FACT-MASTER
2 weeks ago
ESPR: Esperion Secures Additional Commercial and Medicare Formulary Coverage for NEXLETOL® (bempedoic acid) and NEXLIZET® (bempedoic acid and ezetimibe)
Esperion Therapeutics, Inc.
– New Additions to Medicare Formularies at Optum/United AARP and CVS/SilverScript Coupled with Humana Provides Access to More Than 65% of Medicare Insured Lives and More Than 92% of Commercially Insured Lives –
– Increased Coverage and Improved Prior Authorization Processes Make Prescribing NEXLETOL and NEXLIZET Easier for Healthcare Providers –
– NEXLETOL and NEXLIZET are the Only Non-Statins FDA Approved to Lower LDL Cholesterol and Reduce Risk of Myocardial Infarction and Coronary Revascularization in Both Primary and Secondary Prevention Patients –
ANN ARBOR, Mich., Sept. 03, 2024 (GLOBE NEWSWIRE) -- Esperion today announced that NEXLETOL® (bempedoic acid) and NEXLIZET® (bempedoic acid and ezetimibe) have achieved additional coverage on national and large regional formularies since the U.S. Food and Drug Administration’s (FDA) approval of the expanded indications, increasing total coverage to more than 136 million commercially insured lives (92% of all commercial lives) and 34 million Medicare lives (65% of all Medicare lives). Additionally, many payers have accelerated alignment of utilization management criteria since the FDA approval of the expanded indications to the new labels.
“We are pleased with the response from insurance providers and large pharmacy benefit managers in embracing the CLEAR Outcomes trial data and aligning their utilization management criteria to the most recent FDA approved label indications for primary and secondary prevention,” said Sheldon Koenig, President and CEO. “Garnering optimal patient access with a breadth of coverage accounting for 90% of all national commercial and Medicare plans at an accessible price point allows healthcare providers to prescribe NEXLETOL and NEXLIZET with confidence.”
NEXLETOL and NEXLIZET are the only non-statins FDA-approved to lower LDL cholesterol and reduce the risk of myocardial infarction and coronary revascularization in primary prevention and secondary prevention patients.
INDICATION
NEXLIZET and NEXLETOL are indicated:
The bempedoic acid component of NEXLIZET and NEXLETOL is indicated to reduce the risk of myocardial infarction and coronary revascularization in adults who are unable to take recommended statin therapy (including those not taking a statin) with:
established cardiovascular disease (CVD), or
at high risk for a CVD event but without established CVD.
As an adjunct to diet:
NEXLIZET, alone or in combination with other LDL-C lowering therapies, to reduce LDL-C in adults with primary hyperlipidemia, including HeFH.
NEXLETOL, in combination with other LDL-C lowering therapies, or alone when concomitant LDL-C lowering therapy is not possible, to reduce LDL-C in adults with primary hyperlipidemia, including HeFH.
IMPORTANT SAFETY INFORMATION
NEXLIZET and NEXLETOL are contraindicated in patients with a prior hypersensitivity to bempedoic acid or ezetimibe or any of the excipients. Serious hypersensitivity reactions including anaphylaxis, angioedema, rash, and urticaria have been reported.
Hyperuricemia: Bempedoic acid, a component of NEXLIZET and NEXLETOL, may increase blood uric acid levels, which may lead to gout. Hyperuricemia may occur early in treatment and persist throughout treatment, returning to baseline following discontinuation of treatment. Assess uric acid levels periodically as clinically indicated. Monitor for signs and symptoms of hyperuricemia, and initiate treatment with urate-lowering drugs as appropriate.
Tendon Rupture: Bempedoic acid, a component of NEXLIZET and NEXLETOL, is associated with an increased risk of tendon rupture or injury. Tendon rupture may occur more frequently in patients over 60 years of age, in those taking corticosteroid or fluoroquinolone drugs, in patients with renal failure, and in patients with previous tendon disorders. Discontinue NEXLIZET or NEXLETOL at the first sign of tendon rupture. Consider alternative therapy in patients who have a history of tendon disorders or tendon rupture.
The most common adverse reactions in the primary hyperlipidemia trials of bempedoic acid, a component of NEXLIZET and NEXLETOL, in ≥2% of patients and greater than placebo were upper respiratory tract infection, muscle spasms, hyperuricemia, back pain, abdominal pain or discomfort, bronchitis, pain in extremity, anemia, and elevated liver enzymes.
Adverse reactions reported in ≥2% of patients treated with ezetimibe (a component of NEXLIZET) and at an incidence greater than placebo in clinical trials were upper respiratory tract infection, diarrhea, arthralgia, sinusitis, pain in extremity, fatigue, and influenza.
In the primary hyperlipidemia trials of NEXLIZET, the most commonly reported adverse reactions (incidence ≥3% and greater than placebo) observed with NEXLIZET, but not observed in clinical trials of bempedoic acid or ezetimibe, were urinary tract infection, nasopharyngitis, and constipation.
