Q2 2023 Neurocrine Biosciences Inc Earnings Call

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Speaker 1: Good day, everyone, and welcome to today's NeuroCream Biosciences Report's second quarter results. At this time, all participants are in a listen-only mode. Later, you will have an opportunity to ask questions during the question-and-answer session. You may register to ask a question at any time by pressing the star and 1.

Speaker 1: on your touchtone phone. Please note this call may be recorded and I will be standing by should you need any assistance. It is now my pleasure to turn today's program over to Todd Tuschla, Vice President of Investor Relations.

Speaker 2: Good morning and welcome to New York runs second quarter of 2023 earnings call. Today I'm joined by Kevin Gorman, our chief executive officer, Matt Abernathy, our chief financial officer, Irie Roberts, our chief medical officer.

Speaker 2: Eric Benevitch, our Chief Commercial Officer, and Kyle Gano, our Chief Business Development and Strategy Officer. During today's call, we will be making forward-looking statements. These statements are subject to certain risks and uncertainties, and our actual results may differ materially. I encourage you to review the risk factors discussed in our latest SEC filings.

Speaker 2: After prepared remarks, we will jump into Q&A. With that, I will turn the call over to Kevin Vorman.

Speaker 3: Thank you, Todd. And good morning, everyone. It's a pleasure to be here this morning. We've had a very strong 1st, half of the year, as you can see from our press release this morning. We are raising our guidance. So, what was previously the high end of the range is now the bottom of the range. Very strong performance and very.

Speaker 3: led by our Perdufidate for Ingressa in the Korea associated with Huntington. We have a focal onset seizure and data coming out, anhedonia data coming out. And last but not least at all, we have a focal onset seizure and data coming out.

Speaker 3: is the CAH studies, both in the adult and in the pediatric population. And I really going to have a lot more to say about that a little later. And we'll also be taking your questions on that. So quite a bit going on here. It's all been very nice thus far. So I'm really looking for the second half of the year.

Speaker 2: And right now I'm going to turn it over to Matt. Good morning. NURQRING continues to execute with growing ingressive sales, improving profits, and an advancing pipeline. During the second quarter, ingressive sales were $440 million with year-over-year growth to 26%, driven by record new patients.

Speaker 2: Our commercial and medical affair teams continue to do an excellent job educating prescribers in developing the TD market, helping many new patients receive treatment.

Speaker 2: With a solid first half of the year, we are increasing 2023 in resident sales guidance from 1.77 to 1.82 billion dollars reflecting over 25% growth at the midpoint of the range.

Speaker 2: This compares to our previous Ingressa sales guidance range of $1.67 to $1.77 billion.

Speaker 2: With growth in sales and reduced operating expenses, our profit profile improved during the quarter to over $120 million of non-gap net income. These profits generated strong cash flow and now have over $1.3 billion of cash on hand, ZIPbowing plenty of money.

Speaker 2: the TD market for Ingressa, advancing our clinical pipeline, and expanding our internal research efforts. As you all know We are all imports, commitments, droplets, earnings Rooney at market...

Speaker 2: We believe this strategy will create shareholder value in both the short and long term. I will now hand the call over to Eric Benavich, our Chief Commercial Officer.

Speaker 4: Thanks, Matt.

Speaker 2: I'm very pleased with Ingressa's sales performance through the first half of the year.

Speaker 2: year-over-year sales grew 26% driven by strong prescription demand across new and existing patients.

Speaker 2: As previously noted, we anticipate a majority of growth in 2023 to be driven by the psychiatry and neurology business segments where most TD patients receive their care.

Speaker 2: In long-term care, we are gaining traction and expect to see good growth as we continue to develop that segment.

Speaker 2: With 850 million of Ingress sales in the first half of the year, as Matt said, we felt it prudent to raise the guidance range from 1.67 to 1.77 billion up to now 1.77 to 1.82 billion.

Speaker 2: The low and high end of the updated range is driven primarily by the pace of new patient starts throughout the second half of the year.

Speaker 2: Outside of TD, our commercial and medical teams have been preparing for the anticipated FDA approval and subsequent launch of albinozine to treat chorea associated with Huntington's disease.

