NASDAQ:CRMD CorMedix Q4 2024 Earnings Report $7.67 +0.15 (+1.99%) Closing price 04/17/2025 04:00 PM EasternExtended Trading$7.69 +0.02 (+0.26%) As of 04/17/2025 06:11 PM Eastern Extended trading is trading that happens on electronic markets outside of regular trading hours. This is a fair market value extended hours price provided by Polygon.io. Learn more. Earnings HistoryForecast CorMedix EPS ResultsActual EPS$0.22Consensus EPS $0.17Beat/MissBeat by +$0.05One Year Ago EPSN/ACorMedix Revenue ResultsActual Revenue$30.00 millionExpected Revenue$27.46 millionBeat/MissBeat by +$2.54 millionYoY Revenue Growth+29,900.00%CorMedix Announcement DetailsQuarterQ4 2024Date3/25/2025TimeBefore Market OpensConference Call DateTuesday, March 25, 2025Conference Call Time8:30AM ETUpcoming EarningsCorMedix's Q1 2025 earnings is scheduled for Thursday, May 8, 2025, with a conference call scheduled at 8:30 AM ET. Check back for transcripts, audio, and key financial metrics as they become available.Q1 2025 Earnings ReportConference Call ResourcesConference Call AudioConference Call TranscriptPress Release (8-K)Annual Report (10-K)Earnings HistoryCompany ProfilePowered by CorMedix Q4 2024 Earnings Call TranscriptProvided by QuartrMarch 25, 2025 ShareLink copied to clipboard.There are 11 speakers on the call. Operator00:00:00Good day, and welcome to the CorMedix, Inc. Fourth Quarter and Full Year twenty twenty four Financial Results Conference Call. All participants will be in listen only mode. After today's presentation, there will be an opportunity to ask questions. Please note, today's event is being recorded. Operator00:00:28I would now like to turn the conference over to Dan Ferry with LifeSci Advisors. Please go ahead. Speaker 100:00:34Good morning, and welcome to the CorMedix fourth quarter and full year twenty twenty four earnings conference call. Leading the call today is Joe Tedisco, Chief Executive Officer of CorMedix, and he is joined by Doctor. Matt David, Executive Vice President and CFO Beth Zelnick Kaufman, EVP and Chief Legal and Compliance Officer Liz Hurlburt, EVP and Chief Clinical Strategy and Operations Officer and Aaron Mistry, EVP and Chief Commercial Officer. Before we begin, I would like to remind everyone that during the call, management may make what are known as forward looking statements within the meaning set forth in the Private Securities Litigation Reform Act of 1995. These statements are statements other than statements of historical fact regarding management's expectations, beliefs, goals and plans about the company's prospects and future financial position. Speaker 100:01:33Actual results may differ materially from the estimates and projections on which these statements are based due to a variety of important factors, including the risks and uncertainties described in greater detail in CorMedix's filings with the SEC, which are available free of charge at the SEC's website or upon request from CorMedix. CorMedix may not actually achieve the goals or plans described in these forward looking statements. Investors should not place undue reliance on these statements. CorMedix does not intend to update these forward looking statements except as required by law. During this call, the company will discuss certain non GAAP measures of its performance. Speaker 100:02:14GAAP to non GAAP financial reconciliations and supplemental financial information are provided in CorMedix's earnings release and the current report on Form eight K filed with the SEC. This information is available on the Investor Relations section of the CorMedix website. At this time, it is now my pleasure to turn the call over to Joe Tedisco, Chief Executive Officer of CorMedix. Joe, please go ahead. Speaker 200:02:41Thank you, Dan. Good morning, everyone, and thank you for joining us on this call. Having completed our initial partial year of commercial launch of DefenCath, I'm incredibly proud of the team's efforts and pleased with the commercial results thus far. The fourth quarter saw continued growth with both existing as well as new customers in the outpatient segment, which was the primary driver of our strong revenue and profit results for both Q4 and full year 2024. Net revenue for the fourth quarter and full year were $31,200,000 and $43,500,000 respectively, both of which exceeded Wall Street consensus prior to our preannouncement on January 7. Speaker 200:03:24The fourth quarter was also the first profitable commercial quarter in the company's history with net income of $13,500,000 and adjusted EBITDA of $15,300,000 Fourth quarter results were driven by strong uptake amongst patients at U. S. Renal Care, ramping implementation at our mid sized customers, IRC and DCI, as well as utilization by other small outpatient dialysis customers. As we announced back in early January, we began the first quarter of twenty twenty five with more than $25,000,000 of purchase orders in hand from existing customers for first quarter delivery. While we are not going to provide full year revenue guidance at this time, we currently estimate that net revenue from existing purchasing customers for the first six months of twenty twenty five should be in the range of $50,000,000 to $60,000,000 with more than $33,000,000 expected in the first quarter. Speaker 200:04:20DefenCath's net selling price has been fairly stable throughout the first three quarters of outpatient commercialization. However, we do expect to begin to see some net price erosion beginning in the second quarter of twenty twenty five. With respect to patient growth opportunities, there is still some potential for new patients with existing outpatient customers. However, to a large extent, our ability to grow patient volume significantly in the back part of 2025 will be contingent upon the timing of purchasing and scale of implementation by our contracted large dialysis organization customer. Prior to year end, we met with our contracted LDO customer who communicated to CorMedix that the Fenkata implementation was pushed into 2025 due to operational resource constraints. Speaker 200:05:08Over the course of February and early March, we've had multiple meetings with this customer, provided significant requested information around resources available at CorMedix to assist with training and the implementation of DefenCaf, and we remain hopeful the customer will begin ordering and commence utilization prior to mid year. Turning to the inpatient segment, we have started to see utilization increase at a handful of larger hospitals, and we are hopeful to increase penetration as we move throughout 2025. Back in January, we announced a change to our inpatient commercialization strategy, whereby we reorganized our field team covering outpatient and inpatient customers. This process is now complete as we are partnering with Syneos Health to build a dedicated inpatient field team that is highly experienced in the hospital formulary process and the launch of first in class products in the setting of care. We also recently announced a partnership with WSI to provide marketing and promotional resources for DefenCath specifically to facilities operated by the Veterans Administration. Speaker 200:06:11I am happy to announce that the new inpatient team is nearly fully staffed and is expected to be active in the field in the next four to five weeks. The team contracted through WSI has already commenced promotional activities to VA facilities. While we do not currently report inpatient sales as a separate segment, we do expect to see meaningful growth in this setting of care by the end of twenty twenty five with an increased contribution to overall revenue and earnings in 2026 and beyond. Focusing now on our clinical developments, we are in the process of beginning our Phase III clinical study for the reduction of central line associated bloodstream infections or CLABSIs in patients receiving total parenteral nutrition or TPN through a central venous catheter. We began site selection in February and expect to begin patient enrollment for the study in the second quarter of this year. Speaker 200:07:07As we communicated previously, this is a twelve month study in less than 150 patients, and we are targeting completion of the study and submission of a new drug application to FDA by the end of twenty twenty six. We recently submitted to FDA an application for orphan drug status for this indication and are awaiting FDA's determination of eligibility. The company's goal for TPN is to obtain FDA approval for an expanded use of our tirodine and heparin catheter lock solution in the late twenty twenty seven to early twenty twenty eight timeframe, and we estimate annual peak sales potential in this indication to be in the range of $150,000,000 to $200,000,000 We'll provide investors with updates on progress in this important area of unmet need as we move forward. During our previous earnings call, we also discussed three additional clinical initiatives, all