Q3 2024 Neurocrine Biosciences Inc Earnings Call
Yeah.
Please standby your program is about to begin.
Speaker Change: Good day, everyone and welcome to today's new Oregon, Biosciences reports third quarter was.
Speaker Change: At this time all participants are in a listen only mode. Later, you will have an opportunity to ask questions. During the question and answer period, you may registered to ask a question at any time by pressing star one on your telephone keypad. Please note that this call will be recorded and I will be standing by should you need any assistance. It is now my pleasure to turn today's call over to Todd Tusa.
Speaker Change: Vice President of Investor Relations. Please go ahead.
Todd Tusa: Thank you and happy Halloween and welcome to Neurocrine Biosciences third quarter 2024 earnings call with me are Dan <unk>, Our Chief Executive Officer, Matt Abernethy, Chief Financial Officer, Eric benefits, Chief Commercial Officer, and IV Roberts Chief Medical Officer.
Speaker Change: Note that today, we will be making forward looking statements. These statements are subject to certain risks and uncertainties and our actual results may differ materially.
Speaker Change: Currency to review the risk factors discussed in our latest.
Speaker Change: Islands with that for the first time I hand, the call to call.
Dan: Thank you Todd before we dive in I'd like to acknowledge that this is my first earnings call at Neurocrine CEO I'm excited to share my enthusiasm for our future. So my opening remarks, they run a bit longer than usual.
Dan: First I want to express my deep gratitude to our board of directors for their confidence in my leadership as we embark on this next chapter of growth.
Dan: Thanks to the exceptional guidance of our patios, Garry Lyons and Kevin Gorman Neurocrine is in a strong position to become a true leader in neuroscience I extend my heartfelt thanks to both Gary and Kevin for their invaluable contributions to the company's success.
Dan: Given our company's growing multibillion dollar franchise in and grab that the potential of professor Bart as our next blockbuster the registrational programs for MBIA 845, and MBIA 568, and what we believe to be the industry's most robust neuroscience focused pipeline neurocrine future is bright with significant value creation ahead to.
Dan: To build on this at our core we are a company driven by innovation and operational excellence, our capital allocation strategy flexes by prioritizing revenue growth diversification and regenerative pipeline.
Dan: As announced in this morning's press release, our board of directors has authorized a share repurchase plan of $300 million, which we intend to implement through an accelerated share repurchase transaction.
Dan: Centering our expected revenue growth for both <unk> and Grubhub, Inc. Pronounce your box and the breadth of the early to late stage pipeline. We believe neurocrine is trading at a significant discount to its underlying enterprise valuation, making share repurchase a high return investment opportunity. In addition, we maintained the flexibility to further invest in the growth of our business.
Dan: On the topic of capital allocation, our strategy is aligned with our plan for value creation. This approach is driven by four key pillars that ensure we continue as a high growth company and position ourselves as a leading neuroscience organization with both commercial and scientific scale and expertise.
Dan: Core pillars of our strategic plan are one drive revenue growth by investing in Gaza and preparing for a successful <unk> launch to aggressively develop our highest value pipeline assets, such as NBA 845, and N V. I 568, like accelerating early stage programs through proof of concepts three.
Dan: Pursue external opportunities to expand our portfolio with strategically aligned assets that can be rapidly developed into commercial products leveraging our expertise in neurology psychiatry, endocrinology and R&D to commercial infrastructure and for return excess capital to shareholders beyond what is required for organic and inorganic.
Dan: Growth.
Dan: With these guiding pillars, we are well positioned to deliver substantial near and long term value to both patients and shareholders.
Dan: Now as far as Q3 within grants that we continue to reach more and more patients suffering from tardive dyskinesia and Huntington's disease Korea with an estimated 85% of the 800000 patients with tardive dyskinesia and not yet receiving a <unk> inhibitor for the symptoms.
Dan: There is much work and opportunity ahead.
Dan: To this end, we are again raising full year aggressive guidance.
Dan: Regarding <unk>, our regulatory activities remain on track with potential approvals by year end, we're excited to deliver a groundbreaking treatment to patients of black the new option for 70 years.
Speaker Change: Congrats Ed <unk> when approved will be first in class medicine for patients and has the same hallmarks of a blockbuster medicine no doubt <unk> will offer a second leg of revenue growth for Neurocrine and helps diversify our business over time.
Speaker Change: On the pipeline front. This year, we obtained proof of concept data in two of our three novel Psychiatry Phase III programs, having spent nearly 25 years in this therapeutic area I understand the inherent risk that comes with drug development within psychiatry.
Speaker Change: TV success in just one of these programs would have been remarkable succeeding in two out of three exceeded our internal expectations and significantly derisked those assets and their associated biology.
Speaker Change: As we move MDI 845, or Amp up positive allosteric modulator for major depressive disorder, and MDI 560, <unk> are selected Infor muscarinic agonists for schizophrenia into Registrational studies early next year, we are well positioned for the next key value drivers after in Gaza and pronounce our path with several internally developed.
Speaker Change: You'll set to enter clinical trials in multiple phase III programs lined up for 2025 prioritizing R&D investment becomes even more critical today's decision to de prioritize EBITDAX stat. In MDI 104 reflects this disciplined approach decisions like these are never easy and I want to acknowledge and thank the patients families and health care.
Speaker Change: Professionals involved in the studies.
Speaker Change: Disciplined capital allocation are cornerstones of our strategy and we will continue to evaluate all of our clinical and preclinical programs to ensure we invest and potential treatments that offer meaningful value for patients and shareholders alike.
Speaker Change: In closing with an exceptional leadership team and a dedicated energized organization, we are well positioned to become the leading neuroscience company I'd like to wrap up my remarks by sharing thoughts I expressed earlier this year when Kevin announced his retirement.
Inspired by the work we have ahead more confident than ever in the potential of our future and are measurably proud to collaborate with the best team in the industry to release suffering for people with great needs, but few options and drive value for our shareholders with that I'll now turn it over to Matt.
Matt Abernethy: Thank you Kyle and graduate team delivered $613 million in Q3 sales, reflecting continued strong patient demand and positioning us to increase our guidance range to $2 three two to three $2 billion, reflecting 25% year over year growth at the midpoint of this range.
Matt Abernethy: The tardive dyskinesia market remains very attractive and as Kyle mentioned, our number one capital allocation priority remains investing in growth.
Matt Abernethy: Of note, our psychiatry and long term care sales force expansion is complete and fully expect to see the benefit of this expansion during the first half of next year.
