Milestone Pharmaceuticals Inc. (MIST) Q3 2026 Earnings Call Transcript

Welcome to the Milestone Pharmaceuticals Third Quarter Earnings Conference Call. At this time, all participants are in a listen-only mode. A brief question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. I would now like to turn the conference over to your host, Michael Wood of LifeSci Advisors. Thank you. You may begin.

Thank you and good morning, everyone, and welcome to Milestone Pharmaceuticals' third quarter 2026 financial results and business update conference call. Earlier this morning, the company issued a press release providing an overview of its financial results for the quarter ended September 30, 2026, and recent corporate highlights. The release can be accessed on the Investors Media section of the company's website, MilestonePharma.com. Before we begin, I'd like to remind you that some of the information presented on this conference call contains forward-looking statements under the securities laws. These forward-looking statements involve substantial risks and uncertainties that could cause actual clinical programs, future results, progress, timing, performances, or achievements. to differ materially from those expressed or implied by such forward-looking statements. These risks and uncertainties associated with Milestone's business and factors that could cause or contribute to such differences are described in detail in the company's filings with the SEC, including in the risk factor section of the annual report on Form 10-K for the year ended December 31, 2025, and as updated by subsequent filings, including the quarterly report on Form 10-Q for the quarter ended September 30, 2026. Speaking on today's call will be Joseph Oliveto, President and Chief Executive Officer, Lorenz Muller, Chief Commercial Officer, and Anthony Crick, Vice President of Finance. So I'll now turn the call over to Joe to begin. Go ahead.

Thank you, Michael, and good morning, everyone, and thank you for joining us today. We're excited to report our third quarter results, and in particular, the continued progress on the launch of Cardamist and PSVT. Starting with the KPIs that we report each quarter, we recorded approximately 1,800 prescriptions of Cardamist in Q3, representing a 50% increase over the prior quarter, with total scripts from launch through September reaching approximately 3,400. Q3 saw approximately 750 unique healthcare providers prescribed CardMist, a 16% increase over Q2, and bringing the total number of unique prescribers to approximately 1,600 from launch through September. As of today, insurance plan formulary coverage of CARDAMIS increased to approximately two-thirds of commercially covered lives, up from approximately 50% that we reported during our second quarter call. Beyond the figures, we remain encouraged by the positive feedback we continue to receive from a growing number of patients about their use of CARDAMIS and what it has meant for them as they deal with the burden of PSV2. We remain confident that steady script growth will improve based on increased awareness and usage of Cardamist by healthcare providers and ever-growing positive patient experience, and that continued steady increase of payer coverage will result in greater revenue realization over time. In a moment, I'll ask Lorenz to take you through the launch metrics in greater detail and provide color around the demand and coverage components of the launch. Now I'll turn to some organizational efficiencies that we are implementing. Over the last year, and since before the approval of Cardamist in late 2025, we have built our commercial organization largely through contracted partners in order to optimize launch speed and flexibility. That experience has yielded an increasing level of understanding of where we believe our investments have the greatest impact on the business. At this stage, we can better identify the health care providers who represent the greatest opportunity and the activities most effective in generating prescriptions. These insights are driving a significant change in how we're operating the business. Today, we're announcing cost-efficiency measures that are intended to create a more focused and efficient organization designed to drive continued adoption of Cardamist, gain further payer coverage, and advance our clinical development in atrial fibrillation at