Q1 2021 Kala Pharmaceuticals Inc Earnings Call
Good morning, and welcome to Kala Pharmaceuticals, first quarter 2021 financial results Conference call. At this time all participants are in listen only mode. Following management prepared remarks.
Rene session will be held as a reminder, this call is being recorded I would now like to turn the call over to Ranjan Camass wanted senior Vice President of strategy for Kala Pharmaceuticals. Please proceed.
Thank you operator, and thank you all for participating in today's call.
Joining me from the company are Mark <unk>, Chairman, President and Chief Executive Officer Todd.
Todd <unk>, Chief operating officer Mark.
Mary <unk>, Chief Financial Officer, and Kim Brazzell, our Chief Medical Officer.
Today's call is being webcast live.
Webcast link can be found in the investors and media section of our website at Www Dot Kala Rx Dot Com <unk>.
During this call, we will be referring to non-GAAP financial measures share.
Not prepared in accordance with generally accepted accounting principles.
A reconciliation of the non-GAAP financial measures to the most directly comparable GAAP measures is available in our press release issued today, which can also be found on our web site.
On this call, we will make certain comments about kala future expectations plans and prospects that are forward looking statements within the meaning the private Securities Litigation Reform Act of 1095.
These statements will include statements regarding the potential market and commercial launch plans for Isis.
Observations associated with our commercialization of <unk> and the sufficiency of our cash resources.
These and other forward looking statements are based on the beliefs and expectations of management as of this conference call. Our actual results may differ materially from our expectations. The company undertakes no obligation to revise or update any forward looking statements to reflect events or circumstances that occur. After this conference call, except as required by law.
Mark.
Investors should carefully read the risks and uncertainties described in today's press release as well as the risk factors, which identify specific factors that may cause actual results or events to differ materially from those described in our forward looking statements included in the company's quarterly report on form 10-Q, and other filings we make with the SEC.
The form 10-Q will be filed with the SEC later today and will be available on our web site.
I will now turn the call over to Kala CEO, Mark Hi, Ricky.
Thanks, Jim and good morning, everyone. Thank you for joining us today to review <unk> first quarter 2021 financial results and recent business highlights.
An exciting time at Kala.
I'll have two commercial products available for eye care professionals and patients deep relationships across the ophthalmology and optometry markets and.
And they are advancing a suite of innovative and CE pipeline programs.
Taken together, we are working to extend our reach to address a broad range of front and back of the eye diseases and help millions more patients.
We believe this provides us with a tremendous foundation for future growth.
As we look to the remainder of 2021, we are working hard to ensure the commercial success of Isis to this and in deltas.
We are pleased with the early I assume this launch feedback from doctors and patients as well as the significant commercial coverage that we have.
Been able to secure in the few months since launch.
In addition, we are encouraged by recent trends, suggesting that elective ocular surgeries are growing towards pre COVID-19 levels as vaccines are becoming more readily available.
We believe this positions and belt us for future growth in the market.
We also continue to advance our next wave of therapeutic candidates, which includes programs for the treatment of both front and back of the eye diseases.
As we have described before we believe these programs which include a selective glucocorticoid receptor modulator or set growth.
And a tyrosine kinase inhibitor or Teekay all I.
Has the potential to fuel future growth for Kala by leveraging our existing capabilities and extensive scientific knowhow to deliver new solutions for retinal disorders.
Millions of people worldwide.
We look forward to providing additional detail around these programs later this year as they move towards clinical development.
We believe we're in a strong position to advance our portfolio of innovative products and development programs.
This morning, we announced we entered into a new credit facility and increased the funds available to us subject to certain conditions to up to $125 million and also pushed out the beginning of our debt repayment obligations by a minimum of two years.
This is an important milestone that ultimately contributes to enhancing our cash runway.
We now anticipate that our cash resources as of March 31, 2021 together.
Together with anticipated revenue from <unk> and Delta as well.
We will enable us to fund our operations for at least two years as we continue to invest in our company.
Barry will provide some additional comments about this update later in the call.
