Ardelyx Q2 Earnings Call Highlights

Key Points

• Second-quarter product revenue reached a record $118 million, up 31% year over year, but Ardelyx lowered its 2026 IBSRELA revenue forecast to $350 million–$370 million because stricter payer requirements are slowing new patient starts.
• XPHOZAH revenue rose 27% to $31.9 million, and its 2026 outlook remains $110 million–$120 million. However, Ardelyx withdrew its longer-term $750 million revenue target amid uncertainty around reimbursement changes, market dynamics and competing phosphate binders.
• Ardelyx increased commercial and research spending to improve access and fund pipeline development, while reporting a $16.7 million quarterly net loss and $281.8 million in cash and short-term investments. Management expects operating expenses below $500 million in 2026 and sustainable profitability in 2027.

Ardelyx NASDAQ: ARDX reported second-quarter product revenue of $118 million, up 31% from a year earlier and representing the company’s largest quarterly revenue total to date. The company lowered its 2026 revenue outlook for IBSRELA while maintaining its forecast for XPHOZAH, citing increased payer restrictions affecting patient access to IBSRELA.

“Growth in the second quarter was robust, yet performance fell short of our expectations,” President and CEO Mike Raab said. He said IBSRELA demand remains strong and that the company’s view of the product’s long-term opportunity, including its potential to reach $1 billion in revenue, has not changed.

IBSRELA Guidance Lowered Amid Payer Restrictions

IBSRELA generated $86.2 million in second-quarter revenue, a 33% increase from the comparable quarter of 2025. However, Ardelyx reduced its full-year IBSRELA revenue guidance to $350 million to $370 million. At the midpoint, the revised forecast would still represent annual growth of more than 30%.

Chief Commercial Officer Eric Foster said the company has encountered more step-edit requirements and more stringent prior authorization criteria from payers. These barriers have slowed new patient starts, though Foster said they have not completely blocked access. The company reported its highest quarterly IBSRELA demand to date, including growth in refills, total prescriptions, total prescribers and prescriptions per prescriber.

To address access challenges, Ardelyx has doubled its field reimbursement team, with all added personnel in the field as of July 1. The company also expanded its sales organization to 144 representatives during the second quarter and is directing more prescriptions through the IBSRELA Pharmacy Network.

According to Foster, prescriptions processed through the pharmacy network have higher fulfillment rates, faster fills and an average of one additional refill per patient annually. Ardelyx also plans to expand direct-to-consumer activities in the second half, alongside its existing LPGA partnership and digital outreach efforts.

Management expects IBSRELA revenue to increase sequentially in the second half of 2026, with the fourth quarter expected to be the year’s highest-revenue quarter. Chief Financial Officer Sue Hohenleitner said the revised guidance incorporates the payer friction observed in the first half as well as the company’s planned access initiatives.

XPHOZAH Growth Continues, but Long-Term Target Withdrawn

XPHOZAH produced $31.9 million in second-quarter revenue, up 27% year over year. Ardelyx reiterated its 2026 XPHOZAH revenue guidance of $110 million to $120 million.

Foster said total XPHOZAH dispenses rose 33% year over year during the quarter, while paid prescriptions increased 25%. The product also reached its highest levels of total prescribers and prescriptions per prescriber since the first quarter of 2025.

Ardelyx said it will not pursue further litigation following the June 26 ruling by the U.S. Court of Appeals for the D.C. Circuit affirming dismissal of the company’s lawsuit against the Centers for Medicare & Medicaid Services. The decision leaves oral phosphate-lowering drugs in the dialysis payment bundle.

The company withdrew its prior $750 million XPHOZAH revenue target, saying it is reassessing market dynamics and growth assumptions amid uncertainty. Raab said the end of the TDAPA period this year, as well as a proposed phosphorus-related quality measure in the Medicare payment system, are among the factors Ardelyx is evaluating. The company also cited phosphate binders in development as part of the evolving market landscape.

Expenses Rise as Company Funds Commercial and Pipeline Investments

Research and development expense totaled $26.1 million in the second quarter, compared with $15.7 million a year earlier. Ardelyx attributed the increase primarily to development activities and patient enrollment costs for its ongoing ACCEL Phase 3 trial in chronic idiopathic constipation.

Selling, general and administrative expense increased to $101.4 million from $84 million in the prior-year period, reflecting investments intended to address IBSRELA access barriers and support future adoption.

Ardelyx reported a net loss of $16.7 million, narrowing from a $19.1 million loss in the second quarter of 2025. The latest quarter included $15.3 million in non-cash share-based compensation expense, compared with $11.7 million a year earlier.

The company ended the quarter with $281.8 million in cash equivalents and short-term investments. During the quarter, Ardelyx drew $50 million under its existing arrangement with SLR for general corporate purposes and strategic flexibility.

Profitability Expected in 2027

Ardelyx lowered its 2026 operating expense guidance to below $500 million after revising its IBSRELA outlook. Hohenleitner said the company remains on track to achieve sustainable profitability in 2027, as management expects revenue growth to outpace operating expense growth.

Raab said Ardelyx continues to advance tenapanor and a next-generation NHE3 inhibitor while evaluating business-development opportunities to expand its pipeline. He also pointed to the company’s patent portfolio, including its Orange Book-listed 299 patent, as part of its strategy to support tenapanor’s commercial runway.

“The demand for our medicines is evident,” Raab said. “We do understand the challenges that we are facing, and we’ve taken decisive action to address them.”

About Ardelyx (NASDAQ:ARDX)

Ardelyx, Inc NASDAQ: ARDX is a clinical‐stage biopharmaceutical company focused on discovering, developing and commercializing targeted small molecule drugs for cardio‐renal and gastrointestinal diseases. The company's lead marketed product, tenapanor (sold under the brand name XPHOZAH in the United States), is approved for the treatment of hyperphosphatemia in patients with chronic kidney disease on dialysis. Ardelyx's proprietary approach targets epithelial transporters in the gastrointestinal tract, offering localized activity with limited systemic exposure.

Beyond tenapanor, Ardelyx's development pipeline includes treatments designed to address other complications in kidney disease and related metabolic disorders.

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