less cost. The savings are being realized through three primary components. First is a transition of our contracted sales force and other dedicated contracted infrastructure to our own employees and milestone-owned data systems and analytical capabilities. We will be onboarding our existing contracted field team of approximately 45 dedicated representatives in-house as milestone employees at lower overhead costs. The 45-person team was already optimized from approximately 60 individuals in August. At that time, we selected the best-performing territories and reps, as well as territories that have the greatest potential when focusing on electrophysiology and the highest prescribing cardiology accounts. So script trends since September have been a result of our 45 representative territory alignment and the start of our revised targeting. Second is a prioritization of the marketing and support programs that provide the greatest impact on prescription growth and revenue potential of Cardamist and the discontinuation of those programs that have shown limited or no impact. Third, beyond the commercial organization, we're streamlining our operations, including reducing our headquarters workforce and right-sizing our internalizing select contracted activities. As part of the reduction in headquarter expenses, Mr. Amit Hasidja, our CFO, and Dr. David Borucha, our CMO, have departed from the leadership team, with David transitioning to a consultant with the company. Anthony Crick, our Vice President Finance, has been named Principal Financial and Principal Accounting Officer, and you'll hear from Anthony later in the call when he takes us through the financials. Dr. Bruch's day-to-day responsibilities will be covered by our medical safety and pharmacovigilance team and physician consultants and advisors who have a history with our program. On behalf of the company and personally, I thank Amit and David for their many contributions and strong leadership throughout their time at Milestone. These are obviously difficult decisions, particularly those affecting employees and colleagues who have contributed a lot to Milestone and helped advance the company to this stage. However, we believe these actions are necessary to get to a more sustainable operating structure, one that reflects the current stage of launch of Cardamist, while allowing us to maintain our commitment to the product's long-term commercial potential. Taken together, we expect these measures will reduce our operating expenses by approximately 30%, and we plan to have the entire process completed by the first quarter of 2027. We expect to incur approximately $2 million in one-time charges, primarily severance, conversion fees, and other costs related to the workforce reduction. In parallel, we have amended our note purchase agreement with RTW Investments LP to extend the payment-in-kind interest period from March 31, 2027 to March 2029. We are forecasting that these initiatives will extend our operating cash runway into late 2028 and through the anticipated Phase III readout of the Rivera 301 study in the second half of 2028. The Rivera 301 trial is off to a good start and now enrolling patients in the U.S., Canada, and Europe. We believe AFib-RVR represents a substantially larger and potentially more active market than PSVT, with an important opportunity to build on the clinical foundation already established for Cardamist and PSVT. Our ongoing engagement with key opinion leaders suggests that physicians treating AFib-RVR may be more receptive to adopting innovative treatment approaches for this disease state. We believe this creates an opportunity for atripamil to bring a self-administered treatment option to a much larger patient population. The significance of this program underscores why we believe it's important to preserve our financial resources through the Phase III data readout. We view this as a major potential value-creating event for Milestone, and our cost-efficiency measures are positioning us to achieve it while continuing to build Cardamist into a franchise. We believe the actions we're taking today are necessary to achieve both objectives and position Milestone for long-term value creation. I'll now turn the call over to Lorenz, who will provide further details on the commercial launch performance and the work we're doing to drive continued adoption of Cardamist. Lorenz?

