Ironwood Pharmaceuticals Q2 2026 Earnings Report

Ironwood Pharmaceuticals EPS Results

• Actual EPS: $0.31
• Consensus EPS: $0.32
• Beat/Miss: Missed by -$0.01
• One Year Ago EPS: N/A

Ironwood Pharmaceuticals Revenue Results

• Actual Revenue: $113.04 million
• Expected Revenue: $114.84 million
• Beat/Miss: Missed by -$1.80 million
• YoY Revenue Growth: N/A

Ironwood Pharmaceuticals Announcement Details

• Quarter: Q2 2026
• Date: 8/6/2026
• Time: Before Market Opens
• Conference Call Date: Thursday, August 6, 2026
• Conference Call Time: 8:30AM ET

Ironwood Pharmaceuticals (NASDAQ:IRWD) is a commercial‐stage biotechnology company focused on the discovery, development and commercialization of medicines for gastrointestinal (GI) disorders. The company’s flagship product is linaclotide, marketed under the brand name LINZESS in the United States for the treatment of irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). Through a strategic collaboration with Allergan (now part of AbbVie), Ironwood also commercializes linaclotide in select ex-U.S. markets under the brand name CONSTELLA.

In addition to its marketed therapy, Ironwood maintains a diversified pipeline of clinical and preclinical programs targeting GI motility, inflammation and neurological conditions. Lead pipeline candidates include novel small molecules designed to modulate gut motility and secretions, as well as agents aimed at central nervous system targets to address pain and neurodegenerative disorders. The company leverages in-house research capabilities alongside external partnerships to advance its portfolio.

Founded in 1998 as Microbia Biosciences, the business rebranded as Ironwood Pharmaceuticals in 2010 concurrent with its initial public offering. Headquartered in Cambridge, Massachusetts, Ironwood conducts research and development activities in the U.S. and collaborates with global pharmaceutical partners to extend its reach into European, Canadian and other international markets.

Ironwood is led by President and Chief Executive Officer Peter Hecht, who brings extensive experience in both commercial operations and strategic development within the biopharmaceutical industry. Under his leadership, the company continues to pursue innovative therapies aimed at addressing unmet needs in GI health and related therapeutic areas.

Ironwood Pharmaceuticals Q2 2026 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: LINZESS delivered strong momentum: Q2 U.S. net sales rose 14% year over year to $282.3 million, supported by mid-single-digit prescription growth and improved net pricing. Ironwood raised its 2026 LINZESS sales outlook to $1.15 billion–$1.20 billion, implying growth of more than 30% and a return to blockbuster status.
• Positive Sentiment: The FDA approved LINZESS for functional constipation in pediatric patients aged two and older, making it the only prescription therapy approved for this age group and expanding the brand’s addressable patient population.
• Positive Sentiment: Ironwood initiated active enrollment in the confirmatory Phase III STARS-2 trial for apraglutide in short bowel syndrome with intestinal failure. Management believes the once-weekly therapy’s efficacy, tolerability, and potential to reduce parenteral-support dependence could support a best-in-class profile, though enrollment remains an execution priority.
• Positive Sentiment: Q2 GAAP net income was $51 million and adjusted EBITDA was $83 million; full-year revenue guidance increased to $460 million–$485 million and adjusted EBITDA guidance to above $310 million. The company repaid $200 million of convertible notes and expects gross debt below $300 million and leverage below 1x by year-end.
• Neutral Sentiment: R&D spending is expected to rise in the second half as STARS-2 enrollment and site activation ramp, with modestly higher SG&A also anticipated. The ultimate expense increase will depend on how quickly additional trial sites are brought online.

Presentation

[Operator]

Good morning, everyone. My name is Ian, and I will be your conference operator today. At this time, I would like to welcome everyone to the Ironwood Pharmaceuticals Q2 2026 Investor Update conference call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. Thank you. I would like to now turn the call over to Chris Stamm, VP, Investor Relations and Communications. Please go ahead.

