Bristol-Myers Squibb Company (BMY) Earnings Call Transcript & Summary

Good morning, everyone. I'm Greg Gilbert. I cover pharmaceuticals here at Truist. I'm fortunate to be hosting this fireside meeting with Bristol-Myers Squibb. Before we begin, I need to read the following disclaimer. This call, this meeting is arranged by Truist Securities Research, produced by institutional investors and issuer clients as defined by FINRA. If you are not an institutional investor or issuer, please disconnect at this time. For required disclosures, please see our website at truistsecurities.com or our equity research library. On today's session, very happy to have with us Adam Lenkowsky, SVP and GM of Oncology, Immunology and Cardiovascular as well as Winselow Tucker, SVP and GM of U.S. Hematology. Thank you, gentlemen, very much for joining me. Thank you also to our Truist investor clients that are watching now or later. Adam and Winselow , thank you again for joining us. I'd love to ask you to provide a little bit of background on yourselves to give us a sense of what you did before your current roles, and then we'll dig into some questions. Over to you guys.

Sure, Winselow?

Sure. Winselow Tucker. As was said General Manager at Bristol-Myers Squibb for Hematology business in the U.S., which also includes our Part D. Been in the industry for about 20 years, most of my roles have been in commercial and larger operations. Worked in large pharma organizations as well as some biotechs, both U.S. and ex-U.S. experience. Been with Bristol-Myers Squibb for 3 years, and I joined through the acquisition from Celgene. Really happy to be here to talk to you this morning.

Thank you. Adam?

Great. First, I want to say thank you and Truist for having us both today. As you mentioned, my name is Adam Lenkowsky. I am the General Manager and Senior Vice President of our U.S. Commercial Oncology, Cardiovascular and Immunology organizations. I've been with Bristol-Myers Squibb now for over 24 years. Over the last 10 years, though, had the pleasure of launching Yervoy in the U.S., then launching Opdivo Yervoy worldwide, where I was running our worldwide oncology -- organization animation and then our U.S. oncology organization for taking on this role now a little over 1.5 years ago.

Thank you for that. Then, let's start with you, Adam, and a topic familiar to many of us, that's Opdivo. A big part of the Bristol story for investors is the return to growth story for Opdivo.

So I was hoping you could start by framing for us what you see as the growth drivers for that important product in the coming couple of years.

Yes, absolutely. And as we've said, we remain very confident in the underlying foundations of our Opdivo business. And our confidence in Opdivo's growth is really driven by a few things. Notably, in the U.S., we have a very large and stable business across all of our core indications and a number of near-term opportunities for growth. So last year, as you know, we launched our first line lung cancer indications where our [ carers ] now are in the low double digits. We launched early this year, our first-line RCC indication with our 9ER regimen that's Opdivo and CABO, seeing very, very nice uptake there with the -- with that combination. And so our leadership share in -- first on RCC has advanced nicely. Just about 2 weeks ago, the FDA granted us the first ever first-line gastric approval with Opdivo plus chemo. So it's the first IO agent in first-line gastric GEJ and adeno-esophageal cancers. And so that, coupled with the approval now in 21 indications across 12 tumors, we feel very, very confident about our growth in 2021 and beyond. And remember, we still have some other derisked opportunities, including an adjuvant esophageal and in adjuvant bladder that we expect to receive approval for later in this year. So even with some COVID drag on the business, we're very confident in our ability to continue to grow this important business moving forward.

Since you brought up the COVID effect, I wanted to ask you to what degree COVID affected cancer treatments, timing, things you've learned, things that will stick, things that were temporary, just any sort of takeaways about this once-in-a-lifetime, hopefully, "once in a lifetime" experience we've been through. .

Hopefully, as we shared on last week's earnings, COVID did have an impact on our business. But what's interesting, running multiple businesses, the impact does vary by product. So in some therapeutic areas, the decline in patient visits, diagnoses, access to customers. We saw limitations in some area, particularly in the hospital setting. But the teams continue to execute well even through remote engagement. That's something I think will be around for a while, particularly in the oncology space. But on one end of the spectrum, you look at the OAC market, for example, with Eliquis. And although initially, we saw about a 15% decline in OAC due to brand market volume, it's now back to pre-COVID levels. And when our teams are deployed in the field, they're making a high level of in-person calls. So that's one end where we see cardiology and largely PCP. On the other end of the spectrum, though, is oncology and hematology. And I know many of our peer companies reported this as well. We started to see some encouraging signs of patient volume at the end of March, but probably it's still a little bit too early to tell. But as I mentioned, when I think about our IO business, regardless of COVID, we have significant tailwinds with the indications that I mentioned. And regardless, we believe Opdivo is going to continue to grow this year and into the following year as well.

