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Operator
Good afternoon. My name is Chuck, and I will be your conference operator for today. At this time, I would like to welcome everyone to the Amilex Pharmaceuticals Third Quarter 2022 Earnings Conference Call. All participants will be in a listen-only mode. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then 1 on your telephone keypad. And to withdraw your question, please press star then 2. Please be advised that this call is being recorded at the company's request I would now like to turn the conference over to Ms. Lindsay Allen, Head of Investor Relations and Communications. Please go ahead, ma'am.
Chuck
Good afternoon, and thank you for joining us today to discuss our third quarter 2022 earnings. With me on the call are Josh Cohen and Justin Klee, our co-CEOs, Margaret Olinger, our Chief Commercial Officer, and Jim Friedes, our Chief Financial Officer. Before we begin, I would like to remind everyone that any statements we make or information presented on this call that are not historical facts are forward-looking statements that are based on our current beliefs, plans, and expectations and are made pertinent to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Examples of forward-looking statements made during this call include our expectations for the commercialization of and the timing of receipt of revenue from Relivrio and Albreoza, statements regarding regulatory developments, the anticipated timing of coverage and policy decisions by insurance plans related to Relivrio and whether those decisions will be favorable, expectations regarding access to and coverage, our expectations with respect to recruitment and completion of our ongoing Phoenix trial, and the anticipated ramp in our SG&A expenses. Actual events and results could differ materially from those expressed or implied by any forward-looking statement as a result of various risks, uncertainties, and other factors, including those set forth in our most recent filings with the SEC and any other future filings that we may make with the SEC. You are cautioned not to place any undue reliance on these forward-looking statements. And Amilex disclaims any obligation to update such statements. Now, I will turn the call over to Justin.
Josh Cohen
Thank you, Lindsay. And thank you, everyone, for joining the call. Our mission is to end the suffering caused by neurodegenerative diseases. And while much work remains, the past few months have marked incredible progress. including the FDA approval and commercial launch of Relivrio for adults living with ALS in the United States. This marks our second commercial launch following the approval of Albreoza with conditions in Canada. We know the ALS community is counting on us, and we are working every day to help ensure that every eligible person who can benefit from Relivrio and Albreoza can gain access as quickly and efficiently as possible. Given we are only a few weeks into the launch in the U.S., it is too early to discuss specific expectations, but we are encouraged by the initial engagement with both physicians and with people living with ALS. Margaret will share some further insights shortly. Aside of North America, we are actively pursuing regulatory approval of AMX 35 for the treatment of ALS in the European Union. Our marketing authorization application remains under review by the Committee for Medicinal Products for Human Use, or CHMP, of the EMA. We are now in possession of the Rapporteur's Day 150 Joint Assessment Report, which is provided to applicants as a reference as the CHMP collects comments to responses made to the Day 120 list of questions. While we have resolved several major objections from the Day 120 list of questions, some still remain. and we will work to continue to try to address them as part of the MAA review process. The next step in the process is the day 180 list of outstanding issues, which we will respond to accordingly. The CHMP also intends to hold a scientific advisory group meeting as part of the regulatory review process. The EMA process is still on track, and we expect a decision in the first half of next year. With that, I'll turn the call over to Margaret to share some insights into the early days of our launch in the United States and to provide an update on our Canadian launch.
