Q2 2023 TELA Bio Inc Earnings Call
Okay.
Good afternoon.
Ladies and gentlemen, and welcome to be Tela Bio second quarter 2023 earnings conference call. At this time, all participants are in a listen only mode.
A question and answer session will follow the formal presentation.
As a reminder, this conference call is being recorded and I would now like to turn the conference over to Luisa Smith from the Gilmartin group.
Thank you, Chris and good afternoon, everyone earlier today Tela Bio released financial results for the second quarter 2023, the copy of the press release is available on the company's website. Joining me on today's call are Tony <unk>, President and Chief Executive Officer, and Roberto Cooker.
Chief operating officer, and Chief Financial Officer.
Before we begin I'd like to remind you that during this conference call. The company may make projections and forward looking statements regarding future events.
We encourage you to review the company's past and future filings with the SEC, including without limitation. The company's annual report on Form 10-K, and quarterly reports on Form 10-Q, which identify the specific factors that may cause actual results or events to differ materially from those described in these.
Forward looking statements.
These factors may include without limitation statements regarding product development and pipeline opportunities.
Potential the impact of various macroeconomic conditions, including the COVID-19, pandemic recessionary concerns banking instability and inflationary pressures the regulatory environment sales and marketing strategies capital resources or operating performance.
I'll now turn the call over to Tony.
Thank you Luisa.
Good afternoon, everyone and thanks for joining us today for our second quarter 2023 earnings call.
We are pleased to report another quarter of strong financial results.
Operational execution.
As you will hear we continued to deliver on our financial goals and advance our key initiatives.
Total revenue for the second quarter was $14 5 million representing growth of 39% year over year, which significantly outpaced the growth of the markets in which we sell.
I'm happy to report, we are seeing an improving sales environment as procedure volume and elective surgery demand is up.
In the second quarter, we saw strong hernia cells, which may reflect the first steps towards addressing the tens of thousands of procedures delayed during the coding COVID-19 pandemic.
So that bodes well for a solid second half of continued high growth.
This afternoon's call as always I'll provide an update on the progress we are making with the key drivers of revenue.
And revenue growth that we referred to as the five factors then I'll ask Roberto to provide further color on our financial results before we open the line for your questions.
Let me begin with GPO access tell.
<unk> now has contracts with three national group purchasing organizations. These agreements streamline the process by which a surgeon can choose to use our overtaxed products by providing access right off the supply room shelf.
Other than the surgeons, having to go through and administratively burdensome utility utilization committee process.
We recently entered into a four year contract extension with Healthtrust, which as you may recall with our first GPO.
The original term of three years began in 2020, just as COVID-19 pandemic began.
Impacting the health care system.
Notwithstanding the significant headwinds we were able to demonstrate the value of our products to the hospital served by Healthtrust, which led to the extended contract term of this renewal.
Our second GPO contract with Premier, which became effective on October one 2022.
As the second largest GPO in the country. It granted us access to over 4400 hospitals. We are pleased with the progress we've made in ramping up premier in Q2, and it is already an important contributor to our revenue performance.
Our most recently signed third GPO is structured as a dual source contract and the biosynthetic category.
This means that we compete with only a single alternative supplier in the system, which is highly compliant with the contractual product offerings.
<unk> III GPO contracts together cover over 6000 hospitals, providing significant access to our sales representatives.
This leads us to two more of our revenue driving factors Salesforce size and sales force productivity.
GPO contracts give us access to hospitals across the country, but we can only convert this access into sales by our representatives, who can call on and educate the physicians in those hospitals.
In order to capitalize on the figure to a hunting license that contracts represent we've been meaningfully expanding the size of our sales force we have in the field targeting those geographies with the greatest GPO opportunity as of today, we have 75 sales reps on board against the year end target of $75 to $80.
Reps, we have continued to invest in the training of our sales force through our playbook 90 program. So that they are comfortable representing all of our products in our portfolio. We continue to revise and improve our training system with the result that our most recent cohorts of hires have reached breakeven profitability in six months or less.
Less than.
Another important factor underlying revenues and their growth is our continued development of clinical data.
