CorMedix Q4 2023 Earnings Call Transcript

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March 12, 2024

There are 8 speakers on the call.

Operator

Good morning, ladies and gentlemen, and welcome to the CorMedix, Inc. 4th Quarter and Full Year 2023 Earnings Call. At this time, all lines are in a listen only mode. Following the presentation, we will conduct a question and answer session. This call is being recorded on March 12, 2024.

Operator

I would now like to turn the conference over to Dan Ferry from LifeSci Advisors. Please go ahead.

Speaker 1

Good morning, and welcome to the CorMedix full year 2023 earnings conference call. Leading the call today is Joe Tedisco, Chief Executive Officer of CorMedix. He is joined by Doctor. Matt David, Executive Vice President and CFO Beth Zelnick Kauffman, EVP and Chief Legal Officer Liz Hurlburt, EVP of Chief Clinical Strategy and Operations Officer and Aaron Mistry, EVP and Chief Commercial Officer. Before we begin, I would like to remind everyone that during the call, management may make what are known as forward looking statements within the meaning set forth in the Private Securities Litigation Reform Act of 1995.

Speaker 1

These statements are subject to certain risks and uncertainties and include, but are not limited to, any of the following. Any statements other than statements of historical facts regarding management's expectations, beliefs, goals and plans about the company's prospects, including its commercial launch prospects for DefenCath, its clinical development programs for expanded uses of defencast, manufacturing activities and marketing approvals for other product candidates, future financial position, future revenues and projected costs and reimbursement and potential market acceptance of DefendCap or other product candidates. Actual results may differ materially from these projections or estimates due to a variety of important factors, including but not limited to uncertainties related to clinical development, regulatory approvals and commercialization. These risks are described in greater detail in CorMedix's filings with the SEC, including the latest quarterly report on Form 10 Q and annual report on Form 10 ks, copies of which are available free of charge at the SEC's website at www.sec.gov or upon request from CorMedix. CorMedix may not actually achieve the goals or plans described in these forward looking statements and investors should not place undue reliance on these statements.

Speaker 1

Please note that CorMedix does not intend to update these forward looking statements except as required by law. At this time, it's now my pleasure to turn the call over to Joe Todisco, Chief Executive Officer of CorMedix. Joe, please go ahead.

Speaker 2

Thanks, Dan. Good morning, everyone, and thank you for joining us on this call. Since we last presented earnings in November, the company has achieved a number of key milestones, most notably the final NDA approval of DefenCath by the U. S. FDA as well as confirmation from CMS that DefenCath will be eligible to receive a transition drug add on payment or to DAPA for outpatient reimbursement as CMS has classified DefendCAV for renal dialysis service under the end stage renal disease prospective payment system.

Speaker 2

As we previously announced, we submitted our HCPS J code application to CMS in December and our TDAPA application in January, following receipt of that reimbursement guidance from CMS. Those applications remain under review at CMS and CMS has confirmed in writing that they are actively reviewing our J code into DAP applications and are working toward a July 1, 2024 effective implementation for a Defend Cast to DAPA payment. That said, CMS reserves the right to request additional information for any application, which may impact the review timing and or approvability of a J code or TDAPA application are gating items for the outpatient commercial launch of DEFENCAV, which is currently slated for July 1. The company remains on schedule to commence our commercial launch for the inpatient setting on April 15. We have staffed and trained our field sales and medical affairs organizations and held successful internal team launch meeting during the last week of February.

Speaker 2

The team we have built is deeply experienced and specialized with backgrounds in both infectious disease and nephrology spanning both the inpatient and outpatient settings of care. We are also ramping up inventory production in accordance with our internal plan, which is heavily weighted toward the back part of the year. As part of our supply chain strategy, the company is on track to submit a supplement to our NDA in April, qualifying Siegfried's site in Hammel, Germany as an alternative manufacturing site for DefenCath. Assuming a favorable FDA review of the supplement, additional production from that site would come online by the end of 2024. As we think about the inpatient launch trajectory in April, we do expect the ramp for our inpatient utilization to be fairly modest over the first two launch quarters as inpatient health systems and hospitals are working through their respective P and T formulary review processes.

