Q4 2022 Akili Inc Earnings Call

Greetings and welcome to the Chile fourth quarter 2022 earnings call.

At this time all participants are in a listen only mode. A question and answer session will follow the formal presentation.

If anyone should require operator assistance during the conference. Please press star zero on your telephone keypad.

As a reminder, this conference is being recorded.

Now I'd like to turn the conference over to your host Julie Dicarlo Senior Vice President of Communications.

Thanks, Joe Good afternoon, and welcome to Kelly's earnings Conference call for the fourth quarter of 2022.

The market close today, we issued our earnings release, which can be accessed on the Investor Relations section of our website. Additionally, we've posted earnings slides on our IR website that will reference during today's call.

This call is being recorded and a replay of the teleconference will be available on our IR website at the conclusion of today's event.

During today's call, we'll make some forward looking statements regarding future events expectations plans prospects or the financial performance of the company. These forward looking statements are based upon estimates and assumptions that while considered reasonable by the company's management involves certain risks and uncertainties. The company's actual results may differ materially from.

Those expressed or implied by any such forward looking statements as a result of various important factors factors that might cause such differences include but are not limited to those risks and uncertainties set forth in our Form 10-Q filed on November 14th as well as other subsequent filings with the SEC information provided on today's call reflects R V.

Used only as of today March 7th and should not be relied upon as representing our views as of any subsequent date, we explicitly disclaim any obligation to update or revise any forward looking statements or our outlook.

Also during today's call, we'll refer to certain non-GAAP financial measures management does not intend the presentation of these non-GAAP financial measures should be considered in isolation or as a substitute for results prepared in accordance with GAAP, but as a complement to provide greater transparency a reconciliation of the historical non-GAAP financial measures to our GAAP financial measures is <unk>.

Included in our earnings slides and in our earnings release.

If you're following along with the slides. Please turn now to the agenda with me on today's call are of Kelly's CEO , Eddie Martucci, our President and Chief Operating Officer, Matt Franklin, Our Chief Medical Officer, Scott Collins, Our Chief Financial Officer Santos Schon back now please turn to slide four as I hand, the call over to Eddie for his prepared remarks Eddie.

Thanks, Julie Hello, everyone. Thank you for joining our call to discuss our business performance in Q4 of last year and our overall summary of 2022.

Today, you'll hear from Matt Scott and Santos on various detailed aspects of our business growth. We're excited about how we're evolving the business and seeing the increasing traction of endeavour Rx and more generally progress of our business model.

With moves that we announced in early Q1 of this year to restructure the business. We're now operating with a more efficient capital footprint. So that we can execute against our most important business goals and have cash that we expect will fund the business into Q1 2025.

With our heightened focus on endeavour Rx in the ADHD market place well look to prove out that the digital treatment can indeed scale like a drug.

I believe <unk> has the potential to be the first example of this new paradigm and the entire Kelly team is passionate and focused on making that happen.

I'm excited with the early impact of our sales force investment, where we're seeing a positive increased in most commercial metrics.

We're also seeing strong willingness to pay out of pocket by patients as expected, we haven't seen insurers step up to broader coverage and this is a continued area of focus for us.

And we continue to push the cutting edge of a patient experience in medicine with multiple enhancements to both our treatment product and our caregiver caregiver companion product over the last quarter.

In terms of getting into a Rx to all of the ADHD patients. We believe can benefit from our product. We were extremely excited to announce positive outcomes from our Starz ADHD adolescent trial earlier than anticipated in January of this year.

With the needs around mental health in teens, and the ongoing ADHD medication shortage, we're putting urgency around our planned FDA submission. This year for a review of an expanded label for Endeavour Rx to include adolescents over 12 years of age.

If successful that expanded label would essentially double our current addressable market based on our estimates.

Overall I believe we've made good progress to end the year and I'm, even more pleased with our team's increased focus and execution mindset here in the early part of 2023.

I'll now turn it over to our President and C. O M. At Franklin to give you a deeper look into our core business progress.

