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Matthew Pauls - Independent Director
Good morning everyone and welcome to Pelthos Therapeutics 2025, fourth quarter and fiscal year financial results conference call. Pelthos issued a press release today announcing its financial results for the year ending December 31, 2025. A copy can be found in the investor relations tab on the corporate website.
At www.pelthos.com. Before we begin, I'd like to remind you that during today's call, statements about the company's future expectations, plans, and prospects are forward-looking statements. These forward-looking statements are based on management's current expectations.
These statements are neither promises nor guarantees and involve known and unknown risks, uncertainties, and other important factors that may cause our actual results, performance, or achievements to be materially different from our current expectations expressed or implied by the forward-looking statements. Any such forward-looking statements represent management's estimates as of the date of this conference call. While the company may elect to update such forward-looking statements at some point in the future, it disclaims any obligation to do so, even if subsequent events cause its views to change.
As a reminder, this conference call is being recorded and will remain available for 90 days. I'd now like to turn the floor over to Scott Plesha, Chief Executive Officer. Sir, you may begin.
Scott Plesha - President, Chief Executive Officer, Director
Thank you, Mike. Good morning and welcome everyone to today's call, and we're delighted to be with you today and to share with you our 4th quarter and annual operating results and highlights. Joining me today are Frank Nuttall, our CFO, and Cy Rangaro, our Chief Commercial Officer.
The 4th quarter of 2025 was an exciting and busy one for Pelthos, with great progress made in three key areas that I'll share at a high level with you. First, we had substantial demandâgenerated revenue growth for our lead product, ZELSUVMI, following its launch in the 3rd quarter of 2025. Second, we acquired two highly complementary FDAâapproved products, and third, we substantially bolstered our balance sheet and dramatically reduced our quarterly operating and nonâGAAP net losses.
Frank and Cy will provide a more detailed look at the quarters, their launch metrics, and reported financial results, but I'd like to share a brief overview of our results of operations. Our topâline results are driven by a 129% increase in prescriptions as reported by Symphony Health, which increased from 2,716 units in the third quarter to 6,232 units in the fourth quarter. This drove an increase in net product revenue from $7.1 million during the third quarter of 2025 to $9.1 million in the fourth quarter of 2025.
It's important to note that just under $3 million of the 3rd quarter revenue was a result of units being shipped to our distribution partners as part of our stocking for launch. Importantly, we ended the year with slightly fewer days on hand of inventory in the channel than at the end of Q3. Turning to product and operational details, I'd like to start with an update on our lead product, ZELSUVMI.
As a reminder, ZELSUVMI is a novel topical nitricâoxideâreleasing product indicated for the treatment of molluscum contagiosum or MC in patients one year of age or older for up to 12 weeks. ZELSUVMI is an important advancement in the treatment of MC as it's the first and only FDAâapproved therapy that can be applied by parents, patients, or caregivers in the home or on the go. Prior to the launch of ZELSUVMI, other topical treatments or destructive modalities would require patients to make multiple visits to a healthcare practitioner.
These inâoffice treatment alternatives include curettage, cryotherapy, and blistering agents that can sometimes be uncomfortable and painful, especially in the sensitive areas of the body that MC often presents. MC is a highly infectious condition caused by a pox virus that primarily affects children one year of age or older, with ICDâ10 claims indicating that 75% to 80% of MC patients are 10 years of age or younger. Roughly 16 million people in the United States are affected by molluscum, and on average there are up to 6 million new cases annually.
The literature also reports that in a multiâchild household, if one child contracts MC, 41% of the time the other child or children will as well. While the disease is selfâresolving, the meantime to resolution is approximately 13 months, and cases can last up to five years. During that time, children are often ostracized and may be forced to miss school or sporting events and cover their lesions with bandages or clothing.
This leads to considerable child and parental anxiety, which is the primary driver for patients being seen by healthcare providers. These factors led to significant patient demand during the 4th quarter, as opposed to the third quarter during which we launched ZELSUVMI. Virtually all the revenue in Q4 was a result of units dispensed to patients.
In Q3, we had 2,716 prescribed units representing approximately $4 million in net revenue, with the balance of the $7.1 million in net revenue during the third quarter comprised of channel stocking with the launch of the product. Conversely, almost all of the revenue in Q4 was generated by units dispensed to customers, with 6,232 prescribed units in Q4 and $9.1 million in net product revenue. Importantly, while total inventory in the channel rose slightly, inventory days on hand declined by just over one day during the 4th quarter.