Matt Abernethy: In addition, our <unk> font commercial and field medical teams continued to build market awareness of congenital adrenal hyperplasia and gained disease state insight in preparation for the Paducah date in late December then Greta and credential Ponte growth over the years ahead will provide neurocrine the resources.
To invest in our growing pipeline.
Matt Abernethy: On the R&D side. The teams are busy preparing for the initiation of two major phase III programs in major depressive disorder and schizophrenia.
Matt Abernethy: Although we're still working through our budget process for 2025, you should expect an overall increase in both dollars and percentage of revenue allocated to R&D likely to be in the low to mid 30% range of revenue next year.
Matt Abernethy: We will be meeting with the agency over the coming months on both the MBIA four five and $5 six eight programs and we will provide further insight into R&D investment expectations for 2025 during our Q4 earnings call in early February.
Matt Abernethy: Returning to 2024, we have made significant progress in growing our revenue to over $2 billion and advancing and expanding our pipeline.
Matt Abernethy: We anticipate that 2025 will be a year focused on investment for continued growth into the future, which we believe will drive long term shareholder value as highlighted in our press release, our board has approved a $300 million share repurchase plan in the coming days, we intend to enter.
Matt Abernethy: Into a $300 million accelerated share repurchase transaction subject to market conditions together with our board. We believe recent share price levels reflect neither the current value of the company today, nor the growth prospects, we expect to achieve in the future as a result, we believe that use of.
Matt Abernethy: Capital will benefit our shareholders, while also preserving financial flexibility to make the investments required to continue the advancement of our leading neuroscience company with that I'll now hand, the call over to our Chief commercial officer, Eric benefits to provide an update on <unk> and also our CAH launch preparations.
Eric.
Eric Benefits: Thanks, Matt we again delivered a strong quarter for <unk> with over 26% year over year growth driven primarily by demand and continued patient to clients across the tardive dyskinesia and Huntington's disease Korea indications.
Eric Benefits: Congrats on sales are now annualizing at over $2 4 billion and with 14 more years of exclusivity ahead of US we still have a tremendous opportunity to help even more patients.
It's been a number of years since we last updated our TD prevalence estimates after conducting a thorough literature review and analyzing claims data for antipsychotic utilization. We're now estimating TD prevalence of at least 800000 individuals in the U S.
Eric Benefits: Given the continually increasing utilization of dopamine blocking antipsychotics the size of the TD population continues to grow and we continue our efforts to educate and help healthcare providers identify appropriate treatment candidates for Nebraska.
Eric Benefits: Earlier this year, we made the decision to expand our aggressive sales force. This expansion is really a reflection of two things the remaining significant growth potential in the TV market with only a third or less of TD patients currently diagnosed.
Eric Benefits: And the substantially increased number of TD treaters developed over the last few years, especially in the psychiatry statement.
Eric Benefits: We made the decision to expand our field teams in a manner consistent with the market dynamics and commensurate with the <unk> franchise opportunity.
Eric Benefits: On that note I am pleased to report that the psychiatry and long term care sales force expansions are now complete our newest team members are now in the field and settling into their roles as noted on our Q2 earnings call based upon our previous experience. It will take a couple of quarters to see the full impact from this expansion on diagnosis and treatment.
Eric Benefits: Rates.
Eric Benefits: Turning to current answer bot or rare disease endocrinology team remains focused on providing congenital adrenal hyperplasia or CAH disease state education to the endocrinology health care providers and patient communities.
Our team is eager and ready to immediately begin working with the CH community should <unk> be approved by the FDA at year end.
Eric Benefits: I know many investors are contemplating the credential launch dynamics, while credential Ron has all the characteristics of a future blockbuster it won't happen overnight.
Eric Benefits: We are building a foundation with our disease state educational efforts during the prelaunch period.
Eric Benefits: And assuming approval will be in a good position to launch quickly.
Eric Benefits: We intend to offer a free goods program during the period when patients insurance reimbursement claims are being adjudicated and to enable endocrinologists to get familiar with the benefit risk profile of <unk>.
Eric Benefits: And while payer interactions to date have been positive as with most newly launched products commercial payers typically have new to market coverage restrictions or even policies to block reimbursement for up to the first six months when the product was launched.
Eric Benefits: With an estimated 60% to 70% of CAH patients under commercial coverage. This will mean delayed reimbursement for many patients in the first half of the year, but we are adept at managing such situations as seen with our experienced managing the formulary exceptions process with resin.
Eric Benefits: The goal is to help appropriate CAH patients get started on treatment, while we work through their reimbursement.
Eric Benefits: All in all the rarity of chronology team is super excited about the opportunity to help the CAH patient population, who have not had a new treatment option in over 70 years. So.
Speaker Change: With that I'll turn the call over to my colleague Dr. Ivy Roberts, our Chief Medical Officer.
Speaker Change: Thank you, Eric and good morning, everyone.
Speaker Change: I'll begin today's clinical update with <unk> advanced.
Speaker Change: We continue to have constructive interactions with the FDA and remain on track for the December 2930, <unk> date.
Speaker Change: The calendar and the end of the year timing it would not be surprising to potentially receive approval for both formulations on December 30th which falls on a Monday.
Speaker Change: Turning to the mid stage pipeline last month, we disclosed that the erudite study of <unk> stock as a potential treatment for cognitive impairment associated with schizophrenia failed to meet its primary endpoint.
Speaker Change: Did not replicate the positive findings on cognition previously reported in the interact study.
Speaker Change: The results from the every night book confounded by variability in cognition measures across the population studied and the potential imbalance and baseline characteristics to enroll subjects.
Speaker Change: As Kyle mentioned, we therefore discontinuing this program together with the MDI 104 T type calcium channel antagonists program and CSW as I am focusing resources on advancing NPI April five on NPI by six eight into phase III studies.
Speaker Change: Both MDI April five our amtech positive allosteric modulator for the treatment of major depressive disorder, and MDI by six eight selective M for hysteric agonist for the treatment of schizophrenia continue to make good progress towards our end of phase II interactions with the FDA.
Which we anticipate will occur over the next few months to enable the start of Registrational studies for each of these programs in the first half of 2025.
Speaker Change: We will provide more insight into study specifics over the coming months together with our plans to publish key phase two information from each of these programs in the latter part of 2025. Once these registration studies are up and running.
Speaker Change: Shifting to <unk>, 770, or MDA and ought to be.