Thank you, Joe, and good morning, everyone. As Joe outlined, the first phase of the launch of Cardamist has given us a much clearer understanding of the market and where we want to focus our resources.

The underlying business continues to grow steadily.

I'd like to now provide you with more detail on three measures of adoption, prescription activity, including repeat prescribing, breadth of our prescriber base, and patient access. Starting with demand generation, in the third quarter, as Joe mentioned, we recorded approximately 1,800 prescriptions, compared with more than 1,200 in the second quarter, bringing the total since launch to approximately 3,400 prescriptions. Prescriptions were written for around 1,400 patients during the quarter and approximately 2,700 since launch. While realizing this is still only our second full quarter since launch, the refill rate is coming into view and showing an improved trend. The overall refill rate since launch through Q3 is 1.2 scripts per patient, with the refill rate during the third quarter averaging 1.3 scripts per patient. We're also continuing to see healthy and steady expansion in breadth of prescribing by health care professionals. Approximately 750 unique health care providers wrote prescriptions in the third quarter, compared with more than 600 in the second quarter. Since launch, approximately 1,600 unique health care professionals have prescribed Cardamist for their patients with PSVT. Electrophysiologists remain important early adopters, and we're also reaching clinical and interventional cardiologists and advanced practice providers, including nurse practitioners in cardiology practices. Currently, approximately one-third of prescriptions are coming from EPs, 40% from clinical or interventional cardiologists, and the rest from advanced practice providers associated with cardiology practices and a small number of primary care physicians. Two trends are particularly notable. We continue to add approximately 50 first-time prescribers each week, even as the overall prescriber base grows. At the same time, approximately 40% of our prescribers have now written Cardamist for more than one patient. That tells us we have an opportunity both to continue to introduce Cardamist to new physicians and also to help those who have already prescribed it consider the product for a broader group of appropriate patients within their practices. Building that depth of prescribing is essential to improving the current growth trajectory. That's an important part of the rationale behind the changes we made to our field strategy in August. We've identified more than 5,000 high-value healthcare providers who manage disproportionately large numbers of patients with PSVT. Our team has been spending more time with these practitioners, with messaging focused on the broader group of appropriate patients they see, not just those newly diagnosed or recently treated in an emergency department. Early results suggest these focused efforts are producing a stronger prescribing response among these high-value targets. Bringing the field team in-house, as Joe discussed, will allow us to manage these approaches more directly and continue to deploy resources more quickly to where they can be most productive. Joe had mentioned that we continue to hear from patients regarding their positive experience with Cardamist, and we believe that this positive patient experience will be a natural amplifier of its expanded use. Continuing with the patient experience, we're learning from the targeted digital patient activation program that recently began and which we mentioned on our August earnings call. We look forward to measuring this program more fully toward the end of the year so that we can best plan our patient engagement activities moving forward. Now, regarding market access. At the end of the second quarter, Artemis had formulary coverage representing approximately 25% of commercially insured lives. By our August earnings call, we had increased to approximately 50%, and today, coverage has expanded to approximately two-thirds of commercially insured lives. It's notable that the improvement in coverage has come without the attainment of broad formulary placement from the third national PBM, CBS Caremark, who we continue to engage with, the expectation of gaining national formulary coverage in the future. Many of these covered lives now have access to Cardamist without a prior authorization requirement. This is obviously important as it reduces administrative barriers for physicians and can help patients obtain treatment more readily. Finally, I'd like to update you on our Medicare status and approach. Our launch to date has had no broad Medicare formulary coverage, and we've invested limited resources in support services for Medicare patients. As our focus in 2026 has been on gaining commercial coverage. Despite this, we're already generating some Medicare revenue through medical necessity or exception processes. For the start of 2027, a small number of regional Medicare plans have added Cardamist to their formularies, although national Part D plans have proved challenging. We expect Medicare utilization to grow modestly over time. Primarily through medical necessity exceptions rather than broad formulary coverage, and we do not anticipate Medicare being a major driver of prescription growth in the near term. Our approach will be to continue engaging Medicare payers with the aim of gaining reasonable coverage. However, we won't chase broad Part D coverage at any rebate level. Instead, we'll rely on and invest more in established medical necessity exception pathways supported by provider education, reimbursement resources, and targeted patient services. In summary, we'll remain selective in Medicare Part D contracting. Our goal is to ensure appropriate patients can access Cardamist while maintaining net price and long-term value so that we can sustain access and continue investing in the product. To close, we're continuing to broaden access and add new prescribers while seeing more physicians prescribe Cardamist for additional patients. We have work to do to increase prescription growth, and our more focused commercial model is designed to support that objective while using capital more efficiently. I'll now turn the call over to Anthony Crick for a review of our financial results.

Thank you, Lorenz. Net product revenue was $1.0 million for the third quarter of 2026, compared with $0.6 million in the second quarter of 2026. For the nine months ended September 30, 2026, net product revenue was $1.8 million. There was no product revenue in the comparable periods of 2025. Research and development expense, net of tax credits, was $3.5 million for the third quarter of 2026, compared with $3.9 million for the same period in 2025. For the nine-month sentence, September 30, 2026, research and development expense, net of tax credits, was $10.2 million. Compared with $12.6 million for the same period in 2025. The decreases compared with the prior year were a result of decreases in outside service costs related to drug development and research. Selling general and administrative expense for the third quarter was $24.2 million, compared with $7.9 million for the prior year period. For the nine-month end at September 30, 2026, selling general and administrative expense was $67.5 million, compared with $32.3 million for the same period in 2025. These increases were primarily due to additional personnel costs, professional costs, and other operational expenses related to the launch of Cardamist. Net loss for the third quarter was $25.8 million, or $0.18 per share, compared to a net loss of $11.9 million, or $0.12 per share, for the prior year period. For the nine months ended September 30, 2026, net loss was $80.5 million, or $0.59 per share. We ended the quarter with $145.4 million in cash, cash equivalents, and short-term investments, compared with $106 million at December 31, 2025. For further details on our financial results, Please refer to our quarterly report on Form 10-Q for the quarter ending September 30, 2026, which was filed with the SEC this morning. I'll now turn the call back over to Joe for concluding remarks. Joe?

