Good afternoon and welcome everyone to the Biomarin Pharmaceutical second quarter 2026 conference call. Today's conference is being recorded. All lines have been placed to unmute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during this time, simply press the star key followed by the number one on your telephone keypad. If you would like to withdraw your question, press star one again. At this time, I would like to turn the conference over to Tracy McCarty, head of investor relations.

Thank you, operator, and thank you all for joining us today. To remind you, this non-confidential presentation contains forward-looking statements about the business prospects of BioMarin Pharmaceutical, Inc., including expectations regarding BioMarin's financial performance, commercial products, and potential future products in different areas of therapeutic research and development. Results may differ materially depending on the progress of BioMarin's product programs, actions of regulatory authorities, availability of capital, future actions in the pharmaceutical market, and developments by competitors, and those factors detailed in BioMarin's filings with the Securities and Exchange Commission, such as 10Q, 10K, and 8K reports. In addition, we will use non-GAAP financial measures as defined in Regulation G during the call today. These non-GAAP measures should not be considered in isolation from, as substitutes for, or superior to financial measures prepared in accordance with U.S. GAAP, and you can find the related reconciliations to U.S. GAAP in the earnings release and earnings presentation, both of which are available in the Investor Relations section of our website. Please note that our commentary on today's call will focus on non-GAAP financial measures, unless otherwise indicated. Moving to slide three and introducing Biomaren's management team joining today's call, Alexander Hardy, Chief Executive Officer, Kristen Hubbard, Chief Commercial Officer, Ray Freiberg, Chief R&D Officer, and Brian Mueller, Chief Financial Officer. I will now turn the call over to Alexander to provide our quarterly highlights. Alexander?

Thank you, Tracy, and thank you all for joining us today. Starting on slide five, Baymarin delivered a standout second quarter, combining strong growth to nearly $1 billion in revenue with the successful close and integration of Amicus while delivering on milestones that strengthen our leadership in genetic conditions. Our strong performance demonstrates both the value creation of our portfolio and the continued execution of our commercial organization, Executing at Scale, integrating meaningfully accretive assets and continuing to innovate, enabling us to bring important medicines to people living with rare diseases as we enter an exciting new phase of growth. Second quarter highlights start with 20% year-over-year total revenue growth, accelerated by a more diversified portfolio and setting up an even stronger second half of 2026 to be fueled by full third and fourth quarter Gallifold and Pombility and Upholder contributions and sustained demand across our other products. Turning to Voxogo, double-digit revenue growth in both the U.S. and international markets led us to increase Voxogo's full-year guidance, putting it on a path to become Biomarine's first $1 billion product. In its first quarter with a U.S. competitor, the continued revenue growth demonstrates our ability to defend Voxogo's leadership position. Building on this momentum, we are pleased to share that we have submitted our SNDA for the approval of Voxogo to treat hypochondroplasia based on strong pivotal data shared during the quarter. We will provide an update on the submission as part of our third quarter results. Turning to Amicus, as anticipated when we announced the acquisition, this deal demonstrates that Biomarin can leverage our scale and capabilities to rapidly integrate high-growth assets to maximize value creation. Today, we provide estimated peak revenue for Gallifold of $1.4 billion and for Pombility and OpFolder of $1.2 billion. Together, these innovative therapies combined with significant cost synergies expected to reach approximately $220 million dollars annual run rate in 2028 are anticipated to drive substantial EPS accretion and operating cash flow. Most importantly, we look forward to bringing Gallifold and Pombility in our folder to more patients with Fabray and Pompe disease worldwide. Briefly on our pipeline, which continues to build momentum. We recently added BMN 820, formerly DMX 200, an exciting new late stage pipeline opportunity resulting from the Amicus acquisition that Greg will expand upon in a moment. I'm also impressed by the speed at which we submitted the SNDA for Voxogo for the treatment of hypochondroplasia. The speed of our submission reflects the benefits of our investments in AI capabilities and sets the new standard for how Biomarin will execute going forward. Together, these results tell a clear story. Biomarin is executing a scale, raising guidance, outperforming on the Amicus integration with substantial combined peak revenue potential ahead and advancing pivotal pipeline data towards Voxogo's next indication. As we enter the second half of 2026, Biomarin is stronger, more diversified, and better positioned than ever to lead in rare disease and deliver for patients worldwide. Now on slide six, the addition of Amicus transforms Biomarin's growth trajectory through the mid-2030s with a combined peak revenue potential of $2.6 billion from Gallifold and Pumbility and OpFolder, and significant cost synergies layering in along the way, we expect meaningful non-GAAP EPS accretion, expanding operating margins, and stronger operating cash flow, powering our next phase of growth. Moving now to slide seven and starting with Gallifold, a growing product in a growing market. From a $522 million base in 2025, we project peak revenue of $1.4 billion by the mid-2030s, supported by two complementary growth drivers. First, we see significant opportunity to expand diagnosis and treatment. Leveraging Biomarin's proven diagnostic capabilities, our goal is to more than double the number of US patients treated with Gallifold. We plan to do this through scaling AI-enabled patient identification initiatives, expanded genetic testing, newborn screening, and family cascade screening, helping more amenable patients access treatment earlier. Second, we see meaningful opportunity to expand market penetration globally. With Gallifold already established in 40 countries, we intend to deepen penetration within existing markets while selectively expanding into new geographies, leveraging Biomarin's global commercial infrastructure to accelerate access and broaden reach. Together, these drivers are expected to support approximately 10% CAGR from 2027 to 2032. Turning to slide eight, Pombility and Outfolder is at an earlier stage in its commercial journey compared to Gallifold. We estimate $1.2 billion in peak revenue by the mid to late 2030s, growing at a greater than or equal to 20% CAGR from 2027 to 2032. We expect growth to be driven primarily by increased patient switching and global market expansion, complemented by continued improvements in diagnosis and treatment rates. We believe switching will be supported by growing awareness amongst healthcare providers and patients of the expanded body of real-world evidence demonstrating the benefits of Pombility and OpFolder on disease outcomes. At the same time, we plan to leverage our diagnostic capabilities to identify and support treatment of additional eligible patients across a global footprint. These growth drivers are expected to be further strengthened by planned expansion into more than 20 additional markets over time turning to slide nine we are pleased with the significant cost synergies identified which we expect to contribute to substantial eps accretion beginning next year we anticipate approximately 220 million dollars of synergies to be fully realized in 2028 representing a roughly 50 percent reduction from amicus's 2025 non-gap operating expenses of 432 million dollars. These synergies are weighted towards GNA which makes up more than 70 percent of the total with the remainder coming primarily from R&D. As planned we retained Amicus's commercialization team to ensure patient continuity and supplement our global capabilities. These synergies combined with peak revenue align with the value creation we anticipated when we announced the deal last year and demonstrate our ability to successfully integrate large accretive assets that strengthen our growth profile. Turning to slide 10, by accelerating our financial profile with the addition of accretive assets that benefit from our proven global expertise serving patients with genetic conditions, the Amicus acquisition sets the stage for our next phase. With peak targets of $1.4 billion for Gallifold and $1.2 billion for Pombility and Uffolda, these revenues, combined with $220 million in anticipated annual cost synergies fully realized in 2028, support substantial expected non-GAAP diluted EPS accretion beginning in 2027 and a significant increase in operating cash flow. Gallifold and probability in our folder combined are expected to reach over 60% non-GAAP operating margin by 2030. At the same time, we believe our rapid integration and growth plans will enable us to deleverage approximately one year sooner than initially communicated. This quarter reinforces what sets Biomarin apart. We are the leading rare disease company operating at scale with a proven integration capability to maximize the value of high growth assets. We look forward to updating on our progress scaling Gallifold and Pombility in OpFolda as we enter the next exciting phase of Biomarence growth. I will now turn the call over to Kristin for the commercial update. Kristin.

