Q4 2021 OptiNose Inc Earnings Call
Good day, and thank you for standing by and welcome to the fourth quarter of 2021 earnings call. At this time, all participants are in a listen only mode.
After the speaker's presentation, there will be a question and answer session to ask a question. During the session you will need to press star one on your telephone.
Please be advised that today's conference is being recorded.
Further assistance, please press star zero.
Now like to hand, the conference over to your Speaker today, Jonathan Neely, Vice President of Investor Relations. Please go ahead.
Good morning, and thank you for joining us today as we review <unk> fourth quarter 2021 performance and our plans for the remainder of the year I am joined today by our CEO , Peter Miller, President and Chief Operating Officer, Rami My mood, our Chief commercial officer, Gabelli and our CFO Keith go down during this call we will refer to the slides that can be viewed on our web.
Site, often knows dot com in the investors section before we start I would like to remind you that our discussions. During this conference call will include forward looking statements. All statements that are not historical facts are hereby identified as forward looking statements forward looking statements are subject to risks and uncertainties that could cause actual results to differ materially from those indicated by such statements.
Additional information regarding these factors and forward looking statements are discussed under the cautionary note on forward looking statements section of the earnings release that we issued today as well as under the risk factors section and elsewhere in Optum knows his most recent Form 10-K that is filed with the SEC available at their website SEC Gov and on our website at <unk> Dot com.
You are cautioned not to place undue reliance on forward looking statements forward looking statements. During this conference call speak only as of the original date of this call or any earlier date indicated in such statement and we undertake no obligation to update or revise any of these statements. We will now make prepared remarks, and then we will move to a question and answer session with that I will now turn the call over to Pete.
Miller Peter.
So thanks, Jonathan and good morning, everybody.
We appreciate you joining us this morning, and a very exciting time for our company first.
First because we continue to produce strong revenue growth on our current business and second because we recently announced positive results from reopened one the first of our two phase III clinical trials evaluating evaluating a chance in the novel indication of treatment for patients with chronic sinusitis.
We also continue to expect top line data from our second pivotal trial in the second quarter of this year.
In a moment I will discuss why we believe potential approval or against as the first ever drug treatment for this indication could be a game changer for both the 30 million patients suffering from symptoms of chronic sinusitis and for our company.
Starting on slide three.
I'd like to begin by reviewing our 2021 full year results.
For the full year of 2021 versus 2020 enhanced net revenues increased 52% to $73 $7 million enhanced total prescriptions increased by 28% and enhanced new prescriptions increased by 27%.
In my view these are outstanding results, particularly in context of the pandemic environment, which has constrained both patient visits to physician offices and the ability of our territory managers to broadly meet in person with our targeted physicians.
Our growth in total prescriptions with 28% was against the category that was flat and new prescription growth of 27% was achieved in a category that increased only 4%.
Revenue growth of 52% outpaced prescription volume growth in 2021, as a direct and intentional consequence of changes we made in 2021 to our copay assistance program.
These changes led to a sizable 19% year over year increase in average net revenue per prescription from $185 for full year 2020 to $219 for full year 2021.
In addition, we continue to be disciplined with respect to our expenses.
For full year 2021, we had $132 million of operating expense inclusive of almost $23 million of development costs associated with the chronic sinusitis programs.
This is aligned with our last guidance range and represents just a 4% increase compared to 2020.
Turning to slide four.
As I mentioned upfront, we believe that if we are successful in the development of <unk> as the first FDA approved drug treatment for chronic sinusitis it could be a game changer for both the 30 million people, who suffer with the disease and for our company.
Last night, we reviewed the data from the trial and the potential benefit for patients.
So I will focus my remarks today on the value for our company.
This new indication creates multiple new opportunities for growth each of which we believe has the potential to be individually larger than the current market opportunity and nasal polyps.
Unlike the largely undiagnosed nasal polyp population for whom its hands on other therapies compete today and approval in chronic sinusitis would make its hands the only marketed treatment and the large well diagnosed and underserved chronic sinusitis population.
At a high level, we believe the CF indication will unlock new value by dramatically expanding our target patient audience, and what address key insurance and promotional barriers to constrain broad adoption of a chance today.
