Corey Jubinville: Hey, thanks for taking our questions and congrats on the early launch metrics. Just building off a question that was asked previously, again, last quarter, you spoke to us about the potential payer headwinds as these non-contracted payers may start to implement more prior auths. In particular, for any payers who have included XDEMVY on their formularies, have you seen them step back on prior auth requirements? And also, now that the prior auth landscape in general has started to settle in a bit, what specifically are most payers requiring on these prior auth docs for reimbursement?
Aziz Mottiwala: Yes. Hey, Corey, thanks for that question. I think the way to think about the payer coverage so far, right, because it’s non-contracted, we’ve seen these PAs out there, and I think that’s always good news in the sense that that means there’s a path to getting the product approved. And I think that that’s something that’s really promising. It also provides incentive for contracting if the payers are covering this. We’re seeing that volume go through. I think in terms of any type of step-back on a PA, I think that’s something that we see as a headwind as volume increases. And the way to think about this is, it’s sort of a race, right? You want to get these contracts in place as your volume increases so that you don’t have any of these hurdles to that extent.
When we see these PAs right now, typically they’re pretty straightforward. They’re limited to an eye care doctor, so the patient needs to be seeing an ophthalmologist or optometrist, which of course makes sense because they’re diagnosed at the slit-lamp. And then secondly, they’re asking for a confirmation of diagnosis. This is typically via the slit-lamp exam. So, those are the two typical things. Of course, if you look out there, you’re going to see some exceptions where it might be a little bit more cumbersome. But again, that is our motivation for contracting, is to simplify these PAs, keep them consistent, and of course, avoid any step-backs once the contracts are in place.
Corey Jubinville: Got it. That’s helpful. And can you also walk us through your bridging program? In your experience to date, do providers and patients have a good sense of how to access that program? And if you were to estimate, given the strong gross-to-nets we’re seeing so far, approximately what percent of scripts have gone through that bridge program versus being fully covered by payers?
Aziz Mottiwala: Sure thing. Yes, so I think the way to think about the bridging program here is, a lot of that is managed on the back end through our pharmacy partners in our network. And essentially what happens is we appeal the insurance. So, we apply for coverage there. If it’s covered, it goes through. If it’s rejected, we appeal. And if it’s still not covered at that point, if the patient is truly uninsured, essentially their insurance is not covering the drug, then we’ll bridge it. So, there’s a step-through process that we manage on the back end. I think that’s really helped us capitalize on the coverage that we have available today. In terms of what percentage is bridge, we’re obviously not going to that level of detail today, but I can tell you even still, that is still the number one channel, right?
So, you think about commercial Medicare and then bridging, bridging is still the number one channel. And again, that’s our motivation for contracting, right, is so that as we reach our steady state gross-to-net of approximately 50%, as we get that commercial coverage at the end of this year, Part D next year, then we can start to wind that bridging down next year and have it be the smallest component and have a very minimal volume going through that going forward.
Corey Jubinville: Fantastic. Thanks for taking the questions and congrats again.
Operator: One moment for our next question. Our next question comes from Eddie Hickman with Guggenheim Securities. Your line is open.
Eddie Hickman: Hey, good morning, guys. Congrats on the strong launch. Just a few questions from me. As you reach deeper into those 15,000 target docs, how much of the hesitation is related to lack of payer coverage, in particular Medicare, and how much is just familiarity to education that you spoke about? Would you expect a significant inflection on getting Medicare coverage given the DB population skews towards older patients? Thanks.
Aziz Mottiwala: Yes, I think it’s a combination, right? I think anytime you have physicians that are sort of sitting on the fence, I think number one, it’s a new behavior, right? And that’s why we continue to put a lot of effort in market education, continuing these disease state efforts, having our sales force out there. It is a new behavior to have the physician start looking for the disease, then trying the product. And what we’ve seen is that there’s a really clear threshold in which we’re shooting for adoption, and that’s about five to 10 prescriptions. And I think there’s two things that happen. One is, the doctor begins the routine of looking for this. They see the results in the patients. And the second, to your point, Eddie, is, the doctor and the staff become more comfortable with the reimbursement process.