Thank you Alexander. The second quarter demonstrated the strength and growing diversity of our commercial portfolio. Now turning to slide 12. Gallifold and Pombility in OpFolda are off to a strong start as we move quickly to integrate following the April close. On a pro forma basis, second quarter revenue for Gallifold grew approximately 10% year over year, and Pombility and OpFolda grew over 65%. Gallifold delivered broad-based patient growth across both established and newer markets. This was driven largely by increased diagnosis and patient identification, including continued success with Family Cascade screening and expanding newborn screening programs, alongside ongoing gains in reimbursed access. For Pombility and OpFolda, we continue to add patients, both in the United States and in more recently launched geographies, supported by its differentiated clinical profile, as we help more physicians better identify disease progression on prior therapies. Importantly, both brands maintained commercial momentum while we rapidly integrated, A testament to the focus our combined team has kept on patience and execution. These are the levers Alexander described, and the results to date reinforce our confidence in the long-term opportunity for both medicines. Turning to slide 13 and the broader metabolic conditions business unit, formerly known as enzyme therapies. With the addition of the amicus medicines, we have changed the name of the business into the metabolic conditions business unit to better capture the breadth of our portfolio. Total metabolic conditions revenue was $695 million and grew 25% year-over-year, inclusive of Gallifold and Pombility and Ofulda, and the number of patients on therapy grew across every one of our marketed metabolic conditions brands, both year-over-year and sequentially. Cell and Zeke revenue grew 27% year-over-year on continued patient demand while also benefiting from order timing in the U.S. during the quarter. We were pleased to have recently received European approval to broaden the Palinzik label to adolescents ages 12 and older with PKU. In the U.S., we have had a strong start in the adolescent age group, and the team is energized to have the opportunity to serve this population more broadly. Across the rest of the portfolio, revenue in any given quarter reflects the timing of large orders. In the second quarter, order timing was a headwind for Vimazim following a strong first quarter, while it was a slight tailwind for Naglozyme ahead of an expected lighter third quarter. Because of these dynamic shifts between quarters, our full-year metabolic conditions guidance remains the best indicator of expected underlying performance. Beneath that quarterly timing, the consistent signal is that patient demand continues to grow across our portfolio, both year-over-year and sequentially. Now, turning to slide 14, Voxogo delivered 14% year-over-year revenue growth in Q2, driven by double-digit growth in the U.S. and OUS markets. The number of children treated with Voxogo grew more than 20% year-over-year globally, and approximately three-quarters of Voxogo revenue was generated outside of the U.S. Notably, even in the first quarter facing a U.S. competitor, the number of children in the U.S. treated with Voxogo increased year-over-year. We also saw continued traction in the under-2 age group, which represented more than half of the new U.S. patient starts in the quarter, reinforcing our position as the only approved treatment for children 2 and younger. As expected, we did see switching to the competitor product since it was approved in February of this year. Since the competitor's launch, approximately 90% of the U.S. children treated with Voxogo remained on therapy as of the end of July, based on information available to us. That reflects the continued confidence physicians and families place in Voxogo's evidence base. Internationally, momentum remains strong across both established and newer markets, and we expect both patient additions and order timing to drive higher total Voxogo revenue in the second half of 2026 compared to the first half. We're confident in Voxogo's durability, built on a growing evidence base and the experience of the thousands of children treated to date and their caregivers. That durability is further reinforced by our exclusive ability to treat patients from birth worldwide. Our ambition is to remain the leader in skeletal conditions through competitor launches in the near term, supported by Voxogo's anticipated launch for hypochondroplasia in 2027 and the potential of BMM-333 should data be supportive. Stepping back, Voxogo is on track to become BioMoran's first $1 billion product. Gallifold and Plumbility and OpFolda are on the path to join it, each carrying peak revenue potential well above $1 billion, and Vimazim is expected to also reach the $1 billion mark over time. Together, they are a clear sign that we can take innovative, genetically targeted medicines and expand their reach worldwide. With that, I'll turn it over to Greg.

