Revance Therapeutics, Inc.

welcome to the revance therapeutics fourth quarter and full year 2023 financial results and corporate update conference call at this time all participants are in listen only mode if anyone has difficulty hearing the conference call please press star zero for operator assistance following management's prepared remarks we will hold a q a session to ask a question at that time please press star forward by one on your touch tone phone to ensure that we have ample time to address everyone's questions we would ask each person to limit themselves to one question and one follow-up. As a reminder, this call is being recorded on Wednesday, February 28, 2024. I would now like to turn the conference call over to Jessica Serra, Head of Investor Relations, Corporate Communications, and ESG for revance. Please go ahead.

Thank you, Operator. Joining us on the call today from revance are Chief Executive Officer Mark Foley and Chief Financial Officer Toby Schilke. During this call, management will make forward-looking statements, including statements related to the impact of our pricing and strategy on Daxify on adoption, expectations and timing related to product adoption and reorders, our product pipeline, consumer needs, preferences, and behavior, the benefits and value to us, practices, and consumers of our products, including the efficacy, duration, and safety of our products, 2024 guidance, cash flow late given, positive adjusted EBITDA, future capital expenditures, funding our business, and capital allocation plans. Our strategic priorities, our anticipated success, our blockbuster and growth potential, our market opportunity and expectations, provider partnerships, the wind down of OPAL, our strategy, planned operations, international expansion, strategic partnerships, and commercialization plans and timing. Our actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of these risks and uncertainties. Factors that could cause these results to be different from these statements include factors the company describes in the section called Risk Factors in our annual report on Form 10-K to be filed with the SEC today, February 28, 2024. RE-VANCE undertakes no duty or obligation to update any forward-looking statements as a result of new information, future events, or changes in its expectations. Also on today's call, we will present both GAAP and non-GAAP financial measures. Reconciliation of non-GAAP to GAAP measures is included in our earnings relief. With that, I will turn the call over to Mark Foley, Chief Executive Officer of Revance. Mark.