Thanks Eddie.

During our third quarter earnings call, we outlined three strategic areas of focus for our business. These are outlined on slide five.

The first is driving awareness and adoption of endeavour interacts with the addition of the first wave of our direct sales force and 13 priority territories, covering roughly 20% of the estimated U S market opportunity for <unk>.

The second is removing barriers to adoption by driving expanded coverage for <unk> and third we aim to continually improve our treatment experience.

In the fourth quarter, we made good progress with expanding adoption and improving the treatment experience.

As expected payers continue to be slow to act and coverage remains a challenge that we are addressing head on.

Let's look at each of these areas starting with adoption.

In the third quarter, we deployed the first wave of our sales team to 13 initial geographic territories. The approximately 70 priority territories, we identified in the U S.

Encouraged by the initial progress we've seen these territories through the end of 2022 growth in sales occupied territories outperformed white space or unoccupied geographies in overall prescription growth.

Overall number of active prescribers and the number of prescriptions per prescriber, we continue to add more than 100, new prescribers per month in Q4, while simultaneously expanding the number of repeat prescribers medium prescribers, who have written multiple prescriptions over time.

This is a key area of focus for our sales team and we've seen repeat prescribers grew by 60% over Q3 2022.

In short we believe there was a strong correlation between direct sales engagement and accelerated growth across key adoption performance metrics.

In addition to seeing the initial impact of our direct sales force on demand for Endeavour and reps. During Q4, we also saw refill prescriptions grow more than 200% over the third quarter of 2022.

This growth was driven by the successful transition of Endeavour X from a 90 day prescription to the 30 day prescription which was initiated in August .

During this transition we maintained the established $450 list price, which now applies to the 30 day treat me of course.

Even with this higher effective per month price, we saw only a 25% reduction in prescriptions dispensed from prior quarter, giving us confidence that the 30 day prescription model is working and that endeavor.

As an ongoing periodically therapy.

Seeing these early indicators of commercial traction we are expanding our sales force and expect to be an approximately 15 additional U S markets by the end of this quarter.

Moving now to coverage.

In Q4, we continued to see families willing to pay out of pocket for endeavor. While this is encouraging we acknowledged that families need expanded access to new non pharmaceutical treatment options more rapidly than payers are currently providing and we continue our work to break down this barrier for them.

Finally in treatment experience as we shared last quarter, we have unique opportunity with endeavour, our extra rapidly iterate the product to drive engagement and compliance.

Enabled by the adaptability of digital therapeutics, and the dynamic nature of video games, we're able to evolve the game play experience for patients while preserving the regulated core technology of the product.

We also continue to update and optimize the treatment experienced surrounding the products, including our companion application for caregivers and better Rx insight.

In Q4, our enhancements, we're focused on improving the patient onboarding experience optimizing core game play to maximize player engagement and implementing progress tracking features to provide caregivers and health care providers increased visibility into patient progress during treatment.

This is part of our ongoing commitment to deliver amazing experiences to our patients and their families.

Turning now to slide six let's look at the numbers.

First on prescriptions more than 4500 prescriptions were written for Endeavour Rx in 2022 during the fourth quarter. We saw about 1800 prescriptions written for Endeavour Rx a 37% increase over Q3, 2022, and 176% increase over Q4 2021.

There were 1064, new prescriptions written during the period similar to the number of written in Q3 2022, despite eight fewer selling days during the period.

Presenting a more than 100% increase in Q4 2022 over Q4 2021.

On refills as mentioned earlier, we also saw a significant increase in the number of refills on prescriptions written during the period.

There were 737 prescription details written during Q4 2022 up about 200% from Q3, 2022 and up more than 400% over Q4 2021.

On prescribers in Q4, the total number of prescriptions were written about 800 unique prescribers, representing a 2% increase over Q3 2022.

Increase of 88% over Q4 2021.