I will now turn the call over to Todd to review, our commercial progress with a service and then deltas.
Thank you Mark I'll begin this morning with the launch of day price service.
We are pleased to report that as of the week ending April 23rd data from Symphony Health and our patient home indicate that more than 11600 prescriptions for IC was had been filled.
Written by more than 2000 unique prescribers since the product launched in early January.
In a short period of time I service is quickly establishing itself in the market as an ideal first line treatment option for John Laing players.
Symphony patient source data indicate that approximately half of all other <unk> prescriptions are for treatment naive patients who previously had not been on a prescription therapy for their dry eye disease.
Porting our belief that <unk> has the potential to become the preferred first line prescription therapy per Jai alai players.
Turning now to execution against two of our strategic priorities for the ICU. This launch.
<unk> optimal access and broad payer coverage and establishing <unk> as the preferred prescription therapy for the short term treatment of dry eye disease.
Our market access team has done a great job expanding our payer coverage for our students.
Just four months into launch we have secured coverage for approximately 43% of commercial lives totaling approximately 69 million lives.
<unk> market access coverage with commercial payers is a core part of our launch strategy in 2021.
Commercial payers make up the largest proportion of dry eye prescriptions and patients with mild to moderate dry eye disease are typically younger and are more likely to have commercial health insurance.
Earlier in the first quarter, we announced that <unk> was added to express scripts national preferred basic and high performance formularies.
We also announced the Sigma would add I service to their formulary as a preferred brand effective may 15 2021.
In addition to these two formulary wins, we have secured coverage from other commercial health plans as well, including emblem health and per marrow.
We are incredibly pleased with this level of coverage. So early in launch and believe it indicates payer anticipation of significant demand price cigarettes.
We look forward to further growing our market access coverage throughout the year, which will be a key driver of our prescription growth in the months ahead.
With substantial progress underway in building payer coverage. We are also making significant headway into establishing a service as a first line prescription therapy for the short term treatment of dry eye disease, which includes dry eye flares.
We are routinely survey eyecare professionals in market research and Ci service awareness growing.
Our most recent survey indicated that nearly 80% of respondents reported that they are familiar to extremely familiar with Ais service.
And the same survey nearly 70% of respondents stated that they have already prescribed by students.
Additionally survey responses indicated that eye care professionals <unk> service as suitable for a wide range of dry eye patients.
We believe these quantitative results are closely linked to the positive anecdotal feedback we have been receiving from eye care professionals. Since we launched <unk> service in January.
Physicians consistently comment that I service is a very comfortable drop to administer and net.
Patients are benefiting from its rapid onset of action.
I care professionals reported that patients are achieving rapid symptom relief and that they are highly satisfied with how well the product works.
In order to support the progress we are making against both securing market access and building demand price service.
We plan to initiate our net sales force expansion in the second quarter income.
Leasing from 91 to approximately 105 sales representatives or the start of the third quarter.
Then pending continued growth in payer coverage and the status of the COVID-19 pandemic, we plan to further expand our sales force to approximately 125 sales representatives by the end of 2021.
We are very pleased with our service launch performance to date. The team is executing against our strategic loans priorities and our ongoing efforts to educate the ophthalmology and optometry communities on a service is generating significant demand.
Look forward to updating you on our launch progress on future calls.
Turning now to <unk>.
As we have shared over the past year depend delek has impacted the ocular surgery market.
In the first quarter of 2021 grew approximately 37000 prescriptions of <unk> reported by Symphony health compared to 41000 prescriptions reported in the fourth quarter of 2020.
Despite the challenges the pandemic continues to present, we believe that <unk> prescriptions and revenues will grow over time.
However, we remain unable to project a specific timing or quantify the potential impact on future revenues given the continued uncertainty around the impact and duration of the COVID-19 pandemic on elective ocular procedures.
Now I'd like to turn the call over to Mary to go over our financial results.
Thanks Todd.
This discussion of our financial results I will reference certain non-GAAP financial measures.
These non-GAAP financial measures exclude stock based compensation depreciation and noncash interest expense per.
