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OI

OptiNose, Inc. (OPTN)·Q4 2024 Earnings Summary

Executive Summary

  • Q4 2024 net revenue was $22.4M, up 13% year over year; OptiNose delivered its first positive income from operations ($0.4M), while reporting a small net loss of $(0.36)M and diluted EPS of $(0.03). Note: the press release text references $(0.04) EPS, while the attached financials show $(0.03) EPS, indicating a minor discrepancy .
  • Prescriptions accelerated: NRx rose 12% sequentially (approx. 25.6K → 28.7K) and TRx rose 23% (approx. 63.9K → 78.5K), reflecting improving commercial execution and coverage pull-through .
  • FY2024 guidance was lowered in November to $75–$79M revenue and raised for average net revenue per Rx to ~$270; full-year results came in at $78.2M revenue, consistent with the range .
  • The Q4 earnings call was canceled following a definitive agreement for Paratek to acquire OptiNose for $9.00 in cash plus up to $5.00 in CVRs (potential total $14.00 per share), a ~50% premium—an immediate stock reaction catalyst and narrative shift toward integration and primary care expansion .

What Went Well and What Went Wrong

What Went Well

  • Prescription momentum: “An inflection in prescription demand first observed in September 2024 NRx continued in fourth quarter 2024 and extended to TRx,” with NRx +12% q/q to ~28.7K and TRx +23% q/q to ~78.5K .
  • First quarter of income from operations ($0.4M) amid tighter cost control and improving mix; FY net revenue grew 10% to $78.2M .
  • Management raised FY2024 average net revenue per Rx guidance to ~$270, citing improved business mix from co-pay program revisions and coverage enhancements (e.g., Express Scripts formulary wins) .

What Went Wrong

  • Guidance reset: FY2024 revenue guidance was cut to $75–$79M in November (from $85–$90M in August) as launch uptake in chronic sinusitis ramped more slowly than expected .
  • Going concern language: All outstanding principal and fees were classified as current liabilities, and FY2024 audited financials will include a “going concern” paragraph given expected covenant non-compliance absent waivers/modifications .
  • Q3 benefitted from ~<$3M inventory stocking, complicating sequential comparisons; 2025 full-year profitability commentary was removed pending better visibility on the ramp and trajectory .

Financial Results

P&L and EPS vs prior quarters

MetricQ2 2024Q3 2024Q4 2024
Revenue ($USD Millions)$20.5 $20.4 $22.4
Cost of Product Sales ($USD Millions)$1.981 $2.065 $1.954
Research & Development ($USD Millions)$0.928 $0.949 $0.772
Selling, General & Administrative ($USD Millions)$24.129 $19.475 $19.338
Income (Loss) from Operations ($USD Millions)$(6.548) $(2.052) $0.354
Net Income (Loss) ($USD Millions)$(7.581) $0.467 $(0.360)
Diluted EPS ($USD)$(0.07) $0.00 $(0.03)

Notes:

  • Press release narrative cited Q4 diluted EPS of $(0.04), while the financial table shows $(0.03); we anchor to the attached financials but flag the discrepancy .
  • Q3 net revenue was aided by channel inventory build of a little under $3M; average net revenue per Rx was $320 in Q3 vs $309 in Q2 .

Balance Sheet Snapshot

MetricQ2 2024Q3 2024Q4 2024
Cash & Cash Equivalents ($USD Millions)$91.4 $82.5 $84.5
Total Assets ($USD Millions)$131.9 $131.0 $128.8
Total Current Liabilities ($USD Millions)$32.7 (reclassified long-term at Q2) $162.4 $162.8
Stockholders’ Deficit ($USD Millions)$(42.9) $(41.1) $(40.4)

KPIs

KPIQ3 2024Q4 2024
New Prescriptions (NRx, approx.)~25,600 ~28,700
Total Prescriptions (TRx, approx.)~63,900 ~78,500
Avg Net Revenue per Rx ($)$320 FY2024 ~$270 guidance (quarterly not disclosed)

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
XHANCE Net RevenueFY2024$85–$90M (Aug) $75–$79M (Nov) Lowered
Avg Net Revenue per RxFY2024≥$250 (Aug) ~$270 (Nov) Raised
Total GAAP Operating ExpensesFY2024$95–$101M (Aug) $90–$93M (Nov) Lowered
Profitability OutlookFY2025Positive operating income targeted (earlier commentary) Removed to reevaluate (Nov) Withdrawn