having either commenced in 2024 or expected to begin in 2025. The most meaningful of the three from a data value standpoint is our real world evidence study, which we are running in cooperation with our study partner, U. Speaker 200:08:14S. Renal Care. Our hope with this study, in which we expect to evaluate outcomes of more than 2,000 patients over twenty four months, would be to generate real world evidence around the impact of DefenCath utilization on cost of patient care, infection rates, hospitalizations, mortality and multiple other metrics such as lost chair time and CRBSI related antibiotic use. Data collection for this study has already commenced. In addition to our adult TPN and real world evidence studies, we will also be commencing a study in pediatric hemodialysis in 2025. Speaker 200:08:50This will be a relatively small study spread over several years as we expect patient enrollment to be a challenge given an extremely small patient population and the need for very personalized protocols for these ultra vulnerable patients. This pediatric study is a post marketing requirement under the Pediatric Research Equity Act by the FDA, and we have FDA's concurrence on the final study protocol. We currently expect patient enrollment to begin in the third quarter of twenty twenty five, and we expect this study to span three to five years. Lastly, in addition to our other clinical initiatives, we have commenced an expanded access program for high risk populations, including but not limited to pediatric TPN, peritoneal dialysis patients with refractory peritonitis and neutropenic oncology patients utilizing a CVC. These high risk patients are those that have exhausted other infection prevention methods and unfortunately remain at significant risk for comorbidities and mortality. Speaker 200:09:53We are fielding a high number of requests for participation in this expanded access program and currently expect patients to be dosed under this program in the second quarter of this year. I would now like to turn the call over to Matt to discuss the company's fourth quarter and full year financial results and financial position. Matt? Thanks, Joe, and good morning, everyone. Speaker 300:10:15I am pleased to be here today to provide an overview of our fourth quarter and full year twenty twenty four financial results as well as an update on CorMedix's cash position. The company has filed its annual report on Form 10 ks for the year ended 12/31/2024. I urge you to read the information contained in the report for a more complete discussion of our financial results. With respect to our fourth quarter of twenty twenty four financial results, our net revenue for the fourth quarter of twenty twenty four amounted to $31,200,000 CorMedix achieved profitability in the fourth quarter as our net income was $13,500,000 or $0.22 per share compared with a net loss of $14,800,000 or $0.26 per share in the fourth quarter of twenty twenty three. The net income recognized in 2024 was driven by the profits associated with net sales of the Fencap following the product's launch in 2024. Speaker 300:11:16Operating expenses in the fourth quarter of twenty twenty four increased 9% to $17,100,000 compared with $15,700,000 in the fourth quarter of twenty twenty three. The increase was driven by higher selling and marketing and G and A expenses, offset by a decrease in R and D. R and D expense decreased by 26% to $1,700,000 driven by the approval of the FenCath. CorMedix is now reporting selling and marketing expense and general and administrative expense as separate line items. On an apples to apples basis, S and M expense increased 1% to $8,300,000 in the fourth quarter of twenty twenty four compared with $8,200,000 in the fourth quarter of 'twenty three. Speaker 300:12:02G and A expense increased 36% to $7,100,000 in the fourth quarter of twenty twenty four versus $5,200,000 in the fourth quarter of twenty twenty three. The increase in S and M expense was attributable primarily to increased marketing efforts and new personnel inclusive of our field sales organization and support for the commercial launch of DefenCath. The increase in G and A expense was primarily due to increases in personnel costs in preparation for support activities related to our commercial launch. With respect to our full year 2024 financial results, total net revenue during 2024 amounted to $43,500,000 dollars This marks the first full year CorMedix is reporting net revenue since launching DefendCath in spring summer of twenty twenty four. Total operating expenses during the full year 2024 amounted to $62,600,000 compared with $49,000,000 in 2023, an increase of 28. Speaker 300:13:05R and D expense decreased 70% to $3,900,000 driven primarily by the approval of DefendCAF. Selling and marketing expense increased 59% to $28,700,000 compared with full year 2023 and G and A expense increased 69 to $30,000,000 compared with 2023. The increases in S and M and G and A were driven primarily by new personnel and cost to support the commercial launch of DefendCap. We recorded net cash used in operations during 2024 of $50,600,000 compared with net cash used in operations of $38,400,000 in 2023. The increase is primarily driven by an increase in trade receivables and inventories offset by a net increase in the change of accrued expenses and accounts payable and a decreased net loss. Speaker 300:14:00The company has cash and cash equivalents of $51,700,000 as of 12/31/2024. Based on accounts receivable collection throughout first quarter of twenty twenty five and to a lesser extent proceeds from ATM issuance, we anticipate completing first quarter of twenty twenty five with at least $75,000,000 in cash and cash equivalents. As described in our January 7 release, we are guiding to 2025 cash operating expenses of approximately $72,000,000 to $78,000,000 The increase over 2024 spending levels is expected to be primarily driven by an increase in R and D spending on clinical initiatives. I will now turn the call back over to Joe for closing remarks. Joe? Speaker 200:14:48Thanks, Matt. CorMedix is working diligently on all fronts to increase our existing customer base as well as expand the use of Defencast to new therapeutic indications. I appreciate everyone's continued support in CorMedix, and I'm happy to take questions. Operator00:15:03Thank you. We will now begin the question and answer session. And today's first question comes from Rowanna Ruiz with Leerink Partners. Please go ahead. Speaker 400:15:33Hey, good morning everybody. So I did have a question about the Syneos Health partnership and your build out of the inpatient sales team. What are your first steps for this team once they're fully launched? And do you have any color on what the ramp might look like in the inpatient setting for defend cath over time? Speaker 200:15:52Well, look, let me I'll comment on the inpatient kind of ramp and then I'll let Aaron and Liz comment a little bit on the team and its deployment. So obviously, we were a little bit slow at the gate on the inpatient side last year. That's not unusual for this setting of care for these types of launches. It takes quite a while to work through P and T processes. I am pleased with what we've seen in the first quarter. Speaker 200:16:17I know we as I said, we don't report anything from a separate segment standpoint on the inpatient side. But right now for the first quarter, inpatient is looking to be about 3% of unit volume and 4% to 5% of dollars. So I feel pretty good about that trend. Inpatient as a total is ten percent of the unit volume of the overall market opportunity. So if we can move toward there, right, as we get into 2026, I think that's certainly a target that we'd like to try to achieve. Speaker 200:16:52We're in the process of just finally completing the staffing of the last two to three roles, right, to fill out the team completely. Training is near complete and we hope to have them out in the field in the next four to five weeks. But Erin, do you want to comment anything beyond that? Speaker 500:17:15Sure. I think that just what we plan for them to do right out of the gate is to focus on the large academic medical centers similar as before. They're not starting from scratch. These hospitals either have going through the P and T process now or they have already ordered the FEM test. And so we're just making sure that they've got the support they need and the ramp to order more. Speaker 500:17:38We're also aligning them closely with VA medical centers that are typically in the same territory or region. Speaker 400:17:48Got it. Thanks. And second one for me. I noticed on the call you talked about net price erosion starting in 2Q. Can you just elaborate a bit on the degree of the erosion? Speaker 400:17:59Could it flow into some of the subsequent quarters as well? Speaker 200:18:03Yes. Thanks, Ron. I think it would be good to comment on the guidance we gave first and what it means. So