The compelling results of our studies of Overtaxed. It played an important role in our ability to take share from older technologies Surgeons are impressed with the exceptionally low recurrence rate of two 6% that <unk> exhibited in our Bravo study compared to the double digit figures that competitive products show.
We're continuously growing our dataset and initiating studies to support physicians and patients in their consideration of Overtax. We also continue to enroll patients in our Bravo to study, which captures data on the effectiveness of <unk> when used in robotic procedures.
As the use of surgical robotics systems in general surgery continues to grow.
And with 45% of <unk> hernia was implanted robotically and the most recent quarter for which data are available. We expect that results from Bravo. Two study will be a great use of physicians and patients and making treatment decisions.
In addition to collecting clinical data, we also study consumer behavior and interest in hernia treatment matters.
The study among consumers that we recently conducted we found that there was significant concern over using permanent synthetic mesh and a strong desire for surgeon expertise and innovative more natural solutions.
Highlight of the study showed that 70%, 77% of consumers, who had a permanent plastic mesh repair would prefer a more natural repair option for subsequent areas requiring surgery. Additionally.
Additionally.
95% of all respondents considered important or very important for their doctor or surgeon to be current with top innovations in medical care there.
The results of this study are indicative of the critical role that patients and their health care decisions and are at the heart of <unk> mission to optimize soft tissue restoration and preservation the.
The impressive set of data we've collected supports both patients desire for a more natural repair product and encourages surgeon confidence to choose overtaxed in future surgeries.
Last factor is our product portfolio, we strive to assemble a range of products that leverages, our current call points to drive expansion in the soft tissue market. We do this through our internal R&D efforts and through external business development activities.
We've already announced several new products in 2023, including two larger configurations of the overtaxed LPR products for use in ventral and infusion of Hernias and minimally invasive surgeries and five 10-K clearance for <unk> long term resorbable or LTR and plastic and reconstructive surgery.
<unk> is committed to creating a broad portfolio that delivers next generation soft tissue preservation and restoration solutions and meets the varying needs of surgeons and patients we look forward to announcing future portfolio offerings and developments as they become ready for commercialization.
Continued execution of these five factors will drive meaningful sales growth and create value for the company and its owners, particularly in an improving procedure environment. We are highly optimistic about delivering a strong second half given where we are today with that I'll turn the call over to Roberto for more details.
On our third quarter financial results.
Thanks, Tony.
Tony mentioned earlier revenue for the second quarter increased 39% year over year, and 22% sequentially over the first quarter to $14 $5 million.
During the second quarter <unk> revenue grew 43% year over year and Prs grew 31%.
Gross margin was 70% for the second quarter and was driven by the cost of goods or product actually sold within the quarter as well as amounts reserved for expected exploration of inventory purchased within the quarter, whether or not sold within the quarter.
This strong showing was driven by slightly lower than expected inventory purchases in the second quarter as well as our ongoing inventory management and dynamic inventory redeployment efforts.
Sales and marketing expense was $14 6 million in the second quarter of 2023 compared to $11 $1 million in the same period in 2022.
The increase was mainly due to higher compensation costs as a result of the expansion of our commercial organization higher travel and consulting expenses and additional employee related costs due to increased head count, particularly in our customer facing roles.
General and administrative expense was $3 $5 million in the second quarter of 2023 compared to $3 $6 million in the same period in 2022.
R&D expense was $2 $5 million in the second quarter of 2023 compared to $2 1 million in the same period last year.
Loss from operations was $10 $4 million in the second quarter of 2023 compared to $10 2 million in the prior year period.
Net loss was $10 $8 million in the second quarter of 2023 compared to $12 $7 million in the same period in 2022.
We ended the second quarter was $65 $3 million in cash and cash equivalents after conducting a public offering in mid April .
Regarding the remainder of 2023, we continue to expect full year revenues to be in the range of $60 million to $65 million representing growth of 45% to 57% over the full year 2022.
I'll now turn the call back to Tony for closing remarks.
Thanks Roberto.
First I'd like to thank all on the <unk> team, who helped deliver another excellent quarter.
We are thrilled with the strong start to 2023 and believe that our momentum will continue for the remainder of the year the.
