Alpha Cognition Q2 2026 Earnings Report

Alpha Cognition EPS Results

• Actual EPS: -$0.40
• Consensus EPS: -$0.39
• Beat/Miss: Missed by -$0.01
• One Year Ago EPS: N/A

Alpha Cognition Revenue Results

• Actual Revenue: $6.00 million
• Expected Revenue: $4.38 million
• Beat/Miss: Beat by +$1.62 million
• YoY Revenue Growth: N/A

Alpha Cognition Announcement Details

• Quarter: Q2 2026
• Date: 8/13/2026
• Time: After Market Closes
• Conference Call Date: Thursday, August 13, 2026
• Conference Call Time: 4:30PM ET

Alpha Cognition (NASDAQ:ACOG), Inc. is a clinical stage biopharmaceutical company that develops treatments for underserved neurodegenerative diseases such as Alzheimer's Dementia and Amyotrophic Lateral Sclerosis. The company was founded in 2000 and is headquartered in Vancouver, Canada.

Alpha Cognition Q2 2026 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: ZUNVEYL net product revenue rose 71% sequentially to approximately $6 million in Q2 2026, with demand increasing each month and June marking the strongest month to date.
• Positive Sentiment: Commercial adoption continued to deepen, with 1,347 active prescribers, 1,095 nursing homes placing prescriptions, and repeat utilization from approximately 76% of writers and 81% of prescribing homes.
• Positive Sentiment: Management highlighted positive BEACON findings across cognition, neuropsychiatric symptoms, activities of daily living, and polypharmacy, while CONVERGE data is expected in Q3 2026 and RESOLVE remains on track to complete in Q2 2027.
• Negative Sentiment: Payer and formulary expansion remains the largest near-term constraint; broad activation has been slower than expected, with coverage holding at roughly 74% and no significant formulary wins reported in Q2.
• Positive Sentiment: The company reduced 2026 operating-expense guidance to $50 million-$54 million from $54 million-$58 million, ended Q2 with $41.4 million in cash, and reiterated its target of reaching operating profitability in 2027.

Presentation

[Operator]

As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Henry Du, Interim CFO, VP Accounting and Finance. Thank you. You may begin.

[Henry Du, Interim CFO, VP Accounting, and Finance at Alpha Cognition]

Thank you, Sachi. Good afternoon, everyone, and thank you for joining us today for Alpha Cognition's second quarter 2026 financial results conference call. Today, after the close of market, the company issued a press release announcing these results. On the call with me are Alpha Cognition Chief Executive Officer, Michael McFadden, and Chief Operating Officer, Lauren D'Angelo. Today's call is being made available via the investors section of the company's website at www.alphacognition.com. During the course of this call, management may make certain forward-looking statements regarding future events and the company's future performance. These forward-looking statements reflect Alpha Cognition's current perspective on existing trends and information. Any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, including those noted in the risk factors section of the company's latest SEC filings. Actual results may differ materially from those projected in these forward-looking statements.

[Henry Du, Interim CFO, VP Accounting, and Finance at Alpha Cognition]

For the benefit of those of you who may be listening to the replay, this call is being held and recorded on August 13, 2026. Since then, the company may have made additional announcements related to the topics discussed. Please reference the company's most recent press releases and current filings with the SEC. Alpha Cognition declines any obligation to update these forward-looking statements except as required by applicable securities laws. I will now turn the call over to Michael. Michael?

[Michael McFadden, CEO at Alpha Cognition]

Thank you, Henry. Good afternoon, everyone. Welcome to today's call. The second quarter of 2026 represents another important quarter of commercialization for ZUNVEYL, the first new oral Alzheimer's treatment approved in more than 15 years. It was a strong quarter of execution with clear sequential growth in ZUNVEYL demand, expansion in prescriber adoption, increased nursing home penetration, and continued progress with evidence generation to clinically support ZUNVEYL. We continue to execute with discipline and confidence, and I believe this quarter demonstrates that ZUNVEYL's commercial trajectory is tracking well with our expectations as we continue to scale the brand in the long-term care segment. In Q2, we generated approximately $6 million in net product revenues, representing approximately 71% quarter-over-quarter growth versus Q1 2026.