Earnings Call Themes & Trends

TopicQ2 2024 (Aug)Q3 2024 (Nov)Q4 2024 (Mar)
Product performance / prescriptionsEarly launch in chronic sinusitis; foundation building; initial signals; H1 avg net revenue per Rx $269 Clear NRx inflection starting September; TRx building; avg net revenue per Rx $320 NRx +12% q/q; TRx +23% q/q
Insurance coverageExpress Scripts national formularies added (Tier 2) to >24M lives Pull-through efforts; reduced prior auth burden; training and tools for HCPs Continued emphasis; not elaborated; focus shifted to reporting
Distribution / HUB networkTransition to HUB; optimization expected; slight headwinds Added pharmacies to HUB; improved fulfillment; capacity scaling Not expanded; results reported
Guidance / trajectoryFY2024 revenue $85–$90M; OpEx $95–$101M; ≥$250 net rev/Rx FY2024 revenue $75–$79M; OpEx $90–$93M; ~ $270 net rev/Rx; Q3 inventory lift < $3M Call canceled post-M&A; results reported via 8-K/PR
Financing / covenantsCash runway through 2025; covenant targets outlined Reevaluating 2025 profitability guidance; cash sufficiency conditional on covenants/waivers Going concern disclosure; current classification of debt-related liabilities
Strategic initiativesSpecialty-focused launch; potential primary care partnership longer term Continued specialty focus; exploring primary care partnership and DTC initiatives Paratek acquisition to accelerate primary care reach

Management Commentary

  • CEO on Q4 preliminary: “Our preliminary unaudited fourth quarter net product revenue of $22.4 million is in line with our prior guidance and demonstrates a sustained growth in XHANCE prescriptions through the fourth quarter of 2024.” — Ramy Mahmoud .
  • CEO on Q3 inflection and peak potential: “We believe we are now observing a clear inflection in new prescription demand… we believe peak annual net revenue will exceed $300 million with our specialty-focused efforts…” — Ramy Mahmoud .
  • CFO on Q3 average net revenue per Rx: “In 2Q, it was $309. And yes, that’s correct, $320 in Q3.” — P. Terence Kohler .
  • CEO on payer policy updates: “We believe that at this point, most plans have updated their coverage to be inclusive of both approved indications.” — Ramy Mahmoud .

Q&A Highlights

  • Sequential Q4 guide context: Q3 revenue included < $3M of channel inventory; Q4 implied demand step-up but average net revenue per Rx seasonally lower, and refill lag expected in chronic disease .
  • Coverage inclusion for new indication: Most plans have updated; qualitative changes often occur within prior auth forms rather than headline coverage changes .
  • Profitability outlook: 2025 full-year profitability commentary withdrawn pending better visibility on the ramp; management cited uncertainty following positive demand inflection .
  • Revenue per Rx cadence: $309 (Q2) and $320 (Q3) with full-year ~ $270 guidance; Q2 uplift aided by change healthcare disruption mix; Q3 aided by inventory stocking .

Estimates Context

  • We attempted to retrieve S&P Global consensus for Q4 2024, but estimates were unavailable due to missing SPGI/CIQ mapping for OPTN. As a result, we cannot provide quantitative beat/miss vs Wall Street consensus for Q4 at this time [SpgiEstimatesError; GetEstimates attempt].
  • Directionally, Q4 revenue of $22.4M fell within the company’s implied Q4 revenue range (approx. $19–$23M) set in November guidance, but we cannot compare to analyst consensus without S&P Global data .

Key Takeaways for Investors

  • Commercial momentum improved: NRx and TRx accelerated in Q4, supporting revenue growth and the first positive operating income quarter; watch sustainability of demand and refill stacking into 2025 .
  • Mix and pricing dynamics: Average net revenue per Rx improved materially in 2024 on co-pay program changes and coverage; expect Q4 seasonality and inventory normalization effects to temper quarterly ARx metrics .
  • Balance sheet risk flagged: Going concern language related to covenant compliance and current classification of debt-related liabilities warrants close monitoring of waivers/modifications and liquidity runway .
  • Corporate catalyst: Paratek acquisition (up to $14/share total) shifts narrative to primary care expansion and integration; potential to accelerate adoption via broader field force reach .
  • Execution focus areas: Continued payer pull-through (ESI and beyond), HUB optimization, and prescriber education are critical to sustain the trajectory; management emphasized time and frequency of calls for behavior change .
  • Guidance reset executed prudently: Lowered FY2024 revenue, raised revenue per Rx, lowered OpEx—aligns with quality of revenue focus; subsequent results landed within revised ranges .
  • Near-term trading lens: Expect stock to be driven by M&A path, covenant developments, and prescription momentum data; acquisition premium provides downside support while closing risk and CVR milestones create event paths .

Appendix: Additional Q4 2024 Press Releases

  • Earnings call cancellation (March 19, 2025) due to Paratek transaction; results reported via press release/8-K .
  • Preliminary Q4 revenue (Jan 15, 2025) indicated $22.4M, consistent with final results and sequential prescription growth .