Shield Therapeutics plc (STX) Earnings Call Transcript & Summary

Good afternoon, and welcome to the Shield Therapeutics plc investor presentation. [Operator Instructions] Before we begin, I'd like to submit the following poll. I'd now like to hand you over to Anders Lundstrom, CEO. Good afternoon, sir.

Good afternoon and good morning, depending on where you are. Welcome to the quarter 4 and full year 2024 Trading Update for Shield Therapeutics. I'll start and then Santosh Shanbhag will continue -- our CFO, will continue after a little bit. So this is the disclaimer. So -- so Shield Therapeutics, we have a product called ACCRUFeR in the U.S. or FeRACCRU in Europe, and it's indicated and approved for treating oral iron deficiency with or without anemia and it's a very broad indication. So it doesn't matter what the person or patient's underlying condition is leading to the iron deficiency. The U.S. market is a very big market, as we will show you in a little bit, and that's why we've also chosen to commercialize on our own together with a partner, Viatris. We estimate the U.S. to have a revenue potential for ACCRUFeR could be up to $450 million annually, and we have very, very strong IP through 2035. So this is our management team. We divide it up in 2 offices. So David and Jackie are in Newcastle in the United Kingdom and the rest of us are just outside Boston, Massachusetts here in the U.S. So in general, across the management team, we have a very experienced management team who's very experienced, especially when it comes to commercialization across many different countries around the world. So iron deficiency, as we also will show you in a little bit, is a very common and can be a very serious condition. So typical symptoms can include that you're very tired, you have headache, you're dizzy, and it can even lead to that the person or a patient become cognitively impaired. And all of these symptoms would, of course, impact the persons or patients' quality of life. The prevalence is highest in women of child-bearing age and in patients with different inflammatory conditions, as you can see on the right side of this slide. And other causes could be malnutrition or malabsorption that could also, of course, lead to iron deficiency. So there is a problem with most of the oral iron salts because most -- the oral iron salts are associated, they break apart in the stomach. And the free iron can cause irritation or damage to the intestinal lining of the stomach, and that leads to different gastrointestinal adverse events. So up to 70% of patients can experience these adverse events, but they include -- they could be -- they could feel swollen, there could be pain, they can feel sick. And that leads to that about 50%, 60% of these patients will discontinue their treatment. And of course, if you discontinue the treatment, there will be no effect to treat the condition they should be treated for. So ACCRUFeR is different. It's different in the sense that we don't use a salt that is bound to the iron. We use maltol as sugar alcohol. What that does to the product is that it does not break apart. It doesn't dissociate in the stomach. It breaks apart in the upper intestine. So thereby, we avoid most of those gastrointestinal side effects I just mentioned on the previous slide. The other thing it does is we can actually also have a lower dose of iron because we have a better absorption as it is absorbed in the upper intestine. So this is what we could look at -- this is the treatment algorithm for oral irons. So typically, most patients start on an oral iron salt. But as I have said, quite a few of them over half, 50% to 60% actually stop. That is where we come in. So we -- as our product is much better tolerated and leads to very good and can normalize the level and maintain the level of hemoglobin, the patient can -- this is a treatment the patient can take and stay on and thereby avoiding that the person or patient would have to go and get an IV iron. We are continually expanding our global footprint. So in the U.S., we have a co-commercialization collaboration with Viatris, and that has been in place. We have had a full sales team in place now about 18 months. In Europe, where