Phathom Pharmaceuticals Inc (PHAT) 2025 Q3 法說會逐字稿

Hello and welcome to the Phathom Pharmaceuticals. Third quarter, 2025 earnings results call.

您好，歡迎來到Phathom製藥公司。2025年第三季財報電話會議。

At this time, all participants are in a listen-only mode.

目前，所有參與者均處於唯讀模式。

After the presentation, there will be a question-and-answer session. To raise your hand to ask a question, press 11. To lower your hand, you may press 11 again.

演講結束後，將進行問答環節。若要舉手提問，請按 11。要放下你的手，你可以再按 11。

Please be advised that today's call is being recorded.

請注意，今天的通話將會被錄音。

With that, I would like to turn the call over to Eric Sciorilli, Fathom's head of investor relations. Please go ahead.

接下來，我將把電話交給 Fathom 的投資人關係主管 Eric Sc​​iorilli。請繼續。

Thank you, operator. Hello everyone and thank you for joining us this morning to discuss FA's third quarter 2025 results. This morning's presentation will include remarks from Steve Basta, our President and CEO, and Sanjeev Norula, our chief financial and business officer. Robert Breedlove, our principal accounting officer, will be joining for the Q&A portion of today's call.

謝謝接線生。大家好，感謝各位今天上午與我們一起討論英足總2025年第三季業績。今天早上的演講將包括我們的總裁兼執行長史蒂夫·巴斯塔和我們的財務長兼業務長桑吉夫·諾魯拉的演講。我們的首席會計官羅伯特·布里德洛夫將參加今天電話會議的問答環節。

A couple of notes before we get started. Earlier this morning, we issued a press release detailing the results we will be discussing during the call. A copy of that press release can be found under the news releases section of our corporate website.

開始之前，有幾點需要說明。今天早些時候，我們發布了一份新聞稿，詳細介紹了我們將在電話會議上討論的結果。該新聞稿的副本可在我們公司網站的新聞稿欄位中找到。

Further, the recording of today's webcast and the slides we'll be reviewing can be found on our corporate website under the events and presentations section.

此外，今天網路直播的錄影和我們將要回顧的幻燈片可以在我們公司網站的「活動和簡報」部分找到。

Before we begin, let me remind you that we will be making a number of forward-looking statements throughout today's presentation. These forward-looking statements involve risks and uncertainties, many of which are beyond balance control.

在開始之前，請允許我提醒各位，在今天的演講中，我們將做出許多前瞻性陳述。這些前瞻性陳述涉及風險和不確定性，其中許多風險和不確定性是平衡所無法控制的。

Actual results may materially differ from the forward-looking statements, and any such risks may materially adversely affect our business and results of operations, and the trading prices for Fathom's common stock.

實際結果可能與前瞻性陳述有重大差異，任何此類風險都可能對我們的業務和經營業績以及 Fathom 普通股的交易價格產生重大不利影響。

A discussion of these statements and risk factors is available on the current Safe Harbor slide, as well as in the risk factors section of our most recent Form 10K and subsequent SEC filings.

對這些聲明和風險因素的討論可以在當前的「安全港」幻燈片中找到，也可以在我們最新的 10-K 表格和隨後提交給美國證券交易委員會的文件的風險因素部分中找到。

All forward-looking statements made on this call are based on the beliefs of Fathom as of this date, and Fathom disclaims any obligation to update these statements.

本次電話會議中所做的所有前瞻性陳述均基於 Fathom 截至當日的信念，Fathom 不承擔更新這些陳述的任何義務。

Later in the call, we will be commenting on both GAAP and non-GAAP financial measures. Specifically, in the scope of this discussion, when we refer to cash operating expenses, please note we are referring to the non-GAAP form of this measure, which excludes non-cash stock-based compensation.

在稍後的電話會議中，我們將對GAAP和非GAAP財務指標進行評論。具體而言，在本討論範圍內，當我們提到現金營運費用時，請注意，我們指的是該指標的非GAAP形式，其中不包括非現金股票選擇權費用。

As always, detailed reconciliations between our non-GAAP results and the most directly comparable GAAP measures are included in this morning's press release. With that, I will now turn the call over to Steve Basta, Fathom's President and CEO, to kick us off. Steve.

像往常一樣，今天早上的新聞稿中包含了我們非GAAP績效與最直接可比較的GAAP指標之間的詳細調整表。接下來，我會把電話交給 Fathom 的總裁兼執行長 Steve Basta，讓他開始今天的演講。史蒂夫。

Thank you, Eric. and thank you to everyone joining us today.

謝謝你，埃里克。也感謝今天所有到場的朋友們。

I'll start with an overview of our financial and commercial highlights this quarter and then provide commentary on our shift to a greater gastroenterology focus, and our current operating priorities.

我將首先概述本季度我們的財務和商業亮點，然後對我們向更注重胃腸病學的轉變以及我們目前的營運重點進行評論。

First, I wish to welcome two new Fathom leadership team members. Joining me on the call today is Sanjeev Narula, our new chief financial and business officer. Sanjeev brings to fathom a proven track record of building successful profitable pharmaceutical businesses of significant scale. His experience and insights will be important to driving our growth. I'm delighted to have Sanjeev as a partner in building Fathom.

首先，我謹歡迎兩位新的 Fathom 領導團隊成員。今天和我一起參加電話會議的是我們的新任財務長兼首席商務官桑吉夫·納魯拉。Sanjeev 擁有建立成功且盈利的、規模可觀的製藥公司的可靠業績記錄。他的經驗和見解對推動我們的發展至關重要。我很高興能與 Sanjeev 合作創作 Fathom。

I'm also pleased to announce that Nancy Keen has recently joined Fathom as our new SVP of marketing and analytics. Nancy brings a wealth of experience in technology-driven marketing, tactical implementations of marketing to integrate with sales activities, and both HDP and consumer promotion in the pharmaceutical industry.

我很高興地宣布，Nancy Keen 近期已加入 Fathom，擔任行銷和分析資深副總裁。Nancy 在技術驅動型行銷、將行銷策略與銷售活動相結合以及製藥業的 HDP 和消費者促銷方面擁有豐富的經驗。

Nancy has successfully led marketing for several successful drugs.

南希曾成功領導過幾種暢銷藥物的行銷工作。

We have a solid commercial and financial team in place.

我們擁有一支實力雄厚的商業和財務團隊。

Starting today with our financial highlights for Q3. Really pleased to report, the end of Q3. We've delivered 25% growth this quarter.

今天首先帶來的是第三季財務亮點。非常高興地報告，第三季結束了。本季我們實現了25%的成長。

While reducing operating expenses by 43%.

同時降低營運費用 43%。

And therefore significantly reducing our cash usage.

因此，我們可以大幅減少現金使用。

We beat expectations on the revenue and on the operating expenses, and we're executing effectively throughout the organization on the plan that we set out 6 months ago.

我們在收入和營運費用方面都超出了預期，並且在整個組織中有效地執行了我們6個月前製定的計劃。

Net revenue for Q3 was 49.5 million, which represents 25% growth quarter over quarter. This is the head of expectations of approximately 47 million and it is in line with our revenue guidance for the year.

第三季淨收入為 4,950 萬美元，季增 25%。這比預期的約 4700 萬高出一籌，符合我們對全年的收入預期。

As a result of the strength this quarter.

由於本季業績強勁。

We are narrowing our full year guidance to the top half of the previously communicated range.

我們將全年業績預期範圍縮小至先前公佈範圍的上半部。

While growing revenue significantly, our cash operating expenses were $49.3 million this quarter, which is meaningfully better than our previously stated target of getting below $60 million in cash A X4Q3.

儘管收入大幅成長，但本季我們的現金營運支出為 4,930 萬美元，這比我們先前設定的將現金支出控制在 6,000 萬美元以下的目標要好得多。

You may recall in May, we set a target for the year of bringing our operating expenses on a quarterly basis below 55 million by Q4 of 2025. I'm pleased to report that we've achieved that milestone early in Q3.

您可能還記得，在 5 月份，我們設定了年度目標，即到 2025 年第四季度，將季度營運費用降至 5,500 萬美元以下。我很高興地報告，我們在第三季初就實現了這一里程碑。

We've cut our cash ex by nearly 50% since Q1, while growing revenues ahead of expectations. Quite pleased with the performance that the entire team has delivered through the course of the past 6 months.

自第一季以來，我們的現金支出減少了近 50%，同時收入成長超出預期。我對整個團隊在過去6個月的表現感到非常滿意。

Our cash usage was less than 15 million for Q3, that's down 77% versus the Q2 cash usage number.

第三季我們的現金使用量不到 1,500 萬美元，比第二季的現金使用量下降了 77%。

One note for Q4. Our operating expenses for Q4 will be somewhat higher than in Q3, primarily due to the start of the EOE phase 2 trial, but we do still expect to operate at below 55 million cash as we've previously stated, even with the additional clinical trial expense.

第四季的一點說明。由於 EOE 第二期試驗的開始，我們第四季的營運費用將比第三季略高，但正如我們之前所說，即使加上額外的臨床試驗費用，我們仍然預計現金營運將低於 5500 萬美元。

My sincere thanks go to the entire fathom team for the dedicated efforts to deliver both our continued revenue growth and our operating expense discipline throughout this period. I'm most impressed every day by the extraordinary talent and dedication of our team.

我衷心感謝整個 Fathom 團隊在此期間為實現持續的收入成長和營運成本控制所付出的辛勤努力。每天最讓我印象深刻的是我們團隊展現出的非凡才能和奉獻精神。

A few notes on commercial performance for the quarter that might be helpful for folks. Launched to date, we have 790,000 filled prescriptions as of October 17th. That's approximately 36% growth since our Q2 calls.

以下是一些關於本季商業業績的說明，或許對大家有幫助。截至 10 月 17 日，我們已完成 79 萬份處方配藥。這比我們第二季的電話會議預測增加了約 36%。

In 3, we had 221,000 filled prescriptions.

第三年，我們完成了 221,000 次處方配藥。

At least 221,000. Prescriptions in 3, 144,000 were covered scripts.

至少221,000人。其中 3,144,000 張處方屬於醫保覆蓋範圍。

Which grew approximately 23% quarter over quarter.

環比增長約 23%。

For everyone who looks at our financials, recalled this is the growth category that drives our revenue.

對於所有關注我們財務數據的人來說，請記住，這是推動我們收入成長的類別。

We also had 77,000 cash prescriptions that were filled, growing approximately 38% quarter over quarter. The growth here includes the impact of having turned on Medicare patient availability on the cash pay for the cash pay program as of April.

我們也完成了 77,000 張現金處方，季增約 38%。此處的成長包括自 4 月起，對現金支付計畫的醫療保險患者可用性進行現金支付所帶來的影響。

As we've previously noted, 70% of our prescriptions launched to date have come from gastroenterologists.

正如我們之前提到的，迄今為止，我們開出的處方中有 70% 來自腸胃科醫生。

During the recent quarter, we are seeing stable payer coverage and expect that moving forward for Buea.

最近一個季度，我們看到支付方覆蓋範圍穩定，並預期布埃亞也將在未來保持這種穩定。

We've pivoted in the last 6 months.

