Q1 2024 Alimera Sciences Inc Earnings Call
Operator: Ladies and gentlemen, thank you for standing by. Good morning and welcome to the Almera Sciences first quarter 2024 Financial Results and Corporate Update conference call. At this time, all participants are in a listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then 1 on your touchtone phone.
Ladies and gentlemen, thank you for standing by good morning, and welcome to the Almere Sciences first quarter in 2024 financial results and corporate update conference call.
Speaker Change #120: At this time all participants are in a listen only mode should you need assistance. Please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions to ask a question. You May Press Star then one on your Touchtone phone to withdraw your question.
Operator: To withdraw your question, please press star, then 2. Participants on this call are advised that the audio of this conference call is being broadcast live over the Internet and is also being recorded for playback purposes. A webcast replay of the call will be available approximately one hour after the end of the call through August 14, 2024. I would now like to turn the call over to Scott Gordon of CoreIR, the company's investor relations firm. Please go ahead, sir.
Speaker Change #122: Jim Please press Star then two.
Speaker Change #109: Participants on this call are advised that the audio of this conference call is being broadcast live over the Internet and is also being recorded for playback purposes.
The webcast replay of the call will be available approximately one hour. After the end of the call through August 14th 2024, I would now like to turn the call over to Scott Gordon of core I or the company's Investor Relations firm. Please go ahead Sir.
Speaker Change #124: Thank you operator.
Scott Gordon: Good morning, and thank you for participating in today's topic. Joining me from Alimera's leadership team are Rick Eiswirth, President and Chief Executive Officer; and Elliot Maltz, Chief Financial Officer.
Scott Gordon: Good morning, and thank you for participating in today's conference call.
Speaker Change #119: Joining me from Alan There is leadership team.
Smith: Hi, Smith, President and Chief Executive Officer.
Elliot malls, Chief Financial Officer, Todd Wood, President U S operations.
Scott Gordon: Todd Wood, President of U.S. Operations; Philip Ashman, President
Speaker Change #117: Ashley President International operations.
Scott Gordon: and International Operations. During this call, management will be making forward-looking statements, including statements that address Alimera's expectations for future performance or operational results, future financial position, outlook, and guidance, and timeline for achieving positive cash. Forward-looking statements involve risks and other factors that may cause actual results to differ materially from those stated. For more information about these risks, please refer to the risk factors described in Alimera's most recently filed periodic reports on Form 10-B.
During this call management will be making forward looking statements, including statements that address all of them as expectations for future performance or operational results.
Speaker Change #109: Our financial position and outlook and gotten some timeline for achieving positive cash flow.
Speaker Change #109: Forward looking statements involve risks and other factors that may cause actual results to differ materially from those statements.
Speaker Change #109: For more information about these risks please refer to the risk factors described in our mirrors. Most recently filed periodic reports.
Scott Gordon: Thank you for joining us on Form 10-Q, the Form 8-K filed with the FCC today.
Speaker Change #109: Form 10-Q or form 8-K filed with the SEC today.
Scott Gordon: and the Form 10-K filed with the SEC for the year ended December 31, 2023, as well as Alimera's press release that accompanies this call, particularly the cautionary statements therein. Today's conference call will include references to adjusted EBITDA, which is a non-GAAP financial measure. Please see the explanatory language and reconciliation table located in Alimera's earnings press release that accompanies this call. The content of this call contains time-sensitive information that is accurate only as of today, May 14, 2024. Except as required by law, Alimera disclaims any obligation to publicly update or revise any information to reflect events or circumstances that occur after. It is now my pleasure to turn the call over to Rick Eiswirth. Rick, please go ahead.
Speaker Change #109: And the Form 10-K filed with the SEC for the year ended December 31, 2023, as well as Alamos press release that accompanies this call, particularly the cautionary statements there is.
Alamos: Today's conference call will include references to adjusted EBITDA, which is a non-GAAP financial measure. Please see the explanatory language. The reconciliation table located in <unk> earnings press release that accompanies this call.
Speaker Change #109: The content of this call contains time sensitive information that is accurate only as of today may 14th 2024.
Speaker Change #115: Chapter as required by law, Hello, marrow disclaims any obligation to publicly update or revise any information to reflect events or circumstances that occur. After this call.
Speaker Change #121: It's now my pleasure to turn the call over to Brett Hi, Greg. Please go ahead.
Yeah.
Richard S. Eiswirth: Thank you, Scott, and good morning to everyone on the call. We experienced a very good first quarter, aligning with our internal expectations. As we continue to see the benefits of integrating UTIC into our U.S. portfolio, we're also seeing excellent growth in both our international distributor markets as well as some of our key direct markets in Europe. In Q1, our consolidated global net revenue increased 70% over Q1 2023 to $23 million, driven primarily by the acquisition of Boutique and growth in global end-user demand, 23% on a pro forma basis.
Speaker Change #114: Thank you Scott and good morning to everyone on the call.
Greg: We experienced a very good first quarter, along with our internal expectations.
Greg: As we continue to see the benefits of integrating your cheek in our U S portfolio. We're also seeing excellent growth in both our international distributor markets as well as some of our key direct markets in Europe.
Greg: In Q1, our consolidated global net revenue increased 70% over Q1, 2000 $23 million to $23 million.
Greg: Driven primarily by the acquisition of beauty and growth in global end user that 23% on a pro forma basis.
Richard S. Eiswirth: You may note that this revenue is below that for Q4 2023, but this seasonal decline is anticipated each year as patient deductibles are reset and physicians resubmit their benefit verifications, lowering the utilization of higher-priced products like Q-Teq and Illuvia. As we communicated last quarter, we are now generating positive adjusted EBITDA on a quarterly basis, achieving $1.8 million in Q1 2024 versus an We reiterate our confidence in achieving $105 million in revenue and at least 20% adjusted EBITDA margins this year.
Greg: You May note that this revenue is below that for Q4 2023, but this seasonal decline as anticipated each year.
Greg: Patient deductibles are reset and physicians resubmit their benefit verifications lowering the utilization of higher priced products like you've taken a look.
Greg: As we communicated last quarter, we are now generating positive adjusted EBITDA on a quarterly basis.
Greg: Leaving $1 8 million in Q.
2024 versus an EBITDA loss of $2 4 million in Q1 'twenty three.
Greg: We reiterate our confidence in achieving $105 million in revenue and at least 20% adjusted EBITDA margins this year.
Richard S. Eiswirth: As I mentioned before, we do expect our revenue to fluctuate quarter-to-quarter due to the seasonality of our business. Adjusted EBITDA will also fluctuate quarter-to-quarter due to this seasonality, as spending is more consistent on a quarter-to-quarter basis.
As I've mentioned before we do expect our revenue to fluctuate quarter to quarter due to the seasonality of our business.
Greg: Adjusted EBITDA will also fluctuate quarter to quarter due to this seasonality.
Greg: Spending is more consistent on a quarter to quarter basis.