I know it's unusual to guide for a partial part of the year. But the way we're kind of looking at it or the way I think investors should look at it is the $50,000,000 to $60,000,000 range is really, I guess, what you would think of as our base business, right, in terms of the customers that we're really buying by year end and then into the early part of the first quarter. Speaker 200:18:32Certainly, to the extent we bring in either new customers, obviously new customers, there's upside, right, from those numbers if certainly if our LDO customer starts buying in the second quarter, right, that there's upside in those numbers. Now when we talk about price erosion, I'm not going to I don't know if I can give you an exact percentage, but the way in which we're thinking about it is our agreements with customers and the way that we're currently priced, there are, let's say, discounts and rebates off of government ASP. And government ASP has remained kind of stable, right? It starts out at WACC during TDAPA and then it adjusts for the first quarter. I think it was down only one percent from what it was the prior quarter. Speaker 200:19:17Next quarter is still second quarter going to be fairly stable. The third quarter, it should come down a little bit. But we're going to have to or we're expecting to take a shelf stock adjustment at the end of the second quarter, right, as we move into third. And what we don't really have a handle on right now is exactly how much inventory will be in the channel by the end of the second quarter. So that's something that we're still working through and that kind of factors into the range that we gave for revenue from existing base what we'll call the existing base business over the first part of the year. Speaker 400:19:57Got it. Helpful. Thanks. Speaker 200:19:59Thanks. Operator00:20:01Thank And our next question today comes from Jason Butler, Citizen JMP. Speaker 600:20:12Joe, can you maybe just give us some more color about the process that the contracted LDO is going through and your interactions that kind of just reinforce your confidence that they will begin ordering in the next couple of months, next few months? Speaker 200:20:26Thanks, Jason. Look, I think what I can say at this point of time is we're being as supportive as we can possibly be. We've had a lot of information requests come from them, right, specifically around support services we could provide for training, for reimbursement. And we're making our staff available to them right kind of across the board. So as I said, we're hopeful that we'll stick with the original kind of planned or communicated timeline of implementation by mid year. Speaker 200:20:57But that's really all I have to go on at this point in time. Speaker 600:21:01Okay. Helpful. And then just from in terms of the magnitude of use within the LDO, has that number remained consistent throughout your dialogue with them? Speaker 200:21:11Yes. Look, they haven't given us any indication right now that that number or they're going to deviate from that number, but we do know they're looking at implementation. I think there's a possibility that number could be higher. There's a possibility that number could be lower, right? I think what we're trying to do right now, as I said, is make all the resources of CorMedix available to them and hopefully accelerate the rollout, both in terms of speed and scale. Speaker 600:21:38Great. And then just a second one for me. In terms of potential new customers, obviously, there's the other LDO. Could you give us an update there? But beyond that, are there other smaller providers that potentially could come online in the second half of the year? Speaker 600:21:54Thanks. Speaker 200:21:58Yes, thanks. Look, with respect to the other LDO, obviously, we remain in communication with them. We've provided them additional information. I think candidly, we haven't moved the needle there as much as we would have liked to over the past couple of months. We are still working there, call it, top down, right, for the senior level of management. Speaker 200:22:18We've also started to work there bottom up, right. These a lot of these, large Dallas Operators, they have joint venture owned entities where the JV partner has some decision making authority. So we've started to work through some of those joint venture organizations that have expressed interest in DefendCat and we're hopeful to kind of make inroads there over the next two to three months. On the small side, yes, right, there's there are a lot of I guess, first, I'd say we are shipping to a number of small customers where we don't talk about them specifically. Some may have 10 dialysis centers, some might have 20. Speaker 200:23:03But in addition to some health systems that have, right, 10 to 25 hospitals. But yes, that's absolutely part of our focus over the next part of 2025 to build inroads with those smaller customers and to increase ordering size and frequency. Speaker 600:23:23Okay, great. Thank you for taking the questions. Operator00:23:27Thank you. And our next question today comes from Gregory Renzo with RBC Capital Markets. Please go ahead. Speaker 700:23:34Hi, guys. It's Anish on for Greg. Congrats on all the progress and thanks for taking our questions. Just a couple from us. First, just on TDAPA, how should we be thinking about patient applicability? Speaker 700:23:44And what are your thoughts and trends in coverage such as Medicare Advantage over the next two to three years? And second, what are the key levers you look to pull to maximize uptake of DefendCath to ensure the best possible post ADAPA add on adjustment? Thanks so Speaker 200:24:00much. Thanks, Anish. Look, I think with respect to DAPA, I am not sure what you meant by applicability. But in terms of what we're seeing I'll start now with what we're seeing from Medicare Advantage now, right? So when we look at our payer claims, we launched the product in mid-twenty twenty four in the outpatient setting and initially 100% of claims were fee for service, right? Speaker 200:24:22Because it's the Medicare Advantage, there was a little bit of a lag in picking up to DAPA. And as we move toward the back part of last year, we started to see the trend going toward Medicare Advantage. I think we closed out last year with about 25% or 30% of our claims being Medicare Advantage. Through this first part of the first quarter, '40 percent of our claims are Medicare Advantage and other payers and 60% are fee for service. That's certainly the trend we want to see. Speaker 200:24:48When you look at the broader ESRD market, 80%, eighty five % of it is Medicare and within Medicare, half of it is fee for service and half is Medicare Advantage. We do see the Medicare Advantage market share of Medicare growing over time. We do think it ultimately will become seventy percent of ESRD patients. And we do see that as a good opportunity for CorMedix. So what we're doing to better prepare ourselves, call it, for the out years of TDAP and beyond, is the real world evidence study that we're running in collaboration with U. Speaker 200:25:23S. Renal Care, right? A lot of that data and specifically around the pharmacoeconomic benefits of DefendCast is what we'd like to utilize as part of a direct contract negotiation with EMA plans, right, for separate and more sustainable reimbursement. Did I address the second question as well, Anish? Speaker 700:25:47Yes. That's very helpful. Thank you. Speaker 200:25:49Okay. Speaker 400:25:49All right. Operator00:25:52Thank you. And our next question comes from Les Zieluski with Tuohy Securities. Please go ahead. Speaker 800:26:00Hey, this is Jeevan on for Les. Thanks for taking our questions. We recently saw the news on FDA's acknowledgments of bloodline shortages that might impact hemodialysis procedures. Can you provide any commentary if this has any impact on utilization or uptake of defencaf? Thank you. Speaker 200:26:20Yes. Hi. Thanks, Steven. No, it's not like it had any impact, but I'll let Liz explain why. Speaker 900:26:27Yes. So thanks for the question. The good news is that there are two equivalent alternative manufacturers for this. So hemodialysis isn't going to stop. I think that the dialysis providers feel pretty good about that. Speaker 900:26:40But I don't anticipate any impact to defend cath utilization with this. It's simply a manufacturing challenge that can be addressed with alternatives. Speaker 800:26:50Okay, great. Then just a quick second one for me. Can you provide any updates on the status of defense cap manufacturing capacity? Have there been any readjustments needed or challenges to filling the open purchase orders to Q1? Thank you. Speaker 200:27:07I'm sorry, Jeevan. Was that question around inventory availability? Speaker 800:27:13Yes, yes. Just your any challenges in filling the $25,000,000 in open purchase orders? Speaker 200:27:19No, we have more than a year's worth of finished dosage on hand at our current