Stuart Paul
Analyst · David Bouchey from IFS Securities. Please go ahead
Thank you, Judy. Good afternoon everyone and thank you for joining our call. This is truly an exciting time for Rockwell, so I'm happy to have this opportunity to update you on our progress today. I'd like to begin by discussing the overall opportunity we have for Triferic. Triferic is a therapeutic platform that we believe has the potential to transform anemia management across the globe. It's a novel therapy that mimics the body's natural process of iron absorption that we believe can be applied for the treatment of anemia in a number of different disease states. Rockwell has developed multiple formulations of Triferic for the treatment of anemia in hemodialysis patients. And earlier this week, we announced the commencement of U.S. commercial sales of the first formulation in Triferic portfolio Dialysate Triferic. And before the end of the second quarter, we expect to file a new drug application, or NDA, for I.V. Triferic. We're pleased that Dialysate Triferic is now commercially available and physicians have access to the first and only FDA approved therapy indicated to replace iron and maintain hemoglobin. Let me start with this week's launch of our Dialysate Triferic formulation and the commercial and medical education infrastructure that we built to support it. We believe our Triferic platform has the potential to transform the management of anemia in hemodialysis patients. There are over two million people who receive hemodialysis across the globe including more than 450,000 here in the U.S. and because all hemodialysis patients lose five to seven milligrams of iron at each dialysis treatment. We believe Triferic is appropriate for substantially all of these patients. We are executing a phased launch of Dialysate Triferic. First to centers of excellence in the U.S., and our sample sites and then more broadly to the medium, small and independent dialysis organizations that treat roughly 25% of the hemodialysis patients in the U.S. To give you a sense for the potential volume in this segment, according to DOPPS, roughly 80% of patients receive traditional I.V. iron and more than 75% have ferritin levels that exceed industry guidelines and 50% have ferritin levels in excess of 800, which is one guidepost used in the anemia protocols of certain dialysis providers. We expect to expand our focus to include the large dialysis organizations next year following the introduction of I.V. Triferic if approved, which we estimate would increase the potential patient pool for Triferic by fourfold. And we believe that Triferic has the potential to become a key component of the standard of care for anemia in this patient population, which based on our estimates, would translate into a peak market opportunity of $400 million in the U.S. alone. The current standard of care for anemia management in hemodialysis patients includes traditional I.V. iron and ESAs, erythropoiesis stimulating agents. However, these therapeutics are costly and have been associated with significant complications. By contrast, Triferic delivers the iron and hemoglobin maintenance that hemodialysis patients need without the risks associated with other therapeutics. Triferic mimics natural iron homeostasis and its physiologic mechanism of action donates iron directly and completely to transferrin. Its ability to deliver effective hemoglobin maintenance without increasing ferritin levels makes it a particularly attractive proactive iron maintenance therapy. And with a safety profile that is similar to placebo, Triferic offers an on label method for hemoglobin maintenance. Turning to our launch activities, much of the last six months was dedicated to ramping up planning for and supporting this week's commercial launch. We have hired a top notch team of sales representatives, nurse educators and medical science liaisons to focus on our potential customers with a strategic accounts team providing support at some of the larger customers. And we expect to ramp our total sales headcount to approximately 25 by the end of 2019. Our key programs for 2019 will include engagement with key opinion leaders to support peer to peer medical education programs, advancement of our publication strategy to provide real world evidence of the benefits of Triferic and enhance presence at key industry conferences. And in addition, we will deploy our experienced sales and medical personnel to engage with potential customers and key centers of excellence while rolling out digital promotion to increase our share of voice. To provide you with some of the specifics to our activities to date, last month we attended the American Nephrology Nurses Association Conference in Dallas, where we held a training meeting for the sales force. We conducted a focus group with clinical administrators and sponsored a symposium on Triferic to over 400 attendees. The session entitled breaking the mold, challenging current protocols and iron management in CKD patients on dialysis was a combination of a presentation by a physician, who is currently using Triferic in a major academic institution and a patient advocate for the product. We were very gratified by the turnout and interest from these healthcare providers. In addition, we continue to engage with key opinion leaders across the industry both at medical and commercial advisory board meetings our company held at the Annual Dialysis Conference in March also in Dallas. Evidence that our marketing efforts are already having a positive impact can actually be seen in the recent Spherix survey results. Spherix Global Insights is an independent healthcare research firm that specializes in renal, autoimmune, neurologic and rare disease markets. In its recent quarterly survey of dialysis centers, there was a notice – a notable spike from Q4 to Q1 and the number of respondents, who agreed that Triferic was a more physiologic approach to treat iron deficiency than traditional I.V. iron in hemodialysis patients. This is a solid early indicator. And as we continue to expand our sales and marketing efforts, we look to build greater awareness of Triferic’s benefits and potential impact on the market. Also of note, we recently signed an agreement with a medium sized dialysis organization to receive data from their use of Triferic in the sample program and going forward. And we're in the process of collecting that data and analyzing it for publication. We're also receiving and analyzing data from additional sample size to potentially supplement our publication strategy and we believe that real world evidence is critical to our strategy of making Triferic the standard of care. We feel confident in our ability to execute on our strategic commercialization plans and to build out the therapeutic portfolio of products for Triferic. We also understand that there will be some challenges as we set out to change the mindsets and behaviors in hemodialysis clinics and adoption will likely take place over the course of time. So for 2019, our key goals are to increase awareness of