Margaret Olinger
Analyst · Bank of America. Please go ahead
Great, thanks Jim. Today, we are focused on three key priorities for our U.S. launch. The first is our effort to drive awareness and education about RELYVRIO for people living with ALS and clinicians. This includes educating that RELYVRIO is the first approved drug for ALS to demonstrate a statistically significant benefit and function in a clinical trial as well as an observed benefit on survival in a longer-term post hoc analysis, as well as sharing publications on supporting clinical data such as a peer-reviewed publication in the New England Journal of Medicine. Our second priority is engaging with payers to work towards our goal of ensuring that every eligible person who can benefit from RELYVRIO treatment has access as quickly and efficiently as possible. The third is ensuring that people living with ALS have positive interactions through their treatment journey with RELYVRIO and ALS clinics have positive interactions with Amylyx. This includes facilitating an organized, clear process for people enrolled in the Amylyx Care Team Support program helping navigate the insurance process, being able to field questions, and optimizing peoples experience as best we can. Now let's run through a few specific details to help illustrate the progress we are making on each of these focus areas. Starting with our first priority of ensuring broad awareness of RELYVRIO, we are seeing our efforts yield strong results and have observed rapid uptakes on the FDA's approval on September 29. There were just over 1300 people living with ALS on RELYVRIO in the United States at the end of 2022, and uptake has continued since then. We remain optimistic about our ability to continue growing from here as we believe people with ALS and their clinicians are eager to learn about and try new treatment options. By the end of this quarter we believe we are on our pace to roughly double the amount of people on RELYVRIO on a net basis. On the clinician side, we are encouraged by the prescriptions coming from the top ALS doctors and key ALS centers, but there is still significant opportunity for growth. Prescribing was fairly concentrated with roughly 70 prescribers, mostly at major ALS centers, representing approximately half of all RELYVRIO prescriptions during the quarter. With regard to the total clinician market, we believe there are roughly 2700 potential ALS prescribers in the United States. Out of the roughly top 500 prescribers, approximately 55 of these clinicians prescribed RELYVRIO by the end of the fourth quarter. From the healthcare office perspective, about two thirds of the top ALS centers have prescribed RELYVRIO to at least one patient. We see these numbers as encouraging. As we expand our education efforts, we have an opportunity to see broader and deeper uptake among the key providers. Another notable part of our launch is the interest that we are seeing across the spectrum of people living with ALS when we look at the times of initial diagnosis. We are encouraged that regardless of the time since diagnosis, people with ALS are interested in and gaining access to this important new treatment. In other words, we are seeing people on RELYVRIO who have been newly diagnosed as well as others who have been diagnosed for more than three years. Shifting gears to our second priority, insurance coverage. More people have already gained access to RELYVRIO through their insurance than we had anticipated at this point in our launch. U.S. insurers representing approximately one third of the covered lives have already published formal coverage policies and the vast majority provide broad access to RELYVRIO. In addition, many of the key players are included in this early group. We remain engaged with insurers across the country, including commercial and Medicare plans, and we continue to anticipate that the majority of them will formalize their policies during the first half of this year. Moving now to our third priority of ensuring people living with ALS, who have been prescribed RELYVRIO and ALS clinics, have positive interactions, our team is working expeditiously to get people living with ALS who have been prescribed RELYVRIO enrolled in the Amylyx Care Team Support programs, also known as ACT and on therapy. Currently, it is taking us a little more than 45 days between receiving an enrollment form and RELYVRIO being shipped. We expect this process will speed up as more insurers implement formal coverage decisions. In this interim period, while the majority of plans are determining their coverage policies, access to RELYVRIO is generally through the medical exception/prior authorization process. We have been pleased to see that approximately 80% of prior authorization requests have been approved on the first submission despite most patients having unique coverage and related requirements. Overall, our team has had great success helping people with ALS who have been prescribed RELYVRIO gain access through their insurer. In the limited cases where access hasn't been granted through an insurer, we have used our interim access program and our patient assistance program for eligible patients. In the fourth quarter, roughly 10% of people taking RELYVRIO were part of these programs. Now turning to our launch in Canada, the interest ALBRIOZA remains widespread across the entire ALS ecosystem in Canada, and most importantly, with the approximately 3000 Canadians living with ALS and their families. We are encouraged by what we are seeing in treatment uptake. Mirroring our efforts in the U.S., we continue to educate Canadian payers on ALS disease progression and ALBRIOZA's efficacy and safety data to ensure broad and equitable access to as many eligible Canadians as possible. On this front, we are pleased to have negotiated agreements with all of the largest private Canadian insurers to cover ALBRIOZA representing approximately 80% of the privately insured population. With respect to public government funding, as expected, we are in ongoing negotiations with a Pan-Canadian Pharmaceutical Alliance or PCPA, which represents the provinces and territories in regards to the scope and breadth of coverage they will provide. As a reminder, this process typically takes up to 12 months to complete. Amylyx, as well as the ALS community at large, will continue to advocate for people who are covered by Canada's public insurance options to have equitable and broad access to ALBRIOZA similar to what we have secured on the private side. Time is something this community just does not have a lot of and thus we have an elevated sense of urgency. It's important to note that for now, due to expected public reimbursement process timelines, we anticipate a more limited revenue opportunity in Canada through at least the first half of 2023. We are encouraged by the progress of our launches and our momentum to date, and I am very proud of our team, but there is much more work to be done. As we look throughout the rest of the year, our team remains vigilant in our efforts to educate ALS centers and look forward to educating the general neurologist. We believe we have a large untapped opportunity for additional growth as we conduct ongoing research outreach. We remain committed to driving access with and support to every eligible person living with ALS who can benefit from treatment. With that, I'll turn the call over to Josh and Justin for some final updates and closing remarks.