Thank you, Anthony. In closing, I'd like to thank our team for their dedication and grit as we work through the streamlining measures that we expect will extend our operating runway into late 2028, which is more than one year beyond our prior guidance. We at Milestone are fully committed to the success of Cardamus. The quarters ahead represent an exciting time for our company as we grow the PSVT business and simultaneously progress our AFib RVR Phase III Pivotal Trial, all for the benefit of the millions of patients suffering from these conditions. I'll now turn the call back over to the operator for questions.

Thank you. We will now be conducting a question and answer session. If you would like to ask a question, please press star 1 on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star 2 if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. Thank you. Our first question comes from the line of Ritu Baral with T.D. Cowan. Please proceed with your question.

Good morning, guys. Thanks for taking the question. I wanted to ask about how we should be thinking about forward top-line growth. Obviously, the numbers for August and since, well, especially August, have been an improvement over prior numbers and Q2. But as we think about Q4 and as we think about Q1, how do you expect How do you expect continuing growth to occur with the new 45, well, not new, but the sort of concentrated 45 rep? Group, as well as the optimized sales operations. And then second question, just as you spoke about Loren's balancing of the targeting, can you talk to how you might have, you are rebalancing the focus? Are you targeting electrophysiologists more? Are you targeting interventionalists less? Is there more in the community setting or better targeting of high-volume cardiologists? If you could talk to that qualitatively more. Thanks.

Okay. Hey, great to hear from you, Ritu. Thanks for the question. I'll lean in a little bit more on the first one and ask, as you had directed, Lorenz, to help with the balancing efforts. And you're exactly right. I think what you're seeing in August and September is really the start of when we optimized our sales force to 45 and started, if you will, that retargeting initiative that Lorenz will talk about in the second question. And so this is our first kind of call it month and a half to two months of seeing what that means for us. We do expect to see continued inflection of scripts over time, and that's not only a result of the retargeting and the Salesforce, they're a big piece of it, but also other programs that we have that we call surround sound around the Salesforce. And as we've built this launch and gotten into it, we've seen which ones have created promotional response and which ones have created less promotional response and continue to dial up and down. So it's still a little bit of a work in progress. We don't guide to numbers, but I can try to guide to shape a little bit of a curve. I do think we'll see shifting up and we expect to see shifting up in Q4. What we haven't been through yet for this product, but we watch a lot of comps. Is that, you know, Q1 shifting down a little bit as things like out-of-pockets for patients and, you know, their insurance plans reset? So we expect that will hit us like it will hit other retail drugs. We don't know if it will hit us more or less. So that's something we're following. So maybe we see a shape that continues to inflect up in Q4. We don't know exactly if it flattens a little bit in Q1 because of that feature and then starts to, again, inflect up in Q2, that type of thing. But what we're expecting now is we're happy with continued steady growth. We think we're going to right-size based on this cost savings to match that growth that we're seeing now, and we'll continue to see that ramp up as we get through the second half of 27. Lorenz, maybe I'll ask you to talk in more detail about what that targeting has meant for us and how we continue to think about it.

Yeah, thanks, Joe, and thanks for the question, Aritu. You heard on the introductory remarks that we've refocused our representatives, the 45 territories, on what we call high-value targets, and these are HCPs, primarily cardiologists, as you indicated, but also some APPs and a small number of primary care that really treat a disproportionate number of patients with PSVT, and we know this from claims data, And we see this in a contemporary basis, like, you know, recently that those are the volumes. So that just suggests that we're, you know, fishing where the fish are kind of thing. And by focusing more energy on those, both reach, getting to more of them. So I mentioned on the call that we, you know, we've identified more than 5,000 of these that fall into this category. And so we both try to get to as many of them as we can. We haven't gotten to the majority of them yet, as you heard, in terms of the number of doctors, you know, that have actually written. But we are increasing the numbers that are writing their first script, and we're also now focusing on depth to get doctors to write their second, third, fourth, fifth, and tenth patients. So that's a big part of this. And in terms of the type of physician that falls into this bucket, it is a mix of electrophysiologists and clinical cardiologists and interventional cardiologists primarily. As we alluded to on the call, electrophysiologists are more promotionally responsive right now. They are KOLs. They're the early movers. They don't necessarily have as much of a potential for refills as clinical cards that are managing patients without ablation, so there's no curative solution for those patients in that treatment pathway. So while we're seeing initial more rapid uptake by EPs, we are seeing growing promotional response on the part of cards that I think in the longer haul will end up delivering more of the volume.