Thank you, Kristen. The second quarter was a productive period for our pipeline with meaningful progress across our portfolio turning to slide 16 you can see that we have had a lot of positive news over the last few months i am particularly pleased to highlight our very recent submission of the supplemental nda for voxogo for the treatment of hypochondroplasia by implementing parallel work processing aided by technological advancements we were able to shrink the time from database lock to filing down to just 79 days, easily within the top quartile for modern industry benchmarks. The full Phase 3 data will be presented at SP as a late-breaking oral presentation in September. As Kristen noted, we're also very pleased that adolescents in both the U.S. and Europe will now have access to Palinzeek, following the label expansion in both regions earlier this year. Moving now to slide 17 and BMN-820, formerly known as BMX-200, a late-stage addition to our pipeline resulting from the amicus acquisition. BMN-820 is a first-in-class oral CCR2 inhibitor, which it accomplishes through blockade of receptor heterodimerization. It is currently in phase 3 development for focal segmental glomerulosclerosis, or FSGS. This is an asset for which we hold exclusive U.S. commercialization rights and are partnered with Dimerix, who remains responsible for operationalizing the Phase III study. If the data are supportive, this could provide a new mechanism of action for the treatment of FSGS. FSGS is a progressive kidney disease that leads to proteinuria and declining kidney function over time. There are an estimated 30,000 addressable patients in the United States. Only one therapy is approved as of today, and its label is somewhat narrow, excluding patients with nephrotic syndrome. Durable stabilization of kidney function remains a significant unmet need. DMN820 targets an orthogonal mechanism to the vascular targeting agents with the potential to treat a broad FSGS population. It has shown a favorable safety and tolerability profile to date. The FDA has agreed that proteinuria is an appropriate endpoint for approval in our Phase 3 Action 3 trial, and we expect Phase 3 data in 2028. If the data are supportive, BMN 820 represents an attractive new pipeline asset with upside in a large area of unmet need. With that, I will turn the call over to Brian. Brian? Thank you, Greg.

Please refer to today's press release for detailed second quarter 2026 results including reconciliations of gap to non-gap financial measures which will also be available in our upcoming form 10q turning to slide 19 we were pleased that second quarter revenue reached nearly 1 billion dollars representing 20 top line growth year over year second quarter non-gap operating margin was 36.4 percent with non-gap diluted earnings per share of $1.20. Non-GAAP R&D and SG&A expenses each increased year over year, reflecting the operating expenses of the acquired Amicus business, together with continued investment in our pipeline and commercial execution. On a GAAP basis, second quarter SG&A results also included approximately $84 million of transaction and integration-related charges associated with the acquisition. These charges are excluded from our non-GAAP results. Below the operating income line, interest expense increased year-over-year due to the acquisition debt financing, and interest income decreased as we liquidated investments to fund the acquisition. These items, along with the higher operating expenses, contributed to the year-over-year decrease in non-GAAP diluted earnings per share. I want to spend a moment on our interest expense and interest income to make sure your expectations are aligned with ours. Based on current interest rates, interest expense associated with the acquisition debt financing is estimated at approximately $200 million on an annualized basis, or approximately $50 million per quarter. with the term loans and senior notes scheduled to mature after 2030. Importantly, this interest expense is included in our non-GAAP results and therefore reduces non-GAAP diluted earnings per share. In addition, due to lower cash and investment balances following the close of the acquisition, we expect interest income to decrease year over year in the near term. Turning to slide 20 in our updated full year 2026 guidance, on the strength of our first half performance and our expectations for the balance of the year, we are raising our full year total revenues, Roxogo revenue, and non-GAAP diluted earnings per share guidance. As you can see, our guidance updates today reflect double-digit growth from the midpoint and our strong trajectory leading into the second half of 2026. Briefly on phasing, we expect third quarter revenue to be slightly higher than the second quarter, reflecting a full quarter of amicus revenue contributions and continued patient growth across our brand. Similar to prior years, we expect the fourth quarter to be our strongest quarter of the year, with a significant step-up versus Q3 and representing well over 50% of our second-half revenue outlook, primarily due to ordering dynamics in select markets. On non-GAAP diluted earnings per share, the third quarter will reflect a full quarter of amicus operating expenses, while benefits from cost synergies are expected to become more meaningful in the fourth quarter. Combined with the anticipated revenue phasing and realization of synergies, we expect third-quarter non-GAAP earnings per share to be slightly higher than Q2 and fourth-quarter non-GAAP earnings per share to be significantly higher, representing the highest quarterly earnings per share of the year. In summary, the second quarter reflected strong execution, disciplined investment, and continued progress integrating Amicus. While some integration activities will continue into next year, the integration is well underway and on track, with the majority of enabling decisions made and operating plans in place. We are impressed by and appreciative of the focus and efforts of both our Biomarin colleagues and all of our Amicus colleagues since the close of the acquisition. We are looking forward to the second half of this year, where we remain focused on delivering our updated 2026 outlooks while building towards the longer-term revenue and earnings potential that Alexander outlined in his remarks. Thank you for your attention. We will now open the call to your questions. Operator?

