IDRSF - Idorsia Ltd (IDRSF) Q1 2023 Earnings Call Transcript
2023-04-25 13:07:10 ET
Idorsia Ltd (IDRSF)
Q1 2023 Earnings Conference Call
April 25, 2023 07:00 AM ET
Company Participants
Andrew Weiss - Head of Investor Relations
Jean-Paul Clozel - Chief Executive Officer
Simon Jose - Executive Vice President and Chief Commercial Officer
Andre Muller - Executive Vice President and Chief Financial Officer
Conference Call Participants
Peter Verdult - Citigroup Inc.
James Gordon - JPMorgan
Jo Walton - Credit Suisse
Sachin Jain - Bank of America Merrill Lynch
Rajan Sharma - Goldman Sachs
Leonildo Delgado - Baader Helvea
Presentation
Operator
Good day, and thank you for standing by. Welcome to the Idorsia Q1 2023 Financial Results Conference Call. At this time, all participants are in a listen-only mode. After the speakers' presentation, there will be a question-and-answer session. [Operator Instructions] Please be advised that today's conference is being recorded.
I would now like to hand the conference over to your speaker today, Andrew Weiss. Please go ahead.
Andrew Weiss
Thank you, Melanie. Good afternoon, good morning, everyone. My name is Andrew Weiss, I'm the Head of Investor Relations and Corporate Communications at Idorsia. I want to welcome everyone to our webcast to discuss the publication of the first quarter results published this morning at 7:00 a.m. Central European Summer Time.
With me on the call are our CEO, Jean-Paul Clozel; our Chief Commercial Officer, Simon Jose; and our Chief Financial Officer, Andre Muller. They are all here to provide more color on the press release that was issued.
Next slide, please. As customary, before handing over the microphone, I need to remind everyone that we will be making forward-looking statements. You have therefore have been appropriately warned about the risks and opportunities of investing in Idorsia shares.
With that, Jean-Paul, the floor is yours.
Jean-Paul Clozel
Thank you, Andrew. So soon Idorsia is going to be six years old. And within these six years, we have accomplished a lot. We have developed, registered and launched two products worldwide, at least in the U.S., Europe and in Japan. We have a third product which is filed, and this is aprocitentan and the PDUFA should be in December this year. We have built a commercial organization starting in Japan, in U.S. and we are starting in Europe. We have built the pipeline with several late stage products, but we have also discovered several new products, and unfortunately, we will not have the time today to discuss the very early product that we have discovered.
Next slide. Clearly, what is key for us is QUVIVIQ, our insomnia drug. And I would like in a few words to explain the strategy we have to make it a really blockbuster drug. First, we had to establish QUVIVIQ as a leading brand in insomnia in the U.S., and we have spend last year and this year a lot of energy to really build the QUVIVIQ as lead brand. And now Simon will show you that indeed we are the leading brand in insomnia in the U.S.
And this increase of demand has helped us and is helping us to expand the reimbursement. And this was a prerequisite and this is why we have spent so much efforts to increase the demand. But as you have seen, we got in the first quarter of the year ESI reimbursement and we are continuing with several other payers to work and to find a solution to expand this reimbursement.
Then now we are launching and we want to establish QUVIVIQ as also the leading brand in insomnia in Europe. We are – in Europe, as you know, there have been no other orexin receptor antagonist, and we have launched in the beginning of the year in Germany and Italy, and we hope in several other European countries in the second part of the year. Then we want with QUVIVIQ to change the treatment paradigm in insomnia. That means for example, to promote and to use QUVIVIQ chronically every night because we have shown that the benefits of QUVIVIQ increases with time.
We have signed recently a Citizen Petition to really [indiscernible] QUVIVIQ in the United States. Therefore, we are making now, and we have I think, many opportunities to explain to the prescriber that insomnia is indeed a very serious issue that patient should be treated chronically, and that indeed – they should choose a drug which not only improve during the night, but also has some impact on the day performance is what can be achieved with QUVIVIQ.
