Mallinckrodt PLC

mostly from a competitive standpoint, mostly from payer reimbursement challenges, et cetera?

Yeah, so great question. So let me start, and then Brian, I think, will add to it. So overall, obviously, ATA is quite a complex product. It has multiple indications. It's promoted in quite a few therapeutic areas. I think the opportunities, what we have seen is, We have seen a stabilization in naive patients and even growth in our naive patients, which is really a big step forward versus previous years. We have seen that now over the last two quarters, and they're really happy to see that improvement in the business. I mentioned in the prepared remarks it's the returning patients that have been a challenge for us in the first quarter. The returning patients are patients that have been on drugs sometime in the last few years, and getting a prescription again. We feel, and we have looked into this, that the key reason for that is the restructuring of Salesforce that we did early in 22. We've restructured the Salesforce, so we now have a sales rep that visits all therapeutic areas, so they're geographically put down, but they focus the all therapeutic areas within their geography. And we think that upset the returning patients because of relationship with the doctors. We already see that improving significantly in April. So we feel really good about where we are coming out now on the returning. It's much more stable as we see after the first quarter. So that's the key reason. Obviously, there is a competition in the market that came to the market last year. We see that. The market has grown a little bit. The overall market has grown a little bit due to that. But clearly, obviously, when you get a competition on a product like ACT-R, we will feel it. But probably the biggest impact is the affordability. It's the issue because you need a pre-approval for reimbursement for every prescription. These are patients that are getting this, which have gone through multiple therapies before they go on ACT-R. We have shown that in our multiple clinical trials how important this product is. So we are working very, very hard with the payers to find the opportunity for the right patients to get reimbursement for this product. So that's an ongoing challenge. It's a big challenge. It has been the challenge over the last few quarters, but we feel now we understand how we need to work, where the focus is, and also what are the right patients that benefit from Aftab.

I think just to touch on your one point around seasonality, it is hard to bucket exactly, but if you look back historically, the first quarter has been the lower quarter because of seasonality, and that's really impacted by benefit plan resets. Typically, once you get through the holiday season, it takes a little bit before ordering resumes. I think you could probably look back historically and see the seasonality impact.