Q1 2024 scPharmaceuticals Inc Earnings Call

Damian: [music].

Operator: Good afternoon, ladies and gentlemen, and welcome to the SC Pharmaceuticals first quarter 2024 earnings conference call. At this time, all participants are in a listen-only mode. Following the presentation, we will conduct a question and answer session. And if at any time during this call you require immediate assistance, please press star zero for an operator. Also note that the call is being recorded Tuesday, May 14, 2024, and I would like to turn the conference over to PJ Kelleher, Investor Relations. Please go ahead.

Good afternoon, ladies and gentlemen, and welcome to U S. C Pharmaceuticals first quarter 2024 earnings conference call. At this time all participants are in a listen only mode. Following the presentation. We will conduct a question and answer session and if at any time. During this call you require immediate assistance. Please press star.

Operator: D O for an operator.

Speaker Change: Also note that the call is being recorded Tuesday may 14, 2024, and I would like to turn the conference over to.

Speaker Change: P J killer Investor Relations. Please go ahead.

PJ Kelleher: Thank you, operator. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements on this conference call, other than historical facts, are forward-looking statements within the meaning of the federal securities laws, including, but not limited to, statements regarding Scpharmaceuticals' expected future financial results, management's expectations and plans for the business, the ongoing commercialization and marketing of Perothix, and the Potential Label Expansion and Other Regulatory Approval of Perothix.

Thank you operator before turning the call over to management I would like to make the following remarks concerning forward looking statements. All statements on this conference call other than historical facts are forward looking statements within the meaning of the federal securities laws, including but not limited to statements regarding S. T pharmaceuticals expected future financial results.

Speaker Change: No.

Management: Management's expectations and plans for the business, the ongoing commercialization and marketing of Peru, and the potential label expansion and other regulatory approval up for robotics. The words anticipate believe estimate expect intend guidance confidence target project and other similar expressions are used typically to identify.

PJ Kelleher: The words anticipate, believe, estimate, expect, intend, guidance, confidence, target, project, and other similar expressions are used typically to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and may involve and are subject to certain risks and uncertainties and other important factors that may affect SC Pharmaceuticals' business, financial condition, and other operating results. These include, but are not limited to, the risk factors and other qualifications contained in SC Pharmaceuticals' annual report on Form 10-K, quarterly reports on Form 10-Q, and other reports filed by the company with the SEC to which your attention is directed. However, actual outcomes and results may differ materially from what is expressed or implied by these forward-looking statements.

Management: Such forward looking statements.

These forward looking statements are not guarantees of future performance and may involve and are subject to certain risks and uncertainties and other important factors that may affect S. C pharmaceuticals business financial condition and other operating results.

Speaker Change: These include but are not limited to the risk factors and other qualifications contained in S. T Pharmaceuticals annual report on Form 10-K quarterly reports on Form 10-Q, and other reports filed by the company with the SEC to which your attention is directed.

Speaker Change: Actual outcomes and results may differ materially from what is expressed or implied by these forward looking statements.

PJ Kelleher: Any forward-looking statements made in this conference call, including responses to your questions, are based on current expectations as of today, and Scpharmaceuticals expressly disclaims any intent or obligation to update these forward-looking statements except as required by law. It is now my pleasure to turn the call over to Mr. John Tucker, Chief Executive Officer of Scpharmaceuticals.

Speaker Change: Any forward looking statements made in this conference call, including responses to your questions are based on current expectations as of today.

C Pharmaceuticals: And that's C pharmaceuticals, expressively disclaims any intent or obligation to update these forward looking statements, except as required by law.

C Pharmaceuticals: It is now my pleasure to turn the call over to Mr. John Tucker Chief Executive Officer of <unk> Pharmaceuticals, John.

John H. Tucker: Thank you, PJ, and thanks to everyone listening to this afternoon's call and webcast to review our first quarter 2024 results. As has been our practice, I will begin with an operational update before turning the call over to Steve Parsons, our Senior Vice President of Commercial, for a more detailed commercial update on Ferocix, and then Rachael Nokes, our Chief Financial Officer, for a review of our financials. We will then open the call to your questions.

John H. Tucker: P J and thanks to everyone listening to this afternoons call and webcast to review our first quarter 2024 results.

Has been our practice I will begin with an operational update before turning the call over to Steve Parsons, Our senior Vice President commercial for a more detailed commercial update on for us.

John H. Tucker: And then Rachel knows our Chief Financial Officer for a review of our financials. We will then open the call for your questions.

John H. Tucker: During the first quarter, we saw a continuation of the positive trends that we believe reflect growing awareness and utilization of furosics as a new and innovative part of the heart failure care continuum. As Steve will detail shortly, our leading indicators, including doses written, unique prescribers, and in-services completed, suggest that providers are increasingly more comfortable prescribing furosics to their heart failure patients during critical intervention windows, which are pre- We reported net revenue of $6.1 million, despite experiencing approximately 10% negative impact on doses filled during the quarter due to the widely reported and previously disclosed healthcare cyber change. We also experienced some seasonal impact during the first quarter as patient deductibles reset with the new year.

Rachel: During the first quarter, we saw a continuation of the positive trends that we believe reflect growing awareness and utilization of <unk> as a new and innovative part of heart failure care can be.

Steve: As Steve will detail shortly our leading indicators, including doses written unique prescribers and in services completing suggests that providers are increasingly more comfortable prescribing for 60 of the heart failure patients.

Steve: Critical intervention Windows, which are pre hospital admission or post discharge.

Steve Johnson: Net revenue was $6 1 million, despite experiencing approximately 10% negative impact on doses filled during the quarter due to the widely reported in previous we disclose change healthcare cyber attack. We also experienced some seasonal impact during the first quarter as patient deductibles reset with the new year.

John H. Tucker: We continue to take steps to increase and improve our prescription fill rate. In March, we transitioned our patient service provider, or as we call it, the hub, which we think will result in an improved patient and physician experience. We are very pleased to have turned in another solid border, notwithstanding these temporary headwinds.

We: We continue to take steps to increase and improve our prescription fill rate in March we transitioned our patient service provider or as we call. It the hub, which we think will result in improved patient and physician experience.

We: We are very pleased that turned in another solid quarter notwithstanding these temporary headwinds.

John H. Tucker: Our gross net discount during the first quarter was 19%, up slightly from 2020. We continue to expect the GTN discount to increase over time as contracting with payers and the marketplace evolves. And we expect that the GTN discount will approach 30 to 35% on a quarterly basis by the end of this year, consistent with our prior long-term guidance for GTN. Inventory levels at the end of the first quarter at our specialty pharmacy partners were generally consistent with inventory levels at the end of 2020. Shifting now to payers.

We: Our gross to net discount during the first quarter was 19% up slightly from 2023, we continue to expect the G. T M discount to increase overtime as contracting with payers in the marketplace evolves and we expect that the GPM discount will approach, 30% to 35% on a quarterly basis by the end of this year consists.