[Chris Stamm, VP of Investor Relations and Communications at Ironwood Pharmaceuticals]

Good morning, and thanks for joining our second quarter 2026 investor update. A press release issued this morning highlighting Q2 results can be found on our website. Today's call and accompanying slides include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Such statements involve risks and uncertainties that may cause actual results to differ materially. A discussion of these statements and risk factors is available on the current safe harbor statement slide, as well as under the heading Risk Factors in our annual report, Form 10-K, for the year ended December 31st, 2025, and in our subsequent SEC filings. All forward-looking statements speak as of the date of this presentation, we undertake no obligation to update such statements. Also included are non-GAAP financial measures, which should be considered only as a supplement to and not a substitute for or superior to GAAP measures.

[Chris Stamm, VP of Investor Relations and Communications at Ironwood Pharmaceuticals]

To the extent applicable, please refer to the tables at the end of our press release for reconciliations of these measures to the most directly comparable GAAP measures. During today's call, Thomas McCourt, our Chief Executive Officer, will review second quarter business highlights and strategic priorities. After Tom, Chief Commercial Officer Tammi Gaskins will provide an overview of second quarter LINZESS performance. Jeff Silber, our newly appointed Chief Medical Officer and Head of Research and Drug Development, will give a brief update on apraglutide.

[Chris Stamm, VP of Investor Relations and Communications at Ironwood Pharmaceuticals]

Ron Silver, our Interim Chief Financial Officer, will close our prepared remarks with a financial update before we open the call for questions. Jeff Ruberti, our Chief Strategy Officer, will also be available for the Q&A at the end of the call. Today's webcast includes accompanying slides. For those joining by phone, please visit the events section of our website to access the presentation. With that, I'll turn the call over to Tom.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Thanks, Chris. Thanks everyone for joining us to review Ironwood's second quarter 2026 financial results and business update. Before I begin, in addition to welcoming Chris, who joined the team in June to lead our IR and communications efforts, I'd like to introduce two recent additions to the Ironwood leadership team, who you'll be hearing more from today and in the weeks and months ahead. First, I want to sincerely thank former Chief Medical Officer and Head of R&D, Mike Schutzelein, who retired after a distinguished career dedicated to advancing GI science and patient care. Most recently, he led the team through a major company milestone, the successful initiation of the confirmatory phase III STARS-2 trial. Last month, we welcomed Dr. Jeff Silber, Mike's successor, who brings more than 30 years of experience in the industry and academia.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Jeff is an accomplished leader in drug development from pre-clinical through submission, commercialization, and expanding value of brands through lifecycle management. Previously, chief medical officer at Vedanta Biosciences, he brings broad late-stage development expertise to Ironwood, having supported multiple successful new drug applications and valuable brands in leadership roles at AbbVie, EMD Serono, Merck KGaA, and Merck & Co. His leadership will be instrumental as we advance apraglutide through phase III and commercialization. I'd also like to introduce Ron Silver, our senior vice president, corporate controller, and chief accounting officer, who is serving as interim chief financial officer. Ron has been with Ironwood for eight years, serving in key financial leadership roles, providing him with deep knowledge of our business and strategy. His experience and leadership will be invaluable as we continue to execute against our priorities. Now, let's dive into the second quarter business updates.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

At the beginning of the year, we outlined three key priorities for 2026: maximizing the performance of LINZESS, advancing apraglutide, and delivering sustained profitability and cash flow. These priorities remain central to achieving our mission to redefine standard of care for patients living with gastrointestinal rare disease while creating long-term shareholder value. During the second quarter, we made meaningful progress across each priority. Starting with LINZESS, the brand continues to demonstrate exceptional strength in its 14th year on the market and remains the prescription leader in both irritable bowel syndrome with constipation and chronic idiopathic constipation. We're pleased to report a second consecutive quarter of strong LINZESS performance, delivering $282.3 million in U.S. net sales, fueled by improved net price and mid-single-digit prescription demand growth. This outstanding performance supported our decision to raise our full year 2026 financial guidance.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Based on the updated outlook, LINZESS is positioned to grow more than 30% year-over-year, return to blockbuster status, and deliver the highest annual U.S. net sales in the product's history. We also achieved an important regulatory milestone during the quarter with the FDA approval of LINZESS for the treatment of functional constipation in pediatric patients two years of age and older. This is another important milestone establishing LINZESS as the only prescription therapy approved for functional constipation in this age group, addressing yet another unmet patient need. Turning to apraglutide. In June, we initiated the STARS-2 confirmatory phase III clinical trial evaluating apraglutide in adults with short bowel syndrome with intestinal failure, or SBS-IF. The trial is now actively recruiting patients, we continue to activate additional sites to drive enrollment.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

