Earnings Labs

Xeris Biopharma Holdings, Inc. (XERS)

Q3 2021 Earnings Call· Wed, Nov 10, 2021

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Transcript

Operator

Operator

Welcome to the Xeris Biopharma Third Quarter 2021 Financial Results Call. My name is Ruby and I will be your moderator for today’s call. [Operator Instructions] I will now hand over to your host, Allison Wey, Senior Vice President of Investor Relations and Corporate Communications to begin. Allison, please go ahead.

Allison Wey

Analyst

Thank you, Ruby. Good morning. And welcome to Xeris’ third quarter 2021 financial results and corporate update conference call and webcast. A press release with the company’s third quarter financial results was issued earlier this morning and can be found on our website. We are joined this morning by Paul Edick, Chairman and CEO; and Steve Pieper, our CFO. Paul will provide opening remarks, Steve will provide details on our financial results and then we will open up the call for Q&A. We will also be taking questions from the chat function of the webcast portal. Before we begin, I would like to remind you that this call will contain forward-looking statements concerning the impact of COVID-19 on Xeris’ business practices, Xeris’ future expectations, plans, prospects, clinical approvals, commercialization, corporate strategy and performance, which constitute forward-looking statements for the purposes of the Safe Harbor provision under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by these forward-looking statements, as a result of various important factors, including the effect of uncertainties related to the COVID-19 pandemic on U.S. and global markets, Xeris’ business, financial condition, operations, clinical trials and third-party suppliers and manufacturers. Other risk factors include those discussed in our filings with the SEC. In addition, any forward-looking statements represent our views only as of the date of this call and should not be relied upon as representing our views as of any subsequent date. We specifically disclaim any obligations to update such statements. I’d like to turn the call over to Paul.

Paul Edick

Analyst

Thanks, Allison. Good morning, everybody listening today. Let me start by welcoming you all to our first call as Xeris Biopharma as a result of the overwhelming support and approval of shareholders of both Xeris Pharmaceutical and Strongbridge Biopharma, we are now Xeris Biopharma, operating as one commercially focused biopharmaceutical company with a very compelling value proposition. For context, I’d like to spend a couple minutes talking about the profile of the new company. We have a very diversified revenue base. Our current commercial assets, Gvoke and Keveyis give us a rapidly growing presence in large addressable markets that already established strong revenue base has the potential to generate double-digit revenue growth over the next several years. With the additional opportunity for potential rapid launch of Recorlev in the first quarter of 2022 if approved by the FDA, leveraging our experienced endocrinology-focused commercial infrastructure. We also have a specialized commercial platform in a robust endocrinology and rare disease-focused infrastructure, including a fully operational patient and provider support teams trying to bring benefits of the company’s products to a wider range of patients with unmet needs. We also have a robust pipeline. In addition to Recorlev, which is filed and under review by the FDA for a relatively small and young company, Xeris has an extensive pipeline of development programs. We have the opportunity to extend current marketed products into important new indications and uses, as well as bringing new products forward using our formulation technology platforms in support of long-term product developments and commercial success. Importantly, we are also in a very strong financial position. We have forecasted year end 2021 cash of approximately $100 million including cash equivalents and investments, we will realize $50 million in pre-tax synergies by the end of 2022 from the Strongbridge acquisition resulting from…

Steve Pieper

Analyst

Thanks, Paul. Good morning, everyone. My remarks this morning will focus on a few of the key financial results, the details of which are in the press release issued this morning and our Form 10-Q that will be filed later today. Due to the timing of the closing of the Strongbridge Biopharma acquisition, which as a reminder was October 5th, the financial results I am covering today reflect financials for Xeris on a pre-acquisition basis as of September 30, 2021. I will however comment on net sales as it relates to pro forma financial results and additionally, we will provide year-end guidance for net sales and cash. We continue to build momentum in the third quarter for Gvoke and reported another strong quarter from a net sales perspective reporting $11 million in Gvoke net sales in the third quarter, which is up approximately 25% from the second quarter of 2021, and up approximately 17% from the third quarter of 2020, which as a reminder was the quarter we initially launched the Gvoke HypoPen. The $11 million of Gvoke net sales in the third quarter was driven by strong underlying patient demand as evidenced by over 27,000 Gvoke prescriptions generated in the third quarter, a new record high for Gvoke. Gvoke net sales on a year-to-date basis through September 30, is $27.9 million, which is an increase of approximately 114% versus the nine months ended September 30, 2020. This is again being driven by continued growth of underlying patient demand for Gvoke. Keveyis had another outstanding quarter in net sales with $11.5 million in the third quarter, representing a 42% increase in net sales versus the third quarter of 2020. Keveyis net sales on a year-to-date basis through September 30 was $29.9 million, which is an increase of approximately 33% versus…