Speaker 2

On average, the P and T process for a particular system or hospital can range from 3 to 9 months. That said, we have received significant interest over the last few months and are actively working through the P and T process with several large and midsized health systems. We expect this activity to intensify in the coming months as our field based key account managers have just begun calling on hospitals and health systems to effectuate pre launch contracting discussions. On the outpatient side, we continue to have productive discussions with large and midsized dialysis operators and we look forward to providing additional updates over the coming months as these discussions advance. Based upon our current base case forecast for 2024, we continue to believe that the company can achieve breakeven profitability on a run rate basis by the end of December 2024, assuming we are able to achieve our internal base case assumptions for DefendCap demand, uptake, net pricing and reimbursement.

Speaker 2

We believe we have sufficient cash resources on hand to achieve this objective. However, should the launch and uptake of DefendCath be slower than our internal projections requiring more capital, we believe we have several financing alternatives available to the company, including non dilutive sources of financing. CorMedix has grown in size with the addition of new hires in field sales and medical affairs as well as other additions across the organization. I am thankful for all of those involved in the latest expansion, our new team members and all the work that has gone into preparing the company for our anticipated commercial launch. I am proud of what we've accomplished over these recent months and excited to bring Defencast to patients.

Speaker 2

I would now like to turn over the call to Matt to discuss the company's Q4 and year end financial results and financial position. Matt?

Speaker 3

Thanks, Joe, and good morning, everyone. I am pleased to be here today to provide an overview of our Q4 and full year 2023 financial results, as well as an update on CorMedix' cash position. The company has filed its annual report on Form 10 ks for the year ended December 31, 2023. I urge you to read the information contained in the report for a more complete discussion of our financial results. With respect to our Q4 of 2023 financial results, our net loss was approximately $14,800,000 or $0.26 per share compared with a loss of $8,200,000 or $0.20 per share in the Q4 of 2022.

Speaker 3

The higher net loss recognized in 2023 compared with 2022 was primarily driven by increases in costs related to market research studies and pre launch activities for DefendCAF and increases in personnel expenses due to new hires in 2023 compared to the same period in 2022. Operating expenses in the Q4 of 2023 increased approximately 86% to $15,700,000 compared with $8,400,000 in the Q4 of 2022. R and D expense decreased by approximately 19% to $2,300,000 driven primarily by decreases in manufacturing costs related to Defend Cat. SG and A expense increased approximately 140% to 13 $400,000 in the Q4 of 2023 compared with $5,600,000 in the Q4 of 2022. This increase was primarily attributable to an increase in costs related to launch activities and higher personnel costs due to the additional hires in Q4.

Speaker 3

With respect to our full year 2023 financial results, total operating expenses during the full year 2023 amounted to $49,000,000 compared with $30,700,000 in 2022, an increase of 60%. R and D expense increased 23 percent to $13,200,000 driven primarily by an increase in personnel expenses, an increase in costs related to medical affairs activities and increase in costs related to the technical and quality operations for the manufacturing of Defend Cat prior to its marketing approval. SG and A expense increased approximately 79 percent to $35,800,000 primarily driven by an increase in costs related to market research studies and pre launch activities in preparation for the commercial launch of DefenCath and an increase in personnel expenses as a result of the additional hires in 2023. These increases were partially offset among others of lesser significance by a decrease in legal fees for the period. We recorded net cash used in operations during 2023 of $38,400,000 compared with net cash used in operations of $24,400,000 in 2022.

Speaker 3

The increase is primarily driven by an increase in net loss, primarily attributable to an increase in operating expenses as compared with the same period in 2022. CorMedix remains in a good position from a balance sheet perspective as we prepare the company for a commercial launch of Defencat in April. The company has cash and cash equivalents of $76,000,000 as of December 31, 2023. As we've discussed previously, we expect our operating expenses, especially SG and A to increase in 2024 given the growth of the company and the cost driven by the commercial launch of DefenCAT. CorMedix anticipates 2024 quarterly operating expenses to range from around $15,000,000 to 18,000,000 to support commercial infrastructure and the launch of DefenCath.

Speaker 3

We believe our cash, cash equivalents, short term investments and projected future operating cash flow gives the company the ability to fund operations for at least 12 months and to fund the commercial launch of Defend Cat through to anticipated profitability, which may occur on a run rate basis by the end of December 2024, assuming we are able to achieve our internal base case assumptions for defend cap demand, uptake, net pricing and reimbursement. I will now turn the call back over to Joe for closing remarks. Joe?