Thank you. We will now begin the question and answer session. If you have dialed in and would like to ask a question, please press star 1 on your telephone keypad to raise your hand and join the queue. If you would like to start your question, simply press star 1 again. We'll go to our first question from Chris Raymond at Raymond James.

Thanks for taking my question. I got two, actually. First, on Amicus, you guys gave a lot of metrics here on synergies with this integration. Just looking at 2028 synergies that look really impressive. I'm just wondering if maybe you could maybe give a few waypoints as we get through 2027 and tell us the specific steps you're taking to get to these numbers and maybe what's behind the delivery of the two and a half leverage a year early. And then I have a Voxoco question. Thanks.

Hi, Chris. It's Brian. I'll take that. Thanks. So, yeah, just to start, we know we communicated a lot of metrics today. We do believe that this Amicus integration framework demonstrates the comprehensive value creation from this acquisition. We quantified synergies at this approximately 50% level. That's going to drive significant accretion powered by the revenue growth as well. This not only validates our hypothesis at the time of the transaction, but exceeded our expectations at the time. And I'd also like to emphasize that these decisions are made. we are now executing on an end-to-end integration plan to bring the Amicus business onto the Biomarin platform. And as I noted there in the prepared remarks, it took a lot of work on both sides, and it's going very well. This accretion also translates to cash flow. As you noted, we pulled forward our leverage target by approximately one year. And altogether, we're not only delivering on the potential of this transaction, but exceeding it. And specific to your question in terms of waypoint, you know, we shared that we expected the transaction to be modestly dilutive in calendar 26. I'll share that that's still the case, but it's honestly close to break even. Still expecting it to be accretive in the first, you know, calendar year. but I would point you to the substantial accretion that begins next year and then 2028 being the first full year because we are still integrating next year. 2028 will be the first full year where we're realizing all of the benefits from the synergies and integration. And in terms of a waypoint, I might guide you to saying that, you know, next year we're expecting half to slightly more than half of the synergies to be realized.

Great. Thanks. And maybe on Voxogo, just hearing Kristen's commentary around 90% of Voxogo patients remaining on therapy, I think you mentioned post the UV well launch. Ascendus gave us some numbers today. I think they said, you know, 770 patients are enrolled to start therapy. And I think two thirds of those are actually paid. Maybe just doing some math on the switchers and based on your commentary. Can you maybe give us a sense of the dynamic in terms of your competition for new patients?

Thanks very much for your question, Chris. This is Alexander. Yeah, I think this is really important to sort of unpack the numbers and make sure there's no misunderstandings here with the various data points communicated by both companies. I mean, clearly their number uh was uh was based on a total patient enrollment number that includes naive patients vox ergo discontinuations whenever those may have happened and of course switches from vox ergo and of course the latter one the switch rate uh is of course the one that's relevant for us so according to to our data and we have good good visibility as you would expect in the United States in terms of patient numbers and ongoing treatment. We've seen approximately 10% of patient switch. That translates to less than 100 patient switches in the approximately six months since they have been approved. That translates, of course, to a very small impact on almost $4 billion in revenue this year. So, you know, taking all things into account, based on the strong growth that we are seeing and projecting with 20% of increase in patients globally on Vox Ogo in the quarter. We feel comfortable increasing Vox Ogo revenue guidance for the year for over $1 billion. I think zooming out as well, if I can comment, I think bigger picture uh their update on on the launch and the pace reflects how hard the u.s market is in chondroplasia when you have geographically dispersed patients you have low visit frequency care split between general pediatricians and specialists this all impacts the the opportunity and the pace of switches and starts. And of course, as you know, new patient starts are dominated by the zero to two patient populations. The guidelines say diagnose and treat as early as possible after birth. And as you know, we remain the only product with the less than two indication and we expect to remain so for a good amount of time. So I hope that helps, gives you a little bit of perspective on the data and what we're seeing and what we're looking forward to in the remainder of the year.

Yep. Thank you.

We'll go next to Corey Kazimov at Evercore ISI.

Hey, good afternoon, guys, and thanks for taking my question. So I also want to ask something on the heels of the competitive update this morning, And I'm wondering how you think about the combination of a weekly CMP analog plus growth hormone eventually slotting into that treatment algorithm. And is there anything that's stopping you from or physicians from using Voxelgo and or BMN-333 in the future with growth hormone? Thank you.

