After the presentation, we'll open to your questions. With that, Josh, I'll turn it over to you.
Great. Thanks, Alex. Appreciate Sidoti having me, and thanks for everyone for attending the conference and for taking time to listen to the Aytu story. If you're relatively new to the Aytu BioPharma story, you're hearing it at perhaps the most exciting time in the company's history as we really start to inflect in significant ways. I'll start off by saying again, as Alex mentioned, AYTU is the ticker on Nasdaq, and this data that I'll present is current through our most recently reported quarter, March 31. We are a June 30 year-end, and so we are gonna be excited to be releasing our fiscal 2024 numbers, and the Q4 for the quarter and year ended June 30, just about 6 weeks ago.
We'll be releasing those numbers in the September timeframe, likely that third full week in September. So be on the lookout for that. Before I get started into the meat of my presentation, let me just remind you that I might be making some forward-looking statements, and so here I've got on the screen the obligatory forward-looking statement. So without further ado, let me jump in. Again, thanks for joining me, and excited to share with you what has really been some exceptional progress for the company over the last year and a half or so. That is really typified by what has been significant revenue growth for the company's core commercial assets, which I'll get into here in a moment.
But taking a step back, you know, the company, if you were to look at us, say, two years ago, you would have seen a company that was certainly in the prescription pharmaceutical business, but one that was also in the manufacturing business, making our own ADHD medicines, also in the consumer health business, driving some revenue, but frankly, not generating any, any profit on that side of the business, and a company that was in the R&D business. We had an interesting pipeline of opportunities, and ultimately, we made the critical decision, and starting a couple of years ago, that we are going to wind down any operation that we don't believe can drive near-term shareholder value.
And ultimately, what that has netted us is an opportunity to become exquisitely focused over the last 12 months, and one that is specifically looking at the prescription business and one that we know that can drive EBITDA and ultimately cash flow for the company. We are commercial stage, as I've obviously referenced, and our prescription products compete in a couple of therapeutic areas, most notably Attention Deficit Hyperactivity Disorder, ADHD, and in other pediatric categories. The company is revenue generating, as I mentioned, and we very excitedly have been consistently EBITDA positive when looking at the prescription segment, or the RX segment, as we call it, and we'll talk through some of that and what is driving some of that.
Of course, we do compete in the ADHD segment, and it's a huge category here in the United States, and it is a category that, first of all, represents in excess of 80 million prescriptions annually here just in the United States, billions of dollars in annualized sales and one of the most prevalent conditions that are diagnosed today. What's been happening uniquely in the ADHD category over the last year and a half plus is there's been intermittent shortages of some of the key products on the market, most notably Adderall and Adderall XR, as well as Ritalin and Concerta and their generic equivalents.
And we've been able to materially increase sales of our products, our ADHD brands, Adzenys and Cotempla, largely organically as of late, but really prior to that, largely also as a consequence of being able to fill the void that was left by this shortage and intermittent supply challenges, that ultimately resulted in, you know, Adderall, Adderall, and Adderall XR, Concerta prescriptions going unfilled because patients simply could not find, drugs at their neighborhood pharmacies, and there's various reasons for that. One of the things that we're really excited about is when patients get experience with our products, they don't just get experience with our products from a clinical perspective, they get the whole patient experience inclusive of the access piece.
There's a real challenge in getting prescriptions, covered, filled on a timely basis, and if they're covered, it's not always clear what the out-of-pocket will be for that patient. And so there's a great deal of confusion around whether I'm going to get it as a patient or as a parent, and if I get it, where exactly I'm gonna get it, what pharmacy can I get that prescription filled, and most importantly, at what price am I gonna be able to get it? And so we have a program called RxConnect, which cuts through all the noise and enables patients to have a frictionless, pleasurable experience filling their prescriptions if patients are prescribed our brands.
And so I'll talk more about RxConnect, but suffice it to say, that's been a substantial growth driver for the company, and it goes just beyond having a product that's effective and safe and is something that patients like. You've got to be able to get it into their hands, and they've got to be able to get it predictably. And ultimately, our best-in-class patient support program does just that. We've had tremendous revenue growth, and specifically looking at the RX segment over the last few years, we've demonstrated that we can grow our products and grow our revenues accordingly, and we're able to do that really without any material increase in our sales and marketing expenses. In fact, as I'll point out here later on, and you can see subsequently, if you have interest on our investor deck, that will be on the website.
Our expenses have actually been going down, and so we're able to gain leverage and ultimately drive sales while not increasing expenses in any material way. You can see in 2022, $60+ million in prescription revenues up to all the way to $74 million, and expect to see those numbers grow when we report out our final fiscal 2024 numbers for the year ending June 30th. Really good trajectory. This has largely been driven by the growth of the ADHD brands, which I'll point to here shortly. While you do see meaningful revenue from our consumer health segment, it's important to note that that has not been a profitable or even EBITDA positive segment for us.
So we officially sold that off and wound that operation down actually last month, or at the for the quarter ending June thirtieth, and announced last week that we have essentially sold it to a private investor and expect to be able to generate some royalties off of off of that going forward. But the most important aspect is we've stopped the burn, that that part of the business was contributing, and are now squarely focused as a prescription-only business as we move forward. As I mentioned, we took a step back, really evaluated where we were with respect to what can really drive growth, what can drive value, what can ultimately generate cash flow. It's very clear that our prescription segment can do that.