the product is called FeRACCRU, it's Norgine, who is in charge of the commercialization, and that goes also for the U.K. In Canada, it's KYE. KYE just got approval, and we expect to launch in Canada in the first half year of this year. In Korea, we work with KP Pharma, and that file is currently being reviewed. And again, we anticipate an approval during this year. And in China, we work with a company called ASK. There, we have fully recruited a bridging study needed to bridge between our Phase III data in the Caucasian population and then they've done a similar study in the Chinese population. If that study is successful, -- we anticipate to file this year and then a potential approval second half of 2026. And all these collaborations either come with a royalty or a milestone or royalties and milestones based on milestone -- milestone based on sales or different regulatory events like a submission or an approval. This is a picture describing the U.S. iron deficiency market. It's a very big market, and I walk you through this. What we call the addressable market is the total market. So it's about 12 million prescriptions every year prescribed by over 0.5 million health care professionals. We target what is here called the target market, which is about half of the total market with 6 million prescriptions. This part of the market we address with digital marketing efforts. We do it to the health care professionals. We did that last year. We continue to do this year as well. What's new this year, we will also do digital marketing efforts through different channels and initiatives also to patients this year. So we will address about 1.2 million patients that we know have tried an oral iron and have gastrointestinal side effects. That is how precise you can be these days. We also know that about 72% of all prescriptions are written by primary care physicians and about 12% by women's health specialists. So these are also the 2 groups our current field force focus on. With the current field force, which is the smallest of the blue circles, which has about 1.7 million prescriptions, we target about 10,000 health care professionals. We -- 60% of our primary care and 40% of our women's health. And that is also roughly how ACCRUFeR's prescriptions are divided. It's about 60-40. And this group is about 220,000 patients in total. So what we've done in the U.S., we have realigned our sales force starting this year. So we are focusing on the states and the territories where we have the highest potential, we have the best coverage from insurance, and we have had historically the strongest ACCRUFeR performance. So what happens with that is that the top 5 states for us is about 60% of our total volume. And that's also where we have about 50% of our sales force. That's Texas, it's New York, it's California, it's Florida and Georgia. So that goes into effect as we speak right now to really optimize our sales force and have them placed where the business opportunity is the biggest. So there are 3 key initiatives that are new for this year that will help us to drive continued growth and lead us to profitability. So the first one we actually initiated already in the fourth quarter of last year and had actually with very good results as you will hear very soon from Santosh. We have decreased the impact of what we call the consignment business. Consignment business is -- what happened to the slides? Thank you. So the consignment business is the business where we either give away drug for free or have had historically loss-making prescriptions. So we modified the pricing to decrease the number of loss-making prescriptions and thereby, the price per prescription, the average price per prescription is going up as you also will see in the numbers. The second thing is what I spoke about is the realignment of the sales force to territories where we have the highest potential, the best coverage and historically the strongest ACCRUFeR performance. And the third piece is that is the digital marketing initiatives. We've done it toward with physicians last year. We're going to do it to patients this year and the h to drive awareness for ACCRUFeR. So I will now leave over to Santosh. So please, Santosh.