Speaker Change: Negative allosteric modulator for the treatment of major depressive disorder. The phase III program for this molecule continues to enroll well with top line data anticipated in 2025.
Speaker Change: The remainder of the pipeline is also progressing well, including the full muscarinic programs currently in phase one development.
Speaker Change: With that I'll hand, the call back to Kyle Kyle.
Kyle: Okay. Thanks.
We're ready to take questions.
Your line at this time, if you would like to ask a question. Please press star one on your telephone keypad you may withdraw your question at any time by pressing star two.
Speaker Change: Again that is star one we will take our first question from Chris <unk> with Goldman Sachs. Please go ahead.
Chris: Thank you very much good morning, congratulations on it clearly strong quarter commercially I wanted to ask about going forward thinking about the pipeline people as well as strategy Irene.
Speaker Change: I really appreciate your comments I think you have announced previously that youre looking to step away.
Speaker Change: I'll have you given thought to the point people, who will be running the role that <unk> has been involved with that as long as your previous role, which was really managing the business development leadership, there since I noticed quite a bit of focus on capital allocation and secondly can you just give us an update on the Nextgen <unk> two inhibitor I know we started exchange wanted to started this year, but some visibility.
Speaker Change: And when we could learn more would be great. Thank you.
Speaker Change: Thanks, Chris This is Kyle I'll start and then I'll have <unk> add anything that I missed here for our Pheno two follow on compounds as MDI 890, what we're looking here to do is to have a more potent compound that would be amenable to all the same indications that we'd see advantages for <unk>, but also off.
Speaker Change: The opportunity to develop a long acting injectable, which we know is important to the prescriber base as well as the patients. So stay tuned on this program. That's currently in phase one we will look to move that into patients next year pending the review of the ongoing phase one data.
Speaker Change: Yes.
Speaker Change: Yeah.
Speaker Change: Thank you we'll go next to Paul Matisse with Stifel. Please go ahead.
Paul Matisse: Thanks, so much for taking my question.
Paul Matisse: Kyle Congrats on.
Paul Matisse: Moving to the CEOC I wanted to ask you a question just about BD and philosophically where you stand.
Paul Matisse: You guys in your public commentary over the years have kind of ebbed and flowed to the degree to which you've talked about.
Paul Matisse: Prioritizing smaller deals versus something larger than that $3 billion to $4 billion range. How do you think about capacity now and strategically do you feel like this is the right time for Neurocrine over the next year year and a half to do something that's more meaningful in Boulder for a later stage asset or do you still like this kind of smaller BD spread that that strategy that you have.
Paul Matisse: Quite so far thanks, so much.
Speaker Change: Thanks, Paul I appreciate the question in terms of our BD activities. The team that we have here continues to work with a high degree of urgency ports.
Speaker Change: Fortunately, we don't feel like we have to do something right now either large or small we've got a very deep and diversified portfolio with a number of investments that we're making that are late stage next year and we've talked about some of those already within <unk> four or five in major depressive disorder, and MBIA city, our programming and developed.
Speaker Change: For schizophrenia and behind that we have a very rich early to mid stage pipeline. That's developing so right now in my mind is learning about the landscape.
Speaker Change: And figuring out what areas that we want invest in moving or which assets are in those areas, but really focus on executing and what we have in the pipeline right now and making sure that we're doing whatever we can there to put those programs in the best possible situations, where success and if something comes out down the road that is.
Speaker Change: Program that technology is.
Speaker Change: It's something that we could utilize and it takes advantage of our expertise and infrastructure. We will look at that seriously, but right now we feel like we're in a very enviable position.
Fortunately our financial flexibility is very strong at the moment a lot of cash continued cash flow generation, a very clean balance sheet. We retired our convertible debt earlier this year as you're aware so we do have financial flexibility.
Speaker Change: The future.
Speaker Change: Something I've said, a very enviable position to be in.
Speaker Change: Okay. Thanks, guys.
Speaker Change: Thank you, we'll take our next from David <unk> with Piper Sandler. Please go ahead.
Speaker Change: Okay.
Speaker Change: Hey, Thanks, so looking into 'twenty five and beyond how are you thinking about the potential that you might need to compete more on price.
Speaker Change: To hold an aggressive share versus <unk> and then as you think about IRR negotiations do you anticipate any impact on aggressive pricing once aceto is included.
Speaker Change: In IRI negotiations in other words, some sort of spillover effect, if you will.
Speaker Change: And then and then secondly, just on 568, just remind us how youre thinking about indications beyond schizophrenia.
Speaker Change: I would say the psychosis for instance.
Speaker Change: Or are you looking at the other muscarinic.
Speaker Change: For indications beyond schizophrenia, just help us understand your thought process there. Thank you.
Speaker Change: And so David we're going to handle the first chunk of your questions and just out of respect for others in the queue will lead business currently question.
Speaker Change: The others, but Eric can comment on price the only real specifics, we're going to do.
Eric Benefits: For 2025 on prices you do have we do sitting here today I expect our net revenue per script to be very similar to what we've seen in 2020 for us So no significant gain.
And the change that we can see at this time.
Eric Benefits: So what I'll say is that every year, we continue to to.
Eric Benefits: To assess our contracting strategies and we invest in contracts, where we think it makes sense and in some cases, we have.
Eric Benefits: Our contracted access where we think that it's favorable in other cases.
Eric Benefits: We looked at the contract and make decisions to pull back and so as a result of coverage landscape changes from year to year.
Eric Benefits: But overall, our access has and continues to remain excellent with over 80% of lives covered.
Eric Benefits: And the majority of patients paying $10 or less and we expect that to continue into the future. The other thing that I'll say is that.
Eric Benefits: We're going to learn from the first few waves of drugs that go through the negotiation process in terms of.
Eric Benefits: What their access looks like these are the non negotiated drugs. So stay tuned but ultimately our goal is to make sure that patients that need access to the graduate continue to have access we're trying to do that in a manner that.
Eric Benefits: He is responsible from a.
Eric Benefits: From a financial perspective.
Speaker Change: Okay understood. Thank you.
Thank you we'll take our next question from a cash tomorrow with Jefferies go ahead.
Speaker Change: Hi, Thank you for taking a question from CB on for Kash on your M. One asset can you talk about why you feel confident that you talk to dose with Trump's Ken like cracks Titos and then additionally, what should we expect to learn from initial phase one human data next year from Australia.
Speaker Change:
Speaker Change: Thank you.