Does that complete your question?

Yes, thank you. Sorry about that. Thank you. Thanks, Richard.

Our next question comes from the line of Edward Tentoff with Piper Sandler. Please proceed with your question.

Great. Thank you very much. So, when it comes to Rivera, can you remind us a little bit more about the trial design? How many patients are enrolling, when you expect to complete enrollment, and what kind of magnitude delta? Would be, would be successful. Thank you.

Hey, Ted, great to hear from you. So. Yeah, good reminder question for Rivera. Rivera is designed very similarly to how we designed our PSVT Phase III trials. It's an event-driven trial. The way those trials work is we enroll patients. We call it filling the top of the funnel. We enroll patients. We send them home, and as they get events, they treat themselves with study drug. And our expectations are that we're sizing this trial to about 150 events. And that will come, we believe, over a period of about two years from the start of the trial. Remember, we started this trial, and we call START first patient enrolled, and that happened in August. So we're guiding to a two-year time point to be able to deliver on 150 events. of patients with AFib RVR. To get to that, we're expecting to enroll somewhere in the range of 500 to maybe even 700 patients to be able to have those events occur in a reasonable amount of time, i.e., the two years. And the variables there are enrollment rate and event rate. And what we've got investors to is, around that two years, is the enrollment rate we feel should be faster than PSVT. Remember, we're now going to sites that we have a lot of experience with and that have enrolled well, for example, and produce high-quality data. So the combination of operational excellence and efficiency along with the fact that, let's face it, it's easier to enroll AFib. There's many more patients. The other variable of how often they have events and how quickly, that's something we don't know as well as we knew for PSVT, and as a result of that, we gave ourselves a little bit more cushion on them maybe having less frequent events. And so that's where we get to the two-year time point to get to. You know, a data point for AFib-RVR. So, we're putting it out in the second half, 2028. With regard to how the study is powered and what it needs to deliver, another great reminder, this study has two endpoints. The primary endpoint is the reduction in ventricular rate. We saw in the Phase III study that we had about a 30-beat per minute difference between drug and placebo that was highly statistically significant with only 50 patients that was inpatient in the emergency department. But this study is actually powered off of the second endpoint, which we also have to hit for regulatory approval, and that's symptomatic benefit for patients. There we want to see more patients in the drug group seeing significant benefit improvements over the placebo group. That's measured on a seven-point Likert scale of symptom improvement. And again, remind everyone that we did see statistical significance in the Phase II trial with 50 patients, 25 per arm. This is going to be 150 events, 75 per arm thereabouts, and feel like we have the power to be able to deliver that symptomatic benefit. So that's the key for the regular talk.

Yep, totally. That's really helpful. Thanks for the reminder, and wishing Amit and David all the best. We'll miss you guys.

Yeah, thank you, Tab. We will as well.

Our next question comes from the line of Olivia Brayer with Cantor Fitzgerald. Pleased to see with your question.

Hi. Good morning. Thank you for the question. And, yeah, we'll definitely be missing Amit and David going forward. Can you guys talk about the strategies that you have in place to engage with emergency services, just as we think about EMTs? And paramedics. We've gotten some good feedback from some of our channel checks in terms of enthusiasm to use the drug in those settings. So trying to get a better sense for how important that channel could end up being as your launch progresses and PSVT, and obviously the importance of on-demand treatment in that setting. And then I've got a quick follow-up on AFib.