The synergies of all five factors coming together lends itself to some exciting catalysts in the coming period, and we believe we're in a position to drive topline growth capture competitive market share and expand our portfolio with new soft tissue preservation and restoration technologies.
As a result of the offering in April our balance sheet is well suited to support our dynamic growth and strategic initiatives.
I'll finish by simply saying we are still in the early days of a $1 billion plus market opportunity, but our strategy is working and we are capitalizing on it.
I'll now ask Chris to open the line for your questions. Chris go ahead.
Thank you.
To ask a question. Please press star one on your phone and wait for your name to be announced political your question. Please press star one again.
One moment, please while first question.
And our first question will come from Michael Sarcone of Jefferies. Your line is open.
Good afternoon, and thanks for taking the question.
Just to start you talked about strong hernia sales.
Mentioned that this could be the first step in addressing the backlog the procedure. So I guess can you just give us an update on.
Where that backlog stands maybe how you size it and the potential for that conversion to drive growth and maybe also comment on what kind of visibility you have there.
Sure Michael.
This is Roberto <unk>. So the way we have calculated or estimated the backlog as we have used market data on the total number of hernia procedures per period, so by quarter or month pre COVID-19, we mapped out the expected trajectory given that this is a population base.
Procedure.
There really shouldn't be much growth beyond the growth of the population and then we looked at the actual.
Ported procedures post the beginning of COVID-19, and essentially calculated the area between those two curves to estimate the.
The backlog.
We then checked our thinking and approach with a couple of <unk>.
Hospital industry executives that we know and control what's on occasion, who.
It said that they estimated things the same way roughly a 100000 procedures.
And as we've said in the past.
You don't dig into or cut down that backlog unless youre doing procedures at a rate higher than the pre COVID-19 procedure rate. So we don't think we're there yet, but we think that the procedure rate has gone up over more recent periods. It's the most recent couple of quarters and we're beginning to at least slow down.
The rate of accretion into that backlog.
Yeah, Michael our penetration is so low that has plenty of market for us to grow into which we have demonstrated.
Our ability to do so.
Over the last couple of years in the Covid period, so increasing procedure volume will do nothing but help us and it's actually a benefit if this.
Backlog unwind over a long period of time it allows us to harvest that for the next couple of years, which which is advantageous for us.
Alright, thanks for that and I guess, just a quick follow up on that one.
Do procedures stand today versus pre COVID-19 levels.
So we estimated that about.
About a year ago procedures, we're around 85% to pre COVID-19.
Guessing, they're somewhere between 90 and 95% of pre Covid levels now.
Okay. Thanks.
One more for me and I'll hop back in queue and one of your competitors.
Working through some disruption can you talk about your ability to capitalize on that.
And are you seeing more competitive account wins or more conversion given this disruption.
Sure.
Yeah, I'll take that one Michael so.
The product in question has been around for a long time, it's what I would consider an old school first generation biologic material and I think most of the user base.
It tends to skew a bit older.
That's not to say, it's 100%, but a bit older.
In terms of hernia procedures, the product is pretty much niche in the most complicated AB wall reconstruction and then it certainly used.
In our plastic and reconstructive procedures as well.
So the accounts, we have found are spread across the U S and are quite patchy. So although the revenue volume is estimated to be about $40 million between those two procedures.
It is patchy and infrequent right windows when those procedures come in so we benefited a little bit I think from from the situation, but not all that much on the hernia side.
I think our product has the.
The reputation of being a universal hernia product right, it's reinforced with a little bit of polymer suture, whether permanent or resorbable for reinforcement.
46% of our procedures are being done Robotically right now.
And 60% of our procedures are being done both robotically and Laparoscopically.
So we're being used across England, all high eight oz simple events roles and complex AB wall and I think these older generation surgeons that are more tied to first generation biologics.
Probably will reach for a another pure biologic product that's older.
Before they reach for our product given that our product is being known as a more broadly used technology.
So yes, we are picking up some here and there.
But it's not going to be a big conversion I think we are actually marketing and functioning in a much wider piece.
Piece of the market.
So I think that's where we want to be and the trade off of directing our reps to chase. These other procedures versus sticking to our knitting and sticking to our plan is a tradeoff that we evaluate in every territory as the situation comes up most of the time, our preference is to grow our business.