Speaker Change: Good morning. Thanks for the question on MDI 570, it's very interesting molecule that it's one of our basket.
Speaker Change: Small molecules that we have in development that range from <unk> <unk> four cell activity across the most square Enix and $5 70 as an equal.
Speaker Change: Has equal potency on EM one of them for one of the things that's exciting about this molecule as well as the speed of molecules is that it relies on exquisite selectivity of just and one in four across the most square Enix, which we know are the subtypes and one through five so we've got that going for us out of the gate, but the other piece.
Speaker Change: <unk> Nymex our partner has done is what many companies in the early stages of our discovery deal when they are interested in the CNS molecule.
Speaker Change: Dial in the selectivity that desire they desire and then subsequent to that they make the molecule.
Speaker Change: B penetrate to the CNS more versus the periphery and in doing so when you think about 570, that's how we're able to move forward on the <unk> agonist without the need to add back something that blocks peripheral effects, because 570 preferentially gets into the CNS.
Speaker Change: In terms of the ongoing program with 570 other muscarinic Theyre all in phase one right now there'll be reading out data during the course of 2025 and with that we'll be able to look at the totality of.
The data coming from the different molecules and learn a lot from the pharmacology across and one in four and what that will be it will be determined next steps in terms of moving in that patient population.
Speaker Change: Okay. Thank you from Citigroup.
Speaker Change: We will take our next question from Cristina <unk> with Bank of America. Please go ahead.
Speaker Change: Hi, guys. Good morning, Thanks for taking my question.
Speaker Change: Congrats all you had another really strong quarter, how should we be thinking about sequentially the flow and <unk> based on your guidance. It does seem like it could be a little bit flattish I know traditionally <unk> tends to be a stronger quarters and can you give us a little bit of color on that thanks.
Speaker Change: Yes, I think when you when you look at your historical sequential growth in dollars and fall right into that historical range is somewhere between 10 and $11 million sequentially. So I do think our guidance.
Speaker Change: The consideration just a few comments for Q4, we do have our new field sales team in place and actively calling on customers and that handoff processes occurring but as Erik said in the prepared remarks that does.
Speaker Change: A few quarters to start kicking in and then the last piece is something that we thought in historical years, a sequential increase in gross to net discount associated.
Speaker Change: Associated with channel inventory, it's going to be a little bit less.
Speaker Change: Than what it has been historically because of some of the IRI dynamics, but nonetheless are higher and that discount.
Speaker Change: Fourth quarter.
Speaker Change: Okay.
Speaker Change: Yeah.
Speaker Change: Thank you and our next question comes from Jay Olson with Oppenheimer. Please go ahead.
Jay Olson: Oh, Hey, thanks for taking the question and congrats on all the progress were curious about your level of interest in epilepsy. Since it's still an area of Super high unmet need and it's also proven to be a difficult area to conduct clinical trials. So we're just curious how committed is neurocrine to app.
Jay Olson: Let's see and do you plan to replace the <unk>.
Speaker Change: Hi, Dorothy a molecule with another asset thank you.
Speaker Change: Thanks, Jay This is Kyle I'll take your question here, we still have a very strong commitment to the area of epilepsy. We have a number of programs that are moving through various stages of preclinical development and while I don't expect us moving forward with another T type calcium channel blocker, we do have a mixed in one to one.
Speaker Change: <unk> six inhibitor that we're looking forward to bringing up into the clinic next year. So stay tuned on that obviously a lot of the molecules that are required to.
Speaker Change: Move forward.
Speaker Change: Significant body of data around them for GLC talks 90, enabling studies to get through those and then see where we land on the other side for advancing that particular asset that still committed to epilepsy, there's still a high degree of unmet need in that space and we hope to be a player as we move along here.
Speaker Change: That's great. Thank you.
Speaker Change: We will take our next question from Ashwin <unk> with UBS. Please go ahead.
Speaker Change: Hi, Thanks for taking my question so just on <unk>.
<unk> had some time to digest the results in phase two just wondering you know names do you think this artistic agonism was the issue in this case and how should we think about the rest of the Ms. Canadian pipeline based on what you've learned.
I think I hope I answered your question properly, but I think it was that now that we have the exciting phase two data.
Speaker Change: How are we thinking about the whole systemic agonism with respect to next steps.
In the context of the broader muscarinic pipeline, so just to address that so.
Speaker Change: Thank you.
Speaker Change: So just to address that so we are moving forward rapidly with 568 molecule on the back of the encouraging phase two data that we saw in schizophrenia.
Speaker Change: We're planning to enter in the first half next year, a phase III registration program for the treatment of schizophrenia.
Speaker Change: Step on that journey will be our interaction at the end of phase two with the.
Speaker Change: FDA and we're preparing for that in the next couple of months and so in that regard. We think there is a significant opportunity to add.
On to the current success that they've been in the muscarinic area a little bit.
Speaker Change: You can see that the medication approved this mechanism <unk> earlier this quarter.
But I think Tim since the cell activity around for.
The potential benefit risk profile and improvement in that associated with the selective agent. We believe there's a lot more room in this space to add value for patients and so we're excited and encouraged about our phase III planning in that regard.
Speaker Change: As Carl mentioned, we do have a suite of muscarinic agonists behind <unk>, which has again highest cell activity.
Speaker Change: <unk> or Paul as orthostatic agonist.
Speaker Change: And those are currently in phase one development and we're exploring.
Speaker Change: And it sounds the potential areas of.
Speaker Change: Investigation beyond phase one as we generate data next year, which could range all the way from disorders.
Speaker Change: The improvement in cognition is important all the way through psychosis bipolar disorder indication.
Speaker Change: Thank you we'll take our next question from Phil Nadeau with PD Cowen. Please go ahead.
Speaker Change: Hi, This is Alex on for Phil Congrats on the quarter and thanks for taking my question on 506, eight just curious of the upcoming <unk> data will inform a pivotal trial plans in any way and also could you maybe just walk us through your broader strategy for 506, eight pivotal including regulatory conversations and trial design.
Speaker Change: Yes, so we actually have until say much about this phase III trial design, yet, but I think we want to.
Speaker Change: In terms of the two meetings, Paul we do that but certainly as we start to.
Speaker Change: Trials that will be included in that registration program and at this time next year, we'll be able to get into much more.
Speaker Change: Much more detail around that with respect to the.
Speaker Change: The impact in <unk> or even <unk> information on our planning and thinking I think we're very encouraged by the fact that any small cell activity appears to be sufficient to.
