Alpha Cognition Q1 Earnings Call Highlights

Key Points

• ZUNVEYL sales and adoption continued to accelerate in Q1 2026, with net product revenue rising to $3.5 million from $2.5 million in Q4 2025 and bottles dispensed up 23% sequentially. Alpha Cognition said March was its strongest month since launch and April was even stronger.
• Commercial metrics improved across prescribers, long-term care, and repeat use, including 1,060 active healthcare provider writers, 914 long-term care homes with prescriptions, and high repeat rates in both channels. The company says it is on track toward its 2026 goal of about 2,000 prescribers.
• Spending is rising as Alpha Cognition invests in commercialization and studies, with Q1 operating expenses of $11.6 million and a full-year 2026 expense guide of $54 million to $58 million. The company ended the quarter with $54.2 million in cash and still expects to reach operating profitability in 2027.

Alpha Cognition NASDAQ: ACOG reported 40% sequential revenue growth in the first quarter of 2026, as executives said commercial adoption of its Alzheimer’s treatment ZUNVEYL continued to build across prescribers and long-term care facilities.

Chief Executive Officer Michael McFadden said the quarter marked the company’s fourth full quarter of commercialization for ZUNVEYL, which he described as “the first new oral Alzheimer’s treatment approved in more than 15 years.” Alpha Cognition generated net product revenue of $3.5 million in the quarter, up from $2.5 million in the fourth quarter of 2025.

“While we are very pleased with ZUNVEYL’s trajectory, we’re still at only the start of ZUNVEYL’s commercial phase,” McFadden said. He added that March delivered the company’s strongest month of demand sales and that April was stronger than March.

ZUNVEYL Adoption Metrics Improve

Chief Operating Officer Lauren D’Angelo said the company saw “meaningful execution across prescriber adoption, nursing home penetration, and payer engagement” during the quarter.

According to D’Angelo, Alpha Cognition’s commercial team reached approximately 7,900 healthcare providers and called on 3,762 prescribers, a 93% increase from the prior quarter. Healthcare provider writers, defined as prescribers who have written at least one ZUNVEYL prescription, rose 23% quarter over quarter to 1,060.

The company has set a 2026 goal of reaching approximately 2,000 prescribers. D’Angelo said first-quarter growth puts Alpha Cognition on a “strong trajectory” toward that target. She also said 795 of the 1,060 active writers, or about 75%, had placed repeat prescriptions.

In long-term care, homes with ZUNVEYL prescriptions increased 25% quarter over quarter to 914. D’Angelo said that represented about 36% penetration of the facilities called on by the company, with each active home averaging more than six prescriptions in the quarter. She said 736 facilities had placed repeat orders, representing an 81% repeat rate.

Total bottles dispensed in the first quarter were 6,054, up 23% from 4,941 bottles in the fourth quarter. March accounted for 2,321 bottles, the company’s highest monthly demand total since launch.

During the quarter, Alpha Cognition also completed the buildout of a 60-person customer-facing field team. D’Angelo said the company is now focused on improving productivity and conversion efficiency across territories, including through AI-enabled analytics and targeting tools.

Financial Results and 2026 Spending Outlook

Interim Chief Financial Officer Henry Du said first-quarter total operating expenses, including cost of revenues, were approximately $11.6 million. That compared with $10.7 million in the fourth quarter of 2025 and $6.3 million in the first quarter of 2025.

Du said the increased spending reflected investments in the company’s commercial infrastructure, payer engagement, marketing resources and the initiation of the RESOLVE clinical study. Alpha Cognition reported a first-quarter net loss of approximately $6.5 million, or $0.30 per basic share, compared with a net loss of $1.7 million, or $0.11 per share, in the prior-year period.

As of March 31, the company had approximately $54.2 million in cash and cash equivalents, down from $66 million at the end of 2025. Du said Alpha Cognition maintains a debt-free balance sheet and believes its capital position is sufficient to fund operations, sustain commercialization and advance clinical programs as it targets operating profitability in 2027.

The company did not provide revenue guidance but reiterated full-year 2026 operating expense guidance of approximately $54 million to $58 million. Du said second-quarter spending is expected to increase modestly from the first quarter as RESOLVE ramps and peer-to-peer education programs accelerate.

Clinical Studies and Real-World Evidence

McFadden said three real-world studies are underway or preparing to begin, which the company expects will support ZUNVEYL’s positioning with payers and healthcare providers.

• BEACON: A real-world effectiveness study evaluating ZUNVEYL in long-term care residents with Alzheimer’s disease. McFadden said enrollment will complete this quarter, with top-line data expected no later than early third quarter, ahead of the company’s prior expectation of late fourth quarter.
• CONVERGE: A retrospective analysis evaluating tolerability, dosing, polypharmacy and adverse events in long-term care. The study is expected to initiate in the second quarter, with top-line data anticipated in the third quarter of 2026.
• RESOLVE: A Phase IV outpatient study expected to initiate this quarter. McFadden said during the question-and-answer session that RESOLVE is not expected to complete in 2026 and is expected to complete in the second quarter of 2027.

McFadden said BEACON and CONVERGE are expected to provide publication opportunities and data that could support payer coverage expansion and prescriber confidence.

The company is also advancing a sublingual formulation program. McFadden said Alpha Cognition will initiate a comparative pharmacokinetic study versus its tablet formulation this quarter. If the data show equivalence, the company plans to submit an investigational new drug application to the U.S. Food and Drug Administration later this year.

Payer Access Remains a Focus

D’Angelo said payer access remains “both our most significant near-term friction point and our most significant near-term opportunity.” She said the company views access as a timing issue rather than a demand constraint, citing prescription growth and repeat utilization.

Alpha Cognition has Medicare Part D contracts in place with two major pharmacy benefit managers representing approximately 45 million covered lives, with no prior authorization requirements for ZUNVEYL under those contracts. D’Angelo said implementation across downstream plan clients is currently about 16% of the total contracted book of business.

When the company’s reimbursement team supports prior authorization submissions, D’Angelo said the approval rate is approximately 89%. In response to an analyst question, she said Alpha Cognition has not seen a meaningful change in the number of prior authorizations or step edit requirements over the last several months.

The company also implemented a 6% price increase for ZUNVEYL during the quarter, bringing the price to $869.36. D’Angelo said the increase reflected the company’s confidence in the product’s value proposition and underlying demand trends.

Patents, Partnerships and Pipeline Opportunities

McFadden said the U.S. Patent Office issued two patents providing additional protection for ZUNVEYL. One covers dosage regimens for benzgalantamine, while the other covers the use of benzgalantamine for treating traumatic brain injury. Both patents extend protection through 2045.

McFadden said the traumatic brain injury market represents an estimated $14 billion opportunity. During the question-and-answer portion, he said the company plans to use its sublingual formulation for the TBI program and expects to run a 12-week toxicology study this year before advancing an IND.

Alpha Cognition also said CMS Pharma continues to advance regulatory processes across multiple countries in Asia. McFadden said the company anticipates two strategic product approvals in 2026.

In closing remarks, McFadden said Alpha Cognition remains on track with its 2026 priorities and continues to expect operating profitability in 2027. He pointed to upcoming catalysts including BEACON data, CONVERGE data, sublingual pharmacokinetic data and continued ex-U.S. milestones.

About Alpha Cognition NASDAQ: ACOG

Alpha Cognition, 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.

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