過去六個月裡，我們進行了策略轉型。

To focus on gastroenterology target prescribers as a core growth strategy.

將胃腸病目標處方醫生作為核心成長策略。

The intent of this shift is to really target depth rather than breadth of writing. That is, we want to get physicians who adopt Vesna to write prescriptions more and more frequently and grow their utilization of our products as a clear path to driving our growth.

這種轉變的目的是真正注重寫作的深度，而不是廣度。也就是說，我們希望採用 Vesna 的醫生能夠更頻繁地開處方，並提高他們對我們產品的使用率，以此作為推動我們成長的明確途徑。

In alignment with that strategy, we have communicated that and have taken several steps over the past 6 months to align our sales activities to enable that greater focus on the gastroenterology customer. In May, we announced the strategic shift.

為了配合這項策略，我們已經傳達了這一訊息，並在過去 6 個月中採取了多項措施來調整我們的銷售活動，以便更加專注於胃腸病學客戶。五月份，我們宣布了這項策略轉變。

Step one, which actually occurred in May as well in Q2, was to adjust our incentive compensation plan for our sales reps to more reasonably balance and focus on gastroenterologists where previously had been focused on the primary care call point.

第一步（實際上在第二季度的 5 月也發生了）是調整我們銷售代表的激勵薪酬計劃，以更合理地平衡和側重於胃腸病學家，而此前側重於初級保健呼叫點。

Step 2, which we implemented in July, was to reset the sales territory target list to include all of the gastroenterology customers and take out unproductive primary care physicians from those target lists. That allowed the salesforce to start spending more time in gastroenterology practices. We also implemented in July. A modified incentive comp plan which focused on growth of total prescriptions rather than focusing on growth of the new writer base. So, it really is aligned with that strategy of driving depth rather than breadth of writing. Step 3, which we just implemented in October, just in the last couple of weeks, is a realignment of our sales territory geographies to enable better balance and better focus on our gastroenterology target call point. Let me describe that evolution for you a little bit in terms of the Salesforce structure.

第二步，我們在 7 月實施，是將銷售區域目標清單重新劃分，納入所有胃腸病學客戶，並從這些目標清單中剔除效率低下的初級保健醫生。這使得銷售團隊能夠開始花更多的時間在腸胃科診所進行實地考察。我們也在7月實施了這項措施。修改後的激勵薪酬計劃，重點關注處方總量的增長，而不是關注新簽約醫生數量的增長。所以，這確實與注重寫作深度而非廣度的策略一致。第三步，我們剛剛在十月實施，就在最近幾週，是對我們的銷售區域地理進行重新調整，以便更好地平衡和更好地專注於我們的胃腸病目標拜訪點。讓我從 Salesforce 的架構角度來為您簡要描述一下這個演進過程。

Prior to our October restructuring, we had approximately 280 sales representatives in place.

在10月份重組之前，我們大約有280名銷售代表。

But they were situated in territories that had been mapped at launch around total PPI volume, which is basically mapping them around primary care PPI volume because that was our prior strategy.

但它們位於在推出時根據 PPI 總銷量繪製的區域內，這基本上是根據初級保健 PPI 銷量繪製的，因為這是我們之前的策略。

Prior to the restructuring in May. As of 2 weeks ago, what we've done is we have realigned the base territory maps.

在五月重組之前。兩週前，我們重新調整了基礎領土地圖。

So that we consolidated territories that did not have enough gastroenterologists to focus the reps time appropriately on those customers, and we created new territories where there was a high concentration of gastroenterologists.

因此，我們合併了腸胃科醫生數量不足的地區，以便銷售代表能夠將時間合理地集中在這些客戶身上；同時，我們也創建了腸胃科醫生高度集中的新地區。

The transition of territories does create a bit of disruption in the field during this quarter.

本季領土的變更確實為該領域帶來了一些混亂。

At full strength by Q1 when we filled the open territories, we expect to have approximately 300 sales representatives in place.

到第一季我們填補了所有空缺區域後，預計我們將擁有約 300 名銷售代表。

The net effect at the end of this transition is to create territories that are better balanced to enable us to call on every target gastroenterologist with the desired frequency.

此次轉型最終的淨效果是創造一個更平衡的區域，使我們能夠以所需的頻率拜訪每位目標胃腸病學家。

This realignment in the salesforce territories could have some temporary impact in Q4, which we've considered in updating our revenue guidance for this quarter and and setting our updated guidance for the year.

銷售團隊區域的這種重新調整可能會對第四季度產生一些暫時性的影響，我們在更新本季收入預期和製定全年更新預期時已經考慮到了這一點。

We believe the Salesforce realignment can accelerate our growth during 2026. It may take some time to see the full impact of the Salesforce realignment activity.

我們相信 Salesforce 的重組可以加速我們在 2026 年的成長。Salesforce 重組活動的全部影響可能需要一段時間才能顯現。

The gastroenterology opportunity for Vesna includes a target universe of approximately 24,000 gastroenterology writers, and that includes 17,000 physicians and about 7,000 affiliated nurse practitioners and physicians' assistants.

Vesna 的胃腸病學機會包括約 24,000 名胃腸病學撰稿人的目標群體，其中包括 17,000 名醫生和約 7,000 名附屬執業護理師和醫師助理。

Collectively, those 24,000 GI targets write about 20 million PPI prescriptions every year.

這 24,000 名胃腸道疾病患者每年總共開出約 2,000 萬張 PPI 處方。

That's our opportunity set.

這就是我們所面臨的機會。

At our current prescription run rate in GI, we believe we've converted approximately 3% of the GIPPI.

按照我們目前在胃腸道的處方運行速度，我們相信我們已經轉化了大約 3% 的 GIPPI。

Prescribing a market opportunity of 20 million prescriptions a year.

每年可開出 2000 萬張處方，這是一個巨大的市場機會。

If we are able over time to convert 20% to 30% of that 20 million prescription volume, We believe that that penetration could potentially reach or exceed $1 billion in revenue per year within the gastroenterology target universe alone.

如果我們能夠逐步將這 2000 萬張處方中的 20% 到 30% 轉化為實際應用，我們相信，僅在胃腸病學目標領域，這種滲透率就有可能達到或超過每年 10 億美元的收入。

Obviously there's a much bigger opportunity than that, and that opportunity resides in primary care, and we do believe that in future years our expansion back into more depth and time in primary care clinics could potentially drive revenue to an even higher number, possibly reaching $2 billion or more in revenue.

顯然，機會遠不止於此，而這個機會就在於基層醫療。我們相信，未來幾年，如果我們能夠更深入、更長時間地拓展基層醫療診所，就有可能將收入推向更高的水平，甚至可能達到 20 億美元或更多。

A quick update on our clinical program. We have recently initiated our phase 2 clinical trial in Eosinophilic esophagitis.

關於我們臨床項目的簡要匯報。我們最近啟動了嗜酸性食道炎的第二期臨床試驗。

Screening of patients is currently underway in that study. So we've initiated study sites, we've initiated screening patients with the first subject enrolled in the study expected in Q4, as we've previously communicated.

該研究目前正在進行患者篩檢。因此，我們已經啟動了研究中心，並開始篩選患者，預計第四季度將有第一位受試者入組，正如我們之前所溝通的那樣。

Just as a quick reminder, the rationale for this study is twofold. Now, first, in terms of market opportunity, PPI therapy is currently first line therapy for EOE patients.

簡單提醒一下，這項研究的理由有兩面。首先，就市場機會而言，PPI 療法目前是 EOE 患者的第一線療法。

There is an opportunity for Boisean, therefore, to play an important role in EOE treatment, potentially displacing some portion or a meaningful portion of that PPI usage in EOE patients if the trial is successful.

因此，如果試驗成功，Boisean 有機會在 EOE 治療中發揮重要作用，並有可能取代 EOE 患者中部分或相當一部分 PPI 的使用。

And if the program overall is successful.

如果整個專案總體上是成功的。

Second, if this phase 2 study is successful, We believe that we have an opportunity or may have an opportunity to receive a written request from the FDA to conduct a phase 3 study that includes pediatric patients, and that creates the potential for us to extend our regulatory exclusivity by an additional 6 months. That'll be determined at the end of the phase 2 trial as we have conversations with FDA at that time.

其次，如果這項 2 期研究取得成功，我們相信我們有機會或可能有機會收到 FDA 的書面請求，進行一項包括兒科患者的 3 期研究，這將使我們有可能將監管獨佔期再延長 6 個月。這將在第二階段試驗結束時確定，屆時我們將與FDA進行討論。

We expect to report top-line results from this study in 2027.

我們預計將於 2027 年公佈這項研究的主要結果。

As we're on the topic of regulatory exclusivity, just a quick reminder for everyone, we've updated the Orange Book, or FDA rather, updated the Orange Book to indicate that we have exclusivity through May of 2032.

既然我們談到了監管獨佔權，那就快速提醒一下大家，我們已經更新了橙皮書，或者更確切地說，是FDA更新了橙皮書，以表明我們的獨佔權將持續到2032年5月。

The mechanics of how that works actually provides this exclusivity into 2033 because an ANDA filing is not permitted until that May of 2032 date. So with a 10 to 18 month typical and review timeline, we believe generic entry is unlikely until 202,033.

其運作機制實際上提供了這種獨佔性，直至 2033 年，因為 ANDA 申請要到 2032 年 5 月才被允許。因此，按照 10 到 18 個月的典型審查時間表，我們認為仿製藥上市不太可能在 202,033 年之前實現。

A note on the Bresna triple pack update that we've previously discussed. We've had good progress here working with our supplier of the triple packs.

關於我們之前討論過的 Bresna 三重包更新的說明。我們與三包裝供應商的合作進展順利。

You may recall from our update in August that there has been some risk of disruption to the availability of the clarithromycin component in our triple pack from the supplier of that product.

您可能還記得我們在 8 月的更新中提到，我們三聯裝中的克拉黴素成分的供應存在一定程度的中斷風險​​，該成分來自該產品的供應商。

We have not to date experienced any disruption. And triple pack availability, and based upon recent communications do not anticipate any near term interruption, although there is still some uncertainty in this area. We will continue to monitor this closely and provide any updates that are needed.

到目前為止，我們尚未遇到任何中斷。三包裝供應情況良好，根據最近的溝通，預計近期不會出現任何中斷，儘管這方面仍存在一些不確定性。我們將繼續密切關注此事，並根據需要提供最新資訊。

We are executing a fathom with discipline and momentum to implement our TI focused strategy.

我們正以嚴謹的作風和強勁的勢頭執行一項以TI為中心的戰略。

The financial picture of the company is in order with solid execution on our plan.

公司財務狀況良好，計畫執行得也很穩健。

We have a talented and engaged team throughout Fathom driving a revenue growth.

Fathom 擁有一支才華橫溢、積極進取的團隊，致力於推動營收成長。

I'll turn it over at this point to Sanjeev to provide more detail on the financials and the outlook for the year.

接下來我將把發言權交給桑吉夫，讓他詳細介紹財務狀況和今年的展望。

Thank you, Stephen. Hello, everyone.

