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Operator
come up into conversation thanks why don't I start out with the first and maybe the third question there and ask you know max to build on the third and maybe give us commentary on the government pay side of the equation um you know the simple answer belief beyond on titration this is for those that don't know this is the EGFR dosing protocol that we have in place I guess our experience has been that it's only with a few number of weeks out there and limited access to direct information from office to office is that it's on track. So our net calcs in terms of what we think a net value per patient per year is seem to be playing out in the early weeks of the launch. So on track with what our assumptions would be my answer there, Alethea. You know, on the Ben-Lista thing, first, you can feel very comfortable that our team understands our data and understands theirs. And, you know, it's not the primary that comes up in conversation, I think. And I'd ask Max Galau to build on this from what he's hearing at the field level. You know, the primary is getting physicians to, one, identify what patient might be appropriate for Leukinus therapy. and then ensuring that they're committed to differentiating the product versus other therapies that might be available or challenging them on why they may not have a sense of urgency to lower proteinuria in these patients. So there's a big education factor in trying to change the way physicians have historically treated. So I think that's coming up more often than hey, when I'm making a treatment decision, do I use Benlysta or do I use lupinus? So let me turn it to Max and see if he can dig a little more into maybe that question and the public payer side of the equation. Max?
max
Yeah, thanks. Thanks, Peter, and thanks, Alethea. Yeah, Peter's spot on. You know, really what our focus is is really creating that urgency in terms of you know, bringing the patient in and starting the treatment, we're definitely seeing that, you know, there's just a large number of patients with high levels of proteinuria that are not controlled. And so it's really working through creating that urgency and explaining the value proposition of loop kinase. So, Medicaid. So, it's a great question. So, as of April 1st, we've now confirmed that 90% of Medicaid lives have coverage. So, we now are months out and the mandated Medicaid coverage is in place. And so, we've confirmed 90% of lives now having coverage.
Peter
Oh, wow. Thanks. That's awesome. Congrats again. Thanks, Alethea. Any more questions? Now I'll hop back into you. Okay. Thank you.
Operator
Operator, next question?
Joe
Certainly. Your next question is coming from . Your line is live.
Max
Hey, thanks, guys. Good evening. I know you reviewed a lot of different metrics, so I'm just going to ask a couple here to help us out. Just wondering, as we get to the current moment, is the pace accelerating of enrollment forms and, conversion of those enrollment forms. So can you take us up to real time? Are you seeing a constant and steady building, or were we working through a little bit of Ebola? So just love to hear how you frame that out. And then also, now that you have engaged the number of clinicians that you suggest, just wondering, as you're getting almost a real-time survey of the patient landscape, can you talk about your views of actual patient size? I know it's a debate amongst us investors of how many LN patients are out there and accessible. I would think with your interactions, you're able to kind of get a really good sense of that. So you can talk about any learnings in this kind of early interaction. And then also, Peter, I hate to ask the question, but there's been commentary previous from you all about is the street consensus number achievable. Can you just kind of frame your commentary around what you're seeing consensus and how we should be thinking about that? Thanks so much. Okay. Thanks, Ken.
Operator
Well, first, let me just go into all the numbers that we gave for the quarter were sort of locked into the quarter. So I want to try to stay very consistent to that. What I can tell you about both patient start forms and the time from a patient start form turning into a patient on drug have both steadily increased. increased and or decreased, meaning our patient start forms per day, per week, continue to increase on pace, as Max said, with what our expectations are into Q2. And with that, a subsequent decrease we're seeing as policies start to come online, as our Irini Alliance work with physicians and patients starts to come more online, a decrease in the time it takes from a patient to go from a patient initial start form to actual drones. So we feel good about the numbers as although we didn't quote exactly what the numbers are through this time period in a quarter, we feel good at the trends that we're seeing. So I'll kind of leave it at that. One thing you did mention is did we see a bolus of patients in the first quarter through patient start forms? Recall that we have an ongoing two-year extension in our Aurora our original phase three Aurora trial. So we didn't have a group of, you know, 30 or 40 patients that came out of that trial and went on to commercial drugs. So there was no bolus there. And since we didn't have approval and our reps were newly trained, we were not, you know, out there identifying specifically patients for therapy to keep our, you know, our reps in the right zone from a compliance standpoint. So what you see generated has been the grassroots effort in the first, you know, just about just under actually two months of the first quarter of launch. You asked a question about patient size. I think our answer is going to be consistent here. You know, I think we still believe there's somewhere between 80 to 100,000 patients with active lupus nephritis in the U.S., And of that, we think we have an ability to play in about 80% of those patients. Now, what I will put a strong caveat on is we have seen, you know, in this COVID environment, access restrictions at certain centers, which is obvious. Many of the major medical institutions, especially tertiary care centers, are pretty locked down, right? So lupus clinics in many of those centers are not happening or they're happening virtual. And as the data Max shared, patient visits in general and follow-up diagnostic patients or visits for patients with lupus are down almost 50%, according to a very sizable patient survey done by the World Lupus Foundation. So, you know, it's kind of hard to tell what we're learning in terms of real-world, on-the-ground data. because of the COVID environment. But we still stay very confident in those higher level numbers. As we learn more and things open up more, we'll make sure to relay some of that information to the markets. And then lastly, your last question was centered around where consensus is. And I will just reiterate that we feel comfortable in the zone of where consensus is And, you know, as we're hard charging with our business, that has not changed in the first quarter. Any follow-on questions, Ken?