First I'd like to talk about the market expansion opportunities.
The CF indication when increase our current our current target patient audience of adults being actively treated by a physician from approximately 1 million patients diagnosed with nasal polyps are current indications.
Approximately $10 million by adding those who are diagnosed with chronic sinusitis.
Top of that there are an additional estimated 20 million patients who suffer from symptoms of the disease, who are not receiving care.
I'd like to break that down a bit further for you.
With our current commercial infrastructure, we call on a physician universe focussed on the E&P analogy specialists, who treat most of the roughly 1 million diagnosed nasal polyp patients.
This is a sizeable market that we believe represents a total market opportunity for <unk> of approximately $1 billion at our current value per patient.
A new chronic sinusitis indication would triple the accessible patient population treated by these targeted physicians to $3 million with no additional investment in our commercial infrastructure.
In addition to the population of 3 million target patients treated by specialists. There are an estimated $7 million more candidate patients currently diagnosed and being treated by roughly 50 to 60000 additional positions in primary care.
As we've said previously we do not plan to build direct selling infrastructure.
Optimize reach into this primary care opportunity instead, we intend to secure a partner with an existing leverages. Both primary care deployment to efficiently broaden adoption to commission to clinicians outside of our called on universe.
We have been assessing the space and are optimistic there are multiple partners with potential with potential to jointly benefit from helping us realize this additional values.
In addition to the opportunities to create incremental value that I've already mentioned tripling the patient population in our current commercial footprint and accessing a large new primary care population with a partner there was an additional potential value lever.
Today, an estimated 20 million patients who report symptoms of chronic sinusitis, and basically giving given up seeking regular care by a physician for their symptoms.
Hesitancy to progress the surgery dissatisfaction with prior treatment options and a belief that the doctor Wouldnt have anything new to offer them are among the reasons why so many patients lapsed out of the health care system.
Direct to consumer promotional pilots, we conducted in several markets support that many patients can be successfully activated via DTC advertising.
The proposition of DTC is further supported by research, which reveals that the quality of life burden associated with chronic sinusitis is comparable to other serious chronic diseases, such as COPD asthma and chronic angina.
The value of its hands distribution of drug high and deepen the nasal cavity is intuitive to patients.
Partnership with the right primary care partner could open up substantial opportunity to add these estimated 20 million dissatisfied dropout patients.
10 million diagnosed and actively treated patients I discussed a moment ago.
Turning to slide five.
While the dramatic expansion of our target patient population with the chronic sinusitis indication is an obvious lever for potential future value creation. It's also important to consider how the indication will impact the insurance and promotional environment for example.
As we've previously described insurance coverage for a chance is very good with approximately 80% of commercial lives and a plan that covers a chance. However, approximately half of those lives are in our plan the constrains prescribing by requiring physicians to test their prescribing ex hands for the approved indication, which is currently nasal polyps.
Yeah.
This is important.
As we have found that many physicians, who routinely diagnose chronic sinusitis do not often make the diagnosis of nasal polyps.
Ultimately claims data suggests that Cs's diagnose 10 times more often than nasal polyps.
Accordingly, another important implication for value creation with the potential chronic sinusitis indication is in an insurance environment, where some payers interrogate the diagnostic decisions of physicians. Many Hcp's report hesitating before diagnosing nasal polyposis condition, which is already under diagnosed.
For the more readily diagnosed chronic sinusitis population a much broader swath of physicians are expected to prescribe the product to prescribers to prescribe it for more patients and.
And to ultimately be successful in overcoming insurance associated challenges to secure <unk> for their patients.
Turning to slide six.
Additionally, thanks to our <unk> development program objective evidence from large controlled trials of effect on inflammation deep inside the sinuses is available for its hands for the first time.
On this slide you can see before and after images of a patient treated with its hands from the reopened one trial.
This is an example of a coronal image, which you can see as a front to back view with the ice spaces are visible on each side. These.
These images are from a patient randomized to one spray per nostril twice daily VIX hands, who was calculated to have an absolute six 4% improvement in April .
As you can see in this patient there was an obvious increase in the sinus open space, where the black region, representing error in the right image at week 24, compared to the left image of baseline.