run rate. We're well situated. Speaker 700:27:30Great. Thank you. Operator00:27:34Thank you. And our next question comes from Serge Belanger with Needham and Company. Please go ahead. Speaker 1000:27:41Hi, good morning. This is John on for Serge today. Thanks for taking our questions. First, if you could just quickly give us the current business mix between the various MDOs that you have on board, obviously, U. S. Speaker 1000:27:55Renal care has been your anchor thus far. And secondly, in terms of the expectations for the TPN program, are these patients going to be similar to those that were enrolled in the LOCKA trial in terms of CRBSI susceptibility? Speaker 200:28:15All right. Thanks, John. In a minute, I'll let Liz comment on the study design for TPN. From a business mix standpoint, I think we have exact percentages in the 10 ks for where we closed out last year. Obviously, U. Speaker 200:28:30S. Renal Care still remains more than 80% of orders through that period. It is coming down. Beyond that, I don't think we're going to be providing specific customer specific guidance. But we'll reevaluate as we go forward. Speaker 200:28:49Do you want to come in on the study design on TPM? Speaker 900:28:51Sure. So our NutriGard study, which is our Phase three randomized double blind two arm study, which is looking at the efficacy and safety of DefendCat for adult patients receiving TPN is really focused on those that have had a CLABSI in the last twelve months. We know that patients that have had a CLABSI are at higher risk to have another one. They have an average infection rate of twenty percent to twenty five percent. So similar to dialysis patients in the sense that they are very vulnerable to infection and they may Speaker 200:29:24be Speaker 900:29:24immunocompromised for a multitude of reasons, right? That's why they're probably on TPN. But unlike dialysis, these are folks that access their catheter on a daily basis, not three times a week like you would see in hemodialysis. Does that answer your question? Speaker 1000:29:42Yes, that's great. Thank you very much. Operator00:29:47Thank you. And this concludes the audio question and answer session. I'd like to turn the conference back over to Dan Ferry from LifeSci Advisors for written questions. Speaker 100:29:55Thank you, operator. Joe, we do have some written questions from the audience. The first will be, did the change in CMMI, which is the Center for Medicare and Medicaid Innovation, did that policy impact patient uptake in the first quarter? Speaker 200:30:17Okay. Thanks, Dan. I think what you're referring to is the policy change that took place back in November that removed or the patients that participate in a kidney care entity, the benchmarks, they excluded TDAPA from the benchmarks. So they were now allowed to accept TDAPA payments and not be penalized. I think at the time we guided, we did expect a patient lift of somewhere around fifteen percent to twenty percent. Speaker 200:30:47We did see that throughout the first quarter certainly with U. S. Renal Care that we saw a lift in patient numbers as a result of that. I think overall, I think it's important for innovative products in general, right. It was somewhat of a headwind that thankfully CMS eliminated. Speaker 100:31:07Okay, great. And I have another one here. Proposed changes from the new administration have certainly caused volatility in the sector. Have you seen anything in these announcements that you see as a risk or possibly an opportunity? Speaker 200:31:27Yes. Look, I know there's a lot of trepidation from investors right now, certainly in the biotech segment, right, because the new administration and potential tariffs on pharmaceuticals. I think the way we're looking at it specific to DefendCat is definitely more of an opportunity. And I think I would divide it probably in a couple of buckets. I think if you're looking at the situation through the lens of, let's say, DOGE, right, and kind of taking cost out of government spend, I think Defencat is something that fits very well with that agenda, right? Speaker 200:32:04So the government spends over $3,000,000,000 a year between inpatient and outpatient derived CRBSIs in the hemodialysis space. If we can replicate our clinical result in a real world setting, we have the opportunity to offset a large amount of that spend. Second, I think if you're looking at it through the lens of, let's say, Make America Healthy Again, right, type thing, I think we also fit pretty well, right, with that type of mindset where if we are able to have the again, replicate our clinical results in a real world setting and have that type of impact on infections, a byproduct of that is you're reducing hospitalizations from those infections. You'd ultimately be reducing antibiotic use that would result from those infections. I think both of which fit pretty well within that initiative. Speaker 200:33:01I think more broadly for this administration, though, I think we do get just because it's a change of administration, not because of who the administration is, I think there is the ability to look at either past decisions through a new lens or new legislative initiatives. And certainly, there's a lot of, I think, momentum right now on a bipartisan basis for hopefully TDAPA reform. I think TDAPA was a really good start. I think it's we've done okay, but I think everybody recognizes from a long term standpoint that it certainly could be better in terms of incentivizing innovation, reimbursing providers for utilizing that innovation. And we do know that there's a bill that's hopefully making its way through Congress and hopefully will be proposed before the end of this year. Speaker 200:33:56And if not, hopefully CMS through rulemaking can make some more positive adjustments. But I think for us in our situation specifically, I think we see a lot of opportunity. Speaker 100:34:08Great. Thank you for that, Joe. I have another one here that's a bit more on the commercial side of things. What resources does CorMedix have available to help providers with processing reimbursement? Speaker 200:34:24It's a good question. Yes, so we've set up a third party hub specifically to help the providers themselves navigate claims. And Erin, do you want to do you want it's through a third party. Erin, do you want to comment on how that's set up? Speaker 500:34:41Sure. So third party, Prospectus, and they work directly with both us and our customers across inpatient and outpatient settings. There's a couple of main focus areas. One of those is benefits verification for patients and then they have very specific billing and coding expertise to make sure that claims are submitted correctly for TDAPA, for example, on the outpatient side and NTAP on the inpatient side, as well as the J codes. And then they also can navigate any payer policies or complex state Medicaid challenges that we may run into. Speaker 100:35:18Okay, great. Thanks, Aaron. Looks like we have one final one here. I think you touched on this earlier, Joe. But if signing an agreement or a currently contracted LDO requires greater capacity, what is your ramp time? Speaker 100:35:38And how does CorMedix how is CorMedix situated from a raw material standpoint? Speaker 200:35:45Okay. Thanks. I guess that goes back to inventory. So I think we divide into a couple of buckets. I said before, from a finished dosage standpoint, I think we're in pretty good shape based on the current run rate and the anticipated ramp that we kind of built into our LE, right, for the what we expected the LDO customer to do. Speaker 200:36:08Now if they wanted to ramp significantly beyond that, our ability to pivot is pretty good, right? I don't think our ramp time is more than a handful of months. We have more than enough raw material on hand between, I'd say, heparin and tirodene API to cover that ramp over a year. Turnaround time on heparin API is not significant. Turnaround time on tiroledine API is a bit longer, but we have several lots on order that would be delivered in the back part of the year. Speaker 200:36:44So really, we've got two finished dosage contract manufacturers. One of them is definitely underutilized. So we have finished dosage capacity we can pivot to. And I think it's a matter of handful of months to be able to ramp. Speaker 100:37:02That's great. Thank you so much, Joe. Operator, this concludes the written question portion of the call. You may now close. Operator00:37:11Thank you. Ladies and gentlemen, this concludes today's conference call. We thank you all for attending today's presentation. You may now disconnect your lines and have a wonderful day.Read morePowered by Conference Call Audio Live Call not available Earnings Conference CallCorMedix Q4 202400:00 / 00:00Speed:1x1.25x1.5x2x Earnings DocumentsPress Release(8-K)Annual report(10-K) CorMedix Earnings HeadlinesInvestors in CorMedix (NASDAQ:CRMD) have seen decent returns of 81% over the past five yearsApril 