Good afternoon, and welcome to the ADMA Biologics Fourth Quarter and Full Year 2021 Financial Results and Corporate Update Conference Call on Thursday, March 24, 2022. Please be advised that this call is being recorded at the company's request and will be available on the company's website approximately two hours following the end of the call. At this time, I'd like to introduce Skyler Bloom, Senior Director of Business Development and Corporate Strategy at ADMA Biologics. Please go ahead.

Welcome, everyone, and thank you for joining us this afternoon to discuss ADMA Biologics' financial results for the fourth quarter and full year 2021 and recent corporate updates. I'm joined today by Adam Grossman, President and Chief Executive Officer; and Brian Lenz, Executive Vice President, Chief Financial Officer, and General Manager of ADMA BioCenters. During today's call, Adam will provide some introductory comments and provide an update on corporate progress, and Brian will provide an overview of the company's fourth quarter and full year 2021 financial results. Finally, Adam will then provide some brief summary remarks before opening the call up for questions. Earlier today, we issued a press release detailing the fourth quarter and full year 2021 financial results and summarized certain fourth quarter achievements and recent corporate updates, including a $175 million debt refinance with Hayfin Capital. The release is available on our website at www.admabiologics.com. Before we begin our formal comments, I'll remind you that we will be making forward-looking assertions during today's call that represent the company's intentions, expectations or beliefs concerning future events which constitute forward-looking statements for the purposes of the safe harbor provisions under the Private Securities Litigation Reform Act of 1995. All forward-looking statements are subject to factors, risks, and uncertainties such as those detailed in today's press release announcing this call and in our filings with the SEC, which may cause actual results to differ materially from the results expressed or implied by such statements. In addition, any forward-looking statements represent our views only as of the date of this call and should not be relied upon as representing our views as of any subsequent date. We specifically disclaim any obligations to update such statements except as required by the federal securities laws. We refer you to the disclosure notice section in our earnings release we issued today in the Risk Factors section of our 2021 annual report on Form 10-K for the year ended December 31, 2021, for a discussion of important factors that could cause actual results to differ materially from these forward-looking statements. With that, I would now like to turn the call over to Adam Grossman. Adam?

Thank you, Skyler. Good afternoon, everyone, and thank you for joining us on today's call. We hope you all remain healthy and safe. Our 2021 operating and financial achievements mark a pivotal point in the business' evolution towards a profit-oriented growth organization. During the year, we delivered on our financial objectives, including 92% year-over-year revenue growth. Importantly, we took assertive measures to shore up our financing and cash position, notably with today's announced $175 million debt refinancing with Hayfin, which we will address in more detail during this call. The year was capped by delivering fourth-quarter revenues of $26.4 million, consistent with our previously disclosed expectation of annualizing at a rate of more than $100 million. We generated first-time gross profitability for the full year 2021, driven by outsized ASCENIV adoption in our overall product mix, the growth of our plasma collection center network, and the successful conclusion of the supply chain robustness initiatives undertaken at the Boca Raton, Florida manufacturing facility. Of particular note, we are encouraged by the recent and continued utilization uptick for ASCENIV. We believe our marketing, sales, and medical education efforts are effectively catalyzing adoption, and the product's unique manufacturing methods, antibody profile, and commercial value proposition are resonating well with physicians, providers, and patients. Brian will discuss the gross profitability implications resulting from the increasing adoption of ASCENIV. But from our vantage point, we are seeing signals that the product may potentially exceed our previous expectations. Moving on to the supply chain, ADMA's investments towards securing raw material plasma supply and expanding its BioCenters plasma collection center network enabled the company to maintain its production plans and grow its customer base throughout the pandemic and 2021. We are proud to have delivered on our promise of continuity of patient care during this period of plasma supply dislocation impacting the broader immunoglobulin market. We believe in doing so, we have solidified ADMA's emerging reputation as a reliable and growing immune globulin supplier in the United States. The recent approval of ADMA's fifth plasma collection center advances the company towards its goal of having 10 FDA-approved centers before the end of next year, which we believe will allow the company to potentially reach plasma supply self-sufficiency by year-end 2023. ADMA's growing internal plasma collections are currently being supplemented by third-party supply contracts as well as the yield enhancements resulting from the implementation of the Haemonetics’ NexSys Persona system. The successful expansion and operating results of ADMA's plasma collection network further solidify our company's pathway towards profitability. Looking to the remainder of 2022 and based upon current data, we now anticipate total annual revenues to exceed $125 million, representing more than a 50% year-over-year growth rate compared to 2021. From a margin perspective, we anticipate gross profits will continue to increase and net losses will narrow as cost and operating efficiencies begin materializing as a result of our supply chain enhancement initiatives. We believe the commercial, regulatory, and operational milestones achieved during 2021 will serve as a strong foundation for ADMA to advance towards anticipated profitability no later than the first quarter of 2024. We expect the substantial vertical integration achieved to date will position our company to execute through even the most challenging operating backdrops and excel even further in a more normalized environment. We thank the entire ADMA Biologics and ADMA BioCenters teams for their extraordinary efforts in keeping true to our mission of providing quality products for patients. Finally, we'd like to thank the Hayfin team for their hard work in completing their robust diligence process and closing on the debt refinancing with us. The plasma industry is global, and we believe Hayfin's ex-U.S. operations and asset base makes for an ideal partner to enable ADMA's continued exploration of strategic alternatives and evaluation of creating business development opportunities. Brian will discuss the use of proceeds in more detail, but we are pleased to be able to extend the interest-only period by three years to March of 2027, significantly increase non-dilutive funding for our business and reduce ADMA's overall cost of capital. We believe the improved liquidity position resulting from the debt refinancing will enable the company to execute on its operating strategy while continuing to explore strategic alternatives with our advisers, Morgan Stanley. We believe this is an important step towards unlocking shareholder value. We'd also like to thank the Perceptive Advisors credit team for their support these past few years, and the equity team for their continued investment and confidence in ADMA's forward-looking outlook. All of our organization's accomplishments across our business segments could not have been possible without the dedication and focus of ADMA's staff, leadership, and advisers. We commend the entire team for their remarkable efforts focused on the continuity of care for patients who we know are counting on us. With that said, I'd now like to turn the call over to Brian for a review of fourth quarter and full year 2021 financials.