So, it takes a few shots on goal for them to build that muscle, so to speak. And I think in terms of when you get Part D, I wouldn’t expect a huge inflection point. I think the way to think about coverage is, we’re going to build that steadily over time, and I think that’s going to facilitate ramp up steadily over time. So, I don’t imagine like a massive step-up. What I imagine is continued progress, and think about this. As the coverage comes in, you’re also building the utilization among the doctors where they’re starting to think about more patient types. They’re building that familiarity with the diagnosis, and of course the practice is building the familiarity with the reimbursement process. So, I think those things will move in concert, and I think you’ll see a steady ramp over time, and that’ll be on the back of both physician adoption and coverage improvement.
Eddie Hickman: Got it. Thanks. And then what do you think you would need to see before you have a comfortable giving formal guidance, either on a volume or revenue basis going forward?
Jeff Farrow: Yes, Eddie, it’s Jeff. I would say, we’d like to get some more quarters under our belt, see how the payer coverage is proceeding, and then get a sense of some of the dynamics as it relates to scripts, right? Is there some seasonality that we need to be aware of during the summertime, for example, or some other things. So, it’s probably sometime in 12 months down the road we could probably start providing revenue guidance.
Eddie Hickman: Thanks, guys. Congrats again.
Operator: One moment for our next question. Our next question comes from Tim Lugo with William Blair. Your line is open.
Tim Lugo: Thanks for the question and congratulations on the great launch so far. With the new payer contracts being signed and kicking in in Q1, do you expect a script ramp due to these contracts at all? And will these contracts impact your GTN at all on Q1? Maybe I missed a bit. If you provide any kind of broad economics on these contracts or any sort of at least thoughts on how these contracts will impact your GTN?
Aziz Mottiwala: Yes, I’ll start there and and maybe Jeff can chime in on the gross-to-net impacts here. I think that there’s a lot of great news here in terms of building that coverage, getting such a big commercial contract and making that progress towards building the commercial coverage this year. With that said, we do anticipate that should drive incremental utilization, but some of that is also offset by some of the headwinds we mentioned earlier, right? Q1 is always a difficult quarter. You have plan resets. You have a lot of issues in terms of whether when doctors aren’t in the office, aren’t able to diagnose and treat these patients. And obviously, this is a product that’s dependent on getting those new diagnoses in, right?
So, I think that you’re seeing it sort of an offsetting effort here where the contracts are going to drive incremental volume and utilization, but we are obviously in the first quarter seeing some of those headwinds come to fruition, with doctors being out of the practice for a multitude of reasons, and then the insurance impact that we see there. As we progress the year, obviously we should see continued improvements both in volumes and gross-to-nets. But I’ll let Jeff speak more specifically to that.
Jeff Farrow: Yes, well said, Aziz. Not much more to add. I think, Tim, to your point, we do expect to see some improvement on the gross-to-net given some of this coverage, but that will likely be offset by some of the headwinds that we talked about, really the plans resetting the Medicare coverage gap. So, we’ve guided to flat to slightly higher gross-to-net discount just given some of those dynamic. But as Aziz said, as time goes on, we still expect to have the broad commercial coverage by the end of this year, with Medicare coming in in 2025 and ultimately ending at a 50% gross-to-net discount steady state.
Tim Lugo: Okay, great. Thank you.
Operator: I’m showing no further questions at this time. I’ll now turn the call back to Bobby Azamian for closing remarks.
Bobby Azamian: Just wanted to thank everybody for joining us today. We’re very proud of this strong first quarter and we look forward to a steady build from here. So, we really look forward to keeping everybody updated on our progress as we continue to pioneer new categories in eyecare and beyond. Have a great day.
Operator: Thank you for your participation in today’s conference. This does conclude the program. You may now disconnect.