Finally, the fifth effort we will concentrate on expanding the medical utility of QUVIVIQ. We have worked up to now mainly in adults and in patient with chronic insomnia. We are now starting – we have started project pediatrics to use QUVIVIQ in children. We are doing studies in patient with [indiscernible] with sleep apnea, so we want to really show that indeed the very good profile of QUVIVIQ [alos] to use it in several type of patients.
So now I am going to let Simon explain you the progress we are making with QUVIVIQ on the market.
Simon Jose
Thank you, Jean-Paul. Can we just move to the next slide please? Thank you. Good afternoon, everyone, and good morning to those of you in the U.S. So building on the objectives that Jean-Paul outlined, I'd like to share with you today the progress we are making on the launch of QUVIVIQ in the U.S. and Europe, and of course, PIVLAZ in Japan.
Next slide please. As most of you know, of course, we launched QUVIVIQ in the U.S. in May last year and Germany and Italy in November. In the first quarter of 2023, net sales were CHF 4.3 million. And of course, to enable patient access to QUVIVIQ in the U.S. ahead of broad payer coverage, Idorsia continues to offer a strong copay program, including a free 30-day first prescription. And as I've said before, due to this approach, net sales in the U.S. do not reflect actual dispensed prescriptions or the product demand that we are generating.
Next slide please. So moving then to demand generation in the U.S., we achieved a very strong 40% growth in total prescriptions in the first quarter compared to Q4 last year with over 22,000 prescriptions dispensed in March alone. The 50 milligram dose, the dose which shows the greater effectiveness of the two doses continues to be prescribed at a three to one ratio over the 25 milligram dose, confirming that our messaging is reaching and being acted on by our customers.
The chart on the right shows the channel breakdown of TRxs, which we've shown you before. And here now you can see that the IQVIA line is converging with the VitaCare line, which is a positive sign of increasing access and paid prescriptions. This is naturally something that we are tracking very carefully as we focus our efforts on increasing the proportion of scripts that go through the retail channel and on generating paid prescriptions.
Next slide, please. And I'm very pleased that QUVIVIQ is now the leading branded insomnia medication in new-to-brand prescriptions in the U.S. across all market segments, whether that's the commercial and all the government segments. We crossed Belsomra in the first quarter after less than one-year on the market. And given that more than 50% of Belsomra prescriptions come from Medicare Part D, where we are not currently contracted, this is an even greater achievement.
And then as you can see on the right, the continuing prescriptions or refills are growing strongly and increased by nearly 60% in Q1 this year over Q4 last year. And this is consistent with the positive feedback we hear from physicians and patients about QUVIVIQ, particularly with the 50 milligram strength.
Next slide, please. As I just mentioned, Belsomra is overweighted in Part D, where QUVIVIQ is of course underweight due to its current access position. So looking at the commercial market only where we can compete on equal terms, you can see that QUVIVIQ has passed the other DORAs in total prescriptions, not just NBRx, and now has nearly 40% share of the commercial market. We have in less than one-year shown we can compete, differentiate QUVIVIQ and establish it as the leading DORA in the U.S. market.
As Jean-Paul mentioned, our imperative now is to expand payer coverage, which I'll return to shortly, and transform this old generic market into one where the DORAs and QUVIVIQ in particular are central to the treatment of insomnia and not relegated to use after the older addictive Benzos and Z Drugs have failed.
Next slide, please. And expanding the DORA market is exactly what we are doing. As you can see here, QUVIVIQ is not only gaining market share, but it is expanding the class. Following the launch of QUVIVIQ last May, DORA TRxs have grown by 42%, and NBRxs are up 93% with QUVIVIQ prescriptions being almost all additive to the class. We continue to see the source of business for QUVIVIQ coming from the older widely used sleep medicines such as Trazodone, Z Drugs and Benzos, with only a small number of patients coming from the other DORAs.
Next slide, please. So coming then to access and reimbursement, which is clearly essential to convert our prescription demand Internet revenue. Following the launch last year, payer contracting in the U.S. has developed more slowly than we anticipated, but we are making good progress. Today, QUVIVIQ is covered by Express Scripts National Preferred Formulary and Tricare Uniform Formulary, which together represent over 32 million lives in the U.S.