Speaker 2

Thanks, Matt. Ormedix is laser focused on our upcoming launch date in April. It's actively engaged in customer discussions on both the inpatient and outpatient settings of care and is optimistic about our launch potential for 2024 and beyond. With respect to any future potential indications for DefenCath, we are targeting the submission of a post approval meeting request to FDA by the end of March and we expect to have a meaningful discussion with FDA around potential clinical pathways in mid year 2024. As I mentioned earlier, we do not intend to provide revenue or earnings guidance at this time.

Speaker 2

However, we may revisit guidance if and when appropriate. I appreciate everyone's continued support CorMedix and I'm happy to take questions.

Operator

Thank you. Ladies and gentlemen, we will now begin the question and answer session.

Speaker 4

Just wondering if you could give us a little bit more detail on the progress you're making with the hospital P and C Committees. Do you have meetings scheduled at this point? And do you think you can get any when do you think you can get the first decisions out of those meetings? And then secondly, just walk us through how we should think about the early launch and utilization within the hospitals as you get these committee meetings and approvals? I mean, should we expect any use before you get the 1st committee approvals?

Speaker 4

Thanks.

Speaker 2

Thanks, Jason. So from a P and T meeting process, we do have some meetings that are currently scheduled. We have a number that we expect to be scheduled, let's say, in the Q2. I don't I can't really comment on the timing of how quickly that will move and whether they will be adopted on formulary. But the way I would think about inpatient and then I'll even touch on outpatient for a second.

Speaker 2

Yes, we mentioned it'd be a slower ramp, right, due to the P and T process. So when we think about it in the short term and long term, we think about the inpatient side as kind of a more steady gradual ramp. Whereas on the outpatient side, given the potential size of certain large customers as well as even the ability of a midsized customer to move volume, we would expect that ramp to be a little more lumpy, right? And on the outpatient side, we see maybe new patient starts within those facilities focusing initially on fee for service patients, right? As then we begin to onboard MA plans over time, it'd be a little bit kind of in stepped, right, more of a lumpy upward ramp.

Speaker 4

Got it. And then just one more for me in terms of the label expansion activities, other catheter use settings. Obviously, you mentioned waiting for the FDA interactions and feedback. But just from an operational perspective, are you guys preparing to be in a position to launch those trials or start those trials quickly after you get FDA alignment?

Speaker 2

Obviously, that's going to depend on whether or not they adopt the proposal that we intend to make, right? If they are accepting of the pathway that we're going to put forward for certain expanded indications, we can launch those fairly quickly. It's not immediate, right, not just flipping on a light switch. But if they desire for more work to be done, then it could be a longer pathway.

Speaker 4

Okay, great. Thanks for taking the questions.

Operator

Thank you. Our next

Speaker 1

Hi, Joe and team. It's Anish on for Greg. Congrats on the progress this quarter and thanks for taking my questions. Just first, maybe if you could give us an update on the current composition of your commercial field force and for some granularity on the new adds in the inpatient and outpatient segments to date? And then secondly, how are you thinking about current and upcoming shifts and political tides affecting CMS reimbursement policies as it pertains to defend cath?

Speaker 1

Thanks again.

Speaker 2

Thanks, Anish. So from a field team standpoint, we've migrated a little bit from, I think our thinking last year and rather than have a bifurcation between the inpatient and outpatient teams, we've somewhat melded them into 1, with geographic deployment being more important than, let's say, a split between those two settings of care. Given the nature of the role is more of a key account manager than a medical rep, it's essentially the same skill set on both sides of the care from a reimbursement knowledge from a contracting standpoint. The hurdle on both sides really is getting the product adopted in the system, be it a large system or a small dialysis operator. So right now we're staffed with about 30 in the field.

Speaker 2

We think that's sufficient for launch. We may look to grow over time into the 45, 50 range. But right now, we're comfortable where we're at that we have the right team in place. From a political standpoint, it's really hard to tell, right, what may happen. Certainly, we have 4 years of experience with the Biden White House and have just gone through our experience with CMS.

Speaker 2

We also have 4 years of past experience with the Trump administration. So at this time, we're not really seeing anything drastically change at CMS regardless of who ends up in the White House, but it certainly could always change.

Speaker 1

Great. Thank you.

Operator

Thank you. Our next question comes from the line of Les Poluski from Chuba Securities. Please go ahead.

Speaker 1

Good morning. Thank you for taking my questions. Can you, Joe, provide some color around the distribution channels, around your commercial inventory levels ahead of launch and how do you expect the inpatient centers to manage their stocking levels? And maybe your implied ratio on expected demand for 3 mill versus the 5 mill vial? And also a follow-up to that, when which quarter would you expect the manufacturing costs to shift from R and D to COGS?