The most common adverse reactions in the cardiovascular outcomes trial for bempedoic acid, a component of NEXLIZET and NEXLETOL, at an incidence of ≥2% and 0.5% greater than placebo were hyperuricemia, renal impairment, anemia, elevated liver enzymes, muscle spasms, gout, and cholelithiasis.
Discontinue NEXLIZET or NEXLETOL when pregnancy is recognized unless the benefits of therapy outweigh the potential risks to the fetus. Because of the potential for serious adverse reactions in a breast-fed infant, breastfeeding is not recommended during treatment with NEXLIZET or NEXLETOL.
Report pregnancies to Esperion Therapeutics, Inc. Adverse Event reporting line at 1-833-377-7633.
Please see full Prescribing Information for NEXLIZET and NEXLETOL.
Esperion Therapeutics
At Esperion, we discover, develop, and commercialize innovative medicines to help improve outcomes for patients with or at risk for cardiovascular and cardiometabolic diseases. The status quo is not meeting the health needs of millions of people with high cholesterol – that is why our team of passionate industry leaders is breaking through the barriers that prevent patients from reaching their goals. Providers are moving toward reducing LDL-cholesterol levels as low as possible, as soon as possible; we provide the next steps to help get patients there. Because when it comes to high cholesterol, getting to goal is not optional. It is our life’s work. For more information, visit esperion.com and esperionscience.com and follow us on X at twitter.com/EsperionInc.
FACT-MASTER
3 weeks ago
lol, Visions of buy outs may seem logical, especially coupled with all the great due diligence on the benefits of BA / scripts/ etc being posted on st.
The reality that remains preventing a buy out imo, = convertible notes. ( an ugly debt that any major pharma would want no part of, imo)
From the 2023 10-K
Risks Related to our Convertible Notes
Servicing our debt may require a significant amount of cash. We may not have sufficient cash flow from our business to pay our indebtedness.
In November 2020, we completed a private offering of Notes, issuing an aggregate principal amount of $280.0 million of 4.00% convertible senior subordinated notes due 2025. The interest rate is fixed at 4.00% per annum and is payable semi-annually in arrears on May 15 and November 15 of each year, beginning on May 15, 2021. In October 2021, we announced that we had negotiated an exchange agreement with two co-managed holders of the notes to exchange with the Company $15.0 million aggregate principal amount of Notes held in the aggregate by them (and accrued interest thereon) for shares of the Company’s common stock, par value $0.001 per share. Our ability to make scheduled payments of the principal of, to pay interest on or to refinance our indebtedness, including the Notes, depends on our future performance, which is subject to economic, financial, competitive and other factors beyond our control. Our business may not generate cash flow from operations in the future sufficient to service our debt and make necessary capital expenditures. If we are unable to generate such cash flow, we may be required to adopt one or more alternatives, such as selling assets, restructuring debt or obtaining additional debt financing or equity capital on terms that may be onerous or highly dilutive. Our ability to refinance any future indebtedness will depend on the capital markets and our financial condition at such time. We may not be able to engage in any of these activities or engage in these activities on desirable terms, which could result in a default on our debt obligations. In addition, any of our future debt agreements may contain restrictive covenants that may prohibit us from adopting any of these alternatives. Our failure to comply with these covenants could result in an event of default which, if not cured or waived, could result in the acceleration of our debt.
We may not have the ability to raise the funds necessary for cash settlement upon conversion of the Notes or to repurchase the Notes for cash upon a fundamental change, and our future debt may contain limitations on our ability to pay cash upon conversion of the Notes or to repurchase the Notes.
Holders of the Notes have the right to require us to repurchase their Notes upon the occurrence of a fundamental change (as defined in the indenture governing the Notes) at a repurchase price equal to 100% of the principal amount of the Notes to be repurchased, plus accrued and unpaid interest, if any. Upon conversion of the Notes, unless we elect to deliver solely shares of our common stock to settle such conversion (other than paying cash in lieu of delivering any fractional share), we will be required to make cash payments in respect of the Notes being converted. We may not have enough available cash or be able to obtain financing at the time we are required to make repurchases of Notes surrendered or Notes being converted. In addition, our ability to repurchase the Notes or to pay cash upon conversions of the Notes may be limited by law, by regulatory authority or by agreements governing our future indebtedness. Our failure to repurchase Notes at a time when the repurchase is required by the indenture governing such notes or to pay any cash payable on future conversions of the Notes as required by such indenture would constitute a default under such indenture. A default under the indenture governing the Notes or the fundamental change itself could also lead to a default under agreements governing our future indebtedness. If the repayment of the related indebtedness were to be accelerated after any applicable notice or grace periods, we may not have sufficient funds to repay the indebtedness and repurchase the Notes or make cash payments upon conversions.