That's great. So I wanted to ask you about the competitive dynamics at play in the PD-1/PD-L1 space. It seems like in the beginning, each player had kind of its own turf. Now you have some turf battles beginning in certain areas. So how has that sort of competitive intensity changed from what it was early on to what it is now?

Well, I think that the market's always been competitive. KEYTRUDA and Opdivo have together in the market, about 80% of share. And there are now 7 PD-1 PD-L1s approved with GSK's approval now just about 1.5 weeks or 2 weeks ago. But I think, as I mentioned, having the data and broad evidence, the 21 indications, the 12 tumors, the breadth of indications is really critical. So when we look at kind of some of the battleground tumors, if you will, melanoma, renal cell carcinoma and lung represent, for us, about 70% to 80% of our business. And in melanoma, total BMS share with Opdivo Yervoy and Opdivo mono, we have about a 50% share. When we look at renal cell carcinoma, with the Opdivo Yervoy indication, which has been really foundational and for long-term survival and potential for complete remissions have remained relatively stable across the time. And now the Opdivo/CABO combination with a share of about 10% to 15%, so our total share in that market is now up 35% to 40%. And we expect continued growth with the Opdivo CABO indication. And then finally, lung cancer, we've all read a lot about lung cancer, and we certainly know that market extremely well, being the first agent in second line. But we're very excited to have the opportunity with CheckMate-227 and CheckMate-9LA, and we will present additional data coming up at ASCO around the longer term data. And so we've quickly made inroads into that KEYTRUDA chemo business. So our share now is around 10%, as I mentioned, but we think there's still significant opportunity for growth there, particularly in the nonexpressers where that business is largely unpenetrated. So in those 3 tumors, it really is a 2-product race for market leadership.

Something you said just made me want to ask about biomarkers because I remember when PD-1s were a new thing investors announced or were wondering about what the speed and the penetration of PD-L1 testing would be, relative to say HER2, et cetera. Where do we stand now on sort of the biomarker penetration and sort of how ubiquitous it is to measure PD L1 and other things?

Yes. It's a great question. It does vary by tumor. So again, take lung, for example, you've got probably 75% to 80% plus PD-L1 testing at diagnosis, and that helps physicians going to compartmentalize their treatment paradigm. In some of the other tumors, we see much lower rates of PD-L1 testing, but there are other biomarkers like MSI-high that systems are typically looking for, they do a entire basically pathway of testing. But in IO, they really aren't including PD-1, PD-L1. There have not been any really predictive biomarkers to this date. But that's certainly an area of focus for us as an organization, looking to find what's the right drug or the right -- how do we tailor the drug to the patient?

And is the penetration where you would expect higher in academic settings lower in community? Or is it not that simple in terms of just what parts of the system have embraced testing?

I think testing is fairly ubiquitous across. It is higher in the academic medical centers. Remember, they're doing clinical trials. They're looking for unique biomarkers there. So it certainly -- it's higher in terms of the rate of testing and the breadth of biomarkers that they're exploring is also greater. But just in terms of the way that most of the tumors are treated, there was already a high level of PD-L1 expression testing.

Sure. I'm sticking with the theme of a different kind of competition. Over the medium term, let's say, before biosimilars arrive if they arrive, there seems to be concern among investors about the number of PD-1, PD-L1 somehow triggering price competition that hasn't really happened in this space or cancer in general. So you have this fear conceptually, but no one seems to know what the specific mechanism of that pricing pressure would be particularly in the U.S. market. So maybe you could frame for us why there hasn't been and whether you expect there to be any sort of pricing or contracting pressures have to date, not really been an issue in this field.