Thank you, Jessica. Good afternoon, everyone, and thank you for joining our fourth quarter and full year 2023 financial results conference call. I'll first cover our overall performance in our aesthetics and therapeutics businesses before turning the call over to Toby to review our financial results in 2024 guidance. 2023 was an important year for Revance. We realized several pivotal milestones, including the launch of Daxify in aesthetics and the FDA approval of Daxify for cervical dystonia, in addition to achieving record product revenue of $213 million of 80% year over year. From a balance sheet perspective, we ended the year in a strong financial position with $254 million in cash cash equivalents, and short-term investments. Combined with our commercial progress to date, we believe we are well positioned to deliver on our strategic priorities for 2024, which I will cover later in the call. Turning to DAXify for our aesthetics business, we generated total sales of $95 million in our first five quarters of launch, exceeding the combined sales of the last three neuromodulators to enter the market in the same launch timeframe. We also gained important real-world feedback from the early stages of our DAXify launch, which informed our updated pricing and provider engagement strategy, better positioning us for broader adoption and long-term success. As a reminder, we revised DAXify's pricing in September of last year to be more competitive and to facilitate greater trial and adoption. Since adapting our strategy, we began to see the desired impact with regards to usage, reorder rates, and customer perception, with that momentum continuing into Q1. From a sales volume perspective, Q4 vials sold were up 22% compared to Q3, and importantly, more than two-thirds of Q4 revenue came from existing accounts. Based on our current focus on existing customers, we believe this reflected deeper product adoption. We ended the year with over 3,000 Vaxify accounts, which is less than 10% of the total number of U.S. aesthetic accounts, and less than one-half of our existing account base, underscoring our significant runway for growth. Since the rollout of our new pricing and provider engagement strategy, we have focused our efforts on existing Daxify customers since these accounts have already been trained, have experience with the product, and in most cases, are RHA customers. And from a reputational and foundational perspective, we believe it's important to gain their support. Previously, we indicated that we expect this re-engagement plan to take approximately two quarters before turning our focus to new account activation in the beginning of Q2. Beyond pricing, we consistently hear from customers that Daxify is a great product and offers a compelling value proposition because of its unique peptide formulation, fast onset, long duration, and ability to enhance the skin's appearance. To that end, we recently introduced new brand messaging for Daxify which highlights the product's full range of benefits and ability to deliver an optimal overall aesthetic look. The new messaging, along with expanded sales tools and materials, was shared with our sales team at our national sales meeting in January and has been very well received. Based on feedback and in support of our new pricing strategy, we recently removed our no advertised price policy, which was implemented in the introductory phase of our product launches. However, as we move to broaden our share and brand awareness, it is important that we empower practices to market and promote the Revance product portfolio. During the fourth quarter and into Q1, we also expanded and augmented our marketing tools, marketing materials, Salesforce training, and customer education programs. We have and will continue to increase our visibility with customers and KOLs, the advisory boards, congresses, podium presence, media events, and thought leadership. Further, in February, we executed one of several planned promotional programs, a patient coupon program, which has been very well received and aligns with our goal of driving greater practice and consumer experience with Daxify. Turning to our filler business, the RHA collection continues to be vital to our aesthetics franchise and foundational to the long-term growth of Daxify. Three years into launch, the RHA collection is still the fastest-growing HA filler in the U.S., sitting at about 10% market share which was largely achieved independent of a neuromodulator. We believe RHA's success can be attributed to not only our strong execution, but more importantly, its leading innovation. RHA is designed to more closely resemble the natural hyaluronic acid found in the skin, which we believe distinguishes the collection from other competitive offerings. Further, the collection's range of utility continues to expand with new SKUs and indications, including RHA Redensity for lip lines, RHA-4 for cannula use, and more recently, RHA-3 for lip augmentation and lip fullness. The lips are the most frequently treated area for dermal fillers, and the recently approved label expansion provides us with new opportunities to train on RHA's leading innovation and injection techniques. We look forward to launching the new lip indication in Q2. In 2023, we were pleased to deliver 20% year-over-year RHA revenue growth despite softness in the U.S. filler market and while we launched DAXify and worked through our strategy changes. As we move into 2024, we look forward to continuing to drive healthy growth across both DAXify and the RHA product line through a combination of new account activation and deeper penetration while also beginning to unlock portfolio synergies. Across Daxify and RHA, we ended the year with over 7,000 aesthetic accounts, up from 5,000 one year ago. Now, let me turn to our compelling opportunity in therapeutics with the approval of our cervical dystonia indication. Due to Daxify's unique and differentiated profile, we look forward to addressing the unmet needs of patients, physicians, and payers in this category. Based on a published study in the Journal of Neurology, 88% of CD patients experienced symptom reemergence between injections with symptom recurrence happening as early as week 8. Since patients can't get reinjected until 12 weeks due to label and reimbursement restrictions, this can leave CD patients with significant treatment gaps when considering both the delayed onset of action and early wear off. Based on our clinical trial data and early preview experience, We believe that Daxify has the potential to provide patients with better symptom control along with a compelling safety profile. As toxins are the 12th most costly medical benefit drug category, payers are also motivated to find alternatives that offer both clinical value and that can lower the cost of therapy. Based on Daxify's clinical performance, file price, and the dosing used in our clinical trial, there's an opportunity for meaningful savings to payers which we believe is why we've seen such strong commercial coverage at such an early stage in our launch. Taken all together, we believe Daxify's strong efficacy, long duration, and favorable safety profile, coupled with its attractive pricing, have the potential to disrupt the current CD treatment landscape, which has remained largely unchanged for 30 years. Following FDA approval in August 2023, we subsequently launched our CD preview program to leading clinicians in order to optimize treatment outcomes for patients and to ensure smooth practice integration. To date, we have treated more than 300 patients across approximately 30 practices, which is in line with our plan. As the majority of CD patients experience symptom breakthrough, most patients treated to date in the preview program are those who are uncontrolled on their current toxin. In switching these patients to Daxify, Physicians have reported that they are using a wide range of doses in their effort to optimize treatment outcome. In addition, Daxify's safety profile continues to be encouraging even in the presence of escalating doses. To date, approximately one-third of patients have completed their first treatment cycle and are now in their second treatment cycle. As a reminder, with a new toxin, physicians tend to start patients at the lower end of the dosing range before titrating them up over subsequent treatment cycles in order to find the optimal balance between symptom control and safety. Despite being early in the dose optimization journey, when surveyed, 94% of preview physicians who have been in the program since its inception indicated that they perceived Vaxify to last longer than other toxins based on their first treatment cycle. In summary, we've been very encouraged to see real-world clinical results, including safety, efficacy, and duration, in line with those seen in our Aspen clinical program. We remain on track to initiate a targeted commercial launch mid-year, having received our permanent J code in early January. Importantly, we've also made significant progress on the payer front, already securing 25 of the top 30 plans covering over 50% of commercial lives. This impressive achievement reflects not only the team's ability to execute, but also Daxify's differentiated clinical profile and attractive economic profile for payers. Also, we recently operationalized our patient reimbursement support services to minimize potential hurdles to adoption. In addition, we have launched our patient affordability program to ensure out-of-pocket costs do not impede access to therapy. On the commercial infrastructure side, our therapeutics team will include about 40 people across sales, medical affairs, market access, and reimbursement. We believe we have the appropriate resources to target the concentrated CD physician population where 70% of patients are treated by the top 20% of physicians or about 1,000 injectors. As announced earlier today, the Therapeutics Commercial Organization will be led by Dr. David Hollander, our Chief Medical Officer, who has taken on the expanded role of Global Therapeutics Franchise Lead, reporting directly to me. I'm confident that David's deep experience in all stages of the product life cycle, in addition to building strong teams, will add significant value to our therapeutics franchise. As Preview continues to advance, we look forward to presenting two posters and abstracts on our Aspen program at the American Academy of Neurology in April. With that, I'll turn the call over to Toby to cover our fourth quarter and full year financials and our 2024 financial guidance.

