Roger Jeffs
Analyst · Needham
Great question. So I'll take the first one around how we hope to cannibalize the oral market, and then Mike, if you'll talk about the payer landscape, if you will.
So in terms of like oral prostacyclins, currently -- and again, these are just sort of generalized estimates -- Orenitram is doing about $400 million per annum and UPTRAVI's doing about $1.2 billion per annum. Both -- they're different -- they're both prostacyclins. Different in their sort of mechanistic approach.
But Orenitram, it's difficult to titrate. It takes weeks, if not months, to get to a therapeutic dose causes a lot of off-target GI effects -- and those GI effects are the predominant reason that patients discontinue that therapy and then progress to other therapies, which in the past typically has been parenteral therapy.
UPTRAVI has a pretty tight and narrow dose titration curve, pretty much has a dose ceiling, so patients titrate to their top tolerated dose and then inhaled on that dose and then removed from therapy once their disease progresses beyond the capabilities of the dose that they're on. So -- and also comes with the off-target effects.
So we think that we could position YUTREPIA, particularly given its titratability. So again, what YUTREPIA has done through the print-enabled formulation has allowed for a titratable inhaled treprostinil formulation for the first time. So it has a lot more flexibility and can become a much more rigorous and durable choice for physicians and their patients.
Now you asked that, why has United not pointed this out? Well, again, it might be that they don't quite have the flexibility that we do in terms of dosing, so it has limitations in that regard. I think the other aspect here is because they have an oral prostacyclin, they don't want to sort of detail against themselves. And in fact, had they done that, it would have set the table for us quite nicely in terms of what we want to do as I just described. So you can understand why they're not doing that.
But we will not be hindered in any way from that search. So we certainly are going to go after both the totality of the inhaled market and the totality of the prostacyclin market, particularly those patients that are having issues more with off-target effects like GI-side effects, which are significant, and parenteral effects like subcu site pain and erythema.
So again, attractive markets, $1.6 billion, with the $1.5 billion with TYVASO aggregated opportunity now. So you're already at a $3 billion opportunity if we aggregate all of those markets together. And that's with, PH-ILD, I said in my comments, is only marginally penetrated at this point. So really, really nice opportunity.
I think the other thing I will say is this is not -- if you talk about inhaled treprostinil, not a net zero-sum game. I think sometimes people try to position us antagonistically against UTHR's opportunity. I think in PH-ILD, in particular, again, there's a lot of patients there. There's lots of opportunity for both companies to do well, and we look forward to launching in the near future and presenting the choice. And that's what we're about.
So Mike, if you'll talk about payer coverage?