Read the Conversation
Meeting highlights:
- Strategic Importance of Italy: Italy, a top EU market, is vital for Novo Nordisk due to its strong talent pool, highly developed and flourishing healthcare system, and medical sciences tradition.
- Pricing and access framework Challenges: Italy's fragmented regional reimbursement process leads to complexities, varying widely across regions.
- Obesity Treatment Focus: Novo Nordisk is advancing in obesity management, especially with semaglutide, aiming to shift obesity's perception from a lifestyle issue to a recognized disease and long-term consequences of obesity beyond pure weight loss.
- Clinical Development in Italy: Novo Nordisk's new Clinical Development Centre highlights the country's key role in global clinical trials and patient care.
- Leadership and Legacy: Alfredo values authentic leadership, learning from mistakes, and empowering decision-making, aiming to foster accountability and human-centric leadership at Novo Nordisk.
EF: What attracted you to this role?
AG: One of the key aspects that attracted me to this role is the opportunity to contribute to influencing the Italian mentality, particularly in a more global context. Italy has traditionally been quite Italy-centric. Mobility, especially among people of my generation, has not been high—though it might be improving now—but the focus has largely remained within Italy. With over 20 years of experience abroad, I believe there is a need for cultural transformation, exploration, and cross-contamination, starting with simple yet impactful changes.
I was surprised, for instance, by how few foreigners work in Novo Nordisk Italy and how limited the use of English is, even though it is the official company language at Novo Nordisk, and it is still not widely adopted.; that is one small piece of a broader effort to elevate Italy's role on the international stage, both by exporting talent and attracting it. I believe this is a crucial aspect of our broader strategy.
EF: Could you elaborate on Italy's strategic significance to Novo Nordisk?
AG: Italy, by virtue of its size, ranks among the top five markets in the EU, making it automatically one of the most important markets globally for Novo Nordisk. Italy is also unique from a healthcare perspective, which adds to its attractiveness. The country boasts a wealth of talent and a strong tradition in medical sciences, spanning research and manufacturing. Significant drug development takes place here, and the educational system, including universities, produces highly skilled professionals in the field.
Moreover, Italy's healthcare system, which is primarily public and offers full health coverage with 100% reimbursement through a sophisticated—though somewhat fragmented—structure, makes it an especially attractive market, particularly for chronic diseases, which are a key focus for Novo. Given these factors, Italy is a critical country to continue to develop further and to continue to invest in.
EF: Following EU approval, how do you assess the reimbursement timeline and process in Italy, and what do you think can be done to improve that?
AG: There are two types of timelines to consider. First, there is the process with national reimbursement authorities. Once a drug receives EMA approval, the pricing and reimbursement negotiations follow according to different timing and criteria.
Following the national approval process, the next step is represented by regional access, which means navigating the different regions, each with its own timelines, approaches, and varying levels of scrutiny, particularly regarding label limitations or specific patient subpopulations.
EF: What was the strategic decision behind choosing Italy to form part of the network of new clinical development centers?
AG: I think it's a two-way street. On one hand, Italy is highly attractive to a company like Novo Nordisk, much like it is for many other companies. We are not alone in this; if anything, we are just accelerating a journey that many others have been on for longer. This attractiveness stems from Italy's abundance of internationally recognized key opinion leaders and its strong infrastructure for clinical trials. Italy has a substantial patient base, and there is a strong willingness among different centers to identify patients who could benefit from novel treatments long before these treatments are commercially available.
This is crucial for Novo Nordisk because investing in clinical development in Italy is an investment in the country itself. It benefits patients and strengthens our relationships with doctors and physicians by engaging with them more scientifically rather than just through traditional commercial activities. So, it is a mutually beneficial relationship.
Ultimately, this relationship benefits patients, giving them access to treatments that are hopefully more effective and safer than existing ones and doing so earlier than typical regulatory timelines would allow. This is especially critical in areas like – for example - oncology, where access to new treatments can make the difference between life and death.
EF: What excites you about what's coming up, and which upcoming treatments will have the most impact on Italy?
AG: We have recently intensified our efforts in the obesity sector with innovative new drugs. This is a critical development, not just for weight loss, which is undoubtedly beneficial, but more importantly for the broader health implications, as demonstrated in the SELECT trial. The trial revealed the cardiovascular benefits of semaglutide with astonishing results, marking a significant shift in how we view and treat obesity—not just by measuring weight but by addressing the comorbidities and complications that arise from it. These results are truly groundbreaking.
