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Teva Pharmaceutical Industries(NYSE: TEVA)
Q3 2023 Earnings Call
Nov 08, 2023, 8:00 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Hello and welcome to the Q3 2023 Teva Pharmaceutical Industries earnings conference call. My name is Alex, and I'll be coordinating the call today. [Operator instructions] I'll now hand it over to your host, Ran Meir, SVP of investor relations. Please go ahead.
Ran Meir -- Senior Vice President, Investor Relations
Thank you, Alex. Thank you, everyone, for joining us today. We hope you had an opportunity to review our press release, which was issued earlier this morning. A copy of this press release, as well as a copy of the slides being presented on this call, can be found on our website at tevapharm.com.
Please review our forward-looking statements on Slide Number 2. Additional information regarding these statements and our non-GAAP financial measures is available on our earnings release and in our SEC Forms 10-K and 10-Q. To begin today's call, Richard Francis, Teva's CEO, will provide an overview of Teva's Q3 results and business performance, recent events, and our priorities going forward. Then Dr.
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Eric Hughes, our head of R&D and chief medical officer, will discuss progress on our innovative pipeline. Our CFO, Eli Kalif, will follow up by reviewing the financial results in more detail, including our 2023 financial outlook. Joining Richard, Eric, and Eli on the call today is Sven Dethlefs, Teva's head of North America business, who will be available during the question-and-answer session that will follow the presentation. Please note that today's call will run approximately one hour.
And with that, I will now turn the call over to Richard. Richard.
Richard Francis -- President and Chief Executive Officer
Thank you, Ran, and thank you, everybody, for joining us today. I'd like to begin by saying that we are deeply saddened by the terror attacks in Israel on October the 7th. Since that day, Teva's board, leadership team, and I have made the safety and well-being of our Israeli colleagues our utmost priority. I visited and met employees at the facilities in Israel immediately after the attack.
Many of them have families and friends who have perished or been kidnapped. What really stood out and inspired me was that despite all the difficulties, they are rallying together to bring medicines to the patients who need them, especially now. I am personally humbled by their incredible resilience, care, and sense of purpose. Now, we have increased support of our emergency supply of medicines to hospitals, pharmacies, and patients, and we have partnered with our long-standing partners to donate products and provide other humanitarian aid.
Through it all, our production remains largely unaffected, and gratefully, none of our sites have incurred direct damage as a result of the war. We continue to secure contingency plans to be certain we can maintain our business continuity, while, most importantly, taking care to ensure that our colleagues are safe and well in these difficult times. Now, moving on to Slide 5, I'd like to update you on strong performance in Q3 as we continue to execute our pivot to growth strategy. Now, our strong performance of our growth was delivered by our growth engines, Austedo, Ajovy, and our generics business.
Revenues were up 7% in U.S. and in local currency. Our gross margin continues to improve. We saw it increase by 50 basis points versus Q3 2022.
We are pleased to announce the exciting partnership with Sanofi in Q3, the deal to really maximize anti-TL1A asset. Because of these results, I'm pleased to announce that we're going to increase our outlook of revenue to 15.1 billion to 15.5 billion for 2023. Now, to move on to the next slide to continue to maybe update you on our pivot to growth strategy. As you all remember, this was based on four pillars: delivering on growth engines, step up innovation, sustain our generics powerhouse, and focus our business.
So, we're just going to touch on some of the progress we've made in Q3. As I've just mentioned, Austedo is performing well and is on track to hit 1.2 billion for 2023, and we remain committed and confident of hitting the target of 2.5 billion in 2027. Uzedy was launched earlier in the year, and I'll give you an update on that. And we're pleased to announce with our partner Alvotech that we're doing an FDA inspection in early Q1 in 2024.
It raises the opportunity that we may be able to launch Humira next year. With regard to innovation, I'm joined on this call by Eric Hughes, who'll go into more detail, but a couple of highlights are obviously around olanzapine, our long-acting treatment for schizophrenia in a phase 3 study. This is progressing really well and ahead of schedule, so we're confident we'll be able to report results in that in the second half of next year. To have a generics powerhouse, we made good progress.
And as you will see, we have growth across all of our regions. And then finally, on pillar four, focus our business, we continue to do the work to create a stand-alone business unit for Tapi and pleased to announce the appointment of our CEO for that business that allows them to compete in the global market. And moving on to the next slide, just to touch upon one of that -- the news we had in Q3, that exciting collaboration with Sanofi. I'm pleased with this collaboration because it really strengthens our pivot to growth strategy.
It allows us to partner with a global leader in immunology, both from an R&D and commercial perspective, while retaining 50% of the economics going forward, which is important as we want to drive long-term growth for Teva. We see this asset as an asset that can drive long-term growth because of the size of the market we'll be operating in. I'll come to that a bit later on. Now, back to performance on the next slide.
As I said, we had strong performance in Q3. Revenue was 3.9 billion, up 7%. That was driven by both our innovative business, as well as our generics business. Austedo continued its impressive growth, up 30%, while Ajovy continues to grow well at 22%.
Pleased to show that we saw growth across all of our regions, with particularly strong performance in the U.S. and international markets. Now, to double-click and dive a bit deeper, I'd like to move on to Austedo. Austedo, once again, we confirm that we're committed to the $1.2 billion target for 2023.
Revenue was up, the 339 million for Q3, up 30%, and supported and underpinned by good strong TRx growth of 29%. Now, on the next slide, I want to reiterate our commitment to the $2.5 billion target for 2027. We're doing this by investing in our brand and building capability in the company. As we mentioned earlier in the year, we have increased our sales force, we have invested in improving our patient support services, as well as looking to launch this brand into the European market by 2026.
Now, we see the opportunity not only because we're investing in building capability, but there's a significant unmet medical need when it comes to patients suffering from tardive dyskinesia. And tragically, there's a lot of patients who still need to benefit from Austedo, so we have work to do there and an ability to improve patients' lives. Now, moving on to the next slide, Ajovy. We're on track to reach or even exceed the 400 million for 2023, with good growth in Q3 and revenues of 114 million.
