Neurocrine at RBC Conference: Growth and Strategic Insights

On Tuesday, 20 May 2025, Neurocrine Biosciences Inc. (NASDAQ:NBIX) presented at the RBC Capital Markets Global Healthcare Conference 2025, offering a strategic overview that highlighted both promising growth and challenges. The company emphasized its financial robustness and the strong market performance of its key products, while also addressing potential impacts on revenue due to recent contracting decisions.

Key Takeaways

• Neurocrine reaffirmed its 2024 revenue guidance of $2.5 to $2.6 billion.
• The successful launch of Pranesiti exceeded expectations with over 400 treatment forms submitted in Q1.
• INGREZZA achieved a record number of new patient starts in Q1, driven by an expanded sales force.
• The company reported a strong cash position of $1.8 billion and utilized $750 million for debt and share retirement.
• New contracts with payers may slightly reduce net revenue per script for INGREZZA in 2025.

Financial Results

• Revenue Guidance: Neurocrine remains confident in achieving its 2024 revenue target of $2.5 to $2.6 billion.
• Cash Position: The company holds $1.8 billion in cash, highlighting its financial strength.
• Debt Retirement: Over the past year, $750 million was used to retire convertible debt and shares.
• INGREZZA Pricing: New payer contracts effective April 1st might lead to a slight decrease in net revenue per script in 2025 compared to 2024.

Operational Updates

• Pranesiti Launch: The product’s launch surpassed expectations with over 400 new prescriptions in Q1. Approximately 70% of prescriptions were commercially reimbursed, while most doctors prescribed it to one patient due to patient flow dynamics.
• INGREZZA Performance: A record number of new patient starts was achieved in Q1, following a slowdown in the previous year’s latter half. The expansion of the sales team significantly contributed to this growth.

Future Outlook

• Cranesiti Growth: Neurocrine anticipates learning more about Cranesiti’s launch dynamics in the upcoming quarters, focusing on persistency and compliance.
• INGREZZA Growth: Continued volume growth is expected, supported by an expanded sales force and favorable contracting terms.
• Clinical Programs: Three phase three trials for osvampir in major depressive disorder are ongoing, each costing around $50 million. Additionally, a phase three trial for the M4 agonist program in schizophrenia has commenced.

Q&A Highlights

• Pranesiti Prescriber Base: Primarily endocrinologists, with about 1,000 pediatric endocrinologists in the US. Most patients are managed by adult endocrinologists.
• Pranesiti Reimbursement: 70% of prescriptions were commercially reimbursed in Q1, with most approvals occurring within the first week.
• INGREZZA Contracting: Efforts to secure payer contracts aim to ensure therapy continuity for existing patients and smooth onboarding for new ones, despite a gross-to-net hit effective April 1st.

For more detailed insights, readers are encouraged to refer to the full transcript provided below.

Full transcript - RBC Capital Markets Global Healthcare Conference 2025:

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: Okay. Let’s get started so we stay on time. I’m Brian Abrams, senior biotech one of the senior biotech analysts, here at RBC Capital Markets. We’re we’re really pleased to have our next featured company Neurocrine, represented by their CFO, Matt Abernethy, and their chief commercial officer, Eric Benavich. So, Matt and Eric, thanks so much for for joining us.

Matt, maybe you could start with just some kind of opening comments on the general state of Neurocrine. Obviously, it’s been an exciting last six months, the launch of Proneciti, INGREZZA continuing to to do well. What where do we stand? What’s the what’s the outlook?

Matt Abernethy, CFO, Neurocrine: Well, I’ll say one word. I guess I will say my we will be making forward looking statements, so I’ll direct you to our SEC filings for the related risk factors and uncertainties associated with the company and then also the industry. Sorry. A a few things. I was just talking to to a gentleman before this meeting, and Eric reminded him that I speak Indiana.

It’s my native tongue. I am a Pacer fan, and so I am really looking forward okay. This is a

Eric Benavich, Chief Commercial Officer, Neurocrine: cool one.

Matt Abernethy, CFO, Neurocrine: I am looking forward to the Pacers versus next series just to see that battle here coming up. The second more macro comment I’d make is, you know, you never know, Brian, what you’re gonna wake up to every morning these days. You have different headlines swirling. Whether they impact your company or not is question, but it can really drive a lot of in uncertainty, obviously, in the investment community. But even within a company, you have all sorts of noise that, you know, what does this mean?