Thank you, Mark. The press release and the 10K we issued today details our financial results in full, so I will only go over the highlights on this call. Total revenue for the fourth quarter and full year 2023 were $69.8 million and $234 million, up 40% and 77% respectively from the same periods last year. Total revenue for the fourth quarter included $58.5 million of product revenue, $2.3 million of service revenue, and $9 million of collaboration revenue. On the product side for DAXify, we delivered $24 million in sales in Q4 and $84 million in sales in our first full year of launch in 2023. For the RHA collection, fourth quarter and full year 2023 revenue were $34.5 million and $128.6 million. Sales were up 20% for the full year, driven by deeper and broader account penetration. Quarterly sales were down 1% year over year, primarily due to higher than normal RHA sales recorded in Q4 of 2022. This dynamic resulted from both the introduction of the RHA Redensity SKU and the launch of DAXify, where early access to DAXify was prioritized among accounts. that have ordered RHA. Regarding OPL, our services business, substantially all payment processing was stopped as of January 31, 2024, and we are on track to complete the wind-down of the business by the end of Q1, providing cost savings of approximately $20 million this year. We recognized $9 million of collaboration revenue in Q4 related to our biosimilar to Botox program with Beatrice. The revenue is reflective of the progress made in our collaboration effort. Note that since the inception of the program, we have received a total of $60 million from upfront and milestone payments, which have been shown as deferred revenue on our balance sheet. The revenue was recognized primarily from the deferred revenue balance. Turning to OPEX. We are pleased to see our 2023 GAAP and non-GAAP operating expenses of $550.8 million and $319 million come in on the low end of our previously announced guidance, underscoring our continued efforts of disciplined capital allocation and cost controls. Further, we continue to see operating leverage within our business. Full year 2023 non-GAAP operating expenses increased 19% from 2022, while total product revenue increased by 80% during the same period. On the balance sheet side, our current cash position, operating plan, and anticipated revenues provide us with multiple levers to appropriately fund our commercial growth while maintaining our path to break even positive adjusted EBITDA in 2025. Finally, revances shares of common stock outstanding as of February 16, 2024 were approximately 88.2 million, with 97.7 million fully diluted shares, excluding the impact of convertible debt. Before I turn the call back to Mark, I'd like to review our 2024 revenue and OPEX guidance in greater detail. We recently provided our product revenue guidance, which includes sales of Daxify and RHA of at least $280 million for 2024. Our guidance assumes continued market share growth for the RHA collection and Daxify aesthetics and modest revenue contribution for the launch of Daxify for cervical dystonia. Further, our guidance takes into consideration normal seasonality. As a reminder, the U.S. facial injectables market experiences traditional seasonality, where Q1 and Q3 are typically slower periods during the year compared to Q2 and Q4. Turning to our OPEX guidance, we expect our 2024 GAAP OPEX to be between $460 million to $490 million, and our non-GAAP OPEX to be between $290 to $310 million. you will note that we are aiming to deliver increased year-over-year product revenue growth while at the same time decreasing our operating expense levels. The midpoint of our 2024 non-GAAP operating expense guidance represents a 6% reduction from last year, driven primarily by the divestiture of our OPALS payments business in addition to organizational streamlining and operational efficiencies. Further, we expect our non-GAAP SG&A expenses to be between $240 to $255 million. And with that, I'll turn the call back over to Mark.