Thank you, Anders. Hello, everyone, and good morning and good afternoon, depending on where you are. I'm going to spend a few minutes really talking about our Q4 and full year performance. I'm excited to report we had a strong quarter in Q4. Let me just orient you to the slide. You've seen this before. We had 3 key big priorities for full year 2024, growing ACCRUFeR revenues, prescriptions and gross to net. Number two was making sure that we had a balance sheet that was strong and had allowed us to have operational flexibility. And then, of course, expanding global patient access of direct maltol. I'm happy to report that we made significant progress across all 3. Let me take each one of them one after the other. From a total revenue perspective, we reported unaudited financials, $32.2 million for the year. Of that, ACCRUFeR represented $29.3 million. That's 153% growth over full year 2023. The remaining portion, $2.1 million was from ex revenue -- ex U.S. revenues that includes royalties and milestones, predominantly driven by Norgine. In Q4, specifically, ACCRUFeR did $11.2 million in revenues. That's a 56% growth over Q3 of 2024, primarily driven by our price, which we reported $237 of a net price in Q4. That was a growth versus $167 in Q3. You can see that in Q4, while we had 41,000 total prescriptions, only 22% of them were consignment, while 37% was consignment in Q3. Now what do I mean by consignment? Consignment business is the part of the business where we actually give prescriptions for free or at a significantly subsidized price to patients who either cannot afford them or are waiting for their insurance companies to make a decision on coverage. Now as a net revenue, that actually has a negative impact on revenue because net of fees and any other costs that are included with the prescription, we actually lose revenue on every consignment script. So by changing that consignment program in Q4, we still allow patients to have access to our prescriptions. It's still at a subsidized price. So we still make it available to them. However, we reduced the impact that it has on the net revenue from a negative perspective. So we actually are able to increase the price per prescription and hence, increase the revenue on a lower prescription count. So that is what we have done, and that is what Anders alluded to in his prior slide. We took a significant step forward in that direction, reduced our consignment business and hence, increased our overall price and hence [indiscernible]. From a balance sheet perspective, as we have reported through the course of the year, we have raised nearly [ $31 million ] in new financings, new monies in 2024. We ended the year with $6.5 million cash on hand. This excludes the $10 million that we received from AOP on the subscription that was received on January 3. So we feel pretty strong about our financial strength entering 2025. As you have heard from us previously in late -- in early Q4, we also reset our operating base in Q4 and into 2025. We announced a 10% reduction in our base operating cash -- in our base operating costs to help us get to cash flow positive by the end of 2025. That is a constant theme you'll hear from Shield through the course of the year. We aim to be cash flow positive by the end of 2025. And then finally, and importantly, expanding our global patient access of FeRACCRU. We've had significant progress across multiple programs across the globe in 2024. As we had indicated earlier, China, our partner recruited -- fully recruited their Phase III program and now are moving into finishing up the trial and will hence transition into a regulatory phase later this year. Health Canada has provided an approval, and we expect to launch in Canada in early part of this year. We also announced and are excited about the pediatric pivotal trial being very successful. We are making progress on the regulatory front, both with -- in Europe as well as in the U.S. associated with that. And South Korea, our partner is ready for the final approval and submission and is waiting and is chatting with the Korean authorities to be able to get an approval for our product in South Korea as well. So across the globe, significant progress in both regulatory processes as well as getting the clinical trials across the line. On the next slide, let me walk you through some of the details of our ACCRUFeR progression in the U.S. throughout the course of 2024 as well as in Q4. You can see on the left-hand side, the ACCRUFeR net revenues has grown quarter-over-quarter. We started the year at $4.1 million in Q1 2024, ended the year with $11.2 million in Q4 2024. We're excited about that progress, and we expect that to continue to progress in 2025 as well. Net price per script, I alluded to this in my prior slide. We started the year at $139 price per script -- net price per script in Q1 2024. We ended the year at $237 price per script in Q4 2024. That is a significant progress that and increase that we have seen through the course of the year, predominantly in Q4 driven by the changes in the consignment business that I just talked about. And on the extreme right, you can see our total prescriptions. The gray bars on the prescription represents consignment and the blue bar represents the nonconsignment or retail. So the retail prescriptions are the ones where the revenues -- those are revenue-generating prescriptions, while the gray bars are consignment where we actually give it for free or is at a significantly subsidized rate and net of fees, we actually end up losing money on those prescriptions. So with the changes that we've addressed in Q4 2024, you can see the blue bar continues to grow, which is the revenue-generating prescriptions, while we are shrinking the gray bar from Q3 into Q4. We expect this trend to continue. We expect that the consignment business will be a part of our business going forward. However, it will be a much smaller portion of the business in 2025. And finally, 2025. Again, this should look familiar. We are, again, focused on 3 key areas. We want to make sure that we grow ACCRUFeR net revenues. We are seeing all the right ingredients in place to make sure that, that happens. We want to make sure that we turn cash flow positive by the end of 2025 and become a self-sustaining business. We see that we have incorporated all the right initiatives in place to make sure that, that happens. And then ex U.S., we expect to launch in Canada with our partner, KYE Pharmaceuticals. We are looking forward to that. You should hear from us pretty soon on how that -- when and where. On the regulatory side, both in Korea and China, we see significant progress with through our partners in Korea and China. And then last but not least, the pediatric population. We expect to announce the progress on the regulatory front, both in the U.S. as well as in Europe with our -- on our pediatric population. So with that, I'll hand it back to Anders to close the prepared remarks, and then we can open it up for questions.