As a reference, the balance of the $0.3 million in nonâproduct revenue in each of the 3rd and 4th quarters of 2025 was revenue recognized associated with the XEGLYZE license in Japan. We have strong patent protection on ZELSUVMI with a compositionâofâmatter patent that runs to early 2035 and have a patent term extension on file that may extend the patent life to Q3 2037. Finally, there are significant knowâhow and trade secrets associated with our manufacturing process, which complement our patent protection, providing us a broad IP moat around our technology.
We believe this provides a long runway to grow ZELSUVMI's revenue. Regarding our product acquisitions, our first acquisition was XEPI. XEPI is a novel FDAâapproved topical treatment for impetigo that addresses a critical unmet need in antibioticâresistant skin infections caused by staph and strep infections, most commonly affecting children.
Impetigo is the most common skin infection in children seen by pediatricians, with approximately 3 million patients diagnosed each year. We believe XEPI is a highly complementary product as it mostly treats children that are treated by the same healthcare providers as ZELSUVMI. Importantly, this allows us to leverage our commercial infrastructure, including our salesforce.
We acquired the US rights to XEPI in November and are currently working to establish the manufacturing process and build launch inventory. We expect to stock this product by the end of the 4th quarter of 2026 with a launch in January of 2027. Importantly, at several recent DUM meetings, we've received very positive feedback from major KOLs with respect to the relaunch of the product, as resistance to current treatments has been rising dramatically.
With respect to our most recent product addition, we acquired XEGLYZE in December for the treatment of head lice. XEGLYZE is also a novel FDAâapproved product that is highly complementary with both ZELSUVMI and XEPI and will require minimal additional overhead costs to bring to market. While this indication is largely treated by nonâprescription drugs, resistance to current treatment options is growing, and unlike other products on the market, XEGLYZE requires only one application.
We believe this will support the growth of XEGLYZE becoming the standard of care when prescription medications are required and that the return on investment for Pelthos will be substantial. At the operational level, we are standing up manufacturing for XEGLYZE and expect to bring it to market in late Q2 2027. Both XEPI and XEGLYZE will have tremendous call overlap for the existing salesforce, providing the company with greater operational and financial leverage from our existing team and infrastructure.
Supporting the continued rollout of ZELSUVMI and the acquisition and launch of XEPI and XEGLYZE, we closed an $18 million convertible note in November and a $15 million term debt loan in January, of which we drew $30 million. Frank will provide more details on both, but I wanted to note that the additional cash from these two transactions strengthens our cash balance and, combined with our revenue growth and current business plan, strongly supports our path to cash flow generation. In summary, we are extraordinarily pleased with the receptivity ZELSUVMI has received since its launch in July of 2025, the acquisition of two novel, highly complementary FDAâapproved products to our portfolio, and the additional capital supporting our drive to profitability.
We remain fully committed to maintaining strict financial discipline, as evidenced by the decrease in our operating and nonâGAAP EBITDA losses. And we'll continue to evaluate and optimize our commercial strategy as we want to seize every opportunity to deliver sustainable longâterm shareholder value for Pelthos shareholders.
I'll now turn it over to Sai to provide more specifics on the results of the ZELSUVMI launch and key performance indicators.
Sai Rangarao - Chief Commercial Officer
Thank you, Scott. Good morning, everyone, and I'm pleased to provide an update on our Q4 2025 performance following the Q3 2025 launch of ZELSUVMI. While we are still early in the launch, our progress to date has gone better than expected.
For 2025, shipments and prescriptions were ahead of expectations, leading to an increase in internal expectations for 2026. On the qualitative side, we continue to receive very positive feedback from HCPs, patients, and caregivers on the ease of use and efficacy of ZELSUVMI. Digging into the prescription details, the number of prescriptions rose a very strong 129% to 6,232 prescribed units, and the number of unique prescribers rose from 1,169 to 2,712 unique prescribers by the end of the fourth quarter with both sets of data reported in Symphony Metadata.
We generated a significant increase in prescriptions despite the fact that the fourth quarter is historically the weakest annual quarter for MC claims. The average monthly MC claims in the 4th quarter, driven by lower November through December patient visits, averaged approximately 33,700 claims per month, whereas March through October 2025 saw an average of approximately 45,100 claims per month. The fact that we were able to grow this much during the fourth quarter shows the strong value ZELSUVMI provides in the market and portrays the significant growth we expect going forward.
Our belief remains strong that ZELSUVMI is revolutionizing the treatment of MC and becoming the firstâline treatment of choice. From January 1st, 2026 through the week ending March 6, 2026, we recorded 5,297 prescribed units for ZELSUVMI written by HCPs and recently hit an allâtime high of 695 prescribed units in one week. On top of that, since early February, we are regularly seeing new weekly highs in new prescriptions, total prescriptions, repeat prescribers, and continue to add new HCP writers.