A number of new prescribers was down 29% from Q3 2022, but this decline was more than offset by growth in the number of repeat prescribers a key area of focus for our sales team, which grew more than 60% from Q3 2022.

40% of new prescriptions written in Q4 were dispensed during the quarter down from 52% in Q3, but up from 33%. We saw in Q4 2021. We believe this was driven by two factors the transition from a 90 day to 30 day prescription and the impacts of the December holidays.

During Q4, we received payment for 98% of dispensed prescriptions.

96% of dispense prescriptions were paid out of pocket by caregivers, 2%, we're reimbursed and 2% were provided free of charge qualifying families under our patient assistance program.

Now I will turn it over to Dr. Scott Collins, our Chief Medical Officer, who will provide an update on our clinical programs.

Thanks, Matt and Hello, everyone I'm excited to be joining my first earnings call since joining a Kelly on December one.

Before I get started a quick note on my transition to the company.

I've spent nearly my entire 25 year career studying new treatments for ADHD, including running the Duke University ADHD program for 18 years and I've grown impatient at the fact that we have not provided new options to patients in decades.

The standard of care has not changed since I finished graduate school.

Never Rx, we now have an FDA authorized product that can change that and I'm excited to be leading the medical and scientific aspects of the Kelly as we worked to get this product into the hands of everyone who can benefit.

Broadly the current strategy for my team will focus primarily on supporting our commercial efforts by continuing to generate and disseminate high quality evidence of the effectiveness and safety of Endeavour Rx is an important component of ADHD clinical care.

As a reminder, we made a strategic decision to focus our resources on the growth of our endeavor Rx product for ADHD and subsequent clinical development activities will coincide with additional capital raise or business development opportunities.

Turning now to slide seven I'll provide an update on where we are with our ADHD clinical programs.

As we reported in early January of this year, we now have topline results from the stars ADHD adolescent pivotal trial of Endeavour Rx our label expansion study in 162 patients with ADHD, aged 13 to 17.

Results strongly support the efficacy and safety of Endeavour Rx in adolescence.

As you can see on the slide the magnitude of effect across a range of outcome measures, including objective measures of attentional functioning and ADHD symptoms were equal to or greater than those we've seen in two previous pivotal studies in younger children.

These findings are timely given the current and growing mental health crisis in our country that is disproportionately affecting teenagers.

We're in the process of preparing results from this study for presentation at a future scientific meeting and for submission to a peer reviewed journal.

We're on track to use the adolescent study findings to support a five 10-K submission to FDA this year to potentially expand our label for Endeavour Rx.

Referring to our pipeline on slide eight we also previously reported that we stopped enrollment for Starz ADHD adult our pivotal study of Endeavour Rx in adults with ADHD.

We shared on our last earnings call that this study was recruiting more slowly than expected.

Given the strong clinical data in adolescence that I. Just described we closed enrollment in this adult study to preserve capital and analyze the data.

The study enrolled 223 patients, which was more than the number enrolled in the adolescent study.

Data analysis for this adult study is ongoing and we stated that we expect to have top line results from this adult study in the second half of 2023.

We expect to make a decision later this year about our regulatory strategy as it relates to the stars ADHD adult study.

In addition to the completion of our adolescent and adult pivotal studies. We're also actively enrolling participants into a real world registry that will allow us to collect data to support other regulatory and market access initiatives.

As announced in January outside of ADHD, we've chosen to prioritize other clinical programs that would require additional significant investment.

We are continuing previously launched investigator initiated and collaborative studies, which include two studies of Endeavour Rx to treat cognitive impairments in patients following COVID-19 infection.

Data analysis for one of these studies is in the process of being finalized and we expect the second study to complete enrollment in Q2.

We expect data from both studies to read out by the end of Q2.

I'll hand, it over now to our CFO Center Schoenberg.

Thank you Scott and Hello, everyone.

Now on to the financials on slide number nine.

We continue to see quarter over quarter growth of endeavor robotics revenues and as Matt mentioned earlier. We are also seeing the positive impact of the first wave of our sales reps in the field.