[Michael McFadden, CEO at Alpha Cognition]

While we are pleased with ZUNVEYL's trajectory, we are still in the early phases of the product's commercial phase and remain optimistic that we will continue to see signs of sustained product performance and adoption in the long-term care setting. Looking at the quarter, monthly prescription volumes strengthened consistently with high single-digit sequential growth each month. All KPIs were positive, including prescriber number increases, nursing home prescriptions, and repeat prescriptions. Overall, we believe we are on track with our 2026 strategic priorities as we continue to drive prescription growth and build a durable path toward operating profitability in 2027. Turning to our clinical and medical programs, we continued to advance our evidence generation priorities in Q2, which we believe will strengthen ZUNVEYL's positioning with both payers and healthcare providers over the long term. During the second quarter, the company reported positive top-line results from the BEACON study.

[Michael McFadden, CEO at Alpha Cognition]

We initiated CONVERGE, a retrospective data review in long-term care, and we initiated RESOLVE with sites selected, sites activated, and initial patient enrollment underway. Of note, the BEACON study demonstrated that following initiation of ZUNVEYL, providers observed improvements in cognition, improvements in neuropsychiatric symptoms, and improvements in ADLs, along with reductions in polypharmacy. These are all meaningful outcomes for long-term care practitioners treating patients with mild to moderate Alzheimer's disease. Based on these positive findings, our medical team has submitted the data for presentation at several upcoming medical meetings. We look forward to announcing additional details as presentations are accepted and confirmed. We expect CONVERGE top-line data in Q3.

[Michael McFadden, CEO at Alpha Cognition]

We believe this will provide the company two nursing home data sets that can be utilized to inform stakeholders of the changes in cognition, neuropsychiatric behaviors, and ADLs they might expect to see when utilizing ZUNVEYL in the nursing home setting. Henry will provide financials in detail in a moment, and Lauren will provide a more comprehensive commercial update thereafter. But first, let me make a few high-level remarks on our financial position. Our operating spend of $13.5 million this quarter continues to reflect a deliberate investment in our commercial capabilities and in studies that support our positioning with healthcare providers and payers. As I said last quarter, I want to be direct about the way we are thinking about this investment. Our net product loss this quarter reflects the company's intentional scaling.

[Michael McFadden, CEO at Alpha Cognition]

We are deploying capital against our highest return opportunities in the business, including expanding prescriber reach, building real-world evidence to support ZUNVEYL, and unlocking additional payer access. These are investments that will drive the company to achieve operating profitability in 2027 and beyond, and we continue to remain on track with these targets. I will now turn it over to Henry.

[Henry Du, Interim CFO, VP Accounting, and Finance at Alpha Cognition]

Thank you, Michael. Good afternoon again, everyone. As I review our second quarter 2026 financial results, please also refer to today's press release and 10-Q to be filed this afternoon. For the second quarter of 2026, ZUNVEYL generated approximately $6 million in net product revenue, compared with approximately $3.5 million in the first quarter, representing approximately a 71% sequential growth quarter-over-quarter. Total revenue for the quarter was $6.1 million, compared to $1.7 million in the prior year period, driven primarily by ZUNVEYL product sales. From a margin perspective, GAAP gross product margin was approximately 94% for the second quarter, based on net product sales of $6 million and cost of product sales of approximately $0.4 million. Regarding spending, total operating expenses for the second quarter were $13.5 million, including $11.5 million of SG&A and $2 million of R&D expense.

[Henry Du, Interim CFO, VP Accounting, and Finance at Alpha Cognition]

SG&A reflects continued investment behind the commercial infrastructure, payer engagement, marketing resources, and public company operations. R&D reflects continued investment in evidence generation and development programs required to build ZUNVEYL for the long term. Net loss for the second quarter was $8.8 million, or $0.40 per share, compared with a net loss of $13.2 million or $0.82 per share in the prior year period. As of June 30, 2026, the company had $41.4 million in cash and cash equivalents and $57.9 million in total current assets. Total current liabilities were $6.4 million, resulting in working capital of approximately $51.5 million. During the quarter, we also completed the early settlement of Galantos Pharma royalty obligation. This transaction simplifies our capital structure, eliminates future royalty burdens on the product economics, and increases our long-term participation in the value created by ZUNVEYL.