Thank you, Santosh. So what we wanted to share with you this morning or this afternoon is that we wanted to share with you what the big market opportunity we have in the U.S. And just to remind you, we had about 150,000 total prescriptions last year. And our sales force is focusing in a market segment where the total number of prescription is 1.2 million. So I mean, we have -- there's a lot of growth opportunity still. And as you have seen in our partnership with Viatris, we have been driving growth, a very healthy growth over last year, and we have a very good jump-off point with a strong fourth quarter as you just saw. Our global footprint continued to progress at a steady pace. And with that progression, we also anticipate milestones and double-digit royalties to continue to come in. Our financials are in a good place right now, especially since we got the extra $10 million from the AOP investment and also some additional cash from some of our retail investors as well. So our goal is to be cash flow positive by the end of this year. And that ends the prepared remarks, and we are ready to go to questions.

Anders and Santosh, thank you very much for your presentation this afternoon. [Operator Instructions] Alice, could I please hand back to you to read out the questions and give responses where appropriate to do so, and I'll pick up from you at the end.

Fantastic. Thanks, Anders and Santosh. So I'm going to start with the pre-submitted questions, and then we'll run through things that were suggested throughout the presentation. So #1, can you please tell me how U.S. sales reached $11.2 million in Q4 from U.S. sales and the calculation of 41,000 prescriptions by $287 equal $9.72 million. Where does the other $1.5 million in U.S. sales comes from?

That's a great question, and I appreciate the math behind these numbers, well done. The 41,000 prescriptions represents demand. That's the prescriptions that were picked up by patients after a physician wrote them. We do not use the 41,000 prescriptions in terms of revenue recognition, we recognize revenue when a title is transferred from Shield to the wholesaler. And so when you think about the revenue that is associated with the title transfer, we take the title transfer number, as the basis for calculating what our price is. So the $237 that we shared with you as the net price, that is the price based on the sale of the units from Shield as a title transfer to our wholesalers. And then you take the revenue associated with that to get to $237. Hopefully, that's helped.

Thank you, Santosh. And second question, how are ex U.S. sales going? Are you seeing a marked uplift in cash inflows from this part of the business?

Anders, I can take that and you...

Yes, you do that. Yes, please.

Yes. We have our partnership with multiple ex U.S. organizations. The one that is commercial today is Norgine in Europe, and we expect to launch in Canada, as I mentioned in my prepared remarks very soon. So most of our revenues come through royalties from Norgine, and there are a few milestones that we achieved in 2025 as well. Overall, like I said in my prepared remarks, the royalty revenue and monsoon revenue in 2025 was $2.1 million in 2025 compared to $1.5 million in 2023 -- sorry, $2.1 million in '24 versus $1.5 million in 2023. So we do see growth and we should anticipate to see additional growth expected through the launches in additional countries beyond Europe.

Yes.

Great. Can you please give us some insight into what the current cost base is and what sort of quarterly sales revenue is required to achieve cash flow breakeven?

Yes. Maybe I can take that, Anders and feel free to chime in as well. We have not yet released our total financials, including operating expenses for the year 2024. You should expect to hear from us pretty soon on the full year audited financials. However, what we have said though in early Q4 is that we have reduced our operating cost base, and we did that by about 10%. Looking at all the initiatives that were put in place to help us get there, I feel pretty confident that we will achieve that, and we have mostly achieved those cost savings. Those cost savings have come across the board across every function in the organization, including headcount and expenses that we incurred through external supplies. And all those initiatives are in place, and we should expect to see that 10% reduction through the course of 2025. That leads us to the key objectives that we have set for ourselves, which is we want to be cash flow positive by the end by 2025 by implementing not just the cost base change but also growth in revenues. Anders, anything to add on that?