Paul Edick

Analyst

Thanks, Steve. As you heard, Xeris fundamentals have never been stronger. We have two growing products. We are generating revenue with both Gvoke and Keveyis. They are both in the large addressable markets. Our guidance for yearend 2021 net sales is improved. We also have some near-term catalyst for the UK launch of Ogluo at the end of the year; potential for Recorlev approval early in the first quarter; the availability of the Gvoke kit in the first quarter; data from the Phase 1 study of levothyroxine in the first half of next year and additional work on the EIH program; and we are in a healthy cash position. So, with that, I will turn it over to the operator for any questions that we may have from people listening in. Thank you very much

Operator

Operator

Thank you. [Operator Instructions] Our first question is from David Amsellem of Piper Sandler. David, your line is now open. Please go ahead.

David Amsellem

Analyst

Hey, thanks. So, I have a few, starting with Gvoke. Paul, I may have missed this. But I just wanted to get your thoughts on how you think the market for the glucagon rescue market might accelerate if it accelerates at all as we move out of the pandemic. Are you looking for some appreciable uptick? And just help us think about dynamics for 2022. And then, secondly, can you comment on the potential impacts that you are seeing if any on Zegalogue, Zealand product? And is that a factor in any way? Then, on Recorlev, can you just talk to how you are thinking about access in the payer landscape? Because that lost on May that ketoconazole the racemic mixtures used with some frequency. So, how are you looking at tackling the payer landscape there? And then, the last question is on levothyroxine. I know, it’s early, but do you have a sense of your timeline to a potential NDA filing on that asset and what you might need to do for registration quality work? Thanks.

Paul Edick

Analyst

Thanks, David. That’s a whole bunch in there. So, let me take up one at a time. The market acceleration for glucagon, if you recall, pre-pandemic with just Lilly and Xeris out there, the market was accelerating. It was growing at 25 plus percent, high 20s, almost 30%. We would have anticipated and we did anticipate that by this summer, we’d be back to that kind of growth. Unfortunately, the delta variant sort of got in the way and we had kind of resurgence and doctors offices didn’t really open up and things haven’t. But if you look at the recent growth and you look at what’s going on in the market, of late, we are starting to see some acceleration and we think that’s going to continue into the fourth quarter. 2022, all things being considered. And if we kind of move a little bit beyond the pandemic, we expect the market to continue to grow and we think we are going to be part of driving that growth. The important thing we are focused on in the short-term is gaining share. As I said in my remarks, we are up to over 18% share and that’s our focus right now is to continue to penetrate gain share, gain share faster than the other companies and be in a position when the market does start to open up and physicians do start to change how they are behaving with patients we’ll be the beneficiary of that growth. So, exactly what that’s going to look like in 2022. We are not projecting yet, but we do expect it to kind of come back. In terms of Zealand, that product has not been a factor in the marketplace at all yet. So, we are not at all concerned about that. As you know, it requires cold chain refrigeration until once it’s taken out of the refrigeration it only has one year of shelf life. So, not a big impact. Payer access for Recorlev, what we are seeing with the new branded non-generic products is, payer access is pretty good. Our market research tells us that payers are going to be willing to pay for a better product will see what side-effects. And what payers usually put in place is they’ll put a step through. Most people have – will have already stepped through keynotes. So, will it be easy? Probably not, but we are very confident we will get payer support for Recorlev. And then, from a levothyroxine perspective, we don’t have a timeline. As you would expect, this first study, the Phase 1 study is to understand do we have a product. Do we have a once-weekly subcutaneous injection of levothyroxine, that’s what this study is designed to show us. Can we achieve that goal and if we achieve that goal, within a dose range that’s acceptable, then we’ll move aggressively into further development and we’ll talk about a timeline at that point.