Produced antipsychotic effect.
Speaker Change: Yeah.
Speaker Change: I think from that point of view.
Speaker Change: The fact that Oh.
Speaker Change: Our molecule.
Speaker Change: Alright agonist, that's the approach we've chosen that unlock the inputs that we are confident and Athabasca about phase II data that we generate.
Speaker Change: And so we're very much more focused on our own programming centers about Sandy you mentioned.
Speaker Change: <unk> benefits from our phase two data and ensuring that incorporates all of that moving into a phase III trial designs that into our phase III program and we'll be happy to talk more about that as it came through.
I think two attraction with the FDA.
Speaker Change: Maybe just to add to that the excitement that we have around our own program of stems from the fact that we're the only approach that can selectively directly activate them for and deliver on the promise that we've seen from the muscarinic, thus far without any need to rely on any other aspect of it.
Speaker Change: Add back therapy, or some sort of.
Speaker Change: <unk> ligand for either efficacy or safety and Tolerability and we think at the end of the day, our physicians are going to be applying a lot more confident about our approach to vehicle to be used in a wider population of patients.
Speaker Change: Thank you.
Speaker Change: Thank you we'll take our next question from <unk> Rama with Jpmorgan. Please go ahead.
Speaker Change: Hey, guys. Thanks, so much for taking my question.
Speaker Change: Can I ask the same question I've asked for the last 10 years on third quarter earnings so any chance of them. Congrats a pre announced in guidance at a small health care conference in January or is this more of a fourth quarter earnings report scenario in February.
Speaker Change: Yes unopposed.
Speaker Change: Can pickup in trend without you.
Speaker Change: And yet so always good to hear your question.
Speaker Change: We're obviously looking forward with Jpmorgan this year.
Speaker Change: <unk> planned for 2020 filed with both detail but.
Speaker Change: Consistent with the last but believe two years this will be the third year, where we did not pre announce our revenue at the JP Morgan Conference and we'll say the commentary for both Q4 results and then all your sales guidance for 2025 until our February earnings call, but always glad to.
See you.
Speaker Change: In January thank you.
Speaker Change: The new leader.
Speaker Change: Thank you next to Evan <unk> with BMO capital markets. Please go ahead.
Hi, guys. Thank you so much for taking my question. So as we think about your sales force expansion and the opportunities for chicken chorea associated with Huntington's disease, how should we really frame that opportunity has been there but.
Speaker Change: <unk> investment, where do you see I guess in graduate going in the next couple of years and then how does this really compare with the TD market I think secondarily why focus on epidemiology for TD now.
Speaker Change: Imply that youre, not satisfied with where TD is going.
Speaker Change: We're trying to emphasize that there is still more room to grow I'm, just trying to get a better understanding of what that commercial story looks like.
Yes, let me take your second question first in terms of.
Speaker Change: Our Ah.
Speaker Change: Our reassessment of the prevalence of TD and that's something that we haven't looked at for a number of years.
Speaker Change: And so I would look at that as more of a just in updating our prevalence estimates using a methodology thats. Similarly, consistent with what we had done previously the time that we launched in 2017, our estimate was at least 500000 people in the U S with TD a.
Speaker Change: A couple of years later, we updated our estimate of at least 600000, and then fast forward I think it's been four or five years since the last time, we looked at it and.
Speaker Change: The numbers of people living with TD continues to grow I think commensurate with the.
Speaker Change: Expanded use of antipsychotic, especially in non psychotic conditions. So in our prepared remarks, we did update the number now to at least <unk> hundred 1000 people with TD in the U S and I think that that number is similar to other estimates that are out there and frankly, maybe a little bit on the low end of the range.
Speaker Change: So that's the prevalent story in terms of.
Speaker Change: The sales team.
Speaker Change: We we certainly felt like the decision to expand our sales force was.
Speaker Change: In line with the growth of the market.
Speaker Change: And.
Speaker Change: No.
Speaker Change: Okay.
Speaker Change: And certainly as I mentioned in the prepared remarks.
Speaker Change: Consistent with the growth of the prescriber base and TD.
Speaker Change: And in terms of Huntington is the only part of our our commercial team that we didn't expand.
Speaker Change: Expand our change really was the.
Speaker Change: Was the neurology team.
Speaker Change: And the strategy.
Speaker Change: Penetrating that Huntington's opportunity is primarily through our neurology sales force.
Speaker Change: On a relative basis, the neurology opportunity is much smaller excuse me the huntington's opportunities a lot smaller than it is in tardive dyskinesia.
Speaker Change: And yet there is still significant unmet need in Huntington's Chorea, you may have seen that were recently presented some data showing the.
Speaker Change: Use of AV and graduate and patients better with Huntington's Chorea that are also on MSC products and I think that thats. Some important data to get out there because that is a segment of patients with Huntington's chorea that are typically not treated with <unk> inhibitors and so we wanted to show that.
Speaker Change: Have no impact on relative safety, but they can still improve their choreiform movements.
Speaker Change: So overall the growth driver in the future. We will continue to be primarily a TD, but huntington's is still an important strategic opportunity for us, especially.
Speaker Change: Within the framework of our neurology team.
Speaker Change: Maybe just to put a finer point on that we've talked about the TD prevalence being around 800000 in the U S for HD creators about 30000 patients about 28000 patients have chorea, that's moderate severe.
Speaker Change: <unk> 5000 patients currently on <unk> two inhibitor. So that 15000 patients that we're looking to address that's about a 50 to one ratio of patients that we can serve what's been brought it up.
Speaker Change: When you look at the opportunity versus TD. So we do feel that would be greater opportunity will be in tardive dyskinesia, but we'd look to penetrate more into the HD Korea.
Speaker Change: Base in particular with the launch of lowering breath of sprinkle the health access patients who might have difficulty swallowing are dysphasia that tends to be more prevalent in the HD population.
Speaker Change: Thank you we'll take our next question from Catharine <unk> with Evercore. Please go ahead.
Speaker Change: Hey, good morning, guys. Thanks for taking the question wanted to ask about.
Speaker Change: Harness the font and if you can talk about how many prescribers are located at the CAH centers of excellence.
Speaker Change: And of the overall patient population. They serve <unk> are there certain segments of the CAH population. They are most eager to treat upon approval. Thank you.
Speaker Change: Yes, So let me let me take a step back and say that we're really excited about the opportunity to make a difference with the CAH community with the <unk> date coming up here at the end of the year, we've been preparing for a launch early in 2025.