Max
No, thanks, Peter. I appreciate it, and thanks to the whole team.
Operator
Thank you.
Peter
Operator, we have another question in the queue.
Joe
Certainly. Your next question is coming from Joseph Swartz. Your line is live.
Joseph Swartz
Great. Thanks for all of the helpful insights about the launch. It's good to hear the encouraging leading indicators. I was wondering if you could just expand a little bit by passing on some of the most common adoption patterns you're seeing so far. For example, is it mostly physicians that you've met with in person or virtually? Is that also the case? And who have submitted start forms? And for which patients are they reaching for vocosporin? Is it larger practices or academic practices versus smaller practices and community practices at this point, given what I heard you say about the greater appreciation for the importance of protein area at some places? Who have been the early adopters and how do you expect the adoption patterns to evolve at the ground level?
Operator
Thanks, Joe. And let me turn that right to Max Kalau, and he can give you a little bit more color, you know, from the first 60 days or so of what we're seeing in terms of doc and physician trends. Max? Sure, thanks.
max
Absolutely. So, yeah, so the prescribers, it's 50% of them. It's really kind of splits down the middle between rheumatologists and nephrologists. 50% on each side. Most of our prescribing at this point is in the community. Now, you know, most of the patients are in the community. Now, the issue there is that, you know, the physicians in the community will only have a handful of patients, right? So you have to reach many physicians in the community to drive adoption. In the lupus centers, we've talked about this before, there are about 60 lupus centers in the United States. They're all within academic centers. They're definitely the areas where we have the most difficult time gaining access Some of the lupus centers are actually still virtual. Some of them plan to be virtual till year end. But we've gotten adoption in 50% of the lupus centers. And we have some leading lupus centers that are starting to start to lead the way, including Hopkins, UCSF, SUNY downstate. So we're pleased to see that we are making progress, even though it's it's more challenging because of the access issues.
Joseph Swartz
Yeah, right. I can appreciate that.
max
And I'll make one more point, which is in terms of patients. So the patients that are going on treatment are across all, you know, class three, four, five, primarily.
Joseph Swartz
Okay. That's where I was going next, actually. And, you know, are you finding that physicians are, is there really no set of common patterns? I mean, how are the physicians choosing these patients? Is it the next patients that were, you know, set to come in? Anyway, are they reaching out in any cases to their worst cases? Is it patients that are, you know, the most refractory and advanced?
max
Yeah, I would say that it reflects what we see to be the largest patient opportunity at launch, which are basically the patients that likely have been treated, but are treated and they're not achieving their proteinuria targets.
Operator
Yeah, and Joe, the one thing I would add that was already said, and I think it's an important point, we're seeing some regional differences, right? Like Where access is much higher, we're seeing a higher productivity, and we think that trend is going to evolve as things open up in some other geographies more. That's the only thing I would add.
Joseph Swartz
Very helpful.
Peter
Thanks again. Thanks, Joe. Operator, do we have another question?
Joe
Certainly. Your next question is coming from Maury Raycroft. Your line is live.
Maury Raycroft
Hi, everyone. Congrats on the progress and thanks for taking my questions. First one is just checking in to see if it's possible to see some of the Aurora 2 data at ULAR. So just wanted to clarify on that. Or what else should we be expecting at the ULAR meeting?
Operator
Yeah, Neil's on the phone. Neil, I don't know if we've submitted any of our I think I don't see what the deadlines are for ULAR, but you want to give any commentary on what might be seen this year around Aurora to the Aurora 2 or the Aurora 2 year extension?