Following the contract with ESI for its National Preferred Formulary, we are working closely with the ESI downstream accounts to pull the ESI rate through and add additional contracts and covered lives. There are a few small accounts totaling around 2 million lives that have already added QUVIVIQ and have taken the ESI rate, but the larger ones have their own procedures and timelines that we have to work through with them, which does take some time.
Furthermore, we are in very active communication and negotiation with CVS Caremark, which represents just under 30 million commercial lives. So we remain laser focused on driving more access and gaining coverage for QUVIVIQ, including the Medicare Part D Formulary for 2024 for which we've submitted bids.
Next slide, please. Turning now to Europe, where we launched QUVIVIQ in Germany and Italy, as I said, late last year, while it's still relatively early days, demand is growing well as shown here with the weekly unit sales from wholesalers to pharmacies. So this essentially represents pharmacy purchases. As pack sizes differ between the two countries, we've normalized units to tablets, which is what you are seeing here. And this picture represents and reflects the positive feedback we hear from physicians and patients on the differentiated profile of QUVIVIQ, the first and only DORA available in Europe.
In Germany, the AMNOG processes to set pricing and reimbursement after the free price period is ongoing, as well as the GB-A review of the potential exemption of QUVIVIQ from the four-week prescription limit on hypnotics. In Italy, all sleep medicines are C-Class or privately paid by patients, and QUVIVIQ has launched into the same C-Class. Prescribing is currently limited to specialists only at this stage where the feedback on their experience to date has also been excellent.
Next slide, please. So looking further across Europe, following the launches in Italy and Germany, we are next preparing to launch in our home market of Switzerland in June. We will initially launch in the private market focusing on specialists while the reimbursement process is running. In the UK, the NICE assessment is also underway, and we anticipate launching there later next – this year. And our local teams in Spain and France are preparing for subsequent launches in those markets.
Next slide, please. So finally, just to finish with PIVLAZ in Japan, we launched pretty much to the day one year-ago. It was the 20 of April last year. And next slide, please. You can see that the first quarter sales were CHF 13.5 million. Net sales in the first quarter continue to be impacted by the strong Swiss Franc as well as by wholesaler ordering patterns related to the end of the calendar year and the fiscal year in Japan.
Neurosurgeons continue to incorporate PIVLAZ into treatment protocols and awareness amongst our target customers is now greater than 95%. Approximately 27% of patients were treated with PIVLAZ in March based on the estimated incidence of aSAH. Now, as I've mentioned before, the initial rapid uptake seen last year benefited from study investigators fast adoption of PIVLAZ, and we are now entering a period of more moderate growth as new accounts build experience with the product.
So in summary, I'm very pleased to see QUVIVIQ is now the leading insomnia brand in the U.S. commercial market in terms of prescriptions. Although payer access has been slower than anticipated, we have secured access with ESI and TriCare and are in active discussions with other major payers. As further reimbursement is secured, we expect paid prescriptions to continue to increase boosting net sales.
In Europe, demand is growing with our first launches in Germany and Italy, and we are preparing for additional launches later this year. And equally important to establishing QUVIVIQ as the leading treatment for insomnia is transforming and modernizing the entrenched generic market we have entered creating a future where orexin antagonism and QUVIVIQ are central to the treatment of chronic insomnia.
Thank you. And I'll now hand over to Andre. Next slide, please.
Andre Muller
Thank you, Simon. Melanie, next slide, please. First, comment on Idorsia U.S. GAAP net results came about. So starting from left, we see a net revenue, CHF 18 million net sales that Simon just explained plus CHF 3 million contract revenue. We will come a little later. We see a breakdown of non-GAAP OpEx. D&A CHF 5 million, stock-based compensation CHF 12 million leads us to U.S. GAAP operating results of minus CHF 198 and below EBIT is minus CHF 15 million is mainly driven by financial results. Non-GAAP, it's mainly CHF 7 million interest paid on the outstanding convertible bonds and U.S. GAAP, we had also an impairment on our equity stake in Santhera for CHF 7 million. The remainder CHF 1 million is mainly tax. So this leads us to our U.S. GAAP net results of minus CHF 212 million.
