Q2 2021 Esperion Therapeutics Inc Earnings Call
Ladies and gentlemen, thank you for standing by and welcome at this time all participants are in a listen only mode. Following the presentation. There will be a question and answer session. Please be advised and today's conference call may be recorded I would now like to hand, the conference over well, which have been church Investor Relations Inc.
Corporate communications and Experian and please go ahead, Sir that's true.
Thank you operator, good morning, and welcome to the spirit on second quarter, 2020, 1 financial results and company update conference call and then church and I'm responsible for Investor Relations and corporate communications here at Asbury and I want to.
Remind callers that the information discussed on the call today is covered under the Safe Harbor provisions of the private Securities Litigation Reform Act I caution listeners that management will be making forward looking statements actual results could differ materially from those stated or implied by our forward looking statements due to the risks and uncertainties associated with the business.
These forward looking statements are qualified in their entirety by the cautionary statements contained in today's press release and SEC filings. The content of this conference call contains time sensitive information that is accurate only as of the date of this live broadcast August 3.2021, we undertake no obligation to revise or update any forward looking statements to reflect.
Events or circumstances. After the date of this conference call and webcast as a reminder, the conference call and webcast are being recorded and archived we issued a press release. This morning detailing the content of today's call a copy can be found at www Dot Experian dot com within the investors and media section. We will begin with prepared comments and then open the call for your questions.
Following today's call the team will be available for follow up questions. Please email investor relations at disappear and Dot Com just schedule time to speak with our team I'd now like to turn the call over to our president and CEO Sheldon Sheldon.
Thanks, Ben and good morning, everyone with me today for prepared remarks are Rick Bartram, Chief Financial Officer, and Dr. Joanne <unk> experienced new Chief Medical Officer.
Also on the line as Eric Warren, our Vice President of U S sales and marketing.
We brought on board and January to integrate and lead a unified sales and marketing organization.
Area 2 is a pharmacist by training has 25 years of commercial experience focusing primarily on cardio metabolic and acute care medicine.
He will be available for your questions at the end of this call as well.
A special thanks to everyone joining us today and my first earnings call as President and CEO and disappearing.
I'm excited to share with you all the great strides taken by Experian and over this past quarter Tim.
Additionally, ourselves for long term success as a nimble and innovative organization solely focused on addressing cardiovascular disease, which remains the number 1 killer and the United States and worldwide.
When I joined disappearing and in December of last year. The company has recently launched the first oral non statin LDL C lowering medicine and nearly 2 decades Netflix Hall index was that.
These are powerful first in class medicines with a novel mechanism of action and the potential to save patients' lives.
However, the commercial strategy was not yet and maximizing the full potential of these medicines on top of the persisting COVID-19 pandemic headwinds.
Having previously worked across many of the available LDL C. Lowering medicine I have deep experience of what it takes to capture growth and the cardiovascular market and immediately recognize the untapped potential of next total index was at.
Flash forward to today, we have now made many of the changes that were needed to strengthen our foundation and begin to recognize the potential of next little index was at.
This includes bringing diverse experience to our senior leadership team streamlining our commercial strategy and implementing refined positioning for our medicines all of which is moving this trajectory of Mexico tall and next was that in the right direction.
Our results from the second quarter show that these initiatives are already gaining momentum and materializing into growth.
Prescribing physicians and prescriptions per physician are at their highest yet and.
To demonstrate a consistent double digit and high single digit growth respectively in.
And the quarter next total index was that prescriptions grew 28% with accelerating month over month growth.
But most importantly, our medicines have reached nearly 40000 patients here in the U S.
Since the mid April and introduction of the revised product positioning providers have expressed a clear understanding of where to prescribe Mexico tall and NEC was that in patients that stand to gain the largest benefit.
The revised next total and that's with that positioning has resonated with payers as well and it has been beneficial and our new market access approach focused on improving formulary status of our medicines, specifically among Medicare part D payers.
The success and these efforts is evident from the immediate response by Humana and.
Audi Both next total index was at to their formulary as of May 1st.
We continue to have promising conversations with Payors, who acknowledged the need for additional treatment options and formulary to tackle the large patient population not yet and ldlc golf.
A strong power or the for the team this quarter was maximizing their awareness and value of next total index was at and driving quality prescriptions.
While our generous financial benefit co pay programs supported patient and encourage adoption of our medicines throughout the first year of launch and the COVID-19 pandemic.