No, I think it's worth mentioning also that with the initiatives -- the 3 key initiatives we mentioned, they are, of course, fully funded with the budgets we have. But we also -- we stopped some initiatives where we didn't see the return on investment as we wanted to see and that's why we sort of refocus the resources where we see the biggest opportunity to grow -- continue to grow as we have done in the past. So I think that's important to note as well. So we are investing more behind those 3 things that I mentioned and especially then in the -- on the digital channels and the new things that we go towards patients this year. We haven't done that at all in the past. And as I also mentioned, that this has shown us that when we've done it with physicians, we -- that's -- the ROI and that is very, very good. And we believe if we can now address patients as well to drive up awareness, it will help our sales force and it will help the company to grow even further.

And you've already answered the first half of this next question, when do you expect to break even? And will there be any further dilution to shares?

Yes. I think the -- we are hyper-focused on making sure that we get to cash flow breakeven by end of 2025, we have not commented on any dilution of shares at this point.

Thanks, Santosh. And how do you feel about meeting your covenants on the SWK financing going forward?

Yes. Based on our 2024 financials, clearly, we are -- we have no concerns or issues with the covenants. As we look forward into the future, again, we have not commented on that, but we don't see, based on our internal projections, any reason to be concerned. And we work very closely with SWK on this front anyway. So we feel pretty comfortable with our current position on that topic.

Thank you, Santosh. What level of insurance coverage do you have? And should it expand?

So yes, it is actually expanding. So I mean, the market access team, which is, by the way, run by Viatris, is they constantly work with the different PBMs and plans to expand our coverage. So yes, we added another 7 million lives just in the beginning of this year, but getting another plan, [ plan ] therapeutics to approve to reimburse ACCRUFeR. So that happens constantly. That never stops actually. And what is -- and I think we've tried to explain this before, the reason why you continue to actually support even prescriptions where we lose revenue is that if you don't have any demand, if you can show there's demand, they will never reimburse you. So you have to do that. Now we limited it because we are at the point where we have shown there is good demand, but there's still a continuum of trying to get more and more lives covered. So on the -- and as we said before, commercially, we have strong coverage. I think it's just about 60%. For Medicaid, we have very good coverage in general. But for Medicare, not at all actually. So that's the sort of the market environment we work in. But as I just said, I mean, we just expanded. We added another 7 million lives with the plan to just approve ACCRUFeR.

Thank you, Anders. And can you explain the net selling price in more detail? Does the majority of revenue come from reimbursement from insurance companies? If so, is it a fixed price or does it vary per insurer? Does Medicaid pay the similar? In previous RNSs, you mentioned things like wholesalers, book buying, et cetera. Why does this impact the price Shield receive?

Maybe I can take a stab at it, Anders and...

Yes, you start.

Yes, I think we may have to set aside a few hours to walk through the insurance process in the U.S. But let me try and take a stab at it at a very high level. Think about our business as consisting of 2 pieces. We mentioned the consignment business a few times on this call. 22% of our business in Q4 was consignment. The price there, like I said, was either it was given away for free or at a significant discount. The net price was negative on that part of the business. Now you look at the nonconsignment side of the business. You can broadly classify them as commercially covered or government covered such as Medicaid, right? So there are 2 real pieces there. Within commercially covered, there are multiple sort of insurance plans and insurance programs that an individual may have that we try and work with to help them get coverage for those prescriptions. So -- and the pricing can vary across each one of them, depending on the size of the patient population and how open they are to covering our product. As you can imagine, there are certain authorizations that need to be put in place. They are called prior authorizations that a physician needs to fill out. And those things like that have an impact on what the price is. So that price can be varied across those commercial plans. On the Medicaid side, they have a standard formula. The formula is actually a pretty complex standard formula. We apply that standard formula, and there's a discount that's applied based on that formula to all Medicaid patients. So that price is constant across all Medicaid patients. The combination of these 3 pieces of business, so the consignment, the commercial plans and Medicaid then eventually lead to what we would call the average net selling price per prescription for the specific period. Hopefully, that's helpful. Our objective is to maximize the commercial part of the business that then relates to what the Medicaid price gets set at and while converting the consignment patients over into the commercial side of the business so that they can get access to ACCRUFeR and get covered by insurance companies. Anders, feel free to add.