[Henry Du, Interim CFO, VP Accounting, and Finance at Alpha Cognition]

We believe this was a prudent use of capital and a strategic step that improves the future cash flows and strengthens the economics of the franchise as the brand continues to grow. We continue to believe our current capital position, together with expected future sales of ZUNVEYL and potential milestones and royalties, can support our plan towards operating profitability in 2027. Lastly, based on the strong commercial performance of ZUNVEYL and our continued focus on operating discipline, we are lowering our full-year 2026 operating expense guidance from our previous range of $54 million-$58 million to a new range of $50 million-$54 million. While we remain committed to supporting the growth of ZUNVEYL and advancing key evidence generation initiatives, we have identified opportunities to operate more efficiently across the organization. This revised outlook reflects our confidence in our ability to balance growth investments with prudent expense management.

[Henry Du, Interim CFO, VP Accounting, and Finance at Alpha Cognition]

With that, I will now turn the call over to Lauren to discuss commercial progress. Lauren?

[Lauren D'Angelo, COO at Alpha Cognition]

Thank you, Henry. I am pleased to provide a detailed update on our Q2 2026 commercial performance. Building on the momentum we described last quarter, Q2 was a period of meaningful execution across prescriber adoption, nursing home penetration, and payer engagement. The data tell a compelling story of durable and accelerating commercial traction. Let me start with the headline. Q2 demand generated approximately $6 million in net product sales, representing 71% sequential growth over Q1. That result was driven by approximately 8,294 bottles, up roughly 37% quarter-over-quarter. Turning to adoption. In Q2, the commercial team reached 8,194 total customers and called on 3,905 prescribers, reflecting the reach of our now right-sized, approximately 60-person productive field organization and the continued refinement of our targeting approach. HCP writers, prescribers who wrote at least one ZUNVEYL prescription, grew 27% quarter-over-quarter to 1,347, and cumulative life-to-date writers reaching 1,908.

[Lauren D'Angelo, COO at Alpha Cognition]

This keeps us firmly on track to meet or surpass our 2026 goal of approximately 2,000 cumulative writers. As I have said in the past, depth matters as much as breadth. Of our 1,024 Q2 writers, approximately 76% placed repeat prescriptions, and productivity per writer continued to climb, rising to approximately six prescriptions per writer. Evidence that adoption is deepening, not just widening. That sustained repeat behavior is one of the strongest signals that ZUNVEYL is moving from initial trial into routine clinical practice. We see the same pattern at the facility level. Homes with ZUNVEYL prescriptions grew 20% quarter-over-quarter to 1,095, including 346 new homes added during the quarter. Of homes with prescriptions, roughly 81% placed repeat orders, consistent with the durable facility-level adoption we described in Q1.

[Lauren D'Angelo, COO at Alpha Cognition]

The monthly trajectory shows how momentum built through the quarter, each month delivering sequential growth, with June our strongest demand month-to-date. That exit velocity establishes clear momentum as we move into Q3. Payer access remains our most significant near-term opportunity and candidly, our most significant near-term friction point. Implementation across the downstream plan clients in Q2 was roughly consistent with Q1. We want to be very direct about that. The broad formulary activation we anticipated has not yet materialized at scale, and access expansion is tracking slower than the access curve we outlined last quarter. Critically, we view this as a timing dynamic, not a demand constraint. The clearest evidence is that our Q2 demand grew approximately 37% in bottles and 71% in net sales, even without any expansion in payer access.

[Lauren D'Angelo, COO at Alpha Cognition]

Underlying prescription growth and an 81% facility repeat rate are being driven by genuine clinical pull, not by a formulary tailwind. That means payer conversion remains almost entirely ahead of us as upside. Reinforcing that access work is our real-world evidence program, BEACON, CONVERGE, and RESOLVE. We expect these studies to deliver meaningful promotional value, supporting peer-to-peer education, strengthening payer discussions, and building physician confidence around tolerability, polypharmacy management, and caregiver burden. That evidence base is already fueling our education efforts. Since March, we have conducted more than 240 peer-to-peer programs, reaching 1,058 attendees and 325 prescribers. We also maintained a strong scientific presence at key congresses, including NADONA and NPA, reinforcing ZUNVEYL's credibility among high-value prescribers. In summary, Q2 2026 reflected strong commercial execution with growing demand, improving conversion, high repeat utilization, broader prescriber adoption, and deeper facility penetration.

