Martine A. Rothblatt
Analyst · ISI Group
Thank you, operator. Good morning, everybody, on the conference call. I'm joined this morning by John Ferrari, our Chief Financial Officer; Roger Jeffs, our President and Chief Operating Officer; and Andy Fisher, our Chief Strategy Officer; and individuals in charge of Legal and Investor Relations. I'd like to start by making a few introductory remarks, and then welcome any questions that could be directed to Andy, Roger, John or myself. The press release that we issued this morning certainly makes this about as joyful a quarterly and annual conference call as any CEO could ask for. We're reporting record revenues, record profits, record profits per share. So across the board, it's just been a fantastic quarter and a fantastic year for United Therapeutics. Our excellent annual results reflect both our leadership in pulmonary hypertension medicines and our discipline in focusing company resources on transformative growth opportunities. One of the things which is especially noteworthy is that as of the end of 2012, our medicines are now being prescribed to more pulmonary hypertension patients in the United States than any other company's medicine. That's a high watermark that we've achieved after our several years of slugging it out against other companies which are much larger and better capitalized than we. I think the reason for this is completely due to the fact that physicians over time have found that the United Therapeutics medicines are the ones that they can rely on to provide superior results for their patients. Let me briefly mention what those medicines are, briefly mention some of their key highlights, and then say a word or 2 about our pipeline and then move into question-and-answers. Remodulin is a medicine which continues to grow now even though we're actually in the 10th year after its approval. But it's in a way, like a kind of a version of a human being that they keep growing until they get to sort of the tween period, and then they just really burst out into becoming a full potential-ed young adult. And that's what you see here with Remodulin. It's the medicine that physicians reach for when patients are struggling with managing their pulmonary hypertension due to the oral treatments not being able to halt the progression of the disease. It's interesting, I was in conversations with the leading physician the other day. And he said to me, Martine, I know that the name Remodulin has nothing to do with the fact that it seems to remodel the patient's vasculature, but that is what it seems to do. And that was just that physician's point of view, but it has certainly allowed patients to live a much more vigorous lifestyle than would be the case if they were not on Remodulin. Now what does Remodulin have going forward? Well, it's really exciting because what we have right now is a point where Remodulin is on the cusp of being approved in China. It's about a year or so from being approved in Japan. And intravenous Remodulin, which is generally doubles the number of patients who take Remodulin, above subcutaneous Remodulin, has just been approved in Europe, and now it's getting country by country the pricing approvals necessary for us to begin commercializing it. So we definitely expect a nice surge in Remodulin revenues from both the international opportunities for Remodulin, as well as continued confidence in physicians that the earlier they give patients Remodulin, the better chance there is of perhaps having some favorable remodeling of the pulmonary vasculature. Now let me move in to Tyvaso. Tyvaso is really like a horse in the -- that you see at the races who's right behind the lead horse, right behind the lead horse, pulls nose-to-nose and then pulls ahead. And it's been exciting for us here at United Therapeutics to watch Tyvaso gallop closer and closer to Remodulin. Right now, Tyvaso is literally nipping at Remodulin's heels, and it doesn't really take a great expert at mathematical drawing of lines of growth to see that we are somewhere between 12 and 24 months for Tyvaso to in all likelihood surpass Remodulin's revenues and become the #1 revenue generator here at United Therapeutics. Now that's real exciting for us because one of our kind of mantras that we have here in the company and is driven by our desire to always make life better for the patients is to make the older therapies seem to be relatively barbaric compared to the newer therapies, and to always try to go for the next, next. What is the next, next? The therapies that will work in the last decade, we're not a company that rests on those laurels. We're one that constantly pushes the ball forward. So with Tyvaso, you can offer a patient who is otherwise be on a catheter 24 hours a day, and it's a hell a lot better than being in a bed, and these patients are able to do things from skiing and snowboarding, one patient ran for mayor, you name it. But if you say, what would you rather do, be on a catheter 24 hours a day or take a four 2-minute inhalation sessions a day, I mean, everybody would choose the latter. And this has taken a number of years for physicians to gain comfort with Tyvaso having that kind of a potency because they have looked at Remodulin as the gold standard for so long. They have been very cautious about taking the patient who might otherwise be prescribed Remodulin and instead prescribing them something which is such a different therapy like Tyvaso. But it's a conservative field of pulmonary hypertension, and as 2010, 2011, 2012 rolled forward, we have now reached a point that there is a critical mass of physicians that will reach first for Tyvaso where as they would've previously perhaps reached first for Remodulin, and that's especially true with regard to patients earlier and earlier in the disease process. The early New York Heart Association class III patients, even some of the late New York Heart Association Class II patients. Physicians are gaining comfort with the fact that when you combine a PDE-5 inhibitor and an ETRA with inhaled Tyvaso, you're going to get a superior result. So we are just really excited at this galloping of our revenues on Tyvaso and the trend lines which lead to it becoming our #1 revenue producer within the next 12 or 24 months or so. And now let me speak about Adcirca. Adcirca is really