Neurocrine Biosciences Q3 Earnings Call Highlights

Key Points

• Record Q3 performance: Neurocrine reported more than $1.1 billion in net product sales and record operating profitability, led by INGREZZA sales of $801 million, up 17% year over year. The company raised full-year INGREZZA guidance to $2.9 billion-$2.925 billion.
• Portfolio expansion: CRENESSITY surpassed $200 million in quarterly sales for the first time, while VYKAT XR reached $107 million despite potential delays to its growth trajectory. Neurocrine is also studying expanded uses for both medicines.
• Pipeline and financial strength: Neurocrine is preparing for multiple 2027 clinical milestones, including phase III data for direclidine and osavampator, while advancing programs in Alzheimer’s disease, obesity and Friedreich’s ataxia. The company ended the quarter with about $800 million in cash and generated $400 million in operating cash flow.

Neurocrine Biosciences NASDAQ: NBIX reported record third-quarter net product sales exceeding $1.1 billion and record operating profitability, supported by growth across its three marketed medicines: INGREZZA, CRENESSITY and VYKAT XR.

Chief Executive Officer Kyle Gano said the company’s commercial performance and financial position are enabling continued investment in its pipeline, with several clinical milestones expected in 2027. Those include phase III data readouts for osavampator in major depressive disorder and direclidine in schizophrenia.

“The third quarter reflects Neurocrine’s continued evolution into a diversified, highly profitable biopharmaceutical company,” Chief Financial Officer Matt Abernethy said.

INGREZZA Sales Lead Commercial Growth

INGREZZA, the company’s treatment for tardive dyskinesia, generated third-quarter sales of $801 million, up 17% from a year earlier. The company attributed the growth to continued volume gains and record new and total prescriptions.

Abernethy said the quarter included a $20 million benefit from customer order timing that is expected to reverse in the fourth quarter and has been incorporated into the company’s full-year outlook. Neurocrine raised its full-year INGREZZA sales guidance to a range of $2.9 billion to $2.925 billion.

The company expects INGREZZA prescription growth to be in the high teens during 2026. For 2027, Neurocrine expects double-digit volume growth to offset anticipated mid- to high-single-digit net pricing headwinds, supporting another year of revenue growth. Formal 2027 guidance is expected in February.

Gano said Neurocrine expects 2027 coverage and access for INGREZZA to be at least as strong as in 2026. The company said roughly 70% of Medicare lives were covered under contracts executed in 2025.

Chief Commercial Officer Eric Benevich said the company sees growth opportunities across psychiatry, neurology and long-term care. He said psychiatry remains the primary growth driver, while long-term care has also delivered consistent growth. Neurocrine said about half of patients with tardive dyskinesia have now been diagnosed, while only about 10% of the total prevalent population is being treated with either of the two available VMAT2 inhibitors.

The company also said its expanded INGREZZA sales force is expected to have a greater impact in the fourth quarter and into 2027, noting that sales-force expansions historically take several quarters to show their full effect.

CRENESSITY and VYKAT XR Reach Sales Milestones

CRENESSITY generated $211 million in third-quarter sales, exceeding $200 million in quarterly sales for the first time. Neurocrine said more than 15% of the estimated diagnosed U.S. population with classic congenital adrenal hyperplasia, or CAH, has now been prescribed the treatment.

Benevich cited steady patient additions, favorable reimbursement and strong persistence as key contributors to CRENESSITY’s performance. He said roughly half of patients on treatment are adults, with prescribing continuing to expand in adult endocrinology practices. Most prescribers still have only one or two patients on the medicine, according to the company.

Neurocrine recently initiated a study of CRENESSITY in patients younger than age four. Chief Medical Officer Eiry Roberts said the company believes earlier treatment could help address the need for high steroid dosing in younger patients and potentially support an expanded label.

VYKAT XR generated $107 million in third-quarter sales, reflecting sequential growth driven by new patient demand. The medicine is approved for hyperphagia in patients age four and older with Prader-Willi syndrome, or PWS.

Neurocrine estimated there are approximately 10,000 to 12,000 patients with PWS in the U.S., with the majority experiencing hyperphagia. Benevich said the company continues to see substantial long-term opportunity, but acknowledged that recent external events may delay the anticipated growth trajectory.

Management said it is focused on physician, caregiver and patient education related to patient selection, dose titration, monitoring and management of potential adverse events. Roberts said Neurocrine remains confident in VYKAT XR’s benefit-risk profile and believes its existing label provides effective guidance for safe use in the relevant population.

The company plans to initiate a study in 2027 evaluating VYKAT XR in people with PWS who also have complex health issues. Roberts said the study was proposed by Neurocrine in collaboration with key opinion leaders and is intended to broaden understanding of how to use the medicine in patients beyond those represented in the registration studies. The company said the average current dose is about 250 milligrams per patient, representing an annual wholesale acquisition cost of roughly $550,000.

Pipeline Activity and 2027 Catalysts

Neurocrine said it is preparing for a data-rich 2027 while continuing to broaden its development pipeline.

• The company initiated a phase II study of NBI-’567, an M1-preferring selective muscarinic agonist, as an adjunctive treatment for cognition in Alzheimer’s disease. The study includes approximately 135 adults ages 50 to 85 with mild to moderate Alzheimer’s disease.
• A phase I study was initiated for NBIP-’1968, an investigational triple G agonist for obesity. Neurocrine is also studying its CRF2 agonist, NBIP-’2118, in phase I and said it may explore combinations of the two approaches.
• NBIB-’223, a Friedreich’s ataxia gene therapy being developed with Voyager Therapeutics, is expected to enter phase I in the coming months, with initial patient-level data anticipated in 2027.
• Top-line data from the first short-term phase III study of direclidine in schizophrenia are expected next year. The company said it is focused on the drug’s potential safety, tolerability and convenience profile, including once-daily administration without titration.

Roberts also said Neurocrine discontinued development of NBI-’986, an M4 antagonist evaluated for movement disorders, after reviewing phase I pharmacodynamic, pharmacokinetic and tolerability data. She said the decision was a portfolio-prioritization action and was not driven by a specific safety issue.

Cash Flow, Capital Allocation and R&D Day

Neurocrine ended the third quarter with approximately $800 million in cash. The company generated $400 million in operating cash flow and used approximately $100 million for share repurchases intended to offset dilution from share-based compensation.

Abernethy said capital-allocation priorities remain commercial investment, advancement of high-value pipeline programs and disciplined business development. Chief Business Officer Samir Siddhanti said the company is focused on opportunities involving differentiated science and strong intellectual property in neurology, psychiatry, endocrinology and immunology, but does not believe it needs to complete a transaction immediately.

Neurocrine plans to host its 2026 R&D Day in New York City on Dec. 15, featuring a discussion of VYKAT XR and an update on the company’s pipeline. Gano said the company remains on track to deliver six phase I studies and initiate five new phase II studies during 2026.

About Neurocrine Biosciences (NASDAQ:NBIX)

Neurocrine Biosciences, Inc is a San Diego-based biopharmaceutical company focused on discovering, developing and commercializing medicines for neurological, neuroendocrine and psychiatric disorders. The company's research programs target conditions in which treatments may address significant unmet medical needs.

Neurocrine's leading product is INGREZZA (valbenazine), a vesicular monoamine transporter 2 inhibitor approved in the United States for the treatment of tardive dyskinesia and chorea associated with Huntington's disease.

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