Relatedly, we are closely and steadily managing our channel inventory to make certain there is ZELSUVMI available for patients and to minimize stockouts at the wholesaler level led by our stellar market access and trade team. We ended the 4th quarter with just over one day fewer units of inventory on hand throughout the distribution system. While we expect that days on hand might gradually decline over time, we are currently managing to an estimated 3â to 4âweek inventory level.
We launched ZELSUVMI without any commercial contracts following a selective contracting approach, but entered into a commercial contract with a PBM during the fourth quarter with approximately 20 million covered lives. We've executed a contract with this PBM to increase access to patients, and importantly, the contract removed friction on access to ZELSUVMI almost immediately and helped numerous patients gain the clinical benefits quickly at a contract rate that does not impinge on our Medicaid rate and provides for annual price increases. The effect of this contract, which kicked off in early December along with improved Medicaid coverage, is an expansion of our covered lives and access to patients.
As of today, we have a 59% coverage rate for commercial insurance plans and a 99% coverage rate for Medicaid. This is a testament to the fact that ZELSUVMI, as the first FDAâapproved atâhome treatment for MC, is being adopted as the firstâline treatment option and is being well received by HCPs and coverage providers. For Medicaid coverage, several large states including New York do not require prior authorization, and in most other states Medicaid only requires a prior authorization written to label.
Overall, this is very healthy for a drug at our stage of launch, supported by the fact that the drug largely treats children, is the first and only atâhome treatment option, and is acute. Due to ZELSUVMI being an acute treatment, payers have a limit on cost exposure, and therapeutic programs aimed at children generally have a better approval profile. We continue to have very good grossâtoânets or GTNs, with current GTNs revolving around distribution costs, Medicaid discounts, payer contracts, and our copay voucher program.
With the copay card program, it is our goal to pay down so prescription costs are zero or close to zero in almost all instances for the patient. For the 4th quarter of 2025, we had favorable GTNs at 28.7% in line with expectations, and going forward we expect GTNs to move into the midâ to upperâ30% range. Next, I would like to provide an update on our sales team.
We commenced launch with 50 territory managers placed in locations based on ICDâ10 data of the most prevalent MC cases. It's important to note MC is an underreported indication largely because there was no atâhome FDAâapproved product until ZELSUVMI. With the success of the launch, we added 14 territory managers in metropolitan areas not previously supported including Seattle, Minneapolis, San Francisco, and Salt Lake.
We added those additional team members who have been trained and are now active in the field. Early data suggests this was an advantageous expansion as prescriptions in some of those territories have jumped markedly to the point where in a short time they already cover their sales efforts. We continue to grow awareness for ZELSUVMI as the first and only atâhome prescription treatment option for MC through multiple channels and venues.
On top of Q3 efforts, including our Moms Against Molesca movement, strong HCP engagement, and broad social media campaigns, we launched our first ever YouTube commercial in Q4. This commercial has been very successful with more than 4.5 million total views and this informative video has prompted parents, caregivers, and adult patients to ask their HCPs about ZELSUVMI. Finally, we will be attending the largest dermatology congress in the U.S. at the end of the month with full promotional and medical engagement activities.
The American Academy of Dermatology meeting brings thousands of HCPs together and is an ideal opportunity for us to engage further and inform them about the featured benefits ZELSUVMI provides their appropriate patients. We will continue to build off the success of these tactics and will be adding more to keep momentum going. I am very pleased with our performance and launch success to date alongside our passionate and hardworking commercial team.
And with that, I now turn the call over to Frank to discuss our financials. Frank.
Francis Knuettel - Chief Financial Officer, Treasurer, Company Secretary
Thank you, Cy, and good morning and thank you all for joining us on today's call. Overall, we had a very good fourth quarter and are delighted to report that net product revenue rose approximately 28% from $7.1 million in the third quarter of 2025, which was our first quarter of launch, to $9.1 million in the fourth quarter of 2025. For the year and quarter ended December 31, 2025, our cost of goods sold was $4.0 million and $1.7 million respectively.
The quarterâoverâquarter decline from the 3rd quarter of 2025 to the 4th quarter of 2025 in cost of goods on an absolute basis, as well as a percentage of revenue, is due to the writeâoff of one outâofâspecification API batch in the 3rd quarter. A key reminder is that our cost of goods also includes the fair value stepâup of the inventory, both API and finished goods on hand at the time the merger was closed. We expect to run through the steppedâup fair valued finished goods inventory by late summer of 2026, and approximately a year to 15 months later to run through the steppedâup fair valued API inventory.