In addition, our indebtedness, combined with our other financial obligations and contractual commitments, could have other important consequences. For example, it could:
•make us more vulnerable to adverse changes in general U.S. and worldwide economic, industry and competitive conditions and adverse changes in government regulation;
•limit our flexibility in planning for, or reacting to, changes in our business and our industry;
•place us at a disadvantage compared to our competitors who have less debt;
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•limit our ability to borrow additional amounts to fund acquisitions, for working capital and for other general corporate purposes; and
•make an acquisition of our company less attractive or more difficult.
Any of these factors could harm our business, results of operations and financial condition. In addition, if we incur additional indebtedness, the risks related to our business and our ability to service or repay our indebtedness would increase.
The conditional conversion feature of the Notes, if triggered, may adversely affect our financial condition and results of operations.
In the event the conditional conversion feature of the Notes is triggered, holders of the Notes will be entitled to convert the Notes at any time during specified periods at their option. If one or more holders elect to convert their Notes, unless we elect to satisfy our conversion obligation by delivering solely shares of our common stock (other than paying cash in lieu of delivering any fractional share), we would be required to settle a portion or all of our conversion obligation through the payment of cash, which could adversely affect our liquidity. In addition, even if holders do not elect to convert their Notes, we could be required under applicable accounting rules to reclassify all or a portion of the outstanding principal of the notes as a current rather than long-term liability, which would result in a material reduction of our net working capital.
Transactions relating to our Notes may affect the value of our common stock.
The conversion of some or all of the Notes would dilute the ownership interests of existing stockholders to the extent we satisfy our conversion obligation by delivering shares of our common stock upon any conversion of such Notes. Our Notes may become in the future convertible at the option of their holders under certain circumstances. If holders of our Notes elect to convert their notes, we may settle our conversion obligation by delivering to them a significant number of shares of our common stock, which would cause dilution to our existing stockholders.
In addition, in connection with the issuance of the Notes, we entered into the Capped Calls with certain financial institutions, or the Option Counterparties. The Capped Calls are generally expected to reduce potential dilution to our common stock upon any conversion or settlement of the Notes and/or offset any cash payments we are required to make in excess of the principal amount of converted Notes, with such reduction and/or offset subject to a cap.
In connection with establishing their initial hedges of the Capped Calls, the Option Counterparties or their respective affiliates entered into various derivative transactions with respect to our common stock and/or purchased shares of our common stock concurrently with or shortly after the pricing of the Notes.
From time to time, the Option Counterparties or their respective affiliates may modify their hedge positions by entering into or unwinding various derivative transactions with respect to our common stock and/or purchasing or selling our common stock or other securities of ours in secondary market transactions prior to the maturity of the Notes (and are likely to do so following any conversion of the Notes, any repurchase of the Notes by us on any fundamental change repurchase date, any redemption date, or any other date on which the Notes are retired by us, in each case, if we exercise our option to terminate the relevant portion of the Capped Calls). This activity could cause a decrease and/or increased volatility in the market price of our common stock.
We do not make any representation or prediction as to the direction or magnitude of any potential effect that the transactions described above may have on the price of the Notes or our common stock. In addition, we do not make any representation that the Option Counterparties will engage in these transactions or that these transactions, once commenced, will not be discontinued without notice.
We are subject to counterparty risk with respect to the Capped Calls.
The Option Counterparties are financial institutions, and we will be subject to the risk that any or all of them might default under the Capped Calls. Our exposure to the credit risk of the Option Counterparties will not be secured by any collateral. Past global economic conditions have resulted in the actual or perceived failure or financial difficulties of many financial institutions. If an Option Counterparty becomes subject to insolvency proceedings, we will become an unsecured creditor in those proceedings with a claim equal to our exposure at that time under the Capped Calls with such Option Counterparty. Our exposure will depend on many factors but, generally, an increase in our exposure will be correlated to an increase in the market price and in the volatility of our common stock. In addition, upon a default by an Option Counterparty, we may suffer adverse
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tax consequences and more dilution than we currently anticipate with respect to our common stock. We can provide no assurances as to the financial stability or viability of the Option Counterparties.
FACT-MASTER
1 month ago
ESPR: Q2 2024 Esperion Therapeutics Inc Earnings Call
In this article:
ESPR
-2.17%
Participants
Alina Venezia; Director of IR; Esperion Therapeutics Inc
Sheldon Koenig; President, Chief Executive Officer, Director; Esperion Therapeutics Inc
Benjamin Halladay; Chief Financial Officer; Esperion Therapeutics Inc
Eric Warren; Chief Commercial Officer; Esperion Therapeutics Inc
Betty Jean; Chief Business Officer; Esperion Therapeutics Inc
Dennis Ding; Analyst; Jefferies
Serge Belanger; Senior Analyst; Needham & Company LLC
Unidentified Participant
Presentation
Operator
Ladies and gentlemen, thank you for standing by, and welcome to Esperion's Second Quarter 2024 earnings conference call. (Operator Instructions) Please be advised that this conference call may be recorded.