Yes. Yes, I'll give you my impression of that. As I mentioned, there are now 7 approved agents in the U.S. with GSK's being the latest. And we expect to see a number of additional PD-1, PD-L1s enter the market over the coming years. And as you mentioned, we've only seen this commoditization or this price erosion happening in China thus far, it has not happened in Europe, it hasn't happened in the U.S. But I think having robust data and having evidence is really key. So with the breadth of indications we have and the number of tumors, it's difficult to generate that data and match that data and the belief -- you have to believe that to have this in the U.S., it will require perceptions of interchangeability by payers, by physicians and by patients, and physicians in the U.S. have been evidence driven and the importance of reimbursement is essential for them. So that evidence plays a key role. We've got robust planning that's ongoing, that continues to look at what happens if the U.S. starts to look more like China. But from an action standpoint, the best thing we can do is continue to leverage the broad set of data that we have, make sure the [ physicians ] remain clinically driven, pathways and payors remain clinically focused. And we, as a company, continue to change the standard of care, bringing continued new data like we're doing in the adjuvant setting to the marketplace.

So maybe this is a good segue to talk about the role -- you see combinations playing. Let's start with where combinations have become most important and where you see them becoming important. I know you touched on some of this already, but let's talk about that conceptually first, and going back to if you launched Yervoy, you've been in on the ground floor in terms of one of the earlier IO/IO combo. So what role have combinations already starting to play? And where do you see that going?

Absolutely. And so when I think about where we were just 10 years ago with the launch of Yervoy and where we are today [indiscernible]. It does. And we did -- we've made remarkable progress as a company and as an industry. And when we look across most of the tumors, that we compete in, combination therapy is already the standard of care. So in melanoma, Opdivo + Yervoy commands about a 35% share there. So -- and then on -- when you even look at BRAF inhibitors, the BRAF/MEK combinations tend to play a very significant role in BRAF mutation. So that's one tumor that it's already seen as the standard of care combinations. When we look at renal cell carcinoma, Opdivo Yervoy came in, in first-line and quickly took over as the standard of care. And with KEYTRUDA, their indication with Inlyta, shortly thereafter, the 2 agents together have about 70% market share, with Opdivo Cabo coming and increasing share there as well. There's still about 30% of monotherapy in that market. So there is a little bit of stickiness. And I would say the same in melanoma as well. There's still about 30% there. And the same thing with lung, I think lung is a little bit more segmented based on PD-L1 expression, but the majority of that business, about 80% of that business is in combination, combination Opdivo Yervoy or combination with Opdivo Yervoy, limited chemo or KEYTRUDA plus Inlyta. And even being [indiscernible] when we look at head and neck cancer, where we're looking at IO, non-IO combinations, the next wave of indications. We're excited about the LAG-3 positive data that we'll be presenting at ASCO in metastatic melanoma, another combination. So we continue to see combinations doublets, even triplets start growing even further over the next 5 years or so.

So you mentioned triplets and that spawns another question, and that is, is there a sort of a price level that becomes problematic for the system as you start stacking these on. I don't think we've seen any pushback about Opdivo Yervoy from a price standpoint. I know treaters are worried about synergistic side effects as you stack any 2 therapies or 3 therapies together. But what are your thoughts on sort of the wallet effect? Or is it really just more about side effects?

No. I think there's both. I think it's fair, making sure that, that one that the regimens are well tolerated. Even when you think about prior to the advent of the PD-1s, standard of care in first-line lung was multiple combinations of chemotherapy. So I do think that making sure that the drugs are well tolerated and have be able to minimize toxicity is key because if patients are discontinuing, they're not going to get the benefit of the combinations. But in terms of the effect on dollars, the critical part there is the goal of patient affordability, that's really critical. And so we have a number of very robust patient support programs, the ability to reduce co-pay for patients that they are commercially insured, but it's something I know that is being discussed at pharma as well on how do we improve patient affordability. And so here's an example. We were talking about COVID, we were able to launch a program in -- for anybody who lost their insurance and was on a BMS drug, we were able to supply that drug for free for those patients. And so again, I think it's about making sure that patients can afford the products that they're on.

Yes. Since you were in on the ground floor on Yervoy, I just wanted to ask you kind of a sidebar question. How is the perception of that molecule evolve from launch until now in the eyes of physicians in terms of their excitement, their fears, et cetera, over that [ now ] to 10-year period.