After that, we will be at our true cost of goods value, which is midâsingleâdigit percentage of our WAC price. Similarly, we're also in the process of moving towards the expected longâterm costs associated with our GTNs. Our GTNs for the fourth quarter were 28.7%, meaning that 28.7% of our gross revenue was allocated to thirdâparty distribution, Medicaid, commercial PBM contract, coâpay cards, and similar fees.
With the PBM contract and a meaningful percentage of our business coming from Medicaid thus far, we're expecting GTNs going forward to move towards the midâ to highâ30% range. The bulk of our expenses during the quarter were for SG&A with low levels of expenses associated with R&D. We provided a table in the 10âQ that provides the detailed breakdown of our SG&A expenses, but at a high level the bulk of the cash expenses are attributed to personnel, marketing, professional services, and royalties.
Of the $18.5 million in SG&A for the fourth quarter of 2025, approximately $2.1 million are nonâcash charges associated with equity compensation expenses and depreciation. A further amount of approximately $1.2 million are oneâtime items associated with a convertible note and term debt that we were unable to capitalize, and we booked a royalty obligation of $1.6 million. This resulted in a steadyâstate cash amount for SG&A of $13.5 million for the fourth quarter of 2025.
The continuing cash SG&A expenses in the 4th quarter are down approximately 5% from the 3rd quarter, demonstrating our intent to manage our expenses tightly. Notwithstanding that, quarterly SG&A will rise in 2026 with the increase in the size of the sales team we have discussed and getting XEPI and XEGLYZE ready to launch. In all instances, we expect to closely manage our expenses.
The quarterly cost of the additional sales team and other support personnel will be approximately $1 million per quarter, and the costs for the XEPI and XEGLYZE launch prep are both in the low singleâdigit millions for the entirety of 2026. The royalty amount will grow in direct proportion to the growth in net revenues. Netting this out, our quarterly net operating loss improved from a loss of $15.4 million during the third quarter to $12.0 million in the fourth quarter, and on an adjusted EBITDA basis, our EBITDA loss improved from a loss of $11.5 million in the third quarter to a loss of $9.0 million in the fourth quarter.
Our balance sheet as of December 31st is strong, with $18.0 million in cash and $8.9 million in accounts receivable, up from $14.2 million in cash and $8.0 million respectively at the end of the third quarter. We added to our $18 million cash balance at December 31st with the issuance of $30 million in term debt in January 2026. The additional capital from the term debt gives us comfort going forward with our cash balance and hitting our goals in cash flow generation.
I would also like to provide insight into some specific line items on the balance sheet and income statement. On the balance sheet, the $3.8 million in other shortâterm liabilities and the $30.1 million in other longâterm liabilities are largely the result of the fair value assessment of the future royalty obligations, which are not general obligations and will be recognized only when actual royalties tied to actual net sales occur. On the income statement, we booked a nonâcash expense of $15.0 million attributable to the fair value assessment of the convertible notes issued in November.
The expense is largely attributable to a fair value valuation of the future royalty streams and a beneficial conversion feature associated with the convertible notes. The note holders are entitled to royalties on future sales of XEPI and revenues from the Japanese license for ZELSUVMI, and the beneficial conversion feature is associated with the conversion price relative to our market price. As our stock is fairly variable, the quarterâoverâquarter valuation could potentially swing considerably.
As Scott referenced earlier, we entered into a $50 million term debt with Horizon in January, of which we drew $30 million. The debt has a fiveâyear term with three years of interestâonly payments and carries an interest rate of prime plus 3.75%, currently totaling 10.5%. We can draw upon additional capital upon reaching certain milestones, but based on our current plan, we do not expect to need to do so.
Regarding our capitalization, as of 12â31â2025, excluding the convertible notes, we had 8.9 million shares of stock outstanding on an asâconverted basis. This is comprised of approximately 3.2 million shares of common stock outstanding and 5.7 million shares of common stock underlying our Series A and Series C convertible preferred stock. Other than the warrant for 65,488 shares of common stock issued to Horizon as part of the term debt, there has been no change in our capitalization since yearâend.
Were the convertible notes to convert to common stock at the conversion price, we would issue approximately 605,000 shares, leaving us with approximately 9.5 million total shares outstanding on an asâconverted basis. Summing it up, we believe we have made excellent progress and continue to maintain fiscal discipline and act as wise stewards of our investorsâ capital. With growing revenue, tight expense controls, and revenue from new product introductions, we believe we are in a strong position for solid future growth, positive cash flow, and profitability.
I will now turn the call back to Scott to discuss key points regarding our future progress and thoughts.
Scott Plesha - President, Chief Executive Officer, Director
Thank you, Frank. In closing, I would now like to highlight a few key points regarding our strategy and path forward for Pelthos. Again, we are extremely pleased with the success of the ZELSUVMI launch and the financial results to date.