I would now like turn the conference call over to Alina Venezia, Director of Investor Relations, please go ahead.
Alina Venezia
Thank you, operator. Good morning, and welcome to Esperion's second quarter 2024 earnings conference call. With us today are Sheldon Koenig, President and CEO; and Ben Halladay, CFO. Other members of the executive team will be available for Q&A, following our prepared remarks. We issued a press release earlier this morning detailing the content of today's call. A copy can be found on our Investor page of our website, together with a copy of the presentation that we will also be referencing.
I wanted to remind callers that information discussed on the call today is covered under the Safe Harbor provision of the Private Securities Litigation Reform Act. I caution listeners that management will be making forward-looking statements. Actual results could differ materially from those stated or implied by our forward-looking statements due to the risks and uncertainties associated with the business.
These forward-looking statements are qualified in their entirety by the cautionary statements contained in today's press release and in our SEC filings. The content of this conference call contains time-sensitive information that is accurate only as of the date of this live broadcast, August 12, 2024.
We undertake no obligation to revise or update any forward-looking statements to reflect events or circumstances after the date of this conference call and webcast. As a reminder, this conference call and webcast are being recorded and archived. We will begin the call with prepared remarks and then open the line for your questions.
I'll now turn the call over to Sheldon.
Sheldon Koenig
Thank you, Alina, and good morning, everyone. Thank you for joining us today to review the meaningful progress we have made during the second quarter and to review our plans moving forward to continue to cement NEXLETOL and NEXLIZET as Cornerstone therapies in reducing cardiovascular risk.
The second quarter was an undeniably watershed period as we successfully executed our strategic initiatives across all areas of the business, key to building Esperion into a leading biopharmaceutical company, improving outcomes for patients with or at risk for cardiovascular and cardiometabolic diseases.
The second quarter was highlighted by double-digit increases in US product revenue, significant progress by our partners in expanding international access to NILEMDO and NUSTENDI, and importantly, the monetization of our European royalties from our partner, Daiichi Sankyo, Europe or DSE, and the early discounted payoff and termination of our existing revenue interest purchase agreement or RIPA with Oberland.
This strategic transaction significantly enhances our balance sheet and better positions us to focus on optimizing our US commercialization efforts. Ben will discuss this transformational transaction in greater detail later.
Now let me turn to our progress with our US commercialization efforts, which are gaining momentum as validated by US product revenue growth in the second quarter of 2024 of 14% sequential and 39% year over year growth. This growth was driven by the expanded new labels we received in late March. Our prior labels for NEXLIZET and NEXLETOL were limited to LDL cholesterol reduction in a population of patients that already had a CV event and were on statin therapy.
Our expanded labels have three significant differences. One includes CV risk reduction benefits, two, expand the patient population by including primary prevention and three, enables use in patients that are unable to tolerate or maximize statin therapy.
NEXLETOL and NEXLIZET are now the first oral non-statin LDL-cholesterol lowering drug to be approved by the FDA to reduce the risk of CV events in both primary and secondary prevention patients. We have the opportunity to bring the benefits of NEXLETOL and NEXLIZET to the 70 million patients eligible under the expanded new labels.
To support these broad expanded label and drive awareness and ultimately prescriptions we increased our field sales team. Critical to continued growth in prescriptions and product sales is broad and payer access. Here, we have done excellent work, partnering with major payers to update utilization management criteria to include the recent label update.
The majority of payer updates began on June 1, and we were finalized by mid-July with more than 80% of UM criteria now in place. Today, I am pleased to report that more than 114 million lives now have payer UM criteria updated to reflect the new label updates. We also continued to garner new formulary coverage, resulting in 92% preferred commercial coverage and increased our Medicare preferred coverage to greater than 50%.
This strong payer acceptance that aligns with our new outcomes label underscores the payers recognition of a clinical benefit and economic value our products bring to both patients and the health care system, respectively. As a result of this enhanced patient access and streamline prescription process we expect increasing physician confidence in prescribing NEXLETOL and NEXLIZET, which should translate into increasing product sales in the upcoming quarters and beyond.
With payer access advancing our next important commercial initiative is to ensure we are further educating our health care providers or HCPs. In tandem, we have a campaign aimed at empowering patients to talk their HCP about their CV risk. We are using a variety of digital and traditional sales and marketing tactics that are gaining traction.
For example, our expanded sales force has been targeting specific subsets of primary care physicians and cardiologists with in-person detailing. We also gained meaningful traction with our digital campaign with a team like eight digital channels, including search, e-mail, peer-to-peer, EHR, point-of-care, banners, and social media to reach over 90% of our targeted health care providers.
As a result of these combined initiatives by our managed care sales force and marketing teams. We now have more than 21,000 HCPs writing scripts. And total retail prescription equivalents increasing approximately 11% in the last four weeks of June compared to the prior four weeks of May. I'll note that we used this comparison because there were five weeks in May this year.