David Amsellem

Analyst

Okay. And thanks. I know there was a lot there, but that was helpful. Thanks.

Paul Edick

Analyst

You are welcome.

Operator

Operator

Our next question is from Oren Livnat of H.C. Wainwright. Your line is now open. Please go ahead.

Oren Livnat

Analyst

Thank you for taking the questions. On Recorlev coming up, can you just remind us what are your base case assumptions around labeling, particularly with regards to hepatotoxicity and whether you expect class sort of ketoconazole like labeling or what differentiation you would expect there? And to what extent that even matters commercially in your view given that one is approved that yours will be approved and ketoconazole isn’t? And then, just on Gvoke, I know Dave asked about the impact on Zegalogue. I am just curious what you are seeing and I know you are gaining share. So, it’s something I don’t know a huge problem, but what do you think with regards to generic emergency kit availability and to what extent that is affecting physician or patient access to Gvoke with regards to utilization management? Are there any changes out there and do you expect that to be a headwind going forward? And I’d ask you an apology. Go from there.

Paul Edick

Analyst

Okay. We haven’t even started labeling negotiations. So I am not going to start get into the label on Recorlev. At the end of the day, I really don’t think at the end of the day it’s going to matter. You’ve had non-approved products out there for a long time that are being used broadly. We are going to have a differentiated product that we are not worried about that. In terms of generic glucagon, no impact on Gvoke that we can assess. The change in the marketplace has been from the kits, the branded kits to the generic kits. We are not seeing any impact on overall market or on our ability to gain share.

Oren Livnat

Analyst

Okay. And then, just on Keveyis, I know it’s a transitional quarter. It looks surprisingly good. I think you took a price increase, or they good took a price increase going into 4Q and the guidance implies sort of, I guess, flat to even down in fourth quarter. So, could you just remind us, is that just a lumpy product given the high price point we are at there or are there other moving parts? And just longer term, I know a big part of the potential upside to your deal with Strongbridge there was potential listing of additional IP on that product. So I am just wondering if there is any update on that front. How optimistic are you that there will be anything there listable in the orange book or issued in general to potentially extend the exclusivity. And just remind us what your base case assumptions are for the 2022 and beyond trajectory for Keveyis? Thanks.

Paul Edick

Analyst

Yes. So, we are not giving 2022 guidance on Keveyis yet. The fourth quarter or the third quarter I think was mostly patients growth. If price increase didn’t really hit until late in the quarter if not at the beginning of the fourth quarter, so really no impact there. We think it’s going to continue to grow and grow nicely. Our focus is patient acquisition and then persistence. In terms of IP, there is no update there. We are still prosecuting and appealing and going through the process with the Patent Examiner’s Office. We think there is an opportunity there. That said, ultra-rare products, experienced generics, probably about 50% of the time. So, and this particular product is sold only through one specialty pharmacy in the U.S. and the critical aspect of this drug the patient support is you really have to support the patients in terms of therapeutic initiation or initiation of therapy. You really have to support them in terms of their – in the first few months in terms of getting stabilized and you’ve got to provide support to have consistency and persistence of therapeutic management. So, that’s a total order for any potential generic company. So, whatever the total business is, it would decline very rapidly in a generic world, which I think is less attractive at the end of the day, not to say it won’t happen, but we don’t see that being a high likelihood at this point.

Oren Livnat

Analyst

Alright. I appreciate it. Thanks much.

Paul Edick

Analyst

You are welcome.

Operator

Operator

Our next question is from David Steinberg of Jefferies. Your line is now open. Please go ahead.

Unidentified Analyst

Analyst

Hey guys. This is [Indiscernible] on for David. Thanks for taking the question. Two questions here. The first on, it looks like you guys recently outlicensed to Tetris for the EU. It looks like you are still on track to launch before the yearend. Could you just tell us a little bit more about the terms of the agreement? When you expect to start receiving milestone and/or royalty payments? And then just more broadly, you plan to look for more partners for other areas. And then, the second question just on XeriJect, you recently announced the collaboration agreement with Merck, obviously, a major pharmaceutical company. Can you just describe their interest in the technology and maybe tell us a bit more about XeriJect?