Neil
Yeah, I mean, obviously, the Aurora 2 continues in a blinded fashion, but there are interim cuts that have been made for ULAR. the regulatory submissions, so there was a cut made obviously for the FDA submission, but also a cut made for the MAA in Europe, which is going in at the end of June. And there is a presentation at EULA that has some of that Aurora 2 aggregate data that's going to be presented in June. We don't have the exact date or time, and the abstract's not been released yet, but you will see some of that And obviously, towards the back half of the year, there's ASN and ACR, and it's our intention to submit even more data there.
Maury Raycroft
Got it. Okay. That's helpful. And for the Aurora 2 extension data, just wondering if you tested that in your market research surveys with KOLs, and if that had any impact on their future use of loop kinase, or if there's any additional color you can provide on KOLs. the market research and some of the results you saw there.
Operator
Yeah, I mean, I'll start. And obviously, the guy who's the closest to it, Max Klaus, should build on whatever I might miss here. But listen, I mean, Max said it, right? Like the intent to utilize a drug by both rooms and nephrologists is greater than 50%, right? So I think it's encouraging. And that's irregardless of the Aurora 2 extension study. I wonder, Max, if we've done any research specifically asking about that, but I think it's intuitive to assume that with that data, it's only going to strengthen our position. I mean, it's primarily a safety study, but showing that the drug continues to be safe after that time period is only going to strengthen Doc's conviction around the product and the amount of time they can use the product. Do we have anything specific, Max?
max
Not specific to Aurora 2, but what we do have specific to in the market research is that you know, the efficacy messages are resonating, and there's both strong recall and high impact from the efficacy messages. Definitely, we see that the physicians are looking for more safety data, and we believe that Aurora 2 will be important in helping to kind of illustrate especially what the long-term treatment, the consequences of long-term treatment. So, Yeah, we're looking forward to that.
Maury Raycroft
Got it. Okay, thanks for taking my question.
Joe
Thank you. Thanks, Maury. Operator, another question? Absolutely. Your next question is coming from Justin Kim. Your line is live.
Maury
Hi, good afternoon. Thanks for taking the question. Just one for me. Is the team able to characterize what a goal depth of engagement might be for a target prescriber? maybe just to say it another way, how many sort of interactions on average, um, maybe ideal before a physician has enough comfort in writing a script, et cetera. Um, and how that sort of engagement has been impacted by the pandemic or improved over the recent months.
Operator
Yeah, I think we actually have some of that data and, uh, and Max, I don't know if you want to go maybe into a little of that detail.
max
Yeah, sure. And so, and I alluded to this, you know, in the areas really in the South where access is more open and actually we can get frequency with physicians, that's where we're seeing the highest levels of prescribing. And your question is spot on. You know, it takes multiple engagements with the physician to get comfortable, to identify the patient, to get into a renal alliance. You know, on average across the nation, we've had about, I think it's about two and a half engagements across all of the prescriber base. But in the areas where we see the highest prescribing, that average goes into like seven, 10 and above.
Maury
Got it. And maybe just another one as a follow-up, how long does the team expect to reach that sort of doubling of the physicians engaged? Is there a sort of a time estimate in terms of how long that might take?
Operator
Yeah, I think we have our internal projections of, you know, how reps getting out there and talking to docs. But, you know, the live engagements, you know, is going to evolve. So I'm not sure we have a you know, we definitely don't hold that up as a metric to our sales force. You know, we want you to see X number of physicians, X number of times. Max, would you have a more, you know, quantifiable answer to that?
max
No, that's spot on. Because of the regional differences around access, we haven't set specific targets. But, you know, but again, what we're seeing is that frequency increases as we, you know, as things open up.
Maury
Understood. Thanks so much, and congrats on the progress.
Peter
Thanks, Justin. Operator, do we have another call?
Joe
Yes, your next question is coming from Ed Ark. Your line is live.
Ed Ark.
Hi, everyone. Thanks for taking my questions, and congrats on the early progress of launch. First question is just on the first obvious tier as you just get into the launch, which is... patient access and reimbursement. You mentioned at this point you've already got 120 million lives covered. And 11 payers have actually published the kind of specific coverage plans. I was wondering first if you are free to disclose any of those 11 payers. And then, With those policies, are there any specific sort of restrictions along the coverage pathway that are of interest, you know, especially given the broad label and the very favorable, you know, ICER recommendation? Just curious if there were any sort of odd restrictions placed by any of those. You mentioned the number of start forms and the conversions. Again, it's early days. I'm just wondering if there have been any payer declinations so far. Thanks again.
Operator
Max, I'll TD you on the payer and other questions that Ed just ran through. Happy to add color, but you're the closest.