[Lauren D'Angelo, COO at Alpha Cognition]

While payer access has not yet expanded, the strength of demand underscores the clinical pull behind ZUNVEYL and the opportunity ahead. As access improves, we believe we are well-positioned for continued acceleration. I will now hand it back to Michael for closing remarks.

[Michael McFadden, CEO at Alpha Cognition]

Thank you, Lauren. Let me briefly summarize what I believe are the key takeaways from the quarter. First, ZUNVEYL is growing. We delivered approximately 71% sequential growth from Q1 to Q2, and monthly prescriptions increased from April through June. The commercial trajectory is accelerating. Secondly, adoption is deepening. We had over 1,300 HCP writers, over 1,000 repeat writers, 1,000 nursing homes with prescriptions, and almost 900 homes with repeat prescriptions. Repeat utilization remains one of the most important indicators of good product adoption. Third, we are executing on our commercial and company strategy with discipline. Our commercial organization is in place. Our focus is on deploying capital against high-return opportunities in the business, and our evidence generation continues to advance. The company is enrolling RESOLVE, CONVERGE is underway, and BEACON was completed ahead of schedule.

[Michael McFadden, CEO at Alpha Cognition]

The company will have publications from that study to present to the medical community this fall. So we are excited about the balance of the 2026 year. The foundation we built for ZUNVEYL is strengthening. Our commercial indicators are moving in the right direction. We remain focused on disciplined execution. With that, operator, we will now take questions.

[Operator]

Thank you. We will now be conducting a question-and-answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. The first question is from Ram Selvaraju from H.C. Wainwright. Please go ahead.

[Ram Selvaraju, Analyst at H.C. Wainwright]

Thanks so much for taking our questions, and congratulations on a very solid quarter. I was wondering if you could comment on the following three aspects at this point in the launch. Firstly, when you look at the repeat prescribers and the percentage of repeat prescribers that you have seen write prescriptions in multiple months, can you give us an additional granularity on that specific element of prescribing behavior? Particularly, what it may be that converts a repeat prescriber into not only writing more than one script, but sticking with the product over a lengthy period of time, and if at this point we have enough data to indicate what the characteristics of that group of prescribers are.

[Ram Selvaraju, Analyst at H.C. Wainwright]

Secondly, I was wondering if you could give us a sense of, at this point in time, given where you are with the launch, when you believe you might expand sales and marketing outreach beyond long-term care into the specialist neurologist population. Lastly, with respect to formulary access, I was wondering if you could elaborate a little bit further on when you anticipate that emerging as a tailwind above and beyond the pull-through demand that you're seeing? Thank you.

[Lauren D'Angelo, COO at Alpha Cognition]

Thanks, Ram. Very solid, good three questions there. I'll start with your first one around our repeat prescriber rate, what we're seeing in terms of what's causing that repeat group to continue writing ZUNVEYL. I think it really comes down to their experience with the drug. We've talked previously on many quarters that you start out with breadth. You call on a significant amount of physicians. Once you convince them to try the drug, it takes two to three months for them to really get that experience to monitor the one or two patients. Then, of course, they'll start repeating once they've experienced positive effects from ZUNVEYL. What we're seeing is these are significant repeat rates. 76% of providers are writing again. That's some of the highest I've seen in my experience.

[Lauren D'Angelo, COO at Alpha Cognition]

We believe, based on all of the feedback we've gotten from our customers, is that it's really three things. First, they want to make sure this drug is tolerable, because obviously their experience with the generics in the decades past has not been great as it relates to tolerability. Once they see that ZUNVEYL is a very tolerable drug, they're then looking obviously at the efficacy, and they see significant cognition, that core foundation of why they use these drugs in the first place. Then, as we've talked about in the past, they're seeing significant benefit across the behavior. So those are really the three things. Those are the three factors that are causing these physicians to write again, and that feedback is consistent across the board.

[Lauren D'Angelo, COO at Alpha Cognition]

As it relates to when we will step outside of long-term care and potentially go into retail or that neurology space, we are really focused right now on maximizing the long-term care opportunity. We obviously believe there is tremendous upside and opportunity in the long-term care space. As we get to operating profitability next year, that is when we would look to start evaluating whether it is time to go into the neurology space. Another key aspect of that expansion into neurology is the payer lens, which obviously goes to your next question. You do not want to launch into retail without solid formulary coverage because you will see significant abandonment rates in the retail setting, when the copay is too high. It is really operating profitability and payer coverage that would determine at what point in time we will expand into neurology. Then finally, your question around payer.