Lindsay
Great. Thanks, Justin. In the days and weeks following the FDA's approval of Relivrio on September 29th, we immediately started receiving enrollments and prescriptions through the AMLEX care team and have heard very positive feedback from physicians and the ALS community about the level of support we are providing. Importantly, on October 24th, the first shipment of Relivio from one of our specialty pharmacies was sent to a person living with ALS earlier than we had originally anticipated. In regard to interest in Relivio, we are seeing a solid initial bolus, including an encouraging number of product enrollment forms and prescriptions coming into the Amelix care team. This initial excitement has also been widespread across the country and not limited to one geography or group of physicians. The field teams have engaged with clinicians throughout the country and the feedback from those serving the community has been positive. We are initially focused on the leading 186 ALS centers and the teams are already actively engaged with all of these centers since approval. We are also dedicating time to smaller, local centers, and neurology practices to help ensure that every person living with ALS has access to and information on Relibrio. While we are pleased to see this level of initial excitement and have both the people and the product needed to fulfill it, we cannot yet comment on how quickly this demand will translate into revenue, given it can take 30 to 45 days for a person with ALS to get on treatment through the payer's medical exception process, which is standard for any new launch, especially in orphan diseases. As a result, we continue to expect a gradual commercial ramp up as outlined on our approval call in September. As it relates to working with insurers, our conversations have been productive. We have had robust discussions with the majority of major payers and pharmacy benefit managers And in general, they have been supportive of Livrio's clinical profile and have understood the urgency to provide access to people living with ALS. We are working hard to educate and encourage the broadest coverage possible, which we believe is appropriate given the data supporting the Livrio label. Although it is early days, we are receiving generally good feedback at this point. We anticipate payers will begin to publish policy decisions in the first half of next year. Now turning to our launch in Canada. The interest in alveoli across the ALS community continues to be wide and national. The number of prescribers continues to build month over month with interest spread across the country. As it relates to access, as announced on our US approval call in September, we are in negotiations with the four largest private Canadian insurers which represent approximately 80% of the private insured population. To date, we have already closed one negotiation and expect the others to follow suit. On the public side, we are currently in negotiations with the provinces and territories about the scope and breadth of coverage they will provide. Our team knows that people living with ALS and their families have no time to wait. And we continue to be committed to reaching our goal of broad and equitable reimbursement criteria. We continue to strongly believe that Relivrio and Albreoza have the potential to make a significant impact on the treatment of ALS. Our commercial and medical affairs teams are in place to make this important treatment as accessible as possible. Each quarter, you will hear more from us as we progress through the launch and more experience and insights are gained. To close, I want to add that at every step, our focus is on providing access and support to every appropriate person living with ALS who can benefit from our product. And we will continue to partner closely with the ALS community. With that, I'll turn the call over to Jim to review our financials for the quarter.
Justin
Thanks, Margaret. I'll now summarize our results from the third quarter. where we were particularly focused on launching in Canada, the reconvened advisory committee, and our September 29th PDUFA date. For the quarter ended September 30th, 2022, net product revenues were .3 million dollars, and related to the sales of Albreoza in Canada. Although we've seen strong interest in Canada thus far, we do not expect this to translate to meaningful revenue in the near term, given that the reimbursement process takes six to 12 months, and there were only a small number of people covered by private insurers at this time. Cost of sales were 0.2 million dollars and represented the cost associated with our revenue in Canada this quarter. This is elevated as a percentage of revenues since the majority of people who received Albreoza received it for free and a dynamic that will continue into the fourth quarter. Research and development expenses were 24.9 million dollars for the quarter compared to $12.9 million for the same period in 2021. The increase was mainly driven by higher product manufacturing and development expenses to support the global phase three Phoenix trial and launch preparation activities for commercialization. It was also driven by additional personnel related expenses due to new headcount to support research and development efforts. Selling and general administrative expenses or SG&A were $29.9 million for the quarter compared to $10.4 million for the same period in 2021. The increase was primarily due to personnel-related costs, which included hiring additional headcount to support commercialization preparation initiatives and other expenses for launch readiness activities and operations. We expect some growth in SG&A expense going forward as we incur additional sales and marketing expenses as part of our U.S. launch. That loss for the quarter was $53.9 million compared to a net loss of $23.1 million for the same period in 2021. As for cash, we're in a strong position. Cash and short-term investments were $162.6 million at September 30th, compared to $206.7 million at June 30th, 2022. The third quarter balance does not reflect the net proceeds from the recent follow-on stock offering we closed on October 11th of approximately $230.8 million in net proceeds. On a pro forma basis, we had roughly $390 million of cash and short-term investments at the start of Q4. We're well positioned with sufficient capital and resources necessary to fund our ongoing commercial launches in the U.S. and Canada and our launch in Europe in 2023 if AMX 35 is approved. This is an exciting time for all of us at Amalex as we deliver delivery to patients in the U.S. for the first time. With that, I'll turn the call over to Josh for some closing remarks.