I think significantly, Greg. I mean, obviously, Yervoy remains the only CTLA-4 approved on the market. As we were just talking about, it is hard to believe, but it's 10 years now of experience on the market, delivering long-term survival, delivering complete responses. Physicians they understand the profile, how to use it in combination, the durability that it brings. We now have 8 approvals across multiple tumors for Opdivo Yervoy across multiple doses as well. So we do understand as a company the best way to deliver Yervoy in combination, and that differs across indications. So when we look at our indication mix, when I launched Yervoy in the U.S., the majority of that business was in the institutions, the academic medical centers for treating metastatic melanoma. Now with indications in lung and renal expanding in melanoma, we're seeing the majority of our Yervoy business in the community set. So there's a much better understanding now on how to use it and how to minimize the adverse events.

And that's really mostly been dose adjustments on the AE side, combined with just expectations of what to look for.

Yes, exactly. It's low dose Yervoy, so using 1 milligram versus 3 milligram. It could be, for example, using it q6 weeks versus q4 weeks or q3 weeks. So I think that's really helped as well. And then just a knowledge of what to look for and how to manage the immune-related adverse events, which is really the same across all of the immune-related adverse events.

Since we've brought up dosing, just to go back to PD-1 dosing and frequency there, regardless of who has what label on sort of and who had it first on dosing frequency. Our physicians kind of seeing Opdivo KEYTRUDA somewhat, interchangeable is the wrong word, but in terms of dosing flexibility and frequency, does it really matter it's labeled versus not?

Yes. I think so. I don't think doctors see the -- I'm confident Opdivo and KEYTRUDA are not seen as interchangeable because you look at what the indications that we have, the combination is so very different. But in terms of the dosing flexibility across now multiple PD-1s, I think many physicians do like the flexibility of, for example, q4 week dose, it certainly was very helpful during the COVID period where they wanted to keep patients out of the institutions. We hear back from doctors, they really like the q4 weeks because of that cadence of going back into whether it's an oncology community office or an institution. And I think that, coupled with the fact that we're looking at the ability in the adjuvant setting, a it's huge benefit for patients who really don't have any residual disease in their body or hopefully for a longer period of time, a q4 week regimen is more, I think, readily used now than the q2 week. I think we see that across the PD-1 as we move into like adjuvant melanoma, that's the indication where with the most use of our q4 week or Merck's q6 week dose is being utilized.

Thank you. I know this is not an R&D session, per se, but you brought it up. So I'll ask you about relatlimab, it seems like the company is quite excited about not just the top line but what's to come in terms of the full data set at ASCO. So maybe from a commercial guy standpoint, you could give us a sneak peek of how you see that fitting in.

Sure. Happy to do that. I'd say we're very pleased around our progress on this next-generation IO agent. It'll be the third IO therapy for BMS, the third mechanism and now a proven mechanism to treat metastatic disease. And we think we have got a potential to expand patient options and expanding into other tumors. But it's a new mechanism offering a potential new treatment in melanoma, where we already had a strong leadership position and strong legacy. We're encouraged by the results, and you'll see that at ASCO with 047 and clear that relatlimab boost the activity of Opdivo in melanoma. Opdivo is a high bar to beat alone. So we're able to do that delivering a superior PFS, well tolerated and the potential to provide additional franchise durability. So we're looking at longer patent life as well. And this is also in a co-formulation. So commercially, I think that's going to be advantageous for our physicians. And it just -- it fits really well into our approach to integrate, as we talked about earlier, new combinations, new formulations into a fixed-dose combination. There are still, from a commercial standpoint, 30% -- roughly 30% of patients who are still being treated with a monotherapy, that could be monotherapy KEYTRUDA or monotherapy Opdivo and then, of course, the BRAF mutant opportunity. So I think that's going to be the significant opportunity to expand the business. We'll get more data over time in melanoma and across other tumors to expand our leadership position outside of melanoma, and we're excited about presenting it at ASCO as well as sharing with the FDA and health authorities around the world.

Great. Maybe before we talk about immunology and cardiovascular, let's give Winselow some airtime and wake him up. Winselow, and then we'll come back to you Adam. Winselow, maybe you could give us a little bit of a state of the union on the hematology franchise and what the near-term priorities are for you in your organization?