STARS-2 will build on the positive data from the phase III STARS trial, which we believe demonstrates that apraglutide has the potential to be a best-in-class therapy for patients with SBS who are dependent on parenteral support. Our goal is to ensure apraglutide will be the first long-acting GLP-2 analog to market. Finally, we delivered strong financial results during the quarter, generating $51.3 million in GAAP net income and $83 million in adjusted EBITDA. We also repaid our $200 million convertible notes at maturity with cash on hand. Looking ahead, we expect to leverage LINZESS generating cash flow to further reduce our debt and we are well-positioned to end 2026 with a gross leverage below 1x, while maintaining resources necessary to advance and prepare for the potential commercialization of apraglutide. With that, I'll turn the call over to Tammi to provide some additional context on LINZESS. Tammi?

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

Great. Thanks, Tom, and good morning, everyone. As Tom just stated, LINZESS delivered another strong quarter with U.S. net sales of $282.3 million. That's a 14% year-over-year increase driven by both demand growth and improved net price. Through the first half, LINZESS U.S. net sales reached $555 million, up 44% year-over-year, underscoring the strength and momentum of the brand. If I just double-click for a minute on demand, the slide you see shows year-on-year UTRX volume growth of 4% for quarter two and 5% year-to-date June. We expect this demand momentum to persist and anticipate mid-single digit demand growth for the full year, giving us the confidence to raise our full-year financial guidance.

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

Turning to price, the positive impact seen in Q1 from elimination of inflationary rebates across channels really continued to benefit net price as planned, in addition to favorable timing of gross to net rebate reserves as compared to the second quarter of 2025. Our full-year net sales guidance reflects the ongoing benefit of improved net price combined with anticipated reduced variability in sequential quarterly U.S. net sales as compared to 2025, really due to more consistent net price across channels. To that end, since demand volume is historically highest in the second half of the year, we expect quarterly performance to build, with the fourth quarter projected to deliver the highest net sales for 2026.

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

This performance also highlights the significant unmet needs that LINZESS helps to address for millions of patients with IBS-C and CIC across the U.S. The recent FDA approval for FC, functional constipation, down to two years of age further expands the reach of LINZESS and helps highlight its importance for an even broader range of patients. I'd like to hand the presentation over to Jeff Silber to highlight our progress advancing apraglutide.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

Thanks, Tammi, and good morning, everyone. I'm excited to be joining the Ironwood team at such an important time. We work to bring apraglutide to patients suffering from SBS-IF as quickly as possible. Today, I'd like to share my perspective on why the science behind apraglutide and what it could mean for patients is so compelling. There's a considerable unmet need for patients with SBS-IF. On average, these patients require parenteral support, that is IV fluids and nutrients, 10 hours per day, six days per week, creating a real burden to their quality of life. Although parenteral support meets the nutritional needs that enable them to survive, patients continue to face many significant daily challenges. As highlighted in the landmark HCP survey that Ironwood presented at DDW last May, central line infections, fatigue, central line pain, and abdominal pain are all common and highly distressing challenges associated with parenteral support.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

These findings underscore the need for therapies that reduce patients' IV dependence and the associated burden of parenteral support while improving their quality of life. One of the reasons I'm so excited to have joined Ironwood is the opportunity to help advance a therapy with the potential to address this significant unmet medical need. First, apraglutide is currently the only once-weekly GLP-2 analog with positive Phase III efficacy and safety data in adults with SBS-IF.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