As you see on the slide in the fourth quarter of 2022, and never IDEXX revenues grew to $111000, representing a 35% growth over third quarter of 2022, and 76% growth over the fourth quarter of 2021.

Similarly, full year 2022 endeavor IDEXX revenues grew to $323000 up from 186000 in 2021.

Note that the total revenues in 2021 and Q4 of 2021 included an additional 352090 $8000 respectively of revenues associated with the shionogi collaboration.

From an expense perspective, we incurred approximately $91 million of GAAP total operating expenses and about $78 million of non-GAAP total operating expenses in 2022.

The growth of expenses compared to the third quarter of 2021 was primarily driven by expenses related to the commercial launch support of endeavor robotics. The ADHD label expansion studies and also the costs associated with the business combination and operating as a public company. Similarly, we incurred approximately $22 million of GAAP total operating.

Expenses and $20 million of non-GAAP operating expenses in the fourth quarter of 2022 the.

The growth in expenses compared to the third quarter of 2022 was primarily driven by business expenses related to commercial launch support of endeavor robotics.

And last but not the least chroma capital perspective, we ended the year with approximately $136 million of cash cash equivalents and short term investments.

Now on to guidance on slide number 10, we are reaffirming our expense guidance from January that we expect our 2023 non-GAAP total operating expenses to be between 55 and $60 million. This represents a reduction compared to the 2022 non-GAAP total operating expenses of approximately $78 million.

In support of our 2023 operating plan the company underwent a reduction in workforce impacting approximately 30% of employees across the organization.

We estimate that we will incur about one and a half to two and a half million of severance and termination related costs related to this action and expect to record. These charges during the current quarter Q1.

Please note that these severance and termination related cost. In addition to stock based compensation are excluded from the projected full year 2023, non-GAAP total operating expense guidance.

This brings me to our capital plans. We are also reaffirming the cash runway guidance that we previously announced in January we expect our cash position at year end 2022 of approximately $136 million to be able to fund our current and planned operations into the first quarter of 2025.

I'll close on the financial update with this our 2023 operating plan allows us to one focus our resources, primarily on endeavour, IDEXX commercialization and ADHD label expansion and to preserve capital, especially in these cut in capital market conditions.

With that I'll hand, it back over to Eddie Eddie.

Thanks Santos.

If you'd like to turn to slide 11, you can see our key takeaways from this quarter overall I think we had a strong quarter. We're excited by the increasing traction we're seeing with Endeavour Rx.

We announced positive topline data from our first pivotal trial designed to expand the <unk> label and we're moving forward with the regulatory submission and obviously as noted we've structured the business to give us cash runway into 2025.

With that I'll hand, it back to the operator, and we're happy to take questions.

Thank you.

Ladies and gentlemen, if you would like to ask a question. Please press star one on your telephone keypad and a confirmation tone will indicate your line is in the queue. You May press star two if you would like to remove your question from the queue for.

Since using speaker equipment, it may be necessary to pick up your handset before pressing the star keys.

One moment, please while we poll for questions.

Our first question comes from the line of Judah Frommer with credit Suisse. Please proceed.

Hey, guys. This is Nick on for Judah from Credit Suisse. Thanks for taking our question congrats on the progress.

I was hoping if you guys could provide some incremental insight on refills.

Are you able to share just for those patients that are getting refilled. How many retails are they getting on average and is there any time gap between prescriptions.

Hi, Thanks. This is Matt I appreciate the question.

A couple of comments there.

First.

We need to as we announced we made two significant business changes in Q3 and Q4 first was the changed from 90 day to 30 day prescription and the addition of our direct Salesforce, where we're engaging in discussions around retail prescription so with those two significant business changes, we'd love to get a little bit more.

<unk> to see how the refill patterns of balls. So we're not at this point, providing specific guidance I can.

State, However, and shared that the vast majority of prescriptions that are written or written with multiple refills, so a new prescription.