Speaker 2: Despite the availability of approved treatment options, there remains a significant unmet need across this patient population.

Speaker 2: While we have not factored in any potential HD Korea sales into our guidance, we are not going to be able to find any additional information. We will continue to do so and we will continue to do so in the coming weeks. Thank you. Thank you. Thank you. Thank you. Thank you.

Speaker 2: We are confident in the efficacy and safety data that we've generated with albendazine in the clinical program And we look forward to a potential approval in HD Korea next month

We believe we can make a positive difference for patients suffering from HDKorea.

All in all, we are on track to deliver another year of record results for Ingreza.

Growth numbers like these are especially impressive for a product in its sixth year on the market. However, the fact remains that a majority of TD patients still have not received the diagnosis or even any explanation for their TD movements.

We know we still have a tremendous opportunity to help more TD patients and hopefully someday soon, AC Korea patients as well.

With that, I'll turn the call over to Dr. Irie Roberts, our Chief Medical Officer.

Thank you Eric and good morning to everyone on the call.

Our clinical programs continue to make steady progress, which will lead to several important milestones and data readouts throughout the rest of this year and in the years to come.

Looking specifically to the second half of this year, we will soon be reaching infection points for a number of mid to late stage programs, beginning with the August 20th PDUFA date for the treatment of Korea associated with Huntington's disease.

Eric highlighted the confidence we have in the strong efficacy and safety data package generated to support approval.

We've also had very good engagement with the FDA and look forward to the agency's feedback regarding the potential approval for an important second indication for valvenazine. With respect to data readouts, we remain on track to report top-line results from four studies in the fourth quarter of this year. This includes data from both the pediatric and adult registrational studies.

which remain on track to read out in Q4.

This includes NBI 352 for the treatment of focal onset seizure in adults.

and NBI 846 for the treatment of anadonia associated with major depressive disorder.

Turning now to our muscarinic portfolio, we're making very good progress with enrollment in the phase 2 study of NBI 568 for the treatment of schizophrenia. In addition this year, we're advancing into phase 1, our second muscarinic molecule.

NBI 570, a dual M1 M4 agonist.

These first two assets represent just the first wave of muscarinic compounds we expect to progress into the clinic over time and explore across a number of neuropsychiatric conditions. Overall, I continue to be very pleased with the progress our teams are making with the most broad and diverse pipeline Neurocrin has ever had.

And with that, I'll hand the call back to Kevin. Kevin? Thank you very much, Irie. And we're ready to take questions now. At this time, if you would like to ask a question, please press the star and one on your touchstone phone. You may remove yourself from the queue at any time by pressing the pound key. Once again, that is star and one if you would like to ask a question.

I hope you don't mind if I ask kind of a pipeline BD question. You've talked historically about how there's really not a lot of high quality neuroscience assets that could kind of fit your budget and make a kind of near to mid-term impact on the top line. In the context of that, I guess, how do you think about cranesor font?

and what that could do to neurocrin scope. If crinestrifont works as well as you hope, could neurocrin start to go into the direction of either endocrine, rare disease, and really not just be in neuroscience for the foreseeable future? Thanks so much.

Thanks for the question, Paul. Good morning. Kyle can add to what I would say, but we do look in the endocrine space quite a bit. As you know from discussions that you've had with Kyle and him speaking at several of your conferences, he and his team look broad and deeply into both neuroendocrinology and neuroendocrinology.

if we see assets that really meet all of our criteria, Kyle, you want to add to that? Yeah, just to add to Kevin's remarks. I think what would be interesting is with Positave with Prince Arpon, it does open the door to looking at things that are later stage commercial on the end of the side, but we haven't done historically. So

We know what those opportunities look like and we await our NACIRPON data. We will take our next question from Tasin Amin with Bank of America. Your line is open. Okay, I think that's me.

that you expected for Q, what should we expect and what should we really be comparing that to in terms of standard of care to get a sense of whether or not your products could have improvements if it was currently given? Thanks. Tozina, it's Ira here. Thanks for that. I think I got all the questions. You were breaking up a little bit, but.

proof of concept study, initial phase two in focal onset seizures. Three things we're predominantly interested in the context of this study. First of all, obviously the initial tolerability and safety of 3, 5, 2 in this patient population in adults. The second is to understand the pharmacokinetic profile which will help us with...

the measures of seizure frequency. And we will be looking at seizure frequency comparing from baseline to the primary endpoint. And essentially, we look at a normalized seizure frequency over an eight-week period of monitoring. And so obviously, the absolute.

leaving a 50% reduction in seizures and from the small study also looking at whether any patients are able to become seizure-free. Looking at the totality of that information then obviously that will give us an indication of the strength of any signal that we're seeing in that position as well for future discussions.