As you can tell we're very excited about the potential value of a chronic sinusitis indication for our company.
We are also feeling very good about the business. We are currently drilling with a nasal polyp indication I would now like to turn to those results.
Turning to slide eight.
Yes.
With respect to our Q4 2021 performance I'd like to highlight four key takeaways from today's presentation first <unk>.
Consistent commercial execution drove strong year over year growth in fourth quarter 2021 across the board on revenue prescriptions and.
In size of our top physician prescriber segment <unk> delivered strong growth rates.
Second we are providing initial financial guidance for full year 2022.
Importantly, please be aware they are for 2022, we believe that our territory managers access to our target physician offices will not meaningfully improve from the levels that existed in 2021, we.
We expect a year over year growth rate implied by the guidance range for its hands full year net revenues to be at least 22%, which is strong double the double digit growth.
Keith will have more on financial guidance later in the presentation.
Third there is an increasing recognition in our target physician audience of the important role <unk> can play in a medically appropriate and fiscally prudent stepwise care paradigm for treating nasal polyps. Moreover.
Moreover, with our fresh reopened one results physician adoption in 2022, we'll have new support from controlled trial evidence for nasal polyp patient is treated with its hands, who also have chronic sinusitis.
As I have already discussed looking beyond this year and assuming positive data from reopened to an FDA approval, we expect greater potential value from promotion of a chance as the first drug treatment for patients with chronic sinusitis.
And fourth getting results from both chronic sinusitis trials. This year has been a key objective for our organization as.
As highlighted earlier, we successfully completed that objective for reopened one and remain on track for topline data from reopened two in Q2 2022.
Given the positive results of reopened one if reopened two is also positive we plan to move quickly to file a marketing application with the FDA.
Turning to slide nine.
We had strong performance in fourth quarter, 2021, and I will briefly touch on the year over year growth highlights on this slide and the next.
In fourth quarter of 2021, there were approximately 29900, new prescriptions for <unk>, a 21% increase compared to fourth quarter 2020, while the market increased 14% over the same period.
We remain pleased with the relative strength of expanse, new prescriptions of <unk> prescriptions.
It is important to note that in addition to increasing the number of new prescriptions through 2021, we also have durably improve the quality of our new prescriptions due to changes in our co pay assistance program.
Changes in 2021 increase the proportion of covered versus uncovered patients filling first prescriptions, which is improved average revenue per prescription.
Covered patients also tend to have higher refill rates benefits. It takes more time for us to realize but we are seeing improvement there as well.
The total number of <unk> prescriptions in the fourth quarter of 2021 was approximately 93700.
This represents 27% growth over the fourth quarter of 2020 in a market environment, which increased only 6% over the same period.
Turning to slide 10.
<unk> market share increased from five 1% in fourth quarter of 2020 to six 3% in fourth quarter of 2021.
As market volumes potentially grow in the future. We are focused on continuing to grow our market share in the near term and it remained lots of and the remains lots of headroom for continued share growth, especially we should achieve the new chronic sinusitis label expansion.
Breadth and depth of physician prescribing as measured by the total number of physicians, who have patients filling a chance prescriptions and the numbers of prescriptions filled for writing physicians, respectively increased from fourth quarter of 2020 to fourth quarter 2021 as well.
Regarding breadth in fourth quarter 2021, approximately 7500 physicians had a patient fill at least one prescription of <unk>, an increase of 12% compared to fourth quarter 2020.
Regarding depth the number of physicians, who had more than 15 <unk> prescriptions filled by their patients in a quarter has grown even faster.
With that number increasing by 25% from fourth quarter 2020 to fourth quarter 2021, with nearly 600 physicians now in this segment.
In a few moments I will provide some closing remarks, but first I'll turn the call over to our CFO Keith called in for comments regarding fourth quarter 2021 results and perspectives regarding our corporate guidance.
Thank you Peter and thanks to everyone for joining us this morning.
Turning to slide 12.
As we reported <unk> recognized $22 5 million or <unk> net revenue this fourth quarter, an increase of 44% compared to the fourth quarter of 2020.