Next slide, please. So here we have the breakdown of this non-GAAP operating expenses. You see research is slightly lower than in the same quarter in 2022 with CHF 28 million. That's fundamentally a fixed cost base. See a development of 56 includes clinical development, CHF 35 million with roughly CHF 19 million study costs and CHF 16 million fixed costs will allow us to advance the pipeline and notably see a Phase III compounds selatogrel and cenerimod.
There is also CHF 21 million in chemical and pharmaceutical development, of which I would say study costs or drug substance, 9 million drug products, CHF 7 million are really variable costs and CHF 5 million fixed cost. So SG&A at 117 increased by almost 18% compared to last year, 117 include marketing and selling, CHF 96 million. And Simon explained you that we are going – we have now an organization almost not fully fledged, but in U.S., in Europe and in Japan. And you have CHF 21 million G&A, which leads us to see CHF 202 million non-GAAP OpEx in Q1 2023.
Next slide, please. Liquidity, if we want to reconcile, we see a non-GAAP operating result, we just commented, limited CapEx CHF 4 million, inventory built CHF 26 million mainly for semi finished daridorexant, working capital requirements increased by CHF 34 million. That's mainly a prepayment that we usually have in Q1 in various department, including marketing fees and DTC campaign, IT licenses et cetera and pension which also increased by CHF 20 million. This explains the lion share of this CHF 34 million increase plus other items, which brings us to a liquidity of CHF 212 million by the end of March.
Next slide, please. Not going in too much detail with this CHF 212 million. I'm sure we get some question with how we will extend the cash runway. So let's go directly to next slide, please, which is the guidance. As you can see, we removed sheer revenue guidance issued with the full-year 2022 result, which was CHF 230 million, mainly because there's uncertainty around sheer sales as Simon explained. We have nice sheer volumes in the U.S. are nicely picking up, but we have some headwinds in the gross to net. And converting these volumes into net sales will mainly depend on securing some additional coverage for 2023 of course in commercial and also working on Medicare Part D that this would kick in for 2024.
So maintaining the non-GAAP operating loss around CHF 650 million means that we have already taken some cost containment measures in order to secure this loss. So to certain extent, we minimized the risk notably on the topline by lowering the OpEx base.
Next slide, please. We still keep this guidance with profitability by 2025 with revenue above CHF 1 billion based on what we know i.e. QUVIVIQ, PIVLAZ in Japan and aprocitentan tiered royalty because we strongly believe that aprocitentan will be approved with a PDUFA date on the December 19, 2023, and in H1, let's put it this way for Europe.
And next slide, please. Jean-Paul, turn it over to you.
Jean-Paul Clozel
Thank you, Andre. So as I mentioned at the beginning, we are progressing on the commercial front, but we must continue to innovate. And as I've mentioned, also aprocitentan review by the FDA, by the European authorities is continuing. The PDUFA for aprocitentan is planned for December 19, 2023. In Phase III, selatogrel is also progressing well. We have recruited more than 4,500 patients in this study and we are continuing to recruit at a very good pace. Finally, we have started our two studies, two registration study with cenerimod in lupus. And as I have mentioned, we are continuing to progress our early stage pipeline.
Next slide, please. So momentum is building in 2023. We have mentioned ESI contracting, we have also submitted aprocitentan in Europe, and we are waiting in the coming weeks, I would say a regulatory decision for QUVIVIQ in Canada. We are discussing with both U.S. and European authorities the path forward for lucerastat and QUVIVIQ should be launched before middle of the year in Switzerland. Also, this in the second part of the year, we should launch QUVIVIQ and we are in discussion, of course, with NICE. We should launch QUVIVIQ in the United Kingdom. And the submission for QUVIVIQ in chronic insomnia in Japan should be filed before the end of the year.
And as I mentioned just before Christmas, we should hear about the FDA decision for aprocitentan. So you see quite a lot of action in 2023. And I think that's on that, I give the word to Andrew to start the Q&A session.
Andrew Weiss
Next slide, please. Thank you, Jean-Paul. Thank you all for your prepared remarks. We now have time to address questions. We have come to the bottom end of the hour, so we've got ample time here. Operator, please open the line for questions.