Triferic, educate providers and patients about the medical and potential pharmacoeconomic benefits of Triferic and gain adoption in key centers of excellence. And based on the sales cycle at dialysis clinics, we do not expect to see material sales during the second quarter. Now, I'd like to walk you through our pricing strategy for Dialysate Triferic starting with the pricing metrics for the existing standard of care. Traditional I.V. iron and ESAs are reimbursed within the CMS bundled payment regime for hemodialysis. And the leading traditional I.V. iron product, iron sucrose, has an ASP equivalent of about $5 per hemodialysis treatment. The other key component of the current standard of care, ESAs, are priced at the equivalent of approximately $25 to $40 per treatment according to Medicare ASP and MedPAC data. So dialysis clinics are spending a combined $30 to $45 per dialysis treatment on these anemia management strategies. Turning to Dialysate Triferic, we have set the list or WAC price for the powder packet presentation at $8 per treatment and the list price for the liquid ampoule product is $9.50 per treatment. Importantly, due to customer discounts, reserves for product returns and other potential gross to net discounts, list price is not a reflection of the actual price we expect to realize on sales of Triferic. As an example, iron sucrose sells at a WAC [ph] to ASP discount of approximately 40%. And we believe our list prices for Dialysate Triferic reflect the value that the therapy can bring to patients in dialysis clinics through improved clinical outcomes and potential reduction in the use of ESAs and traditional I.V. iron at the same time, ensuring proper access to this important therapeutic. As a reminder, Dialysate Triferic will be reimbursed within the CMS bundle payment for dialysis. On April 26, the Centers for Medicare & Medicaid Services, or CMS, issued a preliminary recommendation, which finalized – would establish a new level to Healthcare Common Procedure Coding System or HCPCS Code or J-code. In this case, J1444 for the Dialysate Triferic powder packet. If finalized, this preliminary recommendation would result in a unique J-code for the powder packet that would be separate from the existing J-code, J1443, that describes Dialysate Triferic solution. We're very pleased about this potential or this preliminary recommendation from CMS, which you finalized, would help provide additional clarity for coding and claims processing and connection with distinct treasurer products. Even with a separate J-code for the powder packet, it will be reimbursed within the Medicare bundle. Now let me turn to the I.V. formulation of Triferic. In the next several weeks, we plan to file a 505(b)1 new drug application with the FDA for I.V. Triferic, which was developed pursuant to a special protocol assessment or SPA. As part of the SPA, the FDA indicated that an equivalence approach to Dialysate Triferic be acceptable for review. The NDA is supported by data from our equivalency study, which demonstrated that I.V. Triferic delivers the same quantity of iron to patients is Dialysate Triferic. And in March, we presented positive data from two separate studies. One evaluating I.V. Triferic and the other evaluating a peritoneal dialysate or PD formulation of Triferic at the Annual Dialysis Conference. And of note the I.V. Triferic study demonstrated equivalence between I.V. Triferic and dialysate Triferic and will support our upcoming NDA filing. The infrastructure that we're building to support dialysate Triferic will lay the groundwork for advancing this extension of the Triferic portfolio if approved. And we anticipate that subject to CMS approval I.V. Triferic will be eligible for reimbursement under the transitional drug add-on payment adjustment or to TDAPA meaning it would be eligible for separate payments for 24 months. So let me now turn to the global opportunity for Triferic. We believe the opportunity for I.V. Triferic is especially compelling as many dialysis clinics in large global markets such as Europe and China. Predominantly use dialysis monitors that utilize dry bicarbonate cartridges or bags and thus the existing protocols would integrate easily with I.V. Triferic. As a reminder, our strategy for the development and commercialization of Triferic outside the U.S. is to identify and work with partners to bring this needed therapeutic to market. And over the last few months we have made significant progress. In China, where the hemodialysis population exceeds 300,000 and is growing rapidly, our partner Wanbang Biopharmaceutical has initiated two PK studies. And both of these studies have now completed enrollment and we expect the results shortly. Following the completion of these studies, we expect to have the equivalent of a pre-NDA meeting with the CFDA. And depending on the outcome of that meeting, our partner Wanbang may be in a position to file for regulatory approval later in 2019. Our agreement with Wanbang provides for up to $35 million of regulatory and sales based milestone payments, including $8 million upon approval, plus a royalty and net sales in the low to mid 20% range. And in Europe, we’re current – we're continuing to work to identify and advanced discussions with potential partners. We recently completed market research for Europe and among other things that research gave us important insights into how clinicians might adopt to Triferic and the potential pricing dynamics in key European countries. Overall, the research indicated that we have an attractive market opportunity for Triferic in the EU and we believe this research will support our partnering activities. We're also in active discussions regarding the license for Triferic in Japan, another attractive market with a hemodialysis patient population of more than 300,000. For both the EU and Japan, we expect that these partnership agreements if completed would include a mix of upfront payments, milestone payments and royalties payable to us. In Canada, our dossier for I.V. Triferic is nearly ready to be filed. Our licensing agreement there provides us with an opportunity to realize a majority of the economics on sales of Triferic in Canada. Turning now to our concentrate business, through the first quarter of 2019, concentrates account for substantially all of our current sales. We supply significant amounts of concentrates to key players in the dialysis industry, including Baxter and DaVita and having a seat at the table with these strategic players is key to further development opportunities with both companies around our therapeutic portfolio. We're also currently exploring opportunities to improve the economics of the concentrates business, including potential price increases, operating efficiencies and expansion of our customer base, actually both in the U.S. and internationally. And in summary, we're excited about the opportunities we have ahead of us and the progress that we have made with Triferic. I'll now turn the call over to our CFO, Angus Smith, to review our first quarter financials. Angus?