Thank you, Adam. Since we issued a press release earlier today outlining our fourth quarter and full year 2021 financial results, I'll just review some of the highlights. As Adam mentioned earlier, for the fourth quarter of 2021, total revenues were $26.4 million compared to $14 million for the quarter ended December 31, 2020, which represents an increase of approximately $12.4 million or 89%. The revenue growth for the fourth quarter of 2021 compared to the fourth quarter of 2020 was favorably impacted by the continued commercial ramp-up of our IVIG product portfolio. Additionally, total revenues of $80.9 million were recorded during the year ended December 31, 2021, as compared to $42.2 million during the year ended December 31, 2020, representing an increase of $38.7 million or approximately 92%. The year-over-year increase is mainly due to greater sales of our immunoglobulin products and intermediate fractions generated by our Boca Raton manufacturing segment operations in 2021 totaling $38.1 million, as we concluded our second full year of commercial sales of BIVIGAM and ASCENIV. One of the notable highlights in what we believe to be an otherwise very strong set of financial results was the continued expansion of the company's consolidated gross profits. For the fourth quarter of 2021, ADMA generated a gross profit of approximately 13%, which further enabled the company to report gross profitability for the full year ended 2021. This key financial milestone was primarily attributable to the favorable product mix achieved during the fourth quarter, where we sold more of our higher-margin products compared to the previous quarter's results. Our unique patented IG ASCENIV and hyperimmune Nabi-HB yield higher gross margins than our standard IG product, BIVIGAM, and we are encouraged by the market penetration of ASCENIV, which continues to establish commercial traction. As a result of the greater-than-expected adoption of ASCENIV observed over recent periods, we had increased ASCENIV's production from our original 2022 production plan at the plant to support continued upside for the product in 2022 and beyond. In addition to a favorable product mix, we anticipate the trend of positive gross profit and narrowing net losses to continue to improve during 2022 as efficiencies continue to be realized from the FDA approvals received in 2021 for both the 4,400-liter expanded production scale as well as our in-house fill-finish capabilities. As Adam mentioned earlier, ADMA significantly strengthened its balance sheet during the fourth quarter and subsequent periods. Earlier this afternoon, we announced a $175 million debt refinancing with Hayfin. The new loan agreement will provide for, among other things, a 5-year interest-only period, which is the duration of the credit facility maturing in March of 2027. Borrowings under the Hayfin credit agreement bear interest at a rate per annum equal to 8.25% with an accumulating 2.5% paid-in-kind or PIK component. The first tranche of $150 million from Hayfin was fully drawn and used to completely discharge the obligations under the previously held Perceptive senior secured notes, including all associated prepayment fees, which totaled $102 million. With this new credit facility, we also have the ability to access an additional $25 million under the second tranche, which is tied to revenue milestones. And if drawn, will be used to support continuing operations and to fund the company's ongoing growth. All told, we have taken assertive measures over recent periods to ensure ADMA is well-capitalized as we embarked on the growth and profit-oriented phase of our business cycle. During the year ended December 31, 2021, ADMA grew its total asset value to $276 million, which includes $125 million in inventories. ADMA expects the robust inventories, which are recorded at our cost to support continued revenue growth throughout 2022 and beyond. Our consolidated net loss was $16.6 million for the 3 months ended December 31, 2021, as compared to $19.4 million for the 3 months ended December 31, 2020. The $2.8 million decrease in net loss compared to the prior year period was primarily attributable to a gross profit contribution of $3.5 million for the fourth quarter of 2021 compared to a gross loss of $5.2 million during the fourth quarter of 2020. The decrease in net loss was partially offset by an increase in selling, general and administrative expenses of $2.4 million related to employee compensation, new hires, along with other costs to support the commercialization efforts for BIVIGAM and ASCENIV. Additionally, we recorded a $2.5 million increase in plasma center operating expenses related to the company's plasma center build-out and expansion activities to support our target of having 10 plasma centers open and FDA approved by year-end 2023, of which 2 additional centers have already received FDA approval during this first quarter of 2022. With that, I will now turn the call back over to Adam for closing remarks.