[Lauren D'Angelo, COO at Alpha Cognition]

We are, again, actively engaged with all of the key payers that really matter to the long-term care business. We are having consistent conversations. We are focused on increasing our demand so that we increase the likelihood that we can gain formulary coverage. What we are seeing across the board, not just specifically to ZUNVEYL, but really across the industry and the Medicare Part D space, is the impact of the Inflation Reduction Act. That is having a significant impact on the plan and the additional cost that they have to pick up. So that is why we have got to continue driving demand. We are hopeful that we will see something, as we have always communicated, the second half of the year.

[Lauren D'Angelo, COO at Alpha Cognition]

But it is not a matter of if, it is a matter of when, because the payers definitely recognize the demand and the growth that we are driving, and we will continue to have those conversations to make sure that obviously we start to obtain formulary coverage.

[Ram Selvaraju, Analyst at H.C. Wainwright]

Just very quickly, I was wondering if you could maybe provide us with your sense of when CONVERGE data becomes available, to what extent that constitutes a potential game changer in bending the curve upwards, as well as when you anticipate being able to provide data from the RESOLVE study. I know you have guided towards when the study would be completed, but when data would be available. Then if you could also comment on the size of the market opportunity that you expect to be addressable with the sublingual formulation and whether you would consider the possibility of instituting a revenue guidance range for 2027, along with possibly also instituting an expense guidance range for that year.

[Michael McFadden, CEO at Alpha Cognition]

A lot to unpack there. First, I'll start with CONVERGE. We anticipate top-line data for CONVERGE in Q3 of 2026. The significance of CONVERGE, it's a quantitative retrospective data analysis on the entire Alzheimer's market, and it will provide data on persistence, adherence, polypharmacy with all drugs, as well as a number of other elements like ADL improvement, tolerability, types of patients that are being profiled for each of the drugs, et cetera. That data will result in multiple publications. They likely will not be public until 2027. We'll begin writing data post-study and then submitting those for publication thereafter. We also believe that with CONVERGE quantitative data and BEACON qualitative data, there's an opportunity to analyze that data pharmaco-economically, which will provide additional information that we believe will be useful for payers and decision-makers that have a financial interest in how Alzheimer's drugs are used.

[Michael McFadden, CEO at Alpha Cognition]

RESOLVE study's underway. It's recruiting to our expectations. We anticipate that study will complete in Q2 of next year. We'll have data in the summer, fall, depending on when in Q2 the data of RESOLVE is provided. From a sublingual perspective, we're really excited about the sublingual opportunity. We believe that the opportunity represents about 10%-20% of patients with Alzheimer's disease. The data indicates that about 10%-20% of patients with Alzheimer's have either aphagia or dysphagia, meaning they cannot swallow or have difficulty swallowing, and the treatment choices for those patients currently are very limited. So, we believe the sublingual has the opportunity to take significant share from existing therapies and from a patch that's often used on the torso or the arm of these patients, which is quite difficult and challenging to administer and for the patients to utilize that drug.

[Michael McFadden, CEO at Alpha Cognition]

We have a gating item for the sublingual product. We're running a comparative PK study this quarter. We anticipate that data will be available in Q3, and that will determine timeline for clinical program for sublingual. Then for revenue guidance, currently, we haven't commented on when we'll provide revenue guidance. We will provide expense guidance for 2027, and we'll likely do that the very beginning of 2027 or the latter part of Q4.

[Ram Selvaraju, Analyst at H.C. Wainwright]

Thank you very much.

[Operator]

The next question is from Nav Rahman from Maxim Group. Please go ahead.

[Nav Rahman, Analyst at Maxim Group]

Hi, everyone. Congrats on the quarter and the progress, and thanks for taking my questions. I just have two quick questions. In the quarter, did you have or see any outsized stocking or material stocking in the quarter that could have impacted sales? Also, if the current reimbursement and coverage is going slower than anticipated, what do you expect your gross nets to be by the end of the year or through the year? Thanks.