謝謝你，史蒂芬。大家好。

I wanted to begin by saying how privileged and excited I am to be part of Fathom Pharmaceutical at this critical inflection point for the company.

首先，我想表達我多麼榮幸和興奮能夠在這個對 Fathom Pharmaceutical 而言至關重要的轉折點成為其中的一員。

Because I thought about my next chapter, I focused on three questions. Does the work matter for patients? Can I help build something durable and if they seem truly aligned with the mission?

因為我在思考人生的下一個階段，所以我專注於三個問題。這項工作對患者有影響嗎？我能否參與建造一些持久耐用的東西，並且它們看起來確實與使命相符？

At the heart of it, I wanted to join a company where work being done has potential to directly improve patients' life.

從根本上說，我希望加入一家能夠直接改善病患生活的公司。

Fathom and Vesna checked all three boxes for me. That, that's what drew me here.

Fathom 和 Vesna 完全符合我的三個要求。正是這一點吸引我來到這裡。

Poly conversation with Steve made the strategy clear sharper on focus and execute with discipline. The company's on a solid footing in the plan, growing the top-line while being disciplined with expense management resonates with me. I'm especially aligned with the depth among GI writers commercial approach.

與史蒂夫的深入交流使策略更加清晰，更加重視重點並有條不紊地執行。公司目前的計畫基礎穩固，在保持成本控制嚴格的同時實現營收成長，這一點我很認同。我尤其贊同GI作家們深入的商業方法。

I've seen the specialist playbook work for worked in my prior experience and I believe it's the right fit for work.

我之前的經驗表明，這種專業化的策略手冊是行之有效的，我相信它非常適合這份工作。

My first week here I've only strengthened that conviction. We are all in in our goal to become a profitable, durable GI company. The foundation is strong, and I'm excited to help this team build on existing momentum.

我來到這裡的第一周，就更加堅定了這個信念。我們全力以赴，致力於成為一家獲利且永續發展的GI公司。基礎很牢固，我很高興能幫助這個團隊在現有動能的基礎上再創佳績。

Before I dive into the results, I would be remiss if I did not thank Robert Breedlove for his effort during the transition phase while Fathom was searching for a CFO. Robert will continue to serve as our principal accounting officer and as an important leader in our organization. With that, let me turn to results.

在深入探討結果之前，我必須感謝 Robert Breedlove 在 Fathom 尋找財務長的過渡階段所做的努力。Robert將繼續擔任我們的首席會計官，並繼續擔任我們組織的重要領導者。接下來，讓我來看看結果。

We're pleased with our solid financial results for third quarter for 2025 and feel that clearly demonstrate the progress being made as a result of shift in our strategy.

我們對 2025 年第三季穩健的財務表現感到滿意，並認為這清楚地表明了我們策略轉變所取得的進展。

As he mentioned, we reported topline net revenue of 49.5 million in quarter 3. In connection with our strong quarter and year-to-date results, we're updating our full year revenue guidance to 170 to 175 million.

正如他所提到的，我們第三季的淨收入為 4,950 萬美元。鑑於我們強勁的季度和年初至今的業績，我們將全年營收預期更新為 1.7 億至 1.75 億美元。

Q3 revenue represents a 25% increase compared to prior quarter, driven almost entirely by covered prescription, which grew approximately 23% during the quarter.

第三季營收比上一季成長了 25%，幾乎完全得益於健保處方藥的成長，該季健保處方藥成長了約 23%。

Cash pay prescription and changes to wholesale inventory had minimal impact to our courts.

現金支付處方和批發庫存的變動對我們的法院影響甚微。

For 3rd quarter of 2025, our gross to net came in towards the lower end of previously guided 55% to 65% range. Based on these results and our expectation for the rest of the year, we're tightening our quarter 4 gross to net range to between 55% to 60%.

2025 年第三季度，我們的毛利潤與淨利潤之比接近先前預期的 55% 至 65% 範圍的下限。根據這些結果以及我們對今年剩餘時間的預期，我們將第四季度毛利潤與淨利潤的比率範圍收窄至 55% 至 60%。

A gross profit for the quarter of approximately 87% in line with our expectation. This margin, which includes product cost as well as licensing royalties, continues to be consistent compared to previous quarter.

本季毛利率約 87%，符合我們的預期。此利潤率（包括產品成本和許可費）與上一季相比保持穩定。

After accounting for quarterly cash expenses, we reported a loss from operations excluding stock-based compensation of only $6 million.

扣除季度現金支出後，我們報告的營業虧損（不包括股票選擇權費用）僅為 600 萬美元。

This is an 88% improvement compared to previous quarter.

與上一季相比，提高了88%。

Overall, we believe our revenue results today reflect the progress of ongoing commercial efforts to focus on GIs.

總體而言，我們認為今天的營收業績反映了我們持續專注於胃腸道疾病的商業努力所取得的進展。

Now let's turn to operating expenses as a reminder in the scope of this discussion, when we refer to operating expenses, we will be referring to non-GAAP form of this measure, which excludes non-cash stock-based compensation.

現在讓我們來談談營運費用。需要提醒的是，在本討論範圍內，當我們提到營運費用時，我們指的是該指標的非GAAP形式，其中不包括非現金股票選擇權費用。

For quarter 3, we reported operating expenses of 49.3 million, which excludes 9.3 million of stock-based compensation.

第三季度，我們報告的營運支出為 4,930 萬，其中不包括 930 萬的股票選擇權費用。

Compared to the same period in 2024, this represents a decrease of 38%.

與 2024 年同期相比，這代表下降了 38%。

The year over year decrease primarily reflects a reduction in personnel cost and a sharper focus on commercial activities that we expect to materially drive forwent adoption.

與前一年相比，下降主要反映了人員成本的降低以及對商業活動的更加重視，我們預計這將實質地推動放棄採用。

We believe these results demonstrate our commitment to discipline; cost management will continue to grow revenues.

我們相信這些結果證明了我們對紀律的承諾；成本控制將繼續促進收入成長。

In fact, we also achieved a meaningful reduction in spending this quarter compared to quarter 2 and quarter 1 of 2025.

事實上，與 2025 年第二季和第一季相比，本季我們的支出也實現了顯著下降。

Our Q3 operating expenses reflect a 36.8 million or 43% decrease from quarter to 2025 and 48.8 million or 50% decrease from Q1 2025.

我們的第三季營運費用較 2025 年第一季減少 3,680 萬美元，降幅達 43%；較 2025 年第一季減少 4,880 萬美元，降幅達 50%。

Importantly, this quarter cash operating expenses were well within our previous guidance of below 60 million.

重要的是，本季現金營運支出遠低於我們先前設定的 6,000 萬美元的預期。

For additional context, the main driver for decreasing spend between Q3 and Q2 for a reduction of approximately 19 million in advertising spend. Primarily DTC was turned off as of June 30th, 10 million in headcount and restructuring related spend, and 8 million in vendor cost.

補充說明，第三季和第二季支出下降的主要原因是廣告支出減少了約 1,900 萬美元。主要 DTC 業務已於 6 月 30 日關閉，涉及人員和重組相關支出 1,000 萬美元，以及供應商成本 800 萬美元。

Looking forward to Q4, we expect expenses to be somewhat higher than Q3, primarily related to the initiation of phase 2 EOE trial. Even with EOE included, we read to date our previous guidance for 4th quarter operating expenses being below $55 million excluding stock-based compensation.

展望第四季度，我們預期支出將比第三季略高，主要與啟動 EOE 第二期試驗有關。即使將EOE（股權激勵計畫）計入在內，我們目前的數據顯示，第四季營運支出（不包括股權激勵）仍低於5,500萬美元，與我們先前的預期相符。

Based on our Q3 results and anticipated Q4 targets, we're refining a full year 2025 non-GAAP operating expenses to 280 to 290 million.

根據我們第三季的業績和預期的第四季目標，我們將 2025 年全年非 GAAP 營運費用調整為 2.8 億至 2.9 億美元。

We believe our results clearly show a path towards operating profitability in 2026, excluding stock-based compensation.

我們相信，我們的業績清楚地表明，在不計入股權激勵的情況下，公司將在 2026 年實現營運獲利。

Net revenue this quarter have already begun to outpace cash operating expenses, and we believe gross profit will follow suit.

本季淨收入已經開始超過現金營運支出，我們相信毛利也將隨之成長。

In this event, we expect the operating profit generated to organically strengthen our balance sheet and provide an opportunity to further investment in our business.

在這種情況下，我們預計產生的營業利潤將有機地增強我們的資產負債表，並為進一步投資我們的業務提供機會。

As of September 30th, 2025, our cash and cash equivalent total approximately 135 million, reflecting only a 14 million reduction in that cash.

截至 2025 年 9 月 30 日，我們的現金及現金等價物總額約為 1.35 億美元，僅比去年同期減少了 1,400 萬美元。

This net cash us usage reflects a significant 77% reduction compared to last quarter of approximately 63 million.

這筆淨現金使用量較上一季的約 6,300 萬美元大幅減少了 77%。

Based on our current revenue outlook and operating forecast, we rerate our belief that current cash balance can support operations through the anticipated point of achieving operating profitability in 2026, excluding stock-based compensation without the need for additional equity financing.

根據我們目前的收入前景和營運預測，我們重新評估了我們的看法，即目前的現金餘額可以支持營運到預計在 2026 年實現營運獲利為止，不包括股票選擇權費用，而無需額外的股權融資。

I feel very confident in our financial position and our path forward. We believe we have brought down expenses to a point that materially improves financial profile of the business in concert with anticipated revenue growth. With this improved financial profile, we expect to have the ability to modify or refinance an existing debt to provide greater flexibility.

我對我們的財務狀況和未來發展方向充滿信心。我們相信，我們已經將開支降低到一定程度，從而在預期收入成長的前提下，顯著改善了公司的財務狀況。憑藉這種改善的財務狀況，我們預計能夠修改或再融資現有債務，從而提供更大的靈活性。

I'm excited to be at fathom at such a pivotal point in the company's journey. Our strong results this quarter are encouraging, and we remain confident in our ability to execute on our strategy for the remainder of 2025 and into next year.

我很興奮能在 Fathom 公司發展歷程的這個關鍵時刻加入公司。本季強勁的業績令人鼓舞，我們仍有信心在 2025 年剩餘時間和明年繼續執行我們的策略。

With that, I will note on the call back to Steve for his closing comments. Steve.

最後，我會記下稍後給史蒂夫打電話，請他做總結發言。史蒂夫。

Thank you, Sanjeev, for the helpful financial update. To wrap up, I'll just reiterate a couple of key points. And I realize we've already, said some of this, but just in summary, we're really pleased with the way the third quarter went. Revenue was up 25%, cash operating expenses were down 43% for Q2, and cash usage was down by 77%. We are executing on the strategy that we laid out, approximately 6 months ago on our May call. Our strategy to concentrate on our gastroenterology call points is being executed crisply.