This is truly a Herculean effort, and we are proud of the tremendous progress we have made throughout the launch so far. We have a tremendous opportunity ahead of us and are well poised to go NEXLETOL and NEXLIZET into blockbuster products for a variety of reasons.
First and foremost, we have compelling clinical data from the clear outcome study that supports and validates safety and efficacy in reducing cardiovascular risk reduction and lipid lowering in primary and secondary prevention patients.
Second, there is a large underserved patient population of 70 million people at risk who need better treatment options.
Finally, we have the right people and programs to drive this market and are taking all the right steps to successfully penetrate it. I say this because we have a team who have all either led or been a part of successful pharmaceutical product launches during their careers. And I'm confident in this team strategy and execution capabilities.
Importantly, we are managing this launch in a methodical way, understanding that we need to have all the pieces in place for payers, physicians, and patients to be successful. We see it as like a flywheel, the initial rotations take time and effort, but the subsequent rotations create momentum that compound. We are off to a strong start and are confident that the work we are undertaking today will translate into increasing scripts and ultimately into accelerated product revenue.
Let me now turn to the progress we and our partners are making internationally, starting with the EU where our partner DSE is making important strides. DSE received its approved expanded labels from NILEMDO and NUSTENDI from the European Commission, which reflects the new indications for cardiovascular risk reduction and expanded LDL-Cholesterol lowering in primary and secondary prevention patients.
They have begun launching these new labels in European territories with most areas anticipated to be launched by year end 2024 and Italy in 2025. We expect this to be a substantial market for DSE as up the 80% of patients in Europe are unable to reach guideline recommended levels for LDL-Cholesterol despite taking statins.
We are confident that with the strength of the approved indications, DSE will be able to position the NILEMDO and NUSTENDI as the first and only non-statin lipid lowering medicine approved for CV risk reduction, both in primary and secondary cardiovascular prevention in Europe.
Do you see, we'll have a medical and commercial presence at the upcoming European Society of Cardiology Congress at the end of this month in London. This exciting Congress is the largest cardiovascular medical meeting of the year and is well attended by key opinion leaders from around the globe, including the United States.
Consequently, we expect the efforts DSE will make at ESC to also benefit our efforts to enhance the awareness and visibility of our products among US HCPs. Beyond Europe, our partner, Daiichi Sankyo Company Limited, or DS Esperion gained approval for NEXLETOL and NEXLIZET in Thailand for NILEMDO and NUSTENDI in Macau and submitted new drug applications in Korea.
While these are smaller regions, we expect to see incremental growth in our royalties from these product launches. Our Japanese partner, Otsuka Pharmaceutical announced that the primary endpoint of LDL-Cholesterol reduction from baseline at week 12 was achieved in their Phase 3 clinical trial in Japan for bempedoic acid as a treatment for hypercholesterolemia.
Otsuka plans to file a new drug application in Japan in the second half of 2024, with expected approval, a national health insurance pricing anticipated in 2025. We are enthusiastic about the continued momentum in Japan as it is one of the largest markets for lipid lowering therapies. This could be a substantial market for Otsuka as well as a valuable royalty contributor for Esperion growth in the future.
Our Esperion team continues to make strides expanding the global reach of bempedoic acid for use in cardiovascular risk reduction in patients with or at high risk for cardiovascular disease. We continue to advance our work to file new drug applications in Canada, Australia and Israel and are on track for these submissions by the end of this year.
We are continually evaluating opportunities for additional collaborations and partnerships around the world. And given the label expansions for bempedoic acid and the worldwide total addressable market for cardiovascular risk reduction. We believe we are an attractive partner with a compelling value proposition.
Finally, we continue to build a growing body of scientific and clinical knowledge that support the cardiovascular risk benefits of our bempedoic acid products. To that end, we are pleased to have two datasets published in peer-reviewed journals over the past months, including an article titled comparative cardiovascular benefits of bempedoic acid and statin drugs that was published in the Journal of the American College of Cardiology. This analysis of clear outcomes data demonstrated the cardiovascular risk reduction benefit of bempedoic acid treatment predicted per unit increase in LDL-Cholesterol is comparable to that seen in statin trials.
Another article on the impact of the COVID-19 pandemic on conduct and results of clear outcomes trial was published in the Journal of Clinical Cardiology. This analysis confirms the benefit of bempedoic acid and suggest that the global COVID-19 pandemic may have underestimated the benefit of bempedoic acid on both MACE 4 and MACE 3, based on the contribution of undetermined death that likely represented COVID-19 infection for pandemic related fatalities. We will continue to publish our data and presented at key medical meetings and look forward to updating you on the progress over the months.
With that overview of the business, let me turn the call over to Ben for a detailed review of our financial progress during the second quarter.
Benjamin Halladay
Thank you, Sheldon.