Sure. Absolutely, happy to do that. Thank you, Greg. First, as you know, we had a leadership in hematology, built really off of our IMiD franchise with Revlimid and Pomalyst. Over the last year or so, we've had the opportunity to launch 4 important medicines and really expand that hematology franchise. I'm really excited about. First, Reblozyl has been launched for both Beta thalassemia and MDS transfusion dependent, a low-risk MDS. And so this is a really important indication for us because we see an opportunity to grow significantly in that indication. And it's an area we have experience because Revlimid was in MDS. So it's a market we know and an area that we really think that we can expand. I'll talk to you a little bit more about that. Secondly, Onureg, really exciting product. Overall survival benefit, first continued therapy in AML after post induction therapy. And that is an area also where we have experience from IDHIFA. So it's another area that we know we have experienced, and we feel really good about that opportunity as well. Lastly, this first quarter has been a very exciting quarter for us. We've been anticipating to have the opportunity to launch 2 cell therapies. Breyanzi, which is a potential best-in-class therapy there, broad enthusiasm for the profile and what we are seeing is really strong enthusiasm to onboard sites. And we have had sites onboarded there. We have had patients apheresed and we've had patients infused. So really excited about how that's going. Secondly, we were able to launch Abecma, really important for us, second cell therapy, builds off of our multiple myeloma franchise and builds off the cell therapy platform that we've built with Breyanzi. And I can tell you the enthusiasm for the first-in-class BCMA CAR-T is really, really exciting. If I think about where we're headed, which also excites me is, I'm most excited about things like our CELMoDs, which give us an opportunity to continue to expand our leadership in multi myeloma. So just overall, with the state of the business, really strong foundation, really strong launches, and I think a bright future and continued leadership.

Sure. Before I ask you to drill down into a little more detail about how those launches are going and the key metrics you're looking at. You mentioned Revlimid has set the stage and a lot of us on the street just have as a line in the model, and it's going to do it's thing, right? Meanwhile it's the foundation for this franchise. So how has the Revlimid sort of infrastructure, if I can call that, and know-how sort of changed as the growth expectations and durability expectations for that asset have changed versus these launches that you're going to go a little bit deeper into. So has the organization size and structure changed very much? Or is it simply repositioning what you already have?

Yes. That's a great question. If you think about where we have -- we've had a very large presence in multiple myeloma and a team there. And what it's really allowed us to do is 2 things. One, continue that presence because we're going to continue to build off of it. It's also helped us to use that when it comes to Abecma because we're going to really the at the community level trying to support referrals to the community sites. So from that perspective, we still have a strong presence in multiple myeloma. We've been able to add-on and expand our presence in the marketplace to support the launches. So the presence we had for multiple myeloma continues. I'll also remind you that we're in a very unique place when it comes to multiple myeloma. We have what's going to be more of a slope than a cliff. And going over time and continuing to position Revlimid and Pomalyst, which is moving to early lines of therapy, along with Abecma and then the CELMoDs, which are not that far away. I think that's given us a great opportunity to continue that presence, but then build on it to support the launches.

So let me ask the commercial guy the CELMoD question and the 1 that I think I can ask in this -- you mentioned it a couple of times. What -- I guess the question for you is when are we going to know more about bringing back to life?

So we saw there at ASH, and we will see more data potentially later this year. What's important about the CELMoDs is just to think of the fact that multiple myeloma with all the combination therapies we have with the advent of cell therapies. There's still tremendous unmet need for patients. And we also know that this is a marketplace in which combination is really, really important. So the CELMoDs give us an opportunity to bring in another mechanism in later lines of therapy and then ultimately move those forward, combined with Abecma and other assets as well. So from that perspective, I think it's going to be really exciting to position us for continued future leadership in the multiple myeloma in the future.

So Winselow, maybe one more for you before we turn back to Adam. I personally haven't followed CAR-T in the past. So I guess I'm asking for a little bit of a background here. What can you say about the commercial world's readiness to embrace these products? What headwinds existed before? How that's evolved? And how are your products and strategy differentiated in CAR-T?