What’s gonna happen with biotech? And a couple quarters ago, Todd Tuchla, our head of IR, got up in front of the company and said, okay, guys. This is what it takes to drive shareholder value. It’s help more patients. And, fortunately, as we sit here today, we can help more patients.

That’s something fully within our control. And a lot of companies, I I guess, aren’t in the same position that we’re we’re in today. You know, in 02/2017, we had our first approved product, which is INGREZZA. Believe it or not, fast forward eight years later, we’re at two point five to two point six billion dollars in guidance this year. At the time of approval, there was 800,000 patients, but only two percent were diagnosed at that time.

You fast forward to today, we’re at forty percent diagnosis, and Eric and his team have done an excellent job leading and driving that diagnosis, but still only a subset of those patients diagnosed are getting treated, and there’s still an ample room for continued growth into the to the future. The second piece was in December, we had Cranesiti approved, and that was the first approved treatment in over seventy years for patients with congenital adrenal hyperplasia. And in the first quarter, Eric has said this, so far so great with the launch. Over 400 patients received enrollment forms, which is essentially a new script written for patients in the first quarter that exceeded our expectations as well as the expectations of of Wall Street. And I think it’s really reflective of a patient population who knows they need something more than just taking high dose steroid and know they need better androgen control.

So so far, we’re learning a ton in that launch. We’re gonna learn a lot over the next couple of quarters, but overall, Cranesity has done tremendous. So beyond just the commercial products, Brian, we do have two major phase three programs. The first one that I’d highlight is my favorite. It’s osvampir.

It’s being studied as an inadequate response to major depressive disorder. It’s one that we now have in a phase three trial. Three phase three trials have been up and rolling. The reason why it’s my favorite, Eric always elbows me, it’s it’s a little less expensive to run those trials. It’s around 50,000,000 per trial.

It’s a major indication, and it fits incredibly well within our existing sales channels’ hands if it were to be positive. In a similar fashion, we have our second major phase three program, which is the m four agonist program in schizophrenia. We just got that trial up and running as a phase three. And so, you know, overall, feel great with where we’re at on on the product and pipeline front. Financially, we have a billion 8 in cash, and that’s even reflective of using 750,000,000 over the last twelve months to retire a % of our convertible debt as well as retire our shares.

So we have plenty of financial flexibility. We sit here where we expect tremendous growth over the next several years, both out of Cranesity and then also out of INGREZZA. And, you know, even in this turbulent market time, we feel fortunate with how we’re positioned, Brian. So any any who are you a Knicks or a Pacer fan?

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: A Knicks fan. I would have thought you would be a Celtics fan, actually.

Matt Abernethy, CFO, Neurocrine: But Okay. And when you wake up in the morning, are you dreading opening that laptop? Are you how’s the external environment feel for

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: you? On on on the on the on the NICs or Mets or on the on biotech? On biotech. So it feels it feels good on the on the NICs. You know, look.

I think the external environment’s definitely been been volatile, but, you know, our our view is that it creates opportunities in areas where there may not be, you know, a lot of a lot of times people paint companies with this with the same brush when the that’s not necessarily appropriate, and that’s where we see opportunities and and try to find, you know, good good times to step into companies with good fundamentals. And so, you know, speaking of good fundamentals, the launch of Carnicity has been obviously kind of has shot out of the gate, surprised some folks, exceeded many expectations, your own expectations. Or can you maybe provide a little bit more color on the on the overall launch metrics? Maybe just starting with the prescriber base, like how Yeah. How how large is the current prescriber base?

And maybe, you know, how fragmented is this population? Is there kind of a small only a small frag fragment that’s kind of treated with the at these centers of excellence. And where are you kind of initially in terms of your penetration within the key centers and prescribers?

Eric Benavich, Chief Commercial Officer, Neurocrine: Yeah. So I’ll take a step back and just remind everyone that we’re really happy with the registrational data that we generated for Chronicity and the labeling that we got in December. It was a priority review. We got approved a couple of weeks ahead of our PDUFA date, and I and we had put a team in the field actually last summer, a sales team and a meta affairs team to go out there and start doing disease state education to profile future customers, and to do patient finding work. And I think that that was a good decision in retrospect because that allowed us to get off to a quicker start than we would have otherwise.