Thank you, Brian. ADMA's asserted financial and operating measures enacted at the Board and C-suite level over recent periods, we believe will enable the company to continue to execute and deliver on commitments to stockholders while providing for optionality as we continue to explore strategic business opportunities with our advisers, Morgan Stanley. We look forward to executing on all previously stated operating targets, including the newly issued 2022 revenue guidance calling for total annual revenues in excess of $125 million. In closing, I'd like to thank you, our stockholders, for your continued support as your investment in ADMA helps to advance our mission to save lives and make high-quality, safe, and efficacious products that help our friends, family, and neighbors. Please donate plasma, donate blood, help save lives. And with that, I'll now open up the call for your questions. Thanks, operator.

Our first question comes from Elliot Wilbur from Raymond James.

Congratulations on all the progress made in business over the course of the year and continuation of strong underlying fundamental trends. First question for Adam. I think I asked this last call, but just wanted to try to get a little bit more insight and color into the continued favorable mix shift toward ASCENIV vis-a-vis BIVIGAM, obviously, a significant uptick in the incidence of RSV this year. I assume that had something to do with the favorable mix shift. But just trying to understand how much of it was just driven by increased RSV, tightness in overall IVIG supply or specific aspects tied to ASCENIV's profile that you think are driving increased share in the market?