Richard S. Eiswirth: In our U.S. segment, net revenue in Q1 2024 increased 92% to $14.6 million versus $7.6 million in Q1 2023, primarily again due to the acquisition of UT. U.S. end-user demand for our products was up 96% in Q1 versus the prior year when including the addition of Boutique, and 2% on a pro forma basis. We believe that the growth of Alluvion and Utique in Q1 softened from integrating a combined two-product sales call. We've restructured the call plan to prioritize targets across current users and how that's all targeted, and enhance the level of effort against each product.
Greg: And our U S segment net revenue in Q1, 2024 increased 92% to $14 6 million versus $7 $6 million in Q1, 2023, primarily again due to the acquisition to be cheap.
Greg: End user demand for our products was up 96% in Q1 versus the prior year when including the addition of beauty and 2% on a pro forma basis.
Speaker Change: We believe that the growth of ILUVIEN in your teeth, and Q1 softened from integrating <unk>.
Speaker Change: Q2 product sales call.
We've restructured the call plan to prioritize targets across current users and how that's all targets.
Speaker Change: And enhance the level of effort against each product.
Richard S. Eiswirth: We are seeing improvement, as we've seen sequential growth in monthly end user demand for our products on an aggregate basis every month since December of last year. Furthermore, our U.S. sales team has been selling both Utique and Aleven for three quarters now, and we're starting to see the value of cross-selling the two products to accounts this quarter, as the percentage of accounts using both products has slightly increased from 26% to 28%. In order to accelerate the growth of our products, we're tightening our messaging decisions for both Illumina and UT.
Speaker Change: We are seeing improvement as we've seen sequential growth in monthly end user demand for our products on an aggregate basis every month since December of last year.
Further our U S sales team has been selling bulky tea and are leaving for three quarters now and we're starting to see the value of cross selling the two products door counts in this quarter.
Speaker Change: The percentage of accounts using both products are slightly increased from 26% to 28%.
Speaker Change: In order to accelerate the birth of a products, we're tightening our messaging decisions for both live and any cheap.
Richard S. Eiswirth: For Lubion and DME, we are reframing the value proposition, linking the severity of disease to retinal fitness variability, as this concept is catching on with retina specialists and is being utilized by our competition. If the swelling in the retina is allowed to recur as acute treatments wear off, it can lead to permanent retinal damage and vision loss over time. The sooner the retina can return to a healthy level, and the more consistently it can stay there, the better the opportunity to improve and save vision.
Speaker Change: For ILUVIEN and <unk>, we are refining the value proposition Linton.
Speaker Change: Clinton the severity of disease, the retinal thickness variability.
retinal specialists: This concept is catching on with retinal specialists and being utilized by our competition.
retinal specialist: Yes, the swelling in the retina is allowed to recur as acute treatments, where all it can lead to permanent retinal damage and vision loss over time.
Speaker Change #132: The sooner the retina can return to a healthy level and the more consistently can stay there the better opportunity to improve and save lives.
Richard S. Eiswirth: For UT, our sales team now has three-year data from the UT Pivotal LL1 study that illustrates the benefit of long-term control for chronic noninfectious uveitis affecting the posterior segment of the eye. It shows that the median time to the first recurrence of uveitis is over 1,000 days for the UT patient, while it's less than 100 days for the sham patient, a substantial benefit.
Speaker Change #123: Our U T. Our sales team now has the three year data from the pivotal L. One study that illustrates the benefits of long term control for chronic non infectious uveitis affecting the posterior segment.
It shows that the medium time, so the first recurrence of uveitis is over 1000 days pretty cheap patient.
Speaker Change #130: Well, it's less than 100 days for the same patient.
retinal specialists: Substantial benefit.
Richard S. Eiswirth: Turning to our international business, we are pleased with our continued momentum to begin the year. In Q1 2024, international net revenue grew 42% to $8.5 million, driven by a 53% increase in user demand. We continue to see growing utilization in the UK, Portugal, Ireland, Spain, and France. In March...
retinal specialists: Turning to our international business, we are pleased with our continued momentum to begin the year.
In Q1, 2024 International net revenue grew 42% to eight $5 million driven by a 53% increase end user demand.
retinal specialists: We continue to see growing utilization in the U K, Portugal, Ireland, Spain and France.
retinal specialists: In March.
Richard S. Eiswirth: The UK National Institute for Health and Care Excellence, or NICE, issued final guidance stating that the Plucenilin Acetamide intravitreal implant is recommended for treating visual impairment caused by chronic diabetic macular edema, irrespective of lens size. What this means for us is that now fake patients, or those that have a natural lens, now have access to Illuvia. NICE reimbursement has to date been limited to only pseudothapic patients or those that have undergone cataract surgery.
UK National Institute for Health and care excellence or nice issued final guidance, stating that the fusin alone not interdigital implant is recommended for treating visual impairment caused by chronic diabetic macular edema.
retinal specialists: Irrespective of one site.
Speaker Change: What this means for US is that now taking patients are those that have a natural lens now have access to ILUVIEN.
Speaker Change: Nice reimbursement to date has been limited to only pseudo basic patients are those that had undergone cataract surgery.
Richard S. Eiswirth: This is a significant expansion of our potential user base among the chronic diabetic microedema or DME patient population. According to the U.K. Immaculate Society, safety patients represent up to 75% of the broader D&E population in the United Kingdom. We expect the availability of this water reimbursement to positively impact utilization in the UK in the second half of 2024. NICE guidance can also impact reimbursement in other countries, such as Spain and Italy.
nice: This is a significant expansion of our potential user base among the crime chronic diabetic macular edema or do you need patient population.
Speaker Change: According to the U K macular society, making patients represent up to 75% of the broader <unk> population in the United Kingdom.
Speaker Change: We expect the availability of this water reimbursement to positively impact utilization in the U K in the second half of 2024.
Speaker Change #128: Nice guidance can also impact reimbursement in other countries, such as Spain and Italy.
Richard S. Eiswirth: We believe that this positive decision, if adopted in other markets, will broaden our potential patient base in these countries as well. I would now like to highlight the continued progress and key milestones we achieved this quarter in our clinical trial. We reached the enrollment target for the Phase 4 Open Label Synchronicity Study in January that we inherited from iPoint just a few months after our acquisition of UT. This study, which we'll read out in the second half of next year, will provide retina specialists with a broader sense of the utility of our Fucinilum acetinide implant across a variety of patients with chronic noninfectious uveitis affecting the posterior This will potentially benefit both UTIs in the United States and alleviate them in Europe and the Middle East.
We believe that this nice to Susan it's adopting another markets will broaden our potential patient base in these countries as well.
Speaker Change: I would now like to highlight the continued progress and key milestones, we achieved this quarter and our clinical trials.
Speaker Change: We reached the enrollment target for the phase four open label Synchronicity study in January that we inherited from odd point, just a few months after our acquisition of boutique.