Question-and-Answer Session
Operator
Thank you. [Operator Instructions] Our first question comes from the line of Peter Verdult from Citi. Please go ahead. Your line is open.
Peter Verdult
Yes. Thanks, everyone. Peter Verdult, Citi. Three questions. One for Simon, two for Andre. Simon, on QUVIVIQ. Thanks for the update on access and reimbursement, but just wanted to get a better idea. Put simply when you expect QUVIVIQ to inflect because correct me if I'm wrong, I think when you gave guidance at the start of the year, there was roughly a 100 million penciled in for QUVIVIQ, that sales guidance now being removed run rate less than 20. So just question number one, yes just, when you expect to see that revenue conversion?
And then two for Andre. Firstly, on the guidance. Could you help us a bit more over and above your prepared remarks to just understand the assumptions here because sales are trending now less than 100 million, your prior guidance was 230, and you're keeping your EBIT guidance unchanged. So correct me if I'm wrong, looks like a 100 million cut to the OpEx or 10% to 15% cut to the cost base. I'm just a bit worried that you're now cutting into muscle rather than fat in terms of making those numbers. I just want to understand what you've done in terms of cost mitigation.
And then lastly on financing. I think you were signaling at JPM in January that your [royalty] monetization deal was coming and just wanting to better understand why we're still waiting six months after the Phase III data for a deal. And what are you expecting now that you're using the words and/or – equity and/or non-equity financing? Are you expecting a raise in a deal on [indiscernible] to provide you 12-month runway or longer? I just want to get a better understanding as to what your ambitions are? Thank you.
Jean-Paul Clozel
Thank you, Pete. Simon?
Simon Jose
I'll start. Hi, Pete. I mean, I think we're pleased with the demand profile we've got. I think the question around the expectation around revenue conversion clearly is going to be linked to when we get the next access step, which is the ones we most advanced in our conversations are with CVS, which is a big one, of course, the 30 million lives. And that unlike ESI, where you have the downstreams is more of a switch that we're working with the downstreams too. I wouldn't want to put a precise time on it, but I think that our hope would be that we'll have something to be able to say within the next few months, maybe around the summer break. And then after that, we should start to see the revenue inflections. We see it within ESI, now we can see more paid claims going through. That's not the issue. We just need more scale of reimbursement access and lives, which is going to come with the downstreams with CVS this year. And then if we're successful with our conversations on Part D, we'll see it again in January when we – assuming we get Part D.
Andrew Weiss
Thank you, Simon. Andre?
Andre Muller
Yes, Peter. So to your first question, I will not give you a breakdown between revenue and OpEx. But you are right; we're working here on the thin line. We need to – cost containment measures have been taken not touching what we believe the sheer muscle, not saying that what we remove was fat in sheer budget, but that's implemented. And depending on other BD discussions, we'll see if we need to go further in terms of cost savings.
To your second question specific to the royalty monetization deal. Yes, when we spoke early February, we had a non-binding term sheet signed on a deal, which is to be a fully transparent no longer on sheer table. So now we have two other royalty monetization deals ongoing hope that will be able – will be one or the other. And again, hope that in the course of May, we should be able to link one or the other.
And as I alluded to, we have a few ongoing potential collaboration deal, out licensing deal. But you need to be [indiscernible] some unpredictability by the nature of such deals, agreeing, well having – see a partner to confirm their interests after thorough due diligence, and of course, agreeing on sheer terms of such collaboration. So as you can see, we are not relying on only one deal. Nothing here is excluded and as a backstop, meaning that if all this non-equity dilutive initiative cannot be completed within the next four to six weeks, we will then certainly envisage to raise cash through an equity rate. But this is really a backstop in a case everything else would fail.
Peter Verdult
Thank you.
Andrew Weiss
Thank you, Andre. Operator next question, please. And may I ask that analyst remains to one question only, please.
Operator
Thank you. We'll now move on to our next question. Our next question comes from the line of James Gordon from JPMorgan. Please go ahead. Your line is open.