謝謝Sanjeev提供的有用的財務資訊。最後，我再重申幾個重點。我知道我們已經說過一些相關內容了，但總而言之，我們對第三季的表現非常滿意。第二季營收成長 25%，現金營運支出下降 43%，現金使用量下降 77%。我們正在執行大約6個月前，也就是5月的電話會議上所製定的策略。我們專注於腸胃科呼叫點的策略正在有效執行。

And with the momentum both financially and operationally throughout the organization, we believe we are well positioned moving forward.

憑藉公司在財務和營運方面的良好勢頭，我們相信我們已經為未來的發展做好了充分準備。

My sincere thanks to our fathom team members for their extraordinary dedication and diligence throughout this year and on an ongoing basis, and to the physicians and patients who trust in our products every day, and to our shareholders, joining us on this call and all of our shareholders for their continued support.

我衷心感謝 Fathom 團隊成員在過去一年以及未來持續展現出的非凡奉獻和勤勉，感謝每天信任我們產品的醫生和患者，感謝參​​加本次電話會議的股東們以及所有股東的持續支持。

And I'll turn the call over to the operator for any questions.

如有任何疑問，我將把電話轉接給接線生。

Thank you. As a reminder to ask a question, you will need to press 11 on your telephone. To remove yourself from the queue, you may press 11 again. Please stand by while we compile the Q&A roster.

謝謝。提醒您，要提問，您需要在電話上按 11。若要從佇列中移除自己，您可以再次按 11。請稍候，我們正在整理問答名單。

Our first question comes from the line of Omar Raffat of Evercore. Please go ahead, Omar.

我們的第一個問題來自 Evercore 的 Omar Raffat。請繼續，奧馬爾。

Thank you guys and congratulations on on Sanjeev. I have two questions if I may 1st, if I look at your prescription growth over the last couple of quarters, it looks like you're tracking at about 48,000 in additional prescriptions in 2 and 3Q, and Per guidance, even if I take the high end of guidance, it looks like the guidance is baking in only 35,000 prescriptions in 4Q. And I guess that's my question. Is that what you're baking in that prescription growth steps down in 4Q, which leads me to the second question, which is, the cost cuts and the discipline coming through is solid right now. How the cost discipline is very solid right now, but my question is from those advertising cuts that Sanjeev spoke to. Do you anticipate any impact as we head into 12 and 2 next year, because they may not show right away.

謝謝大家，也祝賀Sanjeev。如果可以的話，我有兩個問題。第一，如果我看一下您過去幾個季度的處方增長情況，看起來您在第二季度和第三季度新增處方量約為 48,000 張；而根據指導意見，即使我採用指導意見的上限，看起來該指導意見也只包含了第四季度 35,000 張處方。這就是我的問題。你是不是預料到處方藥成長會在第四季放緩？這就引出了我的第二個問題，那就是，目前的成本削減和紀律措施是否有效。目前成本控制非常穩健，但我的問題是桑吉夫提到的廣告削減措施。你預計明年進入 12 和 2 賽季會有什麼影響嗎？因為它們可能不會立即顯現出來。

Thank you.

謝謝。

Irma, thanks so much for dialing in. This is Steve. I appreciate the questions. First on the growth, we are continuing to see, really, positive traction with all of our gastroenterology accounts in the context of the. Strategy to go deeper within gastroenterology. Our guidance for the full year, was in fact narrowed to the upper end of the range, but we're trying to balance both the momentum that we're going to gain. In the gastroenterology accounts with the fact that in Q4 we are going through the salesforce transition and so those two variables, have somewhat offsetting effects, and we, wanted to guide appropriately to something that we had significant confidence in and to your second point, about the expenses, I think the management has been very disciplined. The expenses that have been kind of streamlined. We're not driving the top-line per se. I think that's the key point to note here and we've been obviously very mindful of watching the script trends, watching the return on the investments, and we feel comfortable with the level that we have is sustainable.

伊爾瑪，非常感謝你撥通電話。這是史蒂夫。感謝大家的提問。首先，就成長而言，我們看到，在當前情況下，我們所有的胃腸病學客戶都持續取得了積極的進展。深入研究胃腸病學的策略。事實上，我們對全年的業績預期已經縮小到預期範圍的上限，但我們正在努力平衡我們將要獲得的成長勢頭。考慮到第四季度我們正在經歷銷售團隊的過渡，胃腸病學帳戶的這兩個變數在某種程度上相互抵消，我們希望引導我們做出我們非常有信心的決定。至於你提到的第二點，關於費用，我認為管理階層一直都非常自律。各項開支已簡化。我們本身並不是推動營收成長的主要力量。我認為這是需要注意的關鍵點，我們顯然一直非常關注劇本趨勢和投資回報，我們認為我們目前的水平是可持續的。

Obviously, our job as a management team is to make sure, we maximize the top-line and we'll continue to watch the expense level, but right now if we feel. We're not going to have any impact from the DTC that we paused at the end of second quarter, but we'll continue to watch as we go forward.

顯然，我們管理團隊的職責是確保最大化收入，我們將繼續專注於支出水平，但現在如果我們覺得。我們不會受到第二季末暫停的DTC計劃的任何影響，但我們會繼續密切關注事態發展。

Thank you.

謝謝。

Thank you.

謝謝。

Our next question comes from the line of Kristin Kluka of cancer. Please go ahead, Kristen.

我們的下一個問題來自患有癌症的克里斯汀·克魯卡。請繼續，克里斯汀。

Good morning everybody thanks for taking the questions. So with the strategy, I wanted to ask how much you are still focusing on those PCPs that you were having success with initially I believe about 30% of the scripts you were seeing prior to this new alignment were on PCP. So was that mixed from several PCPs or did you find that there were some that were higher responders?

各位早安，感謝你們回答問題。所以，關於這個策略，我想問一下，您目前對那些您最初成功的初級保健醫生 (PCP) 的關注程度如何？我相信，在這種新的調整之前，您看到的處方中大約有 30% 是關於 PCP 的。所以這些結果是由幾位初級保健醫生綜合得出的，還是你發現有些醫生的反應更強烈？

So Kristen, that's thank you for the really important point that a large part of the PPI market does come from primary care. We are not ignoring that opportunity at all, and we are continuing to call on the customers that have already written scripts for VWsna. The PCPs that we took out of the call pattern during Q3 were primary care physicians who had not yet written the script. So anyone who had written the script stayed in the call targeting lists, and what we're trying to do is shift time toward GI, but it's not 100%. So ultimately where we want to get to is that 70% or more. Salesforce time is being spent in gastroenterology practices. Now that leaves 30% of our salesforce time to continue calling on the top decile primary care physicians, that is the primary care physicians who write the most PPI scripts and included in that call pattern set. Is the primary care physicians who have already adopted the product because naturally a physician who's already adopted is an opportunity for meaningful growth.

所以克里斯汀，非常感謝你指出這一點非常重要，即 PPI 市場很大一部分確實來自初級保健。我們完全沒有忽視這個機會，並且正在繼續聯繫那些已經為 VWsna 編寫過腳本的客戶。第三季我們從呼叫模式中移除的 PCP 是尚未編寫腳本的初級保健醫生。所以，所有編寫過腳本的人都留在了呼叫目標清單中，我們正在努力將時間轉移到GI上，但這還不是100%。所以，我們最終的目標是達到 70% 或更高。Salesforce 的時間都花在了胃腸病學實務。這樣一來，我們銷售團隊就有了 30% 的時間繼續拜訪排名前 10% 的初級保健醫生，也就是開立 PPI 處方最多的初級保健醫生，並且這些醫生都包含在我們設定的拜訪模式中。那些已經採用該產品的初級保健醫生，自然有機會實現有意義的成長。

I do think in future years you're going to see us after we have deep penetration within GI, think about how do we grow our penetration in primary care, but for the coming, quarter, certainly through 2026.

我認為在未來幾年，在我們深入滲透到胃腸道領域之後，你會看到我們思考如何擴大在初級保健領域的滲透率，但在接下來的一個季度，肯定到 2026 年。

Our focus is going to be, with an emphasis on GI, not excluding at all the PCPs that are adopting and growing.

我們的重點將放在胃腸道領域，但完全不會排除那些正在採用和發展該領域的初級保健醫生。

Okay thanks. Last question for me you mentioned that there were new territories created where there's a higher concentration of GIs. I'm curious if these were doctors that the team was not visiting or perhaps they were outside of the main area so they were still potential customers they just weren't getting as much face time with them since that territory didn't exist before.

好的，謝謝。最後一個問題，您提到在一些新的地區，地理標誌物更為集中。我很好奇這些醫生是不是團隊沒有拜訪過的，或者他們可能不在主要區域內，所以他們仍然是潛在客戶，只是因為以前沒有覆蓋到那個區域，所以團隊沒有太多機會與他們面對面交流。

Thank you.

謝謝。

That's right. That's right. If it's not that we had GI customers that we couldn't see at all. We couldn't see them with the frequency that we wanted to create the depth of adoption that we wanted. And so we had some territories that had 80 gastroenterologists in them. And if you think about the call pattern and the frequency that we want to achieve in order to really drive growth, that is a heavy call load that made sense to split some of those territories to be able to put two reps into that geography. We had other territories where they only had 10 gastroenterologists and they just can't spend that much time in 10 offices. And so that's where the realignment needed to take place.

這是正確的。這是正確的。如果不是因為我們有完全見不到的GI客戶的話。我們無法以我們想要的頻率見到他們，從而達到我們想要的普及程度。因此，我們有些地區竟然有 80 位腸胃病專家。如果你考慮我們想要達到的通話模式和頻率，以便真正推動成長，那麼大量的通話工作就顯得很有必要，因此將一些區域拆分，以便在該區域安排兩名銷售代表是合理的。我們還有一些地區只有 10 位腸胃科醫生，他們不可能在 10 個診所都花那麼多時間。因此，重組的必要性就在於此。

Thank you.

謝謝。

Thank you. Our next question comes from the line of Paul Choi of Goldman Sachs. Your line is open, Paul.

謝謝。我們的下一個問題來自高盛的 Paul Choi。保羅，你的線已接通。

Hi, thank you. Good morning and congrats on all the progress. With regard to the opening up of the Medicare access and and the cash pay component of it, could you maybe just comment on how you think the mix of cash pay as a mix of covered prescriptions and so forth will be evolving over the next few quarters. Any color on that would be great.

您好，謝謝。早安，恭喜你們取得的所有進展。關於開放醫療保險准入和現金支付部分，您能否談談您認為在接下來的幾個季度裡，現金支付、處方藥報銷等的組合將如何演變？任何顏色都行。

And then my second question is with regard to repeat prescribers, particularly in the GI channel, are you seeing any evidence of an increase in the, in the number of repeat prescriptions that your existing prescriber base is offering now? Any any quantification there would be helpful. Thanks for taking the questions.

我的第二個問題是關於重複處方醫生，特別是胃腸道管道的醫生，您是否看到現有處方醫生提供的重複處方數量增加？任何量化數據都會很有幫助。謝謝您回答問題。

Paul, thank you. Appreciate the questions on both of those points. Let me first take the sort of cash and Medicare versus covered prescription mix question, because we don't actually TRY to actively manage the mix or the ratio. And you'll see in the way that we presented the slides and the way that we've revised how we're talking about this, it's not about talking about total script number and what percentage is where, but rather, The growth specifically in the covered scripts and the growth specifically in the cash scripts and what we're attempting to do is drive growth in prescribing behavior, recognizing that both of those categories are going to grow.