Data from the STARS study, the largest Phase III clinical trial in SBS-IF conducted to date, demonstrated significant reductions in parenteral support requirements compared with placebo at week 24, with treatment effects observed as early as week eight. As you can see in the graph on the left, at week 24 in the overall population, the reduction in weekly parenteral support volume in the apraglutide group was more than double that of the placebo group

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

In addition, a significantly greater proportion of patients receiving apraglutide were able to reduce their dependence on parenteral support by at least one day per week. Importantly, apraglutide was well-tolerated in the STARS study, with an overall safety and GI tolerability profile that was similar to that of placebo. The graph on the right comes from our Phase III long-term extension study, STARS Extend. About 90% of the patients enrolled in the STARS trial rolled over into STARS Extend, and the majority remained on treatment at the time of the analysis shown here. These longer-term data show that patients achieve further reductions in their parenteral support requirements with continued exposure to apraglutide. This translates into more patients achieving additional days off of parenteral support, with some reaching enteral autonomy, which is the ultimate goal for patients with SBS-IF.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

In fact, more than one in five patients enrolled in STARS Extend had achieved enteral autonomy as of January 2025. We look forward to sharing additional STARS Extend updates in the future. The clinical profile we have observed to date reflects apraglutide's best-in-class differentiated molecular design, differentiating it from both native GLP-2 and other GLP-2 analogs. Apraglutide is long-acting, enabling convenient once-weekly dosing, and it's demonstrated a favorable tolerability profile that may support better treatment adherence. This is an important point because maintaining patients on therapy is a key factor in achieving full treatment benefit, including meaningful and sustained reductions in parenteral support. When you put all this together, the clinical evidence, the favorable tolerability, and the convenience of once-weekly dosing, we believe that apraglutide has the potential to become the preferred GLP-2 treatment option for patients with SBS-IF.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

Which we expect to expand the number of patients who may benefit from GLP therapy. Looking into the future, a uniquely differentiated GLP-2 analog like apraglutide has the potential to restore intestinal function in patients with other types of GI compromise beyond SBS-IF. Today, however, our top priority is advancing apraglutide to patients with SBS-IF as quickly as possible. To that end, the confirmatory phase III STARS 2 trial was initiated in June as planned and is now actively recruiting patients. STARS 2 is a 24-week global randomized, double-blind, placebo-controlled trial. The primary endpoint is relative change from baseline in actual weekly parenteral support volume at week 24. As we continue to add clinical trial sites, we'll be leveraging the infrastructure and the relationships that we developed during the conduct of the STARS study.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

As a reminder, the phase III STARS study was the largest SBS-IF trial conducted to date with 68 global sites. We're building on that strong foundation, leveraging those existing site relationships and adding new high-potential sites, including more sites in the U.S., and identifying opportunities to accelerate enrollment. Successful execution of STARS 2 remains one of our highest priorities for Ironwood. As site activation continues, we expect enrollment to build, and we're evaluating opportunities to accelerate the enrollment timeline. We look forward to updating you on our progress in the coming months. In summary, if approved, we believe apraglutide's differentiated clinical profile, once-weekly dosing, and long-term data position it to meaningfully improve the treatment landscape for patients with SBS-IF. With that, I'll pass the call to Ron.

[Ron Silver, Interim CFO at Ironwood Pharmaceuticals]

Thanks, Jeff. Thanks, Tom, for the introduction. I'm pleased to have the opportunity to join the call today and look forward to working closely with our investors and analysts as we continue to advance our strategic priorities with a focus on financial discipline and operational excellence. Turning to our financial results. During the second quarter, total revenue was $113 million, GAAP net income was $51 million, and adjusted EBITDA was $83 million. We ended the quarter with $79 million in cash and cash equivalents and $113 million in collaboration receivables. As Tom mentioned, we repaid our convertible notes at maturity in June. Looking ahead, we intend to continue using operating cash flows to further reduce our debt balance. Based on our current outlook, we expect to end the year with less than $300 million of gross debt outstanding, further strengthening our balance sheet and financial flexibility.