[Lauren D'Angelo, COO at Alpha Cognition]

Yeah, both really good questions. As it relates to material stocking, no, we did not have a significant increase in stocking. Our pharmacy and our wholesalers are now at a point where they're pretty much purchasing on demand. What you see this quarter is pure demand growth, and we feel very strongly about that because we can follow the trends and the data. As it relates to our reimbursement, obviously, right now, we're holding strong at about 74%. Obviously, if we do not see any significant formulary adds by the end of the year, we would stay pretty consistent. We'll pick up some of the IRA penalty, but it will stay within a pretty similar GTN by the end of the year.

[Nav Rahman, Analyst at Maxim Group]

Thanks. Thanks for taking my questions.

[Lauren D'Angelo, COO at Alpha Cognition]

Sure.

[Operator]

The next question is from Chase Knickerbocker from Craig-Hallum Capital Group. Please go ahead.

[Analyst at Craig-Hallum Capital Group]

Good afternoon, everyone. Thanks for taking the questions. This is Jake on for Chase. We have seen another nice month in scripts in July. Could you maybe just speak a bit to what you have seen from a demand perspective so far in the third quarter?

[Lauren D'Angelo, COO at Alpha Cognition]

Sure.

[Analyst at Craig-Hallum Capital Group]

What level is plan pull-through and payer dynamics play a role here versus is it just commercial execution from your team?

[Lauren D'Angelo, COO at Alpha Cognition]

Sure. So Q2 results and demand were increasing month-on-month, and June was our strongest demand as of Q2. What I can tell you, I know we do not provide guidance, is that momentum has continued. It is all, in my opinion, we have had no formulary wins, our 16% contracted open book of business is consistent since last quarter. So we believe that the strong demand in Q2 is pure commercial execution. We have gotten a lot smarter with targeting the right customers. We are now at the ideal 60-person customer-facing sales force. So we believe that is really what is driving the demand. That is why we like to say that any formulary wins that will come in the future, it is all upside for us because we have got strong growth and we continue to have strong growth in Q3.

[Analyst at Craig-Hallum Capital Group]

Thanks for that color, Lauren.

[Lauren D'Angelo, COO at Alpha Cognition]

Sure.

[Analyst at Craig-Hallum Capital Group]

Lastly, could you just speak to how adherence is trending now that we are more than a year into launch? How have you seen this change over time, and what do you calculate patient retention is at six or 12 months? However, you want to present it.

[Lauren D'Angelo, COO at Alpha Cognition]

Sure. We are still tracking adherence rates, because long-term care is a little bit different, how you look at the data. It is hard for me to give you a number in terms of the average time on drugs. How much is new business versus refill business. But what we do see is patients do stay on drug longer in the long-term care facility versus a retail segment, obviously, because they are being cared for every day. I would hate to give you a number because we are still working through that adherence rate. But what I can tell you is Q2 was driven by significant new growth as well as those refills from previous quarters. Hopefully, in the future, I will be able to give you a more accurate number around adherence.

[Analyst at Craig-Hallum Capital Group]

Yeah, that would be very helpful. Thank you for taking the questions.

[Lauren D'Angelo, COO at Alpha Cognition]

Sure.

[Operator]

The next question is from Ryan Deschner from Raymond James. Please go ahead. Ryan Deschner, your line is open.

[Ryan Deschner, Analyst at Raymond James]

Hi, can you hear me?

[Michael McFadden, CEO at Alpha Cognition]

Yes, we can hear you, Ryan.

[Ryan Deschner, Analyst at Raymond James]

Hi. Apologies for that. Two quick questions. For me, the first, can you comment on specific geographies or types of prescribers or really any other attributes where you're seeing the most growth this quarter and going into next quarter? Then, as you're collecting feedback from prescribers who switch patients over to ZUNVEYL, what have the primary drivers for switching over been as of recent, and how refractory are the patients that you're putting on drug in terms of number of therapies that they've already been on? How has that looking so far? Thanks.

[Lauren D'Angelo, COO at Alpha Cognition]

Sure. As it relates to the growth across the nation for Q2, we have seen growth across every region. We are seeing, obviously, the largest volume is coming from those key markets that have the largest opportunity. Overall, I am pleased to say that across the country, we are seeing pretty significant growth, and there is not one specific area that is doing far better than, let us say, another area of the country. I think we are finally getting to a point with our 60-person sales team where we are gaining momentum. Every region is gaining traction, so that is really exciting.