保羅，謝謝你。感謝您提出的這兩個問題。首先讓我回答現金和健保與處方藥報銷比例的問題，因為我們實際上並沒有嘗試主動管理這種比例或組合。你會從我們展示投影片的方式以及我們修改後的討論方式中看到，重點不再是討論處方總數及其百分比，而是討論醫保覆蓋處方和現金處方的具體增長情況。我們試圖推動處方行為的成長，因為我們認識到這兩個類別都將成長。

And we're not actively trying to manage in any way what that ratio is, whether it's 30% or 35% in a given quarter.

我們並沒有主動嘗試以任何方式控制這個比例，無論是某個季度是 30% 還是 35%。

That's not a part of the conversation set that we have with any physician. The conversation that we have with physicians is about what patients.

這不屬於我們與任何醫生會談的內容範圍。我們與醫生們的談話內容是關於病人的需求。

Are most appropriate for them to consider starting Bwesna and how they make that decision and how they evolve their prescribing patterns. So I think what you're going to expect to see is growth in covered scripts and growth. In cash scripts and we're not attempting to actively forecast that ratio. We want to drive continued growth in both, on an aggressive basis.

對他們來說，是否最適合考慮開始使用 Bwesna，以及他們如何做出這個決定，以及他們如何改變他們的處方模式。所以我認為，你們將會看到的是承保劇本數量的成長和整體成長。在現金交易中，我們並沒有試圖主動預測該比例。我們希望在積極進取的前提下，推動這兩個領域持續成長。

I think the other important point Paul to note is, as Steve mentioned has prepared a Marxist.

我認為保羅需要指出的另一點是，正如史蒂夫所提到的，他已經準備好了一位馬克思主義者。

Our top-line revenue is driven by the covered scripts, which is what grew 23% this quarter, and clearly that's got a direct relationship and the other thing that I keep in mind is you shouldn't think about that one is cannibalizing the other both are growing depending upon where the patient is right fit. Based on all the coverage that doctor and the patient decides.

我們的主要收入來自健保覆蓋的處方藥，本季增加了 23%，這顯然與醫保覆蓋的處方藥有直接關係。我還要記住，你不應該認為健保覆蓋的處方藥會蠶食醫保覆蓋的處方藥，兩者都在增長，這取決於患者是否適合醫保覆蓋的處方藥。根據醫生和患者共同決定的所有保險範圍而定。

Yes, I think that last point is a really important one. In no way does our cash script volume cannibalize our covered script volume, that the incremental patient on Medicare who gets a cash script was never going to get coverage. So that's not lost revenue in any way. When that patient gets added, that's just. A positive additional impact in terms of the patient being satisfied with the product, the physician being satisfied that the patient gets access to the product, and the physician being more willing to adopt. So we actually think getting that extra Medicare patient started on Bowesna increases the propensity of that physician to prescribe our product for their covered patients as well.

是的，我認為最後一點非常重要。我們的現金處方量絕對不會蠶食我們的健保處方量，因為取得現金處方的Medicare新增患者原本就無法獲得健保。所以這根本不算收入損失。當那個病人被加進來時，就…正面的額外影響體現在：患者對產品的滿意度、醫生對患者獲得產品的滿意度，以及醫生更願意採用該產品。因此，我們認為讓額外的 Medicare 患者開始使用 Bowesna 會增加醫生為他們的受保患者開立我們產品的傾向。

The growth in one actually drives growth in both, so that's a part of the reason for turning on that that opportunity. The second part of the question on sort of the repeat prescribing behavior and evidence for increase, we're not providing specific metrics, but you can. Imagine we are in fact tracking the metrics internally.

一方的成長實際上會帶動另一方的成長，所以這也是抓住這個機會的部分原因。關於重複處方行為和增加的證據的問題的第二部分，我們沒有提供具體的指標，但您可以提供。假設我們實際上是在內部追蹤這些指標。

What we've done is we have evolved our selling model and our coaching model for the sales territories around what we are referring to internally as the adoption ladder, and that is how do we grow physicians from trialing the product, using the product a few times every quarter, to prescribing the product on average every other week, to, as an NRX, to prescribing the product on a weekly basis, to really making this a core part of their practice. And we are tracking physician growth up that adoption ladder. We're tracking it on a territory by territory basis. We're tracking it on a physician. Physician basis this is the coaching conversation that our regional sales managers are having with their territory managers as they are working through each conversation about each of their customers and we are seeing evidence that we're growing utilization. We're growing more and more physicians into that regular prescribing adopter category. And we're doing that on a monthly basis. We're just not giving the metrics because there's so many different metrics and so many different ways of looking at it, that it gets, complex.

我們所做的，是圍繞我們內部所說的「採用階梯」改進了我們的銷售模式和銷售區域的指導模式，也就是如何讓醫生從試用產品、每季度使用幾次產品，到平均每兩週開一次處方，再到成為新處方醫生，每週開一次處方，最終真正將該產品作為他們診療實踐的核心部分。我們正在追蹤醫師群體在這項採納過程中的發展。我們正在逐個地區進行追蹤。我們正在透過醫生追蹤此事。醫生們認為，這是我們的區域銷售經理在與他們的銷售經理討論每個客戶時，與他們進行指導性對話的內容，我們看到證據表明，我們的利用率正在提高。越來越多的醫生加入了常規處方醫生的行列。我們每月都會這樣做。我們不提供具體指標，因為指標太多，看待問題的方式也太多，情況變得複雜。

One other sort of broad perspective is, overall, as we described the 20 million.

另一種更廣闊的視角是，總體而言，正如我們所描述的 2000 萬。

Prescription opportunity in gastroenterology, we had 140,000 prescriptions in gastroenterology, in the gastroenterology segment in an estimate as an estimated number during.

在胃腸病學領域，處方機會方面，我們估計在胃腸病學領域有 140,000 張處方。

23, so annualize that and you get to something on the order of 600,000. You get to 3% of that 20 million run rate on an annualized basis. That's our growth opportunity. If we want to get to 10X, the current revenue in gastroenterology, we need to get to 30% rather than 3% of those scr20 million ipts. That's the focus in every conversation, and we are starting to see evidence of that growth pattern on an account-by-account basis.

23，那麼年化後大約是 60 萬左右。以年計算，你可以達到這 2000 萬運行率的 3%。這就是我們的發展機會。如果我們想達到目前胃腸病學收入的 10 倍，我們需要達到這 2,000 萬 ipt 中 30% 的份額，而不是 3%。這是每次對話的重點，而且我們已經開始看到這種成長模式在各個帳戶中得到體現。

Okay, great. Thanks for all the additional color.

好的，太好了。感謝你增添了這麼多色彩。

Thanks, Paul.

謝謝你，保羅。

Thank you. Our next question comes from the line of Yasin Sea of Guggenheim. Please go ahead, Yasin.

謝謝。我們的下一個問題來自古根漢美術館的亞辛西系列收藏。請繼續，亞辛。

Hey guys, can you hear me?

嘿，夥計們，你們聽得到我說話嗎？

Yes. Hi, everyone.

是的。大家好。

Thank you for all the details and congrats on pretty good execution. Maybe just two questions for me, as you are sort of trying to go more deeper into the GI community, can you just talk about the type of patients you are seeing right now? Can you also talk about, the penetration you might be seeing in nerd versus GERD population? And how should we think about the duration of treatment that is playing out right now? And Sanjeev, congratulations on the new opportunity. Maybe if you can maybe help us understand how should we think about 2026 as the sales ramp up, how should we think about the OpEx there?

感謝您提供的所有細節，恭喜您執行得非常出色。我可能只有兩個問題，因為您正在努力更深入地了解胃腸病學領域，您能談談您目前正在接診的患者類型嗎？您能否也談談您在書呆子族群和胃食道逆流症患者族群中觀察到的滲透率差異？那麼，我們應該如何看待目前正在進行的治療的持續時間？桑吉夫，恭喜你獲得新的機會。或許您能幫助我們理解，隨著 2026 年銷售額的成長，我們該如何看待當時的營運支出？

Thank you.

謝謝。

Okay, I'll let Sanjeev take the AX question at the end. Let me just jump into, the types of patients that we're seeing and sort of nerve versus within GI. The typical patient With either erosive esophagitis or non-erosive reflux, but the typical reflux patient that is landing in a gastroenterology practice has already been having conversations with their primary care physician for some time around their reflux.

好的，最後我讓桑吉夫來回答AX的問題。讓我直接切入正題，談談我們所見的患者類型，以及神經系統疾病與胃腸道疾病之間的關係。典型的患者可能是糜爛性食道炎或非糜爛性逆流，但通常情況下，前往胃腸病科就診的反流患者此前已經與他們的家庭醫生就反流問題進行過一段時間的溝通。

Almost always they will be started on a PPI because they're complaining about heartburn to their primary care physician. Most typically they'll be started on 20 mg. Omeprazole, they might then be escalated within the primary care practice to twice a day omeprazole or to 40 mg of omeprazole every day, or they might be adding Tums or other therapeutic modalities to their PPI whenever they have breakthrough heartburn, and it's when that patient is still experiencing significant pain and the physician has tried a couple of things and has not been able to resolve the heartburn, that's when they get the referral to gastroenterology. So the type of patient who lands in a gastroenterology practice is often a patient who's either tried BID dosing or has cycled through a couple of PPIs or has doubled their dose of PPI or is adding an H2 blocker or is adding antacids to their PPI and they're still having significant pain. So the patients who land in the gastroenterology practice and are being evaluated for their reflux are exactly the patients that should be switching to questa because they need more significant acid suppression. And we're hearing that in every conversation. I was just at ACG for a few days, having a number of conversations with gastroenterologists over over this past few days and the the commonality of the story that every patient who's landing in their office has already been on a PPI. Often they've been on it for years, often they've double dosed it. That's who they're seeing, and that's who they're switching, and that's why we think that we can capture a very meaningful percentage of that PPI volume in gastroenterology practices because that PPI volume is being prescribed to exactly the patients who need our drug. We don't have as clear a distinction on the breakout between non-erosive reflux and erosive esophagitis patients because physicians for a patient who is experiencing significant heartburn might prescribe 20 mg for patients in both categories.