Speaker Change: With our prior long term guidance for <unk>.

Speaker Change: Inventory levels at the end of the first quarter at our specialty pharmacy partners were generally consistent with inventory levels at the end of 'twenty.

Speaker Change: Shifting now to payers, we continue to have productive discussions with commercial and Medicare part D and Medicaid payers in an ongoing effort to make brunswick's broadly available to patients at the most favorable terms possible.

John H. Tucker: We continue to have productive discussions with commercial Medicare Part D and Medicaid payers in an ongoing effort to make fluorosics broadly available to patients at the most favorable terms possible. With favorable market dynamics in Medicare, we have expanded the population and portfolio of patients who have access to Proceqs with fixed-tier co-pays of $100 or less to 70%, moving us closer to our previously stated goal of 75% or more over time. We are progressing with many other health plans, and we hope to have updates in the months ahead.

Speaker Change: Favorable market dynamics in Medicare.

Brunswick: <unk> expanded the population of heart failure patients with access to for US, it's a fixed fee or co pays.

Brunswick: Dollars or less to 70% moving us closer to our previously stated goal of 75% or more overtime.

Speaker Change: We are progressing with many other health plans and we hope to have updates in the months to come.

John H. Tucker: At this point, I would like to provide an update on several long-term growth initiatives that we previewed last quarter that we view as critical to our long-term growth. As we discussed previously, last year, we received positive feedback from the FDA regarding the potential expansion of the Ferocix indication to allow for use in New York Heart Association Class IV heart failure patients. Recall that Ferocix is currently indicated for the treatment of congestion due to fluid overload in adult patients with New York Heart Association Class II and Class III chronic heart failure. We estimate that as many as 10% of all heart failure patients are Class IV, and a meaningful percent of these, as many as 40%, may benefit from birth.

Speaker Change: At this point I would like to provide an update on several long term growth initiatives that we previewed last quarter that we view as critical to our long term growth strategy.

He: He discussed previously last year, we received positive feedback from the FDA regarding the potential expansion of the prostate indication to allow for use in New York Heart Association last for heart failure patients recall that for robotics is currently indicated for the treatment of PTSD do fluid overload in adult patients with New York Heart Association plus two <unk>.

FDA: Class III chronic heart failure, we estimate there is maybe 10% of ballpark failure patients our class four and a meaningful percentage of these as many as 40% may benefit from <unk>.

John H. Tucker: Based upon the feedback that we received from the agency, we filed for the class 4 indication in early October of last year, and we have been assigned a PDUFA date for this August, although the possibility does still exist that the PDUFA date could occur soon. If we are successful, we believe Class IV would represent a meaningful expansion of our market opportunity as providers would be able to prescribe prurosis for the most severe heart failure.

Speaker Change: Based upon the feedback that we received from the agency we filed for the last four indication in early October of last year, and we hadn't been assigned a <unk> date for this August although the possibility does still exist at the Paducah date could occur sooner.

Speaker Change: If we are successful we believe platform would represent meaningful expansion of our market opportunity as providers will be able to prescribe <unk> to the most severe heart failure patients.

John H. Tucker: Turning now to the 80 mg over 1 ml low volume autoinjector that we are developing as an additional option to the on-body infuser. Just a few weeks ago, we announced that we had initiated a pivotal PK study, and we plan to report results later this year. If this is successful, we will allow you to submit a supplemental new drug application to the FDA by the end of this year. As we have stated previously, we believe an auto-injector, if improved, would reduce manufacturing costs compared to the current on-body infuser and confer environmental advantages as well, in addition to giving treating providers and their patients more treatment flexibility.

Speaker Change: Turning now to the 80 milligrams over one ml low volume auto injector that we are developing as an additional option beyond bodies using just a few weeks ago, we announced that we initiated a pivotal PK study and we plan to report results. Later this year that if successful will allow us to submit a supplemental new drug application to the FDA by the end of this.

Speaker Change: Year.

Speaker Change: We have stated previously we believe an auto injector if approved would reduce manufacturing costs compared to the current on body user and confirm environmental advantages as well.

Speaker Change: In addition to giving treatment providers and their patients more treatment flexibility.

John H. Tucker: Finally, we previously discussed feedback that we received from the FDA pertaining to the potential expansion of the ferrocyte indication to include treatment of edema due to fluid overload in patients with chronic kidney disease, or CKD. Recall that in its feedback, the FDA confirmed that no additional clinical studies are needed to expand the indication of this PKB, provided that we can demonstrate an adequate PK and pharmacodynamic bridge for the listed drug, which is flucosamide injection, 10 mg over mL.

Speaker Change: Finally, we previously discussed feedback that we received from the FDA pertaining to the potential expansion of the <unk> indication.

FDA: The treatment of anemia, due to fluid overload in patients with chronic kidney disease or <unk>.

FDA: We call them its feedback the FDA confirmed that no additional clinical studies are needed to expand the indication SDK provided that we can demonstrate adequate PK and Pharmacodynamic bridge for the listed drug which is for us to mine injection Migs around now.

John H. Tucker: CKD is a progressive disease characterized by worsening renal function over time, resulting in frequent episodes of fluid overload that are treated with loop diuretics. It is estimated that 12-15 million Americans are aware that they have kidney disease, and 50% of patients with CKD do not have a diagnosis of heart disease.

FDA: <unk> is a progressive disease characterized by worsening renal function over time, resulting in frequent episodes of fluid fluid overload that are treated with loop diuretic.

FDA: It is estimated at 12% to 15 million Americans are aware that they have TD disease, and 50% of patients with <unk> do not have a diagnosis of heart failure.

John H. Tucker: With fluid overload being one of the most common complications in CKD, which worsens with disease progression, we believe furosics could be beneficial to patients with CKD who have worsening symptoms due to fluid overload and are not responding to oral reduction. To that end, earlier this month, we submitted a supplemental new drug application with the FDA for the CKD indication. At this point, I'll turn the call over to our Senior Vice President of Commercial, Steve Parsons, for a deeper dive into our launch metrics. Thank you.

unknown: Fluid overload being one of the most common complications in CTV, which worsens with disease progression. We believe proceeds could be beneficial to patients with <unk> who have worsening.

FDA: Fluid overload.

Speaker Change: Not responding the oral with direct to that end earlier. This month, we submitted a supplemental new drug application with the FDA for the <unk> indication.

Speaker Change: At this point I'll turn the call over to our senior Vice President of commercial Steve Parsons for a deeper dive into our launch metrics Steve.

Steve Parsons: As John indicated, we continue to be pleased with our progress since launch. From launch in February 2023 through March 31st, 2024, we've had 2,184 unique prescribers, up 29% from the 1,696 unique prescribers we had from launch through December 31st. We are encouraged by the prescriber growth in this quarter as we believe it reflects our strategy of establishing a broader prescriber base. Importantly, more than half of these prescribers have written multiple prescriptions.

