So we see really broad potential, and we’re excited to get to the next point to sort of enable us to be able to pursue that. But right now, we’re focused on VOWST and our 155 program.
John Newman: Great. Thank you.
Eric Shaff: Thanks for the question, John.
Operator: And we will take our next question from Tess Romero with JPMorgan. Your line is open.
Tess Romero: Hello, good morning guys. Thanks so much for taking our question. So how should we think about the sales trajectory in 2024 for VOWST? And specifically, what is the right way to forecast percent of free drug over the course of 2024, given the patient affordability challenges you cited? And then second question is, can you clarify what you mean by the strengthened promotional campaigns and expanded reach of digital promotion by Nestle and what this means with respect to expected pull-through to the launch?
Eric Shaff: Yeah, Tess, thanks for the questions, and good morning. Let me invite Terri to comment on both questions. I would just start by saying Terri spent most of last week with the Nestle commercial group and leadership. So I think it’s a good time to ask that question and provide some visibility as to how we look at 2024 and the trends that are important.
Terri Young: Yeah. So in 2024, we’re obviously, as with any launch, looking for continued growth, breadth and depth of prescribing specifically, right? We’re seeing good access. We seek to preserve that. So it’s really about HCP trial and adoption in 2024. And I’ll touch on predrug last. Digital promotion is actually a key tactic that it’s important for a brand to leverage after you’ve educated your top prescribers and KOLs. So we’ve spent with Nestle the first months after the launch, making sure that we had deep conversations, deep education efforts with the top prescribers, activating the high-volume prescribers. And from there, we’re really seeking to enhance breadth of trial. And so you can do that leveraging the sales force that we have, but we really aim to go broader than that.
And that’s the role of digital promotions. So you tend to scale that anywhere from four to six months after approval and launch. And so that’s what we’ve done. So we had a new campaign that launched and was rolled out to the representatives in October of last year, right around IDWeek and that campaign was significantly scaled digitally to HCPs. We also scaled patient promotion. You typically do that six months after a launch because you don’t want to send activating your patients into a physician and have the patient be the first source of awareness about a new product. So we want to make sure that physicians are aware of the new product before we turn patients on and send them in. So all of that is in the rearview mirror now, and it’s about those campaigns delivering the additional breadth of prescribing and subsequent depth that we would expect because we know once physicians try VOWST, they’re having a good experience and they’re willing to try it on additional patients in their practice, and we’re seeing that in the results.
So we’re very happy about scaling that promotion and look forward to the additional growth that we’ll get this year as a result of it. Switching to free drug. I mentioned that we saw the rate come down in Q4 from Q3, right? But we’ve got three quarters now in sort of the mid-40s. So in terms of forecasting, those are the data points that we have. I think we’ve got 46, 48 and 44 in the three different quarters in 2023. We have said and I have said that we expect the utilization of these programs to go down, the voucher program will go down as we get policies on board. So you could imagine we might see some declines this year as payer policies are issued for the majority of the population. But specifically in 2025, with the IRA provisions going into effect, the patient assistance program, the more traditional path that we have that’s income qualified in Medicare Part D patients, that’s where we’re seeing the majority of the utilization, that should really decline in 2025.
So that’s sort of the data points that we have and the knowledge that we have around patient assistance. Thanks for the question.
Tess Romero: Thank you.
Operator: And we will take our next question from Peyton Bohnsack with TD Cowen. Your line is open.
Peyton Bohnsack: Hey, good morning guys and thanks for taking our question. I guess to kind of build up on the previous question, talking about launch trajectory. I was wondering if you could give us a little more detail about the potential penetration in the first rCDI population. And are there any specific strategies that you guys can do to kind of build further into that population? Or is it just mostly a position education effort? And then I have a follow up.
Eric Shaff: Sure. Pete, why don’t I give the first one to Terri.
Terri Young: Sure. So absolutely, the strategy that we’re taking is to definitely accelerate utilization into the earlier lines of therapy within rCDI, right? So there are a number of ways to do that. One is achieving breadth, and I went into some depth about the breadth there with Tess a minute ago. But digital promotion is really a way that you can reach deeper into the prescriber base even into primary care, we’re — not a lot, but many of the first recurrent patients are treated. So the breadth of — prescribing the breadth of promotion, the breadth of awareness is really important to achieve and that should go a long way toward unlocking additional use in that population. But we do see that our core set of prescribers actually see and are choosing VOWST for these patients.