You know, this is a patient population that, you know, we estimate somewhere north of twenty thousand classic CEH patients in The US, and the for the most part, they’re cared for by endocrinologists. About two thirds of the population is adult, about one third is adolescent or pediatric. There’s a little over a thousand pediatric endocrinologists in The US, and they’re obviously an important future prescriber group for us. There’s less than 10 centers of excellence that are accredited through the CARES Foundation. The CARES Foundation is the patient advocacy group for CH, classic CH, and the balance of these patients are cared for by adult endocrinologists in the community.

And as I mentioned, some of these patients aren’t even seeing an endocrinologist. They may be under the care of a primary care physician or OB, for example. And so our expectation in, you know, at the time that we got approval based on all the work that we did to prepare for the launch was that we’d probably see earlier adoption in the pediatric patient population because, you know, frankly, the earlier you get started on treatment with Pranesiti, the the more benefit that you’ll see over the course of a lifetime, and that we would see probably adoption within those centers of excellence, and the adult endocrinologist would sort of come on over the course of the launch. What we actually saw, and, you know, we disclosed this during our earnings call for q one, was that the adoption exceeded the pace of adoption exceeded our expectations. So it was 413 treatment forms that were submitted, and a treatment form equals an NRx written for that particular patient.

So that, you know, that exceeded, I think, external expectations and internal expectations. Okay. Early on, you know, we saw that there was sort of an equal mix of adult versus pediatric patients and an equal mix of females versus male patients. Over time, you know, we expect it to skew towards younger patients and more females, and it started to do that as we’ve progressed through the launch. And the other part of your question was really amount around the the prescribers.

Most of the doctors that have prescribed Pranesiti have prescribed it for one patient. Now we don’t think that this is necessarily one of those medicines where they’re gonna treat one patient, see how it works, and then decide if they wanna use it anymore. What’s really sort of driving the pace of adoption is more of just the flow of patients through practices. Most of these patients only see their endocrinologist once or twice a year, pediatric, it might be two or three times a year, but ultimately, almost all of the new patient starts that we’ve received have come in conjunction with a patient visit. So when the patients flow through, then they have the conversation about whether or not they wanna be initiating treatment with Cranesiti, and that’s how the process starts.

So obviously, we’re really pleased with the the adoption thus far, and certainly, I think, you know, one quarter doesn’t make a trend, so I think we’ll learn a lot more as we progress through the launch. But I’m just really happy with the the initial receptivity to the new medicine.

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: And maybe tell us a little bit more about those 413 patients. I mean, it sounds like some of the patient finding efforts really laid the groundwork there. Are these patients I guess, to to what degree did these patients represent a sort of initial cohort of ident patients who had maybe been identified in the prelaunch processes and and made an appointment to see their clinician, you know, in the early days when they expected the drug to be available or maybe represent rollover patients from clinical trials versus I guess I’m trying to get a sense of, you know, how sustainable that trajectory may be. Do you have any are there any metrics you’re looking for or or or seeing now that may guide you on on that?

Eric Benavich, Chief Commercial Officer, Neurocrine: Yeah. So, you know, we didn’t expect there to be a bolus per se of of patients that were, you know, warehoused or waiting for chronicity. And as a reminder, you know, we did disease state education to sort of develop the market in advance of our approval, But, you know, we couldn’t talk about Crinesity. And so, really, what we talked about was the issues that these patients faced in trying to manage their disease, and and I’ll call it the deficits of the old standard of care, which was high dose glucocorticoids. So, you know, I do think that there was some awareness within the endocrinologist community about a new medication that was, you know, potentially gonna be coming to market, but less so within the patient community.

So we haven’t seen any indication that patients were trying to move up their appointment necessarily to see their doctor, but I I do think that some of the very early new patient starts that we got in the last couple weeks of December or in early January were from those doctors that were kind of waiting for Chronesity to get approved and we’re eager to go ahead and get their their patients started. But for the most part, I think the pace of adoption has coincided with patient visits and also our team’s ability to get in front of these endocrinologists and educate them on the labeling and the data. So a lot of the work that they did last fall to, you know, do disease state education, patient finding work, and so on, they were also setting up appointments for q one and q ’2 in anticipation of approval and being able to go back in and say, okay. Now Princeton is approved. Let’s talk about the labeling.