For the long haul for durability.
And then keep in mind as well that way.
We get a situation where the product that's recalled as need a replacement there has to be a match up that we have a contract we have access and we haven't wrapped there and that just doesn't happen all the time given the size of our footprint right now and again chasing versus executing is is.
The way, we think about it Michael.
Got it that's really helpful. Thank you.
Thank you.
And one moment please for our next question.
Our next question will come from Frank <unk> of Lake Street Capital markets. Your line is open.
Great. Thanks for taking my questions I was hoping to start with one on <unk> I think in previous calls you've talked about healthtrust specific composition of revenue.
Understanding it's going to be a little bit more challenging but was hoping you could talk about what kind of growth was driven from the three GPO is in aggregate versus growth outside of GPO.
Yes so.
I think from a percent of revenue perspective.
We went from mid to high 30% of revenue at.
At Healthtrust to approaching 60% of our revenue is now from these.
From these GPO.
So the growth is stronger within the GPO footprint.
Also approaching about 60% I would say, but the real story is that we are executing across the entire universe right. So.
Our first priority is implementation into the new GPO and really they're all three new at this point given the health Trust renewal, but we also have a really strong system and process for getting into non GPO <unk> and systems.
We are active and doing very well in both sectors I think we're going to see a pickup within this GPO organization since we're really early days.
All three and I think these implementations are going to take us through the rest of this year and maybe through the rest of next year and beyond these are big systems. They are bureaucratic and the opportunity is quite large so there's a lot for us to harvest here for the long haul as one of our five.
Factors, but we've grown significantly.
From the one GPO just as.
As measured from about a year ago to now.
Got it that's helpful. And then maybe in the back half of the year growth expectations in the hernia versus Prs I know that prs hadn't been outpacing hernia for a little bit it sounds like hernia has been a little bit stronger as of recently so just trying to understand how you guys are thinking about growth from hernia.
Prs as you close out the year.
Sure so.
<unk> grew 43% year over year Prs grew 30, 31% year over year.
A lot of that though.
Lower gross number from Prs had to do with the last year's second quarter. So second quarter revenues for Prs last year were $3 4 million, which was the highest prs quarter of the year.
Just for ins and outs reasons. So it was a tough comp on the growth.
Perspective.
So we do expect that notwithstanding that that it's likely the prs will return to being larger grower certainly for the year overall and likely for the second half.
Okay, and then last one.
Sorry go ahead Tony.
Alright, you said both are going to be strong just to put point on it.
Perfect and then last one from me on the gross margin good to see that hit 70% how should we be thinking about gross margin profile for the back half of the year.
So.
As we pointed out gross margin will bump around depending on how we order. So when we build inventory when we buy any of them before you actually we take a charge reserve for that.
Purchased inventory in the quarter in which we buy it for all potential exploration or destruction of the product subsequent to that quarter.
So the two quarters of this year have been a little bit smoother as far as the amount of inventory that we ordered.
Win them.
But we do expect some bumping up and down so it's going to be somewhere between the 66% that we saw in the first quarter and the 70% that we achieved in the second quarter.
Okay sounds good thanks for taking the questions and congrats on all the progress.
Thank you.
One moment please for our next.
Question.
Our next question will come from the line of Matt O'brien of Piper Sandler Your line is open.
Hey, this is Phil on for Matt Congrats on the great quarter and thanks for taking my question for starters I guess as it relates to guidance can you help us understand the decision to keep the range.
I think it implies growth of 47 to about 70% in the back half.
So just help us understand what gives you get to the top and bottom of that range.
Sure so.
It is a wider range for half of the year, but.
There is still some uncertainty around.
The COVID-19, and its impact on the quarters.
And frankly, the steps up that will be taken in the third and fourth quarters to achieve that 60 to 65 range a reasonably large and you could see some lagging over from the third to the fourth quarter or some acceleration for the fourth the third.
So to give ourselves room, we've just kept it at the same range.
That's helpful and I guess, a multi parter here on <unk>.
