Phoebe Tan

Phoebe Tan inquired about any changes in payer preferences for INGREZZA given Oscedo XR's higher price, and how Neurocrine Biosciences plans to lock in INGREZZA's pricing through 2026 ahead of the IRA negotiated pricing announcement.

Answer

Eric Benevich, Chief Commercial Officer, noted that health plans are recognizing Teva's strategy to push higher doses of deuterated tetrabenazine, leading to higher costs. He observed instances where plans covered the BID formulation but not the XR, making them more willing to engage with Neurocrine. Benevich expects current formulary coverage to carry through 2026, aiming for parity. Matt Abernethy, Chief Financial Officer, reiterated the goal of offering clinicians choice.

Phoebe Tan inquired about INGREZZA, asking if there were any changes in payer preferences due to Oscedo XR's higher price and how Neurocrine Biosciences plans to lock in INGREZZA's pricing through 2026 ahead of upcoming IRA negotiated pricing.

Answer

Eric Benevich, Chief Commercial Officer, noted that health plans are recognizing Teva's strategy of pushing higher doses of deuterated tetrabenazine, leading to more willingness to engage with Neurocrine Biosciences. He expects current formulary coverage to carry through 2026. Matt Abernethy, Chief Financial Officer, added that the goal is parity in formulary perspective to give clinicians choice.

Phoebe Tan from Jefferies asked about Zymeworks' TOPO ADCs, questioning if the higher maximum tolerated doses seen preclinically compared to Enhertu could imply lower potency. She also requested information on the planned go-forward doses for ZW191 and ZW251.

Answer

Chief Scientific Officer Dr. Paul Moore addressed the potency question by stating that direct preclinical benchmarking shows their payload has a very comparable efficacy profile to deruxtecan (Enhertu's payload). While he could not specify go-forward clinical doses, he confirmed that the high preclinical tolerability allows for higher starting doses in patients, consistent with standard ADC development practices.

Phoebe Tan of Jefferies asked about the clinical utility of a cardiac myosin inhibitor that provides gradient relief without affecting LVEF, particularly in hypercontractile HCM patients.

Answer

Fady Malik, EVP of R&D, explained that hypercontractility (e.g., 80% LVEF) is abnormal and a key therapeutic target. He argued that reducing contractility to normal levels is crucial for favorable cardiac remodeling and that simply treating the obstruction without addressing hypercontractility is likely insufficient for long-term patient outcomes.