Let’s talk about the reimbursement process and how you can get a new patient started. The only piece that I’d

Matt Abernethy, CFO, Neurocrine: add is there’s a tremendous patient advocacy group. It’s called the Cares Foundation, and we actually had the Cares Foundation participate in our r and d day a a few years ago. And this patient advocacy group has done a great job informing the community about a potential treatment, but our feedback from clinicians has been even if a patient asks for the therapy over the phone, they just say, let let’s talk about it next time you come in because these doctors, these clinicians are overcapacity, you know, at this time. So I I think there’s gonna be, as Eric said, as patients come in, you’re going to ultimately get more prescribing. The second piece I’d say is we’re right now in the very early innings where patients are are taking are are getting their their blood draws, and they’re seeing what are happening with their biomarkers.

And then the clinicians having to decide what are you gonna do with the glucocorticoids. So I think that there’s going to be a significant amount of learning over the next quarter or two as patients actually get deeper into their care. It will, of course, inform persistency and compliance, but I think it will also inform how durable is this new patient addition, you know, clip. There’s 20,000 patients. There’s clearly many that can we believe can be benefited can benefit from this treatment, but it’s still such early innings both in terms of engaging with patients, but then also getting results back.

Now on the flip side, our open label extension study, we enrolled ninety five percent of patients from, you know, our our our primary study into the open label extension, and pretty much they’ve all stayed on throughout throughout the course of the last twelve to eighteen months. So there does seem to be, you know, a nice level of of compliance and and persistency here. But in terms of commercial use and real world use, we’re just learning a lot right now.

Eric Benavich, Chief Commercial Officer, Neurocrine: Yeah. One one other comment I’ll tack on is you asked about where some of these early patients from our rollovers from our study. We actually just informed the investigators that we’re gonna be winding down the adult open label study in The US, And so those patients will be transitioning over to commercial product over the course of q two, and some of them might trickle into q three. So none of the new patient starts in q one were study patients. That’s only, you know, somewhat it’s between forty and fifty patients, so it’s not

Matt Abernethy, CFO, Neurocrine: a big big number in terms of adults in The US that would roll over.

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: Reimbursement has gone maybe a little bit more rapidly than you had initially expected as well. I think you talked about 70% reimbursement for dispensed drug in the first quarter. More formulary reviews going on. What’s the latest status of of coverage, and how quickly are patients able to get drugs with the exemption process?

Eric Benavich, Chief Commercial Officer, Neurocrine: Yeah. So at the time that we launched Prinesity, it was essentially a non formulary drug everywhere. This is primarily a commercially reinsured patient population. Second biggest segment is is Medicaid. Medicare is about 10% or less of the total patient population.

So we knew that going into this that as a non formulary drug, we’d have to pursue the formulary exceptions process, and all these plans have a defined process. And so in order to get people started on treatment and to avoid any delays or lags, we put a free goods program in place. Essentially, when the prescription goes to our our specialty pharmacy partner, Panther Rare Rx, if after a week they haven’t gotten approval from the health plan for reimbursement, then that patient would be eligible for the free goods, and at that point, a month’s supply of crinesity would be shipped to the patient. So a priority, our expectation was that most patients would get at least a month of free goods, possibly some would need two before getting reimbursement approval from the plan. Actually, it didn’t work out that way.

Most patients were able to get approval for their prescription from the plan within that first week, and so what we shared was that in q one, ’70 percent of the fills were commercially reimbursed, and only 30% ended up needing free goods at all. So, you know, we we we expect that things will evolve over time, and certainly, you know, as we’re in the market longer, more of these plans will take a look and define what their coverage policies are. But so far, it’s been very positive, and that’s exceeded our expectations on reimbursement. And the plans that have published their coverage policy is generally very reasonable and consistent with the labeling. So, you know, for example, a patient has to be at least four years of age, they have to have a diagnosis of classic CAH, and they have to be on concomitant glucocorticoids because acronesity is an adjunct to GCs.

Right. So for the most part

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: Makes sense. It’s working well. Yeah. Yep. I wanna make sure we talk about INGREZZA as as well.

I think you’ve surprised a lot of folks with what seemed to be more negative than expected outlook for INGREZZA coming out of fourth quarter of last year and then probably better than expected performance momentum coming out of first quarter earnings. So can you dive into that a little bit more kind of bigger picture? What’s underlying some of these trends? And how should we think about the balance between pricing and contracting versus volumes going forward?