Sure. First and foremost, we're building a differentiated CAR-T platform. And what I mean by that is making sure that we can deliver the best customer experience. And we think we're poised to do that across having 2 cell therapies and working with centers. Early on, it's all about making sure that we get the sites onboarded. And then over time, getting patients that refer to the centers and schedule apheresis and obviously infused. What I can tell you is that the onboarding is going extremely well. We on-boarded centers very quickly. We have over 55 center now on-boarded for Breyanzi. We follow that with Abecma in those centers because we've already got them on-boarded for Breyanzi, came on even faster for Abecma, which is rich is really, really important. With respect to the CAR-T market, what we have seen is there's some improvement in the reimbursement with the DRG, which is important. We are seeing that patients are starting to be referred more, and we believe there's an opportunity to drive larger referrals from the community to the centers and expand the CAR-T market. We also think with Breyanzi, there's an opportunity to bring CAR-T closer to patients because that profile of that product has a significant safety profile, which we think can be an advantage for us in ways. That we can bring CAR-T closer to patients as well. So early days with our CAR-T portfolio, but what we are seeing is broad enthusiasm for both products, centers on boarded, patients being apheresed and we're having infusions with Breyanzi and with Abecma. We are starting to see patients at apheresed as well. So we're really excited about where we're headed.

Sorry, Winselow one more for you. What are the metrics? We'd like to look at net revenue as announced, Reblozyl [indiscernible] or what are some of the metrics you're tracking that make you enthusiastic at this early stage.

Absolutely. So I'll start with Reblozyl. Reblozyl, once again, first-in-class erythroid maturation agent there. So what we saw was broad enthusiasm for that profile. I'll remind you being pushed back in the midst of pandemic and virtually. And what we saw was a strong uptake of bolus of patients, and that product has performed very, very well. What we're seeing now is continued enthusiasm. We're seeing high awareness and we are seeing that we're getting underlying demand. So NBRxs are growing and continuing to grow. Now be -- that gives us a lot of enthusiasm for this indication, which we said is a tremendous opportunity for us to grow there. So Reblozyl off to a good start. Strong bolus of patients and now underlying demand coming through, NBRx is growing. So Reblozyl, we feel really good about. Onureg, likewise, launched in AML, overall survival benefit first continued therapy. We're seeing that there's a strong enthusiasm for that overall survival benefit and for treating patients in the maintenance setting. And so we are continuing to ensure that, that profile is well understood. We are seeing NBRxs growing as well steadily. So we feel good about where we are with the trajectory on that launch. And we are laser-focused on building that maintenance market. And we've had experience in this area because we've built a maintenance market with Revlimid and Pomalyst. So that allows us to really leverage those experiences to build the market in AML. So those 2 assets, those are the metrics that keep me really excited about where we are.

Great. Thank you for that, [indiscernible] the exciting stuff going on in your business. So let's shift back to Adam and we got 7 or 8 minutes, Adam, more. I'll try to hit a few different topics here. Maybe we'll start with the ZEPOSIA launch or launches, I should say, maybe you could compare and contrast those 2 settings and what you're seeing there?

Sure. So I'll start with MS, and we're very excited by the opportunity we have with ZEPOSIA, both in MS and in UC, which is -- has a PDUFA date, as you're aware, at the end of this month. In MS, we saw a continued strong uptake in Q1. We're now the #1 S1P in written prescriptions. And we continue to gain share amongst the oral agents. So when you look at written prescriptions, our share is around 20% to 25%. So we're either #1 or #2. We made really good progress over the last several months in optimizing patient pull-through, to commercial dispense. So as physicians write the prescription, they then go through the hub and then out to specialty pharmacy for a commercial dispense. And we've seen now an almost doubling of patients on commercial drug in Q1 versus what we saw in Q4. We also see now, when we look at patient and physician receptivity to ZEPOSIA profile, they see it as highly differentiated and not only do we expect to be the #1 S1P on a dispensed NBRx basis imminently. That will set the stage for continued growth. Because unlike what we talked about in oncology, it does take time to grow this asset and you look at a more -- the more chronic therapy. So we've accomplished all this when the dynamic patient volume is down about 5% to 10% below pre-COVID levels, and many of our calls have continued to be remote. So the market feedback has been strong. We've got over 3,300 start form requests or patients who have been initiated through the hub on ZEPOSIA. And we expect continued growth, and we've seen a steady growth of new prescribers. And we also talked about the importance of gaining access. So we have over 90% commercial access in MS today. And I think, as I mentioned, it's -- certainly, we expect continued growth over the coming years. This is going to be a sizable product for us. When we look at UC and I have to contrast that, first, I'd say our field teams have been in place for quite some time, and they are absolutely launch ready. The feedback we get from customers have been really good around the profile of ZEPOSIA in UC. Having the safety and convenience of an oral therapy is key with biologic like efficacy. And that's what gastroenterologist are playing back to us. We also know it's going to be important to establish access in order to enable adoption, and that's going to take some time. We, of course, have a plan to accomplish it, but we're going to continue to leverage our comprehensive patient support services and affordability offerings to maximize demand and initiation early on. So early on is going to be a focus on how do we enable initiation, how do you get a great first experience and drive scripts ultimately to commercial dispense. But we think we have an opportunity to treat patients in either the prebiologic or post biologic setting, but this is a -- certainly, the market is an undeserved market, with only really biologics or JAK. So there's an opportunity for an oral agent with robust efficacy to really make inroads into this marketplace.