No. I mean, maybe we can try to construct a slide to show what it is. It's both complex and complicated actually because with each commercial -- well, with different pharmacy benefit managers, you also have different contracts. You have to give different discounts and different fees. So it becomes a lot of different prices that comes together to the net selling price. So it's predictable for us at this point. But as I said, there is a lot of moving parts to that. And -- and we -- as Santosh mentioned earlier, we get paid when our wholesaler buys from us. And there is a discrepancy between that and the number of prescriptions that are filled. And that difference will increase the bigger we get because they always keep a stock that is constant about 2 to 3 weeks of stock. So that difference that somebody asked about, why doesn't the 41,000 prescriptions times the average price per prescription add up to 11.2 million. That if we -- as we continue to grow, that difference in pure money will actually continue to grow as well. So yes, I mean, hopefully, it's helpful. Otherwise, maybe write us an e-mail and we'll try to put something graphic together as well.

Next question. There are large milestone payments due in the future from Viatris, $30 million and Norgine EUR 50 million. What triggers these payments? And when do you expect them?

So the Viatris milestones are sales-based milestones. And I must say, Sanders, I don't even know if we publicly disclosed what the numbers are, but I honestly don't know that. So I'm sorry if I -- I'm not -- I'm not going to say it. If it is publicly disclosed, I mean, I know the number, but I...

Yes. I think the Viatris one is disclosed. And we haven't -- again, we haven't provided any timing on when we expect to achieve them. We do expect to achieve them. That's the reason we put the deal and structured the deal. And the same thing with Norgine, we haven't provided any timing or quantified exactly when we will get them.

Great. Thank you. There's a lot of focus on marketing. The projected possible revenue increase represents 12x to 15x current levels. Is the organization capable of meeting this demand?

Well, I don't know if we've ever given a projection of what revenues we are supposed to reach this year, first of all. So I don't know where the 12x to 15x comes from what the starting point is and what the sort of the sum of that is. So I mean, we -- I can't answer the question. I mean I don't actually -- I don't know where the numbers are coming from.

Maybe, Anders, if you want to hit on the excitement that we have around the marketing side of the business -- the marketing part of the business in addition to sales because I think that's exciting for us right now.

No, no, it is, of course. I mean -- and that goes back to the slides with the 3 circles -- where we -- with our digital marketing, I mean, with different -- via different channels and initiatives can actually address up to half the market, which represents the 1.2 million patients, which then has about 6 million prescriptions. Yes, you can be very, very focused, with that. And I also mentioned we have 5 key states. We can geo target, which means we can focus our digital effort on those 5 key states, for instance. So we would have unproportionately more initiatives towards those 5 states. So we can do that. And as I also mentioned, we haven't done anything towards patients as of yet, and that's the new thing for this year. But you can find them. There are -- the reason we know it's 1.2 million is that you can identify the number of patients who've been on an oral iron salt and have had adverse events. And that is -- so you can be very precise with these type of efforts. And we think that will be a very interesting initiative we have this year. We know on the health care professional side, it actually gives us a positive ROI. And then again, we can target very clearly. We can even see -- we can link digital activities to an individual physician. So we can see if these activities actually lead to prescriptions. So that is -- those are the type of initiatives we're very excited about this.

