Neurocrine Biosciences NASDAQ: NBIX reported first-quarter 2026 results highlighted by record quarterly revenue and continued growth from its two commercial products, INGREZZA and CRENESSITY, while company executives also discussed pipeline progress and the expected closing timeline for its pending acquisition of Soleno Therapeutics.
Quarterly revenue surpasses $800 million as INGREZZA drives growth
Chief Executive Officer Kyle Gano said the company’s first-quarter performance reflected “meaningful progress” toward its goal of expanding and diversifying its revenue base. For the first time in company history, quarterly net product sales exceeded $800 million, representing 44% year-over-year growth, which Gano said was “primarily driven by INGREZZA.”
Chief Financial Officer Matthew Abernethy said Neurocrine delivered more than $800 million in total revenue, with “over 40% year-over-year growth.” INGREZZA first-quarter sales were $657 million, up 20% year-over-year, driven by “double-digit volume growth and record new patient additions,” he said. Abernethy added that when adjusting for one less order week in the prior-year quarter, growth was approximately 11%.
Neurocrine reaffirmed its full-year 2026 INGREZZA guidance of $2.7 billion to $2.8 billion. Abernethy said the company plans to revisit guidance after the first half of the year, consistent with its historical approach.
On the question of whether first-quarter results were boosted by inventory build or other one-offs, Gano told analysts there was “nothing material, nothing to note,” calling it “a really clean quarter reflecting very strong underlying demand.”
INGREZZA commercial update: continued penetration opportunity and payer dynamics
Chief Commercial Officer Eric Benevich noted May 1 marked the nine-year anniversary of the INGREZZA launch, adding that despite being nine years post-approval, the company “continue[s] to deliver record new patient starts.” Benevich attributed performance to commercial execution and “high unmet need” in tardive dyskinesia (TD), citing ongoing investments in sales force expansion, marketing initiatives including direct-to-consumer efforts, and improved formulary access.
Benevich also emphasized remaining market opportunity, saying approximately 90% of an estimated 800,000 TD patients in the U.S. are “currently not receiving standard of care first-line treatment with a VMAT2 inhibitor like INGREZZA.” He said Neurocrine expects continued growth in antipsychotic utilization to increase TD prevalence over time, and with an expanded sales force, the company anticipates “tailwinds to support strong demand in sales through the back half of the year.”
In response to a question about whether consensus recommendations on TD screening in long-term care could expand treatment, Benevich said increased routine screening across care settings, including long-term care, “is going to help,” adding that screening criteria and consensus guidance may raise awareness in nursing homes.
On payer coverage, Gano said INGREZZA coverage in 2026 is “very similar to where we exited 2025.” He said Neurocrine has “about 70% of all TD and HD Medicare beneficiary lives covered for INGREZZA,” and added he would not expect “any wide changes” in reimbursement this year.
Regarding seasonality, Benevich said Neurocrine typically experiences “seasonal payer disruption in Q1,” driven by Medicare reauthorizations and commercial copay resets, and said the company has now “moved through that phase of the year.” He pointed to the expanded field sales team, which became effective in early Q2, as a factor expected to provide “tangible lift” later in the year.
CRENESSITY launch: steady new patient adds, strong persistence, and favorable reimbursement
CRENESSITY first-quarter 2026 sales were $153 million, Abernethy said, driven by “strong persistency and consistent new patient enrollment forms compared to Q4.” He said the company continues to see “broad prescriber adoption and favorable reimbursement dynamics,” while noting “slight gross to net pressure” in the quarter due to commercial copay resets.
Benevich described CRENESSITY’s launch momentum as carrying over from 2025, with “steady new patient starts, high persistency and compliance rates, and favorable reimbursement,” consistent with trends observed in the fourth quarter of 2025. He said that through the first quarter, more than 1,200 healthcare providers had prescribed CRENESSITY, with adoption balanced across pediatric and adult patients and across female and male patients, though with a “modest ongoing skew towards pediatrics and females.”
Asked how the launch is progressing relative to internal expectations, Benevich said the company is “ahead of where we expected to be at this point,” about five quarters into launch. However, he emphasized that “most physicians that have prescribed CRENESSITY have only treated one patient thus far,” and that “the majority of patients have yet to be treated,” suggesting what he described as “substantial opportunity ahead.”
Executives also discussed payer and reauthorization dynamics for CRENESSITY. Benevich said the classic CAH population is “primarily commercially insured” with Medicaid as the second-largest segment, and that Neurocrine does not see a Q1 surge in reauthorizations as it does with INGREZZA because of low Medicare exposure. He added the company has seen a “high rate of reauthorization approvals,” similar to initial approvals.