I think about help trucks, then how COVID-19 impacted your ability to penetrate into that account during that first contract with them versus where you currently are with that account now.
Where do you think.
Penetration currently stands and where do you think it can get to is that going to be a meaningful tailwind Phil just on the first GPO and then any color on the third GPS, which I believe you started April one.
So.
Phil I would say, we're very early days in terms of penetration even with healthtrust right. So during the Covid period, we probably only had.
I Dunno 16, 18 months of implementation time.
Given the big ups and down with the pandemic.
And we still got to buy.
30%, 35%, 36% of revenue coming out of Healthtrust Healthtrust is made up of a whole bunch of systems known as shareholders. We have really only implemented partially into the HCA component of healthtrust. There are many other.
Shareholders and systems under health trusts that we haven't really touched yet.
I think with a four year run there is a there's a heck of a lot of.
Ceiling for us to work with there not just in HCA component of health trusts.
But in all the others as well whether its tenant Stuart.
All the rest of the bigs that are part of healthtrust. So I feel like that's going to be a great source of growth for us.
The third GPO.
Has essentially gone from nothing to triple roughly in terms of raw dollars and we really didn't start implementing there until April or so which is which was by their instruction and design. So there is a heck of a lot of room for us to grow in the third GPO as well we are just <unk>.
<unk> out there.
Then on the Premier side, that's already become our second largest source of revenue.
And that's coming along very nicely and we're in the very early stages, we are very underpenetrated.
You're penetrated in.
Premier, but that's grown very very well since the end of last year.
So I think we're very early days on all fronts and youre going to see the GPO contribution in raw dollars.
Queued up it may shoot up.
A little slower than the growth rate, perhaps given the fact that we're really good executing at Ics and systems that are part of depots, but.
A lot for us to work with and we're very bullish and optimistic that thats a strong piece of what we're going to do here and we're putting reps in the right places to take advantage as well.
Very helpful. Thanks, so much.
Thanks Bill.
Thank you.
One moment please for our next question.
Okay.
Our next question will come from David Kelly.
MTGE Securities Your line is open.
Hey, good evening.
Turning to I was wondering if you might make a comment on that.
So as you've seen.
Pricing asps.
On either side of the business.
<unk> mix from either larger sheets or.
Anything like that that might have contributed to the hernia side being as strong as it was.
Yes, hernia side was volume.
We have not taken a price increase.
We've rolled these products out.
Our strategy is to offer a tremendous value proposition with superb clinical data and performance for patients and a good value for systems.
We believe this is the right pathway until we have a very complete.
Array of GPO.
There is some more that we want to engage with and win contracts. So we're going to keep our pricing.
Pretty much where it is.
And then the discounting that we're showing at the GPO isn't isn't.
Crippling either.
We've priced the product great fair from a list price level.
And the cost savings that are that are.
Doable by the GPO do not require huge discounting and everyone's happy so we're going to stick with that for now I think for us its topline growth, it's getting access it's validating our technology and its a lot and it's driving the clinical data into situations, where people are anxious to listen to us.
We think that's the best approach.
Approach for now it doesn't mean, we might not.
It takes some price increase in the future, but for now our asps have been pretty steady and we're still hovering around $3000 plus or minus a little bit on hernia.
And about $5000, plus or minus a little bit on Prs.
No.
Nothing really has changed from an ASP perspective, which implies just raw growth across the spectrum, it's not just big pieces or it's not just.
Thing here or there that's making this go its consistency which is good for the long haul.
Great Thanks for that.
Sure.
I know you're aware of it.
A competitor out there that's looking for.
Labeling for <unk>.
Specifically breast so I'm just curious what are your thoughts on Prs.
Prs in that landscape.
Thank you.
If that occurs.
No.
How do you view that if that is coming in the next couple of years.
We have our own program going right. So we're.
We're in the process of completing some large animal models that are designed to get us into the IV gain.
We are collecting a solid good size amount of retrospective clinical data.
<unk> will allow us to retrofit our curve fit into whatever the situation.
That emerges with an FDA decision, one way or the other.
And we have a wide array of programs. After that that include anything from continued retrospective collection of data.
Surgeon engaged studies and IV studies, so we're in the game, Dave and we intend to.