This study, which will read out in the second half of next year, we'll provide retina specialist with a broader sense of the utility of our food similar set not implant across a variety of patients with chronic non infectious uveitis affecting the post your second maybe I also known as Niu PFS.
Potentially.
Speaker Change: This will potentially benefit the E cheap in the United States and are leaving it in Europe and the Middle East.
Richard S. Eiswirth: Additionally, we have three abstracts highlighting our UTEAC Column Registry Study presented last week at two meetings, the Association for Research and Vision in Ophthalmology, also known as ARBO, and the Retinal World Congress, all demonstrating that real-world safety and efficacy outcomes are consistent with the pivotal clinical trial outcome. Additionally, we were pleased to announce that the first patient has been randomized in the DRCR Retina Networks Protocol AL The study is titled A Randomized Clinical Trial evaluating intravitreal furosemide injections or flucinolone acetonide intravitreal implants versus observation for the prevention of visual acuity loss due to radiation retinopathy.
Speaker Change: Additionally.
We had three abstracts, highlighting our U T Com registry study presented last week at two meetings.
Speaker Change: Association for research in vision, and Ophthalmology also known as ARVO and the retinal World Congress.
Speaker Change: All demonstrating the real world safety and efficacy outcomes are consistent with the pivotal clinical trial outcomes.
Speaker Change: Separately, we were pleased to announce that the first patient had been randomized in the DRC, our retina networks protocol a L.
Speaker Change: The study is titled the randomized clinical trial.
Speaker Change: Evaluating interdigital personnel injections.
Speaker Change: I don't want to set nine individual implants versus observation for the prevention of visual acuity loss due to ration radiation retinopathy.
Richard S. Eiswirth: This study will assess the development of macular edema and associated long-term visual acuity effects of consistent and continuous release corticosteroids or repeated injections of anti-VEGF initiated near the time of radiation therapy compared to observation in patients at risk for radiation retinopathy. The study plans to include 600 patients with Primary Corridor Melanoma receiving treatment with plaque brachiotherapy. Over 40% of radiation retinopathy patients have been shown to experience the devastating vision loss associated with radiation retinopathy within three years of treatment. And currently, there are no FDA-approved pharmacotherapies for radiation retinopathy.
Speaker Change: This study will assess the development of macular edema.
Speaker Change: And associated long term visual acuity effects of consistent and continuous release corticosteroids are repeated injections of anti bad Jeff initiated near the time of radiation therapy.
Speaker Change: The opposite observation.
Speaker Change: Developing in patients at risk for radiation retinopathy.
Speaker Change: The study plans to include 600 patients with primary corridor melanoma.
Speaker Change: Treatment with plaque breaking up there.
Speaker Change: Over 40% of radiation retinopathy patients have been shown to experienced a devastating vision loss associated with radiation retinopathy within three years of treatment.
Speaker Change: Currently there are no FDA approved pharmacotherapy radiation retinopathy.
Elliot Maltz: And with that update, I'll now turn the call over to Elliot to review our first quarter financial results in greater detail. Thanks, Rick, and hello, everyone. We completed quarter one as we anticipated, delivering results expected from the street. Consolidated net revenue in Q1 2024 was up 70% to approximately $23 million, compared to $13.5 million in Q1 2023. Consistent with the seasonal business pattern we see in the first quarter of the calendar year, revenue is down versus the fourth quarter of 2023 as patients' insurance plans change, and practices resubmit benefits verification.
Speaker Change: And with that update I'll now turn the call over to Elliot to review, our first quarter financial results in greater detail.
Elliot Maltz: Thanks, Rick and Hello, everyone, we completed quarter, one as we anticipated delivering results expected from the street.
Elliot Malls: Consolidated net revenue in Q1, 2024 was up 70% to approximately $23 million compared to $13 5 million in Q1 2023.
Elliot Malls: Consistent with the seasonal pattern, we see in the first quarter of the calendar year revenue was down versus the fourth quarter of 2023 is patients insurance plans change in practices resubmit benefits verifications.
Elliot Maltz: Looking at our operational segments, U.S. net revenue increased 92 percent to approximately $14.6 million in Q1 2024, compared to $7.6 million in Q1 2023, driven primarily by the acquisition of U.T. End user demand in the U.S. for our fluocinolone implants was 1,968 units in Q1 2024, a 2% increase compared to Q1 2023 on a pro forma basis. International net revenue increased 42% to approximately $8.5 million in Q1 2024 compared to approximately $6 million in Q1 2023. The increase was driven primarily by end-user demand growth of 23% in our direct markets and a 72% increase in stocking shipments to our international distributors.
Speaker Change: Looking at our operational segments U S. Net revenue increased 92% to approximately $14 6 million in Q1 2024 compared to $7 6 million in Q1, 2023, driven primarily by the acquisition of boutique.
Speaker Change: And user demand in the U S for our fluid Standalone implants was 1968 units in Q1, 2024% to 2% increase compared to Q1 2023 on a pro forma basis.
Speaker Change: International net revenue increased 42% to approximately $8 5 million in Q1 2024 compared to approximately $6 million in Q1 of 'twenty three.
Speaker Change: The increase was driven primarily by end user demand growth of 23% in our direct markets and a 72% increase in stocking shipments to our international distributors.
Speaker Change: Total end user demand in our international segment was up 53% to 2016 units compared to Q1 2023 due to strong growth in our direct markets and solid performance from our distributors in France and Spain.
Elliot Maltz: Total end-user demand in our international segment was at 53% to 2,060 units compared to Q1 2023 due to strong growth in our direct markets and solid performance from our distributors in France and Spain. Now looking at the rest of our P&L, total operating expenses in the first quarter of 2024 were approximately $22 million, compared to approximately $14.8 million in Q1 of 2023. The increase was primarily attributable to $3.3 million of additional sales and marketing expenses driven by the expansion of our commercial infrastructure to support selling to products in the U.S., as well as $2.4 million in additional amortization expense attributable to the UTGAC acquisition in May of 2023, as well as a $1.3 million increase in general and administrative expenses relating to $700,000 of personnel costs and $0.5 million of stock-based compensation, Net loss was approximately $6.3 million in Q1 2024 compared to approximately $5 million in Q1 2023.
Speaker Change: Now looking at the rest of our P&L total operating expenses in the first quarter of 2024 or approximately $22 million compared to approximately $14 8 million in Q1 of 'twenty three.
Speaker Change: The increase was primarily attributable to $3 3 million of additional sales and marketing expenses driven by the expansion of our commercial infrastructure to support selling two products in the U S as well as $2 4 million in additional amortization expense attributable to the Utica acquisition in May of 2023, as well as a $123 million increase in general and administrative.
Speaker Change: <unk> related to 700000 of personnel costs and half a million stock based compensation expense.
Speaker Change: Net loss was approximately $6 3 million in Q1 2024 compared to approximately $5 million in Q1 2023.