Thank you, Toby. Before we conclude, I'd like to review our strategic priorities for 2024. First and foremost, we will focus on delivering at least 32% growth on the top line while effectively managing spend to reach positive adjusted EBITDA in 2025. To reach this goal, we plan to execute on our commercial objectives for Daxify and RHA, launch Daxify for CD mid-year, and maintain our disciplined capital allocation while continuing to drive operational efficiencies. The proof points of our commercial strategy continue to provide us confidence in the trajectory of Daxify and RHA. For Daxify in particular, the ongoing positive trends in adoption and improving customer sentiment reinforces our belief in our blockbuster potential in the U.S. aesthetics market. Further, we are on a path to realizing our future growth opportunities in therapeutics, the international expansion of Daxify, and strategic partnerships with Fosun and Viatris. Combined, these represent access to a $5 billion market opportunity outside of the $4.2 billion U.S. facial injectables market. With that, I will now open the call up for questions. Operator?

Thank you. If you would like to ask a question, please press star followed by one on your telephone keypad now. If you change your mind and would like to remove your question, please press star followed by two. When preparing to ask your question, please ensure that your phone is unmuted locally. And our first question today is from the line of David Amslem of Hypersandler. David, your line is now open.

Thanks. Just have a couple. So first, wanted to drill down more on the top line guidance. And I guess I'll just ask it plainly. How realistic do you think the implied assumptions regarding DAXify are for 24? There's clearly expectation here that there's going to be aggressive expansion of the sales footprint. I just wanted to get your thoughts on what gives you that level of confidence. Is it a greater footprint among, a significantly greater footprint among newer accounts? Is it deeper penetration within existing accounts? How are you thinking about that mix and just your overall level of confidence? That's number one. And then secondly, on the fillers in RHA, this is more of a long-term question, but how are you thinking about competitive dynamics with Evelis looking to enter the market? Less about this here and more about the long-term dynamics in the context of a potentially more crowded space. Thank you.

Yeah, thanks, David. This is Mark. You know, on the top line growth, we obviously feel very good about the $280 million guidance that we put out there for top line. As we stated on our, you know, JP Morgan pre-announcement that, you know, we'd expect a little more of that to come from RHA and a little bit of less to come from DAXify. And so we feel very good. I mean, if you look at where we are in our launch, you know, last year, the back half where we made some of the strategy changes and the pivots, you know, we didn't see the normal launch trajectory because we were doubling back to those existing accounts to cement the relationship and, you know, try and address kind of what their concerns and issues were. As we saw going into Q4, we were getting really good feedback from accounts that the pricing change removed an important barrier to adoption. And, you know, with the way that we've leaned in and, you know, are prioritizing some of the other engagement strategies, you know, we feel very good about the way that that is going. We have stated that we would expect to see normal seasonality in this business, but our growth will come from a combination of new account ads along with ongoing reorders. And as we noted in Q4, more than two-thirds of our revenue came from reordering accounts, which I think points to the stickiness of the product in those accounts where we're able to secure. So we feel very good about where we are, and again, particularly with how early we are in the DAXify side. I would also note that we mentioned that we're in about 3,000 Vaxify accounts at the end of the year, and we have an account base of 7,000 accounts. So even before we go outside of our existing account base, we have a number of accounts that we've got relationships with that we can broaden, and there will be opportunity for bundling and cross-selling too as we move forward. On the filler dynamic side, you know, the nice thing about the Teoxane partnership is that, you know, we were able to bring into market the sort of the latest innovation in filler technology. but one that has, you know, years and years of experience. And so, you know, we feel very good about, you know, if you look at how RHA and Teoxian has performed internationally in a very competitive market, how they've been able to continue to take share and to grow it. And, you know, with our expanded portfolio of different RHA filler lines and the expanded indications, we feel very good about how we're positioned in the market, you know, Also, given where we are in our journey, we have plenty of opportunity to continue to grow our share. And we've been the fastest growing share taker over the last three years. And we feel very good about the technology and where we're positioned in the market. Helpful.

Thank you.

Thanks.

Our next question today is from the line of Stacy Ku of TD Cowen. Stacy, your line is now open if you'd like to proceed.

Thanks so much for taking your questions. We did have a few. So just first, probably for Q2, a little bit of a follow-up on the last question. Do you have a sense, as you broaden out what kind of clinicians or accounts you're hoping to target, are they going to be the RHA existing accounts? Just characterize your plans a bit more. And I'm curious if you expect the sales force will have the ability to go beyond 500 accounts roughly per quarter. So just curious if you're targeting the same amount of training that you've kind of focused on recently. And I have a follow-up.