Steve Parsons: Thank you.

Steve Parsons: John indicated we continue to be pleased with our progress since launch from.

Steve Parsons: From launch in February 2023 through March 31, 2024, we've had 2184 unique prescribers up 29% from the 1696 unique prescribers, we had from launch through December 31.

Steve Parsons: We are encouraged by the prescriber growth in this quarter as we believe it reflects our strategy of establishing a broader prescriber base.

Steve Parsons: Importantly, more than half of these prescribers have written multiple prescriptions.

Steve Parsons: During the first quarter, we had 17,736 doses written, and 8,074 doses were filled. As John indicated earlier, our doses filled during the first quarter were negatively impacted by the widely reported Change Healthcare cyber attack. We also face normal calendar seasonality as patient deductibles reset at the start of the year.

Speaker Change: During the first quarter, we had 17736 doses written and 8074 doses have been filled as.

John H. Tucker: As John indicated earlier, our doses filled during the first quarter were negatively impacted by the widely reported change healthcare cyber attack.

Speaker Change: We also faced normal calendar seasonality as patient deductibles reset at the start of the year.

Steve Parsons: Despite those headwinds, we are pleased with the trajectory that we are currently on, and we continue to explore steps to increase our fill rate going forward. One of those steps is a change in our patient services hub that we completed in March. Increasing number of our providers are writing prescriptions for patients in anticipation of future needs. These prescriptions may not be filled in the month or quarter in which they are written, and they make up a significant portion of the spread between doses written and doses filled that we report on.

John H. Tucker: Despite those headwinds we are pleased with the trajectory and we are currently on and we continue to explore steps to increase our fill rate going forward. One of those steps is a change in our patient services hub that we completed in March.

Speaker Change: An increasing number of our providers are writing prescriptions for patients in anticipation of future need.

Speaker Change: These prescriptions may not be filled in the month or quarter in which they are written.

unknown: And make up a significant portion of the spread between doses written and doses filled that we report on.

Steve Parsons: Pre-approved prescriptions are reported in the doses written statistics, and we report on them as doses filled when they actually ship to patients as the prescriber directs. It's a portion of doses that do get canceled by prescribers or patients for a variety of reasons. For example, some patients are very difficult to reach, or have been hospitalized, or are deceased. Other reasons for cancellation are a high copay or because the patient resolved with standard of care before filling through a.

unknown: Preapproved prescriptions are reported in the doses written statistics.

unknown: We report on them as Joseph has filled.

Joseph: Actually shipped to patients as the prescriber directs.

Joseph: It's a portion of doses that do get canceled by prescribers or patients.

Speaker Change: For a variety of reasons.

Joseph: Some patients are very difficult to reach or have been hospitalized.

Joseph: Just fees.

Joseph: Other reasons for cancellation or a high co pay or because the patient resolve with standard of care before selling to euro six.

Steve Parsons: The changed health care situation did lead to an increase in cancellations during the quarter as some prescriptions could not be processed when needed. Cancellation was 19% in quarter one of 2024. Over time, we anticipate that the cancellation rates will normalize. Better position on prescription formularies, quicker coverage decisions by payers, and lower patient out-of-pocket costs will improve fill rates and stabilize the percent who get cancer. During the first quarter, the average number of doses per prescription filled was 6.1, which remains higher than our long-term expectations and is up slightly sequentially from 5.9 in the fourth quarter of 2023.

Joseph: Change healthcare situation did lead to an increase in cancellations during the quarter as some prescriptions cannot be processed when needed.

Joseph: Cancellation was 19% in quarter one of 2024.

Joseph: Over time, we anticipate that the cancellation rates will normalize.

change healthcare: Better positioning on prescription formularies quicker coverage decisions by payers and lower patient out of pocket costs will improve sell rates and stabilize the percent that you cancelled.

change healthcare: During the first quarter. The average number of doses per prescription filled was six one which remains higher than our long term expectations and up slightly sequentially from $5 nine in the fourth quarter of 2023.

Steve Parsons: Our sales force has conducted 2,938 in-services from launch through March 31st, up from 2,331 in-services completed as of December 31st of last year. InServices provide important training to offices on the prescribing process of fluorosics, and this ensures office readiness.

change healthcare: Our sales force has conducted 2938 in services from launch through March 31 up from 2000, and 331 services completed as of December 31 of last year.

Sales Force: And surfaces provide important training to offices on the prescribing process of Euro six and this ensures office readiness.

Steve Parsons: As we open more new accounts, the execution of in-services remains fundamental to career health success, and we regard the number of in-services conducted each quarter as an important leading indicator. Regarding our sales force, we've said previously that we stand ready to add additional territories as demand warrants. We plan on adding additional territories in advance of potential Class IV and CKD long-term growth initiatives. From a marketing perspective... We are engaged in a broad, multi-channel marketing campaign to drive brand awareness, adoption, and commitment.

Sales Force: As we opened more new accounts the execution of <unk> services remains fundamental future success, and we regard the number of in servicing conducted each quarter as an important leading indicator.

Speaker Change: Regarding our sales force, we have said previously that we stand ready to add additional territories as demand warrants.

Speaker Change: Plan on adding additional territories in advance of potential class four and CK D long term growth initiatives.

Speaker Change: From a marketing perspective, we.

Speaker Change: We are engaged in a broad multichannel marketing campaign to drive brand awareness adoption and commitment.

Steve Parsons: This program encompasses many different activities, but some of the key ongoing activities include engagement and development of key opinion leaders, conference presence, Print and Electronic Collateral, and the development of both provider and patient websites, among other critical tasks. We continue to reach out to heart failure patients and their caregivers with patient education materials for a few rounds. Overall, we are pleased with our continued progress and the path that we are on. That concludes my update. I would now like to turn the call over to our CFO, Rachael Nokes, for a review of our financials.

Speaker Change: This program encompasses many different activities, but some of the key ongoing activities include engagement and development of key opinion leaders conference presence.

Speaker Change: Print and electronic collateral.

Speaker Change: And the development of both provider and patient website among other critical tasks to.

Speaker Change: We continue to reach out to heart failure patients and their caregivers with patient education materials for fewer options.

Speaker Change: Overall, we are pleased with our continued progress and the path that we're on.

Speaker Change: That concludes my update I would like now to turn the call over to our CFO Rachel notes for a review of our financials. Thank you.

Rachael Nokes: Thank you Steve.

Rachael Nokes: As of March 31st, 2024, we held $58.4 million in cash and cash equivalents, compared to $76 million in cash, cash equivalents, and investments as of December 31st, 2020. Now, I will cover a few income statement items.

Rachael Nokes: As of March 31, 2024, we have $58 4 million in.