For a child is often written with initial cycle of treatment and that includes multiple retail could be two three or more over time. So we do expect to see.

Continued increases in retailers over time.

And Nick I'll just add.

You asked a question at the very end about.

Kind of a sequential nature of how quickly as we've said before <unk> is meant to be a.

And ongoing episodic treatment or it's something that's used ongoing and may come sequentially are immediately or may bounce in and out.

And we.

We are seeing that in the market so without getting into specifics on metrics. We do see some immediate refill behavior and then we do see in terms of refills patients who come back after a gap in time and when they're reassessing their symptoms with their doctor. So I think this is something that will evolve given this is a really new treatment modality with new dynamics.

It will evolve as we continue to scale.

Got it thanks, again and congrats on the progress.

Great. Thanks.

Okay.

Our next question comes from the line of Michael Cherny with Bank of America. Please proceed.

Evening and thanks for taking the question, maybe if we can dive into a little bit more of a prescriber dynamics, especially as you think about retrenching the business focusing on.

The core product candidates, how do you think about that strategic balance of.

Going after new docs versus going after existing docs and what is I guess you don't have a place for your revenue guidance per se, but what is incorporated in terms of your expectations for how each one of those gets penetrated.

Retention on the.

Returning docs etcetera.

Hey, Thanks, Michael against its Matt I'm happy to take the first crack at that.

So I appreciate the question.

Q4, as we deployed our sales force are.

As you can guess our initial focus here is on driving overall prescription growth. So one of the areas that we focused on initially with the sales team is engaging with those prescribers in those newly populated territories.

Going back and re engaging with those historical provider. So we did intentionally placing emphasis on re engaging historical providers and you saw the benefits of that strategy and we saw a significant increase 60% growth in repeat prescribers, we saw that 200% jump in retail prescription. So we were.

Pleased with the results of that initial strategy now that the team has been in the field for.

Or a quarter, we've taken a more balanced approach so balancing the time, we spend servicing those existing writers and balancing that with engaging educating new providers and we do expect to see new prescribers and new prescriptions grow over time.

Yes.

Thanks, and if I could just dive in a bit on the coverage side.

How do you think about the milestones you're looking for as you continue to focus on covered expansion given that you. Obviously have obviously, Canada candidates in the pipeline relative to coverage from the commercial side, but also you're having to redefine a new model given that digital therapeutics in general it doesn't necessarily have broad coverage.

Within the current payer landscape.

Sure. Thanks, Michael This is Eddie.

So I think youre right that this digital therapeutics prescription digital therapeutics as a class.

Kind of hasn't seen broad coverage at absolutely.

We're pleased with the interactions we have when we have our teams dig in with payers, we're seeing engagement.

We're seeing that the clinical data is sufficient and generally we get feedback that they are impressed with the level of clinical data, obviously, because we've run multiple prospective trials for this clinical program. So.

We're not guiding on you know and we don't announce individual coverages were not guiding on.

Expectations on a number of coverages are our covered lives or things like that.

From our perspective, the milestones are really doing the work to.

Two essentially educate this payer landscape on this product I think broadly what I see is that payers here are like very generally surface level aware more and more of their going deeper product by product into the data and that's where we believe we're going to start to see the success because of our investment.

Our data because of our outcomes to date, so it's really doing internal milestones is really.

Stacking up those meetings doing the work to go deep with each of these payers, which takes time.

Okay. Thanks.

Our next question comes from the line of Rahul rocket with lifestyle capital. Please proceed.

Hey, guys. Thanks for taking the questions.

Pretty impressive adolescent data I was wondering what the feedback was from your existing prescriber base.

And all of that feedback how do you think that will ultimately shape adoption amongst adolescent patients you know upon clearance and commercial launch.

Yeah, Hey, Rahul this is Scott.

It's early we've just we've just announced them we haven't presented the data yet or published but the the general reaction from providers as well as everybody else, who we talked to is very positive I mean this is a this is a very underserved population, it's going to double the number of kids that can get access to a to an effective treatment.