Great. Let's spend a moment on deucravacitinib. We saw some exciting data recently in all its glory there at AAD. How much are you thinking about that in your role at this point? What has to happen? And in what order to kind of set the stage for that product and how does it fit in. I know it will take an hour to answer, but we'll take 1-minute version of that.

I'll give you the 1-minute version of that. We're obviously very pleased with the data that we presented at AAD. And yes, every function is already planning for launch next year. We're meeting with customers extensively right after the meeting, and the feedback has been very, very positive around the data profile. We know that this is a first-in-class selective TYK2 inhibitor with a unique MOA and a favorable efficacy safety and tolerability profile. And we think it has the potential to become the new oral standard of care with efficacy superior to the market leader in Otezla and hitting across multiple primary and secondary endpoints. And we know that from our customer feedback, the safety profile of deucravacitinib compared to apremilast offers an improved tolerability with fewer side effects. And clearly, the need to differentiate this from JAKs is going to be essential, and that's what we've heard from our customers that this safety profile, this adverse event profile, particularly those AEs that are more common with JAK inhibitors deucravacitinib is very, very different. So we have, we believe, a best oral option for PSO patients that will not only source from Otezla, but also has the potential to push back the use of biologics as well. So we're very, very excited about this.

I'm sure you'll be watching the JAK developments very carefully. And I know that BMS thinks it is not a JAK. So that is very clear that deucrav is not a JAK. Listen, 2 more minutes in cardiovascular, it's hard to a justice this, but let's just reflect upon the huge success Eliquis has been from -- I remember the debate about twice a day once-a-day in the development realm. And commercially, it's doing its thing. I don't really know that there's much more to ask there other than where is the ceiling. But maybe more importantly, how is Eliquis setting the stage for mavacamten from your organizational readiness and maybe set the stage for that opportunity for us as the last question.

That's a great question. First, we continue to be extremely pleased with the performance of Eliquis. Even outside of the U.S., Eliquis is #1 OAC in most markets around the world. To give you a sense as to where we are today with our shares. So our TRx share is around 54%, and it's growing linearly as you probably see through your reports. Our new-to-brand RX is now about 65%. So of course, the TRx is going to continue to follow that. NBRx for us is the most important market, adding new patients. And we did that, as I mentioned, where the new-to-brand patient volume for the class was dampened last year by COVID, but now back to pre COVID levels. So as it relates to mavacamten, the beauty of that deal was that the infrastructure is in place for the launch of mavacamten. The teams are preparing to launch. There's a high overlap of targets. Most obviously, for mavacamten, is going to be a cardiology written drug or even a cardiology in some of these COEs, but we've got very, very high overlap. Our training has already begun here. This is a significant unmet need, where only 25% of patients are diagnosed. And has a high prevalence, about 600,000 patients in the U.S. So as we've said, we believe mavacamten has the ability to be a very important medicine across the organization.

Adam, thank you so much. Winselow, thank you. I want to thank the IR team, Tim and Nina. Thank you to our Truist clients for listening in or watching later or reading later. Thank you all. This will end session. Be well.

Thanks for having us.

Thank you.