Q4 2021 Evofem Biosciences Inc Earnings Call
Thank you for standing by and welcome to the <unk> Biosciences fourth quarter and year end 'twenty 'twenty. One results conference call. At this time all participants are in a listen only mode. After the speaker's presentation there'll be a question and answer session.
To ask a question at that time. Please press Star then one when you touch tone telephone.
As a reminder, today's conference call is being recorded.
I would now like turn the conference over to your host Ms. Amy Roscoe Vice President of Investor Relations Ma'am you may begin.
Thank you Valerie and good afternoon, everyone and welcome to the Q4 and year end 'twenty 'twenty. One results call you haven't done so already I encourage you to access the press release, we issued this afternoon and slides that accompany this call both of which are dot com.
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Before we begin I would like to remind you that remarks made on this call will contain forward looking statements, which are made only as of today March three 2022 for a more detailed description of important risk factors that could cause our actual results to differ materially. Please refer to our annual report on Form 10-K , and our most recently filed 10-Q with that ill hand, the call over to Evan.
CEO Saundra Pelletier.
Amy and I want to thank everyone for joining us today on the call.
<unk> delivered strong growth in the fourth quarter of 2021 net product sales affect fee for hormone free birth control more than doubled in Q4, it increased 109% to $3 6 million.
This reflects the hard work of our sales organization the impact of our innovative marketing campaign and ongoing gross to net improvements. We're excited to build on this foundation in 2022 and beyond.
Additionally, we made significant progress in our program developing vaccine for the prevention of Chlamydia and gonorrhea.
They literally two day, we completed enrollment in our Registrational Phase III Guard trial ahead of the schedule. We discussed on our Q3 earnings call with more participants they called for in the study protocol.
This was due to very strong interest in the trial and high screening levels.
We also received qualified infectious disease product designation from the FDA for prevention of Chlamydia. This affords us five years additional market exclusivity on approval.
Discuss next steps for this program in greater detail amongst other initiatives to build shareholder value. After our CFO Jay file reviews. The financial results Jack. Thank you Sandra today I'm going to focus on the fourth quarter of 2021 relative to Q3 for our year end results. Please reference our Form 10-K .
To be filed in the next few days.
Net product sales increased 109% to $3 6 million driven by a 73% increase in <unk> unit shift.
Research and development costs were unchanged at $8 7 million, reflecting clinical trial expenses for the phase III <unk> trial of vaccine for the prevention of Chlamydia and gonorrhea in women.
Selling and marketing costs were $24 9 million down 18% as expected.
This was due primarily to lower media expenses related to the Andy Murphy DTC marketing campaign.
General and administrative costs were $5 7 million up 14%, primarily due to increases in outside services and payroll related expenses, including stock based compensation.
As a result total operating expenses decreased to 41 million or a loss from operations was $37 4 million.
We reduced our net cash burn to $16 8 million in Q4 versus $32 million in Q3.
For 2022, we expect net product sales will be in the range of 30 to 35 million momentum should build as plans and pharmacy benefit managers or pbms adhere to the updated federal guidelines that are expected to expand access taxi at zero out of pocket costs for commercially insured women.
With this expanded coverage for flexi gross to net should improve to 35% to 40% range. We believe this coupled with significantly lower R&D costs. Once we complete the treatment phase of the Evercore trial will get us to cash flow breakeven on a quarterly basis by the end of 2023.
At the close of Q4, we had $7 7 million in cash and cash equivalents as well as 5.5 dollars 1 million in unrestricted cash and adjuvant notes for us.
In Q1, 2022, we raised $10 million in gross proceeds to the company through two unsecured debt transaction. We also secured a $50 million equity line of credit it gives us flexibility should we need it.
Finally, we received a notice from NASDAQ last week that Allison remains non compliant with NASDAQ listing standards, because we do not currently meet the $1 minimum bid price requirement.