And is there any kind of minimum amount that you're looking for in terms of improvement in seizure rate that would determine the go no go?

In obviously there have been a plan number of new trials in this area in the recent past that have demonstrated efficacy for new molecules in this space. We'll be interested in understanding that data, but in reality we'll be focused on the context of our own information to understand the next steps.

We will take our next question from Chris Schupatuni with Goldman Sachs. Your line is open. Hi. Good morning, team. Thanks for taking our question. This is Stephen on for Chris. I think historically your team has been helpful in framing what the guidance range means in terms of...

some macroeconomic factors and overall trends to see if they're business. So I was wondering if you could frame this 1.77 to 1.82 billion range in that context. Thank you.

Yeah, I'd say the guidance range is primarily going to be driven by new patient demand. We had strong new patient demand in the first half of the year and depending on the outcomes for the second half of the year, you know, that's really going to be what the driver of that range is. It's $50 million. It's going to show a nice sequence.

for some disruption, but I'd say based upon how our business is operating, it really comes down to the continuance of new patient additions and we feel confident with the market and how it's operating to provide the guidance we provided today.

Awesome. Thank you. And we will take our next question from Anupam Rama with JP Morgan. Your line is open.

Hey guys, thanks so much for taking the question. With the Huntington's Padufa later this month, how are you thinking about the launch curve for Ingreza and that indication? How do the properties of Ingreza might shift the market dynamics there? Thanks so much.

Good morning, Anupam. So yeah, obviously we're excited about the opportunity and look forward to the FDA decision coming up in August . The way that we're looking at it, the HD-CREE opportunity, there's still significant unmet need for that patient population. We estimate —

And only two out of 10 are currently treated with the only approved medicines, which are BMAT2 inhibitors, the tetrabenazines.

And so there's still significant unmet need and opportunity there. We're looking forward to getting the labeling and certainly being able to get off the ground this year. From a financial perspective, it's not tucked into our guidance.

results in significant problems of comorbidities, metabolic disorder, bone issues, growth issues, et cetera. And so any reduction in steroids is meaningful for individuals. In the context of the clinical trial, we obviously are trying to reduce the steroids in a protocolized way, and we will get the opportunity.

And I'm kind of the package and the whole franchise that you're looking at. And if you're gonna run a blood pressure study with each one of these, or have you yet, thank you. Oh, Mark, thanks. There's a lot of questions in there. Let me start just at the top. I mean, I think one of the things that really attracted us to the opportunity to partner with social health tolerance was the fact that they had a portfolio of really very selective different candidates that we could consider swinging into the clinic. And I think it is very important.

But as we move into phase one and understand the profile of that molecule, we'll be able to say more about that. Then in the preclinical setting, we obviously do have other molecules behind that that we will intend to bring into the clinic in due course. With respect to cardiovascular profiles for each of these, I think we need to see in the clinic first. I can't make a comment about whether or not blood pressure monitoring will be required or blood pressure studies will be required until we've really seen what we get to look at in the clinic.

to provide a few more comments.

Yeah, we're really happy with the growth that we've seen in the first half of the year and obviously our raised guidance reflects our optimism for the second half.

You know, our commercial team is firing and all cylinders right now and the markets growing nicely, but I'd say that in Brazil is growing even more nicely.

We've actually gained share over the past few quarters. And we continue to be very optimistic about continued growth. The vast majority of patients with TD remain as yet undiagnosed and untreated. And we're very focused on bringing this important medicine to those patients. And we're very focused on bringing this important medicine to those patients.

Thanks so much and congrats on the quarter. We will take our next question from Brian Sorky with Bayer. Your line is open.