[Lauren D'Angelo, COO at Alpha Cognition]

Your second question around what has the feedback been and what is causing that reason for shifting. There are several reasons. I think, and we are talking to customers every day, and the feedback continues to overwhelm us with the positive impact that ZUNVEYL is having on patients.

[Lauren D'Angelo, COO at Alpha Cognition]

We see a lot of new patients who have not been on drug in a while because they had already failed donepezil. They already failed maybe one or two generics, and there has been no other alternative for them. The physician is re-energized to try something else for these patients because they were not able to tolerate some of these drugs previously. We also see a significant amount of switching, and I think some of that is due to tolerability. It is due to, which obviously is insomnia on some of the other drugs. It could be the GI issues on some of the other drugs. Also the behavioral impact. I think physicians have started to get experience with ZUNVEYL. They are seeing a positive impact across behaviors.

[Lauren D'Angelo, COO at Alpha Cognition]

Patients that are on another drug, they have seen behavioral impact with patients already on ZUNVEYL, so it is causing them to switch those patients over to ZUNVEYL just from their pure experience with other patients. I do not know if that answers your question, but those two areas are probably the biggest reasons for switch or to try ZUNVEYL.

[Ryan Deschner, Analyst at Raymond James]

That is very helpful. Thanks so much.

[Operator]

The next question is from Dave Storms from Stonegate. Please go ahead.

[Dave Storms, Analyst at Stonegate]

Afternoon. Thank you for taking my questions. Just wanted to start with maybe some of the prescribers that have only been one-time prescribers thus far. Do you feel the need to maybe go back and retrace your steps there, or is there still so much runway in front of you that you're more focused on the white space there?

[Lauren D'Angelo, COO at Alpha Cognition]

That's a great question. One of the challenges with long-term care data is we call them ghostwriters. Even though it might show in the data that they've only written one prescription, they've actually written more. The order was just entered under another doctor. We don't have a lot of physicians who have tried one and dropped off and they're not using the drug anymore. What I can tell you, though, that I think ties to your question is that we have segmented the market, and we have obviously bucketed our physicians and our writers into our first tier, our second tier, where they've written several scripts, but they're maybe not writing it for 30% of patients. Then we've got a third tier. The good news in what we're seeing in Q2 is that every single tier is improving.

[Lauren D'Angelo, COO at Alpha Cognition]

If you'll remember in previous quarters, we talked a lot about those early physicians who have only tried one or two. They need two to three months to get experience with the drug. We're seeing that wave of physicians now move into significant repeat writing. It's kind of a constant cycle where we'll continue to call on a tier 3. They're getting that two to three-month experience with the drug. They will move into the next tier. In every single tier, we've seen significant improvement. It's just time and experience with ZUNVEYL, and we expect that that trend will continue.

[Dave Storms, Analyst at Stonegate]

That is really great color. I appreciate that. Then maybe just one more modeling question. With the SG&A expense guidance decreasing, is there any more you could give us there? Just maybe how sticky that might be, how much of it could be applied into 2027? Just maybe any more color there would be helpful.

[Michael McFadden, CEO at Alpha Cognition]

Yeah, I can comment on that. We anticipate some consistency, Dave, into 2027, but we haven't finalized our 2027 numbers. We have a number of studies ongoing this year which increase expenditures. Those will be concluding in Q2 of next year. Our commercial efforts and opportunities may offset that into 2027. So, I ask you to bear with the company as we finalize our 2027 budget and spending plan, and we'll provide those datas, but it will be in a similar range for next year.

[Dave Storms, Analyst at Stonegate]

Perfect. Okay. Thank you for taking my questions.

[Operator]

The next question is from William Wood from B. Riley Securities. Please go ahead.

[William Wood, Analyst at B. Riley Securities]

Hi, thanks for taking our questions. Just a couple from us. I was curious in terms of the patients that don't or come off drug. On that churn where they don't continue persistence, what is the main driver for the patient to either to get off drug? Is it adverse events or just lack of efficacy? Alternatively, what's driving the prescriber to stop prescribing it? Also, in terms of long-term home care base, it looks like you've got a continued very nice expansion there. I was curious in terms of percentage of total base that you can potentially building into. I know it's still early times, but just curious how much of an expansion you have sort of room to grow on that sort of top line full expansion there? Thank you.