Before I get into the details of the quarterly results, I want to highlight the transformational transaction we completed at the end of the quarter. We were excited to monetize our European royalty stream from DSE for a variety of reasons, not the least of which is it allows us more control to leverage our balance sheet and capital structure.
As we reported proceeds from the royalty purchase agreement facilitated early payout and termination of the overland wrap up, removing all liens and covenants associated with the agreement, avoiding a significant headwind of payment step-ups in 2025 and dramatically improving the liquidity outlook of the company. While we have made significant progress over the past two years and extending our cash runway. This is the single most important action we have taken to build our financial foundation for future growth.
With that, let me now turn to our solid financial performance for the second quarter of 2024. I will provide a brief overview of the results, noting that additional information can be found in our press release issued earlier this morning and 10-Q that will be filed shortly. Please note that unless otherwise specified, my comments reflect results for the second quarter ended June 30, 2024.
Total revenue for the second quarter of 2024 was $73.8 million compared to $25.8 million for the comparable period in 2023. US net product revenue was $28.3 million compared to $20.3 million for the comparable period in 2023, an increase of approximately 39%. Sequential quarterly net revenue growth was 14%. We believe this revenue growth, along with the total retail prescription equivalents growth in June that Sheldon just discussed an early indicator of our progress with the launch and the potential for these drugs.
Collaboration revenue was $45.5 million compared to $5.5 million for the comparable period in 2023, an increase of approximately 727%, primarily due to the revenue recognized from our settlement agreement with DSE for the European Commission approval increased product sales to our collaboration partners and royalty sales growth within our partner territories.
We are working with DSE on the tech transfer to support their ability to manufacture in NILEMDO and NUSTENDI on their own for European distribution. This will significantly reduce our future COGS for the product and reduce working capital costs once completed. We hope to complete this work in 2025 and for DSE to be producing their own product by the end of next year.
Turning to the rest of the P&L for the second quarter of 2024 research and development expenses were $11.5 million compared to $22.1 million for the comparable period in 2023, a decrease of 48% primarily attributable to our clear outcome study that was completed in 2023.
Selling, general and administrative expenses were $44.2 million compared to $34 million for the comparable period in 2023, an increase of 30%. The increase is primarily related to increased commercial headcount in addition to bonus payments and promotional costs. We continue to manage expenses prudently and expect expenses to remain similar to the current levels.
The company incurred a onetime loss on extinguishment of debt of $53.2 million due to the accounting of the termination of the overland ramp-up. Total net loss for the quarter was $61.9 million compared to a net loss of $49.9 million for the comparable period in 2023. Basic and diluted net loss per share was $0.33 compared to a basic and diluted net loss per share of $0.46 for the comparable period in 2023.
Turning to our balance sheet. As of June 30, 2024, we had $189.3 million in cash and cash equivalents. By removing the overlay and rip out, we are in a much better position to address the remaining debt on our balance sheet. We are reiterating our full year 2024 operating expense guidance, which is expected to be approximately $225 million to $245 million, including $20 million of non-cash expenses related to stock compensation.
Now let me turn the call back to Sheldon for final closing remarks. Sheldon?
Sheldon Koenig
Thank you, Ben. In closing, we are proud of the tremendous progress we have made throughout the first half of 2024, and we are looking forward to an exciting second half of the year. As we continue to grow our US product sales, expand internationally, and strive to reach our goals to create and deliver innovative options to reduce the risk of cardiovascular disease for patients around the globe.
Our accomplishments to date are the culmination of the hard work of our talented and dedicated Esperion team who are passionately committed to reaching goals and making a difference in patients’ lives. Importantly, we could not have made these achievements without the ongoing support from our stakeholders. We are on an exciting journey together, and I look forward to sharing more successes with you in the future. Again, we thank you for your ongoing trust and support.
Operator, we are now ready for Q&A.
Question and Answer Session
Operator
(Operator Instructions)
Dennis Ding, Jefferies.
Dennis Ding
Good morning. Thanks for taking our questions. Some two from me. Maybe I can just share a little bit about the feedback from doctors are on the ground around just centers, PA's approval. There's been any directional improvements recently and has that been going to your expectations?
And then number two, just curious on your thoughts on the momentum as of June 1 and what more work we need to do for scripts the pickup? Thank you.
Sheldon Koenig
Eric, do you want to take that?
Eric Warren
I sure do. Good morning, Dennis. Good to hear your voice. So with regards to physicians on the ground. So clearly over the past four years prior to the label change, it wasn't always easy to get our products, especially for some of the patients that they wanted to use it in specifically in the statin intolerant are those primary prevention patients.
And but as a result of the label change and the work that BJ and her team have done a progressively improving and as you noted, a pretty significant improvement in June 1, takes a little time for clinicians to kind of regain that confidence, if you will, but they are progressively improving in their confidence.
And I did see your primary care a survey. I thought that was accurate and that shows that there is still opportunity for us to reach these physicians not only with the clinical message and to get them excited about the brands, but also to get them over the edge from a prescribing and an access perspective.