As I said, revenue -- sorry, as I said, growth was 22%. What I like about Ajovy is not the fact that we're just growing in all of our regions, but we remain very competitive in what is a competitive sector and segment of the market, highlighting our sales and marketing and medical and commercial capabilities. Now, moving on to the next slide. The newest member of our innovative family is Uzedy, a long-acting treatment for risperidone, launched in May of this year.
Now, we're pleased with the launch. And as you can see, Uzedy is capturing over 55% of all NBRx in the risperidone long-acting market, and this is driven by the strong feedback we're receiving from physicians and patients. Physicians -- patients, obviously, appreciate the subcutaneous injection versus intramuscular, and I think the physicians find the fact that Uzedy can reach therapeutic doses within six to 24 hours to be really helpful when they're treating patients who have a relapse. This market is an attractive market.
It's a $4 billion market, and we think Uzedy will have a real part to play in that market. Now, as I've said before, 2023 is a setup year for 2024. We need to make sure we get access, formulary inclusions in our hospitals, and we're making very good progress on that. So, look forward to updating you on Uzedy as we near the end of the year.
Now, moving away from our innovative portfolio to our generics business. And as I said earlier, I'm pleased to show that we're growing our generics business across all of our regions, U.S. included. And as you can see, strong growth in the U.S.
at 15%, solid growth in Europe, and good growth in emerging markets and local currencies of 17%. Now, to move on to our pipeline, which is obviously a key pillar of our strategy -- our pivot to growth strategy and step up innovation, just to look at the late-stage assets we have. I've talked about olanzapine and how encouraged we are with the recruitment of our patients into that phase 3 trial. And we look to be announcing -- well, Eric and his team will look to be announcing those results in the second half of next year.
Once again, to reiterate, this is a significant market. And with olanzapine, there really isn't a satisfactory and long-acting version of this product, this molecule in the market, so we're excited about this and the help we can bring to this patient population. Moving on to ICS/SABA, another product that entered phase 3 clinical trials in Q3. We've started to recruit patients already, and this is a significant opportunity.
As I mentioned on previous calls, based on the guidelines in the U.S., there are 10 million patients who should be on an ICS/SABA combination. And so, if you just take 30% of these, the market is still significant at 2.5 billion. So, a real opportunity to continue to drive growth for Teva in our innovative business. And then finally, anti -- on anti-TL1A, I've spoken a bit about it, and I'm sure Eric will touch on this as well.
But just to highlight the size of the opportunity in UC and CD, which we see is around 28 billion for what we think we have a best-in-class product. And then on my final slide, I'd just like to close out with our recent progress on our ESG strategy and initiatives. In Q3, we made good progress on executing our ESG strategy and we made good progress against some of our ESG targets. And I'm pleased to announce on behalf of the team that the company received some awards.
We were the winner of the best company for ESG reporting in the healthcare sector and also in 2023 Best Corporate Social Responsibility initiative. So, really highlighting the work and the progress we've made on our ESG strategy. Now, with that, I would like to hand over to my colleague, Eric Hughes, who will walk you through some of our pipeline news.
Eric Hughes -- Chief Medical Officer, Head of Research and Development
Thank you, Richard. Can I have the next slide? So, as Richard mentioned, we're excited by the improved sales of Austedo, which is a testament to Austedo's safety and efficacy. To build upon what we've already achieved with Austedo, we want to make sure that the flexibility and the convenience of Austedo is improved with our patients, and we're happy to present this data from our real-world studies called Start. This study was a real-world study to look at how our four-week titration pack is used.
What we see in this study is that 78% of the subjects completed the study, 97% were adherent to the medication, 76% reached the optimal dose, and 95% reached a dose greater than 24 milligrams per day. But why is this important? Well, the important thing is to get patients on the right dose that's optimal for them, use the flexibility of Austedo, and maintain patients on effective treatment. And you can see that in this study, we had actually a very good response rate in the abnormal involuntary movement scale of about 4.8, which is actually numerically better than our pivotal studies. So, we believe with the titration pack, the flexibility of the dosing, and these adherence rates that we see in our Start study, we will maximize the ability of patients to receive and obtain the proper dose and stay on treatment.
Come next slide. As Richard mentioned, we're also excited to see the improvement -- improved sales of Ajovy. Ajovy is a program that we have for migraine, and we can recapitulate our phase 2 -- phase 3 studies and its effect on the monthly migraine days that we improve. So, in this study called Unite, that's a prospective study, but the uniqueness of this study was that we looked at patients with migraine who also had depressive symptoms.
And this is important because depression is a comorbidity with migraine that leads to chronic migraine, increasing -- increased disabilities, and decreases in quality of life. So, we designed Unite to prospectively look at both the effects on monthly migraine treatment and as well as depressive symptoms. And we're pleased to show that the primary endpoint was achieved and recapitulated our good results in the monthly migraine rates, but also in the secondary endpoint on depressive symptoms. So, this is the first study to show, in fact, that we have a significant effect not only on monthly migraine but also on depressive symptoms in a CGRP, either subcutaneous or oral.
So, we're very excited to see this. I think there's a great benefit to patients. Come to the next slide. Now, we're also excited to present more data on Uzedy from our pivotal studies and the sub analysis.
In the Rise study, our pivotal study, we looked at the disease duration across all the patients that we enrolled. And here, you can see that we had patients that were less than five years, all the way up to greater than 20 years. And why is this sub analysis important? Well, there is the thought that after many years of, you know, greater than 20 years, the treatment of schizophrenia becomes slightly resistant to treatment. But here, we can see that, clearly, there's no impact on disease duration on the effectiveness of Uzedy.