[Ron Silver, Interim CFO at Ironwood Pharmaceuticals]

Turning to guidance. Given the continued strength of LINZESS and our very strong first half performance, I am pleased to share that we are increasing our full year 2026 guidance. We now expect LINZESS U.S. net sales of between $1.15 billion and $1.2 billion, representing a greater than 30% increase year-over-year. This increase is driven by significantly improved net price and mid-single-digit LINZESS prescription demand growth. Our revenue guidance has increased to between $460 million and $485 million, and we expect adjusted EBITDA of greater than $310 million. This increase in our guidance reflects both the strength of our underlying business and our confidence in continued execution on our priorities throughout the remainder of the year. I'd like to turn the call back over to Tom for some closing remarks.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Thanks, Ron. In summary, the second quarter was marked by strong commercial execution of LINZESS continued advancement of apraglutide with the initiation of STARS-2, and meaningful progress towards strengthening our balance sheet. Throughout the second half of the year, we will remain laser-focused on executing on our strategic priorities and advancing our vision to redefine standard of care for patients living with GI and rare disease. Before I turn it over to Q&A, I would like to thank our employees, patients, caregivers, investigators, and advocacy partners for their continued commitment and support. Operator, we're now ready to open up the line for questions.

[Operator]

Thank you. At this time, I would like to remind everybody that in order to ask a question, please press star followed by the number one on your telephone keypad. Once again, that is star followed by the number one on your telephone keypad. We will pause for just a moment to compile the Q&A roster. Our first question comes from the line of Jason Butler from Ferguson. Your line is opened.

[Jason Butler, Analyst at Citizens]

Hi, guys. Can you hear me?

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Yep.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Yep.

[Jason Butler, Analyst at Citizens]

Hey, it's Jason Butler from Citizens. Thanks for taking the questions. Just a couple from me. First, I know one question at the beginning of the year was would there be an impact on demand from the net price change. Seems like you have an increased comfort level that isn't going to happen now, even on a delayed basis. Can you just walk us through those dynamics?

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Who do you want to take that one?

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

Hi, Jason. It's Tammi. Appreciate the question. As I stated, through June, we are tracking to 5% year to date TRx volume demand growth, which is modestly ahead of what we had shown or indicated early in the year, which was low double-digit demand growth. Based on where we are in the year and the fact that historically, our performance from a demand perspective even further increases in the second half of the year, that has given us the confidence and the belief to raise the demand number to mid-single digits.

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

We've done a lot. We did indicate previously that we thought there could be some demand softening due to the elimination of the inflationary rebates cross-channels. We've done a lot working with our partner to really help ensure ongoing access for patients across channels. We think we're in a very good spot now to deliver in that mid-single-digit range to the full year.

[Jason Butler, Analyst at Citizens]

Great. Second one for me, just STARS-2. I understand you're still relatively early here in the trial, but can you just walk us through how site onboarding is going? Just the comments you made about potentially impacting or improving enrollment timelines. Can you just give us a little more detail about what your strategies could be there? Thank you.

[Operator]

Yep.

[Jeff Ruberti, Chief Strategy Officer at Ironwood Pharmaceuticals]

Absolutely, Jason. This is Jeff Ruberti. I'll open the response. But as you noted, it's early days. We initiated the trial in June, and we have our first sites activated and enrolling patients. The full weight of the company is really pressing behind ramping up the trial, activating more sites, and we look forward to providing more operational details. As we noted, Jeff Silber just joined the team, and it is top priority as well. Jeff, do you want to comment on the opportunity to accelerate the timeline?

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

Sure. It's week three, and so I am working with the team, and what's impressed me so far is the diligence with which the team is executing on the plan that had been laid out over the last several months. I am just now beginning to look through this with a fine-tooth comb. I will be looking for opportunities to accelerate and look forward to sharing in the coming months. For right now, the priority really is to execute optimally on the plan that had already been developed.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Yeah. I think the big thing here, Jason and Tom, is really the expansion of the number of sites, particularly in the U.S. With STARS, as you recall, there wasn't a lot of U.S. sites. It was largely ex-U.S. We see a real opportunity here, and obviously, that's building off real strong support from our scientific steering committee, who are a lot of the key investigators around the country. Also our ability to identify high-potential sites where there clearly is, or we know there are patients that exist. I think with our trial design and combining that with the clinical profile of the drug, we're pretty confident that we're going to be able to bring in a number of patients fairly quickly. Obviously, we'll be updating you and the rest of the investment community as we progress through that process.