James Gordon
Hello. Thanks for taking the question. I'll ask a question about one thing, which is creatively the cash runway. So within that question, non-dilutive options, what is still being explored? Is it just apro? Or are you looking at other things? And would it potentially just be a stop gap to then raise more capital later in the year? Or do you think non-dilutive options could actually – potentially secure cash runway into 2024? And if you were to instead raise equity again, how long a runway would you be looking to lock in? And just finally as part of this question, in addition to raising cash, could you look to really pause all activities beyond QUVIVIQ and PIVLAZ commercialization? So it sounds like there's still quite a lot of R&D planned, but there isn't a lot of cash to fund it. Is there a way that you could put some R&D activities on hold and do a more drastic cost cutting to extend the runway?
Andre Muller
Well, I can take it and Jean-Paul, feel free to chime in. Thank you, James. Yes, cash runway, obviously with 212, we need, as I just mentioned to raise cash in next four to six weeks. I explained the various options available. It's not only a wishful thinking, I can tell you it's an active discussion. We are running all these potential funding avenues in parallel. And we are also in a position if [indiscernible] to pull the trigger on an equity raise. So it's a sort of a hurdle race. The more we can raise at this term here better and because then it will significantly extend the cash runway. But I want to do it in a pragmatic way so sequentially and we know that we don't have so much time ahead of us in order to secure one or several deals. My favorite option is a string of deals, which would lower to extend more significantly cash runway. But we'll see in the next few weeks.
Jean-Paul Clozel
And James I just thought that what is more important for us is to create value with the asset that we have. I have mentioned – selatogrel, I have mentioned. So I think rather than to stop and to lose this value, it's better to find partnership, to find to out license, there are many solutions, which we are exploring now. We have a company which is discovering, and which has shown that we can really develop – discover, develop and put on the market. So we are creating value, and we should continue to create value. So the strategy of the company is to create – to continue to create new products and to put them on the market, either ourself or with partners. I think that if you mean which type of amount, we really are trying to really bridge the gap to profitability. This is what we are trying to do. And it's interesting to think that we are speaking of profitability to come because we have – also we see that our sales are increasing that we are launching in several products. So we need to build this gap. And the goal and the amount is just this amount and we are working very hard.
As Andre has said, I would just say, we are exploring several avenues. We don't have only one solution. And I'm very optimistic that we are going to really finance this company, bridge this gap and reach profitability as a company based on the marketing, but based on commercial organization and also research together.
Andrew Weiss
Thank you, Jean-Paul. Operator, next question, please.
Operator
Thank you. Our next question comes from the line of Jo Walton from Credit Suisse. Please go ahead. Your line is open.
Jo Walton
Thank you. I'm afraid I'm going to go back to QUVIVIQ. I suspect that we are all a little mystified by the level of prescriptions that we can see in IQVIA, which I think we understand are ones that are beyond a bridge program and should come with some revenue to you, and yet the effectively almost zero revenue in the quarter. So I'm going to ask again if we can get some help on this as to perhaps what proportion of the script that you are seeing at the moment are free. Is it just – it takes a very long time to convert a free – a first month free to a second month that's paying and that's why we are still not seeing it given that the ESI coverage came in January. Can you also confirm for us that you think that the net price that you'll get in Medicare is going to be on a par with the net price that you are hoping to get in commercial? Clearly, Belsomra has a low price that you've had to match. In commercial, I think we are worried that they may have an even lower price within Medicare.
And a follow on surrounding that, you use Syneos as your marketing partner to do your promotion. Can we just ask how you are checking the tires there to see that they're doing a good job and that all the money that you are spending is actually coming good because you are investing a lot, and just at the moment you are realizing really very little. So if you could – I'm sorry, it's the same topic again, but we're all looking for more confidence that prescriptions are going to turn into paid prescriptions in a relatively short period of time?
Andrew Weiss
Thank you, Jo. Simon?
Simon Jose
Sure. Hi, Jo. Yes. Let me just break down the script. First of all, if you look at VitaCare versus IQVIA, give or take with 50/50-ish. But the VitaCare volume is consignment volume and we make no money on that as we've talked about before. But even in the IQVIA segment, as we obviously have paid scripts going through the IQVIA segment, but we still have a copay and a coupon program in the IQVIA segment in the retail segment, which may well be buying down a copay for people who have coverage, for example, in SI patient, we're buying down the copay. But if you're not covered, and we still have a significant proportion of patients that aren't uncovered, we could be buying down the whole script in the retail segment. So the GTN is a combination of VitaCare and the coupon buy down that's going on in the retail segment, which is why the GTN right now is so high.