The rapid increase in prescriptions during our Q3 2025 launch paid for our initial sales force in slightly over two months, justifying the expansion of the sales force this quarter and our drive to cash flow. As we remain early in our launch, we have not yet provided discrete revenue and EPS guidance. Overall, we remain extremely confident about our revenue growth trajectory and believe that our current cash balance provides the runway to execute on our business plan.
Furthermore, we are extremely happy to have acquired two new novel FDAâapproved products that are nearâperfect supplements to ZELSUVMI. While we expect ZELSUVMI to remain the main driver of revenue growth, we believe that with the acquisition of XEPI and XEGLYZE, we now have a portfolio of products that will add to our revenue growth, margins, and profit. I want to thank you for joining us today to learn more about the Pelthos story.
We'll now turn the call over to the operator for any questions.
Operator
(Operator Instructions)
Thomas Flatten of Lake Street Capital Markets.
Thomas Flaten - Analyst
Hey, good morning guys. I appreciate you taking the questions. Maybe for Frank, the step up in the gross to net discount from, where you were 29% up to the mid to upper. I understand the first quarter you might get, hit with a lot more copay assistance, etc. But can you maybe factor out for us what the other, components of that increase are going to look like? I'm assuming it's contracting, but if you could help with that, that'd be great.
Francis Knuettel - Chief Financial Officer, Treasurer, Company Secretary
Sure, thank you. Thomas. So there's a couple of components to it, one of which is the contract that we signed in December. So that'll start, impacting, start impacting the GTNs in December, and obviously we'll have a full quarters effect in this quarter.
Additionally, as we pointed out, the copay cards, and we have had slightly higher utilization, on our Medicaid business, than we had originally forecasted. So I think those three are the primary drivers, to the increased 10s.
Thomas Flaten - Analyst
Great. And then, for my follow-up, any, anything you can share on the competitive dynamics between yourselves and why can't counter detailing? What are you hearing from physicians, maybe even from patients?
Scott Plesha - President, Chief Executive Officer, Director
Yeah, hey, Thomas, it's Scott. I'll provide a little bit of background and Cy will also fill in the gaps for me. So anyways, we still believe this is a large market that both of us can, do quite well in. Obviously our uptake's been, exceeding our expectations and a lot of positive feedback from offices, HCPs and patients about the efficacy, the ability to treat at home for the first time.
And parents even saying they just like to able to have control and do something versus sitting back and waiting we we view them as you know very different products one's in an office treatment kind of. Multiple visits to the office versus, being able to treat it in the privacy of your own home and probably more convenient, not having absenteeism going in.
So.
Thomas Flaten - Analyst
I'll let Sai maybe add a little bit more to those comments. Sure.
Unidentified Company Representative
Thanks, Scott. Good morning, Thomas. Thanks for the question. So, just to add on to Scott's commentary, we firmly believe our positioning for Zel Sumi is as a first line and monotherapeutic option. So how we detail, with practitioners and how it's positioned for patients. Is that it can and should be used first line now as an HCP within their current practice dynamics choose to potentially use us in combination or use other procedures that are out there beyond, the traditional competitors as why can't, that, that's their decision as an HCP practitioner, but we don't form any sort of counter detailing strategy. This is truly where we're positioned as a first line monotherapeutic option for HCPs and patients.
Great, thanks guys.
Thomas Flaten - Analyst
Thank you, thanks.
Operator
Brandon Folks of HC Wainwright.
Brandon Folkes - Equity Analyst
Hi, thanks for taking my questions and congrats on all the progress. Two from me, yeah, a few multi-pass, but I keep it to 2.
As we look out to 2026. Can you just talk about the growth drivers in terms of breadth versus depth of prescribing, with adding the additional 14 reps, should we think about breadth still being perhaps the biggest growth driver in 2026 for they'll soothe me? And, where do you think you could get the high prescribers to write in terms of number of prescriptions or maybe ask another one? How concentrated is the high decile, molluscum prescriber?
Matthew Pauls - Independent Director
Yeah, I'll give a really thanks Brandon Scott, I'll give you a very quick overview and then maybe I dig a little deeper on the prescribers. For me that when we look at it the key drivers first off, the PBM contract we're seeing a really nice impact there to give you some metrics we look at Q4, the total number of prescriptions we already surpassed that after February, so we still have another month and it's gaining momentum so we anticipate that to have nice impact.