Hey, good morning guys, thanks for taking the question. Do you really want to ask about any sort of seasonality instead of going into 3Q? I know 2Qs historically a big quarter for Ingression, and then there tends to be a little less sequential growth than 3Q and then a bigger sequential jump than 4Q. So just looking for any guidance as we kind of think about the remainder of the year with that historical contact.

and how we sort of model out the next two quarters, or the R&D channel, Dynanox to consider price changes, et cetera. Yeah, Brian , I'll try to address the questions here. So the first half of the year had tremendous growth. The second and half of the year, we expect similar growth. I think if you look at the range.

continued sequential growth, largely driven by new patients. Q3 has had a touch of seasonality in the past, but it's always difficult to predict. So nothing that we're going to call out specifically here on this call.

And then also from a price perspective, as I've said previously, we do anticipate our net revenue per script to be around $5600, which is a couple percent increase. If you compare it to 2022, so all feel stable from a net price perspective. So it really comes down to executing.

and driving new patients. And I think what you can hear from myself, Eric, Kevin, we feel very good with how the market's evolving, how our team's performing, and look forward to the second half of the year.

and I think what you can hear from myself, Eric, Kevin. We feel very good with how the markets evolving, how it seems performing and look forward to the second half of the year. Thank you, Matt.

We'll take our next question from Akshay Tarwani with Jeffries, your line is open.

Hey, morning. This is Ivy on for a coach. So he's starting only on M&A. I think he comment that the high end of the range you've considered was around 4 billion but over the next few years I think in grades that will generate more than enough for cash flow to go beyond that point.

So what's the gating, I guess like the gating factor for doing M&A beyond that $4 billion landmark and would there be any appetite on our team's end to pursue a merger of another commercial stage CDS company? Thank you.

So what I would say right now is that we have a very good growing franchise within Ingressa and we're going to be adding another indication to it. And at the same time, we have an outstanding pipeline, which we're going to have multiple readouts going on in the rest of this year and in the early next year. So is mercury funding sort of consistent with every approach is something that makes up in lemon trees and acid

But we have a great opportunity for substantial organic growth here at Nirkland, and that's our focus at this point in time.

We will take our next question from Jeff Hung with Morgan Stanley . Your line is open. Are you making made´s in a Michelin with meat on.

Thanks for taking my question. Can you talk about the potential advantages of ingreza as a jointed treatment in schizophrenia over others approved for the indication? Thanks.

Thanks, Jeff. First of all, I think I don't believe there are currently any injunctive treatments actually approved in the in the space of schizophrenia. And so obviously, this would be an opportunity to have a first approved medication. And we are very excited about the two pivotal phase three studies that we have ongoing that evaluate valbenazine as a patient.

not get full effectiveness from currently available treatments. And if they do get an efficacy response initially, then many of those patients relapse and suffer from acute psychotic episodes later on in their disease. So with respect to valve-enazine, what made us encouraged about valve-enazine and interested in going into this program was a combination of three different patients.

In the marketplace in treatment of tardive dyskinesia, we have a huge database of information for patients who have received antipsychotics and albinozine and grezza treatment together and we're very confident in the safety and tolerability of that. In addition, we have pre-clinical data that was generated that shows the

We obviously do not have space to data for the combination in the clinic, but because of the challenges in psychiatry trials with failed trials and inappropriate readouts, we elected to go directly into fully powered pivotal trials.

And as a result, that's what we're currently implementing. And we look forward to reading out data from the first of those studies at the end of next year. Thank you. We'll take our next question from Miles Minter with William Blair. Your line is open. Hey, just on the CTA for 570, the M1M4...

been seen with that mechanism just obviously referring to, there's an arm-aligned experience that Eli Lilly said just curious as to whether there's an additive

Yeah, I mean, I don't want to comment too much on the specifics of the design of the phase one program, but just by background the reasoning for these the normally requirements of addition of anti-colonurgics at least as I understand it is because of the

peripheral side effect profile seen as normal in which is thought to be predominantly due to M2, M3, and the anticholinergic then knocks out that peripheral effect. We have highly selective centrally penetrant agonists and as such we are developing them in that fashion.

I think I'll probably just leave it at that. I'll take our next question from Danielle Brill with Raymond James. Your line is open. Hi, good morning. Thanks for the question. I'm curious. I believe your competitors also developing their CRF1 antagonist for PCOS. Is this an indication of strategic interest?