We believe the second quarter was the appropriate time to adjust both the duration as well as the buy down magnitude of our co pay card program to typical industry standards.
With our strong commercial coverage in place and and improved economic environment. These adjustments resolved and and limited impact to patient access to our medicines.
Volume and payer coverage prescriptions improved and second quarter net price was more favorable contributing to the 67% sequential growth and U S net product revenue.
We continue to expect additional positive impact of net pricing overtime as plants fully implement coverage and volumes and scale up.
Yeah.
Since assuming the role of CEO I've taken additional steps to position us very entre long term success, whether that be and the addition of prominent cardiologist Dr. Julian to D as Chief Medical Officer.
Well, our priority and steadfast and driving commercial excellence of Nassau Index was at ensuring we are prepared to capitalize on our unprecedented cardiovascular outcomes trial and the potential of our early stage pipeline is vital.
Yeah.
The importance and the clear outcome study cannot be emphasized enough.
Not just first purion, but for the entire field of cardiovascular medicine.
Not only could aren't clear outcomes trial be monumental for encourage you late adopters payors and the broader application of next what's hot and next with that but the potential risk reduction label indicates acceptance of an entirely new patient population that past medicines cannot benefit.
Historically every LDL cholesterol lowering therapy affecting the cholesterol synthesis pathway as next football and those that do.
<unk> consistent outcome improvements this along with a unique and deliberate design of our clear outcomes trials gives me great confidence on what is to come.
All signs indicate that clear outcomes now a little more than a year away will make history, and cardiovascular health and potentially further our leadership position and bringing innovation to underserved patients.
If I could say only 1 thing it would be this.
Experience is evolving quickly to maximize the opportunities that lay ahead and instilling a laser focused mentality and driving operational excellence throughout the commercial sides of the business and also and our clinical and development programs.
I am proud of what this team has accomplished and the short amount of time and continually getting confidence and the trajectory of experience and our future as a company.
Now I'll turn the call over to Joanne to introduce herself and asked her to share with you all heard motivation behind joining our team Joanne.
Yeah.
Thank you Sheldon and good morning, everyone I'm Doctor Joanna Foodie, Chief Medical Officer, and the newest member of the experienced leadership team.
I'm thrilled to join a theory unconstrained and its leadership team as we strive to provide lipid lowering therapies to address the significant unmet need and heart disease.
For the last 3 decades as a preventive cardiologist I have dedicated my career to improving outcomes for patients with or at risk of cardiovascular disease.
And when the opportunity to lead its very young as its chief Medical officer of Roes I knew that this would be the right place to follow and my passion to make a difference for patients.
There is not 1 amongst us who we've not had a family member or friend affected by heart disease or high cholesterol.
Silent killer and have stripped loved 1 far too early and far too often from me as well as countless others, including most of you listening.
Despite existing therapies to many patients remain at risk due to high cholesterol and.
The first new oral lipid lowering therapy and 2 decades.
The delek assets either alone or in combination with it that and Mike has the potential to transform patient care.
During my time at the practice and cardiologist at the Cleveland Clinic, and went out and faculty at Yale and Harvard I learned firsthand, how physicians and patients are frustrated by the lack of tools available to address and stop the progression of heart disease.
As I transition to industry, the lack of novel accessible and patient friendly therapies to reduce cardiovascular risk became only more apparent.
The need for therapeutic solutions and cardiovascular disease had been unfortunately, not changed despite statin or even injectable P. C. S canine inhibitors.
Recently, Jama cardiology published that only 1 third of patients with atherosclerotic cardiovascular disease reached their cholesterol goals.
That means that 2 out of every 3 high risk patients did not achieve their goals and are at higher risk and then they should be for heart disease.
It's Barry on the only company focusing really on oral lipid lowering solutions is poised to tackle this problem head on and transform clinical care with the clear outcomes trial.
And this is the largest cardiovascular outcomes trial to study patients not optimized on their statin or intolerant to statin.
Clear outcomes is unparalleled and aside novel design and unique patient population.
This trial has taken into accounts all the lessons and insights of decades of cholesterol lowing trials and is being run by teams of experts and chaired by doctors see the nissin and exceptional cardiologists and trial.
The trials unique patient population and high starting baseline LDL cholesterol and increases the likely probability of success.
Further given the unique mechanism of action of <unk> acid and it's no secret trophic effect style and inflammation and glucose we anticipate the potential of added benefits for patients.
The thing is.
I've been in cardiology for a long time.
I've been involved and multiple global cardiovascular outcome trials across multiple big pharma companies.