So, greater than 20 years is a very good populations, have shown treatment effect then. Equally as important is those patients that are less than five years duration of their treatment. Here, again, even in this population, which has a higher relapse rate early in treatment, we also had a great effect, which is important because in LAIs -- this is a continuing theory that LAIs are an effective way of starting treatment. Thank you.
Next slide, please. Now, Richard mentioned the olanzapine LAI study. You know, it's going very well. We've enrolled over 550 patients to date.
And I just want to review quickly what the study design is for our phase 3 program. We do have three doses against placebo for eight weeks to the primary endpoint, and then we'll roll those subjects over into three doses again for up to 48 weeks to build our safety database. The study has enrolled very quickly, and I'll go over a timeline of the readout, but we're excited to see that a study enrolls quickly. This is obviously a testament to the capabilities of the R&D organization, as well as the desire of investigators to use an injectable olanzapine.
Come to the next slide. Finally, I just want to touch base on our TL1A program. Richard mentioned that we had a deal signed with Sanofi to advance this very important product forward. As I've mentioned many times in the past, this is a very important underserved market.
There's over 4 million patients diagnosed, about 2.7 million are treated. However, the treatments are -- have good effects that only lasts for so long. People frequently cycle through treatments. And many of these patients actually end up still getting surgery as their disease progresses.
So, more treatments are important in this disease area. We believe we have the best-in-class potential for TL1As. We have a potent compound with great selectivity. We've shown good safety in our Asthma study, and we've shown low antidrug antibodies to date.
The collaboration with Sanofi is going to capitalize on the potential of this target. This target has the potential to go across many different disease indications. It's a pre-atrophic cytokine that affects many different pathways. So, the possibilities are large for this group.
As I've mentioned, we're going to -- we've accelerated the program, and we're putting all our effort on getting our interim analysis read out in 2024. So, looking forward to more in collaboration with Sanofi. And just to review our milestones in development, so I mentioned TL1A, we're moving forward and we're putting resources and investment in making sure that we achieve our interim analysis in the second half of 2024. I have been talking about olanzapine LAI and its acceleration.
We have been reporting that we were going to report the results out in the first half of 2025, but I'm happy to say we've accelerated that to the second half of 2024. We've enrolled patients in our anti-IL15 PoC study for celiac disease, and we will have our PK from our SAD and MAD studies coming up in the second half of 2024. We are well on our path to have our first patient dosed in our anti-PD1-IL2 program in the first half of 2024 when we submit our IND. And as Richard mentioned, ICS/SABA has now launched into our phase 3 program, and we're looking for results in the first half of -- or second half of 2026.
So, lots of things going on. I'm glad to see that we're accelerating our programs and keeping to our timelines. And with that, I'm going to pass it off to Eli.
Eli Kalif -- Chief Financial Officer
Thank you, Eric, and good morning and good afternoon to everyone. I'll begin my review of our Q3 2023 financial results with Slide 25, starting with our GAAP performance. Revenues in the third quarter of '23 were 3.9 billion, representing an increase of 7% compared to Q3 2022, both in reported terms and in local currency. To provide you some color on our revenue performance by region, in North America, we had overall strong performance with 11% growth in Q3 2023 compared to third quarter last year.
This growth was mainly driven by higher revenue from generics products, Austedo, and Ajovy, partially offset by lower revenue from Bendeka and Treanda. As Richard mentioned, revenues in our generics business in North America increased by 15% in Q3 2023, mainly due to revenues from generics revenues, partially offset by an increase in competition to other generics products. Revenues in our Europe segment were flat in local currency terms. We continue to see strong growth in Ajovy and a solid growth in our generics business in the third quarter.
This was, however, largely offset by lower revenues from our legacy brands, including Copaxone. Revenues from our international market segment increased by 20% in local currency terms. This was mainly driven by higher revenue from our generics product, largely coming from price increases as measure to offset higher costs due to inflationary pressures. This increase was partially offset by regulatory price reduction and generic competition to off-patent products in Japan.
GAAP operating income was 365 million in the third quarter of 2023, compared to an operating income of 419 million in the third quarter of 2022. The lower operating income in the third quarter of 2023 was mainly due to higher legal settlements and loss contingencies, higher R&D and S&M expenses, partially offset by higher gross profit. Our higher R&D expenses in the third quarter of 2023 compared to the third quarter of 2022 were mainly due to an increase to support our late-stage innovation pipeline that Richard and Eric mentioned earlier, in line with our pivot to growth strategy. In addition, last year and in the third quarter of 2022, our R&D expenses were lower due to an adjustment in payments related to a contract with one of our R&D partners.
We also saw an increase in our S&M expenses compared to the third quarter last year, mainly due to promotional activities related to Austedo and Uzedy, as well as exchange rate fluctuations in our Europe segment. We had a GAAP income of 80 million, compared to the net income of 56 million in Q3 2022; and a GAAP earnings per share of $0.07, compared to GAAP earnings per share of $0.05 in the same period a year ago. The higher net income in the third quarter of 2023 was mainly due to reduced tax expenses in 2023 compared to Q3 2022. Our tax rate in Q3 2023 was mainly affected by increased deferred tax assets resulting IP-related integration plans.
Such integration plans have been adopted, among others, in an effort of addressing the global adoption of OECD Pillar Two minimum effective corporate tax commencing in 2024. The increase in our net income was partially offset by lower operating income, as discussed above. Foreign exchange rate movements during the third quarter of 2023, net of hedging effects, negatively impacted our revenues and GAAP operating income by 9 million and 53 million, respectively, compared to the third quarter of 2022. This was primarily a result of the impact of stronger U.S.
dollars against currencies of certain international markets in which we operate, partially offset by the benefit from euro appreciation. Approximately 46% of our revenue in Q3 2023 came from sales denominated in non-U.S. dollar currency. Turning to Slide 26.
You can see that the total non-GAAP adjustment in the third quarter of 2023 were approximately 598 million, compared to 602 million in Q3 2022. Notable GAAP adjustment this quarter include legal settlements, loss contingencies of 314 million, mainly related to estimated provision recorded in connection with certain litigation cases in the U.S. Additional notable adjustments included amortization of purchased intangible assets of 145 million, the majority of which is included in cost of sale. Now, moving to Slide 27 for review of our non-GAAP performance.