Elliot Maltz: We generated positive adjusted EBITDA again this quarter, as planned. In Q1 2024, we generated approximately $1.8 million of adjusted EBITDA compared to an adjusted EBITDA loss of approximately $2.4 million in Q1 2023. On our last call, we noted that our target adjusted EBITDA margin is 20% for the full year. We remain confident in this guidance, but we anticipate adjusted EBITDA margins will fluctuate quarter to quarter since expenses remain relatively consistent, but revenues fluctuate due to seasonality.
Speaker Change: We generated positive adjusted EBITDA again this quarter as planned.
Speaker Change: Q1, 2024, we generated approximately $1 8 million of adjusted EBITDA compared to an adjusted EBIT loss of approximately $2 4 million in Q1 of 'twenty three.
Speaker Change: On our last call, we noted that our target adjusted EBIT margin of 20% for the full year.
Speaker Change: We remain confident in this guidance, but we anticipate adjusted EBIT margins will fluctuate quarter to quarter since expenses remained relatively consistent but revenues fluctuate due to seasonality.
Elliot Maltz: As of March 31st, 2024, we had cash and cash equivalents of approximately $14.3 million, compared to $12.1 million at the end of 2023. This quarter, we increased our term loan agreement with our lender, SLR Capital Partners, by $5 million.
Speaker Change: As of March 31, 2024, we had cash and cash equivalent to approximately $14 3 million compared to $12 1 million at the end of 2023.
Speaker Change: This quarter, we increased our term loan agreement with our lender SLR capital partners.
Speaker Change: $5 million.
Elliot Maltz: This provides us with more operating flexibility and defrays the impact of some upcoming contractual obligations, such as the $7.5 million of consideration owed to iPoint in 2024 resulting from the acquisition of Utique last year, of which $1.9 million was paid in March. Additionally, during Q1 2024, we triggered $1.1 million of revenue-based milestone fees under our term loan and exit fee agreements with SLR, and we expect to trigger the remaining $1.3 million over the rest of 2024. Now I'll turn it back over to Rick to give his closing comments. Thank you, Elliot.
Speaker Change #131: This provides us with more operating flexibility and the phrase the impact of some upcoming contractual obligations such as the $7 5 million of consideration I point in 2024, resulting from the acquisition of your cheek last year of which $1 9 million was paid in March.
Speaker Change: Additionally, during Q1 2024, we triggered $1 1 million of revenue based milestone fees under our term loan and exit fee agreements with SLR and we expect to trigger the remaining $1 3 million over the rest of 2024.
Speaker Change: Now I'll turn it back over to Rick to give his closing comments.
Rick: Thank you Elliot.
Richard S. Eiswirth: As we said, we are pleased with our start to 2024, which was consistent with our internal expectations and previous guidance. There remains a significant opportunity to grow the utilization of believing in UT in 2024 and beyond. We believe that our success in growing utilization of alluvium in both DME and uveitis in our international markets is a leading indicator for what we can accomplish with our flucinilin acetinide franchise in the United States.
Rick: As we said we were pleased with our start to 2024, which was consistent with our internal expectations and previous guidance.
Elliot: However, there remains a significant opportunity to grow the utilization I, believing in Utica in 2024 and beyond.
Rick: We believe that our success in growing utilization of ILUVIEN, and both <unk> and uveitis and our international markets is a leading indicator for what we can accomplish with our food spending let it sit in that franchise in the United States.
Richard S. Eiswirth: We believe our restructured call plans in the U.S., which prioritize current users and high-decile targets, will enhance the level of effort against each product and promote the cross-selling opportunity. As I commented earlier, we believe we are seeing early signs of success with sequential monthly demand growth since December and an uptick in the percentage of accounts utilizing both products. We believe that the numerous studies we've conducted around the world with alluvium are a good indicator that the New Day study will report a successful outcome and support the use of alluvium earlier in the treatment paradigm for DMA.
Speaker Change: We believe our restructured call plans in the U S, which prioritize current users and high decile targets will enhance the level of effort against each product and promote the cross selling opportunity.
Speaker Change: As I commented earlier, we believe we are seeing early signs of success with sequential monthly demand growth since December and an uptick in the percentage of accounts utilizing both products.
Speaker Change: We believe that the numerous studies we've conducted around the world with ILUVIEN are a good indicator that the new day study will report a successful outcome and support the use of ILUVIEN earlier in the treatment paradigm for DNA.
Richard S. Eiswirth: And we believe the synchronicity study will highlight increased utility of UTEQ in the general retina specialist population. We remain confident in our ability to deliver more than $105 million in revenue this year and greater than 20% even in March. Thank you very much. That concludes our prepared remarks, and I now turn the call over to the operator for questions.
Speaker Change: And we believe the Synchronicity study will highlight increased utility of the Utica and the general retina specialist population.
Speaker Change: We remain confident in our ability to deliver more than $105 million in revenue this year and greater than 20% EBITDA margins.
Speaker Change: Thank you very much that concludes our prepared remarks, and I'll now turn the call over to the operator for questions.
Operator: We will now begin the question and answer session. To ask a question, you may press star, then 1 on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been answered and you would like to withdraw your question, please press star, then 2.
Speaker Change: We will now begin the question and answer session to ask a question you May Press Star then one on your Touchtone phone. If you are using a speaker phone. Please pick up your handset before pressing the keys. If at any time. Your question has been addressed and you would like to withdraw your question. Please press Star then two.
Speaker Change: Our first question comes from Chase Knickerbocker with Craig Hallum. Please go ahead.
Chase Richard Knickerbocker: Good morning, guys. Thanks for taking the questions. Maybe just first for me, more of a qualitative one. Just as you're engaged, as your Salesforce, you know, combined Salesforce, are going out, you know, looking to harvest the synergies of both indications, are you finding that a lot of positions, you know, still that, you know, might have, might be using your product in VME, for example, you know, we're not aware of the indication for uveitis or maybe just kind of getting a Getting a sense of how warm the water is as far as, you know, those synergies still go and how much kind of more upside there is to drive away.
Chase Knickerbocker: Good morning, guys. Thanks for taking the questions. Maybe just first for me more of a qualitative one just as you're engaged as your sales force you know combined sales force are going out looking to harvest the synergies across indications are you finding that a lot of physicians you know still that might have might be using.
Chase Knickerbocker: Your product in <unk>. For example, you know we're not aware of the.
Chase Knickerbocker: Occasion for uveitis, or maybe just kind of getting a.
Speaker Change: Getting a sense of how warm the water is as far as you know those synergies still go and how much more upside there is to drive awareness.
Richard S. Eiswirth: Yeah, sure. I mean, I think it's a combination of a lot of things.
Chase Knickerbocker: Yes, sure I mean, I think it's I think it's a combination of a lot of things Jason I'll ask Todd to comment on this a little bit more but I think it is it is an awareness issue.
Todd Michael Wood: Chase, I'm going to ask Todd to comment on this a little bit more, but I think it is an awareness issue, you know, making sure doctors know that we have both assets now to some extent where they're using one product. It is a challenge that the team has been trying to figure out how to streamline the conversation about DME and uveitis to be able to talk about both in the same short window they get in the clinic because there are quite a few products that are competing for claim time with our team on the road now.