幾乎所有患者都會因為向家庭醫生抱怨胃灼熱而被開始服用PPI藥物。最常見情況下，他們會從 20 毫克開始服用。如果患者服用奧美拉唑，初級保健醫生可能會將奧美拉唑的劑量增加到每天兩次，或每天 40 毫克；或者，當患者出現突破性燒心症狀時，醫生可能會在 PPI 中添加 Tums 或其他治療方法。當患者仍然感到劇烈疼痛，醫生嘗試了一些方法但仍然無法解決燒心問題時，醫生就會將患者轉診到胃腸科。因此，經常會遇到這樣的患者：他們要么嘗試過每日兩次的劑量，要么已經嘗試過幾種 PPI，要么已經將 PPI 的劑量加倍，要么正在添加 H2 阻滯劑，要么正在將抗酸劑添加到 PPI 中，但他們仍然感到劇烈的疼痛。因此，那些到胃腸病科就診並接受逆流評估的患者，正是應該改用 Questa 的患者，因為他們需要更強效的抑酸治療。我們在每次談話中都能聽到這樣的說法。我這幾天一直在美國胃腸病學會 (ACG) 工作，與多位胃腸病學家進行了交流，他們普遍反映，每個來就診的患者都已經服用過 PPI。他們往往已經服用多年，而且常常服用雙倍劑量。這就是他們看到的，也是他們正在轉而選擇的，因此我們認為我們可以在胃腸病學實踐中佔據 PPI 處方量非常可觀的百分比，因為這些 PPI 處方正是開給了需要我們藥物的患者。我們對非糜爛性逆流和糜爛性食道炎患者之間的界線沒有那麼清晰的界定，因為醫生可能會給出現嚴重燒心症狀的患者開 20 毫克的藥，而這兩類患者都可能屬於同一類別。

Our indication is specifically that the 20 mg should be for erosive esophagitis and 10 mg is the approved dose for non-erosive reflux, but it's really at the physician's discretion. How they use one or the other and one of the things we also see is that many patients who start on 20 mg never switch to 10 mg. They just maintain their treatment on 20 mg because if the patient's doing well, they just continue on with the treatment that's working for them. Which gets to the duration of therapy question. We are looking at that on an ongoing basis in an analysis that we did early on in the 1st 12 months of launch, we saw that we were getting 6 or 7 prescriptions from within a year for patients that converted.

我們的建議是，20 毫克適用於糜爛性食道炎，10 毫克是非糜爛性逆流的核准劑量，但實際上這取決於醫師的判斷。他們如何使用其中一種或另一種，我們還看到，許多從 20 毫克開始服用的患者從未換成 10 毫克。他們維持 20 毫克的治療劑量，因為如果病人狀況良好，他們就會繼續採用對病人有效的治療方法。這就引出了治療持續時間的問題。我們正在持續關注這個問題。在產品上市後的前 12 個月，我們進行了分析，發現一年內，轉化患者平均會獲得 6 到 7 張處方。

We are continuing to look at that on an ongoing basis to see whether or not that evolves in a meaningful way over time. And that analysis is ongoing. I would expect that we're going to get pretty good persistence over years with patients who are experiencing this level of heartburn because they get the positive reinforcement that when they take this drug, they feel better. That's going to cause someone to want to continue using it, but it's hard to predict exactly numerically how that evolves.

我們會持續關注此事，看看隨著時間的推移，它是否會以有意義的方式發展。分析仍在進行中。我預計，對於那些經歷這種程度胃灼熱的患者來說，我們會在幾年內獲得相當好的堅持性，因為他們會得到積極的回饋，即服用這種藥物後感覺好多了。這會導致有人想要繼續使用它，但很難用數字準確預測這種趨勢會如何發展。

Yeah, and yeah, and thank you for your question and.

是的，是的，謝謝你的提問。

Obviously we can't give you like 2026 financial guidance right now. We'll do that at the beginning of the year, but let me tell you a little bit qualitatively how we're thinking about, next year. So let me start first on the top-line. So you obviously you saw strong quarter 3 with 25% revenue growth. You saw in Q2 we had a 39% revenue growth with the pivoting strategy go deeper in GI we'll continue to see.

顯然，我們現在無法提供像2026年這樣的財務預測。我們將在年初進行這項工作，但讓我先定性地告訴你們我們對明年的想法。那麼，就讓我先從最關鍵的部分開始吧。顯然，你們看到了強勁的第三季業績，營收成長了25%。如您所見，第二季我們透過轉型策略實現了 39% 的營收成長，我們將繼續深入 GI 領域。

More prescriptions coming, very effective, calls, so that percentage of revenue growth will continue. Obviously it will moderate as the base becomes bigger and bigger, but you should expect that the top-line will continue to grow next year, quarter by quarter.

更多處方即將到來，效果顯著，因此收入成長百分比將繼續保持。顯然，隨著基數越來越大，成長會放緩，但預計明年營收將繼續逐季成長。

Number 2, I don't expect significant change in gross net. .

第二，我預計毛利不會有顯著變化。。

Because we got a good coverage, and, on where things are there are going to be pushes and pulls, but I don't expect fundamentally what a significant different grows to net, which will kind of give us a steady path to gross margin next year.

因為我們獲得了良好的市場覆蓋，而且，就目前的情況來看，肯定會有一些波動，但我預計從根本上來說，不會出現顯著的差異，這將為我們明年實現穩定的毛利率奠定基礎。

Now coming in terms of the operating expenses, I think the way to think about that in 222 kind of ways. One is what is the operating expense to run the base company with the indication and the strategy that we've gotten, so far, which is, which means pivoting to GI and going after the. The top decile primary care, I think we've reached that point with the expense level that we reached in this quarter or quarter 4. I think you will kind of see that and that will continue next year, as we go forward as a management team, obviously we'll be looking at all other investment opportunities which are revenue enhancing.

現在來說說營運費用，我認為應該從 222 的角度來考慮這個問題。一是按照我們目前所掌握的指示和策略營運基礎公司的營運費用是多少，這意味著轉向GI並追求。我認為，我們已經達到了前十分之一初級保健的水平，因為我們在本季度或第四季度達到了支出水平。我認為你會看到這種情況，而且這種情況明年還會繼續，隨著我們管理團隊的推進，顯然我們會關注所有其他能夠增加收入的投資機會。

And have a payback and then obviously we'll consider those but all of this put together you've got one thing we said that in the beginning of the discussion was we expect ourselves to be operating profit in operating profit position next year and that's kind of what we're striving to with the cash usage that we have of 14 million this this quarter. I mean that that goal is near to us, but again we will be providing all that beginning of the year when we give the guidance, but I feel very good about what the momentum is right now where we're entering into quarter 4 and then entering into next year with a with a solid set of financials.

然後會有回報，然後我們顯然會考慮這些，但所有這些加在一起，我們一開始就說過，我們預計明年將實現營業利潤，而這正是我們努力的目標，我們本季度的現金使用量為 1400 萬美元。我的意思是，這個目標離我們很近了，但我們會在年初發布業績指引時再做詳細說明，但我對目前的勢頭感到非常滿意，我們即將進入第四季度，並以穩健的財務數據開啟明年。

Thank you.

謝謝。

Our next question comes from the line of Joseph Stringer of Needham & Company. Please go ahead, Joseph.

我們的下一個問題來自尼德姆公司的約瑟夫·斯特林格。請繼續，約瑟夫。

Thank you, thanks for taking our questions. Just to from us, kind of a follow-up question, just given the backdrop of the 3Q print here where revenue came in higher than consensus and OpEx a bit lower. So in terms of hitting your goal of sustainable no GAAP profitability in 206 without the need for additional capital, you've been pretty consistent in that messaging so. I guess what's your confidence in hitting that goal now to say compared to your confidence level maybe last quarter and or a quarters past. And then secondly, with the, curious to get your thoughts on the new marketing analytics higher, what have they seen or what are some of the initial insights or takes from looking at the analytics or what the analytics are telling you about the Boquesna launch and the strategy there there was there any area, outside of some of your prepared marks that surprised you, or that could be optimized or areas where you could really drive uptake or growth going forward?

謝謝，感謝您回答我們的問題。我們想問一個後續問題，鑑於第三季財報顯示營收高於預期，營運支出略低於預期。所以，就實現206年無需額外資本即可實現可持續的非GAAP獲利目標而言，你們在資訊傳遞方面一直相當一致。我想問你，你現在對實現這個目標的信心與上個季度或前一個季度相比如何？其次，我很好奇您對新的行銷分析有何看法，您從分析中看到了什麼？或者說，您對分析結果有哪些初步的見解或看法？分析結果告訴您關於 Boquesna 的發布和策略的哪些資訊？除了您事先準備好的指標之外，還有哪些方面讓您感到驚訝？有哪些方面可以優化？有哪些方面可以真正推動未來的普及或成長？

Thank you.

謝謝。

So Jerry, thanks so much for both of the questions. First, in terms of sort of our confidence in getting to, positive, cash flow operations next year or positive, even as we've described it, we have, remained consistent since May in the indication that we believe that that's achievable. And I think what we've done this quarter is just demonstrate. That we are exactly on that path. So it's one more quarter of clear demonstration of exactly the path that we set out in May, which is we're going to continue to grow revenue. The thing that continues to drive revenue growth is sales force time in gastroenterology practices and driving growth. Depth of adoption in GI practices that remains unchanged. That's what we saw when we looked at the metrics back in May. That's what was working. That's what was driving our revenue. We've done more of that. We're continuing to drive revenue. My confidence that as we do more of that, we're going to continue to drive revenue is high.

傑瑞，非常感謝你的兩個問題。首先，就我們明年能否實現正現金流營運的信心而言，正如我們所描述的那樣，自 5 月以來，我們一直堅持認為這是可以實現的。我認為我們本季所做的就是展示。我們正走在這條路上。所以，這又是一個季度的清晰證明，我們完全按照五月制定的道路前進，那就是我們將繼續成長收入。推動收入成長的因素是胃腸病診所的銷售人員投入的時間和推動業務成長的動力。胃腸病學實踐中的應用深度仍然保持不變。我們在五月查看各項指標時就發現了這一點。那樣做是行之有效的。這就是我們收入的來源。我們已經做了更多這樣的事。我們正持續推動營收成長。我非常有信心，隨著我們在這方面投入更多精力，我們將繼續推動營收成長。

Similarly, as Sanjeev just mentioned a moment ago, we've brought down expenses we believe to a sustainable level in terms of our base operations, and we might on a discretionary basis choose to make additional investments in certain areas if we want to do certain clinical trials or if we want to run a program. So we're not. Guiding on this call to what the expense level is going to be in 2026. We'll provide that guidance as we get to 2026, but we are clearly vigilant about maintaining the expense level at a level where we can get to operating cash flow profitability.

同樣，正如桑吉夫剛才提到的，我們已經將基本營運成本降低到我們認為可持續的水平，如果我們想進行某些臨床試驗或開展某個項目，我們可能會酌情選擇在某些領域進行額外投資。所以我們不是。本次電話會議旨在預測 2026 年的支出水準。到 2026 年，我們將提供相關指導，但我們顯然會密切關注如何將支出水準控制在能夠實現經營現金流盈利的水平。

Next year and reaching operating profitability and, we wouldn't have said it if we didn't mean that we were going to TRY to work to diligently doing that and that we didn't believe we could do it. We absolutely do believe we can do it. From a marketing and analytics perspective, Nancy just started a couple of weeks ago, so I'm not going to speak for her as to what she's seen already, but our whole analytics team is spending a lot of time doing a deep dive on exactly how do we see detailed patterns. How can we direct the salesforce time and marketing programs ever more efficiently and effectively? That's something that's not a one or two week exercise. That is something that is going to be months and in fact, years of work on an ongoing basis. But I've just been, delighted working with Ay over the last couple of weeks, delighted working with Angie over the last few weeks, and, we've got a really solid team that is being very thoughtful as they work through the plan.