On discontinuations, Benevich said the discontinuation rate has been low. He said the company has not seen patients discontinuing due to insurance reasons and noted that out-of-pocket costs are “less than $10 per patient per month,” with many patients paying nothing. He cited occasional instances of patients moving or being lost to follow-up.
When asked about seasonality for CRENESSITY, Benevich said it is still early to define normal seasonality, and he suggested CRENESSITY does not show the same type of seasonality seen in INGREZZA. Abernethy added that the flow of patients tends to be consistent given the constrained prescriber universe.
Two-year CRENESSITY data and additional clinical evidence presented
Chief Medical Officer Sanjay Keswani highlighted presentations at the American Association of Clinical Endocrinology 2026 annual meeting, where Neurocrine shared two-year data from the CRENESSITY Phase III CAHtalyst adult study. Keswani said the study showed “sustained and substantial reductions” in glucocorticoid (GC) doses in adults with classic congenital adrenal hyperplasia (CAH).
Keswani reported that approximately 70% of patients achieved GC doses within the physiological range without compromising androgen control, and a similar proportion achieved normal androgen levels. He said the two-year findings demonstrated durable androgen control and meaningful reductions in GC exposure, with positive impacts on bone health and bone aging, hirsutism, acne, weight, and insulin resistance. He noted greater than 80% study retention and said no new safety or tolerability signals were observed.
Keswani said Neurocrine plans to provide additional two-year data across more clinical endpoints at upcoming meetings, including ENDO 2026 in June. Benevich added that the company views ENDO as an opportunity to engage the broader endocrinology community, pointing to strong interest observed at recent endocrinology meetings, including the Pediatric Endocrine Society meeting.
Separately, Keswani highlighted a presentation at the Academy of Managed Care Pharmacy 2026 annual meeting featuring real-world head-to-head claims data comparing INGREZZA to deuterated tetrabenazine. He said the data showed greater treatment persistence with INGREZZA capsules, including higher long-term continuation and lower switching rates during a six-month follow-up period.
Pipeline updates, upcoming readouts, and Soleno acquisition timeline
Gano said Neurocrine is continuing to invest across neurology, psychiatry, endocrinology, and immunology, and plans “6 new phase I and phase II programs this year alone.” He also pointed to expected 2027 data readouts for osavampator in major depressive disorder, direclidine in schizophrenia, and NBIP-2118 in obesity.
Keswani said the company has Phase II studies currently enrolling, including NBI-890 (a next-generation VMAT2 follow-on in TD), direclidine (a selective M4 muscarinic agonist in bipolar mania), and NBI-570 (a selective dual M1/M4 muscarinic agonist in schizophrenia). He said a Phase II study for crinecerfont in classic CAH patients under age 4 is “on track for initiation in the coming months.” Neurocrine also has nine Phase I programs underway, including NBIP-2118, with top-line data expected in 2027, and plans to initiate four additional Phase I studies in 2026, including a triple G agonist program and a gene therapy program for Friedreich’s ataxia.
On the Friedreich’s ataxia gene therapy program, Gano said Neurocrine plans to start the trial shortly and expects to share patient-level data toward the end of next year, describing it as a Phase Ib trial that will begin in the patient population.
Abernethy said first-quarter net income was around $200 million on both a GAAP and non-GAAP basis. He noted GAAP results included gains related to equity investments and the sale of the Diurnal business, while non-GAAP results included $44 million in milestone expense into IPR&D. He also said Neurocrine expects its non-GAAP effective tax rate to be between 22% and 24% in 2026 and “within the low 20s going forward.”
Regarding the pending acquisition of Soleno Therapeutics and the addition of VYKAT XR, Gano and Abernethy said they would be limited in their ability to comment due to the ongoing tender offer. Gano said the acquisition remains on track to close in the second quarter and praised Soleno’s work on clinical results and launch execution. Abernethy said the company is not providing financial guidance related to the transaction and expects to provide additional financial details on the second-quarter earnings call, assuming a second-quarter close.
About Neurocrine Biosciences NASDAQ: NBIX
Neurocrine Biosciences NASDAQ: NBIX is a biopharmaceutical company based in San Diego, California, focused on developing treatments for neurological, endocrine and neuropsychiatric disorders. Since its founding in 1992, the company has pursued a research‐driven strategy aimed at addressing unmet medical needs in movement disorders, reproductive health and central nervous system conditions. Neurocrine's operations encompass drug discovery, clinical development and commercialization activities.
The company's lead marketed product, Ingrezza™ (valbenazine), is indicated for the treatment of tardive dyskinesia, a movement disorder associated with long-term antipsychotic use.
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