As I mentioned, our third quarter revenue were totaled approximately 3.9 billion, representing growth of 7% compared to the third quarter of 2022. Now, let's move down to the P&L, starting with the gross profit margin. Our non-GAAP gross profit margin was 53.5% in the third quarter of 2023, compared to 53% in Q3 2022. This improvement in non-GAAP gross profit margin was mainly driven by several mix of products, including higher revenue from Austedo in our North America segment, partially offset by higher costs due to inflationary and other macroeconomic pressures.
As I mentioned last quarter and as expected, this was an approximate 130-basis-point sequential improvement in our non-GAAP gross profit margin in Q3 2023 compared to the second quarter of 2023. This sequential improvement in gross margin was driven by continuing to shift toward a more normalized portfolio mix, mainly driven by strong growth in Austedo, continued growth in Ajovy, as well as improvement in our cost of goods sold due to the expected easing of the inflationary pressures and other measures we are taking to drive productivity in our supply chain. Our non-GAAP operating margin in Q3 2023 was 26.5%, versus 27.2% in Q3 2022. This decrease in operating margin was mainly due to an increase in R&D expenses, partially offset by higher gross profit margins, as I just mentioned, as well as lower G&A expenses.
We ended the third quarter with a non-GAAP earnings per share of $0.60, compared to $0.59 in Q3 2022, mainly due to a higher non-GAAP operating income, partially offset by higher financial expenses in Q3 2023. Now, let's take a look at our spend based on Slide 28. As you can see, our quarterly spend base increased by 213 million or 171 million on a local currency basis. This increase was due to a higher cost of goods sold related to higher revenue compared to the third quarter of 2022, as well as higher operating expenses related to higher R&D and S&M that I just mentioned earlier, partially offset by efficiencies in our G&A expenses.
As we move forward, we expect our operating expenses to be approximately from 1 billion to 1.05 billion in the fourth quarter, including a quarterly run rate of R&D expenses to be in the range of 230 million to 250 million as we continue to progress our pipeline, including the late-stage innovative asset. This is in line with our pivot to growth strategy to position the business for long-term growth and success. Turning to free cash flow on Slide 29. In the first three quarters of 2023, we generated 0.9 billion of free cash flow versus 1.1 billion during the same period last year, a decrease of 200 million.
This resulted mainly from changes in working capital items, including, on average, higher inventory levels, as well as lower net income as a result of lower gross profit and higher operating and finance expenses. Today, we are reframing our 2023 free cash flow guidance. Our 2023 free cash flow is expected to be in the range of 1.7 billion to 2.1 billion. Our fourth quarter free cash flow expectation includes a sequential ramp-up in our revenue and profitability, with a meaningful contribution from Austedo.
In addition, we continue to drive working capital improvements, including significant inventory efficiencies and continuation of the positive impact from accounts payable as a result of expansion in our vendor payment program, which we launched earlier this year. This free cash flow outlook range does not include the first upfront milestone payment payable to us under the exclusive collaboration with Sanofi for our anit-TL1A, which we announced in October. Turning to Slide 30. Our net debt at the end of Q3 2023 was 17.7 billion, compared to 18.4 billion at the end of 2022.
Our gross debt was 20 billion, compared to 21.2 billion at the end of 2022. The decrease in our gross debt was mainly due to 1.6 billion senior notes repaid at maturity and 54 million of exchange rate fluctuation, partially offset by 500 million outstanding under the revolving credit facility as of September 30, 2023. As I mentioned last quarter, in July 2023, we withdrew a total amount of 700 million under our 1.8 billion revolving credit facility. The proceeds of which were used to repay 1 billion of our senior notes at maturity in July.
In September 2023, we repaid 200 million. And as of today, 500 million is outstanding under the revolving credit facility. Our net debt to EBITDA improved compared to Q2 2023, coming now at 4.03 times for Q3 2023 due to foreign exchange rate movements, as well as free cash flow generation in the third quarter. As part of our capital allocation strategy, debt reduction continues to be our focus, and we expect to continue to work toward our long-term financial target of being two times net debt to EBITDA by end of 2027.
Turning to Slide 31, which presents our upcoming debt maturities. As I mentioned, we have already repaid 1 billion of our 2.8% senior notes at maturity in July 2023. So, there are currently no additional maturity payments due in 2023. Following our successful refinancing of approximately 2.5 billion of our debt through our sustainability-linked senior notes during the first quarter of 2023, we have aligned our near-term debt maturities with our annual free cash flow guidance for this year.
We believe we are well positioned to continue to serve our debt and with these upcoming maturities over the next couple of years with our ongoing cash flow generation. Now, turning to our 2023 non-GAAP outlook on Slide 32. As Richard highlighted earlier, we had a solid third quarter and year-to-date performance in terms of our revenues across all regions. This includes continued strong momentum in our key growth engines, especially Austedo, continued growth in Ajovy, as well as solid performance in our core generics business globally.
In addition, we are seeing relatively higher revenue from Copaxone compared to our initial expectation, which we now expect it to be approximately 550 million for the full year. To reflect this revenue performance in the first nine months, along with the expected development in the fourth quarter, we are increasing our full year revenue guidance range by 100 million. We are now expecting our revenue to be between 15.1 billion to 15.5 billion for and the full year of 2023. We also continue to expect sequential improvement in our margins in the fourth quarter.