Sure, Stacey. So on the number of accounts, as we kind of look at Q2 and where we're going to go, we frankly give a lot of latitude to the sales managers and the sales reps. Obviously, the market continues to grow and expand, and there's a wide range of different providers. Obviously, those that we have a relationship are a natural starting point for us because we know the accounts and they know us. And so we would expect that that would be the initial priority. But having said that, we also know from the RHA launch there were a number of accounts that were certainly intrigued by DAXify but for whatever reason weren't willing to engage with RHA at the time. And we think that that's going to be a great entry point for us for some of these accounts that are excited to offer DAXify and the innovation that it offers in the market. So I think it'll be a mix, and I think you'll see some variability across geographies. As you know, we started more with kind of a prestige strategy that was really tailored and targeted to the top third of accounts. But I think now that we've adjusted our pricing to be more in line, if anything, it's opened up a broader aperture and a broader account opportunity for us. So it's really about qualifying those accounts that are willing to lean in with us, that see the value, that are going to promote and support the product. And again, given sort of the number of accounts that we still have to go, we feel good about it. In terms of the sales force and the training and the number of accounts, again, I think that, you know, if you look back, we never had to target, for example, with the RHA filler line to open up 500 new accounts per quarter. It just turned out that was sort of what the field force could digest between continuing to support existing accounts and try and go deeper, along with opening up new accounts. And then, obviously, we believe very strongly in medical education and training. And given the profile of our products and sort of the innovation innovation that underlines them, we believe that the best way for people to get the full value is through training and education. So that will be an important part of it. And so it's, I think, really hard right now to say for sure exactly what that account ramp is going to look like, partly because we have existing relationships, too, that we're going to go into. But when we've done the roll-up and put together our plan, we feel very good about the guidance that we've put out there.

Understood. And then just briefly on kind of the ongoing relationship repair with these accounts, Are you willing to discuss in more detail what's working, where we see these accounts are increasing orders versus maybe that roughly one-third or so of accounts where there's a little bit more reticence? So just trying to understand where we are and if we're seeing any early signals and kind of the repair overall. Thank you.

Thanks. Yeah, I mean, we like the signals and the signs that we're seeing. Again, we've talked about the percentage of revenue in Q4 that came from reordering accounts, which we think is a good indicator for people leaning in, seeing the value in the strategy, appreciating the adjustment in price, and frankly, appreciating that we're listening and making actionable changes to it. And so it's early. We'll continue to provide metrics and data that we think are representative of trends, not just points in time. And so as we move forward, we'll continue to share things that we think are helpful, but again, reflect what we're seeing. But we're encouraged by what we continue to see as we've moved into the new year.

Okay. Very helpful. Thank you.

Thank you. Our next question today is from the line of Balaji Prasad of Barclays. Please go ahead. Your line is open.

Balaji? Balaji Prasad from Barclays. Your line is now open if you'd like to proceed with your question.

I'm afraid we're getting no audio from Balaji's line, so I'm afraid we'll have to move on to Krish Shibutani from Goldman Sachs. Krish, your line will be open now if you'd like to proceed.

Hi, good afternoon. Krishma on for Krish Shibutani. Thank you for taking our question. I was wondering if you could help us frame the discussion around cervical dystonia How should we think about the positioning of the product in regards to payers and the impact of the permanent J code on the ramp of revenue generation and the adoption curve? Thank you.

Sure. Well, in the cervical dystonia market, you know, in the U.S., it's about a $340 million market. You know, most of these patients are existing patients. So a lot of the patients that we have seen in our preview program and that we expect to convert over to Daxify are going to be switch patients. What's interesting for cervical dystonia, there's no cure, and so it's really a management of the symptoms, and toxins are really the frontline therapy to manage it. Interestingly, as we pointed out in our prepared remarks, is that over 80% of these patients see symptom reemergence before they can get re-injected prior to week 12, and so given the data that we generated in our Aspen clinical program, our ability to potentially give them many more symptom-free days, both from a An early onset of action along with a good duration profile has been incredibly well received by both clinicians and payers. And so we're trying to go forward in a measured way because, you know, within the neurology community, they tend to be conservative. They're going to start low on the dosing, and then they're going to dose them up over time. But as we mentioned in our prepared remarks that, you know, when asked, when asking our preview physicians what they thought of the duration profile, their perception of duration profile of Daxify, 94% of them felt that it was longer lasting. And so we have an opportunity to be the first really truly novel therapy in CD in over 30 years. On the payer side, what makes that interesting for payers is that based on the dosing ranges that we saw in our cervical dystonia clinical program is that we were seeing more one-to-one dosing with other toxins. And based on the current vial price that we have, When you do one-to-one dosing, you know, there's a material discount for these payers. And so the payers are looking at this saying, wow, this is a product that can deliver results that are similar to or better than conventional toxins, and there's that type of price break. We love it, which is why we think we've seen such robust adoption and the commercial lives covered. So we're already over 50% coverage on commercial lives before we even get started into the launch side of it. You know, we do want to be measured because we know as we move into the full launch, what's going to regulate this is the way that physicians treat these patients, which is they will start low. These are switch patients. They'll monitor them through their first 12-week cycle. And then if the symptoms are managed, they won't go up any further. If not, they'll continue to up the dose. And so we just want to give time for that learning process to take place over multiple cycles. We think that this is, you know, really an encouraging gateway for us into the broader therapeutics market, and we really like where we're positioned.