Sure. I'll start, but ask Lorenz to expand. It's so funny, Olivia, when we're out in the market and we're out riding with reps, there's not a day that goes by that we're not challenged to go and speak to the emergency room downstairs or down the street. And then we speak to them, and they get wildly excited about it. And then the questions become, well, how are we going to get it to that and the machinery of that? So we do have it as a growth driver for this brand, but we generally have it as down the road once we're established with at least clinical cardiology and electrophysiology. And Lorenz could maybe expand a little bit on the interim strategy, which is how to get it as they depart the emergency department, but also long-term how we can get to the inpatient setting. So, Lorenz?

Yeah, thanks for the question, Olivia. We've literally been talking about this for almost the entire time I've been here, almost nine years now in terms of an opportunity, and we think it's a real opportunity, as you alluded to and as your calls are suggesting. To us, it's more, as Joe suggested, a timing issue and an operational issue. So the demand is there, the interest is there, both on the part of the emergency medicine physicians and the emergency rooms around the country where these patients show up, and also ultimately on the rigs and the EMTs where we're talking about, you know, they're already administering adenosine now on those rigs, and then the patient has to go to the hospital for, you know, checks and things. There's an interest there in putting Cardamist on those rigs ahead of adenosine and potentially not even having to take the patient to the hospital. So that's the demand and the interest, and we get it. The challenge that Joe was alluding to is more operational. So in the emergency department, and this is where we would start first, to actually get the product into the system in emergency departments around the country is a big lift. Just to get it into protocols, emergency medicine physicians are very protocol-driven. They're very about triaging and moving on. And so making sure that they have a good experience, and even though they want to use it, making sure that they have it in their protocols, that it's in their systems, the PIXIS, whatever, that's going to take time. We will pursue that, but it is not the highest priority right now in this stage of the launch because it's not, in our mind, as big an opportunity as what we're seeing in the outpatient setting with EPs and with cardiologists. What Joe was alluding to a minute ago, which I think is very interesting, is is there a way, even though you may not administer the drug in the emergency department or in the inpatient setting, in a hospital setting, is there a way to get the product introduced into protocol so that once the patient is treated, stabilized, and discharged from the emergency department or even the hospital, is there a way to get protocols written so that that patient leaves that setting with a prescription for Cardamist to avoid the next? What's the emergency department visit and have a better experience? And what are the operational realities around how that product gets to the patient? The prior auth that need to be filled out, in some cases, we know we'll have those. Who's going to fill that out? It's not the emergency department likely. Some emergency departments have, you know, techs that can do that. Most don't. So it's more of an operational issue. And for sure, on the EMT side, that's more of a longer term thing, because as you probably know, ambulances and rigs, those are managed at a state. And in many cases, a county level. And so it's a Herculean task to get that introduced into all of those different systems. We'll get there, but it's not our focus or our priority in the next, you know, 12 or 18 months.

Okay, that's helpful. Thank you. And then on AFib, can you guys just remind us how you've designed the patient-reported outcome part of the study, just to make sure that you're capturing a meaningful improvement in symptoms?

Yeah, so the patient-reported outcome is a seven-point Likert scale on symptom improvement, and I don't have a question right in front of me, but it's along the lines, Olivia, of, you know, how have your symptoms changed since taking the drug? It's performed at a 30- and a 45-minute time point, with the 30-minute time point being the primary, 45 being other supportive information. And it's the CGII is what that symptom PRO is, Clinical Global Impression of Improvement Scale, to be specific. And if you will, the right side of the scale, the middle of the seven point is neutral, and the right side is improvement. In general, over a half hour, symptoms generally don't get worse, is what we believe, but they could, and that's the left side of the scale. And what we're looking for for this study is, I think, again, I don't have the scale right in front of me, but something along the lines of five, six, and seven say something like slightly improved for five, much improved for six, very much improved for seven. And we're looking for people to get into that six and seven category at a rate of about 45% for atripamil versus 20% for placebo. So, it's powered greater than 90% using a two-sided alpha to get to a .05. Great. Is that kind of where you're – yeah.

Okay.

Yeah, that's perfect. Thank you very much.

All right. Thanks, Lydia.

Our next question comes from the line of Mohit Bansal with Wells Fargo. Please proceed with your question.