Speaker Change: As you know we have a sales force thats out there theyre doing disease State education right now.
Speaker Change: We're meeting with future customers.
Speaker Change: <unk> profiling and learning about their practices and so this is all important work that will help us get off to a strong start once we.
Speaker Change: Knock on wood get approval.
Speaker Change: <unk> this year.
Speaker Change: In terms of the proportion of the patient population that's within the care of the centers the cares foundation centres of excellence.
Speaker Change: There is only about a dozen or so of those centers of excellence out there and.
Speaker Change: Still learning about what proportion of the patient population are being managed through those centers.
Speaker Change: But I would say it's in the range of 10% to 15% of patients in total and so the majority of patients with CAH are still being cared for.
Speaker Change: Within community endocrinology practices.
Speaker Change: And also within our pediatric endocrinology practices. So obviously, we are going to be putting a lot of focus early on on those two segments.
Speaker Change: Pediatric endocrinologists as well as the carriers the carriers.
Speaker Change: But ultimately for us to really make a difference in this patient population, we're going to have to make sure that we also are reaching out to those patients that are cared for and community endocrinology practices do you have anything else to add.
Speaker Change: I think you said it well Eric I mean, I think there has been a lot of excitement that we're hearing is talking with clinicians who are working with these patients given that there's been nothing meaningful in this patient population in the last 70 years.
Speaker Change: We do Millington.
Speaker Change: Our focus in the pediatric setting.
Speaker Change: Obviously, there is a very significant level of interest in a potential medications that could help with an antigen reduction in that patient population, we're having tight management of androgen levels become so critical interface as normal growth and development and so we are.
Seeing a lot of our base.
Speaker Change: Significant interest as we continue to hopefully towards approval for both pediatric and adult patients.
Speaker Change: Jonathan.
Speaker Change: By the end of this year haven't you had.
Speaker Change: Just one last thing I want to say is that our team the receptivity that we've seen.
Speaker Change: Since our team has gone out into the field since the summer has been really strong. So I think there's really great interest in the endocrinology community.
Speaker Change: And certainly I think it's a testament to the unmet need in CAH.
Speaker Change: That's helpful. Thank you.
Speaker Change: Thank you we'll move next to Brian <unk> with Baird. Please go ahead.
Hi, This is Luke on for Brian.
Speaker Change: With the upcoming pivotal trials in psychiatry. It should we expect the $845 to $5 68 to progress largely in parallel following the end of phase II meetings or will you be looking to emphasize our accelerated one program over the other thanks.
Speaker Change: I appreciate the question I think given the proximity of what we reported topline data would be commensurate with how we would look at starting the phase III trials in 2025.
Speaker Change: We don't anticipate any needs too.
Speaker Change: Staggered in any particular way for any reason, it's going to be more based on where.
Speaker Change: When we have our into phase twos discussions and we can stand up the pivotal trials for both the profile and slide six eight so I expect them to be started nearly.
Speaker Change: Similar timeframe, but not have the exact time for both of these studies.
Speaker Change: The thing I would add San Carlos obviously from an operational perspective as well. These are focused on two different indications with the name and psychiatry space.
Speaker Change: <unk> in major depressive disorder.
Speaker Change: Right.
Speaker Change: Premium so we don't anticipate competition for patients between on two programs, which I think is really important.
Speaker Change: Our internal team is extremely excited about the opportunity to potentially bring value in both of these areas, but these programs moving forward.
Speaker Change: We'll move next to Carter Gould with Barclays. Please go ahead.
Speaker Change: Hi, good morning, Thanks for taking the question maybe a follow up on one of the earlier questions.
Speaker Change: Some time ago in the queue I guess.
Speaker Change: For a long time, we looked at aircrafts pipeline you guys were sort of mid stage heavy that has clearly evolved and now it's a little bit more of a I guess a barbell approach. We've clearly made those phase III investments are about to make the phase III investments and the earlier stage pipeline now at.
Speaker Change: At least from kind of where we sit.
Speaker Change: We focused on V Madison and muscarinic. So can you maybe talk about how youre looking at that early stage portfolio, you're I guess.
Speaker Change: The the breadth and diversity of those assets and should we expect.
Speaker Change: Another replenishment either through in licensing or homegrown assets to sort of bubble up over the course of 'twenty five.
Speaker Change: Yes. Thanks for the question I think also that we'd like to point out that in addition to the later stage assets in the earlier portfolio that you mentioned that spans the muscarinic agonists and be that too. We also have a muscarinic antagonist that we are moving forward for a variety of movement disorders, and then in phase two we have it in our <unk>.
Speaker Change: For the major depressive disorder, so theres a lot going on across the organization in terms of early too.
Really to the late stage portfolio and we'll have more to say about what's emerging in terms of our earlier stage portfolio and adds to the clinical programs.
Speaker Change: In early 2025, so stay tuned on that Theres a lot of productivity that's ongoing right now in our labs and it just takes a bit of time to move that forward into the clinic and we will start seeing that.
Speaker Change: 25.
Speaker Change: Understood. Thank you.
Speaker Change: Thank you, we'll take question from Brian Abrahams with RBC capital markets. Please go ahead.
Speaker Change: Hi, This is Joe on for Brian. Thanks for taking my question can.
Speaker Change: Can you elaborate more on the growth drivers youre seeing an increase.
Speaker Change: The degree of demand versus gross to net versus any other contributions you could go for US and then how are you thinking about.
Are you seeing on the ground in terms of the competitive landscape in <unk> and the PD market. Thank you.
Speaker Change: Yes in terms of the dynamics for Q3 <unk>.
Speaker Change: Primarily driven the growth was primarily driven by demand.
Speaker Change: And as I mentioned in my prepared remarks continued strong compliance for a <unk> in terms of the.
Speaker Change: The competitive dynamics this is a growing market.
Speaker Change: And obviously, we've seen a strong growth since we launched seven years ago and counting.
As Carl mentioned in his prepared remarks.
Speaker Change: Less than 20% of patients are currently being treated for their <unk>, two inhibitor, which RSV reckon.
Speaker Change: Recommended first line treatments in the treatment guidelines, so there's still a long.
Speaker Change: Opportunity ahead of us with 14 more years of exclusivity and we continue to invest in that growth I think as.
Speaker Change: Yes.
Speaker Change: Doug indicated by the recent expansion of our field sales team and our continued investment in DTC.
Speaker Change: Growth is primarily organic and will continue to be for the foreseeable future.
Got it thank you.