17 at 8:55 AM | finance.yahoo.comCorMedix's (CRMD) "Buy" Rating Reiterated at Needham & Company LLCApril 11, 2025 | americanbankingnews.comTrump’s treachery Trump’s Final Reset Inside the shocking plot to re-engineer America’s financial system…and why you need to move your money now.April 19, 2025 | Porter & Company (Ad)CorMedix reports preliminary Q1 revenue $39M, consensus $32.2M.April 9, 2025 | markets.businessinsider.comRBC stays bullish on CorMedix as Q1 preliminary revenue reassures on near-termApril 8, 2025 | markets.businessinsider.comCorMedix Stock Rises After Preliminary Q1 Results Exceeds Expectations: Retail’s ElatedApril 8, 2025 | msn.comSee More CorMedix Headlines Get Earnings Announcements in your inboxWant to stay updated on the latest earnings announcements and upcoming reports for companies like CorMedix? Sign up for Earnings360's daily newsletter to receive timely earnings updates on CorMedix and other key companies, straight to your email. Email Address About CorMedixCorMedix (NASDAQ:CRMD), a biopharmaceutical company, focuses on developing and commercializing therapeutic products for the prevention and treatment of infectious and inflammatory diseases in the United States. Its lead product candidate is DefenCath, an antimicrobial catheter lock solution to reduce the incidence of catheter-related bloodstream infections in adult patients with kidney failure. The company was formerly known as Picton Holding Company, Inc. and changed its name to CorMedix, Inc. in January 2007. 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There are 11 speakers on the call. Operator00:00:00Good day, and welcome to the CorMedix, Inc. Fourth Quarter and Full Year twenty twenty four Financial Results Conference Call. All participants will be in listen only mode. After today's presentation, there will be an opportunity to ask questions. Please note, today's event is being recorded. Operator00:00:28I would now like to turn the conference over to Dan Ferry with LifeSci Advisors. Please go ahead. Speaker 100:00:34Good morning, and welcome to the CorMedix fourth quarter and full year twenty twenty four earnings conference call. Leading the call today is Joe Tedisco, Chief Executive Officer of CorMedix, and he is joined by Doctor. Matt David, Executive Vice President and CFO Beth Zelnick Kaufman, EVP and Chief Legal and Compliance Officer Liz Hurlburt, EVP and Chief Clinical Strategy and Operations Officer and Aaron Mistry, EVP and Chief Commercial Officer. Before we begin, I would like to remind everyone that during the call, management may make what are known as forward looking statements within the meaning set forth in the Private Securities Litigation Reform Act of 1995. These statements are statements other than statements of historical fact regarding management's expectations, beliefs, goals and plans about the company's prospects and future financial position. Speaker 100:01:33Actual results may differ materially from the estimates and projections on which these statements are based due to a variety of important factors, including the risks and uncertainties described in greater detail in CorMedix's filings with the SEC, which are available free of charge at the SEC's website or upon request from CorMedix. CorMedix may not actually achieve the goals or plans described in these forward looking statements. Investors should not place undue reliance on these statements. CorMedix does not intend to update these forward looking statements except as required by law. During this call, the company will discuss certain non GAAP measures of its performance. Speaker 100:02:14GAAP to non GAAP financial reconciliations and supplemental financial information are provided in CorMedix's earnings release and the current report on Form eight K filed with the SEC. This information is available on the Investor Relations section of the CorMedix website. At this time, it is now my pleasure to turn the call over to Joe Tedisco, Chief Executive Officer of CorMedix. Joe, please go ahead. Speaker 200:02:41Thank you, Dan. Good morning, everyone, and thank you for joining us on this call. Having completed our initial partial year of commercial launch of DefenCath, I'm incredibly proud of the team's efforts and pleased with the commercial results thus far. The fourth quarter saw continued growth with both existing as well as new customers in the outpatient segment, which was the primary driver of our strong revenue and profit results for both Q4 and full year 2024. Net revenue for the fourth quarter and full year were $31,200,000 and $43,500,000 respectively, both of which exceeded Wall Street consensus prior to our preannouncement on January 7. Speaker 200:03:24The fourth quarter was also the first profitable commercial quarter in the company's history with net income of $13,500,000 and adjusted EBITDA of $15,300,000 Fourth quarter results were driven by strong uptake amongst patients at U. S. Renal Care, ramping implementation at our mid sized customers, IRC and DCI, as well as utilization by other small outpatient dialysis customers. As we announced back in early January, we began the first quarter of twenty twenty five with more than $25,000,000 of purchase orders in hand from existing customers for first quarter delivery. While we are not going to provide full year revenue guidance at this time, we currently estimate that net revenue from existing purchasing customers for the first six months of twenty twenty five should be in the range of $50,000,000 to $60,000,000 with more than $33,000,000 expected in the first quarter. Speaker 200:04:20DefenCath's net selling price has been fairly stable throughout the first three quarters of outpatient commercialization. However, we do expect to begin to see some net price erosion beginning in the second quarter of twenty twenty five. With respect to patient growth opportunities, there is still some potential for new patients with existing outpatient customers. However, to a large extent, our ability to grow patient volume significantly in the back part of 2025 will be contingent upon the timing of purchasing and scale of implementation by our contracted large dialysis organization customer. Prior to year end, we met with our contracted LDO customer who communicated to CorMedix that the Fenkata implementation was pushed into 2025 due to operational resource constraints. Speaker 200:05:08Over the course of February and early March, we've had multiple meetings with this customer, provided significant requested information around resources available at CorMedix to assist with training and the implementation of DefenCaf, and we remain hopeful the customer will begin ordering and commence utilization prior to mid year. Turning to the inpatient segment, we have started to see utilization increase at a handful of larger hospitals, and we are hopeful to increase penetration as we move throughout 2025. Back in January, we announced a change to our inpatient commercialization strategy, whereby we reorganized our field team covering outpatient and inpatient customers. This process is now complete as we are partnering with Syneos Health to build a dedicated inpatient field team that is highly experienced in the hospital formulary process and the launch of first in class products in the setting of care. We also recently announced a partnership with WSI to provide marketing and promotional resources for DefenCath specifically to facilities operated by the Veterans Administration. Speaker 200:06:11I am happy to announce that the new inpatient team is nearly fully staffed and is expected to be active in the field in the next four to five weeks. The team contracted through WSI has already commenced promotional activities to VA facilities. While we do not currently report inpatient sales as a separate segment, we do expect to see meaningful growth in this setting of care by the end of twenty twenty five with an increased contribution to overall revenue and earnings in 2026 and beyond. Focusing now on our clinical developments, we are in the process of beginning our Phase III clinical study for the reduction of central line associated bloodstream infections or CLABSIs in patients receiving total parenteral nutrition or TPN through a central venous catheter. We began site selection in February and expect to begin patient enrollment for the study in the second quarter of this year. Speaker 200:07:07As we communicated previously, this is a twelve month study in less than 150 patients, and we are targeting completion of the study and submission of a new drug application to FDA by the end of twenty twenty six. We recently submitted to FDA an application for orphan drug status for this indication and are awaiting FDA's determination of eligibility. The company's goal for TPN is to obtain FDA approval for an expanded use of our tirodine and heparin catheter lock solution in the late twenty twenty seven to early twenty twenty eight timeframe, and we estimate