Margaret
Thanks, Jim. I wanted to provide a brief status update on our phase three PHOENIX trial. PHOENIX is progressing well, currently enrolling in Europe and on schedule. We continue to expect to recruit approximately 600 adults with ALS into the PHOENIX trial with top line data planned for mid to late 2024. We are on track with PHOENIX and continue to look forward to the results from this trial. To close, I want to take a moment to thank our team here at Amalyx. We are excited about the strong initial interest that we are seeing only a couple weeks into launch. Our goal is that every eligible person who can benefit from Relivrio will have access as quickly and efficiently as possible, and our team is entirely dedicated to this. We look forward to keeping you all updated on our progress. Here at Amelix, we are motivated by the community and every day looking for even greater opportunities to make a difference in the lives of people living with ALS. Thank you for joining us and for your support. We welcome questions. Operator, please open the call to Q&A.
Operator
We will now begin the question and answer session. To ask a question, you may press star then 1 on your telephone keypad. If you're using a speakerphone, please pick up your handset before pressing the keys. And to withdraw your question, please press star then two.
Relivrio
And at this time, we'll pause momentarily to assemble our roster. And the first question will come from Corinne Jenkins with Goldman Sachs.
Operator
Please go ahead.
Tammy Sarnelli
Corinne Jenkins Great. Good afternoon, everyone. Sorry, my headset seemed a little funky. can you just maybe provide any detail on the kinds of questions that are outstanding from the day 120 list of questions you got from the EMA? And then how confident are you that you'll be able to address those questions with your existing set of data?
Margaret
Yeah, great question, Corinne. So, you know, as you probably know, we generally don't provide granular details as we go through regulatory process on, you know, questions we're receiving and everything like that. What I can say is, you know, we have a lot of confidence in the data and the studies that we've run. We've already been through two regulatory approvals and processes. But of course, every regulator has to review our package, which is only one study to support approval and come to that decision. I'd add, too, that we have an excellent team behind this. People may be aware of Tammy Sarnelli, our global head of regulatory, who has brought us through our first initial two approvals. We also have an excellent head of regulatory in Europe named Jan, who's doing a fantastic job there as well. So, you know, we're working through it. I think it's much too early to know what the final decision will be. But, you know, of course, we have a lot of confidence in our data and our ability to present the data.
Tammy Sarnelli
Thanks. That's helpful. And then with respect to the ongoing launch in the U.S., How should we think about the cadence for that patient assistance program? I think you mentioned patients today are all getting free drug, but how quickly do we expect that to normalize?
Lindsay
So I did not mention that patients today are getting free drug through the Amalek's care team in the U.S. We've just started to see our initial, now that we have products in channel, we're starting to see a solid initial bolus of demand from physicians across the country. And right now we're not getting any... as to whether or not those are, you know, EAP patients versus clinical SAIF patients. But I will say that there's very few IAP patients or PAP patients going on right now.
Relivrio
Okay, thank you.
Operator
The next question will come from Yuma Rafat with Evercore ISI. Please go ahead.
Yuma Rafat
Hi, this is Mike DeFiori in for Omer. Thanks so much for taking my question and congrats on all the progress. A couple for me. One, when will you start providing sales guidance and or patient number updates? Will that occur sooner rather than later? And with respect to patients who are in the queue to receive Relivio, how many of them would you say are currently enrolled in commercial insurance versus enrolled in Medicare and Medicaid, and does this split reflect the broader U.S. ALS market in general? And I have one follow-up.