I am eagerly looking forward to the launch of the world’s first weekly insulin. I believe that once-weekly insulin will be incredibly important. The response from the media, the medical community, and patient groups has been overwhelmingly positive—they are eagerly awaiting a treatment that’s not only effective and safe but also significantly reduces the burden of daily intervention.
EF: Regarding the cardiology aspect, could the applications of semaglutide help change the perception and implementation of obesity treatment in the broader population?
AG: In Italy, the understanding of obesity as a disease rather than just a lifestyle condition that individuals must manage on their own is growing. The advances in treatments could certainly help shift this perspective. We are well along in our journey, especially from an external relations and public affairs perspective. Significant strides have been made by politicians and public stakeholders, which has helped to raise awareness.
However, it is still true that obesity, in many people's minds, carries a bit of a stigma and is often seen more as a result of lifestyle choices or an individual responsibility to manage than a disease. That is where we are focusing a lot of our efforts—to drive this agenda forward. Fortunately, we are not alone in this endeavor. There are other competitors and players in the space, with more entering the field. In this case, competition is actually welcome because changing the paradigm requires more than just one company, no matter how large or influential it may be.
EF: How do you instill a culture of success in your employees, especially when navigating cultural differences in Italy?
AG: One of my main mantras in leadership is to always be yourself. I have been leading teams for about 12 years across various cultures and contexts, from Japan to Denmark, Switzerland to Brazil—places that could not be more different from one another. The common thread in my leadership success has been staying true to who I am, caring about each other, and not being afraid to make mistakes.
I think this is a trait in the Italian mentality that is quite prominent. Mistakes don’t make you a failure. Mistakes are a natural part of life and of the learning journey, and there's no shame in making them. In fact, acknowledging and learning from mistakes is a crucial part of leadership. It is important not to punish others for their mistakes and not to fear making them yourself, as long as they are made in good faith and lead to growth. I hope this approach contributes positively to my colleagues and to myself as we continue on this journey.
Could you elaborate on how you are building more resilient, sustainable healthcare systems through environmental and social sustainability projects?
I think that in business, as in any other aspect of life, it is fundamental to try to marry and balance values and values. Financials and behaviors. Any system needs to find a balance that can make it sustainable in the long run. I think that all of us – companies as well as just each of us as individuals – have the responsibility to do what we can to tackle important areas that range from energy consumption to environmental footprint to equitable pay to respect for human rights – the list is infinite. There is no magic wand to fix these issues in one go, but we have to do something about it, and often, it is a matter of just wanting to. The circular economy is a dream, but it is not a dream that will happen by itself. One example that is very dear to me is our recent take-back ReMed programme, where we collect and repurpose our pre-filled medical devices instead of dumping them into landfills.
EF: Reflecting on your nearly 20-year journey with Novo Nordisk, what are you most proud of? Which key achievements stand out to you?
AG: The biggest achievement is that the company has entrusted me with a significant role in a major affiliate. But I am most proud of the relationships I have maintained with colleagues over the years. I am still in touch with many of them, mentoring and advising them or just having chit-chat. It is a great source of pride when colleagues from around the world reach out every few months just to catch up or seek advice. When people remember you fondly and value your mentorship, you have left a positive legacy. Ultimately, I believe our true legacy is the impact and the memory we leave on others, not just the roles we have held or what our business cards say.
There are no rigid hierarchies here. Novo Nordisk is a very flat organization, not just in terms of titles but especially in terms of how we interact. I believe this is one of the unspoken yet clearly visible strengths of our company.
EF: As you shape your legacy as a country manager and join the new generation of executives at Novo in leading the company into the future, what are your goals? What kind of legacy are you aiming to create?
AG: I hope that the legacy I leave behind goes beyond personal and behavioral aspects, though those are important too. One of the key legacies I aim to build is decision-making. As the company continues to grow in size and complexity, also the reluctance among individuals to feel empowered and take accountability for their decisions is growing. Throughout my career, I have made my very fair share of wrong decisions, as decision-making was a constant part of the job. But that is okay—it is part of the process. I want to change that mindset. It’s crucial for people to understand that it is okay, even necessary, to feel empowered but also to accept the accountability and responsibility of making decisions and owning the outcomes without the fear of repercussions.
Of course, there are areas and boundaries where we must be absolutely firm, like our guiding principle at Novo: there is no business without ethics. Business ethics are non-negotiable, and I have very little tolerance for deviations in that area. Beyond that, mistakes and wrong decisions made in good faith are perfectly acceptable—they are just part of life.