I mentioned in his prepared comments that, we added 14 reps and really probably 5 or 6 have only been in the field a few weeks and the ones that are there are, if you looked at their body of work, they're already paying for themselves just literally 4 or 5 weeks into the world so they're definitely having an impact. There was some business there but it's been nice to see the quick uptake there, and then, the other thing that we see. We had in our comments that we typical drop off in unique patients seeking treatment November, December, and that's due to typically offices not being open, it's an acute drug, and then the weather, we think it reduces the numbers and it typically starts bouncing back in January, didn't this January as much as it usually does. But we anticipate the rest of the year March through really October being very strong as far as the increase in in patients being seen. So, anyways, that those are drivers for us, just even more patients in the funnel and then I'll give it to Passover side a little bit more detail on the prescriber base. Yeah, thanks.
Sai Rangarao - Chief Commercial Officer
Yeah, hi Brandon. Just to add on, I think the perspective we have for the first part of your question as it pertains to breadth versus death. Yes, we're still very much in gathering more prescribers as a big part of our strategy. So bread being 8 months into our launch, still is a big component of ours and we're growing new prescribers week over week as I shared. We're seeing that go as A really high marker for us and a key performance indicator as we move forward, especially with the newly expanded sales force, from a concentration standpoint we definitely have a cohort of, larger prescribers. It is spread geographically so it's not concentrated to one particular state or particular region. But that continues to be our main focus, for the entire fuel force and for that matter, the entire promotional mix that we have, growing that depth amongst top prescribers and growing the cohort of early prescribers to get to that next point of death is a bigger part of our strategy.
Matthew Pauls - Independent Director
Yeah, the one other data point I'll share is we're approaching 4,000 unique prescribers through March 6th, so we're just about 70,000 or 80,000 underneath that, so. We've seen really nice growth in that and importantly the repeat prescribers is trending quite well also every week it's been growing week.
Sai Rangarao - Chief Commercial Officer
Over week.
Brandon Folkes - Equity Analyst
Thanks very much, very helpful. My second question again, can you just maybe talk about the unaided awareness of Zelsumi and in particular in terms of sort of where you think that could get to by the time you launch SEPI later this year.
Should we think about that they'll see me.
Matthew Pauls - Independent Director
Brandon, you broke up on the first part of your question. We didn't really catch that.
Scott Plesha - President, Chief Executive Officer, Director
Can you hear me?
Matthew Pauls - Independent Director
Yeah, we can hear you.
Brandon Folkes - Equity Analyst
Can you talk about the unaided awareness of Zel'lloM?
How are you thinking about where you can get that to when you launch ZEpi later this year?
And with this growth in prescribers, should we think about Zeloomi remaining as the number one in the bag across all the prescribers that you're calling on, or could we see ZEpi, in the number one position?
Too some prescribers versus they'll sue me.
Sai Rangarao - Chief Commercial Officer
Thanks, Brandon. This is Sy. So from an unaided awareness perspective, the bigger part of our executional strategy as we've shared, in addition to the great work that's happening with the Field Force is a lot of digital promotions. So as we shared, we have a plethora of digital media that's out there from an awareness standpoint, but we've also done a tremendous amount of work, with some, that's called Force Media with our YouTube commercial. So those elements continue to drive a tremendous amount of awareness as we go forward and as I shared in the prepared remarks, those efforts are actually prompting patients and caregivers and even adult patients to go in and ask for the product which is very DTC-like of some bigger brands that are out there. From a perspective of then moving, into the view of our proverbial commercial bag, we do intend to have Zelugmi as the first position as we go forward, towards the Zepi launch and beyond, and truly our promotional synergies there really come to fruition and as a big benefit for our entire commercial approach going forward.
Brandon Folkes - Equity Analyst
Great.
Thank you very much and congrats on all the progress.
Matthew Pauls - Independent Director
Thank you, thanks again, Brandon.
Thomas Flaten - Analyst
David Amsalom of Piper Sandler.
David Amsellem - Senior Research Analyst
Thanks. So just a couple for me. I know you addressed, seasonality to some extent, but. Help us better understand how pronounced the seasonality is, I guess in a good way, during the warmer weather months. In other words, thinking about cadence of volumes this year, should we think about 2 q and 3Q essentially being the high water mark for volumes? That would be helpful color. So that's number one. And then number 2, just stepping back regarding the overall business, so you have Zepi, you have Zeglives, there are obviously, launches that are coming. But how do you think philosophically about the optimal number of products in the Salesforce bag, and are you continuing to prioritize the addition of other assets where you can leverage the commercial infrastructure, particularly given that you've got two launches coming up and obviously you have the recent launch of Zelzoomi.
