What factors influenced NVO's earnings surprises in 2023?

Novo Nordisk's earnings surprises in 2023 were influenced by several key factors:

1. **Sales Growth of Ozempic and Wegovy**: The significant increase in sales of Ozempic and Wegovy, particularly in the U.S., was a major contributor to the revenue surprise. These drugs, which have the same active ingredient semaglutide, have seen substantial growth due to their effectiveness in promoting weight loss. Ozempic sales were up by 58% annually, and Wegovy sales grew by 200% year-over-year.
2. **International and North America Operations Growth**: Novo Nordisk's operations in International and North America contributed to the revenue growth. In the first nine months of 2023, sales in North America Operations increased by 46% in Danish kroner (49% at CER), while sales in International Operations grew by 12% in Danish kroner (17% at CER). This expansion was driven by 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 Ozempic and Wegovy in the U.S. contributed to the updated sales outlook for 2023. This adjustment reflects the improved market dynamics and demand for these drugs.
4. **Increase in Manufacturing Output**: The initiation of a second contract manufacturer for Wegovy in April 2023 helped to meet the increasing demand for the drug, which in turn supported the growth in sales and revenue.

In summary, the earnings surprises in 2023 were primarily driven by the strong sales of Ozempic and Wegovy, the growth in international and North American operations, and the adjustments in gross-to-net sales. These factors, combined with the company's strategic initiatives and market demand, contributed to Novo Nordisk's robust financial performance.