As previously communicated, we are driving and continuing the shift in our portfolio mix, mainly driven by strong growth in Austedo, as well as further improvement in our cost of goods sold. To reflect our year-to-date tax performance that I referred earlier, we are now expecting our annual non-GAAP tax rate for the full year 2023 to be in the range of 12% to 15%, and we expect our fully diluted share count to be approximately 1.132 billion shares for the full year of 2023. Today, we are also reaffirming our 2023 non-GAAP outlook for operating income, EBITDA, earnings per share, and free cash flow as provided in February. I want to reiterate that our full year revenue, operating income, adjusted EBITDA, diluted EPS, and free cash flow outlook ranges do not include the first upfront milestone payment payable to us under the exclusive collaboration with Sanofi for our anti-TL1A, which we announced in October.
With that, this concludes my review of Teva's results for the third quarter of 2023. And now, I will hand it back to Richard for a summary.
Richard Francis -- President and Chief Executive Officer
Thank you, Eli, and thank you, Eric. So, in summary, strong Q3 performance, driven by Austedo, the launch of Uzedy and Ajovy, and good performance across our generics business in all three regions. To that, as you heard from Eli, we're increasing our guidance for revenues for this year. And I'm pleased to show that the pivot to growth strategy is starting to get traction, as I've highlighted with Austedo, the collaboration TL1A, with the capability build that Eric and his team have done that allowed us to accelerate olanzapine, our long-acting product in phase 3 study, as well as with the Teva api with the recruitment of our CEO.
With that, I'll hand it over to people to ask questions.
Questions & Answers:
Operator
Thank you. [Operator instructions] Our first question for today comes from Umer Raffat of Evercore ISI. Your line is now open. Please go ahead.
Umer Raffat -- Evercore ISI -- Analyst
Hi, guys. Thanks for taking my question. I noticed a dose level C was dropped in your TL1A trial. I'm assuming that was the highest dose.
So, I have a two-part question. One, can you confirm that among the dose level A and B that was kept, you have at least a 500-milligram dose in there? And secondly, I understand that the decision to drop the dose level C was informed by optimizing evolving biomarker data. Could you please elaborate on that as well? Thank you.
Richard Francis -- President and Chief Executive Officer
Hi, Umer. Thanks for the call and thanks for the question. Eric, I'll hand that one to you.
Eric Hughes -- Chief Medical Officer, Head of Research and Development
Thank you, Umer. So, yes, we amended our study design and we dropped the dose. This was driven largely, in part, by our comparative in vitro data. As I mentioned in our -- the potency of the compound is -- we believe is best-in-class.
We think the selectivity drives a lot of our potential biomarker movement. You know, we were looking at three TL1A levels, which I think are important in dose selection. And we use this in combination with our PK and what we've observed in other development programs when we look at exposures in the program. So, we took advantage of this, and we optimized the study by dropping a dose and, you know, increasing, actually, the size slightly in the other arm.
So, we're happy with the changes. I think that makes the program more efficient and more useful data that will come out of it, and I can't comment on dosing or which dose was removed at this time.
Umer Raffat -- Evercore ISI -- Analyst
Thank you.
Operator
Thank you. Our next question comes from Balaji Prasad from specialty pharma equity research. Your line is now open. Please go ahead.
Balaji Prasad -- Barclays -- Analyst
Hi. Good morning. This is Balaji from Barclays. A couple of questions from me.
Richard, just want to get your sense if you think that Teva has reached a spot where you are comfortable or actively seeking to expand your pipeline or portfolio either with BD or in-licensing. Secondly, on the guidance, I still see a $400 million spread so late into the year, which is rather interesting. Is it fair to assume that you are still expecting some large one-offs so late in the year that can still impact to the extent of a few hundred million dollars if approved? Thank you.
Richard Francis -- President and Chief Executive Officer
Thanks, Balaji. Thanks for the call and the question. Appreciate that. So, on the BD, to answer that question, yes, we are actively looking to do BD and in-license, and we started that and we've been doing that actively.
I think we are excited by the products we have in innovation within the market and in our pipeline. That said, as we committed in the pivot to growth, we want to build on that. We think we have capacity to add products, both in our pipeline and also commercially. So, we are actively doing that, but we want to be very selective, make sure it fits to our portfolio, our TA strategy, and so that does take some time.
With regard to the guidance, I think your question was the 15.1 to the 15.5, a bit of a range there, do we expect a one-off to drive that? I'll let Eli answer that. So, over to you Eli.
Eli Kalif -- Chief Financial Officer
Yes. Thanks, Balaji, for the call -- for the question, sorry. And basically, you know, we are actually keeping the guidance for Austedo so you can actually look on the first three quarters and understand the growth there, year-over-year Q4, just on Austedo. But namely in terms of the other elements and underlying on the revenue, there is nothing there in specific that are going to be changed versus the current trend, considering this is analogy of Q4 that we have each year.
Richard Francis -- President and Chief Executive Officer
Thanks for the question.
Operator
Thank you. Our next question comes from Jason Gerberry of Bank of America. Your line is now open. Please go ahead.
Jason Gerberry -- Bank of America Merrill Lynch -- Analyst
Hey, guys. Thank you for taking my questions. I guess, firstly, just on the TL1A partnership, I actually had a follow-up question regarding the $600 million milestone for starting phase 3. Is that contingent just on showing something stat sig as a benefit or do you actually need to generate data that are competitive with the more advanced TL1A programs? Just wondering how much risk there is to kind of capturing that $600 million milestone and moving forward.
And then my second question just on your EBITDA guide for the year, I guess to get to the midpoint or the high end of the range, it's a pretty substantial sequential step-up. I get that there's going to be more brand revenue, better mix, better margin in the fourth quarter, but you presumably won't have the generic Revlimid contribution. So, how should we think about opex swings here in fourth quarter versus sort of the run rate in the three quarters leading into 4Q? Like would we expect a step-down in opex or is there some other factor that can drive this big sequential uptick?
Richard Francis -- President and Chief Executive Officer
OK, Jason. Thanks for the question. I'll start in answering, then I'll let my colleagues contribute. So, on the TL1A, the phase 3, there were no conditions around the phase 3.