Rachael Nokes: Cash and cash equivalents compared to $76 million in cash cash equivalents and investments as of December 31st 2023.

Rachael Nokes: Now I'll cover a few income statement items.

Rachael Nokes: We reported a net loss of $14.1 million for the first quarter of 2024, compared to a net loss of $11.2 million for the first quarter of 2020. Product revenues were $6.1 million for the first quarter of 2024, compared to $2.1 million for the first quarter of 2020. Cost of product revenues was $1.8 million for the first quarter of 2024 compared to $0.6 million for the first quarter of 2020. The increase in both product revenues and cost of product revenues for the quarter ended March 31st, 2024 was due to a full quarter of sales in the first quarter of 2024 and an increase in demand at Bureau 6 further into the commercial launch and related manufacturing costs.

Rachael Nokes: We reported a net loss of $14 1 million times for the first quarter of 2024 compared to a net loss of $11 $2 million for the first quarter of 2023.

Speaker Change: Product revenues were $6 1 million for the first quarter of 2024 compared to $2 1 million for the first quarter 2023.

Speaker Change: Cost of product revenues were $1 8 million for the first quarter of 2024 compared to $6 million for the first quarter of 2023.

Speaker Change: Increase in both product revenues and cost of product revenues for the quarter ended March 31 2024.

Speaker Change: As a full quarter of sales in the first quarter of 2024, and an increase in demand erosion further into the commercial lines and related manufacturing costs.

Rachael Nokes: Research and development expenses were $2.7 million for the first quarter of 2024, compared to $2.1 million for the comparable period in 2023. The increase in research and development expenses for the quarter ended March 31st, 2024, was primarily due to an increase in device development costs, employee-related costs, and clinical study costs. Selling general and administrative expenses were $17.4 million for the first quarter of 2024, compared to $10.9 million for the comparable period in 2023.

Speaker Change: Research and development expenses were $2 7 million for the first quarter of 2024 compared to $2 $1 billion for the comparable period in 2023, the increase in research and development expenses for the quarter ended March 31, 2024 was primarily due to an increase in device development.

Speaker Change: Employee related costs and clinical study.

Speaker Change: Selling general and administrative expenses were $17 4 million for the first quarter of 2024 compared to $10 9 million for the comparable period in 2023.

Rachael Nokes: The increase in selling general and administrative expenses for the quarter ended March 31st, 2024 was primarily due to an increase in employee-related costs, commercial costs, and patient support. As of March 31st, 2024, we have 36,054,409 total shares outstanding. That concludes the financial update. John? Thanks.

unknown: The increase in selling general and administrative expenses for the quarter ended March 31, 2024 was primarily due to an increase in employee related costs and commercial costs and patient support.

unknown: As of March 31, 2024, we had 36 million 54409 total shares outstanding.

unknown: The financial update John.

John H. Tucker: Thanks, Rachael. This concludes our prepared remarks. At this point, we will open the call for questions.

Rachael Nokes: Thanks, Rachel This concludes our prepared remarks at this point, we will open the call for questions.

Operator: Thank you. Ladies and gentlemen, if you would like to ask a question, please press star followed by one on your touch-tone phone. You will then hear a prompt that your hand has been raised. And if you would like to withdraw from the question queue, simply press the star followed by two. And out of consideration to other callers today, we ask that you please limit yourself to one question and one follow-up. Please go ahead and press star 1 now if you do have any questions. And your first question will be from Glenn Santangelo at Jeffries. Please go ahead.

Operator: Thank you, ladies and gentlemen, if you would like to ask a question. Please press star followed by one on your Touchtone phone you will then hear a prompt that your hands has been raised.

Speaker Change: We'd like to withdraw from the question queue simply press star followed by tube.

Speaker Change: And out of consideration to other callers we ask that you. Please limit yourself to one question and one follow up. Please go ahead and press Star one now if you do have any questions.

Speaker Change: And your first question will be from Glenn Shannon Jello at Jefferies. Please go ahead.

John H. Tucker: Yeah, thanks for taking my question. Hey John or Rachael, I'm not sure who wants to answer, but I guess my first question is about revenue. It's just sort of looking at the 6.1 million; it's sort of flat sequentially from where you were in 4Q, and I'm just trying to reconcile that versus the fact that the doses billed were up 15% sequentially. So I just want to make sure I understand how the math and all that revenue recognition works.

Speaker Change: Hi, yes, thanks for taking my question, Hey, gentlemen, Rachel I'm, not sure who wants to answer but I guess, Mike. My first question is on revenues just sort of looking at the $6 1 million is sort of flat sequentially from where you were in four Q and I'm just trying to reconcile that versus the fact that the doses build was up 15%. So.

Rachel: <unk>, so I just want to make sure I understand how how the math and all of that revenue recognition works.

John H. Tucker: Yeah, sure guys, this is John. So, you know, 6-1 was similar to the last quarter. Again, we had the impact of the changed healthcare, which knocked that down. You know, you always have the headwinds in Q1 of patients' out-of-pockets resetting, but the difference in the higher amount of doses filled versus last quarter and why the revenue stays the same was that in Q4 we had, as we've talked about on the Q4 call, a very large order from Kaiser Direct that doesn't go So that's why there's a difference between what you would think the difference in net revenue would be from doses filled.

John H. Tucker: Yes sure. This is John so in the six one was similar to the last quarter again, we had the impact of the change healthcare, which knocked that down you always had the headwinds in Q1.

John H. Tucker: Patients' out of pockets resetting, but the difference in that.

John H. Tucker: The higher amount of doses bill versus last quarter and why the revenue stayed the same was just in Q4, we had as we talked about on the Q4 call a very large order from Kaiser direct that doesn't go into our build doses, but is in our net revenue. So that's why there is.

John H. Tucker: The difference between.

John H. Tucker: What you would think that difference in the net revenue would be from doses felt.

Steve Parsons: All right, I'll go back and take a look at that. And then John, maybe just one quick follow-up. Obviously, a lot of people are focused on the compelling value proposition for the managed care companies. But, you know, maybe either you or Steve can just sort of give us some sense of how the conversations are going with the feedback from the doctors. And are you getting any pushback at all at this point in terms of wanting to prescribe more? What are the barriers to prescribing more? Thank you. [inaudible]

John H. Tucker: Alright, I'll go back and take a look at that and then John maybe just one quick follow up.

John H. Tucker: Obviously, a lot of people focused on the compelling value proposition for the managed care companies, but maybe either you or Steve can just sort of give us some <unk>.

Steve: Of how the conversations are going with with the feedback from the doctors and and are you getting any pushback at all at this point in terms of.

Steve: Wanting to prescribe more what the barriers are to prescribing more thank you.