[Lauren D'Angelo, COO at Alpha Cognition]

Sure. Both of those are really great questions. I can tell you that we're talking to customers daily. We're getting significant feedback, and we are following those patients that discontinue ZUNVEYL. What I can tell you, it doesn't mean that it's not happening. I'm not speaking to the universe. But we have not had or heard of patients, especially within our data, that are coming off due to tolerability or lack of efficacy. We've actually heard the very opposite. This drug works, and this drug works really well, and I think the feedback has been overwhelmingly positive. Of course, the downside of long-term care is these patients are very frail and you will see death for patients. You'll also see patients who leave the long-term care facility, and they have a fall, so they get put into the hospital. You might have some break.

[Lauren D'Angelo, COO at Alpha Cognition]

We will recapture those patients when they come back into the home, but the time that they, it looks like a discontinue in the data when they're actually checking, going into the hospital. Those are really probably the two biggest factors. Then, of course, if there's a formulary change or the prior authorization wasn't completed, then our reimbursement team will follow up and ensure that that patient gets put back on drugs. Those would be the main reasons why you would see a patient come off ZUNVEYL. To your question about opportunity and our base, from my perspective and the company's perspective, we have significant opportunity in long-term care. If you look at just the highest volume Alzheimer patients across the country, and you split these out into homes, there's about 5,000 homes that are at your tier 1 targets that provide significant opportunity for ZUNVEYL.

[Lauren D'Angelo, COO at Alpha Cognition]

Then, of course, there's about 3,000 top tier physicians. Right now, we've got about 1,000 writing. Not only do we need to increase the depth of those providers, but we also have significantly more prescribers that we need to activate on ZUNVEYL. From our perspective, tons of upside opportunity from a market opportunity.

[William Wood, Analyst at B. Riley Securities]

Got it. One last one, if I may. In terms of just the patients who are switching, or are starting drug, do you find that you are getting more patients that are refractory to other drugs or more switchers that are actively looking for a drug? So, sort of pulling from a non-drug user or a drug user? It is a minor difference there.

[Lauren D'Angelo, COO at Alpha Cognition]

Yeah. We are seeing about 50/50. If you look at the data, of course, in long-term care, there are many patients who have already tried these drugs. These drugs have been out for decades. There is nothing available to them. So, they have been off drugs for some time. So they look like a treatment naive, but they have actually tried something previously, likely. So we are getting many, we will call them treatment naive, but patients who were not on drugs, but we are also seeing a significant amount of switches.

[Lauren D'Angelo, COO at Alpha Cognition]

So those patients who are either already still on it today, they are having tolerability issues, they are experiencing significant insomnia. Many of them already have behavioral issues. That patient profile right there is probably our highest switch because that is obviously, with ZUNVEYL being core foundation and impacting all of those areas in a positive way, it is a pretty easy switch for a physician.

[Lauren D'Angelo, COO at Alpha Cognition]

I would say about half of our business is coming from patients who have probably tried and failed. They are no longer on treatment right now, but the doctor is then adding ZUNVEYL, or they are being directly switched from a generic acetylcholinesterase inhibitor due to those issues that I described.

[William Wood, Analyst at B. Riley Securities]

Got it. Very helpful. Thank you for taking our questions and congrats on the quarter.

[Lauren D'Angelo, COO at Alpha Cognition]

Thanks.

[Operator]

There are no further questions at this time. I'd like to turn the floor back over to Michael McFadden for closing comments.

[Michael McFadden, CEO at Alpha Cognition]

Thanks everybody for attending the call and those who are listening to the call. We're excited about the quarter. Feel like we had a strong quarter highlighted by our growth, both in bottles, prescribers, adoption, our progress in payer and evidence generation, and the focus on high target opportunities for the company that we believe will continue the growth in quarters to come. Thank you for listening to the call. If you have interest in speaking with the company further, you can reach out to our IR on website. Thank you so much.

[Operator]

This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.

Participants

Executives

• Henry Du, Interim CFO, VP Accounting, and Finance
• Michael McFadden, CEO
• Lauren D'Angelo, COO

Analysts

• Ram Selvaraju, Analyst at H.C. Wainwright
• Nav Rahman, Analyst at Maxim Group
• Analyst at Craig-Hallum Capital Group
• Ryan Deschner, Analyst at Raymond James
• Dave Storms, Analyst at Stonegate
• William Wood, Analyst at B. Riley Securities