What Ardelyx (ARDX) Said on Its Q3 Earnings Call

Key Points

• Third-quarter product revenue rose 19% year over year to $125.5 million, driven by IBSRELA, whose revenue increased 23% to $96.3 million. Ardelyx reaffirmed 2026 IBSRELA revenue guidance of $350 million to $370 million and cited a long-term potential to reach $1 billion annually.
• XPHOZAH revenue grew 7% to $29.2 million, while paid prescriptions increased 22%; Ardelyx maintained full-year revenue guidance of $110 million to $120 million. Management said reimbursement uncertainty remains and is waiting for greater clarity before setting a longer-term outlook.
• Ardelyx completed enrollment early in its Phase III ACCEL trial of tenapanor for chronic idiopathic constipation, with results expected in the second half of 2027. The company reported $285.3 million in cash and investments, expects 2026 operating expenses below $500 million, and continues to target profitability in 2027.

Ardelyx NASDAQ: ARDX reported third-quarter product revenue of $125.5 million, up 19% from the prior-year period, as growth in its IBS-C treatment IBSRELA offset more modest revenue growth for dialysis-focused drug XPHOZAH.

President and Chief Executive Officer Mike Raab said the company’s two first-in-class medicines generated more than $125 million in quarterly revenue and provide a foundation for longer-term growth. Ardelyx is prioritizing IBSRELA expansion, maintaining XPHOZAH momentum, advancing its pipeline and moving toward profitability, he said.

IBSRELA Drives Quarterly Growth

IBSRELA revenue rose 23% year over year to $96.3 million in the third quarter. Raab said demand reached all-time highs, supported by increases in total prescribers, prescriptions and market share.

The company reaffirmed its 2026 IBSRELA revenue guidance of $350 million to $370 million, which it said represents more than 30% annual growth at the midpoint. Ardelyx continues to view the product as having a long-term opportunity to reach $1 billion in annual revenue.

Management said it is working to reduce payer-related barriers that can delay patient access to IBSRELA. Initiatives include an expanded sales force, a doubling of the field reimbursement management team and efforts to move prescribers toward the IBSRELA Pharmacy Network. Raab said use of the network is associated with fulfillment rates that are two to three times higher, faster fill times and at least one additional refill per patient annually.

During the question-and-answer session, Raab declined to provide the percentage of prescriptions currently moving through the pharmacy network or specific metrics on prior-authorization approvals. He said the company is pursuing multiple approaches, including field reimbursement support, discussions with payers, and potential digital and artificial-intelligence tools, rather than relying on a single solution.

Ardelyx also launched its first direct-to-consumer IBSRELA advertisement on Sept. 1, targeting IBS-C patients through streaming platforms including Netflix, Hulu, Prime Video and Disney+. In testing, 91% of IBS-C patients said they would ask their physician whether IBSRELA was appropriate for them, according to Raab. The company has seen increased traffic to its consumer website but said it is still too early to determine whether the campaign is translating into new prescriptions.

Raab also pointed to real-world data presented at the American College of Gastroenterology Annual Scientific Meeting, which showed lower gastrointestinal-related healthcare resource utilization among patients receiving IBSRELA, primarily because of fewer physician visits and laboratory tests.

XPHOZAH Revenue Rises as Reimbursement Questions Persist

XPHOZAH generated third-quarter revenue of $29.2 million, a 7% increase from a year earlier. Paid prescriptions rose 22% from the same quarter of 2025, though Chief Financial Officer Sue Hohenleitner said customer buying patterns offset demand growth during the quarter.

The company maintained its full-year XPHOZAH revenue outlook of $110 million to $120 million. Raab said the dialysis reimbursement environment remains complex and that Ardelyx is taking a measured approach to ensure the drug remains a positive contributor.

Management highlighted real-world evidence presented at the American Society of Nephrology’s Kidney Week supporting XPHOZAH’s ability to consistently reduce serum phosphate. The company also presented findings on the difficulty of managing hyperphosphatemia and the health risks associated with cumulative phosphate burden.

Asked about a longer-term revenue target for XPHOZAH, Raab said Ardelyx would wait until the end of the TDAPA period for phosphate binders and until it has greater clarity on the following year’s reimbursement environment before providing an updated framework.

Pipeline Progress and Financial Position

Ardelyx said it completed enrollment ahead of schedule in its Phase III ACCEL trial evaluating tenapanor, the active ingredient in IBSRELA, for chronic idiopathic constipation, or CIC. The company expects to report top-line results in the second half of 2027.

Raab said CIC and IBS-C have substantially overlapping symptoms, while noting that the CIC trial is focused on a durable constipation response rather than the pain component associated with IBS-C. He said the company expects the most relevant eventual CIC candidates to be patients who have not responded adequately to over-the-counter products or existing prescription treatments.

Research and development expense increased to $25.2 million from $18.1 million a year earlier, primarily reflecting investment in the ACCEL trial. Selling, general and administrative expense increased to $93.9 million from $83.6 million, driven by the reimbursement-team expansion, sales-force optimization and the direct-to-consumer campaign.

Ardelyx reported a net loss of $700,000 for the quarter, compared with a $1 million net loss in the prior-year period. The quarter’s loss included $15.1 million of non-cash share-based compensation expense. The company ended the quarter with $285.3 million in cash, cash equivalents and short-term investments.

Hohenleitner said Ardelyx continues to expect full-year operating expenses below $500 million and believes it can reach profitability in 2027. She said the company’s gross profit margin exceeds 95%, which it expects will support operating-margin expansion as revenue grows.

For the third quarter, Hohenleitner said Ardelyx’s blended gross-to-net rate was 31.7%, compared with 30.6% a year earlier. She attributed the increase to normal business mix and inflation rebate penalties, adding that the company expects gross-to-net to remain in the low-to-mid-30% range.

About Ardelyx (NASDAQ:ARDX)

Ardelyx, Inc is a biopharmaceutical company focused on developing and commercializing therapies for gastrointestinal and cardiorenal diseases. The company's platform is centered on regulating ion transport in the gut, with the goal of addressing conditions that are inadequately served by existing treatments.

Ardelyx's marketed products include IBSRELA (tenapanor), an oral treatment for adults with irritable bowel syndrome with constipation, and XPHOZAH (tenapanor), a therapy designed to reduce serum phosphorus in adults with chronic kidney disease on dialysis who have an inadequate response to, or are intolerant of, phosphate binders.

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