annual peak sales potential in this indication to be in the range of $150,000,000 to $200,000,000 We'll provide investors with updates on progress in this important area of unmet need as we move forward. During our previous earnings call, we also discussed three additional clinical initiatives, all having either commenced in 2024 or expected to begin in 2025. The most meaningful of the three from a data value standpoint is our real world evidence study, which we are running in cooperation with our study partner, U. Speaker 200:08:14S. Renal Care. Our hope with this study, in which we expect to evaluate outcomes of more than 2,000 patients over twenty four months, would be to generate real world evidence around the impact of DefenCath utilization on cost of patient care, infection rates, hospitalizations, mortality and multiple other metrics such as lost chair time and CRBSI related antibiotic use. Data collection for this study has already commenced. In addition to our adult TPN and real world evidence studies, we will also be commencing a study in pediatric hemodialysis in 2025. Speaker 200:08:50This will be a relatively small study spread over several years as we expect patient enrollment to be a challenge given an extremely small patient population and the need for very personalized protocols for these ultra vulnerable patients. This pediatric study is a post marketing requirement under the Pediatric Research Equity Act by the FDA, and we have FDA's concurrence on the final study protocol. We currently expect patient enrollment to begin in the third quarter of twenty twenty five, and we expect this study to span three to five years. Lastly, in addition to our other clinical initiatives, we have commenced an expanded access program for high risk populations, including but not limited to pediatric TPN, peritoneal dialysis patients with refractory peritonitis and neutropenic oncology patients utilizing a CVC. These high risk patients are those that have exhausted other infection prevention methods and unfortunately remain at significant risk for comorbidities and mortality. Speaker 200:09:53We are fielding a high number of requests for participation in this expanded access program and currently expect patients to be dosed under this program in the second quarter of this year. I would now like to turn the call over to Matt to discuss the company's fourth quarter and full year financial results and financial position. Matt? Thanks, Joe, and good morning, everyone. Speaker 300:10:15I am pleased to be here today to provide an overview of our fourth quarter and full year twenty twenty four financial results as well as an update on CorMedix's cash position. The company has filed its annual report on Form 10 ks for the year ended 12/31/2024. I urge you to read the information contained in the report for a more complete discussion of our financial results. With respect to our fourth quarter of twenty twenty four financial results, our net revenue for the fourth quarter of twenty twenty four amounted to $31,200,000 CorMedix achieved profitability in the fourth quarter as our net income was $13,500,000 or $0.22 per share compared with a net loss of $14,800,000 or $0.26 per share in the fourth quarter of twenty twenty three. The net income recognized in 2024 was driven by the profits associated with net sales of the Fencap following the product's launch in 2024. Speaker 300:11:16Operating expenses in the fourth quarter of twenty twenty four increased 9% to $17,100,000 compared with $15,700,000 in the fourth quarter of twenty twenty three. The increase was driven by higher selling and marketing and G and A expenses, offset by a decrease in R and D. R and D expense decreased by 26% to $1,700,000 driven by the approval of the FenCath. CorMedix is now reporting selling and marketing expense and general and administrative expense as separate line items. On an apples to apples basis, S and M expense increased 1% to $8,300,000 in the fourth quarter of twenty twenty four compared with $8,200,000 in the fourth quarter of 'twenty three. Speaker 300:12:02G and A expense increased 36% to $7,100,000 in the fourth quarter of twenty twenty four versus $5,200,000 in the fourth quarter of twenty twenty three. The increase in S and M expense was attributable primarily to increased marketing efforts and new personnel inclusive of our field sales organization and support for the commercial launch of DefenCath. The increase in G and A expense was primarily due to increases in personnel costs in preparation for support activities related to our commercial launch. With respect to our full year 2024 financial results, total net revenue during 2024 amounted to $43,500,000 dollars This marks the first full year CorMedix is reporting net revenue since launching DefendCath in spring summer of twenty twenty four. Total operating expenses during the full year 2024 amounted to $62,600,000 compared with $49,000,000 in 2023, an increase of 28. Speaker 300:13:05R and D expense decreased 70% to $3,900,000 driven primarily by the approval of DefendCAF. Selling and marketing expense increased 59% to $28,700,000 compared with full year 2023 and G and A expense increased 69 to $30,000,000 compared with 2023. The increases in S and M and G and A were driven primarily by new personnel and cost to support the commercial launch of DefendCap. We recorded net cash used in operations during 2024 of $50,600,000 compared with net cash used in operations of $38,400,000 in 2023. The increase is primarily driven by an increase in trade receivables and inventories offset by a net increase in the change of accrued expenses and accounts payable and a decreased net loss. Speaker 300:14:00The company has cash and cash equivalents of $51,700,000 as of 12/31/2024. Based on accounts receivable collection throughout first quarter of twenty twenty five and to a lesser extent proceeds from ATM issuance, we anticipate completing first quarter of twenty twenty five with at least $75,000,000 in cash and cash equivalents. As described in our January 7 release, we are guiding to 2025 cash operating expenses of approximately $72,000,000 to $78,000,000 The increase over 2024 spending levels is expected to be primarily driven by an increase in R and D spending on clinical initiatives. I will now turn the call back over to Joe for closing remarks. Joe? Speaker 200:14:48Thanks, Matt. CorMedix is working diligently on all fronts to increase our existing customer base as well as expand the use of Defencast to new therapeutic indications. I appreciate everyone's continued support in CorMedix, and I'm happy to take questions. Operator00:15:03Thank you. We will now begin the question and answer session. And today's first question comes from Rowanna Ruiz with Leerink Partners. Please go ahead. Speaker 400:15:33Hey, good morning everybody. So I did have a question about the Syneos Health partnership and your build out of the inpatient sales team. What are your first steps for this team once they're fully launched? And do you have any color on what the ramp might look like in the inpatient setting for defend cath over time? Speaker 200:15:52Well, look, let me I'll comment on the inpatient kind of ramp and then I'll let Aaron and Liz comment a little bit on the team and its deployment. So obviously, we were a little bit slow at the gate on the inpatient side last year. That's not unusual for this setting of care for these types of launches. It takes quite a while to work through P and T processes. I am pleased with what we've seen in the first quarter. Speaker 200:16:17I know we as I said, we don't report anything from a separate segment standpoint on the inpatient side. But right now for the first quarter, inpatient is looking to be about 3% of unit volume and 4% to 5% of dollars. So I feel pretty good about that trend. Inpatient as a total is ten percent of the unit volume of the overall market opportunity. So if we can move toward there, right, as we get into 2026, I think that's certainly a target that we'd like to try to achieve. Speaker 200:16:52We're in the process of just finally completing the staffing of the last two to three roles, right, to fill out the team completely. Training is near complete and we hope to have them out in the field in the next four to five weeks. But Erin, do you want to comment anything beyond that? Speaker 500:17:15Sure. I think that just what we plan for them to do right out of the gate is to focus on the large academic medical centers similar as before. They're not starting from scratch. These hospitals either have going through the P and T process now or they have already ordered the FEM test. And so we're just making sure that they've got the support they need and the ramp to order more. Speaker 500:17:38We're also aligning them closely with VA medical centers that are typically in the same territory or region. Speaker 400:17:48Got it. Thanks. And second one for me. I noticed on the call you talked