Got it. Thank you very much. Thanks for taking my question. And I have two questions. So one, I'm trying to understand. So I know you, Lawrence, you talked a little bit about this as well, but just trying to pinpoint. So now that coverage is actually two-thirds of the commercial life for this, and I'm wondering that when you think about the friction points and opportunities here, like, what do you think are the core friction points that still remain? Is it the physician identifying patients, or is it the access that is an issue, or is it a refill behavior? Like, can you talk a little bit about those aspects, like how, what are they, and how you're tackling them? And I think it seems like you have a targeted approach now. So can you give us some comfort that the restructuring doesn't change? Any way you're thinking about the probability of commercial success here. Thank you very much.

Yep. Thanks, Mohit. A lot in there. Question. I'll start again. This is right down Lorenz's alleyway here, though. But I'll start with a more basic variable that, you know, you call them friction points. This is a variable we're working through here. And we mentioned it before we launched. In the world of the launch, there's, you know, probably 20 variables that you really think about. And one of them was, foundationally, the ability... of patients and physicians to act and act quickly. Okay, we talked about things like entering a market that hadn't had any new drugs enter it for three decades since adenosine. And so that was an unknown that we had going into this, into this launch, and one that we were We're cognizant of, but unsure as how bad it would be. And that seems to be the major issue, I would say. The size of the markets there, we believe these physicians, the patients are as concentrated as we thought with these physicians, but it's that ability, once you learn about this option being there, to act and take action to actually prescribe and get the drug. That's kind of the overarching variable that we're really trying to fight through here. And part of this initiative, and again, I'll let Lorenz talk about what we're doing and get over that, but part of this initiative is to give us more time to just let the drug sink in. And people to get used to a new drug option being available for these patients, right? The medical need is there. It just needs to sink in relative to everything else they're dealing with. These are the cardiologists, the heart failures, the lipid management, everything else they're working on. We need a little bit of time for PSVT to sink in there and for our reps to continue to deliver that message. So, Lorenz, maybe you can talk about some of the things we're doing to overcome the launch and the pain points, whether it be that one or others.

Yeah, sure. Happy to, Joe, and thanks for the question, Mohit. Maybe I'll take the second part of your question and then finish up on that sense of urgency that Joe was talking about. So you asked about how the changes or the restructure we announced today, how that's going to affect our ability to generate demand going forward, and I can tell you kind of why we feel like we can do as much as we've been doing with less resource put toward it, which is the savings, and it really comes from three main areas. The first one, as Joe announced, is we're going to be internalizing capabilities. We've gotten past the launch now, and so while our partners have been great and helped us get through some of the hardships we had a few years ago when we had setbacks, we're now at a point where we're going from kind of the launch phase to the growth phase, and so internalizing processes is just going to make it inherently more efficient, so there's cost savings from that, mainly in the sales and ops areas. Um, and because we are now in the growth phase and out of launch phase, some of the investment we had to make in the launch year to build things, they're now built, and we don't have to rebuild them, and we can invest selectively in, you know, driving growth using those tools as opposed to having to build the tools. That's the second area of savings. And lastly, you know, the last nine months, we've done a bunch of pilots, a lot of fast fail work, and so we have a much better understanding now relative to what we knew nine months ago about both personal promotion. So we're able to, going forward, allocate resources toward the things that we know work and even relatively how well they work, which is why we're prioritizing. To answer the first question, we're prioritizing our targeting, our depth of prescribing driven by frequency on the highest value targets. That's a huge driver of growth going forward. And as you heard me say on the call, you know, we see our refill rates starting to grow, and that will also be a governor that will help in going forward to fill in the gaps. And we haven't presented data yet because it's still early, but we started patient activation in earnest in August, and it takes, you know, quarters to start to see the payback from that, but we're seeing early signs of a positive engagement with what we've built. That doesn't mean we've seen it yet or measured yet translating into scripts, but we're cautiously optimistic that those activities that we're seeing are going to translate into real outcomes, meaning, you know, doctor's visits and scripts going forward, which we hopefully will be able to talk to you about, you know, in the upcoming quarters. Helpful. Thank you.

Yeah, and Mohit, access will tip away and get better over time as well, right? So we feel like we're on a good path there, and it'll just continue to get better. So time will help that as well. Darn it. Thank you very much.

