MADRIGAL PHARMACEUTICALS, INC. (MDGL)·Q4 2024 Earnings Summary

Executive Summary

• Q4 2024 net revenue was $103.3M, up 66% quarter-over-quarter from $62.2M in Q3 2024, driven by strong Rezdiffra adoption, expanding prescriber penetration, and broad payer coverage .
• More than 11,800 patients were actively on Rezdiffra by year-end; management highlighted momentum into 2025 and expects robust year-over-year net sales growth with gross-to-net discounts increasing as the launch matures .
• New two-year MAESTRO-NAFLD-1 open-label F4c data showed a mean 6.7 kPa reduction in liver stiffness and 51% of patients achieving ≥25% reduction, reinforcing confidence in the fully enrolled MAESTRO-NASH OUTCOMES trial (data anticipated in 2027) .
• No formal 2025 financial guidance was provided; management indicated consensus could tighten and move higher based on early Q1 2025 trends and reiterated plans for a targeted Europe launch beginning with Germany in H2 2025, pending approval .

What Went Well and What Went Wrong

What Went Well

• “We generated $103 million in net sales in the fourth quarter of 2024, reflecting 66% quarter-over-quarter growth… Our launch trajectory continues to track in line with some of the most successful specialty medicine launches in the past decade.” — CEO Bill Sibold .
• Prescriber penetration improved: ~60% of top 6,000 targets wrote Rezdiffra in Q4 (up from ~40% in Q3), and ~40% of the broader 14,000 target base wrote prescriptions; >75% of scripts came from top targets .
• Two-year F4c VCTE results showed a mean 6.7 kPa reduction and 51% achieving ≥25% reduction, supporting confidence in outcomes data and potential indication expansion to F4c MASH .

What Went Wrong

• Operating expenses scaled materially with commercialization: Q4 SG&A rose to $141.2M (from $107.6M in Q3), reflecting launch activities and headcount expansion; net loss remained high at $(59.4)M for Q4 .
• Gross-to-net discount expected to increase in 2025 due to normal early-launch dynamics and Medicare Part D redesign, potentially tempering net revenue conversion despite strong demand .
• No formal 2025 guidance; while management tone was positive, the lack of explicit targets may limit near-term visibility for investors tracking the trajectory versus consensus .

Financial Results

Quarterly P&L and Key Line Items

Year-over-Year Q4 Comparison

Margins (Document-derived calculations)

Note: Margins are calculated from cited revenue and loss from operations/net loss figures in the company’s press releases/8-K exhibits.

KPIs

Segment Breakdown

• Single-product commercial stage; no reported segment revenue allocations .

Guidance Changes

Earnings Call Themes & Trends

Management Commentary

• “We generated $103 million in net sales in the fourth quarter of 2024, reflecting 66% quarter-over-quarter growth… Our launch trajectory continues to track in line with some of the most successful specialty medicine launches in the past decade.” — CEO Bill Sibold .
• “We ended 2024 with $931.3 million in cash… well resourced to support the ongoing launch of Rezdiffra in both the U.S. and our planned launch in Europe.” — CFO Mardi Dier .
• “Patients achieved a mean 6.7 kPa reduction… the largest mean reduction reported in an F4c MASH patient population to date… 51% achieved ≥25% reduction.” — Management summary of F4c cohort .
• “We are expanding geographically… plan to take a targeted country-by-country approach… beginning with Germany in the second half of the year [2025].” — CEO Bill Sibold .

Q&A Highlights

• Launch cadence and 2025 momentum: Management sees steady patient adds in Q1, typical Q1 dynamics, and believes Q1 2025 consensus will narrow upward based on early trends .
• Clinical meaningfulness of 6.7 kPa reduction: Baseline ~25 kPa; reductions ≥5 kPa or ≥25% are predictive of fewer liver-related events and potential one-stage fibrosis improvement; supports optimism for outcomes trial .
• Guidance stance: No formal guidance; commentary points to robust YoY growth and consensus narrowing upward for 2025 .
• Payer/Gross-to-net and Part D: GTN expected higher in 2025; Medicare Part D redesign impact is incremental given 2024 rebates; ~1/3 of patients are Medicare .
• Competitive landscape & GLP-1s: ~25% of Rezdiffra patients already on GLP-1s; combination seen as market-expanding with Rezdiffra’s liver-directed profile supporting continued leadership .

Estimates Context

• S&P Global consensus estimates were unavailable at time of query due to system limits. Therefore, comparisons to Wall Street consensus could not be provided and should be treated as unavailable via S&P Global at this time.
• Management indicated expectations for Q1 2025 and FY 2025 consensus to narrow and move higher based on observed momentum, but provided no numeric guidance .

Key Takeaways for Investors

• Demand ramp is strong and broad-based: Q4 net sales of $103.3M with prescriber penetration increasing and access infrastructure largely in place; expect continued growth despite GTN headwinds typical of early launches .
• Clinical expansion potential: Two-year F4c VCTE data meaningfully de-risk outcomes; 2027 MAESTRO-NASH OUTCOMES readout is a major medium-term catalyst .
• Europe strategy: Country-by-country launch beginning H2 2025 (pending approval) with disciplined pricing/value positioning, offering additional geographic upside .
• Operating leverage path: SG&A elevated as expected for commercialization; R&D to trend modestly higher in 2025; watch for improving operating loss as revenues scale .
• Near-term trading implications: Limited formal guidance may cap visibility; monitor monthly prescription trends, payer policy stability post-Part D redesign, and competitor entries (GLP-1) as potential sentiment drivers .
• Narrative drivers: First-in-disease positioning, outcomes confidence, and international expansion remain the core bull points; GTN normalization and expense scaling are the main watch items .
• Cash runway: ~$931M cash supports commercialization and European launch prep without near-term financing needs, reducing execution risk .