What drove the significant increase in operating profit for Novo Nordisk in Q4 2023?

The significant increase in operating profit for Novo Nordisk in Q4 2023 can be attributed to several key factors:

1. **Higher Demand for Diabetes and Obesity Drugs**: The most significant contributor to the profit increase is the robust demand for Novo Nordisk's diabetes drug Ozempic (semaglutide) and obesity drug Wegovy. These medications have experienced substantial sales growth, with Ozempic recording a 56% increase in sales and Wegovy achieving a 200% year-over-year sales growth in the quarter.
2. **Sales and Distribution Costs**: The increase in sales was accompanied by a 12% rise in sales and distribution costs, which contributed to the operating profit growth. This was primarily due to promotional activities related to Ozempic and Rybelsus, as well as Obesity care market development activities.
3. **Gross-to-Net Sales Adjustments**: The company's expectation of higher gross-to-net sales adjustments for both Ozempic and Wegovy in the U.S. has likely positively impacted profitability. This suggests that after the initial period of higher discounts, the sales trajectory is expected to be more favorable to profit margins.
4. **International Operations**: Sales in North America Operations increased by 46% and sales in International Operations by 12%, both in Danish kroner. The sales within Diabetes and Obesity care grew by 36% in Danish kroner, driven by GLP-1 diabetes sales growth of 45% and Obesity care growing by 167%.

In summary, the significant increase in operating profit for Novo Nordisk in Q4 2023 is primarily driven by the strong sales performance of their diabetes and obesity drugs, coupled with strategic cost management and market expansion activities.