about net price erosion starting in 2Q. Can you just elaborate a bit on the degree of the erosion? Speaker 400:17:59Could it flow into some of the subsequent quarters as well? Speaker 200:18:03Yes. Thanks, Ron. I think it would be good to comment on the guidance we gave first and what it means. So I know it's unusual to guide for a partial part of the year. But the way we're kind of looking at it or the way I think investors should look at it is the $50,000,000 to $60,000,000 range is really, I guess, what you would think of as our base business, right, in terms of the customers that we're really buying by year end and then into the early part of the first quarter. Speaker 200:18:32Certainly, to the extent we bring in either new customers, obviously new customers, there's upside, right, from those numbers if certainly if our LDO customer starts buying in the second quarter, right, that there's upside in those numbers. Now when we talk about price erosion, I'm not going to I don't know if I can give you an exact percentage, but the way in which we're thinking about it is our agreements with customers and the way that we're currently priced, there are, let's say, discounts and rebates off of government ASP. And government ASP has remained kind of stable, right? It starts out at WACC during TDAPA and then it adjusts for the first quarter. I think it was down only one percent from what it was the prior quarter. Speaker 200:19:17Next quarter is still second quarter going to be fairly stable. The third quarter, it should come down a little bit. But we're going to have to or we're expecting to take a shelf stock adjustment at the end of the second quarter, right, as we move into third. And what we don't really have a handle on right now is exactly how much inventory will be in the channel by the end of the second quarter. So that's something that we're still working through and that kind of factors into the range that we gave for revenue from existing base what we'll call the existing base business over the first part of the year. Speaker 400:19:57Got it. Helpful. Thanks. Speaker 200:19:59Thanks. Operator00:20:01Thank And our next question today comes from Jason Butler, Citizen JMP. Speaker 600:20:12Joe, can you maybe just give us some more color about the process that the contracted LDO is going through and your interactions that kind of just reinforce your confidence that they will begin ordering in the next couple of months, next few months? Speaker 200:20:26Thanks, Jason. Look, I think what I can say at this point of time is we're being as supportive as we can possibly be. We've had a lot of information requests come from them, right, specifically around support services we could provide for training, for reimbursement. And we're making our staff available to them right kind of across the board. So as I said, we're hopeful that we'll stick with the original kind of planned or communicated timeline of implementation by mid year. Speaker 200:20:57But that's really all I have to go on at this point in time. Speaker 600:21:01Okay. Helpful. And then just from in terms of the magnitude of use within the LDO, has that number remained consistent throughout your dialogue with them? Speaker 200:21:11Yes. Look, they haven't given us any indication right now that that number or they're going to deviate from that number, but we do know they're looking at implementation. I think there's a possibility that number could be higher. There's a possibility that number could be lower, right? I think what we're trying to do right now, as I said, is make all the resources of CorMedix available to them and hopefully accelerate the rollout, both in terms of speed and scale. Speaker 600:21:38Great. And then just a second one for me. In terms of potential new customers, obviously, there's the other LDO. Could you give us an update there? But beyond that, are there other smaller providers that potentially could come online in the second half of the year? Speaker 600:21:54Thanks. Speaker 200:21:58Yes, thanks. Look, with respect to the other LDO, obviously, we remain in communication with them. We've provided them additional information. I think candidly, we haven't moved the needle there as much as we would have liked to over the past couple of months. We are still working there, call it, top down, right, for the senior level of management. Speaker 200:22:18We've also started to work there bottom up, right. These a lot of these, large Dallas Operators, they have joint venture owned entities where the JV partner has some decision making authority. So we've started to work through some of those joint venture organizations that have expressed interest in DefendCat and we're hopeful to kind of make inroads there over the next two to three months. On the small side, yes, right, there's there are a lot of I guess, first, I'd say we are shipping to a number of small customers where we don't talk about them specifically. Some may have 10 dialysis centers, some might have 20. Speaker 200:23:03But in addition to some health systems that have, right, 10 to 25 hospitals. But yes, that's absolutely part of our focus over the next part of 2025 to build inroads with those smaller customers and to increase ordering size and frequency. Speaker 600:23:23Okay, great. Thank you for taking the questions. Operator00:23:27Thank you. And our next question today comes from Gregory Renzo with RBC Capital Markets. Please go ahead. Speaker 700:23:34Hi, guys. It's Anish on for Greg. Congrats on all the progress and thanks for taking our questions. Just a couple from us. First, just on TDAPA, how should we be thinking about patient applicability? Speaker 700:23:44And what are your thoughts and trends in coverage such as Medicare Advantage over the next two to three years? And second, what are the key levers you look to pull to maximize uptake of DefendCath to ensure the best possible post ADAPA add on adjustment? Thanks so Speaker 200:24:00much. Thanks, Anish. Look, I think with respect to DAPA, I am not sure what you meant by applicability. But in terms of what we're seeing I'll start now with what we're seeing from Medicare Advantage now, right? So when we look at our payer claims, we launched the product in mid-twenty twenty four in the outpatient setting and initially 100% of claims were fee for service, right? Speaker 200:24:22Because it's the Medicare Advantage, there was a little bit of a lag in picking up to DAPA. And as we move toward the back part of last year, we started to see the trend going toward Medicare Advantage. I think we closed out last year with about 25% or 30% of our claims being Medicare Advantage. Through this first part of the first quarter, '40 percent of our claims are Medicare Advantage and other payers and 60% are fee for service. That's certainly the trend we want to see. Speaker 200:24:48When you look at the broader ESRD market, 80%, eighty five % of it is Medicare and within Medicare, half of it is fee for service and half is Medicare Advantage. We do see the Medicare Advantage market share of Medicare growing over time. We do think it ultimately will become seventy percent of ESRD patients. And we do see that as a good opportunity for CorMedix. So what we're doing to better prepare ourselves, call it, for the out years of TDAP and beyond, is the real world evidence study that we're running in collaboration with U. Speaker 200:25:23S. Renal Care, right? A lot of that data and specifically around the pharmacoeconomic benefits of DefendCast is what we'd like to utilize as part of a direct contract negotiation with EMA plans, right, for separate and more sustainable reimbursement. Did I address the second question as well, Anish? Speaker 700:25:47Yes. That's very helpful. Thank you. Speaker 200:25:49Okay. Speaker 400:25:49All right. Operator00:25:52Thank you. And our next question comes from Les Zieluski with Tuohy Securities. Please go ahead. Speaker 800:26:00Hey, this is Jeevan on for Les. Thanks for taking our questions. We recently saw the news on FDA's acknowledgments of bloodline shortages that might impact hemodialysis procedures. Can you provide any commentary if this has any impact on utilization or uptake of defencaf? Thank you. Speaker 200:26:20Yes. Hi. Thanks, Steven. No, it's not like it had any impact, but I'll let Liz explain why. Speaker 900:26:27Yes. So thanks for the question. The good news is that there are two equivalent alternative manufacturers for this. So hemodialysis isn't going to stop. I think that the dialysis providers feel pretty good about that. Speaker 900:26:40But I don't anticipate any impact to defend cath utilization with this. It's simply a manufacturing challenge that can be addressed with alternatives. Speaker 800:26:50Okay, great. Then just a quick second one for me. Can you provide any updates on the status of defense cap manufacturing capacity? Have there been any readjustments needed or challenges to filling the open purchase orders to