We have requested a hearing with NASDAQ listing qualification panel to present, our case for additional 180 days to meet their requirements, which we expect to take place by mid April this request for sponsor delisting process until the hearing.
We fully expect that our presentation at that hearing will be received favorably and we began to as an additional 180 days to comply with their share price requirement and with that I'll turn it back to saundra.
J R.
Our substantial growth in Q4 was driven by the House rules DTC campaign, starring Emmy Award winning actress Andy Murphy. In addition to the targeting of efforts of our sales force.
Do you and nurse practitioners and Midwest.
Nearly 40000 boxes, a sexy were dispensed in Q4 up 81% from Q3 and total prescriptions grew nearly 70%.
Almost 23000, new patients started vaccine in Q4 up 56% from Q3, which is a strong reflection of our success in driving demand.
Nearly 69000 women have come through our telehealth platform to date and the vast majority of them are under the age of 35.
While the largest segment is 25% to 34 year old women more than 30% of these women are between ages 18 to 24 years old we are implementing programs. This year to further expand <unk> use in these segments and particularly among college age women.
With our strong established prescriber base, our sales team is now focusing on increasing the volume of prescriptions for each provider.
We will launch a national HCP campaign at the annual meeting of the American College of Obstetrics and gynecology and early Bang aimed at increasing awareness effects of <unk>, among prescribers and broadening patient segments.
<unk> goal is to increase the percentage of women, who will be offered vaccine and booster prescriptions for each practice and from each prescriber.
We are very pleased with the direction that things are moving relating to access for taxi.
One of our key objectives that we've laid out on the Q3 call. Let's just first federal actions to mandate coverage of all FDA approved contraceptives, including vaccines and zero out of pocket costs to the patient under the HCA.
I am proud to say that we met that goal.
In January the health resources, and services administration or <unk> in the U S Department of Labor updated guidelines, preventing the FTA birth control guide from limiting contraceptive access.
It required the most commercial insurers and pbms covered new and unique contraceptive options such as vaccines.
Specifically state that the plants may not require patients to try and failed multiple options before covering a different product, it's a provider deemed that product medically necessary.
These updated guidelines are significant.
As plans begin to evaluate their practices to comply with them access to vaccine is expected to increase.
With the removal of payer restrictions like step edits and denials of coverage followed by coverage for <unk> zero out of pocket cost to women, we expect our business will dramatically improve.
The guidelines from the Department of Health Labor and the Treasury took effect immediately in January however, we understand that there are certain insurers that fine legal and semantic loopholes to avoid compliance.
Bad debt in February .
<unk> signed by 34 U S. Senators was sent to these departments, calling for heightened enforcement of the ECA requirements that insurance companies cover all FDA approved forms of birth control at no cost to patients.
The letter targets. These noncompliant insurers that are not following the guidelines as intended.
Now turning to R&D.
We have made tremendous progress with our program to develop vaccines for the prevention of Chlamydia and gonorrhea in women.
Met need here is significant due to the increasing incidence as well as the rise of antibiotic resistant strains.
As Murray sexually active women no matter what form of contraception. She is using is that risks to contract one of these stis.
Chlamydia is the most frequently reported bacterial infection in the United States and gonorrhea is number two.
The CDC estimates that 4 million new cases of chlamydia occurred in 2018, resulting in a direct medical cost of almost $700 million.
And there are one 6 million new cases of gonorrhea.
Cases are underreported because infected people are often unaware that they have these sexually transmitted infections.
Up to 70% of women infected with chlamydia have no symptoms.
But untreated this can lead to major health problems.
Chlamydia is a primary cause of pelvic inflammatory disease and infertility in women.
Based on FDA action in February tax. He is now qualified for an additional five years of marketing exclusivity following FDA approval for either chlamydia or gonorrhea or both.
This stems from a qualified infectious disease product designation from both potential indications.
We also have fast track designation for both indications, which means the FDA will review our regulatory submission in six months versus the usual 10 months period.