The answer as we keep coming back to is, is payer coverage. Because as soon as you get payer coverage, and we've seen it with ESI, then your paid scripts go up. And it's really then just the copay buy down that you are dealing with and the free scripts then essentially sort of move away. And we're increasingly now working on different tactics and activities to move more volume into the retail segment and work and support doctors with prior authorization processes and various other things to increase the pay prescription. So it'll keep coming back to – we need to get the payer coverage one; and secondly, we need to make sure that we're working with physicians to be able to manage the prior authorization process if those patients don't meet the step edit requirements for results in the Benzos.
Part D, I'm not going to comment on the price specifically. We've made our bids and we're working with the Part D payers and we're hopeful that we'll be able to get our Part D coverage in place for 2024, but obviously until that's done, we can't confirm that. Finally, Syneos, I mean, first of all, Syneos is doing our sales force activity. So all of the commercialization, the strategy, the marketing, the access medical is all being done by Idorsia, so Syneos is essentially our sales force and we're pleased with what they're doing. When we benchmark Syneos against other companies who've been around for years, our metrics are either at or above benchmark compared to other companies with sales forces, particularly in the primary care space. So we're very comfortable with Syneos.
Jo Walton
Thank you.
Operator
Thank you. We'll now move on to our next question. Our next question comes from the line of Sachin Jain from Bank of America. Please go ahead. Your line is open.
Sachin Jain
Hi, there. Thanks for taking my questions and the same topics again, if I may. So firstly, for Simon on the payer coverage, ESI, downstream and CVS, do you have a sense of what volumes are needed to get there across the line? I just want to get a sense of how explicit your conversations have been that give you confidence you'll get there by summer versus still more of a hope? And then related, sorry…
Simon Jose
Sorry, go on. No, you carry on.
Sachin Jain
And then related, I'm just trying to, also, just following from Jo's questions, if we get a sense of does that payer coverage definitely convert given the 30 million covered lives is quite a lot to be only selling 4 million? So just it's a two part question there. And then I've got one for Andre on financing.
Simon Jose
Yes. I mean there isn't a volume target that you say if you hit this number, then you're done. It's a negotiation that usually involves the volume. And I think at the moment are being number one, the NBRx, the TRx in the commercial space are helping us a lot with those conversations because it's evident now that the physicians and patients are seeing the product differentiated. So that's helping a lot, but there isn't if you like a numeric target that we have to hit.
And then it's mixed in with their own processes and timings and when things have to happen, you can't just say, can we have this on Monday. They've got a process to follow. They're also spending a lot of time doing biosimilar stuff and all these other things. So I think that all of that mixes together, but it's a lot more than I hope. I think we feel we're making very good progress. And as soon as we have something to say, as I say in the next few months, we will do so. On the 30 million lives for CVS that is more of a switch than ESI. ESI is 13% of their businesses in NPF and 19% is in the downstreams, which we have to work through their own processes on…
Sachin Jain
And then just one, a couple followings for Andre on financing, apologies just to dig into this. So you mentioned two other parties you're in discussion with, is that apro or is that some other pipeline asset? And did those discussions only start post the non-binding deal not progressing? And then I did want to follow on from James's question on just how you think about the size of equity raise should you get there? Because obviously without QUVIVIQ confliction, the total amount of financing you need before you get profitable is in the sort of high hundreds, close to a billion. So if you came to the market, would you still be looking to do that in segments or just trying to get a chunk of it done to give the market comfort that your finance rate profitability? Thank you.
Andre Muller
I think we cannot mention. There are a lot of confidential discussion. We cannot really – we cannot comment on this one. We are certainly not only discussing about only aprocitentan as we mentioned, we are creating value with – we have Phase III products which are moving, we have also products which are moving audio projects. So we are really – as I mentioned, we are trying to find many solutions, and we are in discussion with several partners. But this is remaining confidential and this is only progressing, this is what I can say.