I've reviewed these trials as I wrote guidelines, but I have never seen a global trial of this quality size and scope.
And run at a company our size.
That's a big deal.
Our entire medical team has re energized to bring next latasha and next was that to all patients who can benefit from our indicated therapy today.
And we are prepared to bring next little and excellence that to more patients who can potentially have outcomes benefit tomorrow.
From the moment I started I had been thoroughly impressed by the incredible talent and expertise of this team and their passion and commitment to bring back a sense of urgency to lipid management and cardiovascular risk reduction and advocate for continued innovation to ensure that patients and physicians have.
And best in class highly effective convenient options to combat cholesterol.
Thank you again for your time and attention I cannot say it enough. There remains much work to be done, but I'm confident that driven by science. We will demonstrate continued progress in this mission over the quarters ahead.
Now Rick will provide comments on the quarterly financial performance.
Thanks Joanne.
Earlier today, we issued a press release containing our financial results for the second quarter, which is available on our investor website.
U S net product revenue was $10.6 million for the second quarter compared to approximately $600000 generated and the second quarter of last year and $6.4 million and the first quarter of this year.
Total revenue for the second quarter was approximately $41 million, which included $28.1 million and collaboration revenue related to the $30 million upfront payment received from our expanded partnership with Daiichi Sankyo that we announced in April.
And there was approximately $1 million of royalty revenue from our European collaboration with Daiichi.
Net price for our medicines improved during the second quarter as the commercial team implemented a number of changes to the copay card program and Sheldon highlighted earlier over time, we expect our net price to continue to improve as plants fully implement coverage and volumes and scale up.
Unexpected R&D expense for the second quarter approximated $25 million down 10% from the first quarter.
SG&A expense was approximately $46 million for the second quarter down 24% from the first quarter the sequential.
<unk> decline and SG&A expense was driven predominantly by a onetime charge associated with a legal settlement and the first quarter.
We continue to expect our full year 2021, R&D expenses to fall between $120 million to $130 million and SG&A expenses to be between 200 and $210 million.
Note that these amounts are inclusive of approximately $30 million and noncash stock based compensation expense for the full year.
Our cash balance as of June 30th was approximately $219 million, we remain committed to prudently managing expenses and will ensure the organization is adequately funded to advance the business.
Going forward, you should expect us to continue to balance cash spend against growth potential and the cash needs to ensure the business is resources for full year for future growth.
Before handing the call back to Sheldon, Let me summarize our financial progress.
First we had 67% quarterly growth of Mexico tall, and Mexico that net revenue.
We saw improved net price of our medicines through the adjustments of our copay card program highlighted earlier.
And lastly, we remain extremely diligent managing our cash while supporting the commercial launch and our clear outcomes trial.
By maintaining this focus we are confident our financial position will continue to strengthen throughout the remainder of the year.
With that I will turn it back to Sheldon for closing remarks.
Thanks, Rick I wanted to say again, how proud I am of what the team has accomplished and the direction Experian is headed and while there is still a lot of work left to do we continue to drive a sense of urgency across the organization to bring value to our shareholders health care providers and most importantly patients are.
Our refined commercial strategy and have begun to demonstrate traction across a number of friends and translate into expanded Medicare part D coverage substantial prescription growth of next of Tal and next was that and.
Other key commercial metrics, including net pricing.
While we continue to work towards operational excellence, we remain steadfast on the true mission at heart and opportunity to transform the lives of millions of patients struggling to lower their LDL cholesterol.
A big Thank you to all our colleagues and partners for their hard work passion and commitment this quarter and every quarter and again. Thank you all for joining today and your continued support and interest and experience.
Operator, we are now ready for Q&A.
And as a reminder, task a question you will need to press star 1 on your telephone to withdraw your question press the pound key please standby, while we compile the Q&A roster.
Our first question comes from from the line of Michael <unk> from Jefferies. Your line is now open.
Hi, guys. Good morning. Thanks for the question, we got 2 questions 1 was.
Comments around gross to net which was great to hear that you think it will improve could you just maybe quantify that a little bit you know what 2020, we think that you were around 35.40 something percent dropped a lot off in Q1, you think you think the rest of the year is more like 50% is that a ballpark range to use.
And maybe you could just comment on that and then the second question was more of a macro which was.
That COVID-19 has impacted things over the last few quarters things.
Things, obviously improved a lot and there's maybe some changes recently so maybe just comment about the environment, you're seeing do you feel like patient volumes are getting a lot better and maybe just comment about that as well. Thank you.