Earlier today, we achieved full enrollment in our Registrational phase III trial of <unk> to prevent chlamydia and gonorrhea. We met this milestone a month ahead of the scheduled discussed on our Q3 conference call.
This reflects the discipline and the rigor of our clinical team along with the high level of demand to participate in the desire for a new FDA approved preventative measure.
I want to thank our study centers as well as the many women who are participating in this landmark study.
As a reminder, this is a double blind placebo controlled clinical trial, achieving the primary endpoint would allow us to file for regulatory approval with the FDA with the end goal of expanding the sexy label to include prevention of Chlamydia and gonorrhea in women as well as hormone free birth control.
With enrollment now complete we are on track to report topline data in the second half of the year, followed by regulatory filings in the first half of 2023 with potential FDA approval expected by the end of 2023.
Thanks, He would be the first and the only FDA approved product to prevent these stis and again every sexually active women is that risk we.
We believe this represents a large market opportunity for <unk> in the United States and around the world.
Meanwhile, with an eye toward pipeline expansion, we entered into a collaboration with Orion biosciences to evaluate the compatibility and stability of Orion's novel CCR five antagonist in vaccine targeting HIV prevention among other indications.
Our collective goal is to develop a new product candidates with potential to be the first and the only products to protect against unintended pregnancy, Stis and HIV.
We expect results of this initial preclinical work in the third quarter, assuming positive results, we will see government grants and philanthropic funding for subsequent clinical trials of the M. P T product candidates.
This goes hand in hand with the work we're doing under our 2020 global health agreement with adjuvant capital.
In the fourth quarter, we submitted our regulatory registration in Mexico.
By Nigeria, and Ethiopia in January of 2022.
The goal of this work is to ensure that safe effective high quality contraceptive and STI prevention products are made available to women and health care providers in low and middle income countries on terms that are commercially viable forever.
We look forward to the day when all women regardless of their income regardless of their geography will have access to hormone free birth control that they can use on their terms only when they need it.
With that operator, I would like to open the call for questions.
Thank you again, ladies and gentlemen, if you'd like to ask a question. Please press Star then one on your Touchstone telephone again to ask a question. Please press Star then one our first question comes from David and Sullen Piper Sandler Your line is open.
Thanks, So just a couple first.
You mentioned saundra.
So certain insurers are potentially looking for loopholes here I guess, what I'm trying to.
Gauges, what do you think is the risk that.
You still see some plans potentially large plans.
You know not covering.
The product the way, it's supposed to be covered and you know what do you think that that could mean for.
For 2023.
Sorry, this year and beyond.
So just help us understand just the overall risk level.
And then secondly.
As far as the mechanics of of all of this happening I think you had you had stated that this is you know.
Mainly you're gonna be a 'twenty 'twenty three impact do you think theres a chance that this could be pull through sooner.
And I guess, where I'm getting going with this is that $30 million to $35 million sales guidance does that contemplate.
Meaningful impact of our coverage at zero co pay or just trying to get a sense of what your underlying assumptions are there so I'll start with those and.
Yes.
Okay, great. Thanks, David very much okay.
Alright, So let me.
Try to unpack that logically so one of the.
The projections that we gave the $30 million to $35 million.
Does not contemplate a positive flood gate this year.
It does not we we want to be very realistic with the guidance that we're giving.
So I'm sort of starting at the end of going backwards to your point 2023 January is really kind of that silver bullet, meaning that's when the mandate is going to all of the plans that are still blocking has said that they basically have this year to decide are they going to enact.
Early are they going to do the right thing and give women coverage and so here's what I would tell you is that right now we have about 70% coverage. The plans that are the culprits are to plan.
United and express scripts, if you could.
Call them, David and tell them to stop it I would be incredibly grateful, but here's the detail. So so here's what we've done is that because of this mandate. They would say things to us like you're going to have to give us a 60% discount in a three year contract or we won't cover effective and so we said you know what that is lunacy like were never doing that that's.