To be part of that dialogue over time.
Right now we feel like it makes sense given the.
The chaotic nature of this to figure out exactly what the best pathway is base.
Based on how it breaks with an FDA decision.
And what we've chosen to do is have all of those.
Activities moving forward, so that we can pick and choose from our menu whatever best fits what happens with the decision.
Great. Thank you.
Okay.
Thank you.
One moment. Please go to our next question.
Our next question will come from the line of Kyle Rose of Canaccord Genuity. Your line is open.
Hey, this is George on for Kyle I have a couple of questions. So the first one concerning reps.
So you noted that you have about 75 reps currently.
What how should we think about cadence in terms of rep adds towards the back half of 2023, and then maybe a little bit on like.
What territories Youre looking to expand into.
Sure. Thanks George.
So we as we said at the beginning of the year. Our goal is to get to $70 70, 75% to 80 reps by the end of the year, obviously being at 75 reps today, it should not be that difficult for us to get to 80, although I will point out that.
As we bring in new reps some of them will exit.
So it's not just five that were maybe needing to recruit to get to that 80.
We've also talked about the fact that if we identify more than 80 reps that we feel like would be good fits here, we would be willing to go beyond the 80.
So we'll continue hiring at the same rate that we have so far.
And could get beyond that 80 before the end of the year, but we.
Feel pretty confident about getting to pretty close to 80% if not a bit over.
What I'll add to that too George is that.
Of the 75 that we have now.
I think approximately seven or so have just been hired in the last week or so.
So we were in the high <unk> really for the bulk of the quarter and I think that speaks very strongly to the productivity. That's capable here and we very much look forward to having the 75 reps be more impactful in the second half of the year and as Roberto said, maybe even beyond we're not going to really lay out where we.
We're hiring the reps.
For competitive reasons, but it's generally where the three GPO is have strong footprint, it's almost all over the country. At this point. So we're very optimistic that of the five factors.
Both rep productivity and the head count are heading in the right direction for the second half and beyond.
Great Awesome.
And then just my other question would be on the long term resorbable product.
Okay.
Where are you at in terms of the rollout of that product and then.
Because of that <unk> based product is that included in the current GPO distribution strategy or is that something that will have to be negotiated later.
We've done a nice job of.
Updating the contracts.
As.
After we got the five 10-K clearance.
We are in the process of rolling out the product to about 50 early users.
We're about two weeks into that process and.
We really like what we're seeing so far I think it's going to be a great contributor.
In the second half and beyond and we should be in a position from an inventory perspective, and an experience perspective.
To turn this wide open.
At some point in the third quarter. So we look forward to strong contribution from Prs L. P. R.
Almost immediately I would say.
Thank you.
Okay.
George.
One moment. Please our next question.
Yeah.
And we have a follow up from Michael Sarcone of Jefferies. Your line is open.
Hey, Thanks for taking the follow up just just one last one for me really a question about 2024.
You mentioned, it's still very early days on all front and the GPO contract plus Youre rolling out new products through 2023.
Plus you are building out.
Through 2023, so when I looked at 'twenty four you'll have the benefit of a full year of all three GPO and the full year of that larger base and then a full year of new product. So.
So for 'twenty, three year guidance of $20 million to $25 million.
Absolute dollar increase versus the prior year is there any reason why 2024 should it be higher than that.
On an absolute dollar increase basis higher than that 20 to 25 youre expecting in 2023.
So we haven't provided guidance on 2024, yet but.
What I would add to what you described.
For the effects of 'twenty 'twenty four is that we may continue to hire reps in 2024 as well.
So we'll continue.
Continue to fuel the growth from those reps with annualized 2024, but also potential additional growth from new reps in 2024.
So we think theres a lot of opportunity.
We talk about us being in the low single digits as far as new use.
Sure.
These markets. So there's a lot of possibility for us.
Okay. Thank you.
Michael Thank you.
Thank you.
And this will end the Q&A session for today's call I would now like to turn the conference back to Tony <unk> for closing remarks.
Hey, Nicole.
I will see you next time.
Yes.
This concludes today's conference call. Thank you all for participating you may now disconnect and have a pleasant day.
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