Great. Good morning. Thank you Michael This is Sheldon and let me first comment on your first topic as it relates to gross to net again I really want to emphasize and hopefully you can hear me, okay here, where the new room.
And the fact that we noticed a net and notable improvement and our net price as you mentioned and this is something that we've been consistently saying since the last quarter and this is something that we would continue to work on feverishly and the <unk>.
Team has done a great job and really and a little less than 2 months and we believe that improvement will continue going into the third quarter and quarters beyond I'm not going to comment on the specific percentages we don't.
Give out our gross to net.
We don't speak to that or advise on that but again I wanted to just state that.
It's something we are committed to as it relates to reducing our exposure.
And I'm sure that we would have quality prescriptions again, we are demand grew by 28% and I think as I mentioned before I know that as we move into the third and fourth quarter, we will see the improvement as it relates to Covid.
And obviously this is something that we're following with the the Delta variant and our reps have always been committed and.
I've been out in the field, even since Covid.
Covid hit last March of 2020.
Reports, we get back from the field is that individuals are returning to the office physicians are returning and more and more patients are getting vaccinated.
Vaccinated I think with the Delta variant and more folks are realizing they need and get vaccinated, if they're not but slowly but surely our folks are returning to the office I have Eric Warren and his here if he has any additional comments.
And thanks, Tilden and nice to meet and Michael and my name is Eric and his Sheldon mentioned I have responsibility for our sales and marketing teams tennis Varian.
I'm, a pharmacist by training and 25 years and the industry and most of my experience has been and cardio metabolic disease.
Tim here, just a few months ago and really 3 reasons behind that are really the people and.
And incredible.
Medicines have been inspirational and a clear focus on cardiovascular disease and to be complimented Tim with regards to the sales force activity, we've seen a significant increase and the number of calls per day that our team and this has been able to make others being more targeted customers and they are able to.
To increase from frequency and customers and we've also seen a really significant increase and the number of peer to peer programs from Q1 to Q2. So all of those are good signs from a COVID-19 perspective, no and yes, the delta variant and on our minds and we're keeping a close eye on that we can't predict and where it will pop up and where.
It will go down and but we are making sure that our teams are armed with the proper safety equipment and maths I've always been a mandate.
Our with our HCP and offices, and we're really committed to making sure that our team is out there and they're communicating the benefits and risks of our compounds and that they're making sure that appropriate patients who receive our product.
Thank you.
Thank you. Our next question comes from the line of Joseph Thome from Cowen and company. Your line is now open.
And they're good morning. Thank you for taking my questions. The first 1 and you could dimension sort of at your non honing in and sort of the heavy prescribers are targeting those accounts can you comment a little bit on the blend of sort of a specialty cardiology accounts versus primary care physicians and and maybe where you are seeing that and higher prescribing.
Right and then second maybe and those and those docs that are you know immediately reaching for the therapy right now and what else do they need to seek and they wanted to see that CV outcomes data.
There anything that you can provide them maybe ahead of that that could drive additional adoption.
Great. Thanks, Joe.
Microphone, a little jumbo here, but I think I got the first part of your question and that is how do we really see prescribing net flows out of the NEC football once that break out between primary care and cardiologists and what we're seeing is that there is more primary care physicians are writing.
And Ah both net flows that and excellent hub and cardiologists is probably yeah.
And closer to a 60% to 40%, 60% primary care, 40% cardiology. This is not unexpected. This is a as you may or may not be aware I ran the brand value of <unk>.
And while I was at Merck and we saw that majority of prescribing of others.
<unk> was and primary care and we're starting to see the same here as well as it relates towards absolute debt and next tall.
And the second part of your question is.
Yeah.
I can I can try and repeat it if.
And what else do they need to say, it's alright, yeah. So yeah. So actually for US you know what are the things that we mentioned that last quarter was awareness and we're starting to see awareness as these brands and improving.
The clear outcome study, which I will have Joanne comment briefly on and just a second and it's definitely something that's going to be very important for us, but again looking at other products and analogies.
A lot of patients close to 18 million patients and the United States, who have a lipid abnormality are not achieving their LDL C goals and they need treatment now so our physicians realize this and positions also.
And I don't want to delay and trying to get their patients to their LDL targets. So we believe we have a lot of room to grow as we mentioned in the script. We have 48000 patients currently on these drugs I mentioned the number of $18 million as my partner here, Eric Warren would say, we're just scratching the surface and.