Thanks, Corey. This is Greg Freiberg. I think I'll tackle that one. And, you know, looking at that data, I think first and foremost, we have to recognize that the COACH study is a small study. I think it's about 21 patients, single arms split into two, you know, two cohorts. So we have to be careful in over-interpreting it, particularly when we slice the data at six-month intervals. Now, that being said, I think the question with the growth hormone combination today is the same as it has been from the start. We know growth hormone alone can cause increases in AGV, but they're temporary, and actually they don't result in major increases in achondroplasia and increases in final adult height. So the question remains, what are we learning from the data set? With this data point, I would say just the eyeball test tells us that it looks like the effects of growth hormone adding on to CNT appear to be waning. I don't know why that would be in the naive patients more than the add-on to people who are already on CNP. It's a small data set. But the question then becomes, is this the beginning of a longer-term trend? It's an unanswerable question. I think the question that our endocrinologists care most about, which they're a sophisticated group, they've worked with growth hormone for a long time, is will this ultimately contribute to the health and wellness and, by extension, the final adult type of patients? The concern always is that growth hormone may close growth plates early, and that is not something that is, in a short study of 18-month duration, something that you can really get a read on. So I think today it's incremental data. We're certainly seeing that the growth spurts might be declining. You see the slopes increases. And, you know, that's as compared to the Achieve, I'm sorry, the Approach Study, where you don't see that kind of a shift out at two years. I was happy to see that they're following up on the two-year data there as well. And again, I think there are unanswered questions that time will tell. Of course, we're watching this very closely. We're going to follow the data. We're going to make evidence-based decisions. And from a biologic standpoint, there is nothing unique about Transcon CNP when it comes to taking a CNP agent and combining it with growth hormone. It's too early to tell, and we're looking forward to seeing more data out in the order of three years plus. Very helpful. Thanks, Greg.

We'll take our next question from Jess Fai at JPMorgan.

Hey, guys. Good afternoon. Thanks for taking my question. I was curious if you could speak to whether those synergies associated with the Amicus deal will fall to the bottom line or whether you expect those to be reinvested in the business.

Hey, Jess. It's Brian. Thanks. Great question. We do expect those synergies to drop to the bottom line. However, to your point, there is also reinvestment. So part of the strategy is to accelerate the growth potential of Gallifold and Pombility and Uffolda, which will require some incremental investment. I'll share with you that compared to the synergy numbers we shared today, it is a modest portion But more importantly, and this is why we spoke to synergies on a growth basis, any of that reinvestment fits within the existing structure of our P&L. It's part of normal metabolic condition sales and marketing going forward. So we don't consider it an offset to the synergies itself, which will, you know, live on. And again, if you chose to calculate net synergies with the investments, it's very modest.

Thank you. Our next question comes from Selvyn Richter at Goldman Sachs.

Thanks for taking your question. This is Tommy on for Selvyn. I'm curious if you could provide more detail. You spoke to the mechanisms behind, you know, driving increased diagnosis and switching for pompility unfold and for gallifold. How do these efforts differ in or strategy differ in the U.S. versus ex-U.S.? And a follow-up, what is your appetite for future BD and what stage or type, if so? Thank you.

Yeah, I'll take that first part of the question, Tommy. Thank you so much. And I hope you could hear it in the prepared remarks, but I'll say it again. We are absolutely delighted about what we have both the opportunity and quite frankly the responsibility to do for both the Febre and Pompeii communities. And the more we've been able to dig into it since the close, we've really unearthed what I think are some meaningful levers that we can pull to drive the growth and therefore target the peak revenues of $1.4 billion for Gallifold and $1.2 billion for Pompeii, excuse me, for POMOP in the future. Now looking specifically, and I know you asked the question kind of differentially across the U.S. and ex-U.S., in large part, the overall lever, the levers are very similar. While they make it executed at the country level slightly differently, the areas that we're going to really put our investment into are quite similar, and they fit very well within the biomarinsetic capabilities that we've built over the decades that we've been doing this. For Gallifold, this really is going to be about diagnosis. We recognize that in the medical population or in the FAMBRE community at large, there really is still very limited diagnosis, especially for those with late onset and or the female patients. So we plan to really target those communities trying to drive broader diagnosis and importantly, really starting to close the gap between kind of diagnosis and treatment so that we can show that kind of physicians that treating earlier and even in milder sets or milder conditions is really important. On the POMOP side, this really is about accelerating switches. And this is true, again, in both the U.S. as well as outside the U.S. And here, our focus is going to be on the waning or the clinically declining patients that are on a current therapy, where we believe that we can really kind of continue to show what disease progression could look like. And if patients aren't meeting those targets, how to ensure that they're advocating for treatment. So those are the areas we're really going to be focused. And I know that the next question, Oh, Greg, do you have something to add?

I would just add, I mean, from the medical affairs standpoint, particularly for February, where we know, you know, I would say generously, maybe only 40% of the patients are actually diagnosed with a condition. You know, just to give you some granularity there, electronic health record work to, again, shorten the time between diagnosis and, again, when the symptoms arrive. you know, family cascade testing and reclassification of variants. These are things that we've done previously in other settings. There were also some great work that our former amicus colleagues had begun, and we have the opportunity to scale that a bit larger. Just to give you a data point, there's over almost 50 different diagnostic activities and, you know, programs going on around the globe right now. And so it is a very local phenomenon. We think that we can put more firepower and technology behind some of those assets?

These are things that we can start right away in the countries where Gallifold and PalmOp are already commercialized, but what's also really important to note is that we plan on geographically expanding these products, so in over 10 countries relative to where we are today with Gallifold, and more than 20 countries for PalmAbility, which will also help to drive that growth. Over to you, Alexander. Tommy?