So the.

The reaction has been overwhelmingly positive.

Got it Okay. That's helpful. And then I know you guys you are expanding your sales territories.

In terms of a vital in which territories to expand into or is there any thinking around growing into the areas with existing reimbursement coverage or are you just trying to.

Cash is one of them that is possible in terms of driving script growth.

Yeah, Hey, Rahul, it's Matt Yeah number of factors that we consider I would imagine it's similar to other pharmaceutical biotech.

Medical device launches, we look at overall opportunity in terms of addressing our addressable patient population. We look at prescriber density we look at geographic boundaries as well, making sure that these are small enough where we can get to these physicians on a frequent basis right.

Maintain that reach and frequency.

So I think we're looking at it in terms of opportunity. The one thing we do.

We do do is we do integrate our market access with our sales strategy. So we are engaging with the commercial plans.

Those areas that we have existing sales force. So we were able to pull it through for example last call we talked about high Mark we do have active sales presence in Pennsylvania.

So as an example, again how we're integrating all of these different aspects of our commercial team.

Got it that's really helpful. Appreciate it and I guess, just one more from me.

I'm wondering if you could kind of touch on the proportion of new patients that are coming through the telemedicine platform through your website.

Our sales force on the ground.

Yeah, we haven't provided specific guidance telemedicine continues to be what I would say modest but meaningful contributor to our prescription volume.

We're pleased that we have that capability think it may be.

More important as we expand into the adult population so.

More to follow on that.

Got it really appreciate it thanks again guys.

Thanks.

Our next question comes from the line of Vikram <unk> with Morgan Stanley . Please proceed.

Hey, good afternoon, thanks for taking our questions.

Two from our side both on your commercial efforts with Endeavour Rx, So I guess first what.

Is the typical profile of patients that are demonstrating receptivity to Debra Rx in terms of there.

Pretreatment status and the status of their condition overall when they presented their providers will eventually end of prescribing them endeavor Rx and secondly.

Which aspects of specifically of your commercialization and messaging efforts do you think are helping to drive to that.

Quarter over quarter increase in scripts that you reported in <unk>.

I mean, when you reflect on the initial phase of your commercialization effort like what's resonated and what do you think really hasn't so far.

Alright.

Hey against Matt. Thanks for the question I'll do my best to address that Multipart question keep me honest to make sure I don't forget any I think first on the patient profiles I'm one of the things that I really appreciate about our endeavor Rx and the investment that team has made in the clinical pipeline is that it has been studied in been demonstrated to be effective as both a standalone treatment.

And as well as combination with medical therapy, and it can fit seamlessly into any child's treatment plant right.

In conjunction with the physician and the caregivers.

Input. So it's very flexible with that said, we do see in our early engagements to patient profiles really stand out. The first is newly diagnosed patients. So those who have recently been diagnosed who are interested in exploring or the caregiver is it is interested in exploring non pharmaceutical.

So that's the first second area that we're seeing a lot of demand is for those patients that are not well controlled on medical therapy. They may be experiencing side effects that often come with these prescription drugs. These stimulants and are looking to explore alternate non pharmaceutical options. So.

Those are really the two areas those use cases, if you will or patient profiles.

As we discussed those with physicians had been an area of interest and uptake. So I think going through the clinical data demonstrating the flexibility demonstrating the impact of our treatments in conjunction or as a standalone therapy had been very compelling.

So I would just highlight those are sort of the initial the feedback we're getting from the team.

Got it thank you.

Yes.

Our next question comes from the line of Marie Thibault with.

BTG. Please proceed.

Hi, Thank you for taking the questions. This afternoon I wanted to ask my first here on the conversion rate I know that you mentioned a couple of headwinds here in the fourth quarter that.

Cause that rate down to 40% I wanted to understand are you expecting that to improve in Q1, I know certainly we won't have the holidays like we did in Q4, but then the 30 day refill.

Hum.