We think that we can again.
Really grow.
And have an inflection point and a clear study as I've always said, we will provide us maybe a secondary inflection point to add any color you'd want to add on the clear outcome study and thank you Sheldon and thank you Joseph for your question and I think as Sheldon mentioned that clear outcomes trial will be an important inflection point however over the next 15.
And months as we anticipate that study close and we have developed a very significant evidence of price that will average real world data to provide information for providers clinicians and payers with respect to our value proposition and so there is that Sheldon mentioned and a significant amount.
And the work that will be ongoing to refining and standalone treatment gaps.
Phenotype.
And who might be most likely to benefit.
And from our therapy.
And ultimately do you also have a fertile ground for TCR T.
And what you may not be aware and outcomes research or and my academic career from many years like having recently been kind of state and filed for and Johnson and Johnson and the cardiovascular space and most of that work was really on how we could leverage big data, how we can leverage and electronic health records and all the data that exists and the real work.
To help providers understand the value and all of this ultimately drives our commercial utilization so a share.
Eldon mentioned I think right now we want to continue to work from from patients and applications improve understanding and awareness and those patients most likely to benefit from Netflix all and expose that today, while we anticipate the data generated from the CV outcomes trial and the future.
Great. Thank you.
Thank you. Our next question comes from the line of Chad Messer from Needham and company. Your line is now open.
Great. Thanks, and thanks for taking my question.
So you you talked a little bit about.
And in mid April revising your product positioning.
Just wondering if you could.
Talk a little bit too.
And that has affected sort of the.
The patients better and better using.
And so you know and anecdotally issue.
Position.
And what patients.
And the drug and maybe how it.
Changed.
And with the new AR and.
And if depreciating.
Yeah. So thanks, Chad and the question and let me just start off quickly.
1 of the things that we introduced was the new positioning in April 1 of our bellwethers are testing to see you know is this the right positioning was the win that we had with Humana, which is 1 of the largest Medicare part D providers with close to 9 million patients.
And I think what was important there is that it was obvious.
That the positioning was clear and understood that we had a quick turnaround is related to and answer.
From Humana, so that was the test of it I'm going to ask Eric to comment on what he's seen and the field and he's the 1 who's been deploying this positioning and working closely with the field Eric.
Hi, Chad nice to meet you. So yeah, we've deployed some revised positioning and April and really the goal was to hone in on a specific patient type and where are our success would be evident and rather than talking about 5 or 6 patient types that may not stick with our <unk>.
<unk> really driving 1 where we know and that we'd see a success and the team has been doing a great job and executing that it's all about building confidence and momentum.
Populations again that we focused on is consistent with our indication and <unk>.
And she FH patient.
And our goal and they're on and other therapies and statin therapy, and they are obviously and Max that out and there is an intention to do more for the patient and that's where and excellent tall and next day.
And as a play.
The whole population and it gives the opportunity to demonstrate and the.
Cause C as well as the safety profile of the compound and then it creates a base breath to expand and we've got 2 phases of expansion plant.
Phase that happens before Steve and Doug.
And then a phase and that happens after studio teams and as Sheldon mentioned from a payer perspective and that strategy has been resonating well from a practitioner perspective, it's been resonating well and also from an internal perspective and garden sales team I appreciate the clarity and that we've provided.
Yes.
Alright, great. Thanks, sorry, I appreciate that and is it.
And is it fair to say based on your guys' experience. So that the idea of Scotland and tolerance just hasnt gained the traction we want all thought it might.
Let me speak to that and so the standard tolerance I think is something that's been ongoing since status have been launched are more so I think after lovastatin and going into Zocor and there's always been a thought that there is a range of anywhere between.
16, and 20% of all patients who are statin intolerant and that doesn't mean, they can't take a stat and it all it means that they can only take maybe even a certain dose of stat and so this.
And this isn't really about just sat and tolerance, but it's really about patient achieving LDL goal and the treatment paradigm has become a step guided treatment.
Physician Joanne is but I'll just make this comment and evolved from a statin to the statin plus does that and <unk> and now is the stat and pluses atomized and something else and we believe that something else is net flows and excellent Paul priest E V O T. As I mentioned theres millions of patients who are taking statin.
And statin and Ezetimibe and are still not and LDL goal and as we mentioned earlier cardiovascular diseases and number 1 killer. So there's definitely a place for <unk> and excellent Paul again, we've seen that and this quarter, we had 67% growth and revenue, we had 28% growth and.