Paul Edick

Analyst

Okay. In terms of Ogluo and Tetris, the – we haven’t gone into specifics of exactly what the different pieces are. But there are launch milestones for the UK and key countries in the EU. There is royalty on sales for the UK and the EU. And there are sales achievement milestones that we can get. I think what we reported previously is approximately, if all goes well in upfronts and milestones, we could realize in the neighborhood of $70 million, $71 million over the next couple of years. And then, in terms of other partners, yes, we are fielding inquiries from numerous companies for other territories around the world. We are interested in licensing. Our liquid ready to use glucagon anywhere in the world that we can, but we are not in any advance discussions on any other territories as of yet. And then, the Merck collaboration, our XeriJect technology is suspension-based injectable technology. So, if you got a product, lot of the monoclonal antibodies require IV administration. So, sitting in a chair with an IV over some period of time, getting an infusion in order to get the product where it needs to be. What we believe and what we think we are demonstrating and what companies are interested in is we can take that monoclonal antibody, suspend it in our system and put it in a prefilled syringe for injection where the product reconstitutes using bodily fluids instead of in an IV bag. Four companies that are in that business, it could be a game changer and we can put very large molecules into that system and inject them in a very unique way that frankly other companies can’t do.

Unidentified Analyst

Analyst

Awesome. Thanks very much guys. That’s it for me.

Paul Edick

Analyst

Anything else?

Operator

Operator

[Operator Instructions] Our next question is from Alexandre Bouilloux of Mizuho. Your line is now open. Please go ahead.

Alexandre Bouilloux

Analyst

Hi, good morning. Thanks for taking my questions. Just a follow-up question on the collaboration with Merck, could you give us a sense for the time frame of when this license agreement could be exercised?

Paul Edick

Analyst

I can’t, not because I won’t but because the first piece of the collaboration is the feasibility piece which requires that we formulate the product in our suspension that we put it up on stability and that we achieve a certain level of stability over some period of time. So that I think historically that evaluation period has been anywhere from a year to 18 months. But they all vary depending on the product and the process.

Alexandre Bouilloux

Analyst

Okay. Great. Thank you. That’s helpful. And then, just my second question on the peak sales opportunities for Gvoke. Just given the scrip’s data, you talked about it a little bit earlier that COVID environment, the launch curve so far. Has anything changed with respect to your view of what this product can achieve commercially at peak?

Paul Edick

Analyst

Not at all. We are bullish on Gvoke. At the end of the day, we say it all the time, I think the other companies say the same thing. There is over six million people who are on insulin. Insulin utilization is a risk factor for severe low blood sugar. If you are on insulin, you should have a ready-to-use glucagon of some form available, just in case. We think the Gvoke HypoPen is the best option. So we think there is a tremendous opportunity. We, like, many other companies have not had the ability to take advantage of that opportunity for the last 18 months to two years, because we have gone in the middle of a pandemic. As people – its effect, it should affect, but we are bullish as we’ve ever been.

Alexandre Bouilloux

Analyst

Great. Thank you. Thanks for taking my questions.

Operator

Operator

Our next question is from Kelley Prince of Close Concerns. Your line is now open. Please go ahead.

Kelley Prince

Analyst

Good morning and congratulations on all the progress. It’s really cool to see. I had a related question on the market size, because I was just assuming – I was assuming the six million people and I mean, I would like to also assume the people who are on the sulfonylurea, that does on the – all of the sulfonylurea, so it’s also called hypoglycemia, because we know that many of the 230,000 people that go to hospital in the U.S. every year for their hypoglycemia to take sulfonylurea. So, one is, is there any progress about the indication and especially, as you start talking to more doctors and all of that and by getting payments for that. So that’s one. But if we assume that no one would ever use this, which is the hope and given the massive advantage that this is last for two years. Is it reasonable to think that the market even just using this self-papers which is on the lower side? And that market appears to people who may buy it every two years and it’s none of the people with sulfonylurea is – and the market is certainly approaching, well, well, well, well over the – like the – I don’t know, I guess the amount of savings, rather it would be well, well over you would think and the investment required to get this full. But people would be well over what is being spent in ambulance visits, ER visits and hospital stays. And I mean, I had some estimates on ambulance, ER visits and hospital stays just to kind of understand what the costs actually are in this U.S. system for each of those because is it pretty different. But I don’t know it’s – I don’t know if its possible to get any help on those expense. But just wondered if this could we will have a linear way to think about it?