Full year 2021, <unk> net revenue was $73 $7 million.
Aligned with our guidance range of $71 million to $75 million and an increase of 52% compared to full year 2020.
Turning to slide 13.
Based on available prescription data purchased from third parties and also on data we received directly from our preferred pharmacy network enhance average net revenue per prescription for the fourth quarter of 2021 was $240 an increase of 14% compared to $211 of average net revenue per <unk>.
Prescription in fourth quarter 2020.
Full year 2021 average net revenue per prescription was $219 and reflects an increase of 19%.
<unk> to $185.
Full year 2020.
We believe the 19% increase in full year 2021 average net revenue per prescription is driven in large part by changes made in 2021 for our co pay assistance program.
The changes to our co pay assistance program in 2021 are important going forward as they are intended to sustainably increase average net revenue per prescription.
Reducing the rate of growth in prescription fills by commercially insured patients and plans that do not cover a chance while sustaining the rate of growth in covered plans.
We believe the changes had the targeted effect, resulting in reduced growth in unprofitable prescriptions, an increasing average net revenue per prescription and we expect the benefits of average net revenue per prescription to continue going forward.
Turning to slide 14.
Today, we announced our initial financial guidance for 2022.
First we expense expected <unk> net revenue to be at least $90 million for full year 2022.
Second as part of our expectation for full year 2022.
We anticipate the first quarter 2022, <unk> net revenue will decrease compared to fourth quarter 2021, enhance net revenue, which was $22 5 million.
This reflects the same pattern of calendar effect conics, hence revenue as we've reported the last two years.
As in prior years, the primary driver for the sequential revenue decrease in first quarter 2022.
It is our expectation that average net revenue per prescription will be lower in Q1 2022 and it was in Q4 2021.
Also as in prior years, we anticipate that average net revenue per prescription will improve substantially for the remaining three quarters of 2022.
This cadence for net revenue per prescription is driven by two effects that we believe are common for chronic treatments in our industry and that we highlighted last year as well.
The first factor relates to patient insurance deductible resets that occurred in January .
A second factor contributing to this decrease is the delay or loss of refill prescriptions by patients, whose insurance coverage changed with the new year.
We expect average <unk> net revenue per prescription for 2022 with respect to average that out.
Average net revenue per prescription for 2022 we expect the full year to be at least $210.
Moving on to operating expenses, our initial guidance for full year 2022 includes modest increases associated with key commercial and development initiatives.
Notably, including one time costs associated with the planned filing of an NDA for chronic sinusitis.
Other factors driving the modest 2020 to increase our volume related fees paid to preferred pharmacy network partners and other distribution fees.
As well as the completion of conduct of our chronic sinusitis clinical trials.
For the full year of 2022, we expect total operating expenses to be in the range from $135 million to $140 million of which approximately approximately $10 million and stock based compensation.
Total operating expenses, excluding stock based compensation are expected to be in the range from $125 million to $130 million.
Yes.
Turning to slide 15.
Yesterday, we announced positive topline data from reopened one.
A replay of the webcast we hosted to discuss those results will be available in the investors section of our company website for the next 60 days.
Producing topline results for reopened one in the first quarter of this year was a key objective for our organization.
Looking ahead with recruit recruitment complete we remain on track to deliver topline results from reopened two in the second quarter of 2022.
I'll now turn the call back over to Peter for closing remarks Peter.
Thanks, Keith turning to slide 17.
Today. We've described several reasons why we are so excited about the progress that has been made and the opportunities that lie ahead in 2022.
The last two years have certainly created challenges for our people and our business, but I am so proud of how our team has weathered the storm and put us put us in the position we are today poised for great things.
In the near term commercial team continues to focus on driving our business and if we see a second positive trial by the end of <unk>. We are prepared to race towards filing of an S. NDA for chronic sinusitis as soon as possible.
Thank you now I'd like to open up the call for Q&A.
Thank you as a reminder to ask a question you will need to press star one of your telephone to withdraw.
Your question press the pound key.
And while we compile the Q&A roster.
Our first question comes from Brandon Folkes with Cantor Fitzgerald. Your line is open.
Hi, Thanks for taking my questions and congratulations.