A full reconciliation of our GAAP to non-GAAP financial measures. Please refer to today's press release, which is available on our website.
This morning, we announced that we have further strengthened our cash position by entering into a new five year $125 million credit facility with Oxford finance, replacing our existing $75 million facility.
Terms of the new facility provides for an initial tranche from $80 million with the ability to borrow two additional tranches totaling $45 million based on meeting certain revenue targets.
It turns also eliminate the minimum cash balance required under our previous facility, resulting in additional cash on our balance sheet at $10 million.
Principal payments will begin in December 2024 at the earliest for two years beyond our previous facility.
Additional information regarding the new credit facility is available in the 8-K, we filed this morning.
As Mark mentioned, we believe this will allow us to invest in our company as we continue to establish our marketed products and advance our preclinical pipeline.
Based on our current operational plans, we anticipate that our cash resources as of March 31, 2021, along with anticipated revenue from <unk> and <unk> will enable us to fund operations for at least the next two years.
Now turning to a recap of the first quarter of 2021, our cash position as of March 31, 2021, there's $156 million compared to $153 5 million as of December 31, 2021.
This increase primarily reflects net proceeds of $34 7 million received from sales of common stock under our aftermarket or ATM offering program in the three months ended March 31, 2021, partially offset by cash used in operations.
For the period ending March 31, 2021, we reported net product revenues of $3 3 million. This.
This is comprised of $163 million from net revenues from <unk> sales and 164 million of net revenues from my students sales.
Net product revenues from <unk> sales increased approximately 500000 compared to the first quarter of 2020 in which we reported $1 1 million from sales of inductors.
As a reminder, we recognize revenue when product is shipped to wholesalers.
Cost of product revenues for the first quarter of 2021 with 800000 compared to 400000 for the same period in 2020.
The increase was primarily due to the launch of ice David during the quarter as well as an increase in total in Belgium units sold during the three months ended March 31, 2021 compared to the three months ended March 31 2020.
Non-GAAP cost of product revenue was 700000 for the first quarter of 2021 compared to 300000 per the same period in 2020.
SG&A expenses for the first quarter of 2021, or $27 7 million compared to $15 4 million for the same period in 2021.
The increase was primarily due to an increase in cost as a result of the launch of ICU beds.
Any expansion of the sales force and increased stock based compensation.
Non-GAAP SG&A expenses were $23 $8 million per the first quarter of 2021 compared to $13 5 million for the same period in 2020.
R&D expenses for the first quarter 2021 were $3 1 million compared to $5 4 million for the same period in 2020.
This decrease was primarily due to a decrease in external spend on stride three phase III clinical trial of I stupid for which we announced positive data in the first quarter of 2020.
Non-GAAP R&D expenses were $2 1 million for the first quarter of 2021 compared to $4 6 million for the same period in 2020.
Loss from operations for the first quarter of 2021, with $28 3 million compared to $21 million per the same period in 2020.
Non-GAAP operating loss was $23 4 million for the first quarter of 2021 compared to $17 4 million for the same period in 2020.
Net loss for the first quarter of 2021 was $30 4 million or <unk> 49 per share compared to a net loss of 22 million or <unk> 54 per share for the same period in 2020.
Non-GAAP net loss was $25 2 million for the first quarter of 2021 compared to $19 million for the same period in 2020.
Please refer to today's press release for the weighted average number of shares used in the calculation of our net loss per share for each of the quarterly periods.
That concludes our prepared remarks for today I will now pass the call over to the operator for questions.
Thank you as a reminder to ask a question you will need to press star one on your telephone.
Joe Your question press the pound key.
Please standby, while we compile the Q&A roster.
And our first question comes from Andrew.
Yes.
With Wedbush Your line is now open.
Operator.
Morning. This is one.
Andreas on for Gautam.
Congrats guys on the quarter.
Just a quick question on <unk>.
What trends are you seeing in the amount of cataract surgeries would give you confidence sales are going to pick up later in the year. Thanks.
Yes, Andreas this is Todd base, what I'm happy to answer that question for you. So we're currently seeing surgical volume roughly at around 80% of its pre COVID-19 levels, but I think what gives us some.