Matthew Pauls - Independent Director
Thanks. Yeah, thanks David. I'll, jump into that and if anybody else wants to come they can also, but yeah, seasonality is important with this. We've learned, as we spent our 1st 8 months now in the market, but looking at, claims you can get from Viva on a monthly basis, I'll give you, the exact numbers that we have at this point. They're, they backfill a little bit still, but like November and December you're looking at like 34,000, 33,000 unique patients. But then last year in like March, April, May, 43,000,000, 47,500, 46,000, so it's pretty pronounced difference and January did not bounce back, at least it hasn't as much. It's still probably somewhere between 10% to 15% less than what we would, we had seen in previous years as far as unique patients. I think that was the extreme weather. That came about. So, important though is we've really started to see a nice trend since after the holidays, and, putting us in a great position for growth for this year, and we, I think part of it also is we were early in launch and we're still building prescriber base and as we have a wider prescriber base, we'll be able to endure and grow through, the down months I think because we have more shots on gold.
Now philosophically, obviously we have 3 highly complementary products that we were really opportunistic on those. They became available to us and we got them for it, I think, a really favorable, we can get a nice ROI and long-term, we're staggering those launches so we can always focus on Zelsumi. The thing we gotta, no matter what we're doing here, we gotta make sure we execute there.
But if we did have something to present that made sense, we would look at it. There's no doubt, we'd be opportunistic there. The other thing we're still evaluating also as a reminder our nirosil platform which Zelzelsumi is built around, there's a lot of work that's been done there previously, the rights to many of those different indications and the IP there. Sits within LA, so we would have to license that, but we are evaluating that, but that's more long-term. Those would, be programs that would take time and, if and when we were to commit something, obviously we would, we'd make everybody aware of that. But that again, that's more a long-term thing that we're looking at right now, so.
David Amsellem - Senior Research Analyst
Okay, helpful, thanks.
Okay, thanks, David.
Operator
Jeff Jones of Oppenheimer.
Jeff Jones - Analyst
Good morning, guys, and thanks for taking the. Question. I guess, as you look to your experience from your 1st 6 months in the market, with pediatricians, dermatologists, can you speak to sort of where you're seeing, uptake?
Is it amongst pediatricians who haven't had an option?
What are you seeing from dermatologists, maybe what kind of pushback do you get when you get it, and, maybe comment on how your strategy adapts now that you're, 6 months in.
Francis Knuettel - Chief Financial Officer, Treasurer, Company Secretary
Thank you.
Sai Rangarao - Chief Commercial Officer
Thanks. Good morning, Jeff. This is Sy. I'll take that question first. So from an adoption perspective, as expected, being a cutaneous condition, we do see fast adoption amongst the dermatology community and then concentrated within there are pediatric dermatologists and then the NPA NPPA community that serves that dermatology, specialty. We are seeing a better than expected uptake within the pediatrician. Community, it's definitely where they see it first line and they're the first to truly diagnose it either before referral or the decision to actually treat and I think to date they have not really had that, first and only at home prescription treatment option tools they'll soon be launched.
So I think the uptake is very much in line with a need for a tool within the toolkit to to serve the disease state. So we are seeing, again, better than expected, traditional uptake there. As it pertains to your second question with pushback, as with any launch, within this therapeutic category or adjacent or others for that matter, it's typically, going to be market access related or access to medication. And to date, outside of the typical friction that you might see, from a launch, there have been no, really truly major hurdles.
So from an enablement standpoint. Within our field force, within everything else that we conduct and execute upon within our market access team broadly and patient services team broadly, we're really able to get over those hurdles by offering strong copay assistance as we mentioned, other support mechanisms as it pertains to the PA process or medical necessity process should it get to those steps. So we are surely and truly seeing the uptake occur because we are getting over those hurdles literally every day.
Matthew Pauls - Independent Director
And Jeff, I'll add that our, approval rates early in launch are quite good based on past experiences and you know we went in with this strategic plan to contract where we have friction. We've done that one plan there may be, a plan or two still that we would like to address going forward, but you know we gotta make sure they make sense, from rebates and. And whatnot, but, going back to like the pediatricians, I think the only thing there is really getting them to take action. If you think about it, they, looking at claims data, they really don't, haven't really treated a lot in the past with the destructive modalities, maybe 10, 15% of the time. So a lot of times they'll wait and see or pres prescribing things like topical steroids or antibiotics that really don't treat the virus.
So now that there's something available, it's getting them to feel comfortable. Unfortunately we have not only an efficacious product, but I think a very safe product as well based on the AE profile that fits really well in their practice. So what enables them to actually go out and treat now, which, it's kind of a first time for them.
Jeff Jones - Analyst
Greatly appreciate it thanks guys.
Thanks, Jeff.
Operator
James Malloy of Alliance Global Partners.