Todd Wood: Making sure doctors know that we have both both assets now to some extent, where they're using one product.
Todd Wood: It is a challenge that the team has been trying to figure out how to streamline the conversation about the mi and uveitis to be able to talk about both.
Speaker Change: The same short window, they get in the clinic because there are quite a few products that are competing for claim time with our team on the road now and so you're getting less time in the clinical and talking to the Doctor and it's trying to squeeze both of those in the same conversation, but Todd do you want to talk a little bit more about how we've been trying to refine that messaging.
Todd Michael Wood: And so, you know, you're getting less time in the clinic lane talking to the doctor, and it's trying to squeeze both of those into the same conversation. But Todd, do you want to talk a little bit more about how we've been trying to refine that messaging? Yeah.
Todd Michael Wood: Yeah, yeah, certainly. Thanks, Chase.
Todd Wood: Yeah, Yeah, certainly thanks Chase.
Todd Michael Wood: Thanks for the question and, To add on to what Rick mentioned, sometimes for classic uveitis and DME, there are different providers and different patients because sometimes it just gets referred on to a uveitis specialist. And what we are currently engaging in is an education campaign because there are many disease states that are of chronic inflammation that are uveitic. And so we're educating providers on the fact that they are probably seeing a lot of uveitis even though it's not classic uveitis, it's tied to another disease. So that's currently what we're implementing right now to create that crossover.
Speaker Change: Thanks for the question and.
Speaker Change: To add onto what Rick mentioned, sometimes for classic uveitis and dnb, they're different providers in different patients because sometimes it just gets referred onto a uveitis specialists.
Speaker Change: And what we are currently engaged in on as an education campaign, because theres many disease states.
Speaker Change: That are of chronic inflammation that our UV edick and so we're educating providers on the fact that they are probably seeing a lot of uveitis, even though it's not classic uveitis, it's tied to another disease. So that's currently what we're implementing right now to create that crossover.
Chase Richard Knickerbocker: Got it. And then kind of staying on the same line of taking a different tack, you know, taking a look at the ASP data, it looks like there's never been any rebates done here on either product line. Have you given any thought to, you know, potentially initiating any sort of rebate strategy to kind of help drive those initial conversations forward and, you know, maybe drive some extra demand early for the combination of these indications in the U.S.?
Speaker Change: Got it and then kind of staying on the same lines, taking a different tact.
Speaker Change: Taking a look at the ASP data it looks like there's never been any rebating done here on either product line have.
Speaker Change: Have you given any thought to potentially initiating any sort of rebating strategy that kind of helped drive those initial conversations forward and maybe drive some extra demand early in the combination.
Speaker Change: These indications in the U S.
Richard S. Eiswirth: Yeah, Chase, it's a timely question. We actually have been looking into that. You know, we call it, we refer to it as a non-clinical value program, but we have implemented, as of April 1st, a non-clinical value program in the U.S. where, you know, we are providing value back to physician practices that are using Illuvian or Utique more consistently. And frankly, there's a separate program for Illuvian and Utique, and then there's a little bit more value provided for those practices that are using both products more consistently.
Chase Knickerbocker: Yeah Chase that it's a timely question, we actually have been looking at that we call. It we referred to it as a non clinical value programs.
Speaker Change: But we have implemented as of April 1st a non clinical value program in the U S, where we are providing value back to the physician practices that are using ILUVIEN or you take more consistently.
Chase Knickerbocker: And frankly, it's a there's a separate program for ILUVIEN and <unk> and then there's a little bit more value provided back for those.
Chase Knickerbocker: Practice that are using both products more consistently so we implemented that on April 1st it's slowly been rolled out, but we do expect that.
Richard S. Eiswirth: So, you know, we implemented that on April 1st. It's slowly been rolled out, but we do expect that it will have some small impact in Q2 and have a greater impact as we move throughout the year.
Chase Knickerbocker: We'll have some small impact in Q2 and have an impact greater impact as we move throughout the year.
Chase Richard Knickerbocker: Any sort of impact on initial conversations from that, you know, nonclinical, you know, value that you're willing to add to your, you know, potential new customers as well? And then, just lastly, on the model side, sales and marketing spend, would you expect that to kind of be flat from here? Or were there any sort of nonrecurring or noncash items in the quarter?
Speaker Change: Are you seeing any sort of impact on additional conversations from that you know non clinical value that you are willing to add here and potential new customers as well and then just on the on.
Chase Knickerbocker: On the model side sales.
Speaker Change: Sales and marketing spend would you expect that to kind of be flat from here or was there any sort of nonrecurring and noncash items in the quarter, sorry, if I missed it.
Elliot Maltz: Yeah, well, I'll ask Todd to comment on some of the early feedback we've gotten from the, it's what we're referring to as the Amplify program on the non-clinical value, and then maybe Elliot can address the comment on the financials.
Speaker Change: Yeah, well I'll ask Todd to comment on some of the early feedback we've gotten from the it's what we're referring to as the amplify program on the non clinical value and then maybe you can address that.
Speaker Change: Comment on the financials.
Todd Michael Wood: Yeah, the initial feedback has been very, very good. It's greatly accepted. Obviously, the marketplace has been anticipating something like this for some time, and as we've launched it, we've just gotten a tremendous amount of positive feedback. Now it's just a matter of seeing what type of impact that has as we look at their purchasing patterns throughout the end of this quarter.
Speaker Change: Yeah. The the initial feedback has been very.
Speaker Change: Very well it's greatly accepted obviously the marketplace has been anticipating something like this for some time and as we've launched it. We've we've just got a tremendous amount of positive feedback now it's just a matter of to see what type of impact that is as we look at their purchasing patterns throughout the end of this quarter.
Elliot Maltz: Yeah, and with regard to just total expense in the sales and marketing line, I think this quarter was maybe a bit higher than what we anticipate on a go forward basis. We did have some one-time costs that were incurred during the first quarter of 24, which should normalize as we move through the rest of the year. Not a very material number, but maybe in the 5 to 10% range that we're talking about in terms of one-time costs that hit our P&L this quarter and sales and marketing.
Speaker Change: Yeah, and with regard to just total expense in the sales and marketing line I think this quarter was maybe a bit higher than what we anticipate on a go forward basis. We did have some some one time costs that were in.
Speaker Change: <unk> during the first quarter of 'twenty, four which should normalize as we move through the rest of the year.
Speaker Change: Very material number.
Speaker Change: It may be in the 5% to 10% range that we're talking about in terms of one time costs that hit our P&L this quarter in sales and marketing.
Yi Chen: Got it. Thanks for the question. The next question comes from Yi Chen with H.C. Wainwright & Company. Please go ahead.
Speaker Change: Got it thanks for the questions guys.
Speaker Change: Okay.
Speaker Change: The next question comes from E Chen with H C Wainwright and company. Please go ahead.