Yes, this is Alexander. I'll answer your BD question. So as you've heard from Kristen and from Greg, you know, the integration and acceleration of Gallifold and Pomboliti in our folder, you know, strengthen our growth outlook for Biomarin. So, you know, we are now more diversified and growing commercial portfolio. Our focus is now more shifting to expanding our clinical stage pipeline. Of course, we're going to continue doing, you know, research collaborations as we've always done. I think you just saw, you would have seen the announcement recently of the collaboration with NLORUM. But as we delever, you can expect us to do deals to expand out our clinical stage programs over the next 12 to 18 months.

We'll move to our next question from Fernando at TZ Cowan.

Good afternoon. Thanks for taking our questions. Two from us. First, on the upcoming ITC case, we expect a decision by the end of August. We're curious to get your most recent thoughts on that case, and in particular, any thoughts you have on the possibility of a settlement. And then second, just to follow up on the diagnosis points that you just made.

I think 20 years ago, we heard from Genzyme that they thought they were to penetrate more quickly the late onset and female patient population so you've talked about what you can do but why haven't those patients been diagnosed so far it does seem like others have had efforts where those efforts falling short thanks thanks thanks for your question phil this is alexander i'll i'll take the opportunity to clarify some of the some of the timelines uh and the facts around the uh the itc case um but as you can probably expect i'm not to get into our legal strategy or speculate on the outcomes. So on the 21st of this month, so the 21st of August, the administered law judge will deliver their initial determination. Within weeks following that initial determination, the commission decides whether they're going to review that initial determination. The final decision is expected on the 21st of December of this year. That's either affirming or reversing all or portion of that initial determination. And then either party has 60 days to lobby the president. and he has a presidential review period which goes through uh february the 21st of next year but i would just highlight that uh if a if a exclusion order uh is uh is determined in that that decision by the commission then it's effective during that period so um that's sort of a what you can expect from a timeline perspective uh and uh we're waiting uh that uh that data the 21st which is coming shortly i'd also highlight that uh you know upon the completion of the itc process uh we would expect to to enforce our patent in federal district court where of course monetary damages are are available and uh phil i'm going to tag this is greg freiberg i'm going to tackle your second question on the diagnostic points if that's all right.

With regard to why there hasn't been more progress in the field, I think it's a pretty simple answer in that this is a very elusive disease. It's one where patients can have a very heterogeneous presentation, something like seven different organ systems that can be affected presenting in a variety of clinics. And true with all rare diseases, it's this elusiveness of diagnosis, you know, seven to ten years to actually make their way to knowing what's causing their symptoms. And Febre is really a case study in that. That's why we're trying to focus on where we think we can have the most impact. And again, we highlighted a couple of them. But obviously, this isn't just about educating, you know, community physicians to be on the lookout. Using technology, using electronic health records, using testing and training approaches to try to identify flags earlier. Again, it's not just about patient finding. It's about shortening that time to diagnosis. I would say that on top of that, you know, one of the very fruitful endeavors that we've been involved with in other genetic conditions is family cascade testing. If you find one person in the family who is affected by this, again, you do the boots on the ground work to find the other patients that could be affected. Finding them early is the name of the game with Febre, but it's been elusive up until now, and I think it reflects the wiliness and, unfortunately, the heterogeneity of this disease.

That's very helpful.

Next, we'll go to Ellie Merle at Barclays.

Hey, guys. Thanks so much for taking the question. So, I guess, of those 10% of patients in the U.S. who switched from VoxoGo by the end of July, I guess, what trends or characteristics are you noticing in those patients versus, say, patients that are more likely to stay on VoxoGo? And I guess what degree of switching in the U.S. is baked into the guidance for this year. And then a second part of a question on VoxoGo, you mentioned that over 50 percent of U.S. new starts were in ages two and under.

Maybe just how should we think about, I guess, the annual incidence of new starts in under age two or maybe just the size of the U.S. incident market for that age group and how you're thinking about this as a growth contributor going forward? yeah thank you for the thank you very much for the question so on to the first question around the the 10 percent um that has switched I mean primarily what we're hearing is is injection fatigue or wanting to try a weekly therapy but what I think is more important is looking at the 90 percent who we retain and and what we're finding there is that really it is about not only the surround sound services we have around these patients and their families namely with their clinical coordinators, how we're in there talking to the family, and really building out that trusted relationship that is so important in this community, but also importantly, reminding them of the evidence base that we have, the safety, the efficacy, and something that, quite frankly, no competitor can catch up to. That is something that we find is continued to be very compelling, and I expect that to be true in the future. Now, with regard to the incidence of the zero to two population. We estimate that there's about 150 births in the U.S. a year for infants with achondroplasia, and so our intention is to very much target treatment as early as possible. As you know, the consensus guidelines certainly state that this is the most efficacious and beneficial for them to be treated early, but also what we're finding is that by targeting new specialties such as maternal fetal medicine and really getting out that early to help them understand possibly when in utero or even right at birth, the attributes of treating early. That's what we're out there doing, and we find that to be quite successful.

Thanks, Kristen. Hi, Ellie. It's Brian. I'll take your guidance question. Absolutely. We appreciate the interest in our switch assumptions, especially given the competitor update today and our competition metric as well. As noted in February when we initially gave guidance, we do expect switching. And we shared what we're observing today. Our guidance did include a switch assumption. But we're not going to quantify that at this time, nor comment on expectations at this time. Thank you.