Speaker Change: Thank you we'll take our next question from Vincent.
Speaker Change: <unk> with Wells Fargo. Please go ahead.
Speaker Change: Great. Thank you very much for taking my question and congrats on your first call as the CEO.
Speaker Change: Maybe would love to understand how you are thinking about internally you're thinking about the upcoming competition in CAH space, I mean kind of via.
Speaker Change: Probably putting cart before the horse here, but but these and ACTH antagonist I would that is that.
Speaker Change: How do you see that as a competitor to <unk> do you see this as a direct competitor automotive like in la.
Speaker Change: LIFO therapy that something could be first language second line, how do you how should we think about that.
Speaker Change: Maybe I'll start that question that there's anything I'm missing I'll ask my team that the chime in here. So when we think about CAH I think we can all agree that this is a very serious disease.
Speaker Change: At the heart of the matter is the body struggled to capture its HPA access and by <unk> I mean, the hypothalamus to theory adrenal access.
In terms of how the diseases initiated its caused by mutations on the 20 182 gene and that results in dysfunction or absence of the synthesis of cortisol, which is the key regulator of the HPA access so for the past 70 years patients physicians that use super physiological or very high dose.
Speaker Change: The Gcs Glucocorticoids to act is that regulator of the HP access what we get with <unk> is the ability for the patient to capture recapture their HP access allows them to control ACTH reduced ACTH, and therefore control reducing controlling <unk>.
Speaker Change: At the same time, we think about that when you control ACTH the energen as youre able to remove the requirement for access of control of your excessive use of glucocorticoids and we've seen it from our phase III trials.
But there are a number of patients and to using a physiological range of their GC dose.
Speaker Change: So when you think about the competition then our approach uses the angle of working upstream at the HP access to control.
Speaker Change: The regulation of the HPA at the top and then everything below that we are able to reduce and control as well starting with ACTH.
Speaker Change: Better in this space a company here in San Diego that we know quite well <unk> is developing an ACTH antagonist called up to low debt and it's in early stage clinical development right now with a small number of subjects.
Speaker Change: Time will tell to see how their coach will work relative to ours, because they actually work downstream of our approach. So they only looked at the energy and not the other piece of the Cascades.
Speaker Change: Th, but ultimately wherever you are right now we're very excited about our position we've got very strong efficacy across both children and adults with excellent safety and Tolerability and we have formulations that match the needs of both children and adults. So we feel like we're in a very fortunate position here and we look forward to hopefully getting approval later.
Speaker Change: This year in launching this important medicine for patients, which is going to change the standard of care and C. H.
Speaker Change: Okay.
Speaker Change: Helpful. Thank you.
Speaker Change: Thank you we'll take our next question from Morgan.
Speaker Change: Leerink partners. Please go ahead.
Speaker Change: Yes, I just wanted to come back to that question about any aggressive competition and the competitive environment. There seems to be a lot of agila going into the quarter.
Speaker Change: A lot of investors kind of felt that Teva has been the one growing faster theyre, making more noise can you give us a sense of what's really going on out there.
Do you feel like Youre outgunned with respect to the share of voice and the noise on the on the media maybe you can just give us a sense there I think.
Speaker Change: Description trends are really confused people. So anything that you could do to help us just think about this thank you.
Speaker Change: Yes.
Speaker Change: Yes, I mean, obviously, we felt good about the quarter, we just reported.
Speaker Change: As I mentioned before the female to market is a growing market.
Speaker Change: Majority of TD patients remain undiagnosed and untreated.
Speaker Change: Both brands are growing.
Speaker Change: And as expected with the rollout of their XR formulation of <unk> et cetera tendency, it's helped the growth of our competitor.
Speaker Change: You are right there is and it remains the most prescribed <unk> inhibitor with over 1 million prescriptions written since launch and with 14 more years of exclusivity ahead, we believe strongly in the growth of the potential of <unk> and continue to invest in our franchise commensurate with the opportunity and I think the testament to that is the reason.
Speaker Change: Sales force expansion that we just completed as I mentioned in my prepared remarks, specifically in psychiatry.
Speaker Change: In LTC psychiatry is the area that we didn't touch on when we expanded our team back in 2022, and we felt that with.
Speaker Change: With the growth of the prescriber base, we were overdue in terms of adding more ftes to continue to support that segment.
Speaker Change: <unk> is a relatively newer segment for us and certainly it's been fast growing and we think that the.
Speaker Change: The investment there was appropriate so overall.
Speaker Change: Continued investment in our team and in DTC and other areas of promotion. We think that this is a sign of the conviction we have in the current and the long term opportunity with resin.
Speaker Change: Thank you we'll take our next question from Myles Minter William Blair. Please go ahead.
Myles Minter: Hi, Thanks for taking the question I think just start for awaited Guy there was some correspondence in the new England Journal about for NASA fonts. It from a couple of Spanish stocks and that would kind of call. It isn't a question of definition you use for almost thresholds of dynamically concurred protocol dosing.
Myles Minter: Just curious as to your response to that.
Myles Minter: Pi is in particular in your early conversations are asking historic metrics like insulin resistance and percent of titled Fat masses.
Myles Minter: Inventory endpoints that you are getting an efficacy in this population. Thanks.
Speaker Change: Yeah. Thanks, Mark So first of all I think we.
Speaker Change #100: We are really happy with the phase III data that we have both from an efficacy perspective incentive fee Amgen redemption effective connected box on the ability to reduce steroids.
Speaker Change #100: The vast majority of the population treated and that's the case in both the pediatrics.
Speaker Change #100: The adult population now in terms of the discussion in the New England Journal.
Speaker Change #100: I think it's important.
Speaker Change #101: Got you in Iraq.
Speaker Change #101: What criteria, we use in a clinical trial et cetera, but I want to remind you. This is the first on the trial.
Speaker Change #101: And so we negotiated very closely with the agency to come with a set of definitions.
Speaker Change #101: Building the definition of what constitutes a physiologic levels that GC.
Speaker Change #101: That was in.
Speaker Change #101: Important because this is a highly heterogeneous population and so I think our bottom line from the connect dataset.
It is that we really believe that the vast majority of patients living with CAH, whether they'd be pediatric or adult patients can gain benefit from.
Speaker Change #101: Treatment connected box.
Speaker Change #101: When it's approved.
Speaker Change #101: So from that point of view.
Speaker Change #101: Hi.