And demand, we're calling these quality prescriptions and again and I think theres a lot of potential for for these for these brands.
Yeah.
Right, Yeah and if.
And I could just and I think you know from a physician perspective, and again, you know and speaking as a cardiologist on net I think statin intolerance definitely and I think the challenge is that it is under recognized because the patients have had just suffer with their muscle symptoms because there were not therapies available. So I think.
To your point some of this has not been fully leveraged and I think we do now have a compound and getting a combination of compounds and neck plateauing and excellent that that can address that.
I think you also have to recognize that when statin and we're really and still are the only game in town as an oral therapy for that.
People do suffer with it.
And we have the operating I think he was fine, but importantly, as Sheldon mentioned, it's not just statin intolerant.
There's also sat and hesitancy that people decide to vote with their feet and not take any therapy and leave their party basketball hockey and of that there's also a lack of optimization.
And so people can be on smaller doses and they simply to achieve their goal to reduce their cardiovascular risk and there's a whole host and a range of patients who cannot take what should be the optimal dose and if that 1 for a variety of reasons and we think this is where it would fall and excellent that Pittsburgh and square.
Alright, Thanks, appreciate it and look them up.
Hearted believer that more options.
And that large problem. Thank.
Thank you Tim Thanks, Jeff Thank you.
Thank you. Our next question comes from the line of Jason Butler from JMP Securities. Your line is now open.
Hi, Thanks for taking the questions.
First 1 with the focus on are the high quality prescriptions are you continuing to evaluate sales force sizing and territory prioritization and then secondly can you just give us an update on the launch in Europe, how that's progressing.
Sure Great. Thank you, Jason so as it relates to sales force size.
And where we're at right now we do believe that.
And we do have the right sales force and the size and I'm going to ask Eric to comment in a day.
But let me just first talk about Europe. So in Europe, we continued to see strong performance from Daiichi Sankyo. They launched both of these products in October of 2020, and they've continued to see have seen growth. There currently launched in Germany, and they're also launching and.
And the U K and a handful of other smaller countries.
We meet with them on a weekly basis, we have a great partnership with Daiichi Sankyo and.
Again performance is it.
It's doing quite well there Eric just talked about how we evaluate our sales force and I'm sure sure absolutely and.
Nice to meet and Jason.
Right now our sales force is approximately 200 territory managers.
And stable through Q2 average.
And good time and I do think right now it is right sized to support the near term opportunity. However in order to really reach the maximum potential and there are a lot of.
Customers and specifically primary care physicians.
And so we could and should be able to cover them constantly evaluating appropriate ways to reach these practitioners and but we have to do so.
And a cost effective manner.
Great. Thanks for taking the questions.
Thanks, Jamie.
Thank you. Our next question comes from the line from Tom Shrader from V. T. I T and your line is now open.
Good morning, I'm getting long patches of silence I can't tell if it's me or the general call, but I wanted to re ask the piece of Chad's question is it is the majority or the vast majority of your users now people already on is that am I.
Hey, Tom first of all I guess, we're not getting reports out maybe it might be your connection.
I know last quarter, we had some issues and people were telling you that's right away but.
We are not getting we're not getting those reported so I just wanted to <unk> and if other people arms and use.
Ping or chat to the operator.
We actually specifically pick the new room to make sure we would have that this time.
And so.
And as it relates to Ah patients are currently on net flows out and extra Tal I think we see a very we see a good mix of patients who are on statin and annual run statin and Ezetimibe.
And are taking both of these products so.
Our positioning of course right now as we've mentioned is talking about those patients who are on our staff.
And pluses atomized.
And then before you would actually go through and injectable P. C. S. Canine and we think there is you know the the the room and ability to use net flows at an extra tall. There are other adopters, who are just use that and and they have added net flow tall or net flows that so and right now the <unk>.
Split of those 2 drugs when you look at net football Index was at is approximately 50.50 and the use of both of those drugs.
Alright, and then just 1 housekeeping question are the are the copay cards greater than 3 months are they completely gone and did they have any impact. This this last quarter and second quarter.
And so I'll have Eric comment on the Copay cards sure sure Hi, Tom Nice to meet you. So.
And as mentioned earlier profitable growth is really important to us and.
Yeah, and the past, we've leveraged copay cards for for multiple purposes.
Not only to lower the out of pocket cost that a patient pays for and approved or a commercial patient pays for and approved threat.