Craziness.
So our reps are doing prior ops, we have trained our sales force NOLA I know some people might say Oh, yeah. Prior offs are a pain for offices, they're not just an easy lay up even though our prior off I mean this is one of the most simple prior offs I've ever seen and I've been in this industry forever.
But so our reps literally.
When we know that its geographies that are heavily United Our express scripts, our reps insist that all of these prior IOSCO through they actually go into the offices. They are willing to help the staff do it. So that the scripts are getting covered is what I would tell you we've actually heard from United that were torturing them with prior offs, which we love and we say well we'll stop it.
If you just do the right thing for women the.
The good thing that has happened, though David is that they are not telling women they have to fail on seven or eight products and that was literally what they were telling women.
Women with cancer, who can't use hormones anyway ever again, we're being told they had to fail on seven or eight products and obviously they can't they're not even February products a mistake. So one that's been a huge improvement too I would also tell you that those two plants have said to us that they're very interested in playing ball and that between now and.
January that they will consider some kind of a contract.
Agreement that is a discount less than 60% in the 30% range. So I would tell you that the mandate has helped it's given much more reasonable percentage terms for anybody listening that windows is that higher LOE.
Kind of standard frankly, what happens in the industry I'm not the 60% to 30%. So I would tell you the numbers that we have now don't reflect it I would tell you that many of the smaller plans adopted it already they knew the writing was on the wall and they'd have to that's why our coverage has increased so we've actually already seen very very positive coverage increases.
Already at one point, we were 50%, 60% or 70 now.
But I would tell you that we still have some struggles with some of the two big players, but the prior offs are still getting coverage for womens.
Okay. That's helpful. Let me sneak in a follow up.
So you talked about the gross to net of 35% to 40%. This year. What do you think the gross to net is gonna be.
After this year once were.
You know noted where we're finally sort of.
Seeing the real impact of of the mandate zero copay.
Yes.
Yeah, Hi, David This is Jay so.
Yes.
Estimate with gross to net is with the full impact.
Of 2023, so really rolling into 2000 through 2022.
I can say that early looks into 2022, we are seeing some favorable impacts from gross to net as we kind of outlined a little bit on our prior call.
For Q3 results with turning off denial conversion.
As you can imagine that did have a positive lift and we're already seeing a decrease.
From the low 70 is down into the low <unk> and we do anticipate that will be a trend that will continue.
So just to be clear to you that 35% to 40% is how we should think about steady state gross to net going forward.
Yes that should be.
Where we would like to get to by the end of 2023, and I think that would even be better from after that as well, but we think that's a reasonable approach to kind of what youre looking to go forward in 2023.
Okay, great. Thank you.
Great. Thanks, David.
Thank you. Our next question comes from Annabel <unk> of Stifel. Your line is open.
Hi, This is stacy calling in for Annabel, Thanks for taking our questions and congrats on the fourth quarter numbers. Two questions. First one is how much co pay assistance, what's baked into the fourth quarter relative to the third quarter and secondly guidance has already taken effect. This year have you seen any evidence of benefit.
From an access perspective prescription trends are showing their typical first quarter patterns, which presumably you shouldn't be pronounced with a zero dollar copay or would you say, it's still too early to tell them. Thank you.
Hey, do you want to take the first one I'll take the first one.
Yes, no. That's a great question actually because Q4 is an interesting kind of anomaly with how gross to net work. So co pay assistance itself in theory was on.
As a kind of a full bore approach within our conversion on secondly through the entire fourth quarter of last year. However, how we forecast gross to nets, knowing that it was turning off in January .
Just to have a positive impact on how we calculate gross debt in December so.
Long story short, we did see some lift in gross to net in Q4, not the majority because October and November were full blast Q1 of this year will be the very first quarter, where we have the full implementation of our adjustments to the co pay program and Youll see that reflected in our net revenue number for the quarter.