Chad on the very good performance. So maybe just three for me.
I guess, maybe one high level.
How do you see the competitive market shaping up I think we've seen.
Some companies recently talk about studying mm.
Migraine drugs in Crs.
Helping the category, just yet to be a bit of excitement.
We were out there.
And maybe just on the guidance net revenue per prescription.
I think its guidance as she kin that's down from $2 19 in 2021.
And I'm.
I'm looking at this in context, you have exceeded this guidance in the past, but can you just elaborate on the assumptions in that net revenue.
Got it.
<unk> guidance for 2022 compared to 2021.
Last if I may I'm sorry.
And the more upfront.
Can you just remind us on the follow ups and re opened two just if we look at the enrollment timeline.
And we try to think about when it could get data any reason just at this stage not to sort of book not to just push it.
It's going to be three months later.
Then reopened one just because of when you complete enrollment thank you.
Thanks, very much Brandon I'll take the first one and then I'll pass it to Keith and Rami for the next two.
Akshay Brennan I think the interest youre seeing in CFS is an indication of how big and how underserved the market is and I think you know that.
People for years been trying to be successful in studies to show that they work in chronic sinusitis, because it's a very big market. As we described very very underserved currently as I described as well so I'll start off by saying that I view the activity in the market as a sign of this is a big market with with high potential.
<unk>.
Relative to competitors on the thing I feel really good about Brandon as we are out front I mean, we're a good bit ahead of anybody.
It's behind Us and.
There are some therapies out there that are going to be more appropriate just in the E&P space.
But there are some migraine treatments that are beginning some trials, but.
We don't really see broad competition in the near term.
Certainly in the primary care space, but also in the anti allergy space.
And now if the team has anything to add on that.
Keith I would just point out that with regard to the.
It should be competitors that are running trials that some of those trials like you mentioned the one rig.
A migraine product those are really not the same design in their focus to the best that we're aware I have I have no nonpublic information of course, but they're.
They are focused on facial pain or pressure as you might expect for a migraine product.
I'm not entirely clear what will come from that but as you pointed out and we're very happy to see the sort of enthusiasm created around this market space by the multiple different products.
Yes.
The last comment I'll make brands. We're just so excited about our trial results.
Rami covered last night, this really could be a landmark.
The landmark study that we published first ever.
The evidence of being bringing benefit not only on symptoms, but also objectively on showing benefit in the sinus cavities and we just think that as you saw the images that we showed on the screen, we think that could be very compelling.
So Brandon this is Keith I'll take the second question with respect to average net revenue per prescription so as we've done in prior years the guidance that we've given this year, including the guidance for <unk>.
Expected net revenue for the year was setting a floor. So I think in the past two years. We've done the same this year, we set the floor at.
At least $90 million so with respect to average net revenue per prescription I made comments in my prepared remarks with respect to some of the changes that were made last year and our co pay assistance program that were intended to have sustained benefit and I think you can see by the results that we put up for 2021 those those.
Benefits were surely recognized we took the same approach to guidance guiding on average net revenue per prescription this year by setting a floor of 210.
I'll remind you that 219 is at.
At least 200 and the number that we achieved last year. So it's definitely within the range.
We are.
Because we are setting floors in terms of revenue and averaging around prescription we were intending to capture a.
A variety of outcomes with respect to revenue and.
Total prescriptions, which of course are the numerator and denominator in the calculation.
And Brandon your last question was.
As you might expect results and I think youre on the right track based on when we announced completion of enrollment the knowledge Theres, a 24 week follow up and it takes time of course to lock and clean the database performance fiscal analysis before you could produce topline results I think it's reasonable to expect that it will be the back half of the quarter before we see results.
Great. Thank you to all three of you and congratulations on all the success.
Thanks, Brendan Thanks Brennan.
Our next question comes from David <unk> with Piper Sandler Your line is open.
Okay. Just a few questions. So I know this has been asked before but can you just talk about.
The mix between.
Paula.
Nasal polyp patients and non.
Non polyp patients or at least volumes.
Currently.
That's number one.
Number two is as you think about commercialization.
Peter can you talk about.
Your latest thinking.