Steve Parsons: Cheers. Steve, you want to handle that? Yeah, we're not getting pushback from the doctors. You can see our demand is going up month over month. It's continuing. Our conversations with payers, you know, most of our prescriptions are getting covered, and they're getting covered at affordable co-pays, as you heard John say, 70% of our co-pays are $100 or less. You know, we're engaging with them; they're all calculating what they're going to do in 2025. So, you know, we're meeting with them regularly, and it's been pretty positive for us. So, and the doctors aren't having an issue really at all getting the product that they want.

Steve: Sure a stimulant and model.

Steve: Yeah, well, we're not getting pushback from the doctors.

Speaker Change: You can see our demand is going up.

Steve: Other months.

Steve: Continuing.

Payers: Our conversations with payers and most of our prescriptions are.

Payer Representative: Getting covered in there.

Speaker Change: Getting covered.

John H. Tucker: At Affordable co pays as you heard John say, 70% of our co pays or $100 or less.

John H. Tucker: We're engaging with them, they're all calculated on what theyre going to do in 2025.

John H. Tucker: So.

Speaker Change: We're meeting with them regularly and it's been pretty positive for us so.

Speaker Change: And the docs are already having an issue really at all we're getting the product that they want.

John H. Tucker: Okay. Thank you.

Bob: Thanks, Bob.

Speaker Change: Next question will be from Stacy <unk> TD Cowen. Please go ahead.

Operator: Hey, thanks so much for taking our questions. Congratulations on the progress, especially navigating the healthcare cyber attack. We just had a few questions.

Speaker Change: Hey, thanks, so much for taking our questions and congratulations on the progress, especially navigating the change healthcare cyber attack.

Speaker Change: Just a few questions.

John H. Tucker: First, it sounds like we're seeing good prescriber and patient demand. So can you just comment on expectations regarding seasonality this year? And if so, if you think there is gonna be seasonality, what do you have planned that could allow you to capture patient share during crucial high-demand quarters? Is it just trying to get a lot of infrastructure in place ahead of the summer, for instance? Where you might have a higher need for furosics, unfortunately.

Speaker Change: Sounds like we're seeing good prescriber and patient demand. So can you just comment on expectations regarding seasonality this year and if so if you think there is going to be seasonality. What do you plan that would allow you to capture patient sure John Chrystal Heidelberg quarters, just trying to get a lot of infrastructure in place ahead of the summer for instance.

Speaker Change: Where you might have.

Speaker Change: A higher need for <unk>. Unfortunately, and then the second question is going to be around formulary additions. So when you talk about the hospital systems and it comes to kind of the forensics opportunity. How are you thinking about it long term and how long do you expect that process will take with kind of ideas and then kind of formulary access so we're.

John H. Tucker: And then the second question is gonna be around formulary additions. So when you talk about the hospital systems and it comes to kind of the furosics opportunity, how are you thinking about it long term, and how long do you expect that process will take with IDNs and kind of formulary access?

Speaker Change: Are you in that progress if you think about accounting target.

Speaker Change: Thank you so much.

John H. Tucker: Thanks, Dave. This is John.

Steve: Thanks, Kate this is Jon I'll, let Steve comment as well seasonality.

John H. Tucker: I'll let Steve comment as well. Seasonality, you know, it's interesting. So there's some seasonality. You know, you get an impact in Q1 mainly because out-of-pockets reset patients to deductibles, and they're out-of-pockets reset. So there's always a little headwind in Q1. But if you look at Q2, Q3, we don't see that same seasonality

Steve: And so there's some seasonality you get an impact in Q1, mainly because out of pockets reach that patients deductibles in their out of pockets reset. So there's always a little headwind in Q1.

Steve: You look at Q2 Q3, we don't see that same seasonality into it into the end of Q4.

John H. Tucker: Into the end of Q4, you know, the second half of Q4, you have something Steve calls holiday heart, where patients are, you know, doctors are worried they're going to grab too much salt. So you tend to see doctors writing a lot more scripts for the patients just in case. And a lot of patients end up using them. So I do think there's some seasonality based on the holidays in Q4. We don't see it quite as much, like around July 4th or something as opposed to Christmas and Thanksgiving.

Steve: You know second half of Q4, you had something Steve calls holiday heart, where patients are doctors are worried they're going to grab too much salt. So you tend to see doctors, writing a lot of lot more scripts kind of or the patients just in case a lot of the page.

Steve: Send up and abuse in them. So I do think there is some seasonality based on the holidays in Q4.

Steve: We don't see it quite as much like around July 4th or something as opposed to Christmas and Thanksgiving.

John H. Tucker: So the question on the IDNs, I'll just jump in. So, you know, IDNs come in all shapes and sizes. Obviously, the biggest one is a VA. Our goal this year is to get on the national formulary. The VA, we're selling the VAs, you know, every month to separate companies. But again, we want to go up on the national formulary.

Steve: So and the question on the idea of it so.

Steve: <unk> come in all shapes and sizes. So obviously the biggest one is the VA.

Speaker Change: Our goal this year is to get on on National formulary at the VA or we're selling to be as you know every every month.

Kaiser: To separate Bas, but again, we wont go up a national formulary second biggest bas Kaiser.

Steve Parsons: The second biggest VA is Kaiser. We talked about the formulary there and did ship a big, almost thousand unit order there at the end of Q4. And they put it in their protocols. So they're using it now on patients. So we anticipate them continuing to order.

Speaker Change: We thought we've talked about in our formula.

Kaiser: Formulary, there and did ship a big almost 1000 unit order there at the at the end of Q4.

Speaker Change: And they put it in their protocols so they're using it now on patients. So we anticipate them continuing to order. That's your second biggest IDM.

Steve Parsons: That's your second biggest IDN. And then you have a number of other IDNs. Again, IDNs all look different, and that sometimes this hospital system. Maybe, Steve, you could talk about some of the ones we're working with now. Yes. For example, the University of California system. That's UC Davis, UC San Francisco, UC LA, San Diego, Irvine. We're working with them to purchase furosics directly, put it into all of their sites, load it into their EMRs so they're fully integrated. It's really fast and really easy.

Steve: And then you have a number of ideas, but again I D ends all look different that are sometimes as hospital says maybe Steve you could talk about some of the ones. We're working with now for example.

Steve: Example, the University of California system that UC Davis, UC, San Francisco U C. L. A San Diego Irvine, we're working with them to for them to direct purchase Fierro sticks.

Steve: I'll put it into all of their sites Hello to ancillary EMR. So they're fully integrated it's really fast real easy.

Steve Parsons: You know, having that integration, having the patient information, and being able to see who got what when across the whole system. So that's one that's, you know. Q2, we think.

Avnet integration: Avnet integration, having the patient information and being able to see who got what when cros.

UC Davis: Across the whole system. So that's one that's you know.

Steve Parsons: There are other ones all over the country like that. Think of big IDNs that are academic or university systems. They have the same interest in bringing fluorescence in directly and giving their patients access through them.