But also to create a bridge if you will for those patients that are awaiting prior authorization approval. So the copay card and will continue to last for an extended time for those patients that are commercially approved and that we are paying down their prescription to make it more affordable however.
We've made some changes to the co pay card and no longer will we.
And we'd be creating that bridge, if you will and to cover those patients that are awaiting their prior authorization and instead, we've implemented additional programs, including something we're calling the prescription support program to support those patients.
Got it thank you.
Youre welcome Tim.
Thank you. Our next question comes from the line of Geoff Meacham from Bank of America. Your line is now open.
Hi, guys, just somebody a barrier and thanks for the question.
Sheldon can you give us an update on where you are and conversations with payors on the Medicare coverage side.
I know you've been added by Humana and then obviously took some time to play out. So how do you think about timelines for getting out into other major formularies and and whether that's something that could realistically play out this year and then I have 1 follow up after that.
And yes first of all and thanks for your question again, just to reiterate we're really happy about the win with Humana I know I mentioned it a lot, but that was a big win for US again, and the largest Medicare part D provider and a good test of our positioning.
As it relates to Olivia sorry, as it relates to the.
The contracting where we are today. So we're currently in talks with other providers I think it's important to note, though that while we're also and talks with other providers. We can still do pull through of both contracted and non contracted accounts and that is something that we are really concentrating on.
And then focusing on really driving demand and while we have those while we have those discussions we're happy where we sit today as it relates to our commercial coverage with greater than 90% and our Medicare coverage is 60% and we'll continue to update you as we go through.
Through the third and into fourth quarter I'm not going to comment on when we actually think we have contracts we want to make sure that whatever we do is is very well thought out makes sense and in the meantime, still be able to drive demand, which we are able to do.
And I'll tell you and a.
Yeah, sorry, Yeah, and then our second question and it's really around opportunities for partnerships beyond what you've already been able to establish and I know you guys had talked about China and other geographies that that could help drive growth over the longer term, but are there certain countries that are maybe more of a priority at this point or more of a near term focus and others.
Yeah. So first again want to reiterate as you know we have and agreement with Daiichi Sankyo for Europe, we expanded that agreement with the ask or region. So that.
<unk> allows for a partnership of different markets not only in Asia, but some also in Latin America.
China and Canada are 2 that still stand out that we have complete ownership of and I think the best way to think about this is our focus really is on the U S. Right now we're focusing on the U S and continuing to drive performance and drive the growth of net football index was at.
And that's where we'll be spending the majority of our focus as we move throughout this year.
Okay, great. Thank you.
Yeah.
Thank you. Our next question comes from the line of Jeff Hung from Morgan Stanley. Your line is now open.
Thanks for taking the questions you've talked about addressing the copay card and then in the past the need for greater touch points with physicians to generate written scripts, what additional levers do you have to impact the trajectory of scripts.
Hi, Jeff I'm actually going to have Eric speak to that Eric.
Thanks, Sheldon and nice to meet you as well Jeff.
And so obviously scripts come from awareness of our of our compounds, so being able to have a live interactions as critical as I mentioned, we've been able to increase the number of and.
And direct engagements, we've had and with our customers and not only are customers that are targeted at HCP, Inc, which is really important and we've had double digits and improvements in free.
And 1 SKU 1 to Q2 in terms of our reach we've seen increased frequency I've also mentioned that we've improved our ability to reach.
Our customers from a peer to peer perspective, we had a significant bolus.
Activity in June.
Not only are smaller programs.
The tender and size, but we did 2 national programs, where we're able to engage more than a thousand HCP is and peer to peer activity. So that's important to us and that.
And we see that as a mechanism to drive scripts.
In addition, I mentioned the prescription support program is going to be critical obviously.
And then prior authorizations for some plans and it's important that our customers are prepared to be able to complete those to maintain and timely access and as I mentioned August 1 we have implemented this description and support program and this program includes a dedicated support team.
And that works, both with the patient as well as the office to ensure that all the proper documentation is processed and that the prior authorization is approved.
Thanks, and then you've indicated that a sphere and could only get to about half the physicians that needed to cover and June how is the ratio of reached versus targeted physicians changed over the last few months.
Yes, so and so we've actually been able to reach more than half of our of our targeted H C piece.
And.
Closer to 2 thirds of those targeted <unk>.
And what was the latter part of the question.
I was just curious how that's changed over the last few months and if that.
Yeah.
Yes, we're seeing significant improvements and our ability to get and toward targeted customers and have meaningful discussions on our products and that's really a testament to the sales force.