Peter
Actually, maybe I'm mute.
max
Yeah, thanks for that. So, thanks for the question. And so, yeah, the 11 payers, they include, let's see, Aetna, Cigna, Highmark, Anthem, a number of the Blue Crosses, Health Now. So, that's the, those are the ones that have published loop kinase specific coverage policies. And like I said, all of them are lying to the labeled indication. All of them, you know, are consistent with how we kind of studied. And I would say out of all those lies in the covered by the 11 policies, 90% of them don't have any step-through requirements. And then the ones that do the primary step-through requirement is through MMF and steroids. So those are the coverage policies. Of course, we've had payer denials. That's common just because even though if there isn't a covered, you know, if there isn't a kind of specific policy, then it's unclear what the criteria is. And so you do, and this is typical in any rare disease launch, you do go through a denial and appeal process on a set of, you That's just par for the course. But that's, you know, from what we've seen in terms of denials, appeals, and working through the process, there's nothing really that stands out that would be different than what we've seen in other rare disease launches.
Ed Ark.
Great. Thanks, Max. Appreciate it.
Peter
Operator, do we have another question?
Joe
Thank you. Your next question is coming from David Martin. Your line is live.
David Martin
Yes, thanks for taking my questions. The first one relates to the last question that you were asked. So the 11 payers that you named, what percent of the 100 million lives do they represent?
max
Yeah. So on that one, you know, it's hard to, you know, exactly quantify that. I would say it's, you know, kind of a very rough estimate would be, you know, 20%.
David Martin
And if they don't, if amongst those 80 million other lives, there isn't a specific coverage plan in place, How are the requests for reimbursement handled, and what is the reimbursement in those situations?
max
Yeah, so every payer has a non-formulary request process, and it's typically just a generic power authorization type of form where the physician articulates the rationale of why they want to use the name therapy. And so that's the process if there isn't a coverage policy in place.
David Martin
Okay. Another question, are any patients, are many patients coming on to loop kinase as they start MMF and steroids, or are most of them coming on only after they failed those?
max
Yeah, so, you know, we don't have visibility to exactly all of the treatments that the patients are on and when they've started treatments. We don't have the visibility through a renal alliance. But I can just tell you anecdotally that we are hearing of, you know, newly diagnosed patients coming on Leukinus, even though the bulk of the patients that are on Leukinus are ones that have been on other treatments and just are not getting to their proteinuria goals.
David Martin
okay and last question has there been any pushback like you mentioned that some doctors are waiting for the long-term safety data um are any not prescribing it until they get that data because calcineurin inhibitors do have you know the older ones have a history of long-term nephrotoxicity and is there any pushback because there are cheaper calcineurin inhibitors on the market
Operator
Well, let me start there. First off, I just want to make sure we put the right context out there. Calcium urine inhibitor data in terms of nephrotoxicity has been seen in primarily the transplant population in higher doses. That's not to say the problem doesn't accrue to us, and it's not to say that we don't get the question, because we do. We do hear from some physicians out there not a hesitancy to wait to utilize the product, but I think one of the areas we got to, you know, focus on and really put intention intensity of our education efforts around impact, not just our, not just our data, but also around disease state awareness and what the impact of not aggressively treating is on these patients. We do hear that, um, you know, uh, well, yeah, I know the drug, I know the data and you know, I'll consider it for, you know, patients that, you know, that I consider for first generation CNI, you know, like this is a better CNI. Obviously, those physicians don't even really understand how we studied the drug. And I think that's just a matter of education. But Max, you know, you can build on and I wouldn't say that that is a and that is representative of the full community. We I'm just being, you know, completely clear that we do hear that question. I don't know that we hear a lot that I'm not going to utilize the product until I see two-year data. Have we, Max?
max
You know, I would characterize just very consistent when you launch, you know, a new therapy that's been studied in clinical trials. You have a subset of physicians that are cautious and they want to see more data, more safety data, right? And I think that's just very consistent. with what we're seeing is very consistent with what we've seen in other launches.
David Martin
Okay, great. Thank you.
Peter
Thanks, David. Operator, anyone else up in the queue?
Joe
There are no further questions in the queue at this time.
Operator
Okay, beautiful. Listen, I want to thank everybody for joining us after business hours on the East Coast. And as I said in my closing comments, I want to thank you and promise everyone that as we continue to make significant progress here, we'll look forward to laying that out over the quarter and quarters and months to come. Thank you for your time tonight. Take care.
Joe
Thank you, ladies and gentlemen. This does conclude today's event. You may disconnect your line to this time and have a wonderful day.
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