Bobby Azamian: Yes. I think a couple of things, right? Starting with the gross to net. All of our gross to net of getting to 50% steady state, that accounts for all the factors in Part D. So, we’ve taken that into account in our goals there. In terms of when you get to that 2025 point, I would tell you that, we’re already seeing Medicare scripts come through, as you mentioned through exception or through PA. We are seeing a decent amount of volume come through that. Of course, that volume should continue to grow as we get more coverage. But one thing to keep in mind is at the beginning of the year, of course, you get on formularies, but then you have the typical Q1 headwinds. There’s some time to get through that first period of time.
That would build over time. It’s not like a light switch. The coverage is a light switch, but to be able to pull it through does take a few months to really get to that steady state. It’s a steady build as you get that coverage and I think the biggest factor of getting that coverage is going to be, our ability to optimize that gross to net and hit that 50% target because then we’ll be not giving away free product anymore in terms the bridge. That’ll go away. I think the way to think about it is we factored in all the accounts in terms of gross-to-debt modeling. The trigger to get to that steady state of 50% is getting on Medicare. Obviously, the volumes will increase as we get that opportunity, but it’s a steady build over time
Operator: Thank you. One moment for our next question. The next question comes from Andrea Tan with Goldman Sachs. Go ahead. Your line is open.
Andrea Tan: Good afternoon. Thanks for taking our questions. Aziz, maybe one for you here. Of those 8,000 prescribers that you’ve talked about, could you quantify the proportion that fall into the three buckets that you’ve spoken about previously? Maybe specifically how many of the 8,000 are early adopters versus those that are newer to DB? And then, is there anything else you think you need to do to reach the balance of those prescribers outside of the additional sales force that you’re planning here?
Aziz Mottiwala: Yes. So, we don’t get into the specific breakdown, but what I can tell you is that, clearly at 8,000, we’re beyond 50% of our prescribing base. Clearly, we’ve gotten all the early adopters or the vast majority of them. We’re really deep into our eager treaters, and we’re really starting to bring in those new to DB and when you think about the sales force expansion, it’s not as much of a reach play. We’re very confident in our current sales force ability to reach all these segments. We’ve been calling on all of them, but it’s really an opportunity to be able to increase frequency and go deeper, right? So, the early adopters have a higher prescribing pattern right now. They’ve really adopted this in their practice.
The eager treaters are getting to that threshold and the new to DB, they’re just getting the feet wet. They’re just starting that early prescribing and they’re looking to get that second, third, eventually fifth, 10th prescription to become routine. So, while we don’t get into quantitatively breaking those down, what I can tell you is that, we’ve got the vast majority of early adopters who really make great progress in the early treaters and now that is new to DB, doctors are the ones that are coming in. And I think the other things we can do beyond the sales force, is really potentiate the success the early adopters have had and share that with the eager treaters and the new to DB. That’s been one of the most compelling things. Particularly when you go to conferences, you hear a personal experience of the podium where doctors say, ”I wasn’t even looking for this before.
I started looking for this. I can’t believe I was missing it. I’m having great success. I’ve now implemented this across the practice, whether it be in my cataract patients or if it’s an optometrist. I’m starting to look in this when people complain about contact lenses or dry eye.” That compelling peer-to-peer education is something that we think is going to help unlock that new to DB doctor, in addition to our sales force. And then the third leg of that would be obviously the consumer. Empowering the consumer really does resonate coming in actively asking, right. It’s going to prompt the doctor to take a second look and think about, okay. Wait. Let me understand. Let me look at your list. Let me understand your history and symptomatology.
So, I think those are the waves we think about. The way I see this is, I think that we have made great progress so far and the sales force expansion and continued sharing stories of early adopters and then eventually a consumer effort is really what’s going to allow us to deepen the prescribing across all these segments.
Andrea Tan: Got it. Maybe one quick question, if I may. Just recognize it may be a bit early, but curious, if you’re hearing anything yet on retreatments.
Bobby Azamian: It’s still pretty early. We are starting to see this right. We’ve been several months in the launch, so you’re starting to see this and I would say, it’s too early to draw any massive conclusion here. I think you’re going to really start to be able to see that more meaningfully in 2025. But right now, we’re hearing some patients coming back for that second treatment. In some really rare one off cases, perhaps the doctors are shooting for perfection. They saw a great response, and they maybe do a second treatment just to get complete clearance. But those are anecdotal and really one-offs. I think to get any meaningful insights here, it’s probably going to be in early ’25 when we really start to see that volume.
Operator: Please hold for our next question. The next question comes from Telani Uthman [ph] with Goldman Sachs. Go ahead. Your line is open. Telani, are you there?
Bobby Azamian: Operator, I think, Telani works with Andrea.
Unidentified Analyst: I work under Andrea. Questions have been answered. Thank you. Great.
Operator: Thank you. Our next question will come from Tim Lugo with William Blair. Go ahead. The line is open.
Unidentified Analyst: This is Lachlan on for Tim. Congrats on the strong quarter. So, I was wondering on gross to net. I think you’ve previously said, you expect to get to about mid-50s by the end of this year. But you’re obviously already there and talking about some incremental improvement over the end of the year. So, can you maybe just sort of update us on how we should be thinking about the next few quarters sort of into the end of the year on gross to net and related to some of your comments around the payers, can you give any color on how many or how much volume at the moment, what proportion is through covered scripts that are on formulary versus those that are not yet there?
Bobby Azamian: Sure. I’ll go ahead and start on the gross-to-net question and great question. Ultimately, just sort of realigning with what Aziz said earlier. We expect incremental growth as we get more of the commercial payers on. So small increases in gross-to-net yields 1% to 2% per quarter upwards, but it’ll get much closer to 50% once we cross the threshold with the Medicare patients in 2025. And as Aziz alluded to, it won’t be a light switch, but we’ll start to see more improvement in the early part of ‘25 and then getting that broad coverage sometime in the middle of ‘25.
Aziz Mottiwala: Yes. In terms of, the coverage scripts, I would say that we don’t get into the gory detail there. But obviously, we’ve got some really big commercial plans last quarter and this quarter that we’ve announced. Those are obviously covered. The vast majority of those have been preferred. That’s really great in terms of our ability to drive utilization and optimize our gross-to-net. One of the prior questions we mentioned that we are seeing Part D scripts go through medical necessity or exception. Those are obviously getting covered as well. And then as we continue to build that commercial coverage reaching critical mass at the end of the year and then the remainder of Part D really kicking in in 2025, I think then you’d start to see sort of the bridging product go away to a very minimal level.
I think that’s the way to think about it. Every quarter that should improve and that ties back to what Jeff’s talking about those incremental improvements quarter-over-quarter is really as coverage comes in, that’s going to allow us to reduce the gross-to-net discount and optimize to that 50% gross-to-net at steady state.
Unidentified Analyst: Thanks. And I guess quickly on the sales force, should we expect any disruption as you add more reps in realign territories there?
Bobby Azamian: So, we’ve done a really good job here of mapping this out. I think one of the great things about expanding a few quarters into the launch is, we’ve got some great learnings from the launch. We’ve got some great insights from our sales force. We got great data. So, I think there’s a few things that work in our favor. One, the launch has gone well and the word’s gotten out. We’ve gotten a lot of great talent that wants to join the team. So, it’s really nice to see the volume and quality of paper that’s coming across our desk in terms of folks wanting to join the team. We’re going to be able to get some really high-quality talent into the Tarsus organization, which I’m delighted by. Secondly, we’ve got the data that’s going to inform exactly where to put this incremental effort to get the best return, right.