The next question, we have already seen a list we have there are some small and middle plans that.
Frankly, they saw the writing on the wall right. When this new mandate came out they knew that it was inevitable now for example, some of them said well you know we update our system administratively at the beginning of the year in the middle of the year. So we will update it in July but the majority said, but this is <unk>.
Evitable and we understand that the legislative mandate is intended to give a woman zero out of pocket pay for one product in every category. That's what the intention is under HCA and so a lot of the plants have done it already and so we've already seen that positive uplift you know as I said.
The answer to Davids previous question, there's still two big players that are culprits that we're whittling away at but to.
To be honest the car even the conversations with them are much more positive. So we feel good that we're already seeing increased access without question already out of the gate and I also appreciate your point too you know January is always Hartford.
Any company for script growth.
And.
But we actually are very very positive and optimistic that the coverage is continuing to grow and.
It's just a matter of time.
Amazing Thank you so much.
Yes. Thank you.
Thank you.
Our next question comes from Ryan Fellow borrow of H C. Wainwright Your line is open.
Thank you so much for taking my questions and congrats on all the progress.
I just wanted to know when you anticipate you might be in a position to provide.
Some frame of reference with respect to revenue guidance for 2022.
Also wanted to see if there are specific metrics that you expect it to be in a position to provide.
As we go further into the year.
Pertaining to effectively the commercial performance effects.
And also if you could maybe comment on you know with respect to those insurers who are likely to be more reluctant to we're actively looking for ways to get around the guidance.
If you can quantify to what extent those insurers represents you know X Y Z percentage of covered lives that youre seeking to reach with sexy. Thank you.
Yes, Jay do you want to talk about first the guidance, yes, sure Rami joined the call late we did give it an idea that we are expecting 22 net revenue to be somewhere between 30% to $35 million for 'twenty two.
Yeah.
Okay, great. Thank you.
Yes, and then.
Do you want to talk about he asked me is there any specific metrics that we're going to be getting yes, I think it's fair to say that we're going to continue to assess what makes sense to give guidance wise the metrics as the quarters go on I wouldn't necessarily say, we're not willing to give more guidance, we're continuing definitely to get a better understanding of.
What the commercialization is in some of the underlying metrics that are used on that.
Last year was our first 12 months of the year and now we've made some adjustments to the co pay program.
Not to mention the research with insurance at the beginning of the year. So we do want to get some bit of a level playing field under this new kind of environment, but I think as the year goes on it will be much more faster that should probably expand on some of the guidance we've been given.
And try and be a little bit more.
Insightful on some of those.
Yeah, and Rob to the point about you know these plans that are really trying to find these loopholes.
I would say.
Look we still have about a 30% gap to get to our goal of 100% coverage and our goal of 100% coverage.
Is not unrealistic I mean, it's it's realistic, particularly because of the category right. So.
So.
The tough part for US is that you know United and express scripts do represent a lot of lives, but the interesting part is that the prior authorizations are.
They've become a daily part of the Rep sales call right and the areas in which United and express scripts are the big players so to speak.
<unk>.
Although we don't like it you know we want to be very transparent with the shareholders and hopes frankly that maybe one of them are on the board of United and Express.
Frankly, but.
I don't want to seem delusional and say Oh, we don't think it's a huge issue, but our homes our leadership of our sales team was at our corporate office. This week and we had a very serious come to Jesus about.
How difficult is it so we know 2023, it's going to be great and frankly, they said look these rats.
So keenly focused on prior off because they know that's how they're going to.
Get their money, how theyre going to get paid so I would tell you that we're still getting those scripts through so I don't want to misrepresent that yes, its not great. We wish the plans would comply to the law.
And we know the way the lives intended but we still are getting those scripts covered.
Almost 85% of the time, there is still a percentage of the time that they're not going through but we actually see our business growing this year. So.
I feel good about that.