With regards to the momentum in June. So yes, as you saw a great pickup in June, it directly related to sales force execution, but also the improvements that we had from a prior authorization UM perspective, I expect our growth to continue. I'm happy with that and what we saw in June, I'm happy with the overall 14% that we delivered from Q2 -- Q1 to Q2, and I continue to expect and progressive improvements in growth.
Dennis Ding
Thank you.
Operator
Serge Belanger, Needham.
Serge Belanger
Congrats on the progress on a couple of questions for us. I guess first on the coverage, done some great work on the commercial side and are expanding on the Medicare side. Again, remind us what is the breakdown between those two segments for this market opportunity and how much of a focus is it for the company spending on the Medicare coverage side.
And then secondly, can you remind us how many scripts are currently going through your specialty pharmacy and trying to figure out what we're missing out when we're looking at the datasets? Thank you.
Sheldon Koenig
So maybe I can start this, and I'll turn it over to BJ. First of all, a surge, as you mentioned, our coverage is continuing to increase just from a commercial perspective, we have over 90% of the plans covered from a Medicare perspective. We have over 50% covered, and we're pretty much there as far as maximizing our coverage there is one Medicare account that we're still working with that we feel good about.
So stay tuned there. But yes, just from an overall coverage perspective, we're in a great place. And just to reiterate what Eric said earlier, you know, as you know, one of our greatest headwinds previous to our new label where the utilization management criteria that has gotten a lot easier in some areas. There are for some accounts there are no prior authorizations.
As it relates to Esperion, what I would say is remember that was a bridge that we set up so that until we have this coverage patients could get their medications until maybe their PA was approved, et cetera. So that was really a great stopgap measure from the team. And maybe I'll turn it over to BJ if she wants to add any more color as it relates to prescriptions going through Esperion, et cetera.
Betty Jean
Yeah. Thank you, Sheldon. And I would say third, that Medicare's most important channel to the adjunct grower, no lipid-lowering treatments. And so we are laser focused to garner more coverage there and stay tuned positive negotiations continue there. So where we're at 50% now, we continue to have that as a key focus going forward, showing captured Esperion correctly.
We use that -- that was a great tactic for us to bridge patients while payers were updating their UM criteria. But we were so pleased that payers really accelerated those reviews. And so less than less patients went in there because of the payers now updating and we're getting patients on payer paid prescription. So hopefully that answers your questions.
Operator
Jason Zemansky, Bank of America.
Unidentified Participant
Hey, good morning. This is Cameron for Jason. Congrats on the quarter and thanks for taking your question. So with regards to PA, when you think about launches in the cardiovascular space, you know, they often require sometimes longer to ramp relative to other indications like oncology. And so I'm curious what you expect dynamic to look like here for uptake? And would you expect growth to be continue to be more steady? Or are there factors that could potentially support a more near-term inflection? Thank you.
Sheldon Koenig
I'm happy. I'm sorry, I was going to just leave this off and then Terry, can you I was on mute here. First of all, thanks for your question?
Yeah, I would refer you to slide 9 of our corporate deck, which is available, which aligns to our prepared remarks. And again, what you'll see is this 14% growth, and we've shown double-digit growth quarter over quarter. And so we're seeing that ramp up now. And you're just taking a look at the launch angle that we have. We're going to continue to see that momentum and you're going to continue to see prescriptions go higher.
And Eric, I'll turn it over to you because I know you've done some analysis?
Eric Warren
Yeah, thanks. And thanks for your questions. So absolutely, it takes a little bit more time than oncology to reach peak in this market, but we're confident in our ability to deliver continuous growth quarter over quarter, year over year. And I did look at some other cardiovascular and analogs products that had significant CBOT trials that resulted in a label change and looked at their growth over the course of three years, also looked at their one year growth.
And we're tracking right on if not ahead of where these competitive analogs are also remind you from that our PCSK9 perspective in Repatha that there are nine years into this mission, and they're still not peaked yet. So really confident in our ability to deliver a progressive continuous growth and realize the full potential of small molecules.
Operator
Thomas Shrader, BTIG.
Unidentified Participant
Our Good morning. This is [Salman] for Tom. Thanks for taking our questions. So the two questions for us. So first, could you just provide any additional color on gross to net and any potential remaining headwinds.
And then for the second question, just wanted to ask about what the market dynamics in Japan is and what the unmet need related to statin tolerances. Thank you.
Sheldon Koenig
So I'll go first with Japan, and then we'll hand it over to Ben Halladay. As it relates to Japan, the opportunity in Japan, Japan is, as we've said in our prepared remarks, one of the largest markets, that is out there as a matter fact, with Zedia Vytorin around that brand. That was really kind of the number three market in the world.