We're following their data, but at this point, that's PCOS is not an indication that we're following upon.

We will take our next question from Evan with BMO. Your line is open. Hi guys, thank you so much for taking my question. I'd love to hear a little more about the expansion of Ingreza into the long-term care market. We didn't hear much about it and I know that's a unique setting, so maybe just some more on that and how that could help support growth this year and next year. Thank you.

time of launch with Ingressivac in 2017, but we didn't have the capacity to take that on, you know, on top of outpatient psychiatry, community mental health, and outpatient neurology. And so, last year, actually, just a little over a year ago,

you know, we launched our efforts into long-term care with a dedicated team. What we've seen so far is a lot of really good progress and strong growth. We estimate that about 10 to 15 percent of the total TD population resides in various residential care facilities.

And so it's early days yet in terms of that business segment. You know, our neurology and our psychiatry segments are more established than LTC. But all signs are positive and we continue to be.

very optimistic about the opportunity there going forward. We will take our next question from Laura Cinco with what Bush securities are open.

Good morning. Thanks very much for taking the question. Back to Ingreza, a commercial question. I'm wondering if you can offer any comments on the duration of treatment that people are experiencing with Ingreza, how long is staying on board and just curious how that has been impacting, for example, the increase in guidance here. Has there been any improvements or increases in duration of treatment? I'll just flip one. Have you actually quantified the number of patients that were on therapy?

starts, you know, even ever since we came out of COVID lockdown environment.

In terms of persistency, that's been really strong ever since the early days of the launch. And we've looked at this serially going back to 2017, 2018, 2019, and so on. And what we've seen is that patients are staying on treatment and certainly longer than what we had expected prior to the launch and longer than what we're seeing with some new non-Up SoftwareART 86.

persistency with underlying psychiatric meds. The majority of these patients are on either hemipsychotics, antidepressants, or both. And I think though we haven't given out specific numbers for a duration of average duration of treatment for a patient, what we're seeing is that the persistence

I'll take our next question from Sumit Kilakari with Concord. Your line is open. Good morning. Thanks for taking our question. Could you remind us as to the nuance that drives the primary endpoint being glucocorticoid reduction at week 24 for

while it's serum apore in pediatric patients with glucocorticoid being a secondary endpoint at week 28. And what could this difference mean in terms of your ability to drive successful on aggregated disguised as us id Increased and about patient.

Hey, Sumant, you came in pretty muffled. Do you mind repeating that? Sorry about that, I hope this is better. So could you remind us as to the nuance that drives the primary endpoint in glucocorticoid reduction at week 24 for adult patients, while it's serum A4 in pediatric patients with glucocorticoid being a secondary endpoint at week 28?

what could this difference mean in terms of your ability to drive successful regulated discussions in pediatric and adult patients.

Thank you, Samantha. So, both measures are important in the management of congenital adrenal hyperplasia in the pediatric and adult population. The function of choice of primary versus secondary endpoint really reflects the ability in a clinical trial setting and the kind oftheme of adverse sp?

heterogeneity of the population in terms of the ability to demonstrate that outcome. And let me expand on that a little bit more. So from an adult perspective, obviously, androgen control is extremely important and that is the primary mechanism of action of cranesophon is to act on the HPA axis and reduce androgen.

In adults, however, because you don't have the physiologic changes that are happening to the same extent in pediatric population growth, development, and things of that sort, it was possible to protocolize the steroid reduction and look at steroid dose.

as a primary endpoint. And that is important in the management of these patients. And we look forward very much to seeing the information there and understanding the impact of connective on that endpoint. In the pediatric setting, obviously, the primary endpoint is the four-week androgen control. And that is extremely important as a measure in these patients.

since obviously they are growing, developing and changing rapidly over time. In addition, however, we do have a real world assessment of more real world assessment of steroid reduction, which is measured out to 28 weeks. And so as we look at the data, we'll be able to look across the populations at the consistency of the infrastructure.

We will take our next question from Mohit Banzel with Wells Fargo. Your line is open.

Mohit, your line is open.