And their passion and dedication out there and they've been out there consistently throughout the year.
Covid time, if you will and they've seen significant improvements now because.
I think their persistence, but also because of the quality of the compounds that we have.
And I would also add Eric I think just the introduction of data analytics, and how you've applied analytics to really territory targeting and performance measurement and there's also been key and doing that.
Thank you.
Okay.
Thank you. Our next question comes from the line of Jessica Fye from J P. Morgan. Your line is now open.
Hey, guys. Good morning, Thanks for taking our questions. First question is can you talk about how the franchise is doing in Europe, and maybe translate what the royalty revenue means for overall sales in Europe. So we can get a sense of how the business is doing there.
Hi, Jess let me first say that Europe has been performing well our partnership with Daiichi Sankyo as I mentioned earlier are they continued to see growth and number of patients.
On a monthly basis I'll have Rick comment on as it relates to royalty aspects, yes. Thanks Jess.
So we.
And we did we did communicate that we had about $1 million of royalty revenue from the European collaboration.
Collaboration is is available publicly.
And we're not commenting on the actual revenue dollars you can do calculations, but given some of the exchange rates.
We're not commenting on I don't know.
Okay and next 1 is just on the cash runway.
Either for Sheldon or Rick I think Sheldon and prepared remarks, you mentioned and the clear outcomes data is a little over a year away.
Is it your expectation that you have the cash to get to that data read out and can you talk about strategies you might use to top off the balance sheet. So you get to that clear outcomes data with a little cushion.
Hi, Brad comment on that Yeah, I think Jeff, yes, so as we as we mentioned in the prepared remarks and as you saw in the press release, we had about $220 million and cash.
And when we look at the business and we look at the.
The cash available to us I, just want to point out and reiterate we have about $1.2 billion of future milestones.
We do expect those to continue to.
Feed our balance sheet over time.
Constantly evaluating cash runway and looking for ways to not only optimize cost and our expenses.
But just be thoughtful about how we bring additional capital into the organization as.
And as you know we capitalized on to non dilutive funding sources. This past quarter the expansion with Daiichi under that partnership and then with our financial partners Oberland capital, we're going to continue to have that mindset evaluate options and just make sure that that business is funded to deliver the bid.
And this plan and grow our products.
Okay, Great and then just lastly on the progress of clear outcomes, we try to think about maybe win and the second part of <unk>.
2022 that could come.
Is there any next communication that we should be anticipating from you guys on maybe the.
Proportion of events that have occurred.
And just anything we should be kind of watching for on progress updates there.
Let me have Oh.
Joanne and comment on that just as it relates to events, where it adds a 75% right now, but Joe and you want to comment to that so and so thank you guys for the question and clearly just to first say that the clear outcome study is currently on track to execute and close out.
At the end of 2020.2.
Importantly, we have accumulated.
75% of our Mi.
It's important for people to recognize I think theres a lot of concern about COVID-19, but remember again that the.
Study was fully enrolled prior to Covid and 2019 and has not seen any impact from COVID-19.
We will continue to report out.
Accumulation of mace events net.
Last year and otherwise the study is fully on track and when we compare this study to other studies and historical benchmarks and.
We are in a good place to execute on it.
Great. Thank you.
Thank you. Our next question comes from the line of.
Our last question comes from the line of Paul Choi from Goldman Sachs. Your line is now open.
Hi, everyone and thank you so much for taking my question and Christmas Charlie on for Paul.
I think just 1 from bucket at this point.
Regarding the adjustments that have been made to improve and net price.
Lunch can pay and you could you give us a sense of like the timing of those adjustments growth quarter, because the entire quarterly revenue kind of reflects growth adjustments or was that something that kind of arose as time went on throughout the quarter such that maybe only a portion of our Howard the quarter really reflects the improvement and that price and thank you so much.
Thanks, Charlie so as it relates to the improvement it was something that was done over.
A couple of months' honestly and still as I mentioned earlier and also in our prepared remarks.
And we still see further improvement that can be obtained as we move into the third and fourth quarter. Again. This is something that we are looking at very diligently.
And the fact that we can say that we had a notable improvement in net price and such a short amount of time was very important for us and it's something that we set out to do we said we would do it and we're going to continue to do it.
And as each and every day goes by wherever we can look for those type of efficiencies.
Got it sounds great. Thank you so much for taking my questions.
Thank you. This concludes today's conference call. Thank you for participating you may now disconnect.
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