The phase 3 is about completing the phase 2 and have an FDA approval to move into -- sorry, have a phase 2 -- complete the phase 2 and FDA approval to move into the phase 3. So, that's what the deal is on. There's no criteria around that. So, I think, hopefully, that's very clear.
With regard to the EBITDA and the range, I think it was, and a bit about opex. So, maybe I'll start this, and then Eli can contribute. So, you have seen and Eli did talk about our opex going up, but this is in line with our strategy. This is in line with what we plan to execute.
We're driving Austedo and making sure that brand is supported appropriately. The same for Uzedy, a product we just launched for schizophrenia. And obviously, Eric and his team have started to hit the ground running, particularly on olanzapine and also TL1A and recruiting, you know, faster than we expected. So, obviously, it incurs costs, but I think that's a good thing, particularly if that's part of our pivot to growth strategy.
So, those are the reasons why the opex is probably has gone up. Those are the reasons why it's gone up, but we're pleased with them because it's in line with what we want to do. Now, obviously, going forward, just to give a bit of flavor to the opex on the R&D, obviously, TL1A in partnership with Sanofi will have a 50% of that cost taken by Sanofi. So, as we move into next year and possibly depending on where it closes this year, we'll have a contribution from Sanofi.
So, I think that we've thought about that, that allows us to manage our pipeline and to be very thoughtful, but also think big about what we want to do with TL1A now we have this collaboration. So -- and then the final part I'll say is, as we've commented before, you know, Revlimid was a contributor in Q3. We see that as a significantly less contributor in Q4, a very, very small part of that. And so, you take that into account.
But, Eli, maybe you'd like to add a bit more flavor to that as well.
Eli Kalif -- Chief Financial Officer
Yeah. So, thanks, Jason. So, overall, the way we need to think about it, we will end up according to the guidance with higher revenue versus the last year. But we will trend the opex at the level of close to 26% of our revenue.
And that's the way to think about it. And another point for you to consider, we're still looking for the 53% gross margin for the year-end, which means there is a step-up in Q4, which is mostly related to a further mix that we have in that quarter, and that will drive our ability to sustain the EBITDA guidance, although obviously still increasing in terms of dollars.
Richard Francis -- President and Chief Executive Officer
Thank you, Jason.
Operator
Thank you. Our next question comes from Nathan Rich of Goldman Sachs. The line is now open. Please go ahead.
Nate Rich -- Goldman Sachs -- Analyst
Great. Good morning and thanks for the questions. You mentioned the higher R&D expense in the quarter. You know, I think you kind of expect maybe a bit of a step-down in the fourth quarter.
But I guess going forward, what's the right way to think about R&D expenses as a percent of sales, just given the investments you're kind of making in the pipeline? Does that, you know, move up a bit over time? And then on Uzedy, you mentioned the positive feedback from providers. I was wondering if you could just elaborate a little bit on that and how that's kind of informed your view on the pace of uptake and what -- how we should be thinking about the revenue contribution from this product as we go into next year?
Richard Francis -- President and Chief Executive Officer
Thanks for the question, Nathan. So, just to -- I'm sorry, but just to sort of comment on the R&D expense, no, we don't expect a step-down in Q4 because this is part of our strategy, and the strategy is to aggressively move our innovative pipeline through the clinic. And as I said, we have ICS/SABA entered phase 3. We have olanzapine at full tilt in phase 3 and, obviously, TL1A in phase 2, which we're moving very aggressively.
So, I think that's on purpose and that will continue. I'll let Eli talk a bit about where we will be in percentage of sales, but obviously, one thing to always consider which may be slightly new with Teva is our sales, we have shown that we've grown our sales for the second quarter in a row and we are moving the business back to growth. And so, obviously, that does allow us some flexibility. Although I want to assure you, our focus on expenses is maniacal.
So, that's just a link worth understanding. But, Eli, do you want to give a bit more flavor?
Eli Kalif -- Chief Financial Officer
Yes. So, overall, the way to think about R&D, we are actually looking to trend just a bit above 6% for the year-end, which means that Q4 will also have a step-up. And as I mentioned in my prepared remarks, we're actually providing kind of a more transparency here between 230 to 250, and that will be, by itself, very close to -- I will say to the 6% that we see in the quarter and for the year. The way to think about it going forward -- of course, we will provide our guidance for '24 on the back of Q4 in February, but the way to think about it, it will be a range between 6% to 6.5% of our revenue going forward according to our strategy.
And this is mostly related to the mix inside the innovative feed in the R&D.
Richard Francis -- President and Chief Executive Officer
Thanks, Eli. And then moving on to Uzedy, and we talked a bit, I think the question was around the positivity we have and then for next year. So, I'll hand that to Sven, head of the North America, to give us some flavor for the excitement in the market.
Sven Dethlefs -- Head of North America Commercial
Yes. Thank you, Richard. So, we have a very good uptake. Our launch plan is full on track.
We are, of course, now working toward market access. In hospital access, listing on hospital formularies, we are right on plan. Medicaid and Medicare, we are also in discussions here. We have secured on par access with Uzedy and Austedo in a couple of states, and we are working toward this goal with all the remaining states, but also with the Medicare plans so that we are quite confident that we will have a very good market access position going into 2024.
What is very encouraging for us is that the product profile that we hope for will find a good reception with physicians actually plays out as planned. We have generated so far about 4,000 prescriptions. Please keep in mind that we have a large number of free samples in the market to get patients started. So, when we move forward and have utilized these samples, we will see more paid-for prescriptions.
But we get to also today the majority of our patients from switches from oral therapies to Uzedy and then from within the category of switches from other LAIs to Uzedy. We have here sources of revenues that come primarily, of course, from the risperidone market, from Perseris and Consta, but also from the other LAIs. So, we believe what -- we always hope for -- aim for that this becomes a new standard of care in LAI in the LAI segment will actually materialize. And for that reason, we believe that Uzedy will be then a material contributor to our growth in innovative medicines in 2024 and going forward from there.