Oh, sorry, this is Serena on for Mohit and thanks for taking our question. So I wanted to ask more about the expected launch in Huntington's Korea. And if you can talk about any differences versus product is Kinesia such as expectations for compliance rates or duration.

and if you expect the bolus of patients waiting for an Osteo alternative or new patients to be switches from Osteo. Thank you. Yeah, let me, let me, um, kind of start with the last part of your question and work forward.

You know, obviously we're excited about the opportunity and you know we think that with the data that we've generated we have potentially a differentiated product. You know we're eagerly anticipating the PDUFA date and you know a favorable outcome with the FDA and what those labeling look like. But it's important to note that you know we haven't been out there talking about valbenazine I can't have been…

newly diagnosed with their Korea or they've had Korea for some time and they've been reluctant to be treated with existing treatment options. You know we don't expect that there'll be a lot of switching in this market and certainly we haven't seen that in the TD market either. But you know ultimately you know the product attributes that make Ingreza so attractive in TD, the simplicity of true once daily dosing without complicated titration, the efficacy, the side of the low rate of side effects.

These are things that we think would translate well over to the HD Korea opportunity and we look forward to making a new treatment option available because certainly one is needed. We will take our next question from David and Salim with Piper Sandler. Your line is open. Thanks. So regarding

that ultimately new starts are going to be driven in the pediatric setting given sort of the obvious pitfalls of a high steroid burden in PEDs as it relates to growth. Is that the right way to think about...

this market and uptake of the drug or do you see a real opportunity in adults as well? Thank you.

I'll start off by just caveating my comments by saying, you know, first we need to see the data. And secondly, obviously, you know, we need to get approved by the FDA. But with that, you know, I see a significant opportunity really across all patient segments.

There's been no significant medical advances for the CAH opportunity for decades. Literally the standard of care is and has been and remains glucocorticoids. And as Irie was discussing, there are significant issues associated with high-dose GC treatment.

And so, you know, if you look at the different patient segments and think about, you know, who might benefit from treatment with crinocer font, the ability both to improve day-to-day control over the androgens, the excess androgens, as well as being able to lower the risk of

also at various stages of their lives will benefit from a new treatment approach. And so, you know, we think that there's going to be significant opportunity across all of those patient segments. We're just looking forward to generating the data and, you know, being able to bring a new

different approach to treatment of CAH to that population, which definitely deserves one. We'll take our next question from Ash Verma with QPS. Your line is open.

Hi, thanks for taking my question. I wanted to ask about IRA implementation. So what are you assuming with respect to how commercial channel may respond to Medicare negotiating the price down? And do you have conviction that your commercial pricing is insulated in our post IRA implementation environment?

Thanks. So I've said all along that IRA is going to be a moving target, but we're going to carefully monitor what is happening, especially as this September starts with the first group of companies that are going to be

We get protected for quite a while here because of both of the provisions for small biotech companies. The first one, the specified small manufacturer phase-in for the new Part D program, that's going to be a discount that is phased in for us over a seven-year period of time.

starting in 2025. That's a real nice advantage for us actually because we're going to be, if as written, we should be having lower payments to Medicare than what we currently shoulder in the current Part D. We also expect to qualify for the small biotech exemption.

and it's phased in over 2029 to 2031. So while we're going to be following this quite closely, and as I've said before, I'm certain there will be changes, just can't predict exactly what the changes will be with IRA. We monitor it and we take it into consideration as we move our business forward. And we'll take our next question from...

Could you maybe just comment on how it trended from Q1 to Q2? How should we think about Q3, Q4, and maybe where you expect to end? And then in terms of the guidance, the Korea is not included. At what time point you might start incorporating that in your guidance.

Yeah, on the guidance for HD front, yeah, it's not incorporated, but we don't expect it to be too material this year, so I would expect it to be incorporated as we think about 2024. From a net revenue perspective, as is typical, we had a few percentage improvement from Q1 to Q2, and as you've seen historically, you see it fairly consistent from a net revenue

to remain very good. So I think always consistent there.