Sure, Elliot. Good question. The product is indicated for the prevention of serious infections in patients with primary humoral immune deficiency. As you know, with our patented methods and if you look at the asceniv.com website, it is the only IG produced and available in the United States that is manufactured by blending normal source plasma and RSV high-titer plasma. So when you look at that and you look at the published data, our antibody profile is unique. If you start with plasma that has higher levels of antibodies to certain pathogens that result in IG, in theory, it should have higher levels of antibodies to this panel of pathogens. I don't believe that the tightness in the IG market is driving utilization. ASCENIV is a unique product. And if you spend some time on the asceniv.com website and you look at the types of patients and the risk factors that we're calling out, not all PI patients are created equal. Some have a more severe form of PI than others. There are over 400 different classifications of disorders that make up primary immune deficiency. Some affect TMV cells and some patients have just had a bad course throughout their life, even while they're on immune globulin therapy. So we really look at the product as this is a product for problematic patients. This is a product that clinicians are trying and that payers are reimbursing for patients who don't have the best outcomes on regular IG. Medical letters of justification, again, certain risk factors, comorbidities, socioeconomic factors, all of this plays into a potential prescriber and payer's decision to allow or prescribe ASCENIV to these patients. So really, what I think is driving increased utilization is that the product has been on the market now for a couple of years. It was launched in the second half of '19. Obviously, the beginning part of COVID was tough for us in the 2020 timeframe engaging with clinicians. But for the back half of '21, we were front and center at medical conferences, and we've been really hitting the pavement from a medical education standpoint. I think that it's a combination of just what's going on in the world today with COVID and Omicron and respiratory viruses. I think patients are doing more diligence and research about their quality of care and what kind of options they have available to them. But I really think it's a culmination, as I said in the prepared remarks, of the marketing, the sales force, the medical education strategy, our platform is available publicly, which supports a wide array of different applications. But the majority of the use of ASCENIV is still coming from the outpatient setting. These are patients that are receiving IG every 3 to 4 weeks, like they would with standard IG. The same thing for BIVIGAM. Our BIVIGAM numbers are also increasing, and the pull-through there is very favorable and positive. So we feel that all of our IG products are really being viewed favorably. They are of high quality and we're just very proud of the fact that the message is resonating. I can't comment per se on whether it is the uptick in RSV. I mean I've seen the same data you have on the CDC website, Elliot, that I'm sure you're referring to. And there were some peaks of RSV throughout last year, and that could be driving clinicians to consider the product. But again, it is not indicated for it. What I can tell you is that the utilization we're seeing is quite sticky business. It's patients that are being prescribed ASCENIV, and they're having favorable outcomes. They're seeing improved quality of life measures, and their chronic persistent infections are declining, with reduced use of antibiotics and other concomitant therapies. When a doctor sees favorable outcomes in one of their PI patients on the drug, that makes them want to try it in others. Once they get reimbursement approved for one patient, the daunting task of getting reimbursement is something that they can manage. I think all of this is evidence of our team executing in the right way with a product that is certainly not mature but is maturing in the market. As I said in the prepared remarks, I really feel very strongly that the product is going to exceed even my expectations. You know that was the original reason why ADMA was founded, and it's been an interesting history, but we're very proud of this product. Again, it is a higher-margin product compared to our standard IG products. We really believe that that medical education messaging is starting to resonate.

Okay. Maybe I can follow up that question with one directed to Brian that ties into the expectation for increased volume of ASCENIV over the course of 2022. Anything, Brian, that you can say about expectations for revenue progression and gross margin progression over the course of the year, and specifically just thinking about sequential trends in each of those as you dedicate more capacity towards ASCENIV versus original expectations?

Sure. Absolutely, Elliot. A few years ago, upon the launch of BIVIGAM and ASCENIV, we were looking at a product mix of around 90% our BIVIGAM product and about 10% for our higher gross margin products, ASCENIV and Nabi. Now we're seeing a mix closer to 80-20, 75-25 because of that patient adoption by providers. When you're looking at gross margin, we really set the company up for success back in 2019, getting the FDA approvals, 2020, the conformance batches, and bringing the plant to a 4,400-liter process capacity as well as fill-finish, bringing that in-house will all contribute to positive gross margins throughout 2022 and beyond, leading up to a 40% to 50% gross margin sometime in the end of 2023 or 2024. As we said previously, ASCENIV's gross margins are in that 75%-85% range; BIVIGAM in the 20%; Nabi-HB, 70% plus; and then we have our intermediates and sales of normal source plasma. So blended, all in 40% to 50% by the end of 2023 to 2024.

Okay. Last question for me, directed back to Adam. With the recent announcement of the FDA approval of your 5th collection center. Could you just maybe talk a little bit about trends in collection volumes, how they're performing versus expectations? I know some of the bigger players in the space, even though they've been able to experience some recovery in volumes have really had to ratchet up incentives in order to be able to drive their volume recovery. So just curious what you're seeing in terms of collection volume levels versus expectations, price per liter and what you may be offsetting the incentives with in terms of realizing the efficiencies.