Speaker Change #101: And I think it's going to be very important to understand the real world experience for patients once feedstocks get out into this chronic condition unless we start to see the long term benefit.
Speaker Change #101: From a treatment.
Speaker Change #102: Thank you we'll take our next question from Jeffrey <unk> with Morgan Stanley. Please go ahead.
Speaker Change #103: Hi, This is Michael Rehaut on for Jeff hung. Thank you for taking my questions and congrats on the strong start.
Speaker Change #104: For the NDA and RTD program is it safe to assume that 717 is being developed as an adjunct to background antidepressants and if so how are you thinking about evaluating the top line what would you want to see to gauge the competitive potential like maybe versus bravado. Thank you.
Speaker Change #103: Yeah.
Speaker Change #105: So yes.
Speaker Change #105: The focus of the trial is being performed.
Speaker Change #105: Right now I think to the patient population is does this have inadequate response to current maintainable antidepressants.
Speaker Change #105: I'll keep cutting you've called people set as an adjunctive treatment all potentially I think as stand alone monotherapy one of the key Differentiators from this obviously is a mechanism for documents and my passion to ketamine, but being more selective in terms of the mechanism of action.
Speaker Change #105: We hope it could translate into an <unk>.
Speaker Change #105: A favorable benefit risk profile relative to other treatments in this space once we get there I understand it.
Speaker Change #105: Oral mechanism obviously competitive.
Speaker Change #105: Some of the other things that are out there right now.
Speaker Change #106: Thank you that's very helpful.
Speaker Change #107: Thank you we'll take our next question from Laura Chico with Wedbush Securities. Please go ahead.
Speaker Change #108: People that are being treated with a breadth of today is it a mixture of people with more severe and less severe abnormal movements, but certainly <unk>.
Speaker Change #108: Significantly negatively impacting their lives.
Speaker Change #109: So in terms of the overall population we feel that the 800000 number is like.
Like I said very supportable, and frankly, probably on the more conservative end of the range of estimates that are out there, but ultimately our mission remains unchanged less than 20% of people are currently being treated with <unk> inhibitors, and we've got a lot of growth opportunity ahead.
Speaker Change #110: Thanks very much.
Speaker Change #111: Thank you we'll take our next question from Matt <unk> with Guggenheim. Please go ahead.
Speaker Change #112: Hi, This is Dan Morefield Yadkin, congrats on the quarter and thanks for taking our question.
Speaker Change #113: On the eighth lo-fi button M. D. D can you guide us through your strategy for the fever program, how many studies that you're planning to them and can we expect to see phase III data Danny upcoming confidence. Thank you.
Speaker Change #114: Thanks for that and so in terms of the actual program design for phase III, obviously, we'll be following a path. That's been followed by other antidepressants and Registrational development, but we haven't talked specifically about number of trials.
Speaker Change #114: Designed the trial, we will do that after we have engaged in our end of phase two and traction with the SBA and I'll start and has cost next year.
Speaker Change #115: Yes, I think as you alluded to in our comments.
Speaker Change #115: We are planning to release the information from our phase II program and the lack of possible <unk> of next year.
Speaker Change #116: Thank you.
Speaker Change #117: Thank you we'll take our next question from the ear with Mizuho. Please go ahead.
Speaker Change #118: Hey, guys yeah. Thanks for taking my question.
Speaker Change #119: Going back to the <unk> launch a bed.
Speaker Change #120: You guys indicated that you know, what you'll be giving out free drugs and whatnot.
Speaker Change #119: Before.
Speaker Change #121: The it's going to take some time to work through the reimbursement. So we are going to have a program in place that allows us to get patients started and <unk>.
Speaker Change #121: And that is really across both commercial and Medicaid ultimately, we're confident in our ability to get patients started as indicated by our success with <unk> and we saw similar dynamics early in the <unk> launch.
Speaker Change #121: But ultimately we think that <unk> offers a significant.
Speaker Change #121: Opportunity here for us to diversify our revenue and we.
Speaker Change #121: That ultimately creates a lot of value for the CH community. So we'll have a lot more to talk about when we get closer to the launch in terms of our access strategy.
Speaker Change #122: Okay. Thank you.
Speaker Change #123: Thank you and we will take our final question from Amit <unk> with Needham <unk> Company. Please go ahead.
Speaker Change #124: Hi, this is going out on for Amit. Thank you for taking my question. So.
Speaker Change #123: So.
Speaker Change #125: By April five.
Speaker Change #126: You see it fitting into the current treatment paradigm and what are your expectations for the upcoming back anything. Thank you.
Speaker Change #127: So in terms of the FDA meeting, we will be getting clarity on a phase three strategy that will enable us to start I think it's b program in the first half of next year in terms of the.
Speaker Change #127: Indication or the area of focus in major depressive disorder.
Speaker Change #127: The phase II data that we generated was in the context of inadequate response to currently available treatments and and then in that setting we anticipate it could either be a an adjunctive treatment to other antidepressants currently in the field or as it stands alone monotherapy and we'll be exploring both that's moving forward.
Speaker Change #127: Yeah.
Thank you Tom.
Speaker Change #128: And there are no further questions at this time I will turn the call back to Kyle for closing remarks.
Kyle Kyle: Thanks, Ashley So this morning, we covered our greenfield ground I'd like to close by reinforcing by opening message our exceptional leadership team.
Our energized organization are really positioning nerf into lead and neuroscience moving forward.
I'm certainly inspired by all of our it doesn't have an ever more confident in our potential and know today, we touched on a lot of different things, we talked about a bit on our strategy our pipeline and our promising commercial opportunities. If you think about this being my first earnings call I'm, hoping you take away two things from our opening remarks, and our Q&A one is our.
Kyle Kyle: Commitment to discovering developing and commercializing innovative medicines and I think <unk> seen from our discussions that this comes with risks and it requires time and investment, but I don't think that you also see that we're committed equally committed to delivering near and long term value for our organization and our shareholders. So with that I think.
Kyle Kyle: We'll close here today by saying that it's busy.
Kyle Kyle: Busy year end ahead for us all and we're looking forward to connecting with many of you virtually and in person for those of you there'll be sending some of the many health care conferences that remained here in the next couple of months.
Kyle Kyle: Thanks again for the call and look forward to speaking with you soon.
Speaker Change #130: Thank you and this does conclude today's program. Thank you for your participation you may disconnect at any time.
Speaker Change #130: [noise] [music].
Hum.
Speaker Change #130: [music].
Speaker Change #130: Okay.
Speaker Change #130: [music].