Yi Chen: Hi, thank you for taking my call. With respect to the Protocol AL trial, does Alimera need to financially support your study? I'm sorry, I didn't quite understand that. Yi, can you repeat the question?
Yi Chen: Hi, Thank you for taking my question.
Yi Chen: With respect to the protocol.
Chase Knickerbocker: Trial.
Speaker Change: I've been married to financially support their study.
Speaker Change: I'm, sorry, I'm, sorry, I didn't quite understand that.
Speaker Change: Can you repeat the question.
Yi Chen: The protocol AL, the DRCR retinal network study with eluvium or farismat injections. Does Alimera need to financially fund this study? Yes, we are making contributions of about a million and a quarter over the period of four or five years. So it's, and it's pretty straight line over the course of the year. So it's about a quarter of a million dollars a year. Okay. And could you give us some color on how many radiation retinopathy patients out there could potentially benefit from this?
Speaker Change: The protocol the DRC retinal network study.
Speaker Change: Our fiber cement injections.
Speaker Change: Oh, there's a numero need to financially from this study.
Speaker Change: Yes.
Speaker Change: We are making contributions of about a million and a quarter over the period of four or five years. So it's and it's pretty straight lined over the course of the year. So it's about a quarter of million dollars a year.
Speaker Change: Okay. Okay.
Speaker Change: And could you give.
Speaker Change: Give us some color on how many radiation retinopathy patients out there.
Speaker Change: That potentially benefits right.
Yi Chen: It's a, it's a, it's a pretty small population. I mean, it'd be considered an orphan disease indication, you know, probably less than 10,000 patients a year. But at the same time, there's nothing out there approved to treat it at this time.
Speaker Change: It's a it's a it's a pretty it's a pretty small population I mean, it would be considered an orphan disease indication.
Speaker Change: Probably less than 10000 patients a year, but at the same time and Theres nothing out there approved to treat it at this time.
Speaker Change: Okay.
Speaker Change: Okay.
Yi Chen: Okay. And regarding the U.K. NICE recommendation,
Speaker Change: Yeah regarding the UK nice work.
Speaker Change: Inundation for.
Speaker Change: Chronic <unk> patients with natural lives, having access to Google.
Yi Chen: Patients with Natural Less Having Access to the Blue Guide
Richard S. Eiswirth: much more. I mean, how large is the impact on the top line revenue from the UK do you expect to see?
Speaker Change: How much more I mean.
Speaker Change: How large is that impact on the top line revenue.
Richard S. Eiswirth: What K do you expect to see?
Speaker Change: From U K do you expect to see.
Richard S. Eiswirth: You know, it's hard to give specific guidance around that. The fake population is probably about, you know, 25% of the DME population. However, it's probably a little bit greater in the more chronic patients that it would be utilized in, where it would be utilized specifically in the UK. But certainly, over time, we think this could more than double the market for available patients in the UK.
Speaker Change: Yeah.
Speaker Change: It's hard to give specific guidance around that.
Speaker Change: The population is probably about <unk>.
Speaker Change: 25% of the DMD population, however, it's probably a little bit greater than the more chronic patients that will be utilized will be utilized specifically in the U K.
Speaker Change: But certainly over time, we think this.
Speaker Change: Yeah, it can more than double the market for available patients.
Speaker Change: In the U K, how quickly you'll be adopting those patients you know, it's a little bit unclear, yet, we'll probably be able to tell you a little bit more after we get a quarter or two of experience with it but we do know that in and in some of the hospitals you know patients are already being identified where they've got still haven't taken glens.
Richard S. Eiswirth: How quickly it will be adopted in those patients is a little bit unclear yet. We'll probably be able to tell you a little bit more after we get a quarter or two of experience with it. But we do know that in some hospitals, patients are already being identified where they still have a fake lens, and they're being identified for utilization of the lubricant.
Speaker Change: Being identified people organization I believe and so it's starting to pick up but.
Richard S. Eiswirth: So it's starting to pick up, but probably won't be able to give much guidance until we get another quarter or two out. And the 4,020 units for the quarter, that is user demand, including U.S. and
Speaker Change: To give you much guidance until we get another quarter or two out.
Speaker Change: Got it got it.
Speaker Change: And the 4020 units for the quarter that is the use of demand, including U S and ex U S territories Zephyr.
Speaker Change: Yes that is correct.
Richard S. Eiswirth: That's correct. Okay, I got it, got it. Thank you.
Speaker Change: Okay got it got it thank you.
Speaker Change: Mhm.
Nazibur Rahman: The next question comes from Naz Rahman with Maxim Group. Please go ahead. Hi everyone.
Speaker Change: The next question comes from NASA Rodman with.
NASA Rodman: Maxim Group. Please go ahead.
Nazibur Rahman: Hi, everyone. Thanks for taking our questions and congrats on the progress. Just a couple.
Speaker Change: Hi, everyone. Thanks for taking our questions and congrats on the progress.
Nazibur Rahman: I want to expand on the UK match reimbursement question a little bit. Could you comment on how the reimbursement is in the UK or how it differs from other international territories and what the implications that that also means for your margins? Like how could the debtor reimbursement in the UK translate to potential margin improvement if any later down the line? So the reimbursement change doesn't really have an impact on the margin because it's still going to be reimbursed at the same price. But Philip, maybe you could give us a little bit of commentary on where we have FACIC restrictions and don't across Europe?
Speaker Change: Just a couple of expand on that.
Speaker Change: U K match reimbursement question, a little bit could you comment on how the reimbursement is in the U K or how it differs from other international territory and what the application got bad also needs for your margins like how could be.
Speaker Change: Better reimbursement in UK travel.
Speaker Change: You got your margin improvement if any.
Speaker Change: Later down the line.
Speaker Change: So.
Speaker Change: The reimbursement change doesn't mask the reimbursement change doesn't really have an impact on on the margin because it's still going to be reimbursed at the same price.
Speaker Change: But Phil maybe you could give a little bit of commentary on where we have faith restrictions and don't across Europe.
Philip Ashman: Yes, the UK is one of the countries that has adopted this pseudophagic limitation. Other countries include Italy and Spain as well.
Speaker Change: So the UK is one of one of the countries that adopted this limitation.
Philip Ashman: And unfortunately, in Europe, the way things work, all of these reimbursement authorities speak to one another. So even in countries that don't have the limitation, there's a dampening impact, which it'll be interesting to see how it translates across Europe. But clearly, UK guidance is now in place and implemented. We launched it at the end of April. So we're watching carefully to see how it progresses there, and we're working with our partners in Spain and Italy to look at plans for how we can help them challenge the limitation in those countries too. But hopefully, that helps. And just to echo what Rick said, because it's an important point, there has been no change in price at all with this.
Speaker Change: Limitations, the other countries, including Italy, and Spain, as well and unfortunately in Europe. The way things work all of these reimbursement will sort to speak to one another so even in countries that don't have the limitation.