Justin
Yeah. Hey, Mike. It's Jim. Thanks for the questions. I'll start with Adam. Maybe, Margaret, you can address the insurance coverage that we see so far. But, you know, it's really we're 17 days from having drug in-channel, so it's hard to give guidance at this stage, right, in a process that's going to take 30 to 45 days to get through, you know, on average, to get through all the insurance coverage and insurance verifications. So, you know, I expect we'll know a lot more when we talk again after Q4. And, you know, the thing that we want to make sure of is any trends that we see and we start projecting are trends that we understand, right? So we're going to have to get a little bit of experience under our belt before we start to give projections. But, you know, as you said, I think as you heard from each of us on the call today, We're very happy where we sit today with the response.
Lindsay
Yeah, and maybe just to follow up on your second question. So, just as a reminder, in the U.S., our payer mix is roughly 50% commercial and 50% Medicare. It's too early to know exactly which patients in the funnel are, you know, commercial versus Medicare, but I would expect that national trend to actually be the breakdown of what we see coming into the MLS care team.
Yuma Rafat
Great. That's very helpful. And last question, in terms of the total addressable market in the U.S., do you foresee the roughly 7K patients that are currently taking Rilazole every month as the total addressable market, or could Relivio expand it by penetrating into the more of the untreated prevalence pool? Thank you.
Lindsay
Yeah, so there's 29,000 prevalent patients in the U.S. We certainly feel like, you know, that's going to be the The number that we try to target and penetrate, we definitely think that will be added on top of Relivrio or standard of care as we were in the Centaur trial. And physicians really do believe in combination therapy and getting every one of these patients. It's all our mission to give them every shot on goal for treatment. And we've heard from physicians that certainly their intent is to add Relivrio on top of whatever product they're on. And ultimately, our strategy is to become foundational treatment and have other products added onto our librio.
Relivrio
Great. Thanks so much. The next question will come from Mark Goodman with SVB. Please go ahead.
Mark Goodman
Yes, I have two questions. First, how long do you expect patients to stay on drugs in your model? Like, how long are you modeling that? And how long is it, you know, for some of these other products that are there? And And second question is just Radhikava, obviously a new launch with the oral. Just curious if you're hearing anything out there. Is there any way that the market's changed? Is that product doing well? Is there any impact on you with respect to your launch? And are the payers perfectly willing to pay for both? I'm just kind of curious what you're hearing. Thanks.
Margaret
Yeah, good question. So with relates to time on therapy, You know, we haven't given specific guidance as to time on therapy for our product, but I can say we've done some research on past products, probably mostly on Rilazole, where we see, you know, in the ballpark of a year, you know, on average or at median. That being said, you know, one of our hopes with having a really robust education and patient support, you know, function is that we'll be able to, you know, educate about the benefits of staying on therapy as well. So that will certainly be one of our goals. And, you know, as it relates to the oral Adaravone launch, you know, I think we're very confident in the data we have, you know, the relationships we've built and the education we've done in the market. So, you know, I think we have a lot of confidence in where we sit, as Jim said. But I don't know if, Margaret, you want to add any other insights on that?
Lindsay
No, again, what we've heard is that physicians want to add on to standard of care for most of their patients. They're excited about our data and our label and what it could offer to their patients living with ALS. And just in terms of, you know, public information that's out there from M.T. Pharma, I think they communicated that there's about 2,000 patients currently on oral radicava roughly four or five months into the launch. What we don't know is how many of those are naive patients versus switching from, you know, IV. So that's something we'll continue to assess as we, you know, proceed through the launch.
Mark Goodman
And just to be clear, I understand the physicians want combo. The payers' discussions that you're having, it's not going to be an issue with respect to combo?
Lindsay
It's not coming up. We're clearly reviewing our clinical trial data, which was studied on top of really the oil and oral Adarvon. And as you know, roughly over 70% of our patients were on Adarvon. standard of care therapy, so we were added on there. Right now, it's not, and we're going to continue to keep an eye on that as payers start to put together their public policies. But it's clearly a big part of our education now.
Relivrio
Thanks. The next question will come from Ms. Nina Betredo-Garg with Citi. Please go ahead.