明年實現營運獲利，如果我們不是真心想努力實現這個目標，我們就不會這麼說，而且我們也不相信我們能做到。我們絕對相信我們能做到。從行銷和分析的角度來看，南希幾週前才開始工作，所以我不能代表她談論她已經看到的情況，但我們整個分析團隊正在花費大量時間深入研究我們究竟是如何看到詳細模式的。我們如何更有效率、更有效地指導銷售團隊的時間表和行銷計劃？那不是一兩週就能完成的事。那將是一項需要持續數月甚至數年才能完成的工作。但是，在過去的幾周里，我很高興能與 Ay 合作，也很高興能與 Angie 合作，我們擁有一個非常強大的團隊，他們在執行計劃的過程中非常深思熟慮。

Great thank you so much for taking our questions.

非常感謝您回答我們的問題。

Thank you. Our next question comes from the line of Dennis Ding of Jeffrey's. Your line is open, Dennis.

謝謝。我們的下一個問題來自 Jeffrey's 的 Dennis Ding。丹尼斯，你的線路已接通。

Hi this is Anthea on for Dennis.

大家好，我是安西婭，替丹尼斯為您報道。

Thank you for taking our questions and congrats on the quarter. I wanted to ask on the sales territory realignment, when do you expect that to complete and as you ramp up the additional 20 reps, when do you expect to see their productivity reflected in the top-line? And then second, in terms of expansion back into PCPs, what is the gating factor there or what would you want to see to consider taking that on again?

感謝您回答我們的問題，並祝賀您本季取得佳績。我想問一下關於銷售區域重新調整的問題，您預計何時完成？隨著新增 20 位銷售代表，您預計何時能看到他們的生產力反映在營收上？其次，就重新拓展到初級保健領域而言，有哪些限制因素？或者說，您希望看到什麼才會考慮再次涉足該領域？

Thank you.

謝謝。

So, Ding, thanks so much for the questions. Two quick things on sort of thinking about the territory realignment. We've already executed the territory realignments. All of the territory maps have been changed. All of the reps have their new territories. They are in their new territories calling on their new customers. But in the course of that, it does create some vacancies. We are actively recruiting for all of those positions, but obviously hiring doesn't happen in a week or two. Hiring takes months. So we will be bringing folks on through the course of this quarter and next to fill the open positions as we indicated on the call, I expect that, by Q1 as we fill all of the open territories, we will get to a salesforce strength of 300, but I actually feel really good about where we are already today. That as the significant salesforce strength that we already have is in the right territories calling in the right customers, we're going to start to see that traction, but we'll see incremental impact as we fill those territories through Q1, and that should play out through 2026. And as I communicate, I think you're going to see an acceleration in growth through 2026 as we get more and more of that traction. The other element of sort of what drives us back into the primary care market, there's an organic phenomenon that's going to happen, and it's going to turn into revenue. It's going to turn into metrics that then drive when we make the decision. So one of the key metrics that we look at is NBRX per sales call, and that is how many new patient conversions are we getting relative to the amount of time that we're spending in a physician's practice. NDRX for sales call is much higher today for us in gastroenterology versus primary care, which is why we're driving s Salesforce time into gastroenterology practices. NBRX for sales call is going to go up over time in primary care because primary care physicians will become more familiar with Vuesna as more of their patients who've been converted onto Vuesna and GI practices go back into the primary care office and talk to their physician about how. Better they feel. The primary care physician had a patient in pain, sent them to a GI, came back. Their first question was naturally going to be in the next visit. Well, how are you doing? How did that referral go? When the conversation goes to the President, they feel a whole lot better and a physician has heard from 58, 10 patients. That's when that becomes a much softer target call for us to be able to drive conversions, and we'll see that NBRX per sales call number go up. At some point that becomes really profitable to make an investment and growing in that space. Now I don't think that's a 2026 thing. I think that's 27 or 28, but at some point when that metric works and we're getting positive ROI for that incremental investment, you'll see us, expand into more time in primary care as well.

丁，非常感謝你的提問。關於領土重新劃分的思考，有兩點需要簡單說明。我們已經完成了領土重新劃分。所有領土地圖都已更改。所有銷售代表都有了新的負責區域。他們來到了新的領域，拜訪他們的新客戶。但在此過程中，確實會產生一些空缺職位。我們正在積極招聘所有這些職位，但顯然招聘工作不會在一兩週內完成。招聘需要數月時間。因此，我們將在本季度和下個季度陸續招人來填補空缺職位，正如我們在電話會議上提到的那樣。我預計，到第一季度，隨著我們填補所有空缺區域，我們的銷售團隊規模將達到 300 人，但我對我們目前所處的狀況感到非常滿意。由於我們現有的強大銷售團隊分佈在正確的地區，正在聯繫正確的客戶，我們將開始看到成效，但隨著我們在第一季度填滿這些地區，我們將看到逐步的影響，這種情況應該會持續到 2026 年。隨著我不斷溝通，我認為到 2026 年，隨著我們獲得越來越多的支持，你們將會看到成長加速。促使我們重返基層醫療市場的另一個因素是，一種自然的現象將會發生，並且它將轉化為收入。它將轉化為一系列指標，這些指標將引導我們做出決策。因此，我們關注的關鍵指標之一是每次銷售拜訪的 NBRX，也就是相對於我們在醫生診所花費的時間，我們獲得了多少新病患轉換。今天，我們胃腸病學領域的銷售電話 NDRX 比初級保健領域高得多，這就是為什麼我們要將 Salesforce 時間投入到胃腸病學實踐中的原因。隨著越來越多的患者轉用 Vuesna 和 GI 療法，初級保健醫生會更加熟悉 Vuesna，而這些患者會回到初級保健辦公室與醫生討論如何使用 Vuesna，因此，NBRX 在初級保健領域的銷售電話數量會隨著時間的推移而增加。他們感覺好多了。全科醫生接診了一位疼痛的病人，將其轉診至腸胃科醫生，然後又將病人送了回來。他們的第一個問題自然是在下次來訪時提出。你好嗎？那次轉診進展如何？當談話對像是總統時，他們感覺好多了，一位醫生已經從 58,10 位患者那裡聽說了這件事。那時，我們的目標電話就會變得容易得多，更容易促成轉化，我們會看到每次銷售電話的 NBRX 數量上升。當某個階段，投資並發展這個領域變得非常有利可圖時，情況就會有所改變。現在我覺得那不是2026年才會發生的事。我認為應該是 27 或 28，但當這個指標奏效，而我們從這筆增量投資中獲得正的回報時，你會看到我們也會把更多的時間投入到基層醫療中。

Great thank you so much.

太好了，非常感謝。

Thank you. Our next question comes from the line of Annabelle Sain of Stifo. Please go ahead, Annabelle.

謝謝。我們的下一個問題來自 Stifo 的 Annabelle Sain。請繼續，安娜貝爾。

Hi all, thanks for taking my question. I think you guys have covered a lot already, but clearly you have a great opportunity within the GI community. Maybe you can just on the flip side, talk about some of the reasons why physicians have not yet adopted. It is it a matter of awareness or one of reimbursement, and it seems like there is high-end awareness, so.

大家好，感謝各位回答我的問題。我認為你們已經涵蓋了很多內容，但顯然你們在胃腸病學領域擁有巨大的發展機會。或許你可以換個角度，談談醫生們尚未採用這種方法的一些原因。這究竟是意識層面的問題還是補償層面的問題，目前看來，高端意識似乎很強了。

For the GI, the new GI doc, what is the average number of calls that you need to convert these docs? I guess what I'm asking is, at some points do you expect some.

對於 GI（通用資訊系統），即新的 GI 文檔，平均需要多少次調用才能轉換這些文檔？我想問的是，在某些時候，你是否會期待一些事情發生？

Inflection points in sales with this critical mass that you've now focused on GI dots, so that's my question.

銷售拐點，以及您現在關注的臨界規模，都是 GI 點，所以我的問題是：

Annabelle, thanks so much for the question. And I agree we do have a terrific opportunity within GI and that's an opportunity to get to really significant revenue. So, there's not actually an impediment to first adoption within GI. In fact, the vast majority of gastroenterologists have already written prescriptions for Voquesna. What we need to do is change behaviors to frequency of writing. And that happens gradually. The major impediment candidly is 30 years of habit that they've been prescribing PPIs for 30 years. They're comfortable with them. It's their sort of first inclination. It's the easy thing to do. And what we are trying to do is shift practice patterns away from ingrained 30-year habits that are easy and comfortable and familiar to a new product that provides a meaningfully better outcome for their patients. Their patients when they are on Buesna feel a whole lot better, and what it takes to change that is repetition of conversation, repetition of experience, feedback from actual patient experience. So we might get a physician to start writing, but only for the patients that have failed everything else, they switched them to between 3 PPIs. They switched them to double dose BID PPIs, and now they finally switched them to nothing else to do. As soon as that patient tells the doc that they're feeling better. There's an opportunity for the sales rep to have a conversation about, doc, why are you waiting to switch through 3 PPIs before you use the product? Why don't we start using it on anybody who's coming into your practice who looks like this patient characteristic but doesn't need to go through all of that difficulty and challenge, you can get them started sooner. Maybe they start with their erosive esophagitiss grade C&D patients because we've got clear clinical evidence. Superior healing in those patients and then after they see the significant healing, we start talking to them about their grade B erosive esophagitis patients and patients where they think they might not heal well enough on a PPI and they ought to convert. And as they get more experience, they grow their utilization and then eventually we're talking to them about patients that are having nighttime heartburn even though they have no erosive reflux and how do you think about those populations. So, it's really about growing the adoption pattern. It's not enough to get a first adoption. It's about changing patterns in broad categories of patients. It happens incrementally with multiple sales calls, and we are seeing that happen. There's not an impediment to first writing. There's really just a habit change process that comes from reinforcement, multiple calls, multiple patient feedback experiences, and that's happening today and it's happening organically.