Thank you. That was really helpful.

Thank you. Our next question today is from the line of, sorry, Annabelle Smiley of Stifel. Annabelle, your line is now open. Please go ahead.

Hi. This is Jack on for Annabelle. Thanks for taking our question. So could you provide a little bit more color on how you're changing your communications with physicians so that they're fully aware of your new price changes? Have you only really been circling back to the accounts that you have an existing relationship with, or have you kind of brought in that message such that new accounts can kind of gain some increased brand awareness?

Yeah. So on the pricing change, given our focus on existing accounts, we've really allowed that to happen much more through the rep side of it because, again, our primary goal in these first two quarters were to solidify the foundation with many of these accounts that are existing customers on the RHA side, went through training, know how to inject the product, but had feedback for us on how we could improve things. And in some cases, they've got product on the shelf that needs to be worked through before they turn into a reordering account. And so rather than blast out the pricing to everybody, we thought it was best to allow those reps to go back in, to reengage, to explain the rationale and work with these accounts on the different pull through. As we start to move forward and go to more of a new account activation in Q2, then we'll be much more forward leaning on the pricing. And it's not to say that we aren't open about the pricing. But given the strategy, it's been more driven at the rep level and their ability to get back into these accounts and re-engage. And then as we go forward, we'll be able to more broadly disseminate that information.

Great. Thanks.

Great.

Our next question today is from the line of Alana Lalo of Guggenheim. Alana, your line is now open.

Hey there. Thanks for taking the question. Just quick ones. First, regarding the patient coupon program, just wondering if you can provide any color and kind of what that looks like and any metrics that you can share so far on how that has driven increased patient interest in DACSI. And then with the removal of the no advertised price policy, again, any impact you're seeing from that yet and any metrics that you can share from that angle?

Sure. Well, it's Probably premature to share any metrics. I think it's something we can share in more detail on our Q1 earnings call. But the patient coupon is basically $75 off for the consumer that was redeemable through the practice. And so with purchases, the practice received a number of those coupons that they can use. And all this is designed to stimulate trial use and experience with our belief that the more injectors get comfortable with the product and the more that patients experience the look, that there's going to be a bias and a desire to continue to get retreated with Daxify. And as we've said in the past, we're going to continue to pilot a number of these different initiatives. We've had different types of programs like this in the past, whether it's for people to qualify for one of our guru trainings or different influencer events or other types of programs. And so these are fairly common in the industry, and we're going to pilot a number of these. But we've been very pleased to see The receptivity of this, both at the account level and on the patient level, and it's having the desired effect of generating more trial usage and experience. In terms of the removal of NAP, our no advertised pricing policy, this has also been very well received. Obviously, in a B2B, B2C business, it's important that practices are able to drive awareness in a way that's linked to their practice. And so by removing this, this allows practices to more actively promote sort of the range of revamped product lines across RHA and DAXify. And we've gotten a lot of kudos from accounts who sort of felt like, geez, I want to do a better job of promoting this. I'm excited about the product, and I'd like to be able to tell more customers about it. And if I'm limited in some cases to in-office advertising only, then I feel I'm missing out on opportunities to drive more awareness. And so, you know, again, it aligns with the pricing change that we've made, and we've been encouraged by what we're seeing so far there.

Great. Thank you so much.

Thank you. Our next question is from the line of Tim Lugo of William Blair. Tim, your line is now open.

Hi, team. This is John on for Tim. Thanks so much for taking our question. Just one from us. So I was just wondering if the team could provide commentary on the comfort level with the current debt structure. Thanks.