The 30 day prescription factor is still there and I also wanted to understand how you're thinking about conversion rate and their retail space. It certainly looks like that's a nice high 90% or so by our math I'm just how should we be thinking about conversion for rehouse going forward.

Yeah. Thanks, Murray, we have not provided guidance or forecasts regarding the conversion as you mentioned there were two business changes the biggest being that Mike.

Migration from 90, 230 day prescription while holding the pricing constant that was an impact the seasonal holiday is another impact.

Of course that will not persist again in Q1.

Sure.

With that said.

This is also an area of emphasis for our sales team. So in those areas, where we have.

The ability to engage with clinicians were talking about the importance of follow up and making sure that patients and caregivers are prepared so.

We are doing our.

Our best to continue to message and educate around the importance of fulfilling those prescriptions, but as far as giving guidance.

We're not prepared to do that at this time.

Just on the refills I know it is early but given that those are sort of built into the initial prescription should we expect something around that high.

High nineties is is it reasonable range.

Again early days.

We estimated these business changes so we're hesitant to provide guidance on that.

Okay Fair enough and then maybe I'll ask a further question sort of on the sales force.

As youre thinking about adding this next wave here in the first quarter, how should we think about the maturation of the sales forces. This kind of a six months a year long process for these.

Sales reps as they as they enter new territories and what is kind of the key learnings on on who has the right prescriber profile of who has the right kind of a caregiver profile to target yeah.

Yeah. Thanks for that question and consistent with any product launch, particularly in a situation, where we're defining a new category as we are with Endeavour X. There is absolutely a learning and experience curve.

Relatively early days the team has really been in the field for several months with that said we are very pleased with the progress. We're seeing as we mentioned, we're seeing accelerated growth on all of their critical commercial and adoption metrics in those sales territories. So pleased with what we're seeing.

Initially we will continue to see we expect continued improvement there so.

I wouldn't say, we're there yet we're continuing to learn and grow but that learning curve, we're working through that.

Effectively.

As far as.

The patient the physician profile consistent with our initial indication eight to 12 year olds not surprising we're focused on pediatric specialties. So pediatric psychiatrists pediatric neurologists. In addition to general PD attrition that see a large number and a responsible for monitoring a number of these pay.

So over time so.

Really focused on sort of those integrated behavioral health centers, where theyre multi disciplinary practices dealing with these complex cognitive.

Impairments on a day in day out basis, so that focus was.

Consistent from our initial perspective and remains a point of emphasis for us.

Okay. Thank you.

And our next question will come again from the line of Judah Frommer with credit Suisse. Please proceed.

Hey, guys. It's it's Nick on for Judah again, just wanted to go back to the adolescent data any initial thoughts on why the effect on attention was was higher than that.

That population versus the initial eight to 12 year olds.

Or was it something to do with trial design or just this specific.

Population.

And how do you think that efficacy might translate into into adults. Thanks.

Yeah, Hey, Nick it's Scott. Thanks for the question Yeah. It's a very good one we have a couple abroad.

Hypotheses about why we might have seen the greater magnitude of effect in adolescence.

The first is that maybe there maybe they had something to do with the composition of the sample compared to the pediatric population.

That's pretty easy to look at it at least in the top line. It doesn't look like things like the the gender differences the breakdown and.

Racial or ethnic subgroup.

Subgroups is going to make much of a difference, but we're going to interrogate that further.

Where I would think we're likely to uncover some understanding of that effect is with looking at the the way that the participants engaged with the treatment.

Older Kids might just be more motivated and be more engaged with the treatment and therefore derive more benefit.

So that is that is an area that as we prepare the data for presentation and publication that we're gonna be diving into further.

And as far as how we think that might extra.

Extrapolate, it's unknown and we'll know when we when we get topline data from the adult study.

Got it that's helpful. Thanks.

Thank you.

Ladies and gentlemen, this concludes our question and answer session.

And this will conclude today's conference you may disconnect. Your lines at this time. Thank you for your participation.