Encouragement is obviously the vaccine rollout continuing to go very well.
Combined with the fact that market scope is routinely conducting market research with surgeons to ask them.
What the impact from COVID-19 and what they can future surgical volume will be.
The vaccines continue to rollout.
The ophthalmologist, who reported that they expect by the end of the year to be able to return nearly two full pre COVID-19 surgical volume levels.
Yeah.
Okay. Thanks, I'll hop back in the queue.
Ask questions. Thanks, guys true.
Thank you. Our next question comes from Christopher <unk> with Jpmorgan. Your line is now open.
Chris I'm not sure if you're on mute, we can't we can't hear you.
Sorry about that thanks for the questions.
Yes. My first question is on I service payer contracting acknowledging it's still ongoing negotiations can you speak to your confidence in.
Adding additional contracts here near term and secondly, how are you doing the pace and progress for securing payer coverage relative to what you saw for the <unk> launch.
Second on the other.
Steve its patient hub whats been your success rate and feedback from both physicians and patients on.
For patients, who don't have commercial and Medicare coverage as of yet.
Yes.
Any color there would be helpful. Thanks.
Sure. Chris This is Todd I'll try to tick through each of those if I Miss something please don't hesitate to jump back in.
We're really pleased with the way the issue resolved a commercial market access is shaping up here in.
And launch here, we do expect additional wins to come.
I expect additional wins to come within the second quarter.
And as we've always said, we expect that commercial coverage to continue to expand throughout the year and really be the key driver of continued prescription growth.
As we head into the remaining three quarters of 2021, so feeling really good I think the team is doing a great job of executing on that.
We do expect to have additional wins to be able to announce and share with you.
Throughout the year.
I think on the hub side I think.
Most patient hubs, we are having some success there getting some scripts filled.
How this stepped up to help us with the prior officer required required for patients, whose insurance does not yet have I sued us on formulary yet.
So thats certainly a short term solution to help in those situations, but ideally what we want to be able to do is move away from the hub by securing broad market access having most patients have access to a service through their health insurance plan.
Require a prior authorization to get the prescription approved and covered.
That's going to allow patients when they get the prescription from my service to go straight to their local pharmacy get the script filled hyper benefit till the right service prescription at a reasonable co pay and have the ability to start treating their dry eye flare immediately.
I'm not sure if theres enough go ahead.
That's super helpful.
How do we think about the mix between.
Script volume is currently that are on or that are currently covered vs uncovered.
So I think what youre asking about the actual market access coverage is about 43% of commercial lives that we now have coverage for with <unk> Suez is that the question you're asking.
So well what percentage of the script volumes that youre seeing are free.
Currently have commercial access scarred from sprint.
Our going through the hub.
Yes, it looked like like most newly launched products most patients insurance does not yet cover it and that means that most of the prescriptions that were written in certainly in the first quarter did.
We did not have insurance coverage and required a prior authorization approval and so.
It's another thing that gives us great confidence as our market access continues to expand and patients are not requiring prior authorizations.
It will have a significant impact on prescription volume growth.
For the remainder of the year.
That's helpful. Thanks for the questions.
Sure.
Thank you. Our next question comes from Francois visit law with Oppenheimer. Your line is now open.
Alright, thanks for taking the questions.
Just wondering can you help us understand the breakdown a little bit that youre seeing between ophthalmologists and optometrists for prescriptions.
Frank This is Todd good question right now the majority of our prescriptions are being generated by optometrists about 55% of prescriptions from optometrist about 45% from ophthalmologists.
Surprising to us we know that optometrist tend to treat a little bit younger patient population when it comes to dry eye who's more likely has commercial insurance.
Also often times sort of the first line dry eye care professional and so they may be seeing more of the mild to moderate patients who are suffering from 345 acute dry eye flares a year in our patients that are ideal as first line.
Prescription therapy patients for <unk>.
Okay, Okay, great and then on that line of the first line treatment.