Richard Francis -- President and Chief Executive Officer
Thank you, Sven. Thank you, Eli. And thank you for the question, Nathan.
Operator
Thank you. Our next question comes from Ash Verma of UBS. Your line is now open. Please go ahead.
Unknown speaker
Hi. This is [Inaudible] asking question on behalf of Ash. Thanks for taking our questions. So, I have two.
The first one is on Austedo. Can you give us some color on where the XR is taking share from? So, its now run rate, it's at around like 10% of total molecule. So, we just want to understand, is it taking shares from regular Austedo, generics, or Ingrezza? The second question [Technical difficulty] can you give us a rough sense for what's the EBITDA margin for the stand-alone business? Also, how that margin profile has been trending for the last few years? Thank you.
Richard Francis -- President and Chief Executive Officer
Well, thank you -- sorry, I missed your name, but thank you for asking the question. I'll hand over the Austedo question to Sven, who can give a bit more detail on that.
Sven Dethlefs -- Head of North America Commercial
Yeah. Thanks for the question. So, XR uptake is strong. We have a higher share, actually, in the total business than the 10% that you mentioned.
So far, we get around about one-third of our new patient starts on Austedo XR and the other two-thirds on the BID. Of course, that's an annualized figure. It's now ramping up that XR becomes much, much more prominent in new patient starts. And the sources of patients in itself for these patient starts are around about half of them are naive patients that start new on therapy for VMAT2 inhibitor and the other half have come either from BID switches, so from Austedo BID or from Ingrezza or tetrabenazine.
So, here, what is encouraging for us is that we have a significant number of new prescribers that have never prescribed Austedo before that now start prescribing Austedo XR because they value the convenience of a once-daily formulation, and I think that's very good for us because that is a market segment that we could not access before in the absence of a once-daily formulation. So, for that reason here, I think we are right on track in making Austedo a continuous growth driver for our innovative business.
Richard Francis -- President and Chief Executive Officer
Thank you, Sven. And to your second question about Tapi guidance and EBITDA, both past and present and future, we are not giving any level of detail on EBITDA for Tapi at this moment. Thank you.
Operator
Thank you. Our next question comes from Glen Santangelo from Jefferies. Your line is now open. Please go ahead.
Glen Santangelo -- Jefferies -- Analyst
Yeah. Thanks for taking my questions. Just two quick ones from me. Obviously, with so much focus on the innovative pipeline, generics often get overlooked.
I mean, you know, Richard, it seems like the generics business had a great quarter, particularly in North America. The trend seems to be getting a little bit stronger. I was wondering if you could just sort of comment on the competitive and pricing dynamics that may be driving that trend. And then secondly, as it relates to the Alvotech partnership, the company made an additional investment there, you know, in the wake of a number of CRLs, right, more recently on Stelara.
Could you give us an update on that relationship and the biosimilar pipeline as it relates to that Alvotech partnership? Thanks.
Richard Francis -- President and Chief Executive Officer
Thanks, Glen. Thanks for the question. So, we are pleased about the performance of our generics business. I think this is a journey in our strategy to make sure our generics business is a sustainable powerhouse.
And within North America, you've obviously seen a strong quarter there. I think Eli did highlight that, you know, a big contributor to that was Revlimid. What I would say about your sort of more general market conditions around more favorability, and I've been consistent on this, I think to be -- the market conditions will change based on supply, demand, and competition, and that will be constant. And so, as more people come into a market, the prices will go down because the competition will drive that.
I don't see those dynamics changing. There will be quarters where the pricing pressure is less and there'll be quarters when the pricing pressure is more. I think for our strategy to make sure we can be in control of that, we focused our R&D engine under Eric Hughes on making sure we deliver our generics and our complex generics on time and first to the market more than we have done in the past. And that's where we'll drive value creation and will insure ourselves against this volatility within the market.
So, I think that's how we think about the market going forward and how we think about making sure we stay competitive and have a sustainable business. With regard to Alvotech and the partnership, the relationship is actually very good. I mean, one of the things we did when we invested again into this partnership is -- and I've said this before as well, Alvotech is very good when it comes to developing biosimilar, their R&D capability. I think we will have the best product on the market if we launch Humira, both from a device point of view, from a product profile interchangeability, they're very good at that.
What we're doing is working even more closely with them to ensure that from a manufacturing capability, we can help them not only get through the FDA inspection but also be able to be -- be able to deliver the volumes that we see will be necessary. And that's something which we're very capable at because we have 53 sites and we have a roughly 30 FDA inspections a year. So, we do know what we're doing. But I think what -- maybe to conclude, the relationship is very strong.
Our pipeline, we've expanded with them because we see their capability. We continue to build out our pipeline through partnerships. And so, you'll see some announcements on that hopefully in the future because we do believe our strategy is to have a broad portfolio predominantly through partnerships, and that allows us to go to the market with a portfolio play and also to insure ourselves against the peaks and troughs that are associated with launching biosimilars one year and then maybe not having them the next. So, hopefully that answers your question, Glen.
I appreciate the call.
Glen Santangelo -- Jefferies -- Analyst
Yup. Thank you.
Operator
Thank you. Our next question comes from David Amsellem of Piper Sandler. Your line is now open. Please go ahead.
David Amsellem -- Piper Sandler -- Analyst
Hey. Thanks. So, a couple of high-level questions just on overall strategy. So, you know, with the upfront payment in hand from Sanofi, so you have a little more wiggle room here -- wiggle room here, I should say.
And with that in mind, are you focused on assets in neuropsychiatry where you can leverage your commercial infrastructure that you have in place? Is that the top priority there? And then secondly, as it relates to biosims, just coming back to Viatris getting out of that business, how do you think about your role in biosims going forward? I know what you're saying in your comments, but is that something you could be opportunistic about going forward in terms of monetizing that business? Thank you.