Sure. Toby, you want to hit that one? Comfort level on the current debt structure.

Oh, yeah. Sorry about that. I didn't hear the question. Yeah. You know, I think when you take a look at what we've been trying to achieve over time and the operating leverage that we're generating through 2023, decisions we've taken to streamline our business with the reduction of OPAL and kind of moving towards a profitability that we feel is in sight with the guidance we've given both from a top line perspective and the OPEX perspective of having EBITDA positive in 2025. I feel like that really unlocks a lot of options with sort of our capital stack. Clearly, we'll always take prudent measures to finance the business and manage our maturities, but we feel like the first thing to do is prove out the business model, continue the track record of success that we've had growing Daxify RHA with the cost structure that we've outlined here, and that will unlock continued opportunities through either organic or sort of other financing alternatives. Very helpful. Thanks.

Our next question today is from the line of Terrence Flynn of Morgan Stanley. Terrence, your line is now open.

Great. Thanks for taking the question. Maybe a two-part for me on DAXify. I know earlier this year you had talked about one of the things you guys were working through was trying to help practices with some of the prior inventory at a higher cost. And so just you know, maybe talk us through where you are in that process. And then the second question is, I think during your prior remarks, Mark, you mentioned bundling. I think that's the first time we've heard about the potential to bundle DAXE and RHA. So just wondering, you know, is that something that's currently out there in the marketplace or is that something that's being contemplated? And then how would that work, I guess, effectively? And how do you think about the impact of that on this year's revenues? Thank you.

Sure. So first in terms of, you know, working with those customers and, you know, some that had made perhaps product on the shelf at higher cost, you know, that's why, again, we focused these two quarters on going back to those existing accounts. I would say we're a good way through that, majority of the way through that, partly because, you know, the reps were incentivized to go and engage with those accounts, figure out how we can get them back on track and, you know, work with them to develop a strategy to remove some of the barriers and obstacles to getting back on board. So I feel we've made a really good, you know, really good progress there. And that's why I think when we go into Q2, hopefully we've sort of worked our way through those accounts that were existing users, those that are going to get on board with us. We've had an opportunity to re-engage them, and then we can start moving forward sort of with a clean slate. On the bundling side of it, you know, both with RHA and with Daxify, we wanted those products to stand on their own. It doesn't help to try and put together bundling programs until people are sort of fully bought into both individual products. You know, we don't want, you know, the incentive for them to try a product is just, you know, because of discounting. We want them to buy into the products because they believe in the value and they see the value. And then what we can do is look to, you know, how do we create additional incentives for these accounts to go deeper and broader with us once they're embedded. So to your question, we really haven't done anything yet on the bundling side, but that is something that we do plan to kick off as we move throughout the year where there will be additional incentives for practices, whether it's, you know, different benefits that they get or pricing when we link the two together and they're willing to give us, you know, a greater share of their business in return for some additional value. And so we just want to make sure that we're establishing the products based on their own merit first and then can find ways to unlock that. And we do think that that'll be a source of you know, future opportunity for us as we take those accounts that might be RHA accounts only or DAXify accounts only and figure out how we can create, you know, mutual line with those accounts to grow our share.

Thank you.

Our next question today is from the line of Navan Tai of BNP Paribas. Your line is now open. Please go ahead.

Hi, everyone. Thanks for taking my question. A follow-up to the previous one. Could you clarify on what is left to do on the account re-engagement? And maybe you can touch base on the priorities and if we would see any strategy tweaks with the new chief commercial officer and the global therapeutics franchise lead. Thank you. Sure.

So I think you're asking kind of where we are and kind of the re-engagement strategy. And so, you know, that's something we said is, you know, going to be a priority up and through the end of Q1 before we kick off sort of more traditional launch dynamics where new account activation will, you know, be an important part. Not that it isn't today, but it will take much more of a prominent role going forward. And so we're, you know, given where we are now at the end of February, we've made really good progress through that. And you'll see us again move to a more normal launch cadence as we get into Q2. On the leadership side, you know, as we previously announced, we promoted Erica Jordan into the chief commercial officer role over therapeutics. Erica joined the organization in sort of the spring of last year and was doing a lot of strategic workforce on the commercial side. So she has, you know, spent a lot of time with the organization, understanding its strategic priorities, work streams and stuff. And so we feel very fortunate to have her leading our aesthetic efforts, and she's doing a great job and has really been intimately involved with a lot of the streamlining efforts that we have made, and we think her background is uniquely suited to help us get to where we need to go on the aesthetic side. On the therapeutic side, as we announced, we added the additional responsibility to Dr. David Hollander, our chief medical officer, a global franchise head for the therapeutics group in I think given his background and experience being an MD, particularly within the neurology community, we think that not only does he have the gravitas from a leadership and skill set, but we think being an MD and with our targeted launch, he's going to really help ensure that we position things the right way, that we're understanding the subtleties around how physicians are using it and how best to position ourselves for the future growth. And so David's always been close to the program, but more on the medical side. And now in sort of the leadership side, we feel really good to have him in that role. As we said, it's going to be a targeted launch. We'll start with about 40 commercial folks across sales, reimbursement, market access, and medical affairs. And we've got a lot of the leaders already in place in that functional area that David's already had a chance to work with. And so we feel that we've got the right infrastructure in place to execute on our plan.