Regarding our co promote.
And or put differently.
The extent to which you would expand a sales organization that targets some of the GP audience.
That you would need to address four.
For the expanded indication.
And then.
Lastly, I'm just.
Give us a sense of how the payer landscape is evolving.
And what I guess.
Getting out here is with the expanded.
Label to the extent you got it.
How do you see the payer landscape evolving with a wider label. Thanks.
Yes, I'll, probably take all of them and I'll ask for support from Zika Rami.
What we tried to convey relative to the polyp patients currently named US number one.
It's an under diagnosed condition, but.
What we found in this sort of prescribing practices of doctors as we find the majority of of doctors are limiting their prescribing to only Paula patients. That's in research. We've conducted its from lots of work that we've done so the mix as we see it there are some physicians.
A smaller group of physicians that are writing broadly across multiple indications, but the majority of doctors are limiting their prescribing to nasal polyps thats why we believe that the <unk> indication could be an incredible value and locker because as we talk to physicians and I encourage you guys to talk to physicians.
When we ask them the question with the <unk> indication how much do you see your prescribing changing and what's reported as substantially more prescribing.
So.
As I said, we think it's a game changer on that front.
Relative to the few minutes to elaborate yes. Please robyn.
If you look at public data today.
We want to caution you against extrapolating from the proportions by diagnosis that you might see.
From current prescribing to what might be potential for the product in the future because today's proportions are driven disproportionately by the physicians who prescribed the most those people that Peter referred to that if adopted broadly.
The potential for the product so is driven by having an even larger audience of physicians adopt more broadly.
It's not really it's easy, but probably not correct to extrapolate the current proportions.
In the same and assume that we're already getting the business in <unk> that would be available should we get the indication.
On the second question David.
Been very consistent in terms of our view of how we capture the opportunity broadly in primary care.
I'll repeat what I said in my remarks that in our current infrastructure. So in our current called on Universe. We go from a million diagnosed nasal polyp patients to $3 million without doing anything to our commercial infrastructure. So I want to emphasize that point, we think there's a very big potential expansion opportunity just in the doctors were already <unk>.
Going on for the reasons I, just talked about a minute ago relative to that next group, the six or 7 million patients being treated by roughly 50 to 60000 primary care doctors.
We do not David intend to build out a big infrastructure to capture that benefit.
Work, we've done we think there are multiple partners that already are calling on those doctors, who would be interested in a co promoter or a licensing deal in the primary care space. There is potential by the way that we could expand marginally in primary care with our current reps, but we're going to capture.
Our plan is to capture the majority of the value there of the partnering and I think we've been pretty consistent there.
The payer landscape. David This is what excites me honestly is that.
No.
The insurance environment that I described roughly half we have good insurance coverage, 80% coverage by half of our coverage has a PAA associated with it and where we do have a ta it's typically two indications.
The payer says the physician has to attest to our nasal polyp indication.
We believe the majority of those contracts are going to be converted theyre going to stay as they are but with the <unk> indication it will be to know not only the nasal polyp indication, but also the <unk> indication and it's what we were trying to describe in our remarks that there are 10 million diagnosed patients in total 3 million diagnosed.
<unk> in the E&P allergy segment, and we think that is could.
Patients no longer have to attest to nasal polyps day. After a test of chronic sinusitis, which is already broadly diagnosed we think that as sort of a game changer in terms of creating significantly more volume in the in the anti allergy segment alone.
Okay great helpful. Thank you.
Thanks, David.
Thank you as a reminder, chest open at this time. Please press Star then one our next question comes from Gary Nachman with BMO capital markets. Your line is open.
Hey, guys good morning.
The level of in person detailing now coming out of the pads that back and how much do you expect that to accelerate in the coming months I think you said it wouldn't improve that much I'm curious why not.
And do you expect more of the increased use of <unk> to come from deeper penetration of existing riders or by bringing in new physician writers at this point.
I'll stop there are a couple of follow ups.
I'll take the first I'll lead in and Vic can jump in but it's interesting Gary what we found in the pandemic environment. There's obviously two factors that are impacting one is patient volumes and but you're obviously talking about in person detailing and what we found across last year is that as masked mandates either went up or they went down.