Nina Betredo - Garg
Okay, sorry about that. Thanks for taking my question. So I just wanted to ask about the revenue number that was reported in Canada. Can you give us any more color on whether or not that was just reflective of the number of patients that actually are on drug or whether that was mostly an inventory bill? Thanks.
Justin
Yeah, hey, Nina, it's Jim. I think that you can fairly say that's reflective of the patients that are on drugs. But, you know, again, not all the patients that are getting the drug are getting paid for by the insurance in Canada, given the length of time that it takes the insurers to cover it up there. But, no, you know, so that reflects a revenue number based on, you know, the number of patients.
Josh Cohen
And I'd say, Nina, just to, you know, say as well, we continue to believe that, you know, it'll take six to 12 months from commercial availability to get broad reimbursement in Canada. Those are just the sort of standard timelines.
Margaret
And maybe the only other reminder is just that we didn't have product and channel launch in Canada until, you know, about the end of July. start of August.
Relivrio
So, you know, that's an aspect in that revenue number as well.
Nina Betredo - Garg
Got it. And then can you also talk a little bit about how long it took for the patients that are receiving reimbursed drug in Canada? Was it like a similar timeline to what you're guiding to in the U.S. for them to get reimbursement?
Lindsay
It's really too early to answer that question because You know, the patients that are moving on to commercial or as we secure these private pay insurers, they're moving over. So it's really a slow ramp up. And as we get the additional private payers on board, we certainly hope to see more of that. So it's a very different payer landscape in the U.S. and Canada. So I don't think it's really an analog that we can use for that.
Justin
Yeah, it's also important to note, you know, Josh pointed out the drug was not available until the end of July. Good. insurance contract that we signed didn't happen until the very end of the quarter as well. So it's really a, I know people want to look at the Canadian revenues and try and, you know, use that as a crystal ball, but it's very unique and very also specific to the timing of launch and the late in the quarter timing where we got actual reimbursement from a single insurer. So there's a lot more work to do in Canada. And, you know, we'll see that come to fruition kind of more early into next year where the six to 12 months from the late July launch comes into play.
Relivrio
Got it. Thank you. You're welcome.
Operator
The next question will come from Ananda Ghosh with HC Wainwright. Please go ahead.
Ananda Ghosh
Hey, hi. Thanks for taking my question. I'm Ananda on behalf of Andrew Fine. I saw that, you know, there was the reference of the CalPain 2, and I was wondering how should we think about the future neurodegeneration-focused pipeline? And more importantly, how do you prioritize the next indication?
Margaret
Yeah, great questions. You know, so I think we were happy to share a couple weeks ago at the annual NEALS conference some data on a CalPain antisense oligonucleotide that we've developed in-house. That data showed a potent knockdown as well as some other in vitro results. However, I think what's important is one, this is a very early stage product that we've just kind of started work on. And our focus as a company is squarely and purely on launch at this time. So we're continuing to evaluate and think about how we'll continue to grow the pipeline. But I think that's all enabled by having an excellent launch. And so that's where we have to have our focus and our eyes focused. you know, right now. And I'd say similar on the indication side, we do continue to believe that Relivrio AMX 35 has potential in additional neurodegenerative diseases. And we've been hard at work, you know, evaluating which diseases, you know, have the highest kind of clinical and scientific potential. But again, I think the top priority right now for us is the launch. And those are, you know, things that will be really exciting and enabled by a successful launch.
Relivrio
Thanks.
Operator
This concludes our question and answer session at this time. I would like to turn the conference back over to Mr. Justin Klee for any closing remarks. Please go ahead.
Josh Cohen
Great. And thank you, everyone, for joining us on the call today. I just wanted to conclude by saying, well, we're really proud of what our team has accomplished to date. I think this is a really remarkable quarter for us. Much work remains and I think we all feel that working in the ALS community every day. Our focus is on ensuring that every eligible person who can benefit from Relivrio will have access as quickly and efficiently as possible. We know people with ALS and their families have no time to wait.
Relivrio
So thank you all for joining us and hope you have a good night. The conference is now concluded.
Operator
Thank you for attending today's presentation. You may now disconnect.
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