Speaker 2

Thanks, Les. Good questions. So from a distribution channel standpoint, essentially the inventory is going to flow through specialty distribution. On the inpatient side or for inpatient facilities, it will flow through a specialty distributor. On the outpatient side, it will be a mix of going through specialty distributor for some customers and others potentially will go will get shipped direct.

Speaker 2

On the 3 ml and 5 ml issue, the 5 ml was in our label because we had done an initial development work. Remember the product was initially in a 5 ml vial, but it's not our intent to commercialize the 5 ml at this time. So we're launching the intent is to launch the product with a 3 ml. The last question that you asked about when we cut over is a difficult one, right, because it depends on uptake and demand. I think the faster demand goes, you could certainly see cut over earlier, right, this year, right?

Speaker 2

If demand is a little bit slower, may take some more time, right? So we've built a decent amount of inventory pre right that was expensed right prior to approval.

Speaker 1

Got it. Thanks. Just one more follow-up. I think it did. Yes.

Speaker 1

Just one more follow-up, guess, on the strategy around separate payment under Medicare Part B reimbursement. What are some potential timelines for filing and approval that you expect on this and the potential impact to your WACC price?

Speaker 2

Yes. I'm not sure I follow that question, Les. So we have our outpatient reimbursement determination. CMS has made a determination that we're eligible for TDAPA, right? That's going to fall into the scope of the end stage of the ESRD prospective payment system.

Speaker 2

On the inpatient side, we do have our NTAP. So the J code application is required for TDAPA, right? So J code, if that's what you might be thinking is separate from a Part B determination. Does that clarify

Speaker 1

the question at all, Les? Correct. And is there a potential for any adjustments to the WACC price?

Speaker 2

So look, we've launched the product with a WACC of $2.49 I don't at this time envision any adjustments to the WACC price during the TDAPA period, but that will always reevaluate as we move forward.

Speaker 1

Got it. Thank you.

Operator

Thank you. Our next question comes from the line of Sergio Bellinger from Needham and Company. Please go ahead.

Speaker 5

Hi, good morning. Thanks for taking my questions. Joe, I think you mentioned that the P and T review process would take 3 to 9 months. Maybe just talk a little bit about that process and what it entails? And then in the outpatient setting, do you also expect kind of adoption process or evaluation process before there is uptake?

Speaker 5

And maybe lastly, just if you can walk us through your base case for breakeven by the end of the year? Thanks.

Speaker 2

Okay. So I'm going to start with number 3 first and then I'm going to allow Aaron to comment on the P and T process for the facilities. And certainly outpatient, I think that's what you're asking your second question, outpatient. They follow a similar evaluation process when making a determination to put a product on formulary and into utilization, right? They're looking at the clinical data for the product, they're looking at the medical need certainly the reimbursement to the facility as well as whatever the economic terms that we're able to provide that institution.

Speaker 2

So from I think what you're asking at number 3 is, can you clarify, are you asking me to confirm that we get to runway breakeven? What is your question on 3?

Speaker 5

Really just the pushes and pulls to get you to that breakeven status that you talked about as your base case.

Speaker 1

Okay.

Speaker 2

Yes, sure. So I mean, look, we have certain assumptions that we've made for demand and uptake on both the inpatient and outpatient side, right, that produces a revenue forecast internally and a cash flow forecast that we're comfortable with, gets us to run rate breakeven profitability as I mentioned. So I don't think we're going to provide more granularity than that at this whereas I said, we're not going to give revenue guidance. But certainly, I think you can do the math. We've given guidance on what our run rate operating expenses are going to be.

Speaker 2

So you can somewhat back into where revenue really needs to be in order to hit that milestone. And so Erin, you want to provide a

Speaker 6

Sure. I can provide

Speaker 7

a little bit of color around the P and T process. The process itself is driven by the hospital internally, right? So usually you have a physician champion that advocates for the product and then the formulary meeting happens and they adopt the product and then it goes through the process of implementing it within the health systems. We've seen a lot of interest in the product both organically and inorganically, right, where we've done some reach outs and we've also had reach outs from hospitals to us. I think the benefit here is that we have secured the NTAP prior to being approved.

Speaker 7

We have that opportunity to leverage a payment mechanism on the inpatient side and we also have the opportunity to leverage the health economics, right? The long term complications of these patients, the hospitals are the ones that see those patients and those expenses. So we've had a lot of organic and inorganic interest from hospitals.

