Ashley Cordova
Analyst · Piper Sandler
Thank you, Asaf. The fourth quarter was another quarter of progress and execution at NovoCure, setting the stage for a strong 2024. We generated $134 million in net revenue in the quarter and $509 million for the year. We ended the year with a record 3755 active patients on therapy, an increase of 9% from year end 2022. One of our key objectives this year is to drive growth in our GBM business. As we transition into '24 several of the complex situations that have affected our business in recent years have been largely resolved. This includes depletion of the most accessible flow of backlogged Medicare payments, achievement of a revenue baseline in our newly launched French market, and successful negotiations with German payers. The resolution of these variables serves to strengthen the foundation for net revenue growth this year, directly tied to active patients on therapy, duration of therapy and price. NovoCure's team in every function is aligned to support and enhance these drivers in 2024 and beyond. One of our victories in the fourth quarter was the continued success of our Optune Gio launch in France. Our business in France was a tailwind to our EMEA active patient count throughout the year and contributed $8 million in the fourth quarter. This sets a strong baseline as we move into 2024. In the fourth quarter, we also saw strength in Germany with year-over-year increases of 21% in prescriptions and 12% in active patients on therapy. As a reminder, in mid-2022 we engaged with German payers to negotiate updated contract terms that effectively paused our German business. As expected, it took approximately six quarters to recover. Moving forward, we expect the fourth quarter to serve as the baseline for our German market. Gross margin for the fourth quarter was 76%. For color, gross margin was affected by two near-term factors, investment in increased patient support capacity and the rollout of our next generation arrays. In time, we expect these factors to be offset by increased active patient counts and improved efficiencies with scale as we optimize manufacturing of our new arrays. Last year, we implemented portfolio prioritization and strategically restructuring initiatives to realign our business to support near-term growth and long-term value creation. As a result of these initiatives, we streamlined our operating expenses, removing $60 million in residual OpEx. This streamlining will enable us to invest in future growth initiatives like our non-small cell lung cancer launch, without increasing our cash burn. We believe in the immense potential of the Tumor Treating Fields platform and are investing accordingly, but we also recognize the need to accelerate our path to profitability. We are confident that recent adjustments will position NovoCure to create shareholder value while achieving our mission of extending survival in some of the most aggressive forms of cancer. SG&A expenses for the fourth quarter were $99 million. Looking ahead, SG&A expenditures would be distributed to support areas with the highest growth potential and in alignment with our 2024 goals. This includes global commercial infrastructure and launch preparation ahead of our anticipated non-small cell lung cancer launch. Research, development and clinical trial costs in the quarter were $54 million. Our R&D spending is largely tied to the number of ongoing clinical trials at a given moment. As the current slate of Phase 3 trials nears conclusion, we are in the process of launching our next set of trials, including LUNAR-2 and KEYNOTE B58. Following our portfolio prioritization efforts last year, future R&D investments will be focused in areas of highest return; GBM, non-small cell lung cancer, and pancreatic cancer. Cash and short-term investments totaled $911 million as of December 31, 2023. Our net loss for the fourth quarter was $47 million or $0.45 per share, and adjusted EBITDA was negative $32 million. As we prepare for the potential to treat thousands of additional patients in the years to come, we are committed to ensuring incremental investments are allocated to areas that align with long-term strategic vision. Our goal is to focus on growth investments in areas of highest potential return while maintaining balance sheet strength and accelerating our path to profitability. I'd like to close today by highlighting one of our Optune Gio patients, Janice Arms [ph] of Los Angeles. In 2019, Janice moved to New York City where she met Jeff, the love of her life. Avid nature enthusiasts, Janice and Jeff were soon scaling mountains across the country together. In 2021, Janice was diagnosed with GBM and began treatment with Optune Gio. Amid the fear and uncertainty of a GBM diagnosis, Janice and Jeff decided to pursue their passion. They married and moved to California to better enjoy an outdoor lifestyle. With Optune Gio on Janice's shoulder, Janice and Jeff continued to scale mountains and have plans to hike and rock climb across the globe. People like Janice are a constant reminder of the impact we can make in patient's lives, helping them reach more birthdays or anniversaries or the summits of new mountains. With that, I'll hand the call back to the operator for questions.