Paul Edick
Analyst · Piper Sandler. Your line is open
Thank you, Allison, and thank you everybody for joining us today. I hope you and yours have been able to stay safe and healthy during these challenging times. My headline for you today regarding Xeris performance in 2020 and the fourth quarter in particular, is that I believe we achieved a great deal, and performed very successfully in the face of multiple headwinds. I couldn't be more pleased or proud of the efforts of the entire Xeris team, which enabled us to make great progress throughout 2020 and positioned us well for a very strong 2021. And they did so, despite the year long pandemic, which continued to strengthen in the fourth quarter, into the first quarter of 2021, periods of civil unrest and nature periodically being hacked. The consistent growth of Gvoke Pre-Filled Syringe and the work done to get tremendous unrestricted payer coverage in the first half of 2020, set us up for a great start to the Gvoke HypoPen launch in July, and you will hear continued growth in the early stages of the launch during the fourth quarter and into the first quarter of 2021. I'd like to first point out some of the fourth quarter highlights and recent developments. In the fourth quarter, we grew Gvoke prescriptions 11%, while the glucagon market actually declined as a function of normal seasonality of the market in the fourth quarter and the unusual impact of the resurgent pandemic. We'll talk a little bit more about that later in my remarks. In the fourth quarter, we recorded $7.1 million in net sales, which brought us to over $20 million for the full year. Given the unusual circumstances and 100% virtual nature of our sales effort during the year, we consider this to be a very positive start to our Gvoke brand. We receive CHMP positive Opinion for Ogluo, which is the approved name for ready-to-use HypoPen in the EU, and more recently final approval in the EU. We began our ex-US licensing initiatives and entered into an exclusive agreement with a leading Israeli pharmaceutical distribution company to commercialize Gvoke in Israel and the Palestine -- Palestinian Authority. We received initial feedback, in advance our discussions with the FDA on three-pipeline programs; exercise-induced hyperglycemia, post-bariatric hyperglycemia, and our pramlintide-insulin combination product, which we believe has the potential to be a better mealtime insulin. We seamlessly moved our R&D facility from San Diego to Chicago, allowing us to be in one city, more continuous as a team. And that's more aligned as a company, and we’ve reduced our debt by equitizing a significant portion of our convertible bonds. Barry will discuss this in more detail in his remarks later on. Before going into more details on our performance, I'd like to share some additional context regarding the overall impact of COVID-19, the overall impact that COVID-19 has had on the pharmaceutical market as a whole. I think it's important to understand that the headwinds most all companies are experiencing are real and significant. Before doing so, however, I want to be clear, and somewhat reiterate my – Xeris headline. We believe our performance stands out as very positive in the face of what has been happening in the entire pharmaceutical marketplace. That said a few factoids. According to recently published report by IQVIA, nearly 1 billion expected physician visits did not happen in 2020. That same report projects an additional 200 million visits shortfall through July of this year. Those missed visits have a direct effect on prescription utilization. IQVIA projects that 3.5 billion prescriptions that would otherwise have been written will be lost during – due to the pandemic, particularly relevant to Xeris, because we're in the very early stages of our new Gvoke HypoPen launch, is that total prescriptions that are especially new to brand prescriptions across all therapeutic categories declined significantly in 2020. That has a lot to do with the fact that visits to endocrinology offices were down over 44% versus the prior year, and established brands weren't as impacted as newer or launched products because generating new brand awareness and prescribing requires face-to-face interaction and healthcare professionals to build initial recognition and recall. As for the impact of the pandemic had on the glucagon market specifically, it should be –I want to note that during the first quarter of 2020, before we were experiencing the impact of stay-at-home orders, shutdowns and civil unrest, the glucagon market grew 27% year-over-year. Thanks entirely to the introduction of new ready-to-use glucagon products, such as Gvoke and Baqsimi. Conversely from Q2 through Q4, the market only grew 6% versus the year care – the year carried mostly by the launch of Gvoke HypoPen and that growth is concentrated mostly during the summer months, as some areas of the country eased the restrictions and we initiated the Gvoke HypoPen launch. As I've said, despite these headwinds, the launch of Gvoke Pre-Filled Syringe and the Gvoke HypoPen have gone very well. The Gvoke prescriptions grew more than 350% from Q1 2020 to Q4 2020. Gvoke total prescriptions grew 11% in the fourth quarter during the traditionally weak glucagon period. Total prescribers of Gvoke grew another 27% in the fourth quarter and total unique prescribers at year end exceeded 5,000. In Gvoke share, we expanded glucagon market increased to nearly 12% by year end 2020. So how do we do so well in the face of the 2020 challenges? At the initial launch of Gvoke PFS, our commercial strategy focused on converting glucagon emergency kits to Gvoke. This initial effort and focus paid-off and generated momentum to the Gvoke brand. Combined Gvoke and Baqsimi ended the year with almost 45% share of the expanded marketplace and legacy kits lost 16% of their market share since the launch of Gvoke. We were also able to tap into significant pent-up demand for Gvoke HypoPen when we initiated our launch virtually in July. We maintain a very high level of engagement with diabetes community through digital and social media as well as significant number of online community influencers. We invested immediately and consistently in our team's ability to work virtually and to engage healthcare providers virtually, which allows us to steadily grow awareness of Gvoke across the prescriber community, even when physician practices were closed for restricting access. We initially established outstanding payer coverage Gvoke and maintained it through the end of 2020. Since the second quarter and through today, approximately 80% of patients have unrestricted access to Gvoke across all payer types. We also established and continued to this day, our zero dollar copay program to aid people with diabetes during these trying times. As we look at 2021 and beyond, we will concentrate our promotional efforts on reinforcing for both prescriber and patient