Next, we'll move to Mohit Bansal at Wells Fargo.

Great. Thank you very much for taking my questions. So, Christian, regarding the 10% patients who have switched, based on your market research, where do you think, where do you expect this to settle in the U.S. market? And the related question is, how different or similar is ex-US market in terms of how entrenched you are versus how challenging it could be for the competitor to come in and take share from you. Thank you.

And Mohit, if I could maybe, could you maybe that second question just so I make sure I answer it. I didn't quite understand the question in the second one.

So the question is like how ex-US market is similar or different versus the U.S. market in terms of setup and structure where it could be challenging or easy for a competitor to take share versus the U.S. market. So just trying to understand the structure of the U.S. versus XUS market for a contemplation Very good.

Thank you very much for the question. Now, of course, to the first question as to when do we expect, you know, what do we expect going forward as Brian shared? We're not necessarily going to share our expectations because the truth of the matter is we need to continue to monitor this and closely watch if this levels out, if this is, you know, if this is a bolus or if this is a steady state. This is something that we need to very much monitor at this stage in time. I do think that what you would find most likely is that the segment that is most apt to switch first and foremost, as I've said, are those that either have injection fatigue or looking for the convenience of a product that has a very, you know, that Voxogo has a very similar efficacy profile to it. However, they might want a weekly shot. So those are kind of what we're seeing out there, but I wouldn't be able to comment at this juncture in terms of how this is going to go in the future. Now, looking at it relative to the ex-US, I would say the biggest difference, and I know we've talked about this before in the US, is you have a much more segmented market, much more geographically dispersed. You have more specialties involved, and we see that certainly as, I guess, a component in the competitive dynamics here. What we expect ex-US, we have not seen there's not been any approvals or any product in other countries at this point in time. But what we expect ex-US might, you know, I'm not going to speak to it necessarily, but I don't think that the dynamics are going to be wholly different ex-US. But that is something, again, that we will have to remain vigilant on and continue to see.

Thank you. Moving next, we'll go to Akeesh Tawari at Jefferies.

Hi, this is Phoebe on for Akash. Thank you for taking our question. Another one on Voxogo. can you talk about what market work you've done so far for hypochondriplasia and whether you expect any bolus at initial approval and if you've already identified a certain number of hypochondriplasia patients? Thank you.

Yeah, thank you very much for the question. I suppose Greg and I might want to take this on together. I think in terms of the hypochondriplasia market, you know, what we've said very clearly is that we expect a global total addressable patient population of around 14,000, but the work now is really getting in there in the countries and identifying those patients as early as possible so that by the time, assuming we're able to get a regulatory approval, by the time we get there, we can launch immediately and cover as many of those patients who are medical treatment as possible. And so we've already talked a little bit about some of the global initiatives we've been working on to improve diagnosis. We talked about some of the targeted genetic reclassification work we're doing, as well as a lot of the physician and caregiver awareness that we're doing. Most recently, we've launched tactics that are really around having multiple kind of digital and media campaigns really primarily targeted in the U.S., and that's about shaping the marketplace. And what we want to do is make sure that we're including HCP-directed disease education content, as well as caregiver and patient awareness programming that really, again, is about making sure that we're getting as many patients diagnosed as possible and then importantly shortening that path from the time that they are diagnosed to the time that they're willing to treat. Over to you, Greg.

Yeah, thanks. And just to go back as well, we only turned the card over two months ago. We're really pleased by the data that we saw in phase three. Again, the AGV exceeded our expectations. We hit statistical significance on the height variables as well as arm span. And we're looking forward to presenting the subsets and additional safety data and so forth at SP in September. I would say with regard to patient finding, you can be rest assured that we are working hard to bring what we think could be a potentially safe and effective therapy to hypochondroplasia patients. We're doing testing work. Again, we have metrics looking at not only testing rates, but testing yield. We're certainly preparing, you know, again, to know what we think, again, the age of diagnosis is and so forth. And that's work that's ongoing right now. We see that age going downwards, which, again, is a good sign that the classic challenge here, that these patients aren't making their way to the right specialist, is something that we've intervened with. At another time, I'd be happy to talk about other implementation science work we're doing, again, to try to prepare the field in, you know, in a pre-approval appropriate way to, again, make sure that the science is following and that we'll be able to, again, reach the most number of patients as possible.

We'll go next to Paul Matisse at Stiefel.

On BD, what's next in terms of the scope of the types of things that Balmerin's looking at? And Alexander, when you take a step back now and look at the revenue base and the profitability profile you have, what's the optimal number of, I guess, like phase one, two, three assets in a pipeline of bomber and size? Thank you.