You know, one other comment that we've not been asked about is our profit profile during the quarter. We had strong profit, but do want to comment that we did have a non-recurring non-cash stock-based compensation charge that impacted our GAAP earnings, but from a non-GAAP perspective, we had.

you know, very strong profit. And I figured when you continue to look into the financials, you can see that is showing up in the stock-based compensation. We didn't increase GAAP operating expenses, but we actually did reduce our non-GAAP operating expenses. So, profit profile for the company.

remains very strong and we're seeing nice operating leverage in our business. So I wanted to chime in there since I've not been asked a financial question and was feeling a bit left out. So thank you.

We will take our next question from Ami Farah with Niemann-Hamm. Your line is open.

Hi, good morning. This is E. Sanlionfirami. Congrats on the quarter and thanks for taking our question. You know, last quarter you mentioned kind of a big delta in telemedicine utilization between neurology and psychiatry. How do you kind of think about this utilization evolving over the next year or two and the impact this could have on the growth trend? Thank you.

Yeah, the dynamics with regards to telemedicine, I think, have been relatively stable over the past year or two. And there is a pretty significant difference between psychiatry and really all other specialties within our healthcare system.

Early in the pandemic, we saw this significant jump in the use of telemedicine across both the neurology and the psychiatry segments. But as the environment improved and restrictions were lessened, patients started to come back into the clinics and so on, we saw that neurology went back towards its more historical levels of lessening.

of all visits being billed as telemedicine visits. And so, you know, we think that it's here to stay, that it has some staying power in psychiatry, even though COVID has diminished quite a bit. And the other dynamic I think that's important to note.

in psychiatry is really the expanded use of advanced practice providers in that segment. And so those two macro factors I think are important to understand what's happening in

in psychiatry in general and our psychiatry business in particular, telemedicine, which creates a little bit of challenge for some providers with diagnosing TD, though I think that we've adapted nicely to it in terms of helping providers understand how to screen for how to diagnose TD.

remotely when they're evaluating a patient via telemedicine. Then the important work that we're doing to educate new providers coming into psychiatry, nurse practitioners, physician associates, and so on. We continue to evolve as the market evolves, but the important thing is that the majority of patients

like Matt just mentioned, the importance of bringing in another factor. We continue to invest in DTC and DTC is one mechanism that we have to reach patients and care partners directly to motivate them to bring up their TD symptoms and to drive diagnosis.

All of these things I think are important as you think about future growth for the franchise, but the ceiling's high and we're continuing to see strong growth, and I think that our raised guidance reflects that.

We will take our next question from O.E. Ear with Mizzou. Your line is open. Hey, guys. Thanks for taking my question. I might have missed it, but could you tell us what the volume growth rate is for Ingressa in the quarter?

And could you also speak to the, provide some more color on the neurology, the psychiatry, and the long-term care in terms of contributions to this quarter cells and growth rates? Thanks.

So when you think about volume growth, it was incredibly strong. From a dollar perspective, you had about a 20% or 26% year-over-year growth, which was quite nice. And as I said earlier, we did have the bleed of inventory that's also reflective in the number that we reported.

When we have addressed all the questions in the queue, I would now like to turn the program back over to Kevin for any additional or closing remarks.

Thank you very much and thank you for all your questions this morning. I'm just going to close with the fact that

Some of you may become a bit too used to Ingressa just growing quarter after quarter. And while we see this growth continuing, we never take it for granted. This is a tremendous amount of hard work that goes in from our entire sales marketing team, the medical team.

efforts. And yet we see no slowdown in this. That is just incredible. And we are a very fortunate company to have a product like this. They do not come along very often. But what you do see for the rest of this year is a number of other extremely important.

potential medicines in our pipeline. I'm not sure that there's any company out there that has the number of phase 2 and phase 3 trial readouts coming in the next six months as we do. And if you extend it out into the first half of next year, it nearly doubles.

So there's a tremendous amount of information that we're going to be generating in just the next few months. And we very much look forward to talking to you about all these. This company is actually hitting on all cylinders right now. We're always looking for a way to improve and we continue to look for ways to improve our business.

but I couldn't be more happy with the way the company is running at this point. So with that, I'll sign off and look forward to talking to all of you in the near future.

company is running at this point. So with that, I'll sign off and look forward to talking to all of you in the near future.

This does conclude today's program. Thank you for your participation. You may disconnect at any time and have a wonderful day.

I'll see you again soon.