UC Davis: Q2, we think.

Avnet integration: There's other ones all over the country like that think of pick a big IV ends or academic or University systems.

Speaker Change: They have the same interest in bringing through those extend directly and giving their patients access.

Speaker Change: Through that.

John H. Tucker: Okay. Okay. Very helpful. Thank you so much.

Speaker Change: Okay.

Speaker Change: Very helpful. Thank you so much.

Speaker Change: Thank you next.

Operator: The next question will be from Rana Ruiz at Lyrinc Partners. Please go ahead.

Leerink partners: Next question will be from around our voice Leerink partners. Please go ahead.

John H. Tucker: Great. Afternoon, everyone.

Speaker Change: Great afternoon, everyone. So I know Doug you mentioned you completed.

John H. Tucker: So, I noticed you mentioned you completed a transition to a new patient services provider and specialty pharmacy network. I was curious, does that impact inventory or stocking at all? And could it help streamline or even boost the process of getting fluoresics to patients?

Doug: I noticed you mentioned you completed a transition to a new patient services provider and specialty pharmacy network. I was curious does that impact inventory or stocking at all and could it help streamline or even through this the process of getting for Essex to patients.

John H. Tucker: So it doesn't really impact our inventory at all, but yes, we're really looking to improve the patient and physician experience, streamline getting product to patient as fast as we can, and actually get better data as well. So that was the reason we made the change, but it didn't have any impact on inventory.

Speaker Change: So it doesn't really impact our inventory at all but yes, we're really looking to improve.

Speaker Change: Improve the patient and physician experience streamlined getting product to patients as fast as we can and actually get better data as well. So that was the reason we made the change but it didn't it didn't have any impact.

Speaker Change: On inventory.

Speaker Change: Got it okay and as a follow up I was curious knowing that the <unk> date is coming up in August for class four heart failure do you plan to do anything different with the field force strategy educating physicians at that time et cetera to help boost for our sex education.

John H. Tucker: Got it, okay. And as a follow-up, I was curious, knowing that the PDUFA date is coming up in August for class four heart failure, do you plan to do anything different with the field four strategy, educating physicians at that time, et cetera, to help boost O6 education and awareness ahead of the label expansion? Yeah, as soon as you can't do it for free.

Speaker Change: And awareness I had the label expansion.

Steve Parsons: Yeah, as soon as, you know, you can't pre-promote that, but as soon as we have the approval, we'll be doing mailings and notification to all, you know, providers, and obviously, the sales force would have been trained in advance of that. Keep in mind, it's the same, it's really the same physicians that we're calling on. We'll be educating them through direct and non-direct routes that, hey, this is, these patients are now eligible for Ferosix use. So, again, direct and non-direct promotion to physicians that we now have a class four indication. But it's the same doctors, the same staff, in the same office.

Speaker Change: Yes, as soon as you can't appropriately promote that but as soon as we have the approval we will be doing mailings.

Speaker Change: And notification to all providers.

Speaker Change: And obviously the sales force would have been trained in advance of that keep in mind. It's the same it's really the same physicians.

Sales Force: That we're calling on so we'll we'll meet educating them through direct and non direct route.

Sales Force: What's that Hey. This is these patients are now eligible for euro six years, so it'll be it'll be again direct and non direct promotion and awareness to the physicians that we know our class four indication, but it's the same docs the same in.

Sales Force: And the same offices.

Speaker Change: Got it thanks.

Sales Force: Okay.

Sales Force: Thank you.

Operator: Thank you. The next question will be from Chase Knickerbocker at Craig Hallam Capital. Please go ahead.

Sales Force: Question will be from Chase Knickerbocker.

Hallum capital: <unk> Hallum capital. Please go ahead.

John H. Tucker: Good afternoon. Thanks for taking my questions as well. Maybe just to start, I might have missed this, but just to confirm, you've seen kind of that script fill rate normalized thus far in April, where it's kind of back to your usual expectations and along those same lines. Any reason to believe that, you know, doses written could potentially have been partially impacted, as well as physicians maybe being a little less confident around potential script approval in March when we were in the heat of the change situation? Thanks.

Speaker Change: Good afternoon, Thanks for taking my questions as well.

Chase Richard Knickerbocker: Maybe just to start might've missed this but just to confirm you've seen kind of that script fill rate normalized thus far in April we're kind of back to your usual expectations and then along those same lines any reason to believe that doses written could have potentially been partially impacted as well as physicians, maybe we're a little less confident around potential script.

Chase Richard Knickerbocker: Approval in March when we were in the heat of the changed situation. Thanks.

John H. Tucker: You know, Chase, we don't think so. We were looking at the prescription trends coming in as we were going through the cyber attack. There might have been a little lull, but it wasn't anywhere near what we were seeing on the fill side. And, you know, doctors knew what was going on. Don't forget that doctors weren't getting paid because their claims weren't getting paid at all.

Chase Richard Knickerbocker: We we don't think so we were looking at the prescription trends coming in as we were going through the cyber attack.

Chase Richard Knickerbocker: There might have been a little lull, but it wasn't it wasn't anywhere near what we were seeing on the fill side.

Chase Richard Knickerbocker: Doctors knew what was going on and don't forget the doctors learn can pay because their claims we're getting paid at all so.

John H. Tucker: So, there might have been a little slowdown, nothing we could really see that I was worried would cut some momentum out from underneath us. But we don't think so, because we saw scripts really growing through the end of the quarter and into this quarter especially. So, any impact, we really think it was contained in Q1 and really was the impact on doses shipped. Got it. And that dose has shifted. It's certainly normalized to normal expectations, and so far on Q2, just to thicken the soup. Yeah.

Chase Richard Knickerbocker: Might have been a little slow down nothing we could really see did it I was worried that we cut some momentum out from underneath us, but we don't think so because we saw scripts really growing through the end of the quarter and to this end to this into this quarter, especially so.

Chase Richard Knickerbocker: The impact we really think it was it was it was contained in Q1 and really was the impact of doses shipped.

Speaker Change: Got it and that doses shipped is certainly normalize to normal expectations and and so far in Q2 just to yeah.

John H. Tucker: Yep, correct. We should get back to a similar level where we were before.

Speaker Change: Yep correct back to get back to back to the similar level, where we were before change.

John H. Tucker: Great. And is it time for us to kind of adjust our thinking on average doses per script? And then how does that also kind of, that same question, does that become a little bit more relevant as well when we contract with some of the larger Medicare Advantage plans? Are they going to kind of force a cap of four doses per script on the Medicare Advantage side when that's contracted? Maybe it will just kind help us with our long-term expectations around doses per script.

Chase Richard Knickerbocker: Great.

Speaker Change: And is it time for us to kind of adjust our thinking on average doses per script and then how does that also kind of that same question does that become a little bit more relevant as well when we contract with some of the larger Medicare advantage plans are they going to kind of force a cap of four doses per script on the Medicare advantage side, then that's contracted maybe just kind of help.