Speaker Change: It's a dampening impact, which it'll be interesting to see how it translates across Europe clearly when you take guidance is now in place and implemented we launched it in at the end of April.
Speaker Change: So we're watching carefully to see how it progressed and we're working with our partners in Spain, and Italy already to look at plans for how we can help them challenge the limitation in those countries to that.
Speaker Change: Hopefully that helps and then just to that.
Greg: Greg said, because it's an important point there has been no change in price at home with this so.
Philip Ashman: So, in the sense of the United States
Greg: In the sense that the United Kingdom.
Speaker Change: What we expect is more volume with the requisite impact that that volume coming through in the overall revenue.
Speaker Change: Okay.
Nazibur Rahman: Got it. That was helpful.
Speaker Change: Got it that was helpful.
Speaker Change: Question is on the pipeline or indication expansion you mentioned on the call could you expand a little more about what you're thinking and also have you seen any potential off label use of either you take or Louisiana for RVO or potential other indications.
Richard S. Eiswirth: Our next question is on the pipeline or indication expansion. You mentioned on the call. Could you expand a little more on what you're thinking? And also, have you seen any potential off-label use of either UTIC or Alluvian for RBO or potentially other indications? Yeah, so, I think from a pipeline perspective, we've been holding some advisory boards and looking at potential opportunities to expand the indications for Illumina, as we discussed.
Speaker Change: Yeah. So I think from a pipeline perspective, we've been holding some advisory boards and looking at potential opportunities to expand the indications for <unk>.
Richard S. Eiswirth: I think that probably the leading candidate, you know, beyond, you know, potentially something in radiation retinopathy that could arise out of the VRCR study would be vein occlusion. You know, we hear from physicians a lot that there's a need for a chronic, you know, long-term low-dose steroid treatment in RVO. We do know that there are physicians that have, you know, utilized it on a compassionate use basis, you know, or have found patients that have, you know, signs of uveitis and DME with their RVO and treated those patients as well, and have come back to us with cases where it works.
Speaker Change: ILUVIEN as we've discussed I think that probably the leading candidate beyond.
Speaker Change: You know potentially something radiation retinopathy that could arise out of the DRC. Our study would be vein occlusion, we hear from physicians a lot that there's a need for a chronic long term low dose steroid in RVO.
Speaker Change: Do know that there are physicians that have utilized it on a compassionate use basis, you know or have found patients that have no signs of uveitis and dealing with the RVO and treating those patients as well and have come back to us with cases, where it works.
Richard S. Eiswirth: But we are trying to work with the advisory boards to try to refine what exactly that available patient population would look like and what a trial structure would look like. And, you know, that's something that, you know, we hope to flush out between now and the end of the year where we could potentially redirect some of the spending from synchronicity and new day as that sort of bleeds down.
Speaker Change: But we are trying to work with the advisory board to try to refine what exactly that available patient population would look like.
Speaker Change: And what a trial structure would look like and that's something that we hope to flush out between now and the end of the year, where we could potentially redirect some of the spending from synchronicity and new days is that sort of bleeds down.
Richard S. Eiswirth: Got it. And my last question is on the comps.
Speaker Change: Got it and my last question is on the.
Richard S. Eiswirth: Tom's study for UT, could you provide some color on where we might see some data from that study or what conferences data might be presented at? Yes, so that study was a registry study, and it's sort of slowly producing publications by the participants in that study. As we mentioned, there were three presentations, both at ARBO and at the Retina World Congress, over the past couple of weeks. And as those papers are published, we'll be able to share those publicly, but those papers haven't been published yet. They were just presentations at the meetings.
Speaker Change: Calm study for your teeth could you provide some color on what we might see some data from that study or congresses data might be presented that.
Speaker Change: Yeah. So let's say it was a registry study and it's sort of slowly producing publications you know by the participants in that study as we are as we mentioned there were two there were three presentations both at ARVO and at their World Retina World Congress.
Speaker Change: Over the past couple of weeks and as those papers are published we will be able to share those publicly but those papers have been been shared yet they were just presentations at the meeting but in general what Youre seeing there is that the registry studies are showing that the safety and efficacy is very very consistent with what you saw what we saw in the pivotal studies for uveitis.
Richard S. Eiswirth: But in general, what you're seeing there is that the registry studies are showing that the safety and efficacy are very, very consistent with, you know, what you saw and what we saw in the pivotal studies for uveitis. And I'd just like to remind you that the reason you see that, and you see it across, you know, DME as well, is because Lubion and Utique are, for the most part, self-compliant.
Speaker Change: And I'd just like to remind you that the reason you see that and you see it across EMEA as well.
Speaker Change: Because ILUVIEN in Utica or you know.
Speaker Change: For the most part they're self compliant once they're injected in the eye.
Richard S. Eiswirth: You know, once they're injected into the eye, they deliver a very consistent low dose of glucenoloness at night every day for, you know, for three years. And you're not reliant on capacity at a doctor's office, you know, a patient getting back to the office for consistent therapy. And that's, you know, it's why you don't see the same results in a real-world setting with the anti-VEGFs and the other acute therapies because they're not injected at the same frequency they are in clinical studies.
Speaker Change: To deliver a very consistent low dose. So please send alone or is that not every day for you know for three years and you're not relying on capacity at a doctor's office.
Speaker Change: You know a patient getting back to the office for consistent therapy, and it's you know it's why you don't see the same results.
Speaker Change: Real world setting, but the anti VEGF and the other acute therapies because theyre not injected at the same frequency they are in the clinical studies.
Nazibur Rahman: Got it. Thank you for taking our questions.
Speaker Change: Got it thank you for taking our questions.
Speaker Change #105: Absolutely. Thank you guys.
James Francis Molloy: The next question comes from James Molloy with Alliance Global Partners. Please go ahead.
Speaker Change: The next question comes from James Molloy.
James Francis Molloy: Malloy with Alliance Global Partners. Please go ahead.
James Francis Molloy: Good morning, guys. Thank you for taking the time to answer my questions. I had a question on margins in the quarter. Will you guys be able to decouple sort of sales and marketing from sales? I'm thinking of the $23 million in the first quarter here. I know it's seasonality from the fourth quarter, but it looks similar to the $23 million you guys posted in the third quarter last year with better gross margins and better EBITDA margins. Is there a way to sort of get the margins going in the first quarter? Or do you expect to see that go and improve through the year?
James Francis Molloy: Hey, good morning, guys. Thank you for taking my questions I had a question on on margins in the quarter.
James Francis Molloy: How did you guys have.
Speaker Change #108: You guys be able to decouple sort of the sales and marketing.
James Francis Molloy: From sales in Chile.
James Francis Molloy: Looking at the $23 million in the first quarter here I know its seasonality.
James Francis Molloy: Fourth quarter, but it looks similar to the 23, you guys posted third quarter last year.
Speaker Change: With better gross margins and better EBITDA margins.