As it relates to statin intolerance, what we do know globally, and there's a little bit debate around the percentages that statin intolerance is anywhere between 15% to 20% of the population that could need a statin. And you've heard us talk about the millions of people out there that need LDL lowering. So just thinking about 15% to 20% of them is it's very big, but Japan is a great opportunity fortunate to have Otsuka as a partner and looking forward to their next steps and filing.
And Ben do you want to speak to GTN?
Benjamin Halladay
Yes. Thanks, Sheldon. And so as far as gross to net goes, we've had a good year. Things have remained largely consistent with last year. When we saw some significant.
Unidentified Participant
Do we lose that?
Sheldon Koenig
I think we may have what's been Halladay.
Benjamin Halladay
Yeah, I think we have Sheldon.
Sheldon Koenig
Yeah. So maybe I'll speak to GTN, sorry, I wasn't sure if the whole site has gone down and we are texting each other, we don't disclose our gross to net, but I would say is that we are at a steady state. We're comfortable where we are now not only from what we do from a contracting perspective, what we do with wholesalers, et cetera. So we've been managing that appropriately.
I think we can go on to the next question here.
Operator
I am showing no further questions in the queue at this time.
Ladies and gentlemen, that does conclude today's conference call. Thank you all for participating, and you may now disconnect.
FACT-MASTER
1 month ago
And upon further review of the DSE litigation settlement, it appears that most Asian territories, Brazil, Turkey, Switzerland, are already in the hands of DS/DSE ( agreement excludes China / India / USA - North America / Australia, and maybe a few other smaller territories - Indonesia maybe)
All DS has to do is buy out ESPR and they will gain control over all the rest of the territories which would include probably the highest profit margin territories, (USA) . Merck, imo, would be a highly compatible partner for North American distribution, imo, however it's just my opinion and all speculation for the time being.
Item 1.01. Entry into a Material Definitive Agreement.
On January 2, 2024, Esperion Therapeutics, Inc. (the “Company”) entered into a settlement agreement with Daiichi Sankyo Europe GmbH (“DSE”) to amicably resolve and dismiss their commercial dispute now pending in the Southern District of New York (the “Settlement Agreement”). Under the Settlement Agreement, DSE has agreed to pay the Company an aggregate of $125 million, including (1) a $100-million payment within 15 business days of the effective date of the Settlement Agreement and (2) a $25-million payment in the calendar quarter immediately following the calendar quarter in which the European Medicines Agency (“EMA”) renders a decision on the application that was filed with the EMA for a Type II(a) variation for the Company’s oral non-statin products marketed as NILEMDO® (bempedoic acid) tablets and NUSTENDI® (bempedoic acid and ezetimibe) tablets in Europe. The application asks the EMA to approve both NILEMDO and NUSTENDI to reduce cardiovascular risk in patients with or at high risk for atherosclerotic cardiovascular disease. The legal action pending in the United States District Court for the Southern District of New York will be dismissed.
Pursuant to the Settlement Agreement, also on January 2, 2024, the Company entered into a 3rd Amendment (the “DSE Amendment”) to the License and Collaboration Agreement dated January 2, 2019 with DSE, and a 1st Amendment (the “DS Amendment”) to the License and Collaboration Agreement dated April 26, 2021 with Daiichi Sankyo Company Limited (“DS”).
The DSE Amendment and the DS Amendment grant each of DSE and DS exclusive rights for clinical development, regulatory activities, manufacture and commercialization of a bempedoic acid/ezetimibe/statin triple combination pill in their existing respective territories of the European Economic Area, UK, Switzerland and Turkey (the “DSE Territory”) and South Korea, Taiwan, Hong Kong, Thailand, Vietnam, Brazil, Macao, Cambodia and Myanmar (the “DS Territory”). Further, after a transition period, DSE and DS will assume sole responsibility for the manufacture of NILEMDO and NUSTENDI for, respectively, the DSE Territory and DS Territory. As of January 2, 2024, DSE shall have sole authority and control of regulatory communications with the EMA regarding the pending marketing authorization applications for NILEMDO and NUSTENDI.
Pursuant to the DSE Amendment, the Company is entitled to receive one-time cash payments of up to $300 million upon the achievement of certain commercial milestones related to total net sales achievements in the DSE Territory. The Company is also entitled to receive tiered 15% to 25% royalties on net DSE Territory sales.
Pursuant to the DS Amendment, the Company is entitled to receive one-time cash payments of up to $175 million upon the achievement of certain commercial milestones related to total net sales achievements in the DS Territory. The Company is also entitled to receive tiered 5% to 20% royalties on net DS Territory sales.
The foregoing descriptions of the material terms of the Settlement Agreement, DSE Amendment and DS Amendment are qualified in their entirety by reference to the complete text of the Settlement Agreement, DSE Amendment and DS Amendment, respectively, which the Company intends to file, with confidential terms redacted, with the Securities and Exchange Commission.
https://www.sec.gov/ix?doc=/Archives/edgar/data/0001434868/000162828024000123/espr-20240102.htm
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