Speaker Change: With our long term expectations around doses per script.

John H. Tucker: So it's still higher than we anticipated. I do think the changes might have had a little impact on it because if they were going to get his script through, they were going to make sure, you know, if it was a six or a seven. We do think with plans that plans will bring that back down. You know, our contract with United on their commercial formula is a script of four. We think as more and more plans adopt it, that that will help moderate it. But it's important to note that we're still seeing about 75% of our business be the, you know, the pre-acute, the pre-admission patient.

Speaker Change: So it's still higher than we anticipated and I do think change might've had a little impact on it because they were going to get his script through they're going to make sure. It.

Speaker Change: It was a six or a seven.

Speaker Change: We do think with plans that plans will we'll bring that back down.

Speaker Change: Our contract with United on their commercial formularies as a script before we think as more and more plans adopt it but that will help moderate it but it's important to note, we're still seeing about 75% of our business.

Speaker Change #103: The pre acute the preadmission patient and we just know those doses are going to be are going to be five 6%. So I think that combination of things.

John H. Tucker: And we just know those doses are going to be fives and sixes. So I think that combination of things, but I do think it will come back down. Is it going to come all the way back down to four? We don't think so anymore. I think we're thinking it moderates in the five area.

Speaker Change: But I do think it will come back down or is it going to come all the way back down to four we don't we don't think so anymore. I think we're think moderates in the five area.

Steve Parsons: Got it. And you kind of mentioned Kaiser's, you know, protocols around how they're using ferrosics. Can you kind of give us a look into how an IDN like Kaiser, you know, could be utilizing your product? Is it largely on the front end? Pre-acute? Is it post-acute after, you know, just to prevent readmissions? Like, where are they really leaning into ferrosics and kind of talk about their experience thus far that you

Speaker Change: Got it and you kind of mentioned on Kaiser's.

Speaker Change: Protocols around how they are using for <unk> can you kind of give us a look into their on how an IV. Unlike kaiser could be utilizing your product does it largely on the front end pre acute as it post acute after just to prevent readmissions like where are they really leaning into <unk> and kind of talk about their experience, thus far that <unk> heard.

Steve Parsons: So, this is Steve. Their experience, what they're doing, is a little different than what we've seen in preventing admission. They're hospitalists, they're home care staff. They're prescribing medication for us post-discharge pretty regularly to prevent that readmission. That's their first use case of it. We know that it will expand to pre-admission to save on unnecessary hospitalization, but they are a little different than what we see. They're their own animal, and they always... They always think a little differently than everybody else, so that is a nuanced difference, but we expect it to be used in both cases over the long haul.

Steve: So this is Steve.

Steve: Their experience what they.

Speaker Change #101: We are doing is hello.

Speaker Change #100: A little different than what we've seen in preventing admission their hospitalists their home care.

Speaker Change #108: Staff, there are prescribing for Essex post discharge.

Steve: Pretty regularly too.

Steve: That readmission.

Speaker Change #107: That's their first use case of it we know that will expand to a pre pre admission to save on unnecessary hospitalization, but they are a little different than what we see there they are their own animal and they you know always.

Speaker Change #105: They always think a little differently than everybody else. So.

Speaker Change: That is a nuanced difference, but we expect it to be used in both cases over the long haul.

Operator: You got it. Thanks for taking the questions, guys.

Speaker Change #111: Got it thanks for taking the questions here.

James: Thanks James.

Operator: Ladies and gentlemen, a reminder to please press star 1 if you have any questions. Next will be Naz Rahman from Maxine Kapp Group. Please go ahead.

Speaker Change #119: Ladies and gentlemen, a reminder to please press star one if you have any questions.

Speaker Change #106: Next will be <unk> <unk> Maxim group. Please go ahead.

Steve Parsons: Hi everyone. Congratulations on the progress. Just a couple. On the upcoming Class IV and also CKD potential launches, could you comment on what you think the number of doses might be for those indications? I would say for class four patients, they are a little bit sicker, they are more severe, they tend to have excess fluid more often and more times a year where they lose control a little bit. So I don't think the script size will moderate down for class four patients specifically.

Speaker Change #109: Hi, everyone. Congrats on the progress just a couple.

Speaker Change #104: On the upcoming class four and also C J D potential launches.

Speaker Change #118: Could you comment on what you think the number of doses might be for those indications.

Speaker Change #117: Thank you.

Speaker Change #110: Steve do you want to.

Steve: I would say for class four they are a little bit sicker they are more severe.

Speaker Change #114: Tend to have excess fluid more often and more times, a year, where they lose control a little bit so.

Speaker Change #112: Thank the script says will moderate down for a class four patient specifically.

Steve Parsons: It could be in that six range, or maybe they'll get refills more often than a standard patient. For CKD, our market research tells us it's about the same as heart failure, it'll be in that four to five range unless they're sicker with chronic kidney disease and have more fluid. And then it might be similar to a class four in heart failure.

Speaker Change #112: It could be in that six range or.

Speaker Change #112: Maybe they'll get refills more often than a standard.

Stan: Stan your passion.

Speaker Change #113: For CK D. Our market research tells us it's about the same as heart failure it'll be in that four to five range unless they're thicker with chronic kidney disease and have more fluid and then it might be similar to a class four heart failure.

Steve Parsons: Got it, thanks. That was very helpful. And my last question is on: you mentioned that an increasing number of providers are writing scripts in anticipation of future needs. Do you have an idea of what percentage of the scripts providers are writing that are for potential future needs? So it's sometimes hard to tell. You can look at the expedited ones because those are definitely needed. But I think it's 20% or so that they kind of put on layaway. Got it. Thanks. Thank you for asking my question.

Speaker Change #122: Got it thanks that was helpful and.

Speaker Change #116: My last question is on you mentioned that.

Speaker Change #121: Creation of our providers, writing scripts in anticipation of future needs you have an idea of what percentage of the scripts providers are writing better for potential future needs.

Speaker Change #120: So it's it's.

Speaker Change #131: Sometimes hard to tell or you can look at the expedited ones because those are our definitely need it but I think it's 20% or so that they kind of put on layaway.

Speaker Change #123: Got it thanks, and you hear my question.

Speaker Change #123: Thanks.

Operator: Next is Douglas Tsao at H.C. Wainwright. Please go ahead.

Speaker Change #123: Next is Douglas Tsao of H C. Wainwright. Please go ahead.

John H. Tucker: Hi, good afternoon. Thanks for taking the questions. Just, John, maybe as a follow-up, I guess, in terms of the... physicians who are prescribing in advance. Can you maybe just help us understand how far in advance that is? And maybe what's the sort of process between them or the value of writing the script? I mean, I guess it's just pre-adjudicated, and then it sort of ships when they tell you to ship it?