[Jason Butler, Analyst at Citizens]

Thanks, Tom. I appreciate it. Thanks for taking the questions.

[Operator]

Our next question comes from the line of Mohit Bansal with Wells Fargo. Your line is opened.

[Mohit Bansal, Analyst at Wells Fargo]

Great. Thank you very much for taking my questions, and congrats on all the progress. I have two questions, one on apraglutide and one on LINZESS. For LINZESS, there was some concern around could there be some plans they could have an issue given the price is higher now. Are you seeing anything like that in the Medicaid patient population so far? It doesn't seem like that, but would love for you to touch upon that. Then for apraglutide, now that you are expanding to newer sites and all that. How do you make sure that trial conduct issues last time and when people did not dose properly, how do you ensure that a repeat of that doesn't happen as you go into more sites here? Thank you.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Sure. Tammi, do you want to take the first question on that?

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

Yeah, sure. Hi, Mohit. It's Tammi, and appreciate the question. You're absolutely correct in that before we had talked about, and part of the reason we indicated low-single-digit demand growth at the beginning of the year is through the elimination of the inflationary rebates across channels, including Medicaid. We thought there could be some demand softening. Based on where we are at the year, the 5%, and the fact that we have done, as I mentioned, a lot with our partner to work with the states individually to help ensure ongoing access to those patients. We are now very confident in that mid-single-digit expectation for that mid-single-demand growth through the rest of the year, especially since historically our demand has a bit of a seasonality and increases towards the latter of the half of the year, especially in Q4.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

I'm sorry. No, you go.Jeff.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

Just to be clear on kind of this issue or concern that we had at dose. As you recall, with the original trials, the STARS trial, the intent was to deliver a five-milligram dose. Unfortunately, due to the kit and the instructions, what we actually saw was a delivery of three and a half milligrams. Clearly the drug worked, and it was extremely well-tolerated, even at three and a half milligrams. What we wanted to do was match that so we could leverage the great data of STARS with this smaller confirmatory trial. What we've done since then, based on the root cause analysis on the delivery, we've dramatically improved the kit to avoid any kind of errors in instruction or implementation of the new kit. We've done several human factor studies around that.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

We've also done drug exposure and kinetic data. We're absolutely confident that we're in complete control of the dose and we're absolutely confident that this error will not happen in STARS-2. I think moving forward, we see a very, very high probability of success to reconfirm the great data we saw in the original STARS trial.

[Mohit Bansal, Analyst at Wells Fargo]

Very helpful. Thank you. Congrats, Jeff and Ron, and welcome to the group. Thank you.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Thank you.

[Ron Silver, Interim CFO at Ironwood Pharmaceuticals]

Thanks.

[Jeff Silber, Chief Medical Officer and Head of Research and Drug Development at Ironwood Pharmaceuticals]

Thanks, Ron.

[Operator]

Once again, a reminder, if you'd like to ask a question, please press star followed by the number one on your telephone keypad. Our next question comes from the line of Dominic Rose with Intron Health. Your line is opened.

[Dominic Rose, Analyst at Intron Health]

Hi, this is Dominic from Intron Health. Thanks for taking my questions. I have got two. My first question is both Q1 and Q2 saw favorable time phasing of gross to net rebate reserves. Do we expect this to unwind in H2, or would there be more favorable moves? Is there anything you can tell us about that? My second question is, in May, you flagged that Medicaid would be most likely seeing reduced volume growth in H2. Is that still your expectation now given the guidance upgrade? Thanks.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Thanks, Dominic. Tammi, you want to take both of those?

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

Sure. Appreciate the question. This is Tammi. To start with the favorability of phasing of gross to net reserve. First, as I indicated in my comments, we do expect less variability in sequential quarterly net sales this year. We had quite a bit of variability last year because there was for two key reasons. One, there was more difference in net price across channels. Because of accruing rebates relative to actual demands dispensed in a quarter, that variability in price had more of a variability because of seasonality of certain sectors of the business.