something. It's a drug that was launched into competition against Pfizer. And Pfizer had a very aggressive detailing force on the world's best-selling drug, Viagra, which was re-branded as Revatio for pulmonary hypertension. And despite that effort, we are, of course, a small biotech company and nowhere near the resources of Pfizer. Yet our great partner, Lilly, had faith and confidence in us and gave us all manner of scientific and clinical trial support. And as a result of that, we have the data that has been able to demonstrate to physicians that they are better off putting their patients on Adcirca than Revatio. And that data starts with the fact that Adcirca needs to be dosed just 1x a day compared to Revatio or its generic form, sildenafil, having to be dosed 3x a day. But when you're dealing with a life-threatening illness, with patients having just a few years of life, this is not a place to pinch pennies and hoping that the patient will remember their middle of the day and the end of the day dose, because if they don't, there will be serious consequences for the patient's health. So given the relative affordability of Adcirca in the first place, it's not surprising to me that, just to share with you some data I got from just in January, we crested 12,000 prescriptions written for Adcirca in January, which is the highest ever. And many people believe there is something like 25,000 patients with pulmonary hypertension. That means almost half of all patients are prescribed Adcirca alone, not to mention our other drugs. And I really am very, very pleased that our sales and marketing team see this not as a resting point but as a launching pad. And indeed, our goal is to continue to bring the benefits of Adcirca to these physicians until we can get 15,000 and even 20,000 prescriptions for Adcirca in the coming years. I promised to say a couple of words about our pipeline. Let me just highlight 2 programs in particular. Well, I'll touch actually on 3, because I didn't really complete the story on Remodulin as the third. Remodulin has, in addition to its international sales potential, it has a new sales potential that's about to pop out through the miracle of some technology called implantable pump technology. This technology has miniaturized the type of outside the body pumps that our patients wear until they are so small and so -- and made of such materials that are so biocompatible with the cardiovascular spaces of the human that they can be implanted inside the body in a outpatient, minimally invasive procedure -- implanted inside the abdomen, I'm sorry, and continue to gradually seep, S-E-E-P, seep Remodulin out of a tiny specialized catheter built into the device for 24 hours a day, 365 days a year. So we expect to fully enroll -- we have already fully enrolled our implantable pump program with Medtronic, and we expect to report the results of that out in August of this year. And by the way, as a little sign of how well that study is going, the original target date to report the results was October, then it was September, and then it was August. I had never experienced something like this in my years as a drug developer, a program that was ahead of schedule, and a clinical trial that was finishing sooner. And the reason for this is that the duration of this implantable pump program is based on accumulation of a certain number of years, of patient years of safety. And there have been so few dropouts from the implantable pump program. They have predicted that there would be a certain number of dropouts that would result in October, but there've been so few that we are now scheduled to accumulate all the safety data we need by August, just absolutely remarkable. And I have heard the stories from the patients, and certainly, not a surprise to me why they would -- nobody would want to dropout. It's a life giver backer to the patients. The patients say, our lives have been given back to us. We have no pump outside our body, no catheter, this implantable thing -- I visit a doctor once every 1 to 2 months, depending on the patient. They fill it up and I'm good to go. It's really remarkable. So that's in our pipeline. But that's should be popping into commercialization in late 2014, early 2015 time frame. The other 2 things I really wanted to mention is oral treprostinil, which we continue to be very, very excited about. We've got a game buster clinical trial going on right now. We're enrolling over 850 patients. All of the major pulmonary hypertension centers in the world are participating in this study. We believe it's going to result with a statistically significant outcome, showing a delay to clinical worsening when oral treprostinil is dosed in combination with other drugs, which will certainly validate the blockbuster potential for that drug. In the meantime, even as a monotherapy, we have our filing before the FDA accepted resubmission, as many of you seen in the previous press release, and that's pending FDA review right now. Of course, those of you who have been UT watchers or I may say Unitherians for a few years, we have a policy of not commenting on matters that are under FDA review. We would certainly are going to extend that policy to cover oral treprostinil at this time. The second big exciting thing in our pipeline is the TransCon treprostinil program. This program we announced several months back. We've had some fantastic progress on the chemistry, manufacturing and controls side of that project. That project will allow us to ultimately take the magic of Remodulin and reduce it when combined with a couple of additional molecules to a once-daily, 10-second injection, subcutaneous, no site pain and give the benefit of a zero order release of treprostinil over a 24-hour period. This is a therapy which is so transformational. It's exactly what I mean in the press release when I talked about transformational opportunities that it actually harkens to the day when all pulmonary hypertension patients will be able to avail themselves not only treprostinil, which is great, but a zero order release delivery of treprostinil, meaning like a level dosage of it in their bloodstream 24 hours a day, which is the best of the best. So with those introductory remarks, let me now open up the phone lines to any questions to Dr. Jeffs, John Ferrari or Andy Fisher. Operator?