Paul Edick

Analyst

Yes. You are absolutely correct. People on sulfonylureas are at risk as well. No question about that. We tend to focus on the 6.7 million or 6.8 million, because in and of itself, that’s a huge number. And you’ve got less than, maybe 10%, 10% to 15% of those people who are actually getting or ready to use glucagon. That’s where we got to make change and that’s our focus.

Kelley Prince

Analyst

Yes.

Paul Edick

Analyst

In terms of the savings, you are absolutely correct. The data is really not available in the last couple of years, because of the change – emergency room visits for 2020, you couldn’t even go to the emergency room.

Kelley Prince

Analyst

Right.

Paul Edick

Analyst

But historically, historically, anywhere from 230,000 to 275,000 show up at the emergency room every year for severe hypoglycemia. And that’s only the ones who are actually quoted as hypoglycemia. Our estimates would be higher. And there historically been up to 27,000 deaths every year from severe hypo. So, the cost implications are significant. And that’s one of the reasons we’ve had no pushback from managed care. We’ve got no pushback from payers. Anybody that even people who are on sulfonylureas, we’ve had no evidence that there has been any rejected claims for anything because the payers recognize this is a life saving medication.

Kelley Prince

Analyst

And did you say, could you say that you believe that you will be able to continue to really work on being generous about the Co-pays and so forth? Because, I don’t if any of the 230,000 patients like expects this to happen to themselves, but having the generosity to patients that they don’t have to pay a co-pay? It’s just incredibly helpful.

Paul Edick

Analyst

Yes. Especially, during the pandemic, our focus was on patient access and we extend the zero dollar co-pay continually through that period. I don’t see it lasting forever. But even if we go to normal co-pay support, it would be relatively low, 20, 30 bucks, 40 bucks, so.

Kelley Prince

Analyst

Yes. Well, okay, we encourage any learning that we can do in the community as multi-stakeholders to work out what does it actually takes from a policy perspective, because making it zero does make it a lot easier just in terms of people acknowledging need and so forth. And especially given all the people on sulfonylureas has to do need this who might be coming from a more disadvantaged backgrounds and so forth. But thank you very much for all you are doing. It’s just really proud to following to you.

Paul Edick

Analyst

Thanks, Kelley. We appreciate it.

Operator

Operator

Our final question is a follow-up from Oren Livnat. Your line is now open. Please go ahead.

Oren Livnat

Analyst

Hey. Thanks for accommodating. I just wanted to quickly touch on, just going forward, do you expect sales of Gvoke could generally track the prescription volume as you move forward? I know – and you gave pretty encouraging guide, but it’s surprisingly positive that you expect scrips to be flat net worth than Q4, which is impressive given the seasonal contraction we expect to see in fourth quarter of the whole market. So, is it relatively predictable? There no major inventory moves to that scrips to translate to sales in the fourth quarter and beyond at a given value per scrip?

Paul Edick

Analyst

Yes, I believe so, Oren. I think we’ve seen the wholesaler adjustments to inventory as we’ve crossed the one year mark. They’ve now got enough history that their inventory management is getting a lot, lot tighter. So, we think that gap between prescriptions and units is got to narrow somewhat.

Oren Livnat

Analyst

Alright. That’s helpful. Thanks. That’s it for me.

Operator

Operator

We have no further telephone questions. So I will hand back to Paul Edick for closing remarks.

Paul Edick

Analyst

Thank you very much. Thank you for the questions. That was fun. And our message is, we have a healthy growing attractive company. And we appreciate everybody’s time and attention today. Thank you very much.

Operator

Operator

This concludes today’s call. Thank you for joining. You may now disconnect your lines.