community, the importance of ensuring that all patients on insulin therapy, are all at risk of severe hypoglycemia having ready-to-use glucagon product, such as the Gvoke HypoPen available for rescue in the event of a severe low blood sugar episode. As a reminder, there are approximately 6.8 million insulin taking people with diabetes in the United States, and more than six million of them do not have glucagon of any kind, on hand. Let's remember, the number one side effect of insulin therapy is low blood sugar, which is why guidelines from the ADA that anyone at risk of clinically significant hyperglycemia, defined as blood glucose below 54 milligrams per deciliter be prescribed glucagon. Yeah, only 10% of those on insulin, and therefore at risk, have glucagon available. Sadly, as a result, approximately 270,000 people are hospitalized every year and 27,000 people every year die from severe hypoglycemia in the United States at a cost of over $1.8 billion. Our promotional mission will focus on increasing prescriber and patient awareness of Gvoke to reduce this very real impact that severe hyperglycemia can have on people's lives. This takes educating healthcare providers that all of their insulin taking patients with diabetes are at risk, and deserve to have a safe and effective and simple glucagon option available. Our message to prescribers is clear. Every prescription written for insulin should be accompanied by a prescription for a ready-to-use glucagon option, like the Gvoke HypoPen. To aid our effort, we've also expanded our sales organization to reach more healthcare professionals through the addition of 40 in totally virtual inside sales representatives. We also plan to amplify the voices of patients and caregivers who use Gvoke, so that more of the insulin taking patient population, without glucagon, understand the importance of having it on hand. As we turn our attention to our fourth quarter financial performance, specifically, you may recall that on last quarter's call, we discussed the disconnect between net sales of total prescriptions as reported by third-party vendors, such as IQVIA or Symphony, particularly in the launch phase of new products such as Gvoke HypoPen. We have a lot of questions on this and I want to provide as much clarity as possible. This is likely due to the estimated or projected nature of prescription volume and prescription growth rather than actual volume. As expected, we experienced a continuation of this disconnect during our fourth quarter. Just as a reminder, net sales equals shipments the wholesaler and not the number of prescriptions. We have two things that impacted net sales change in the third quarter to the fourth quarter. First, wholesaler and retailer inventories, build in front of the highly anticipated launch of Gvoke HypoPen in the third quarter [technical difficulty], obtained from back-to-school to lower than normal Q4 seasonality. Glucagon market is historically lower in the fourth quarter and into the first quarter and these factors will continue to play into the program buying patterns of wholesalers. Once again, my goal here is to just provide context and some of the variability we're seeing, which has a lot to do with the early stage of our launch and lack of buying history. Overtime, this gap should narrow, wholesaler buying patterns should stabilise, and third-party databases -- database information should more accurately reflect Gvoke's growth, although, probably not in the near-term. That said, we're seeing -- what we're seeing in the most recent February monthly data is encouraging. Some of the leading indicators that could bode very well for beginning momentum into the second quarter include our share of the Glucagon market is up to 16%. We've -- recent weekly script data is trending up, activity in the hub is trending up, zero dollar copay claims appear to be trending up. And our field and virtual engagements with healthcare professionals is also trending up. With that, I'd like to move to Ogluo in the EU, we reserved the -- we received a positive opinion in the fourth quarter, and then the final approval last month for Europe and overall ready-to-use glucagon. As such, we are now approved at all 27 EU countries, plus Norway and Iceland. We're actively seeking a commercialization partner for the EU that launched -- the launch of vaccine in Europe and premium reimburse pricing that their product has been granted, as compared to the legacy kits, which we find very encouraging has actually ignited additional discussions with potential partners. That added to the fact that we believe we have a better option for insulin taking community is that, which is at-risk is also encouraging. Simultaneously, however, we are preparing to launch beginning in the fourth quarter on a country-by-country basis, should a commercial partnership or licensee not materialize. Moving on to the pipeline, at the end of 2020, and in early January, we had as planned our meetings or interactions with the FDA on three of our reserves all programs; PBH, EIH and pram-insulin to align on Phase 3 study designs for each of those programs. Because of the pandemic, these meetings are either telephonic or in writing, not face-to-face with the FDA. We have responded to the initial feedback from the FDA for each program, and expect to have final resolutions on the path forward for each in the second quarter of 2021. Based on that final feedback, study, design and costs, we will potentially take either EIH or PBH forward into Phase 3. As for pram-insulin, once the Phase 3 plan is clear, we will actively seek a partner to further develop and commercialize it. As we have previously discussed, we have an agreement with the FDA for Phase 3 program for diazepam and are looking for a suitable partner to advance that program as well. In summary, we had an impressive year in spite of the challenges the 2020 -- that we faced in 2020. Even as the challenges are persisting into the first part of 2021, we still expect to steadily grow demand for Gvoke brand, aggressively seeking development and commercialization partners for select -- pipeline programs, advanced ready-to-use glucagon for prevention of hyperglycemia, prepared partner and/or launch Ogluo in Europe in the fourth quarter and advance our technology platforms in XeriSol and XeriJect through internal development and external partnerships. Before I turn the call to Barry, I want to take a moment to thank the Xeris employees. We have achieved all of this despite the pandemic and has it not been for the people and talent we have in place, we would not be where we are today. I'm proud of our team's commitment and our ability to be successful during the challenging year. We have prioritized the health and safety of our employees and the communities we serve, while continuing to execute on our strategy and setting up for a great 2021. I'll turn it over to Barry Deutsch to go through our financials.