Let me just touch on some of the macro topics, and Brian, I'm sure you're much more intimately familiar with the donor fee rationale these days. I'll let you handle that one. But Elliot, from an industry perspective, collections are still being pressured. ADMA, we've always said this throughout the pandemic. We have certainly had impacts, but our recovery has been fantastic. We've got a great team out there. We’ve got great donor recruitment efforts that are really driving folks to our centers, social media campaigns, the whole nine, we're doing everything we can to attract donors. Again, I think the awareness coming post-COVID, the fact that more localities are open and people are traveling about, we're certainly seeing an uptick in donors. With respect to the industry, some of our larger competitors, they are still experiencing some impacts. I know that the border continues to plague some of the larger players. It's a problem. Overall, you're going to see some tightness ultimately in the global stage for IG products. It's just happening. I can't tell you how severe it's going to get, but I do think that this is going to continue to persist. If nothing else, the border when you look at the tens of centers or so that are along the border, these centers represent a couple of million liters of plasma that we collect annually. At an ADMA Biologics yield of, call it, roughly 4 grams per liter, that's tens of millions of grams of IG that the world may not have available. It's not just the U.S. that gets product made in U.S. plasma; it's on a global stage. From ADMA's perspective, we are recovering. I saw an internal graph that I probably can't talk about on this call, but it looks great. Q1 is looking very strong from a collection standpoint. Again, as you get the centers approved and we're opening up more centers, certainly, I think we’ve said for the first time in this prepared remarks that we are forecasting plasma supply self-sufficiency by year-end next year. So we feel very confident about our position. I do think that the lingering impacts from COVID as well as the border are going to plague the broader industry for the periods ahead. Brian, do you want to comment on the donor fees and some of the other programs?

Sure, absolutely. We're very pleased, as you can imagine, with the acceleration of how we've built out our 10 centers. We currently have 10 under our corporate umbrella, 6 collecting. So certainly, we've made a lot of progress over the past year. We already received 2 additional FDA approvals this year. Regarding opening up new centers, plasma collection, plasma donors, our collections for 2022, as Adam just highlighted, are ahead of our schedule. So we're pleased with how we're instituting special programs. When we open up a center, we'll have certain incentives for donors to come into the center. We'll run programs throughout the year. But to offset those costs, last year, we implemented the Persona software technology from Haemonetics program. We're seeing anywhere from a 7% to 10% increased yield from donors that we collect plasma from. So we're certainly very proud of our achievements of quickly bringing 10 centers online under our corporate umbrella and the FDA approvals being received in half the time.

Our next question comes from the line of Kristen Kluska from Cantor Fitzgerald.

Congrats on a strong start of the year that you've had. I wanted to see if you could comment on what the reimbursement landscape has been, particularly on ASCENIV in light of your positive comments here around usage. And then maybe are you able to comment a bit about the specific profiles of usage here? Are you seeing that these are PI patients that weren't perhaps having as strong of a response with the standard IVIG products or perhaps are these some of those patients off some of your comments earlier that not all are the same and perhaps they have a more severe type of disease to begin with? Or is it a mix that you're seeing?

Both great questions. Let me just touch on the reimbursement piece first. So all, 70% or so, 80% of all IG requires prior authorization, whether it's ASCENIV, BIVIGAM or any of our competitors' products. No matter what, you need to go through the process of getting a patient approved, whether they have documented primary immune deficiency or are on the borderline with some rare type of immune disorder. The physician community is used to having to fight for reimbursement for any IG product. This is not something that's unique to us and our drugs or ASCENIV; it's just the nature of the business. What I can say is that we're seeing reimbursement because of ASCENIV's approval and efficacy in primary immune deficiency. That's why I think even earlier to Elliot's question, it's not so much about RSV or the respiratory viruses. This is a product that has documented efficacy in patients with primary immune deficiency. Because of its cost, and it is more costly than other IGs in the market, we believe that there's an appropriate patient profile that you want to look for to prescribe a product like this. The payers understand it; they understand that the product is manufactured differently. Some private payers have even published in their IG reimbursement guidelines that if you can demonstrate documented need for a product manufactured from this type of plasma, they will approve it. These patients, it's very hard to tell specifically every patient that we have going on the product, Kristen. Most of them have been on IG for years, some of them even decades. They’ve had multiple bouts of bacterial pneumonia throughout their life while on standard IG therapy. What the data suggests now is that payers really frown upon the practice of increasing the dose, as it doesn't necessarily translate into better outcomes, efficacy, or quality of life. Physicians know they can switch brands but can't ask for more products. Now with ASCENIV, they have an alternative. They want to do better for these problematic patients. About 10% of the PI population experiences these comorbidities. Approximately 30% of PI patients have experienced some type of chronic lung condition. The problematic patients are the target of our sales force and medical education efforts. The reimbursement landscape is relatively stable; CMS is reimbursing at our ASP plus 6%. Our ASP has been stable for ASCENIV and BIVIGAM since their launch, which keeps payers and prescribers content. So we have a well-defined reimbursement pathway with positive utilization from high-risk patients.