Thank you, Anders. We've had a couple of questions about the prescriptions in Q4 being lower than in Q3 and whether there's a reason for this? And do you expect stronger growth to resume in 2025?

I think as Santosh mentioned earlier, this is by design. I mean the portion that is decreasing is the portion where we lost revenue per prescription. That is -- that we are actually -- we're happy with that result. And so that as you see, as the net selling price per prescription goes up rather significantly, that was the intention with that. So we also -- again, coming back to these 3 initiatives and especially then on the sales force side and the 5 key states -- that's why we're investing the most where we foresee to have the biggest return, where the biggest opportunity is. So -- and as I also said, if you just look at the numbers and compare how many total prescriptions we had last year versus how many total prescriptions there are in the segment of the market which we target with our sales force. I mean, if every prescription came from that part of the market, we have about 8% or 9% market share, right? So there's a lot to grow from still. And I think the third piece there is time, right? We've been out with [ full set ] for 18 months. We are not that old in the market. And then again, haven't done any patient awareness, which we're also initiating now. So that's why we're very optimistic to see -- continue to see good growth -- in the retail part, which is the blue bar that we show that, that is growing constantly over last year. And as I said again, the consignment piece, we actually probably would see that flattening out on a constant level, and that is also what we want to see.

Thank you, Anders. So I think we're coming to the end of the questions. So there's a lot of kind of similar themes. So I've tried to kind of condense them all. If a clinician is given ACCRUFeR at a discount, is this for a limited period only? Afterwards, do they pay the maximum price? There still seems to be a number of cheap and free prescriptions. That number seems quite high.

The short answer to that is no. It doesn't work like that, first of all. The way it works is for about half the market, we work with a company called Blink. They help us with -- to help the patient get through insurance. So while that's happening, we give them ACCRUFeR for free. So all of these administrative things can sort of -- which takes time. It can take weeks sometimes or even longer. Sometimes it's fast. It all depends on the plan, and it all depends on if that plan then actually would just approve ACCRUFeR or if the physician needs to write a prior authorization, proving that the patient has had an oral iron salt before, had side effects and now need this to be able to actually tolerate and actually take the therapy. So it all depends. So that's how it works. So all consignment isn't bad in a way. So we're happy to give away drugs for free when it is, for instance, when they are handling that prescription, we're also happy to give away drugs for free if there are patients who have no insurance at all, but we're trying to limit that part, right? So this is a fine balance. So the price for a patient doesn't change after they fill the first prescription that we get paid for, that's constant. That plan has a price. But then, of course, 10 patients in -- that comes up from the same health care professionals can be on 10 different plans and 10 different prices. That's just the nature of the market.

Fantastic. Thank you. There are a number of questions. We will -- we've tried to answer kind of everything that we can, and we will review the questions after the presentation as well and then provide written answers to any that we can. But I think that kind of concludes the questions for now. Thank you, Anders and Santosh.

Anders, Santosh, thank you for answering all those questions you have from investors. And of course, the company can review all questions submitted today, and we'll publish those responses on the Investor Meet Company platform. Just before redirecting investors to provide you with their feedback, which I know is particularly important to yourself and the company, Anders, could I please just ask you for a few closing comments?

Yes. Thank you for all who took the time to listen live to us today, and thank you for all -- it's very good questions. I hope our answers bring a little bit more light to the complex system we are living here within the U.S., especially. And we'll take a look at the questions we haven't been able to answer and see if there are any of those that we can provide a written answer to as well. But again, thank you, and thank you to those who listen to this on the recording as well. So thank you for attending.

Thank you for updating investors today. Can I please ask investors not to close this session as you'll now be automatically redirected to provide your feedback in order that the management team can better understand your views and expectations. This will only take a few moments to complete, and I'm sure will be greatly valued by the company. On behalf of the management team of Shield Therapeutics plc, we'd like to thank you for attending today's presentation, and good afternoon to you all.