This is helpful. Thank you.

Thank you. Our next question today is from the line of Serge Ballinger of Needham and Company. Please go ahead. Your line is open.

Hi. Good afternoon. A couple questions on the upcoming DACSI launch in cervical dystonia. Looks like you've made some significant security coverage, at least on the commercial side. Maybe just talk about the nature of that coverage, how it compares to the other neurotoxins, whether it will impede usage outside of cervical dystonia, and maybe just cover also your plans and timelines for Medicare coverage. Thanks.

Sure. So on the coverage side of it, if you look at the commercial category within CD, it's about 60% of the overall CD lives. We're over 50% already. And within that, you know, about almost, you know, two-thirds of that coverage is going to be first-line therapy. So we feel like, at least in CD, coming into the market, we've got a really strong position within the commercial payer community in terms of our ability to compete effectively and not have any step edits or limits. Within the commercial category, maybe, you know, 14% will have a step edit. And so we'll continue to work to knock that down with additional payer data. Right now we don't have a lot of payer data to go back to those. And so we really like sort of the response that we've gotten in the adoption and, you know, we've made great progress with a lot of the top groups there. On the Medicare side, we already have 100% coverage. On the Medicare side, that's about 20% of the market. And then, you know, same thing on the federal side. We have a little bit more work to do on the Medicaid side of it, but all in all, the team's made, you know, tremendous progress in terms of the overall coverage side of it. You know, with respect to spontaneous use, obviously we can only promote for CD, but there are a number of the coverage policies which are agnostic to the toxin. So you have some that will look at toxins as a sort of a general category, and if you get toxin coverage within that payer network, then they leave it up to the physicians to ultimately use the product, you know, in a way that they see fit. Others will allow for coverage of other indications with additional data. It doesn't need to be indication data. It could be additional data. And then some are very rigid in terms of only covering those indications where you have an FDA approval. So, you know, we feel like we're really well positioned in cervical dystonia. And we're also encouraged by some of the payers that are looking at this as sort of a generic category where the approval of DAXify will allow the payers to ultimately manage the category the way that they think makes the most sense along with the clinicians.

Thanks, Mark.

Thank you. As a reminder, if you'd like to ask any further questions, please ask Star 1 now. And our next question is from the line of Uyir of Mizuho. Uyir, your line is now open. Please go ahead.

Hi. Thanks for taking my question. This is Charles . I guess I had a question about the expanded label for the RH3 launch. And just do you think that's going to be a modest contribution to the sales this year? Thanks.

Sure. Well, I mean, The nice thing about the indication is you can teach, train, market, promote to it. And given that LIPS is the most commonly performed HA filler procedure, having that ability to directly target, promote, teach, train, and go after it definitely helps. And so it's another thing to talk about, and I think it speaks to the ongoing innovation pipeline of that Teoxane is bringing forward in the RHA line. And so it's just yet another thing for us to get in front of customers to talk about. It allows us to get behind it from a promotional standpoint. So I don't think it's the kind of thing that's going to create step function difference in the growth, but it does all help and contribute to the ability for us to have something else to talk to customers about and to, you know, get trial perhaps in accounts that maybe have not yet leaned in. And it fits also really well with Redensity which is used for perioral lines. And so it's a nice combination of using RHA3 for lip fullness and then using RHA redensity for the areas kind of around the lips. And so, you know, it just, again, gives us yet, you know, more to talk about with our customers, more reason to engage, and more reason to get trial.

Thanks. Very helpful. Thank you.

Thank you, and this will conclude the Rebounce Therapeutics fourth quarter and fourth year 2023 financial results and corporate update conference call. Thank you all for joining. You may now disconnect your lines.