10.2% for Trulicity [5][6] - Safety profiles for both drugs were consistent with established data, indicating that Mounjaro is a viable option for patients with type 2 diabetes and cardiovascular disease [2][5]