Thanks very much for the question. So, you know, we're looking, obviously, at, you know, we see ourselves as a leader in the space of genetic conditions. We have strong business units as you heard now we uh we call it metabolic conditions so you know those are areas we're looking to to supplement uh the many products we have in those uh in those spaces that the nine products in our portfolio um but we're also interested in genetic conditions where it's a good fit with our our capability our expertise in genetics for example our regulatory expertise our manufacturing expertise our commercialization So without getting specific at this point about what those additional therapy areas within the umbrella of genetic conditions, I think you probably have a sense of the sorts of types of diseases which really leverage that capability. And I think when you look at the Amicus acquisition, it dropped just perfectly into that metabolic conditions business unit. You can see it's really the capabilities that we have that we can leverage that allows us to really say that, you know, the peak sales potential of these products is greater than they were before. So we think there's a really great opportunity for us to do that with other programs, but bringing them in in the clinical stages. So expect more progress in the next 12 to 18 months. We're looking for a nice steady flow of products at all stages of development. We were excited, and I think it's worth just highlighting, we're excited to announce this quarter we actually put more of a focus and really dug in on the DMX 200 asset, which we call now DMN 820. and we're really excited to with that asset as we've done it to have a phase three asset in the renal space so this hopefully gives you a sense of kind of what we're thinking about from a BD standpoint in a general perspective but you know we're excited about the growth prospects and the opportunity for cash flow generation and the optionality this gives us to further strengthen

in our pipeline we'll take our next question from sean layman at morgan stanley uh good afternoon alexandra and team hope everyone's well and thanks for taking my questions um i guess if you look at the the 2.6 billion dollar in in pom-up and gallifold guidance for mid 2035s like how much of that is uh like market acceleration versus what biomarin's adding to the pie and you know since you've been able to, you know, get the business under your hood, what have you learned down that front that gives you good confidence that you might not have known before? And then if I can slip one in on BMN 333, you know, how would you characterize the rate of enrollment in that study? And when might we see the next signpost? Thank you.

Yeah, so thanks for the question, Sean, around kind of how much of the contribution there is related to perhaps what we can do differently. I'd say that when you look at the contribution in the bill, and we really did do a bottoms up looking kind of country by country about what we could do. So we weren't playing around with the prevalence numbers or changing anything about the disease characteristics per se. This really was about when we put this onto the BioMarin platform, what could we do differently and how does that look country by country? So I would say the biggest, you know, kind of contributor as you would expect on the Gallifold side was opening up the diagnosis. Certainly treatment rate plays a role there, but really the biggest contributor there was around opening up the diagnosis rates. On the Pombility in OpFolda, that really was the biggest contributor was definitely how, you know, around switches and how quickly we could get the switch rate to move on that. And so the question becomes, how are we able to do this? And so as I'd mentioned, we looked at this country by country and really do feel confident about how we can click these into either existing countries where they're already opened up in those markets or importantly have already set in motion what is going to be the regulatory as well as the reimbursement pathway moving into those specific countries. So I'd say that that's the biggest thing. And again, this wasn't about changing prevalence numbers or tweaking with the funnel in that way. This really was about building on our own capabilities.

Yeah, and thanks, Sean, for the interest in 333. We, of course, are incredibly excited. We have active enrollment going on in multiple time zones, multiple countries around the world. Again, we're looking for naive patients. We're entering the steep part of the enrollment curve. I don't expect that we'll give an update until we're completed enrollment in those 40 patients for the phase two portion, but we want to just reiterate that again our expectation is in 2027 we're going to answer this question i know that there's been debate out there of whether or not again the free cnp will translate into more agv we have a a strong conviction that it is an absolutely valid hypothesis happy to drill into that with others in more detail now is the time building on the phase one data that we saw when we know we can increase exposure of free CNP. We know that pulls into pharmacodynamics in the plasma cyclic GMP. Now is the question to look at growth, and that'll be a question that we answer in the next calendar year. Wonderful.

We'll go next to Alex Hammond at Wolf Research.

Thanks for taking that question. Just two from us. So first on the guidance bump on box, does that have left to do with about switching or more about growth? And is that growth more U.S. or O.U.S.? And then on BM3C3 as well, how does the ASM study's operational seamless design give you levers to pull the timeline forward from the base rate perspective?

Thank you.

Hey, Alex, thanks. This is Brian. Appreciate the question on the Vox guidance raise. First and foremost, pleased with the performance in Q2 and our confidence in the outlook for the second half of the year to be able to raise the guidance and get Roxovo to the blockbuster status at the bottom end of the guidance. I'll note that you'll remember previously one of the variables that I pointed out at the beginning of the year when we guided was a couple of international price negotiations that were in process. I'll share that one of those closed successfully with a good outcome, and the other had some initial setbacks, but we are continuing with the process. But there was some upside there to some of the contingency that was in the range. So that was a bit behind it. And then the rest of it was growth and performance. And I'll just say that it was both U.S. and global, adding new patients, growing revenue, confidence in 2026.

Yeah, and thank you for the question again on 333. The operationally seamless phase 2-3 design really gets most of it or provides most of its benefit through recruitment acceleration and site startup. Not every country can start at the same time. They have different requirements with regard to regulatory approvals and so forth. This allows us to, under the umbrella of one protocol, work with the same IRBs, work with the same sites, have a parking lot of patients identified, and really, I think the most impressive benefits will come with the Phase 3 recruitment. The Phase 2, again, is up and going, and we are off to the races.

And this concludes our Q&A session. I will now turn the conference back over to Biomarin CEO, Alexander Hardy. closing remarks.

Thank you, Operator, and thank you all for joining us today. This is a standout quarter across the business. 20% top-line growth, a rapid close and integration of Amicus, advancing pivotal data toward Foxogo's second indication, hypochondriplasia. Strong demand for our innovative products led us to increase guidance today, including four-year total revenues. Foxogo now with a low end of $1 billion, and on GAP earnings per share. As we enter the second half of 2026, Biomarin is stronger, more diversified, better positioned than ever to lead in rare disease to deliver for patients worldwide. Thank you for your continued support. Look forward to speaking to you soon.

And this concludes today's conference call. Thank you for your participation. You may now disconnect.