Speaker 2

Thanks, Aaron. Sir, does that answer your questions?

Speaker 4

Yes. Thank you.

Operator

Thank you. I'll now turn the call back over to Dan Ferry for written questions from the audience.

Speaker 1

Thank you, operator. Joe, we have a few written in questions from the audience here. The first one is your NTAP was approved based on an estimated WACC price of $11.70 per vial. However, you have launched the product with an actual WACC of about $2.50 per vial. Can you explain what impact this will have on the NTAP reimbursement?

Speaker 1

Do you expect this price point to have a positive or negative impact on inpatient utilization? And further, what color can you provide around why the lower WACC was decided?

Speaker 2

Okay. Thanks, Dan. There's a lot to unpack there. I'm going to start with taking a step back and the thought process around when we established the $11.70 price points, all right. So when we filed the NTAP application 2 years ago, market landscape looked very different, specifically on the outpatient side, right?

Speaker 2

TDAPA was 2 years. We didn't where the product would need to be priced on the inpatient side alone for the size of the inpatient market. And ultimately we settled on the $11.70 price. Since that time, obviously, the landscape has shifted to DAPA. It's now 5 years.

Speaker 2

We've had a number of conversations with customers in both settings of care over the last 2 years. And on the outpatient side specifically have gotten much more comfortable and confident around the ability to first of all secure reimbursement with TDAPA and second get sufficient uptake. So the WACC price that we established of 24999 dollars really was driven by the dynamics of TDAPA for the outpatient segment, but is a reasonable price point for inpatient. So one of the other key piece of feedback we took over the last 2 years from inpatient institutions as we messaged around the NTAP and the value

Speaker 1

of the

Speaker 2

NTAP was from many institutions as they perceive lower acquisition cost of product to be preferred to a higher NTAP reimbursement. So to that extent, the feedback we've gotten on the inpatient side is that the lower WACC price is more favorable. So I think to the question you asked about, do you expect this price point to have a positive or negative impact on utilization? The feedback we're getting is that the lower acquisition cost of product should drive higher utilization on the inpatient side. So certainly, we're happy with that.

Speaker 1

Okay, great. Thanks, Joe. Second question here is, are there any expected studies or data to be presented over the coming months? And can you give investors a sense of which conferences CorMedix may have a presence?

Speaker 2

Yes, thanks. I'm going to turn that over to Liz in a moment, but we've got a pretty ambitious 2024 planned with both field organizations being out there and active in a number of industry conferences. But Liz, why don't you go ahead?

Speaker 6

Sure. Thanks, Joe. Yes, we're excited actually. We're going to be presenting 2 abstracts this spring at the upcoming Society For Healthcare Epidemiology of America or SHEA's Annual Meeting. And both field teams, both medical and commercial are going to be present at over a dozen conferences this year and continuing to connect with key stakeholders.

Speaker 6

So those include SHEA, MATID, the NKF Spring Conference, Renal Physicians Association. So I think we have a really good presence out there.

Speaker 1

Joe, final question here is, can you give a sense of what investors may be missing? What is key to understanding CorMedix over the near term?

Speaker 2

Okay. Thanks, Dan. So look, I assume you're thinking about it from a stock price trading standpoint. I still think we're a story that's not completely widely understood, right? We're in a very niche therapeutic segment with an atypical reimbursement and a lot of acronyms we talk about, NTAP to DAPA that are not necessarily common vernacular for biotech investors.

Speaker 2

We're also a young biotech going through its first launch. So I think historically a lot of investors have kind of sat on the sidelines waiting for new perhaps a new equity offering. But as we've discussed today, we're focused on launch. Think that there's a lot of launch value to Venkat that is certainly not captured in the trading value of the stock. And we also think that there's potentially long term value.

Speaker 2

We have 10.5 years of exclusivity. We're expecting to meet with FDA midyear around a label expansion for DEFENCAF. But I think more importantly over the next couple of years, our expectation is to be developing real world evidence demonstrating that the impact that the FENCAF can have on infection rates and on patients. And certainly, we'd look to utilize that real world data as one we obviously establish broader utilization, but also more long term reimbursement across the continuum of care.

Speaker 1

Okay, great. Thanks, Joe. Operator, that concludes the written portion of the Q and A session. You may now close the call.

Operator

Thank you. Ladies and gentlemen, this concludes your conference call for today. We thank you for participating and ask that you please disconnect your lines. Have a lovely day.

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