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

This year, more consistent net price across channels not be affected nearly to the extent of the seasonality and actual units dispensed. Also we expect to see quarter-on-quarter increase in performance with Q4 actually being the strongest quarter that we will have this year from a net sales perspective. In key takeaway, don't expect there to be an unwinding, if you will, due to changes in favorability quarter on quarter.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

The anticipated reduction for Medicaid volume?

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

Yes. As I said, we saw strong 5% demand growth through mid-year. We've worked very hard at a state level with our payer to help maintain access across channels, including Medicaid, and we are still projecting to have our growth across channels to be in line with expectations to drive that mid-single digit demand growth through the full year.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Bottom line, Tammi, I think where we're at is we're not seeing the dramatic reduction in Medicaid that we thought we were at risk of.

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

Correct.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

I think we feel very good about the current trend we're on with regard to volume as well as net price.

[Tammi Gaskins, Chief Commercial Officer at Ironwood Pharmaceuticals]

We expect more consistent sequential quarterly net sales growth, continue to improve performance each quarter throughout the end of the year, with fourth quarter being our strongest.

[Dominic Rose, Analyst at Intron Health]

Thank you. I appreciate the detail.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Thanks, Dominic.

[Operator]

Our next question comes from the line of Chase Knickerbocker with Craig-Hallum. Your line is open.

[Chase Knickerbocker, Analyst at Craig-Hallum]

Good morning. Thanks for taking the questions. Maybe just on LINZESS net sales guidance. Trying to understand the end caps on the guidance there. Is it a little bit of conservatism as far as kind of IRA rebates in the back half as far as the bottom end of the range? Maybe help me understand both sides. Thanks.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Hey, Chase. The increase in the guidance was actually consistent on each end of the range. It was up by $25 million. I think the major driver of the confidence to raise that guidance was the mid-single digit demand, which we've seen now consistently two quarters in a row. It gives us confidence we'll be able to land in that range. To reiterate, the range was improved consistently across both ends.

[Chase Knickerbocker, Analyst at Craig-Hallum]

Understood. As we think about the EBITDA guidance on the year, any additional kind of color you can give us as far as how we should be thinking about R&D progressing in Q3 and Q4 on those step-ups, as we think about the bottom end of the P&L.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Absolutely. Ron, do you want to take that?

[Ron Silver, Interim CFO at Ironwood Pharmaceuticals]

Sure. Thanks, Chase. Appreciate the question. For the remainder of 2026, we do expect R&D expense to increase relative to the first half of the year. That reflects the ramp-up of the STARS-2 trial we initiated in June. We also expect a modest increase in SG&A expense as well through OpEx.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Obviously, Chase, that's all going to be dependent on how many sites we can get up and running and how fast we can do that. Obviously, that's a critical investment in our future. While obviously this quarter the EBITDA was remarkably strong, I think we'll see that continuing throughout the end of the year. We clearly will see an increased expense, as Ron mentioned. That's going to be largely dependent on how many sites we can get up and running and how fast we can do it.

[Chase Knickerbocker, Analyst at Craig-Hallum]

Got it. Thanks, guys.

[Thomas McCourt, CEO at Ironwood Pharmaceuticals]

Thanks, Chase.

[Operator]

There are no further questions at this time. With that concludes today's conference call. Thank you all for joining us. You may now disconnect, and have a good rest of your day

Participants

Executives

• Chris Stamm, VP of Investor Relations and Communications
• Thomas McCourt, CEO
• Tammi Gaskins, Chief Commercial Officer
• Jeff Silber, Chief Medical Officer and Head of Research and Drug Development
• Ron Silver, Interim CFO
• Jeff Ruberti, Chief Strategy Officer

Analysts

• Jason Butler, Analyst at Citizens
• Mohit Bansal, Analyst at Wells Fargo
• Dominic Rose, Analyst at Intron Health
• Chase Knickerbocker, Analyst at Craig-Hallum