Can you talk a little bit more about the endpoints that about 50% of your patients are treatment naive and when you say first line just to be very clear here is it mostly first line for patients experiencing flares or first line for patients with dry eye just simply dry.
Yes, so to your first question, we're really encouraged by the fact that so early in launch already half of the ICU was prescriptions are for treatment naive patients. Those are patients that have not been on a prescription dry eye therapy previously.
As you are probably where oftentimes when a new product is launched you may get used in the more severe patient population that may be on other therapies and you maybe use a chunk of our add on but the fact is so early in launch.
Eyecare professionals already go into ICU versus a first line prescription therapy from many of their patients is really encouraging and when we're talking about first line I think certainly for a patient that's experiencing dry eye flares.
We think that's a lot of where the prescriptions are going but remember that's the majority of all dry eye patients across multiple quantitative research studies.
Indicates that anywhere from 80% to 90% of diagnosed dry eye patients suffer from these acute players. We also know that only about 10% of those guidance patients are currently on one of the FDA approved chronic dry eye medications. So we think that means that the majority of diagnosed dry eye patients are great candidates per.
First line prescription therapy like <unk>.
Okay. That's very helpful. And then lastly, if you can just help us.
Or are we exactly in terms of reimbursement you just mentioned again the wins they their dates of effectiveness and what you would expect once something is effective is it kind of a bullish kind of a pent up demand or is it slow and then and then just lastly, if you could touch on the percentage of patients here that are commercial versus Medicare.
Sure I'll start from a ladder about 50% of all dry eye prescriptions are reimbursed by commercial payers. It's around 40% that are Medicare and the remaining 10% is some mix of cash and Medicaid and look we the Cigna contract goes live here in just a couple of weeks.
ESI has been like since the beginning of February and I think the team is doing a great job getting out there and communicating and educating.
Professionals about where there's access which patients insurance cover that.
Cover I service.
And where they are able to write those prescriptions and get the prescriptions filled without having to call back from a pharmacist.
So I think the team is doing a great job will continue to communicate that.
Just a couple of weeks now from Cigna rolling out with that coverage and.
I'm really confident in the team's ability to drive prescriptions is that coverage comes online.
Alright Thats it from me thank you very much.
Okay.
Thank you. Our next question comes from <unk> with Bank of America. Your line is now open.
Hi, Good morning, Thank you for taking my questions.
Can you tell us if you have any sense yet about.
Number of bottles per year that ever going to be utilized by each patient I know you're still early in the launch trajectory, but are you noticing any trends on that and then I have a couple of follow ups.
Sure Good morning, characterizing it as Todd to your point, it's still too early to know number of refills right. Just just four months into launch.
We do have some transparency to us with the scripts that have come into the hub.
Percentage of those scripts have been written with refills and Mike currently it's about two thirds of all of our prescriptions. We've seen at the hub were written with refills attached to them.
So that gives us really good confidence that most of the scripts are being written with refills and so as patients use their first bottle of ice readers.
And then experienced additional players and need a refill.
Be able to go and get it without having to go back to their doctor's office from another prescription.
And how many refills a day, allowing.
Alright.
Varies the majority of the retailers are being written from more than true refills.
But we're seeing great.
Variance on that we've seen some cuisine as low as one refill to some that have had as many as 10 refills.
Okay.
In the first four months of launch are you able to quantify what the impact of COVID-19 has been.
And as the country reopens.
Kind of easing.
As a result, the easing of restraints do you think how would that impact the the tenor of the lives.
Yes, it's a really good question, we are definitely seeing impacts I think the biggest impact is just on our sales rep's ability to get in and see their customers face to face and have.
Really meaningful.
Sales interactions. It's currently probably about 65% to 70% of our eye care professionals that we're actually able to get in and see face to face in fact US there as you can imagine with sales force is really focused its efforts in the first quarter on our high decile customers that they can actually get in and see and so.
As time goes on and more of those practices get comfortable allowing sales reps back and we think that will certainly have a positive impact as it will give us a chance to.
Get in in detail more eye care professionals to make sure they have samples and co pay cards.