Okay. I appreciate that color. And maybe just because it sounds like ASCENIV has been exceeding some of your internal projections. Just in light of all these positive signals, how are you considering also the longer-term horizon, if this adoption continues to grow and you continue to receive this great feedback? Are you also considering avenues to maybe collect more plasma from those donors who have this efficient level, the naturally occurring neutralizing antibody titers to RSV?

I can tell you that if you were in the halls of ADMA over the past few weeks, we are very, very encouraged by the performance of the product throughout the tail end of last year and the beginning part of this year. We've been collecting plasma for a long time, and a portion of the raw material inventory that we have on the books is plasma that we've collected from RSV donors for the past 3, 4, 5 years. The plasma has a 10-year shelf life when used for the U.S. market. The U.S. FDA mandates a 10-year shelf life, while some other regions around the world have a shorter shelf life. We like all the RSV plasma we can get. When we identify donors, we ensure that they continue to come back in. Some projects that we don't talk about per se, but our analytical development team here in Boca Raton is working to transfer part of the RSV detection assay that we use to identify plasma donors in-house. We believe this can improve turnaround times for donor collections. The quicker we improve turnaround times, the better chance we have of getting that donor to return. We do offer these donors slightly higher donor fees to entice them to come back more frequently. We are using all measures possible to increase donor collections from an RSV standpoint. We have long-term supply contracts for RSV plasma. While our normal source plasma supply contract will end with Grifols at the end of 2022, we are augmenting that with collections from our internal expanded network. Our RSV plasma collection contract with Grifols runs through June of 2027. So we still have more time and we are able to augment our RSV plasma supply from collections from third parties. We’ve been signing additional agreements with new and emerging collectors in the market who we have relationships with. We feel very, very good about our position to collect the high-titer RSV plasma that we used to make ASCENIV. Approximately 5% to 10% of plasma donors have the antibody profile that we are looking for. We can easily identify these donors, and we are confident for the next 12 to 24 months that we've got the plasma we need to meet market demand. We have increased our production of ASCENIV at the start of 2022 to meet forecasted growth and demand throughout the year. Overall, we are confident about our continued supply capabilities. This product is not for everyone; its use is confined to patients who are high-cost to payers. However, there is a pharmacoeconomic value proposition here with the drug that certainly makes sense. Stay tuned for the next couple of quarters, as I think you will be pleased with the uptick of higher-margin products in ADMA's revenue mix.

Okay. And then the last question I have for you is, you noted in the release that your total revenues for this year are expected to exceed $125 million. Obviously, a majority of that is coming from your approved product revenue line. But just thinking about the other important lines here, your plasma collection centers, you publicly stated in press releases that some of these approvals came ahead of your own guidance and then intermediate byproduct revenues, thinking about all the implementations that you took last year in terms of manufacturing. So just simply wanted to ask how we should be thinking about these two avenues moving forward as well in light of some of these implementations that took place.

Sure. Our growth is really going to be driven by finished good product revenue. That’s where we will achieve growth. I know that with our intermediate fractions agreement that we announced a couple of years ago, Brian, I don’t want to misspeak because everybody then comes after me. We say it’s $10 million to $15 million a year that we can generate in intermediate fractions?

Correct. $10 million to $15 million, growing closer to $20 million to $25 million as we're looking in 2024 and beyond. Correct.