Okay, and then just two other very quick ones.
Firstly.
With respect to the Orion collaboration you know you had talked about HIV infection and some other indications can you elaborate on what the other indications might be.
Well, here's what I would tell you, yes. So so the first and foremost theyre looking at HIV and so what I, what I said or what I meant was that this product could prevent pregnancy prevent stis and HIV.
They're also looking at.
HSV, but the bigger thing with this partnership that I think is going to be most interesting is we are looking at.
Two different delivery system. So we're obviously looking at the gel in an applicator as it is now but we're also looking at a thin film almost like when you look at those breath mints those blips decks that you can put on the dissolved on your tongue. We're looking at a thin film Vaginally applied to dissolve.
<unk> as the method that.
This new this new code this new drug would be and so that we can take it all over the world obviously.
Cost of goods, our biggest cost of goods right now is our applicator.
We've actually done a great job looking at all of our costs, but if we can use this new formulation of the thin film and were working in combination with the inventor of <unk> and gentlemen, named Dr. Sanjay Guard then.
That's what I think is going to be an incredible innovation, that's what's going to be game changing and so really the focus is mostly HIV not much other indications, it's just a way to.
Figure out to be the first and the only product that we'll be able to deliver results for that.
Okay.
And then.
Just wanted to make sure I fully understood.
Yeah.
With respect to the.
Our business development initiatives on factory outside of the United States.
Can you give us kind of a sense of.
What direction those are heading and when you might anticipate being in a position to.
And now something on that front.
Yes.
One is the.
One of the reason that the process has been slowed slightly.
Yes.
It's because some of the countries.
The contraceptive market is not as fruitful so the U S is the largest market opportunity for contraception. There is just no question. The profit that can be made in the U S.
So some of the markets, where we've talked to partners it's over the counter so.
We really want this app that can be valued appropriately not just with an upfront payment with the milestones and the royalties. So some of the companies who are very interested in fact fee.
They came back to the table really doing a full market assessment to think yes, theres, a big opportunity, but once you get chlamydia and gonorrhea indications. It's game changing because then it's a drug then it gets registered differently. There is a whole different valuation system that applies to it.
So.
What we what we really found is that some of the players that can give us the most non dilutive upfront capital and the best and most significant milestones and royalties are the ones that really want the STI indications and so we.
We did want to give away market and just taken any money, we could get for contraception and know that we would lock up those markets. When we know a much bigger player with a lot more money wants to come to the table. Once we have our top line readout.
So.
That's what we've really done well so we've slowed the process down a little bit we still intend to make an announcement this year.
As you heard on the call we are not going to released our topline data until the second half of this year.
And a third and fourth quarter timeline, because obviously you need to collect the data clean the data all of that.
So that's really the reason that we haven't made an announcement now we have had ongoing parties interested in Asia Pacific and Latin America. The EU market, we've had interest but that is one of the exact culprits I'm talking about meaning that the contraceptive market is just not that fruitful.
This is not a lot of money to be made so the bottom line is is there are a lot of parties interested which we appreciate but we think it's going to be better for the company and the shareholders and frankly access for women, if we hold off a little bit longer until we get closer to a readout for chlamydia gonorrhea.
Okay.
Thank you.
Thanks, Tom.
Thank you. Our next question comes from Jeff Hung of Morgan Stanley . Your line is open.
Thanks for taking the questions what is the refill rate been like perfect Z and how are you thinking about the refill rate in 2022 four year net product sales guidance and then can you talk about the profile of women, who are refilling scripts and how that compares to what you had been expecting earlier in the launch thanks.
Yeah no. Thanks for the question, Jeff So the retool our three in December they were 37%.
Which is actually a little ahead of what we expected.
The one thing that we continue to say and I know.
I'm a bit like a broken record here, but that's sexy is on demand. So I know that some people want to look at refills for other contraceptive products that are much like rinse and repeat right you'll get your pill every month, because you take a pill every day and in fact these on demand so entirely different so 37% was December .