Which is going to be really important for expanding our reach.
Okay, and we might have discussed this before but I was curious if you have updated thoughts on the number of visits the sales rep might need to make to a physician's practice to carry yourself in scripts being written has that evolved during the course of the pandemic.
Yes, I would say also still a little too early to say we are seeing that it typically takes multiple sales calls to get in.
Gross sales calls involve talking about dry flares identifying who those patients are other practice appropriately positioning I used to do this as.
First line prescription therapy from those patients.
So too early to say on the exact number of calls per tonne. We are certainly seeing that it takes a few sales calls before an eye care professional adopt and begin prescribing nicely with us.
Okay, and then have you adopted virtual Doctor visits I guess, Jim calls or anything like that yes.
Yes, we certainly have virtual tactics in place they involve book.
Two eyecare professional interactions as well as we get tons from virtual pure programs for some of our speaker programs can be done virtually as well.
Okay, Great and maybe just moving on when that question beyond your two marketed products you've talked about a pipeline of preclinical assets.
I would say the front and back of the eye and wondering when we could get some more color about.
About those and when they might enter the clinic. Thank you.
Yes, I'll hand that over to Kevin.
Thank you, yes, what.
What we've said publicly is our second program our target is to identify a lead compound by the end of this year 2022, and then to begin the IMD, enabling mark that would let us get into the clinic.
Hopefully within 12 to 18 months from lifetime.
Sorry, Stephen and you would identify.
By the end of this year 2021.
Yes.
Okay, great. Thank you.
Thank you. Our next question comes from <unk> Chen with H C. Wainwright. Your line is now open.
Yes.
Okay.
Alright, Thank you for taking my questions.
How many eye care professionals have been reached by the sales team from January to April and what other reasons for those that have not prescribed service.
Yes, yes.
This is Todd I'm happy to answer that question as I was saying earlier, it's probably about.
And the range of 65% to 70% of our eye care professionals that were able to see face to face we have certainly gotten to those.
Those eye care professionals, we have others that we're getting to virtual promotion.
The sales force has spent most of his time as you can imagine during the first quarter focused on the higher decile.
Targets that we're able to get in and see face to face.
We believe from the market research and the feedback that we've got that.
I kept professionals are very enthusiastic about.
As we said in the most recent round of quantitative research, 70% had said they had already written a prescription price through this.
And we think the biggest thing that we can do to help them. At this point is to continue to improve market access generate broad payer coverage. So that a larger percentage of prescriptions that are being written and up and they filled prescription that's covered by the patient's insurance.
Yeah.
Okay could you give us an update on the usage per patient access program.
Sure.
Are you referring to the harbor, you're referring to our co pay card the copay card.
Yes, yes, it's a little less than half of the prescriptions are coming in they're getting filled with the copay card.
Okay got it thank you.
True.
Thank you. Our next question comes from Tim Chiang with Northland Securities. Your line is now open.
Hi, Thanks.
I know you guys mentioned that you have about 43% of covered lives secured with market access for <unk> is what is the target what do you think that figure will be by year end.
Yes.
Tim we've not set a specific target or have not.
Externally communicated a specific target per market access by year end net we've just said that.
Our goal is to.
Obtain broad market access coverage within commercial payers by the end of 2021.
With really a focus from Medicare coverage should start coming online in 2022.
Okay.
Maybe just a follow up.
Yes.
We get to the reopen.
What's sort of major medical conferences or you guys are going to be attending near term and throughout this year and it sort of <unk>.
Kris the awareness for your for your products, obviously, I think a lot of ophthalmologists.
Commentaries.
They are much more interested in new products. So I was just sort of wondering.
What sort of conferences, you guys are going to be attending.
Yes, we will be at all of them and we're really pleased at a few conferences is starting to come back online for in person meetings. So just this past week was the big oncology conference down in Atlanta that was.
In person, we had great representation mail from number of programs ongoing.
AI conference will be going on next week that is largely attended by ophthalmologist again that meeting will be in person. So.
As these conferences start to occur in person, we will have a significant presence both of our medical Affairs Department and our commercial teams at each of the conferences.