Down in cities in different geographies, we did not see a dramatic change in offices. The how physicians were sort of reacting to those changes in terms of rep access and this is anecdotal Gary but we're not calling on nearly all of the physicians we were calling on.
Pre pandemic, so I want to be clear by the way, where our reps are out there, making significant number of calls every day, but the number of doctors were able to call on in person is is limited because of physicians not allowing reps into the offices. So the assumption. We've made for 2022 is that as <unk>.
Im going to dramatically change and it obviously varies by territory and by geography, but.
Anywhere from 53% to 50% of offices in a territory or not allowing reps to call on on the office. So we're doing other things by the way. It doesn't mean that we just give up we try virtual we do telephonic, we do things that we can.
But that that is what is been limiting on physician detailing. The other thing is limited to is our speaker programs and our lunches and things of that nature that are very impactful promotional Lee we just found a lot of physicians.
Across last year, not willing to attend speaker programs.
So as we go into this year.
We're coming into the year, not believing it's going to dramatically change.
Our view on that.
Relative to I'll answer your question on where do we look for expansion in our physician universe I'll answer it two ways. Gary one is in the near term and the others in the longer term, but in both cases, it's both so we call on roughly 10000 doctors right now you saw our believer data.
<unk> writer chart about 8000 doctors in total are writing roughly that rate.
About 1600 are in this segment that is writing a good bit more frequently so I think in the near term. The majority of our growth is moving people from that what we call Dabbler segment into the believer segment and we've been very nicely growing that higher prescribers segment year over year.
But we also intend even in the near term to try to expand our writing universe, although even in that second group I think the majority of it is going to come relative to depth of prescribing.
Because we're pretty well penetrated <unk>.
Majority of doctors, we're calling on an etiology are already writing so in the near term, it's largely going to be on getting people to write more.
But I do want to remind you of the of the longer term opportunity with CFS, that's where we think we.
We will get a dramatic expansion of the physician universe. So Jack I don't know if you have anything to add there I mean, I think that's right Peter the only thing I'd add to that is we do see a significant opportunity and doctors, who are writing us, but just occasionally and really encouraging them to integrated as part of their standard of care and we think the data helps us expand that group.
We are Gary I mean, the thing that Vic and his team are working on in the near term as we think we can grow nasal polyp business by the way I want to be clear that while we have.
We're very excited about the <unk> opportunity and the team are working very hard to across the next 12 to 18 months continue to expand our business by these polyps.
Okay great.
And then just following up from yesterday CMS data, if you consider modifying reopen too after fully analyzing reopened one and it sounded like that could be a possibility could you still have reopened two data in the second quarter, regardless, even if you've made some changes and then Peter how are the discussions going on.
On a potential PC partner.
Is it more likely that would happen after reopened two data is it possible it could even happen before.
So Gary.
I think what you are asking if we were to choose to change the statistical analysis plan in reopened two based on what we learned from reopened one would that delay the results and I believe the answer is no I don't envision any changes that would involve changing the timeline for producing the topline report.
Okay.
I just wanted to confirm right Peter before you get to the next slide.
Firm that what you said yesterday.
When you reevaluate the statistical plan. So it doesn't sound like it would be in terms of number of patients like adding enrolled patients into this study. It would just be in terms of how you analyze the data statistically is that correct youre comfortable again with the end in that study.
Number of patients.
We have no plans to add additional patients to reopen too.
Okay Alright, great.
Gary relative to partnering I'm not going to comment Gary on discussions we're having on the partnering front I will say, what we've said historically is that.
Typically in this kind of a situation, where it's a licensing deal or a co promote deals.
Deals are typically done after data before filing.
And that's the time frame that most companies are more interested and candidly you maximize value relative to the deal.
Yes.
Okay. Thanks.
Yeah.
Thank you and I'm currently showing no further questions at this time I'd like to turn the call back over to Peter Miller for closing remarks.
Well, we thank you for joining us both last night and this morning and as you can tell we're very very excited about what lies ahead. So thank you very much.
This concludes today's conference call. Thank you for participating you may now disconnect.
[music].
Yes.
Okay.