安娜貝爾，非常感謝你的提問。我同意我們在GI領域確實擁有絕佳的機會，這是一個獲得可觀收入的機會。所以，在胃腸病學領域，首次採用其實並沒有什麼障礙。事實上，絕大多數腸胃科醫生已經開過 Voquesna 的處方。我們需要做的是改變寫作頻率。而這個過程是逐漸發生的。坦白說，最大的障礙是他們30年來一直開立PPI處方的習慣。他們覺得這樣很舒服。這是他們的第一個反應。這是很容易做到的事。我們正在努力改變的是，將人們的診療模式從根深蒂固的 30 年的、輕鬆舒適且熟悉的習慣，轉變為一種能夠為患者帶來更顯著療效的新產品。他們的病人在服用布斯那後感覺好多了，而改變這一點需要反覆的談話、反覆的經驗、來自實際病人經驗的回饋。所以，我們可能會讓醫生開始開處方，但僅限於那些其他所有方法都無效的患者，他們會將患者換成 3 種 PPI 藥物。他們先是把他們換成了每日兩次服用雙倍劑量的PPI，現在他們終於決定不再採取其他措施了。一旦病人告訴醫生自己感覺好多了。銷售代表可以藉此機會與客戶探討一下，醫生，為什麼您在使用該產品之前要等到更換 3 個 PPI 之後？為什麼我們不開始對任何前來就診、具有這種患者特徵但不需要經歷所有這些困難和挑戰的患者使用這種方法呢？這樣可以讓他們更快開始治療。或許他們會從C級和D級糜爛性食道炎患者開始，因為我們有明確的臨床證據。這些患者的癒合情況良好，在他們看到明顯的癒合後，我們開始與他們討論 B 級糜爛性食道炎患者以及他們認為使用 PPI 可能無法充分癒合的患者，並建議他們轉換治療方案。隨著他們經驗的積累，他們的利用率也越來越高，最終我們會和他們討論那些即使沒有糜爛性反流卻有夜間燒心症狀的患者，以及您如何看待這些人群。所以，關鍵在於擴大採用率。僅僅獲得第一次收養是不夠的。這關乎改變大類患者的模式。這種情況會隨著多次銷售拜訪而逐漸發生，我們正在目睹這種情況的發生。第一次寫作沒有任何障礙。實際上，習慣的改變是一個循序漸進的過程，需要不斷強化、多次電話溝通、多次病患回饋，而這個過程現在正在發生，而且是自然而然發生的。

Okay. That's great to know. So, just one more question, maybe for send you. So, it, it's great that you turn on Medicare, and it's interesting that the average gross margins come down at the same time while the cash pay business, seems to pop, I guess, come back up to about 35%. So, is that I guess if you are guiding gross to the bottom end of the range, is that suggesting that commercial will continue to grow faster than cash pay? Are we understanding these impacts? Like, I just want to understand that what gives you confidence on the gross margin, gross to that being, at the lower end of the range with some of these dynamics going on.

好的。那真是個好消息。最後一個問題，或許可以傳給你。所以，你啟用 Medicare 真是太好了，有趣的是，與此同時，平均毛利率卻下降了，而現金支付業務似乎又回升到了大約 35%。所以，如果你將毛利率預期設定在區間下限，這是否意味著商業支付的成長速度將繼續快於現金支付？我們是否了解這些影響？我想了解的是，是什麼讓您對毛利率有信心，尤其是在毛利率處於較低水平，並且存在一些動態因素的情況下。

Yeah then well thank you for the question. So actually, gross margin if you, look at, last three quarters have been very consistent, within the range, and lower end of the range, I think.

好的，謝謝你的提問。所以實際上，如果你看一下過去三個季度的毛利率，你會發現它們一直非常穩定，都在正常範圍內，而且我認為是在正常範圍的較低水平。

This quarter as well when I looked at the results it came at the lower end of the range and.

本季我查看結果時也發現，業績處於區間下限。

And I find comfortable with the 3 quarters in a hand that we could tighten the guidance for 4th quarter from that perspective as regard to cash pay, the way the gross margin is calculated and and everything that does not have a material impact on our gross to net percentages. So as those percentages continue to grow, they'll all be reflective of that because our bigger part of the gross to net is impacted by the covered script. And I don't expect that to change significantly between this year and next year.

我對前三個季度的業績感到滿意，因此我們可以從現金支付、毛利率的計算方式以及所有不會對毛利淨利百分比產生實質性影響的因素等方面，對第四季度的業績指引進行收緊。因此，隨著這些百分比的持續增長，它們都將反映出這一點，因為我們毛利潤與淨利潤的較大部分都受到了承保劇本的影響。我預計今年到明年這種情況不會有太大變化。

Okay, got it, thank you.

好的，明白了，謝謝。

Thank you.

謝謝。

Our next question comes from the line of Chase Knickerbocker - Craig-Hallum Capital Group. Please go ahead, chase.

我們的下一個問題來自 Chase Knickerbocker - Craig-Hallum Capital Group。請繼續追。

Good morning. Thanks for taking the questions. A lot's been asked, but maybe just to stay on the on the topic of growth to nets. Just as we think about it longer-term, I mean, should we think about that kind of tighter range, as kind of the right way to think about medium to long-term growth, the nets should we continue to see, some improvements, even potentially going closer to 50% from the bottom end of the range now. I mean, where do you think kind of gross nets ultimately mature to? As your business matures over the medium to long-term, and then Sanji, just maybe, any low-hanging fruit that you see on the gross to nets to maybe continue to drive some improvement there from your past experiences. Thanks.

早安.謝謝您回答問題。已經有很多問題被問到了，但也許我們還是繼續討論網的成長這個話題吧。正如我們從長遠角度考慮問題一樣，我的意思是，我們是否應該將這種更窄的範圍視為思考中長期增長的正確方式，淨值是否應該繼續改善，甚至有可能從目前的區間下限接近 50%。我的意思是，你認為各種類型的淨資產最終會發展到什麼程度？隨著你的業務在中長期內日趨成熟，山治，或許你可以利用過去的經驗，從毛利潤到淨利潤中尋找一些容易改進的地方，繼續推動這方面的提升。謝謝。

Gotcha, thank you for the question. So, we obviously are very kind of focused on gross to net, as every other line items I'd say I think one thing I'd say I've seen very consistency. I think management done a good job in getting access and managing, all the contracts and the three quarters results have been very consistent, and they gave me the confidence we can tighten this, for this quarter going forward, Chase, I don't expect a significant. A change in how we look at it obviously we'll look at it at the right time what kind of guidance we want to give maybe it'll be a little bit tighter than what you had before, but we'll come back to that when we give the guidance. I, there would be obviously pushes and pulls, as you think about it, there is.

明白了，謝謝你的提問。所以，我們顯然非常關注毛利潤與淨利潤的比率，就像其他所有項目一樣，我認為有一點我認為非常一致。我認為管理層在獲取和管理所有合約方面做得很好，而且過去三個季度的業績都非常穩定，這讓我有信心我們可以收緊這方面的工作。就本季而言，我預計 Chase 不會有太大變化。我們看待這個問題的方式顯然會發生變化，我們會在合適的時機考慮我們想要給出什麼樣的指導，也許會比你們之前看到的更嚴格一些，但我們會在給出指導的時候再討論這個問題。顯然，正如你仔細想想，這其中肯定會有拉鋸戰。

There is a potential for price increase. There are obviously rebates in the government sector that we got to be mindful of and everything else, but also, we have things like DSA as the company gets matured, we have opportunities for renegotiation, some of those things. So, there are pushes and pulls that are going to happen. We'll manage it, but I don't expect on an overall basis to be a significant change in our gross to net trajectory as we've seen this far for three quarters this year.

價格有上漲的可能。顯然，政府部門有一些回扣，我們需要注意，還有其他一些事情，但是，隨著公司的發展成熟，我們也會有一些事情，例如DSA（直接銷售協議），我們有機會重新談判等等。所以，肯定會有一些推動和拉動的情況發生。我們會應對的，但我預計總體而言，我們的毛利潤與淨利潤的走勢不會發生重大變化，因為今年前三個季度的情況都是如此。

Thank you.

謝謝。

Thank you. My next question. Comes from the line of Matthew Garfield of the HD Wainwright. Please go ahead.

謝謝。我的下一個問題。源自馬修·加菲爾德（Matthew Garfield）的HD Wainwright血統。請繼續。

Hi Steven team, thank you and welcome to Sanjeev.

Steven團隊您好，感謝您的幫助，歡迎來到Sanjeev。

I wanted to ask, is there a sense of the proportion of patients that may be getting lost between having

我想問一下，是否有人估計過，有多少患者可能在接受治療和康復之間迷失了方向？

their script written by their GI not being.

他們的劇本並非由他們的美國大兵撰寫。

Covered and then the patient not subsequently following up for Blink RX for example, and how that may be evolving or ideally improving thanks.

例如，如果患者沒有繼續接受 Blink RX 治療，以及這種情況可能如何發展或理想情況下如何改善，謝謝。

So, Matt, thanks so much for the question. I don't think we've ever disclosed, specific numbers on the number of prescriptions that weren't filled. We obviously are tracking abandonment rates and looking at that pattern actually overall are pleased that we're doing better than industry norms on some of the metrics, but one of the key advantages of offering the blink service is that it improves that pattern. So if a patient goes to a retail pharmacy and their product isn't there, and their script isn't covered by their insurance, for example, and they get, a higher-than-expected co-pay, they may, walk away and not fill that script. If the patient goes to blink and they are getting covered, they will get a $25 co-pay, and if they are not getting covered, they will be offered a $50 cash price. So that Methodology enables us to significantly minimize that process and as we're educating physicians about the fact that there's an advantage to sending their patients to blink, it can just manage, we can manage that cycle to reduce that walk away from a prescription to minimize the co-pay and minimize at all times the patient out of pocket payments so that you have the best likelihood of a patient getting access to the product. One of the advantages of doing that is even if they end up with getting access to the product on a cash pay basis, for example, if they've got a high deductible plan and their, a plan isn't going to cover it or their payment is going to be too high early in the year, at some point, several months later, they may actually get their script covered and we want to be resubmitting it and switch that patient to a covered category patient and that advantage, that whole process is streamlined and works better through blank than through a retail pharmacy typically.

馬特，非常感謝你的提問。我認為我們從未公開過未配藥處方的具體數量。我們顯然一直在追蹤放棄率，並且觀察這種模式，總體上我們很高興看到我們在某些​​指標上的表現優於行業標準，但提供 Blink 服務的一個關鍵優勢是它改善了這種模式。例如，如果病人去零售藥局買藥，發現沒有他們需要的藥品，而且他們的處方藥也不在醫保範圍內，而且他們支付的自付費用高於預期，他們可能會放棄購買。如果病人眨眼後，而他們的保險涵蓋了該病人，他們將只需支付 25 美元的共同支付額；如果他們的保險不涵蓋該病人，他們將獲得 50 美元的現金價格。因此，該方法使我們能夠顯著縮短這一過程，並且我們正在向醫生們普及將患者轉診至 Blink 的優勢，我們可以管理這一流程，減少患者放棄處方的情況，最大限度地減少共同支付，並始終最大限度地減少患者的自付費用，從而使患者獲得產品的可能性最大。這樣做的一個好處是，即使他們最終只能自費購買產品，例如，如果他們的保險計劃自付額很高，而他們的計劃無法報銷，或者他們在年初的自付費用過高，那麼幾個月後，他們的處方藥可能最終會得到報銷，我們希望重新提交申請，並將該患者轉為受保患者。這樣做的好處是，整個流程更加精簡，而且透過空白管道比透過零售藥房通常效果更好。

Understood, I appreciate that thanks Steve.

明白了，謝謝史蒂夫。

Thank you, ladies and gentlemen, that does end the Q&A session and conclude Fathom Pharmaceuticals call for today.

謝謝各位，問答環節到此結束，Fathom Pharmaceuticals今天的電話會議也到此結束。

Thank you for participating. You may now disconnect.

感謝您的參與。您現在可以斷開連線了。