Yes.
Okay, Great and maybe just one last question just sort of.
I don't I don't think youll be able to answer it but obviously.
How do you sort of look at your prices for both <unk> and <unk>.
Throughout the course of this year and next.
Obviously you signed.
From contract share you've got a whack price right. So it was around $460.
And if anything you can highlight and just just in terms of where the gross to net discounts are.
At this point.
Pretty much in line with what other new products are at in terms of that discount.
Yes, I certainly appreciate the question Tim as you know, we're not providing direct guidance on net.
Net revenues or gross to net.
But I think it's a fair statement to say that similar to other new product launches.
We expect there to be deeper discounts in the first few quarters of launch when you start to account for things like initial trade distribution and patient assistance programs and expect those gross to nets to improve over time as we secure broader market access coverage.
And at that point or just paying rebates to the payers.
Post to a lot of the other patient access programs that you have to initially put in place at launch.
Okay, great. Thanks.
Sure.
Thank you.
A reminder to ask a question you will need to press star one on your telephone.
Our next question comes from Kelly <unk> with Jefferies. Your line is now open.
Okay. Good morning, other he's calling from Jefferies.
First question is a follow other on the COVID-19 impact.
Have you seen gradual recovery in Q2 on the new patient starts.
So they are.
Given the vaccination has accelerated even at his stake and a one day, we expect to see full recovery of a backlog there.
<unk> office visit.
And I also have a second question I Wonder if you have a market with such data in from what percentage of their dry eye patients treated with steroids.
Is that fine line treatment for acute flares and DSA difference, Oh, God I'm prescribing steroid that'd be true up to.
And Oh film knowledge it thank you.
Sure.
I'll try to tick through each of those please don't hesitate to jump in if there's something.
Did I Miss.
In terms of COVID-19 impacts as I said earlier, we are encouraged with the vaccine rollout I think at this point, it's estimated that roughly around 50, 657% of U S. Population has received at least one shot.
This is hard for us to predict what future quarters are going to look like in.
How will the rest of the rollout of vaccinations are going to go but we are optimistic we are certainly seeing.
More practices that we're able to get into and see the eyecare professionals face to face.
Certainly at this point compared to back in the winter when we were dealing with a second wave of spikes in cases being reported so that appears to be improving certainly we have seen really good prescription volume growth for both <unk> and I see this in the second quarter looking at the weekly data compared to first quarter. So a lot of really pause.
Signs there.
Your next question about split and use of the product.
We are seeing at this point about 55% of prescriptions being generated by optometrists to about 45% by ophthalmologists.
Commerce is do appear to be early adopters of our service.
We certainly anticipated that based on the low the market research, we did to prepare for launch.
Understanding that a lot of those patients with more mild to moderate dry eye disease.
Not have chronic persistent symptoms on a daily basis.
Really not candidates for a chronic maintenance trial medication. They are patients who are better suited to be treated with a short term treatment a few times a year like ice sugars those patients were largely treated by the optometrist and and so we are not surprised by the fact that they are early adopters and then you asked about general use.
So steroids to treat dry eye flares, it's done quite limited only about 3% of the $17 5 million diagnosed dry eye patients previously would get a prescription for steroid on off label steroids. There are certainly certain subset some physicians like corneal specialists that we're more comfortable.
Steroid use and we're using more steroids, but when you look broadly across sort of all optometrists and ophthalmologists. It's only previously about 3% of diagnosed dry eye patients that would get an off label steroids and of course, we expect that to grow significantly now with IC versus approval and having an on label.
Steroids to treat these acute trauma players.
Thank you feel quite helpful. Thank you.
Sure.
Thank you I'm not showing any further questions at this time I would now like to turn the call back over to Mark <unk> for closing remarks.
Well. Thank you everyone for joining us. This morning, we're really pleased with progress on the business and especially.
The early indicators of launch success with <unk>.
We look forward to updating everyone soon and hope everyone stays safe.
Okay.
This concludes today's conference call. Thank you for participating you may now disconnect.
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