Our next question comes from the line of Brandon Fultz with H.C. Wainwright. Please proceed with your question.

Hi, thanks for taking my questions. Maybe just one for me. Do you have any insight into whether physicians are predominantly prescribing Cardamist to patients with frequent PSVT episodes or sort of starting it on the more milder, less frequent episode patient? And, you know, are you able to sort of change your targeting there? Is there anything you can do from that aspect? Thank you.

I'll say it's both, Brandon, but Lorenz, do you have any real insights into this beyond both?

Now, it's a very insightful question. The answer is it's very heterogeneous in both, but what we were seeing in these first six months is that the physicians, and the reason we have a lot of physicians writing a patient or maybe two as opposed to five or six, is they were very focused when our reps first went in and introduced the product to them on patients that were the most engaged and in their perception had the highest medical need. So we were seeing the majority of our scripts early in the launch coming from patients who were either newly diagnosed, which is a teaching moment, right? The doctor's like, okay, now you know what this is. Let me give you your options. Or a patient that had recently been to an emergency department. And that's fine. Those are great patients. There's a huge medical need there, and those are great patients that are going to really benefit from Cardamist, both initially and with refills over time. But what we introduced, you know, in about six months into the launch is to now expand the messaging and not just have our reps go in and detail Cardamist and talk about its benefits, you know, efficacy, safety, convenience, all that, But also start to help those clinicians think about a broader group of patients and that that medical need isn't just those patients coming out of the ED or newly diagnosed. There's many patients that are suffering in silence and they're seeing them, but they're perhaps not asking the right questions about their burden and understanding it if they haven't been to the emergency department recently, even though they still have many, many episodes a year. So that sort of refocus of the message and broadening of the message, we believe will start to have a beneficial effect, and we're already seeing that doctors are starting to write their second, third, fourth, fifth, eighth, tenth patient. That's a big driver in 2027 of our growth.

Great. Thanks very much. And maybe just one follow-up. You know, just given the focus on expense controls, can you just talk about how you think about your patient assistance program in 2027? And then, you know, where are we today in terms of conversion of written prescriptions versus, you know, potentially abandoned prescriptions? Thank you.

Yeah, so, Lorenz, maybe you can, you know, why don't I just let you comment on both of those?

Sure. So, Brandon, just because patient assistance is a very specific technical term around those that have, you know, a financial need, I think your question was more broadly about patient support services, just how are we supporting patients in terms of reimbursement and education and all that? Is that correct?

Yeah, thank you.

Yeah, yeah, yeah. So, we did launch with patient support services. We both have reimbursement services to help. So patients can identify the ways that they can pay for the drug and actually get it through PRIROS and all that, and that also helps clinicians. And that continues. In fact, we've increased that by now starting to put some actual people in the field whose job it is to engage with customers, meaning HCPs and offices, and actually help them submit PRIROS. So that will help in many ways in terms of patients getting the drug and figuring out how they can do it and afford it with the co-pay programs that we have. We continue to have a robust co-pay assistance program, which is very much front and center for patients. They can download co-pay cards from our patient websites. Our reps distribute this to doctors, so they get it from there. So there is a lot of support to make them able to afford the drug, and we continue to have nursing support and numbers where they can call in and ask questions. When they're in an episode or even if they have questions about how to use the drug. So we continue to invest in that to make sure the patients have a good experience. On the second part of your question in conversion versus abandonment, I can say in general, although we haven't released actual, you know, fill rates, I can say that we do measure our fill rates, you know, over time, monthly, and we compare it to benchmark products, both, you know, episodic products like ours and others, and importantly, ones that use retail distribution like we do, and even ones that use specialty services like Blink and Fill and those kinds of things. And we're happy to report that we feel very confident that we are. Well, benchmarking well against both of those types of analog products that our fill rates are not the primary obstacle toward growing the drug. And that's important because that was a decision we made early on to go retail. So retail distribution is working. Patients are able to access the drug broadly in pretty much any pharmacy they want to go to. And the fill rates are incrementally improving over time on a monthly basis. And I think we'll continue to do so.

Great. Thank you very much.

We have reached the end of the question and answer session, and with that, the conclusion of today's call. You may disconnect your lines at this time. Thank you for your participation, and have a wonderful day.