Q1? Thank you. Speaker 200:27:07I'm sorry, Jeevan. Was that question around inventory availability? Speaker 800:27:13Yes, yes. Just your any challenges in filling the $25,000,000 in open purchase orders? Speaker 200:27:19No, we have more than a year's worth of finished dosage on hand at our current run rate. We're well situated. Speaker 700:27:30Great. Thank you. Operator00:27:34Thank you. And our next question comes from Serge Belanger with Needham and Company. Please go ahead. Speaker 1000:27:41Hi, good morning. This is John on for Serge today. Thanks for taking our questions. First, if you could just quickly give us the current business mix between the various MDOs that you have on board, obviously, U. S. Speaker 1000:27:55Renal care has been your anchor thus far. And secondly, in terms of the expectations for the TPN program, are these patients going to be similar to those that were enrolled in the LOCKA trial in terms of CRBSI susceptibility? Speaker 200:28:15All right. Thanks, John. In a minute, I'll let Liz comment on the study design for TPN. From a business mix standpoint, I think we have exact percentages in the 10 ks for where we closed out last year. Obviously, U. Speaker 200:28:30S. Renal Care still remains more than 80% of orders through that period. It is coming down. Beyond that, I don't think we're going to be providing specific customer specific guidance. But we'll reevaluate as we go forward. Speaker 200:28:49Do you want to come in on the study design on TPM? Speaker 900:28:51Sure. So our NutriGard study, which is our Phase three randomized double blind two arm study, which is looking at the efficacy and safety of DefendCat for adult patients receiving TPN is really focused on those that have had a CLABSI in the last twelve months. We know that patients that have had a CLABSI are at higher risk to have another one. They have an average infection rate of twenty percent to twenty five percent. So similar to dialysis patients in the sense that they are very vulnerable to infection and they may Speaker 200:29:24be Speaker 900:29:24immunocompromised for a multitude of reasons, right? That's why they're probably on TPN. But unlike dialysis, these are folks that access their catheter on a daily basis, not three times a week like you would see in hemodialysis. Does that answer your question? Speaker 1000:29:42Yes, that's great. Thank you very much. Operator00:29:47Thank you. And this concludes the audio question and answer session. I'd like to turn the conference back over to Dan Ferry from LifeSci Advisors for written questions. Speaker 100:29:55Thank you, operator. Joe, we do have some written questions from the audience. The first will be, did the change in CMMI, which is the Center for Medicare and Medicaid Innovation, did that policy impact patient uptake in the first quarter? Speaker 200:30:17Okay. Thanks, Dan. I think what you're referring to is the policy change that took place back in November that removed or the patients that participate in a kidney care entity, the benchmarks, they excluded TDAPA from the benchmarks. So they were now allowed to accept TDAPA payments and not be penalized. I think at the time we guided, we did expect a patient lift of somewhere around fifteen percent to twenty percent. Speaker 200:30:47We did see that throughout the first quarter certainly with U. S. Renal Care that we saw a lift in patient numbers as a result of that. I think overall, I think it's important for innovative products in general, right. It was somewhat of a headwind that thankfully CMS eliminated. Speaker 100:31:07Okay, great. And I have another one here. Proposed changes from the new administration have certainly caused volatility in the sector. Have you seen anything in these announcements that you see as a risk or possibly an opportunity? Speaker 200:31:27Yes. Look, I know there's a lot of trepidation from investors right now, certainly in the biotech segment, right, because the new administration and potential tariffs on pharmaceuticals. I think the way we're looking at it specific to DefendCat is definitely more of an opportunity. And I think I would divide it probably in a couple of buckets. I think if you're looking at the situation through the lens of, let's say, DOGE, right, and kind of taking cost out of government spend, I think Defencat is something that fits very well with that agenda, right? Speaker 200:32:04So the government spends over $3,000,000,000 a year between inpatient and outpatient derived CRBSIs in the hemodialysis space. If we can replicate our clinical result in a real world setting, we have the opportunity to offset a large amount of that spend. Second, I think if you're looking at it through the lens of, let's say, Make America Healthy Again, right, type thing, I think we also fit pretty well, right, with that type of mindset where if we are able to have the again, replicate our clinical results in a real world setting and have that type of impact on infections, a byproduct of that is you're reducing hospitalizations from those infections. You'd ultimately be reducing antibiotic use that would result from those infections. I think both of which fit pretty well within that initiative. Speaker 200:33:01I think more broadly for this administration, though, I think we do get just because it's a change of administration, not because of who the administration is, I think there is the ability to look at either past decisions through a new lens or new legislative initiatives. And certainly, there's a lot of, I think, momentum right now on a bipartisan basis for hopefully TDAPA reform. I think TDAPA was a really good start. I think it's we've done okay, but I think everybody recognizes from a long term standpoint that it certainly could be better in terms of incentivizing innovation, reimbursing providers for utilizing that innovation. And we do know that there's a bill that's hopefully making its way through Congress and hopefully will be proposed before the end of this year. Speaker 200:33:56And if not, hopefully CMS through rulemaking can make some more positive adjustments. But I think for us in our situation specifically, I think we see a lot of opportunity. Speaker 100:34:08Great. Thank you for that, Joe. I have another one here that's a bit more on the commercial side of things. What resources does CorMedix have available to help providers with processing reimbursement? Speaker 200:34:24It's a good question. Yes, so we've set up a third party hub specifically to help the providers themselves navigate claims. And Erin, do you want to do you want it's through a third party. Erin, do you want to comment on how that's set up? Speaker 500:34:41Sure. So third party, Prospectus, and they work directly with both us and our customers across inpatient and outpatient settings. There's a couple of main focus areas. One of those is benefits verification for patients and then they have very specific billing and coding expertise to make sure that claims are submitted correctly for TDAPA, for example, on the outpatient side and NTAP on the inpatient side, as well as the J codes. And then they also can navigate any payer policies or complex state Medicaid challenges that we may run into. Speaker 100:35:18Okay, great. Thanks, Aaron. Looks like we have one final one here. I think you touched on this earlier, Joe. But if signing an agreement or a currently contracted LDO requires greater capacity, what is your ramp time? Speaker 100:35:38And how does CorMedix how is CorMedix situated from a raw material standpoint? Speaker 200:35:45Okay. Thanks. I guess that goes back to inventory. So I think we divide into a couple of buckets. I said before, from a finished dosage standpoint, I think we're in pretty good shape based on the current run rate and the anticipated ramp that we kind of built into our LE, right, for the what we expected the LDO customer to do. Speaker 200:36:08Now if they wanted to ramp significantly beyond that, our ability to pivot is pretty good, right? I don't think our ramp time is more than a handful of months. We have more than enough raw material on hand between, I'd say, heparin and tirodene API to cover that ramp over a year. Turnaround time on heparin API is not significant. Turnaround time on tiroledine API is a bit longer, but we have several lots on order that would be delivered in the back part of the year. Speaker 200:36:44So really, we've got two finished dosage contract manufacturers. One of them is definitely underutilized. So we have finished dosage capacity we can pivot to. And I think it's a matter of handful of months to be able to ramp. Speaker 100:37:02That's great. Thank you so much, Joe. Operator, this concludes the written question portion of the call. You may now close. Operator00:37:11Thank you. Ladies and gentlemen, this concludes today's conference call. We thank you all for attending today's presentation. You may now disconnect your lines and have a wonderful day.Read morePowered by