James Francis Molloy: Is there a way to sort of get the get the margins going in in the first quarter or do you expect to see that improve through the year or what happens in the first quarter that kind of a question of the margins as well besides the seasonality.
Elliot Maltz: What happens in the first quarter that kind of questions the margins as well besides the seasonality? Yes, I mean there were some fixed costs that keep our business really consistent. That's the majority of our P&L structure, but there are some one-off items, some relating to the integration of new hub services and transitioning from having two hubs supporting each product to having a single hub in the U.S. There were some non-recurring expenses in the first quarter that are tied to internal meetings to align the sales force on the cross-sell opportunity and to train, you know, reps on selling both products.
Speaker Change: Yeah. So I mean, there were some fixed costs there.
Speaker Change: Keep our business fairly consistent that's the majority of our P&L structure, but there are some one off items some relating to integration of new hub services.
Speaker Change: Transitioning from having two hub to support each product, having a single hub in the U S.
Speaker Change: There were some nonrecurring expenses in the first quarter that are tied to internal meetings to align the sales force on the cross sell opportunity and to train.
Elliot Maltz: You know, we have some that came over from iPoint last year that needed more training and attention focusing on DME, and vice versa for the legacy Alimera employees as they've taken on the UVIS indication and their selling opportunity. We believe that the majority of those costs are now done, and on a go-forward basis, our P&L should reflect, really, the fixed cost structure we have with fewer of those, you know, one-off items that can weigh down a P&L for an individual quarter.
Speaker Change: <unk> selling both products.
Speaker Change: We have something that came up from high point last year that needed more.
Speaker Change: Training and attention focusing on me and vice versa for the legacy all of their employees as they have taken on the uveitis indication and they are selling opportunity.
Speaker Change: We believe that the majority of those costs are now done.
Speaker Change: On a go forward basis, our P&L should reflect really the fixed cost structure, we have with fewer of those.
Speaker Change: One off items that can can weigh down the P&L for an individual quarter. So as we move through the rest of the year, we expect our cost to remain fairly stable and on a full year basis get us to that 20% EBIT margin that we indicated in our guidance.
Elliot Maltz: So, as we move through the rest of the year, we expect our costs to remain fairly stable and, on a full-year basis, get us to that 20% even margin that we indicated in our guidance. At one point, Jim, the last piece of operational integration was completed as of April 1st, where we and iPoint provided benefit investigation hotlines where we run benefits for the physician's offices to make sure the insurance coverage was there and they understood co-pays, etc.
Speaker Change: At one point.
Speaker Change: The agenda the last piece of operational integration was completed as of April 1st where.
Speaker Change: We and I point provided benefit investigation, hotlines, where we run benefits for the physician's offices to make sure. The insurance cover she was there and they understood co pays et cetera, we were running two systems in parallel until April 1st which means we will incur in multiple more costs and that integration was complete as of April one.
Elliot Maltz: We were running two systems in parallel until April 1st, which means we were incurring more costs and that integration was complete as of April 1st. So that's another issue you can see. And that goes into sales and marketing. Thanks for watching. See you next time.
Speaker Change: So that's another issue.
Speaker Change: And that goes into the sales and marketing.
Speaker Change #100: Expense in the quarter, yes, yes.
Speaker Change: Thank you.
James Francis Molloy: Then, uh, what's the, uh, can you guys break out the U.S. Alluvium versus U.T.
Speaker Change #101: They know what's the do you guys break out the U S ILUVIEN versus peak in the quarter.
Richard S. Eiswirth: The U.S. alluvium versus utique in the quarter? We're not doing that. We talked about that a couple of quarters ago. We're going to talk about the Plutonium-Linos-Setonite franchise going forward because it's on a consolidated basis just like it is in Europe going forward.
Speaker Change #102: We were not doing that going we've talked about that a couple of quarters ago, we're going to talk about the food Simona set not franchise going forward because it's on a consolidated basis just like it is in Europe going forward.
James Francis Molloy: How many reps do you currently have in the field and can you talk about any anecdotal stories in the field about the new messaging and how that's been received? Sure, right now we've got 35 territories in the U.S., but I'll ask Todd to comment on feedback on the messaging. Todd, if you want to do that. Yeah, sure.
Speaker Change #103: Okay, Great and then maybe the last question.
Speaker Change #111: How many reps you guys have currently in the field and then can you talk a little bit about any anecdotal stories in the field on the new messaging and how that's been received.
Speaker Change #112: Sure right now we've got 35 35 territories in the U S, but I'll ask Todd to comment on feedback on the messaging side, it's going to do that.
Todd Michael Wood: Yeah, sure. The messaging is being received quite well. And where this has come from is when you look at some of the growth that we're experiencing internationally. Philip and his team have been out in front with this messaging a little bit before the U.S., and so we've really bolstered our efforts around it with the new call plan that Rick mentioned a little bit earlier.
Todd Wood: Yes sure. The messaging is getting is being received quite well.
Speaker Change #104: And where this has been derived from as you look at some of the growth that we're experiencing internationally.
Speaker Change #116: Philip and his team have been out in front with this messaging a little bit before the U S and so we've really bolstered our efforts around it with the new call plan that Rick mentioned, a little bit earlier and when you look at the advocacy use our key proponents of the product they are aware of.
Todd Michael Wood: And when you look at the advocacy use, our key proponents of the product, they're aware of fluctuating retina thickness, and they take that into account with their treatment paradigm. And they recognize that fluctuating thickness can lead to impaired vision. And, on top of that, early intervention is better to prevent impaired vision. So that's how the advocates of Alluvion are using the product today. So we're trying to expand that to a broader base and get more people on board with that since there is initial momentum from the advocacy groups.
Todd Wood: Awaiting retinal thickness of they take that into account with their treatment paradigm and they recognize that fluctuating thickness can lead to impaired vision.
Rick: And then also on top of that early intervention is better to prevent impaired vision. So that's how the advocates of ILUVIEN are using the product today. So we're trying to expand that to a broader base and get more people on board with that sensor is initial momentum from the advocacy groups.
Richard S. Eiswirth: Great, thank you for taking the question. This concludes our question and answer session. I would like to turn the conference back over to Rick Eiswirth for any closing remarks.
Speaker Change #110: Great. Thanks for taking the questions.
Speaker Change #101: Okay.
Speaker Change #106: This concludes our question and answer session I would like to turn the conference back over to Rick <unk>.
Richard S. Eiswirth: It's worth for any closing remarks.
Richard S. Eiswirth: Thank you, and I'd like to thank everyone for participating in today's call and your continued interest in Alimera. We do look forward to sharing our ongoing progress and reporting our second quarter results in August. Thank you all, and have a good day.
Richard S. Eiswirth: Great. Thank you and I'd like to thank everyone for participating on today's call and your continued interest in Almere, We do look forward to sharing our ongoing progress when we report our second quarter results in August. Thank you all and have a good day.
Operator: The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.
Speaker Change #113: The conference has now concluded. Thank you for attending today's presentation you may now disconnect.
Speaker Change #113: Okay.