Eric Benavich, Chief Commercial Officer, Neurocrine: That’s that’s a balancing act that we’ve tried to manage for these past eight years. So just as a reminder, you know, we estimate, and I think Matt touched on this, that there’s at least eight hundred thousand people in The US with tardive dyskinesia, and INGREZZA has been on the market now for eight years. At the time that we launched, it was a low single digit percent of people that had been diagnosed with TD, and now, you know, we we estimate it’s around forty ish percent of people that have been given a diagnosis for their abnormal movements, but less than ten percent are currently being treated with a VMAT two inhibitor. So there’s still a lot of of organic growth potential in the VMAT two market. Last year, what we saw though was, especially in the second half of last year, partly because of competitive dynamics and also partly because of payer dynamics, it was getting harder to grow new patient starts.

And so things flattened out in the middle of the year, and then we started to see even declining rate of new patient starts as we got into q four. And I think that that slowdown in momentum colored our commentary when we got to that q four earnings call and also shaped our our thinking around the guidance for 2025. But, you know, we also implemented some interventions last year to sort of address some of these challenges. I think the biggest one, the big ticket item, so to speak, was the expansion of our field sales team. And, you know, we started the work in the summertime and we’re able to get the expanded team deployed in q four.

And so, you know, that I think led to, you know, what what we saw in q one, which was a team that was finding its stride and able to drive a record number of new patient starts in q one. So we went from a dynamic of of slowing down or deceleration of new patient starts in the second half of last year and then a reacceleration in q one. And I should point out that q one is always a challenging year for our INGREZZA or a quarter for our INGREZZA franchise because so many of our existing patients need to get reauthorized. It’s a specialty drug. A lot of them are Medicare beneficiaries, and a lot of them have plan requirements that they get reauthorized at the beginning of the calendar year.

So you’ve got this big bolus of people that are doing well on treatment, and all of a sudden, they need their doctor to write a new prescription and go through that prior authorization process all over again. So for us, as a company, you know, we put a lot of energy into being very proactive working with the prescribers and the pharmacies to minimize the potential for patients to fall off therapy or to experience treatment gaps. And so the first half of q one this year, like prior years, a lot of the focus was on that reauthorization process and trying to to keep the continuing patients continuing. And then what we saw was a acceleration of new patient starts, especially in the second half of the quarter. And it’s unusual for us to have a record number of new patient starts in a q one.

You know, typically, we

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: would see something like that more like in q two. And the sustainability, and we we get asked a lot about the overall guidance, and it seems like the guidance presumes pretty steadily increasing volumes over the course of this year, driven by maybe a mix of contracting and or the sales force expansion. Can you speak to that, kind of your level of confidence given where kind of the net price per patients and per patient ended up in in in 1Q? How how do you how do you get to the 2.5 to 2.6?

Matt Abernethy, CFO, Neurocrine: Comment really quickly on net price, and then he’ll talk on the the volume side. So as Eric mentioned, we saw in the second half of last year the payers tightening a bit. And so we’ve been working quite heavily on ensuring that we’re on contract on certain plans to make sure, number one, existing patients will stay on therapy, and number two, it will allow for new patients to be added in a in a in a bit smoother way. We’ve been very successful over the years of adding patients regardless of formulary position. In this environment and at the scale that we’re at, we made the decision to to enter into the contracting.

So we do take a gross to net hit on day one, and that is effective April 1. So we would expect from a net revenue per script to be slightly less in 2025 as compared to 2024.

Eric Benavich, Chief Commercial Officer, Neurocrine: Yeah. The other the other piece of of your question, we do expect an acceleration of growth through the balance of this year, and we reaffirmed our guidance of 2.5 to 2,600,000,000.0 during our last earnings call. Okay. So, you know, once we saw that that record number of new patient starts in q one, I don’t think that our team has hit their full productivity and we would expect to continue to see growth in new patient starts as we move through the year. Great.

Brian Abrams, Senior Biotech Analyst, RBC Capital Markets: I I think I feel like I’ve gotten through maybe less than a third of my questions, but we’re fortunately, we’re out of time. Matt, Eric, great to see you guys. Thanks so much for the updates and insights, and appreciate you being here.

Eric Benavich, Chief Commercial Officer, Neurocrine: Thanks for having us. Good to see you.

Matt Abernethy, CFO, Neurocrine: Thanks, everyone. Thank you.

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