Douglas Dylan Tsao: Hi, good afternoon. Thanks for taking my questions just John maybe as a follow up I guess in terms of the.

Douglas Dylan Tsao: Physicians, who are prescribing in advance can you maybe just help us understand how far in advance that is.

Speaker Change #120: And maybe what's the sort of process between man.

Speaker Change #120: The value of our writing the script I mean, I guess is it just pre adjudicated and then it sort of shifts when they tell you to ship it.

John H. Tucker: Hey, Doug, it's John. Yes, we filled one from January and September. I saw last week that was put on layaway. The doctor checked to make sure everything cleared and understood what the copay was. And as soon as the patient ran into trouble, the doc was ready to send it. Send it to the patient. That's certainly an example that these scripts aren't gone. They're not lost. They're not canceled.

John: Yeah, Hey, Doug its John Yes.

John: Told one from January to September I saw last week that was put on lay away the doctor check make sure.

John: That's got everything cleared.

Speaker Change #128: Understood with the with the co pay it wasn't as soon as the patient ran into trouble. The dock was ready to defend it and send it to the patient.

Speaker Change #125: Steve do you want me.

Speaker Change #127: That's certainly an example.

Speaker Change #127: These scripts arent gone, they're not lost they're not canceled.

John H. Tucker: Every week, we see prescriptions coming in and getting filled from months ago, but the most common utilization is the doctor sees a patient, they have some excess fluid, they have symptoms. If maybe it's early, they order furosics because they think they might need them. The patient progresses, they do the normal standard of care a little bit.

Speaker Change #120:

Speaker Change #129: Every week, we see prescriptions coming and getting sales from months ago, but but but the most common utilization as the doctor sees a patient they have some excess fluid they have symptoms.

Speaker Change #129: It's maybe it's early they order for euro six because they think they might need it the patient progresses. They do the normal standard of care a little bit if that doesn't that doesn't work. They immediately called out Jurassic. So sometimes these layaway scripts are only a matter of days. Other times you know what I know, we have a group of <unk>.

John H. Tucker: If that doesn't work, they immediately call down furosics. So sometimes these layaway scripts are only a matter of days. Other times, you know what? I know we have a group of frequent flyers. Let's just send in a few prescriptions and get those approved. Let's get the known copay. Let's get it all ready to go. And when we see them, if they're in trouble, we'll just call it down. So it's good.

Speaker Change #129: Frequent fliers, let's just send them a few prescriptions get those approved let's forget the known copay, let's get it all ready to go and when we see them. If they are in trouble, we'll just call. It down. So it's it's good it's good housekeeping for them in some cases in terms of fluid management.

John H. Tucker: It's good housekeeping for them in some cases in terms of fluid management. Other cases are they just want to see if the patient resolves under standard of care, and then in some cases it is filled, you know, more room.

Speaker Change #129: Other cases it there just wanted to see if.

Speaker Change #129: The patient resolves the under standard of care then in some cases it is filled.

Speaker Change #129: <unk>.

Speaker Change #129: More remotely from when it was prescribed.

John H. Tucker: And then a follow-up question. It sounds like you sort of navigated the healthcare disruption well. I'm just curious if you have a sense of, you know, how many scripts you ultimately lost, or was it just a matter that most of them ultimately just fell out of the first quarter and maybe were filled in?

Speaker Change #133: Okay great.

Speaker Change #130: Highly variable in nature.

Speaker Change #134: And then a follow up I mean, it sounds like you sort of have navigated the change healthcare disruption well I'm just curious if you have a sense of.

Speaker Change #129: Oh.

Speaker Change #132: How many scripts you ultimately lost or was it just a matter that most of them ultimately just fell out of the first quarter and maybe were filled in Q2.

John H. Tucker: No, I don't think they were filled in Q2. I think we, you know, we said about 10% of units if you look at the units that If you looked at what we were filling, we think it's about 10%. When we looked at what was coming in that should have been going out, that wasn't going out. It was higher than that. We recovered them, and some of them did ship later in March, so we recovered some of them. But I was worried it was going to be closer to 20% or 25% because it had just shut down. I think we recovered most of it, so we think we lost about $600,000 or $700,000 in there.

Speaker Change #137: No I think I don't think they were filled in Q2 Doug.

Speaker Change #139: Thank you.

Speaker Change #135: We said about 10% of units if you look at units that.

Speaker Change #140: If you looked at what we were filling in.

Speaker Change #136: It was about <unk>, we think it's about 10% when we looked at what was coming in that should have been going out that wasn't going out.

Speaker Change #136: It was higher than that we recovered and some of them did ship later in March. So we recovered some of them. It was I was worried it was going to be closer to 20 or 25% because it was to shut down but I think we recovered most of it. So we think we lost about six or $700000 in there.

John H. Tucker: Okay, great. Thank you so much.

Speaker Change #144: Okay, great. Thank you so much.

Speaker Change #144: Okay.

John H. Tucker: At this time, I would like to turn the call back over to Mr. John Tucker.

Speaker Change #135: Q.

Speaker Change #141: At this time I would like to turn the call back over to Mr. John Tucker.

John H. Tucker: Thank you. Okay, that concludes our call this afternoon. We are very pleased with our first quarter results, which we generated, notwithstanding the headwinds of the changed health care cyber attack and the annual resetting of out-of-pocket patient deductions. We expect this momentum to continue as more treating physicians gain comfort prescribing fluorescence to their heart failure patients and as we make incremental progress with payor formulae. At the same time, we are excited about our lifecycle initiatives, having had productive discussions with the FDA, and look forward to providing more updates as we progress through 2024.

Speaker Change #138: Thank you Okay that concludes our call. This afternoon, we are very pleased with our first quarter results, which we generated notwithstanding the headwinds of the change healthcare cyber attack.

Speaker Change #142: Andrew annual resetting of out of pocket patient deductibles, we expect this momentum to continue as more training physicians gain comfort prescribing <unk> for their heart failure patients and as we make incremental progress with payer formularies the.

Speaker Change #142: The same time, we are excited about our lifecycle initiatives that we've had productive discussions with the FDA and look forward to providing more updates as we progress through 2024 by four to a successful year barring our next quarterly update in August. Thank.

John H. Tucker: I look forward to a successful year requiring our next quarterly update in August. Thank you again, and have a good evening. Thank you, sir. Ladies and gentlemen, this does indeed conclude your conference call for today. Once again, thank you for attending, and at this time, we do ask that you please disconnect your lines.

Speaker Change #142: Thank you again and have a good evening.

Speaker Change #143: Thank you, Sir ladies and gentlemen, this does indeed conclude your conference call for today. Once again, thank you for attending and at this time, we do ask that you. Please disconnect your lines.

Speaker Change #142: Okay.

Operator: Please see the complete disclaimer at https://sites.google.com/sites

Speaker Change #142: [music].