So that revenue line item is going to grow significantly as we increase throughput at the facility. We get more intermediate fractions from a batch of 4,400 liters of BIVIGAM than from a batch of 2,200 liters of ASCENIV. However, a batch of 2,200 liters of ASCENIV, priced at $900 per gram, yields roughly 8,000 grams, which translates to about $6 million to $7 million after fees. In contrast, even at double the production scale, BIVIGAM yields less. We would prefer to trade a batch of ASCENIV at an 80-plus percent margin over our BIVIGAM product manufacturing opportunity. You will see significant growth coming from the finished goods line, with ASCENIV taking a larger share as we push for growth this year. From a plasma supply perspective, we have a strong contract with our partners at Takeda, who consistently pay us on time, and we appreciate their business. We are not currently looking to sign new agreements. I want to emphasize that we expect to be plasma supply self-sufficient from our normal sources by the end of next year. It's challenging to increase revenue when we require that plasma. We are confident about our current market position and our ability to be opportunistic due to some of the market tightness resulting from competitors withdrawing their products. We take pride in our ability to take advantage of these market disruptions, which will ultimately enhance our revenue and help us achieve profitability. We are also experiencing shorter turnaround times now that we are filling in-house. There will be some unique updates to share with investors as we complete Q1. We are unlocking efficiencies from our supply chain initiatives and continue to secure loyal customers who perform well on our products, BIVIGAM and ASCENIV. Ultimately, what will drive our success is producing a quality product that benefits people, which leads to ongoing orders and market penetration. If there is a supply downturn, we are prepared to meet that demand. We have ample product in our inventory, and Brian mentioned $125 million in inventory at a blended gross margin of roughly 40% to 50%. That equates to significant revenue, much more than our annual forecast. However, I want to add a caution regarding the unpredictable nature of the supply chain, so please review our risk factors. Nonetheless, we are optimistic about exploiting the current market conditions and deepening our penetration with BIVIGAM while identifying qualified patients for ASCENIV.

Our next question comes from the line of Zach Weiner from Jefferies.

Just a few from us. First, can you give some color on the end users of ASCENIV? Are they new users or are they recurring users just using more product? Just some color on the customer base?

Yes and yes, Zach. Certainly, you've got the clinicians who were early adopters and who began using the product. They are adding to their patient rosters. Many of these physicians have practices where they see 50, 100, 200, sometimes 300 or more PI patients in their private practices. About 10% of the population have higher susceptibility and risk for infectious diseases, especially respiratory viral infections. Once doctors see reimbursement and clinical benefits in their patient assessments, they're putting more patients on. With medical education symposiums and publications provided by clinicians on individual case presentations about actual real-life patients, we are seeing the interest grow. It's the first differentiated opportunity we've had in the clinical immunology setting in years. We’re not just talking about product expiration dates or subcutaneous administration; we’re discussing a differentiated antibody profile and a unique way of blending normal and RSV high-titer plasma. Both utilization and penetration from existing accounts are improving, and we are adding new accounts every week and month.

That's helpful. And then just on the balance sheet and cash usage. In 2021, you spent quite a bit on manufacturing updates, the 4,400-watt capacity, and the fill-finish project. My question would be, what is the expectation? Are there manufacturing upgrades or supply chain upgrades expected through 2022? Or is the focus more on plasma center growth and continuing growth in the business?

Sure, I can take this one. It's predominantly focused on building out the remaining plasma centers. We have 6 currently collecting plasma, so we have another 4 to go in various stages. We will continue to build up our inventory balance; we feel very pleased with our current $125 million as we approach 2023 and 2024 revenues. No major projects at the plant; the capital projects are really just concluding the 10 center build-out, of which we have 4 left.

All right. And then my last one, just on the refinancing and the strategic alternatives. Could you give some color on both of these would be helpful?

We are truly proud of the refinancing effort. Hayfin is a top-tier firm that conducted extensive due diligence and did not leave any stone unturned, especially considering the state of global affairs. We believe the effective rate is lower than what we've previously seen due to the competitive advantage we had in this process. The new terms give us more access to cash and with lower costs. We think they are a great partner, capable of supporting our explorations of strategic opportunities due to their size and reach as a $25 billion fund. This shows we are now fully financed to achieve profitability and strengthen ADMA's position as we look to maximize shareholder value.

I'll add a couple of points regarding the debt process. We were going through a thorough due diligence process. This was a competitive procedure, and there were multiple parties expressing interest. The cash carries interest at 8.25%, the same cash interest we were paying at $100 million. The effective rate is lower than we’ve previously seen. We secured a 5-year interest-only period, maturing in March of 2027. We can also access an additional $25 million tied to revenue milestones, which ensures we have a strong position for continued growth.

This concludes the question-and-answer session of today's program. I'd like to hand the program back to Adam Grossman for any further remarks.

Thank you, everybody, for your interest and attention. We appreciate our shareholders for helping us produce high-quality products that save the lives of our friends, family, and neighbors. Please donate plasma; you can visit admabiocenters.com, where we’ve got a number of new centers opening. Go donate plasma, donate blood, save some lives, and we will keep you posted on our progress throughout the year. Thank you again. Have a good afternoon.

Thank you, ladies and gentlemen, for your participation in today's conference. This does conclude the program. You may now disconnect. Good day.