James Molloy - Analyst
Hey guys, thank you very much for taking the questions. I had a question on, can you talk a little bit about the gross to net discount, in the quarter, and then I see, SGNAs up pretty sharply in taking out the non-cash and the one-timers. Is this kind of the, the jump we you, we should be expecting the SGA to do as sales ramp, or at some point does SGA kind of level off and sales ramp still ramps exponentially, off that.
Matthew Pauls - Independent Director
Base. So I'll take the.
Francis Knuettel - Chief Financial Officer, Treasurer, Company Secretary
Good morning. Thanks, Jim, this is Frank. I'll take the second item first, so with respect to the SG&A there's, the non-cash and non-operating components to it, and with respect to the 4th quarter actually cash SG&A went down, and that strips out the non-cash equity compensation component. It also excludes one-time items that we were unable to capitalize for both of the convertible note.
And the term debt and most importantly with respect to looking at it going forward, there are two aspects of it of note. One, included in there is the royalty obligation. So to the extent that revenues continue to rise, the royalty obligation and payment will rise with it.
So that will rise. The other thing is as we chatted about there will be additional expenses that are layered in in Q1 associated with the increase in the sales team.
A couple of headcount associated with the launch of Zepi and Zegli and then throughout the course of the year there'll be low single-digit million in total for prep costs associated with the launch for Zepi and Zeglis primarily outsourced manufacturing consultants, etc.
So, that sort of is the baseline we expect going forward. So with respect to.
The operating cash component, I think we'll, you'll see a rise in Q1 associated with those items and then we'll remain largely fat flat throughout the year. It'll move up a bit towards the end of the year as the launches get closer and the variable component will be the royalty payment.
With respect to the GTN, I'll stop. Do you have any questions on that, Jim?
James Molloy - Analyst
No, that covers it. Thank you. Cool.
Francis Knuettel - Chief Financial Officer, Treasurer, Company Secretary
Okay, with respect to the GTNs moved up in Q4 as we had expected. And that's really attributable to slightly higher Medicaid usage than we'd originally forecast and the execution of the PBM contract that launched on December 1st.
We do expect that over time, that number will continue to increase to the mid to upper mid 30% range.
With additional copay card usage, the, PBM contract and potentially just some other expenses, in our go to market campaign.
Matthew Pauls - Independent Director
Yeah, the only thing I'll add, Jim, is that, from my experience. 28.7% GTN, our second quarter in the market is quite good, especially when you look at the space we're in, and you know we're really, excited about the fact that we've been able to mean that that time of that type of GTN, and there'll be things we're trying to pull down as we do more volume DSA fees, the fees to the wholesalers could come down.
And I think that 35 to, that kind of mid to high 30%, GTN range give us room even to do, other contract if we, chose to do so.
James Molloy - Analyst
Okay, maybe a quick follow-up if I could, when do you guys, I know you don't, haven't given any guidance, yet, given second quarter of launch, but have, do you have any internal expectations on, when, sort of zeell of me on an all-in basis.
Becomes profitable. I know you got a couple of new launches too coming up here in the next year, next over the next couple of years. And when does, Peltos itself, overall turn profitable, do you think?
Francis Knuettel - Chief Financial Officer, Treasurer, Company Secretary
So, with respect to the first question, they'll soothe me, frankly, as we are off to a very strong start. And on an absolute basis for both it and the company to the extent there are no changes to our business plan or our outlook we do expect that towards the end of the year we will cross over the line.
But that does, it does not, contemplate any change. The business plan, as Scott referenced earlier, there might be a nitroil platform opportunity, or any other changes we make to the business plan or changes in the outlook, but clearly, we have a very strong feeling for the path forward and think, at the end of the year we'll probably cross over that line with, what we know now in our current business plan.
James Molloy - Analyst
Thank you for taking the questions.
Operator
Thank you. At this time, I'd like to turn the floor back over to Mr. Pauls for closing comments.
Matthew Pauls - Independent Director
Thank you, operator. I want to reiterate that even though it's early days, Pelthos is uniquely positioned to capitalize on a large addressable market with the first FDAâapproved atâhome prescription product for MC. We built a strong foundation for the growth of ZELSUVMI and with XEPI and XEGLYZE, two highly synergistic products launching by the end of 2026 and midâ2027 respectively, we believe that there are strong growth opportunities before us.
Finally, I'd like to thank the employees at Pelthos for all their hard work and dedication in supporting patients, caregivers, and healthcare providers. Thank you again for joining our call, and we look forward to updating you on our continuing progress in the future. Have a great day.
Operator
Ladies and gentlemen, thank you for your participation. This concludes today's event. You may disconnect your lines or log off the webcast at this time and enjoy the rest of your day.