Richard Francis -- President and Chief Executive Officer
Thanks for the question, David. So, starting with the -- I think, basically, you're saying because our financial situation improves with the TL1A deal and the 500 million upfront, you know, how do we think about BD? So, as I said, we are thinking about BD. We're active. If you're looking, we've hired Angus Grant, a seasoned professional, dare I say, a legend in the industry who's worked in innovative medicines all his life.
And so, we really have stepped up that and our capability around that and our focus on that. Now, yes, we are targeting CNS immunology. And within CNS, obviously, psychiatry and neurology because we see the synergy play there. We're building a capability.
In fact, in psychiatry, I think we're seen as one of the leaders in psychiatry now. So, I think it makes sense to look there. That said, you know, as opportunities come along, which may be in a broader CNS, we'll look at them. But right now, we're ensuring we stay focused to make sure we allocate our capital in a way that will be synergistic to our P&L and maximize our opex.
With regard to the biosims question, you know, I think our strategy is really clear. I think biosimilars is a massive opportunity to generate revenue. I've seen that in Europe. I believe that's going to happen in the United States.
It'll be a bit bumpy in the United States, as we've seen in the past. But we've also seen with Truxima, our biosimilar of rituximab, it's a great revenue generator. So, the way we address maybe some of that uncertainty is to ensure that we don't allocate a huge amount of capital to it by doing that through partnerships and we build a broad portfolio, so when some assets come to the market in a timely manner or some assets overachieve and other assets underachieve on what their peak sales could look like, we're balancing that out because we have a portfolio approach. But we feel very clear on our strategy and committed to our strategy.
We think it's the right strategy for a company like Teva. Thanks for your question, David.
Operator
Thank you. Our final question for today comes from Chris Schott of J.P. Morgan. Your line is now open.
Please go ahead.
Unknown speaker
Hey. This is Carina on for Chris. Thank you so much for taking our questions. So, first, on gross margins, I know you're not given guidance for next year, but as we think about margin trajectory from here and the trends we saw in Q3 and what we're going to see in Q4, is that kind of the correct starting point as we think about gross margin next year or are there any other pushes and pulls we should keep in mind there? And I think second question is just on Austedo.
It seems like the product has had a very strong quarter. Just latest thinking around kind of investing behind that product and support for the asset, how are you thinking about balancing costs versus kind of maximizing the revenue opportunity? Has that thinking evolved at all and any implications as we think about SG&A spend next year? Thank you so much.
Richard Francis -- President and Chief Executive Officer
OK, thank you, Carina. I'll take a go at both of those and then also allow my colleagues, Sven and Eli, to contribute. So, when we think about margin -- when I think about margin going forward, it's aligned to our strategy. So, when you think about our pivot to growth strategy, it was to make the company get back to growth, but growth in areas where it will drive profitability on the top and the bottom line.
Now, obviously, I think Eli has just highlighted and I highlighted in my comments that we improved gross margin by 50 basis points. The way we did that primarily is our portfolio mix. So, as we drive Austedo, as we drive Ajovy, as we drive Uzedy, as we bring olanzapine into the market, ICS/SABA into the market, those products have a very different gross margin profile than our generics business. And so, that, by definition, will raise our gross margin.
So, that's sort of the big picture on it. I'll let Eli give me a bit more flavor if you want to, Eli.
Eli Kalif -- Chief Financial Officer
Yeah. So, just, you know, we are still actually aligned with our long-term financial target by 2027 to reach the 30% on OP, which means if you look on our trajectory in opex and as we are very, very cautious on even that we are actually dollar spend higher, but you're trending it always versus revenue this year and last year, we believe that between 26% to 27% opex going forward, which means that those gross margin of 65% to 67% on the long term should serve our goals.
Richard Francis -- President and Chief Executive Officer
And then moving on to Austedo, for Austedo we think we have a very important asset here. And because of that, we ensure that that is funded in the appropriate way. And obviously, we have a big cost base at Teva. And so, for us, it's about prioritization, and Austedo is one of the top priorities we have in this company.
And so, when it comes to getting resources, obviously, there's a process to do that. It's not quite an open checkbook for Sven and his team, but it's very much -- this is an asset we want to maximize. Let's understand what that takes and then obviously manage that through other aspects of the business cost structure to make sure we can offset that as much as we can to once again stay very on top of our spend. As our revenue grows, we want to make sure our profitability grows with it.
But, Sven, do you have anything else to add to that?
Sven Dethlefs -- Head of North America Commercial
Yes. I think one area an advantage that we have is, of course, that we can make synergistic investment between Austedo and Uzedy because some of the prescribers that we target prescribed both of the brands. So, we have leverage and we can create some scale effects. We have this year stepped up our sales force.
We have increased our long-term care team. We have made investments in specialty pharmacy programs to increase our fill rates. And we are also working on adherence. And I believe the fact that the prescriber base increases as more and more physicians start prescribing VMAT2 inhibitors, it naturally leads you to an opportunity to invest more behind sales and patient activation.
And that's what we also plan to do for 2024. But as Richard said, of course, we are quite disciplined in analyzing where we want to invest our dollars.
Richard Francis -- President and Chief Executive Officer
Thank you, Sven. And I'd like to thank everybody for taking the time to listen to our call and to answer the questions. We do appreciate the interest in Teva, and I wish everybody a good day or good evening. Thank you.
Operator
[Operator signoff]
Duration: 0 minutes
Call participants:
Ran Meir -- Senior Vice President, Investor Relations
Richard Francis -- President and Chief Executive Officer
Eric Hughes -- Chief Medical Officer, Head of Research and Development
Eli Kalif -- Chief Financial Officer
Umer Raffat -- Evercore ISI -- Analyst
Balaji Prasad -- Barclays -- Analyst
Jason Gerberry -- Bank of America Merrill Lynch -- Analyst
Nate Rich -- Goldman Sachs -- Analyst
Sven Dethlefs -- Head of North America Commercial
Unknown speaker
Glen Santangelo -- Jefferies -- Analyst
David Amsellem -- Piper Sandler -- Analyst
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