Sachin just regarding the equity – potential equity raise. As I told you, it's really a backstop option. We hope to get approval at the upcoming AGM for what is called capital band, which would allow us to have authorized capital plus the condition, but authorized capital on equity raise. And here we would be able – we should have approximately 100 million shares available. So Fed first thing and after CHM again, and depending on the other deals, we'll see how much we will use in an equity rise if need be.
Sachin Jain
Thank you.
Andrew Weiss
Thank you. Andre. Operator, next question, please.
Operator
Thank you. [Operator Instructions] Our next question comes from the line of Rajan Sharma from Goldman Sachs. Please go ahead. Your line is open.
Rajan Sharma
Hi. Thanks for the question. Just on the cost savings, I was just wondering what potential SG&A expense savings you could make this year. Could there potentially be a headcount reduction or could you delay additional QUVIVIQ DTC spend until you're in a better formulary position? And then just on the operating loss guidance, does that include any contribution from lucerastat given that we're expecting an update in mid-year? Thanks.
Andre Muller
Okay. So your line was really bad there Rajan. So first on the granularity of where potentially savings could come from. We will not disclose where the cost containments already made or upcoming ones would come from. Rajan, could you repeat what you meant with lucerastat? I just got that word out, but I didn't understand the context of it.
Rajan Sharma
Yes. I guess, is there anything – can you hear me better now?
Andre Muller
Good.
Rajan Sharma
Yes. So I was just wondering if there's anything within the guidance in terms of the operating loss and any costs relating to lucerastat within that given that we're expecting a decision on the path forward during the first half of this year?
Andre Muller
Yes. So I said no detail breakdown of the cost containments already taken or upcoming ones. We saw that we have the open label extension which is ongoing and sheer costs are properly taken into account. Again, this guidance is unforeseen events and excluded. And here in unforeseen events, there is no potential BD deal with the upfront that we would get, which would help for sheer funding to extend sheer cash runway that would of course, improve sheer revenue line. So here we have not taken any assumption of a potential deal that we are working on.
Andrew Weiss
Thank you, Andre. Operator, do we have more questions?
Operator
Thank you. [Operator Instructions] We'll now move on to our next question. Our next question comes from the line of Leonildo Delgado from Helvea. Please go ahead. Your line is open.
Leonildo Delgado
Hi, good afternoon, and thanks for the questions. I have a couple of questions on Santhera. What do you plan to do with your growing stake and just wondering if it might play any role in your non-dilutive fundraising strategy? And so – or rather if you consider acquiring Santhera, for example, on a sheer swap and merging it into your operations? Thank you.
Jean-Paul Clozel
I must say, Santhera is not my top priority despite our very good relationship with the Executive Team and the Chairman. So it is not on the top priority. So its nothing relating to these funding avenues that I mentioned that would come from Santhera. We have approximately – I speak on top of my mind, but approximately a little more than 10% of the equity of Santhera. So we are a shareholder, but we are not an insider. So wish all the best to Santhera and of course to all shareholders, including Idorsia would benefit from.
And I want to mention, to add that I think Vamorolone is a great product, it should be approved by the FDA. And I think that this is why we have tried to help Santhera to put this product and to give access one day to the patients, which is great product. And that should translate in some – hopefully some share move for Santhera where we will benefit, but we are not active in any other action other than wish them the best and really just looking at the progress of Vamorolone, which is I really repeat, I think a great drug. I speak to CSO, Thomas Meier, Chairman.
Andrew Weiss
Thank you very much. Operator, any further questions?
Operator
Thank you. There are no further questions at this time. So I'll hand the conference back to you for closing remarks.
Andrew Weiss
Thank you, Melanie. Well, this concludes therefore the call for today. Thank you very much for your ongoing intention in our stock and our development. This is going to be an exciting quarter, so stay tuned. I look forward to speaking to you again. Operator, please close the lines.
Operator
Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect. Speakers’ please standby.
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Idorsia Ltd (IDRSF) Q1 2023 Earnings Call Transcript