We actually feel that that's going to grow.
And I mean, I know this is a captain obvious statement, but one of the reasons. We're so interested in this young constituency that we've attracted is there going to be on contraception a lot longer.
So we're going to be able to capture these women now and hopefully have fixed to users for the rest of their fertility years. So the one thing that I am most excited about frankly is the young demographic right. The majority of our users are under 35, when we first launched I did get a lot of questions. There is this product just for.
Women, who live in.
Who are in monogamous relationships and live in suburbia and have sex one day a month no. That's definitely not the case, we actually have found this huge groundswell of young women, who say theres a cell I would tell you that theres a self care movement that is happening yes, it's been.
Happening for a while but COVID-19 has made it happen faster. These young women now that they're back on college campuses.
We get inundated with feedback from them asking if they can do steady if they can they want to do a.
Our whole health a day, our new head of commercial has some very creative ideas on how we're going to target. These campuses talking about maybe having something called the shag weak, which is sexual health and awareness.
So.
The young constituency is growing and it's growing 18% to 25 as I said is about 30% and we.
We really feel like those are the women that.
Are using the product properly they love the product they are talking about it on social media. They are telling all their friends about it so much more than a little bit older patient profile.
I don't know if that answers your question, but what we're seeing right now in the retails and I know this is broad it is the 18% to 35, that's a big range.
So we're trying to capture the younger women constantly and this is the year that we intend to do it.
Thanks, and just to clarify so then for your net product sales guidance are you, assuming a rate higher than 37% and is it meaningfully higher or is it more driven by growth in younger patients.
Go ahead, she said no I wouldn't necessarily attribute it exactly to Ohio recently way, but we do anticipate that it's going up keep in mind, obviously 2021, we're emerging out of Covid.
Everyone says it but obviously considering what our product is that does get affected them are starting to come out of that we think that's going to be a positive lift and then also to with the new guidelines as well with those going away are impacting co base, we think thats going to be a positive lift as well. So I think by natural default, yes, we do anticipate that will continue to grow.
And that's ultimately what we're expecting to see over the next course of the year.
Alright, thank you.
Thank you.
This concludes the question and answer period I'd like to turn the call back over to Saundra Pelletier for any closing remarks.
In 2021.
We ask investors to be patient.
So that we could build our foundation of women, who love backseat. So.
So we could build our foundation of prescribers, who will write sexy for them.
So that we could have our DTC outreach to build a brand for Betsy and build a brand for <unk> as the company that will continue to deliver on innovation.
We understand that patience is not always a virtue however.
You have heard on this call that the wait is over we are committed to delivering on revenue growth improvements to gross to net and building our vaccine franchise.
Much has happened since our last earning call and all of it is positive all of it.
Demand for <unk> increased significantly in Q4 was 109% growth in net product sales.
Our total prescriptions grew by 70% and our units shipped increased by 73%.
Our total operating expenses decreased and we significantly reduced our net cash burn we expect this will continue to trend down in 2022.
We raised $10 million in unsecured debt and obtained a $50 million equity line of credit.
The federal government took a crucial step in increasing women's access to contraception without copays.
We completed enrollment in the <unk> trial, one month ahead of schedule.
We received qualified infectious disease product designation for the prevention of Chlamydia and.
And we submitted regulatory registration in Mexico, Nigeria and Ethiopia.
And we entered into a collaboration with Orion Biosciences to explore the development of a new product candidates that could protect against unintended pregnancy Stis and HIV.
Abraham Lincoln said.
Things may come to those who wait but only the things left by those who hustle.
Our performance in Q4, clearly demonstrated our drive and our ability to hustle. We are confident that 2022 is going to be the year of evolution.
So much for your time and attention.
Thank you ladies and gentlemen, this does conclude today's conference. Thank you all participating you may now disconnect have a great day.
[music].