Quite honestly, the other aspects of our business, R&D, the consumer health segment, most notably, they were masking the strength of the Rx business. They were masking the fact that this had been an EBITDA-positive business for 7 out of the last 8 quarters. It had been positive operating income or cash flow from operations, and ultimately was one that was poised to really take the company and put it in the best position. So we said, "Let's shut down anything that's burning any material amounts of cash," and we did just that. The Rx segment, again, is a prescription business that has two ADHD medicines. I'll talk a little bit more about those, a pediatric suite of medications. And if you look at trailing 12 months adjusted EBITDA for that business, it was over $15 million.
To put that in perspective, I mean, a typical specialty pharma valuation would be an EBITDA multiple of 6-10 times. So you can obviously do the math for yourself. You can obviously see where our market cap is today on the basis of obviously our shares outstanding. I should say, by the way, our fully diluted share count is something closer to 12 million shares out. Even if you use that and obviously apply the share price, it's trading in the $2.50 range, you can obviously see. We believe, and I firmly believe, that there's a significant dislocation, in fact, trading even under our cash balance, which is almost $20 million at the end of March.
So this strategic shift, we believe, in a very, very real way, will drive value for shareholders, and really by virtue of significantly enhancing cash flows, to enable us to continue to, of course, build shareholder value and grow product revenues, and ultimately enable us to invest in future product acquisitions and growth as we move forward. And that's exactly what the growth drivers are, ramping prescriptions and revenue, our net revenue number of almost $74 million for the year ending last June, driven actually by the pediatric growth segment, although the pediatric products have slowed. And the ADHD revenues have significantly increased. ADHD is really our calling card going forward. Those are the products that we believe most strongly have the best opportunity for growth.
What's gonna drive that growth is this very exciting patient support program that we call RxConnect, which I'll speak to. But we're not just focusing on top line. Growing at the expense of gobbling cash and not driving margin is not what we wanna do. We've grown in the face of consolidated expenses. We've grown in the face of improving gross margins, and so ultimately, our calling card is to drive EBITDA. And again, the Rx segment was, you know, call it between $10 million and $15 million on an annualized basis when you look out over the preceding 18 months, depending on the time period that you look at. We are also driving margin by virtue of getting out of our manufacturing facility.
When we acquired these products, we actually acquired an entire company, Neos Therapeutics, and we closed on that deal March of 2021. It's taken us a while, but we are now finally in the final stages of getting products out of that manufacturing facility, which is in Grand Prairie, Texas, just outside of the Dallas-Fort Worth. We have identified and are now approved by the FDA to move these products and have them now being manufactured at a facility in New Jersey, and we will essentially shut down all remaining aspects of the operation for the Grand Prairie facility at the end of this calendar year. So we truly are at the final stages of getting out of that facility, and that will serve to materially improve our working capital situation.
We don't have a lot of things tied up with respect to raw materials, and of course, we will expect to improve gross margins. The facility that we've exited is very large. It's almost 80,000 sq ft, manufacturing two products. And while they're very substantial revenue drivers of essentially $55+ million in revenue, we do not operate and have not operated that plant 24/7, 365, and so that makes it relatively inefficient. So moving to a contract manufacturer certainly puts us in a spot to dramatically improve our, first of all, utilization by virtue of having it spread out over a larger base of products at the contract manufacturer, and ultimately driving just, efficiencies as we move forward.
We've also materially improved our SG&A, and so excited about not just top-line growth, but being able to grow these products and grow the top line through the leverage we're getting through RxConnect, and also collapsing our expense base. Our products, our key products are Adzenys XR-ODT and Cotempla XR-ODT, and Poly-Vi-Flor and Tri-Vi-Flor are our multivitamins, and we also have a liquid antihistamine called Karbinal ER. The ODTs, the orally disintegrating tablets, are, again, our core base of business, and these are significant products that compete in the very large ADHD category, and they are the only orally disintegrating tablet extended-release products on the market anywhere in the world. ODTs are very simple to use. They are convenient, they dissolve very rapidly in the mouth, and they last a full 12 hours.
So they're very uniquely positioned, and they compete very favorably in this very large ADHD category. Stimulants are the primary modality for treatment in ADHD for both adolescents as well as adults. Some pediatric patients will get non-stimulants, and in fact, some patients in general will get, will get non-stimulant products. But the lion's share of this market is the stimulant market, and products like Adderall and Adderall XR, Concerta, and Ritalin, Ritalin LA, just to name a few, are the dominant brands in those categories, and that's where Adzenys and Cotempla compete. And again, these are the only ODTs, so they're very simple to take. And when patients take these medicines, they certainly, of course, feel better. But importantly, particularly in the case of Cotempla, they feel better symptomatically very quickly.
You see 61% improvement in symptoms within an hour, and you see significant, 40+ improvement in math scores over placebo. This is something that, frankly, many products are not able to claim, this very rapid onset and this great clinical data that you see actually in a classroom setting with these patients. Adzenys is indicated for all patients, six and above, so adults, adults included, and in fact, adults represent the largest chunk of patients. Cotempla is indicated for patients between six and seventeen years of age, and so it really is positioned for children and adolescents. Many times patients, as they move into their adult years, may move into a stronger stimulant in the form of an amphetamine, such as Adzenys .
So we really cover the waterfront in terms of the ages that can really contribute, that can take this medicine. And then our multivitamins, Poly-Vi-Flor and Tri-Vi-Flor, relatively small products prescribed in areas around the country that do not fluoridate the water supply. These are utilized as fluoride supplements, but they also contain a fluoride, and so these are products that are largely prescribed in the tri-state area, and ultimately these products have been solid growers for it. We did have an impact on these products about a year ago, such that these products were removed from a key formulary, so we did take a bit of a revenue hit.
We now believe we can grow those revenues back on the basis of some improved payer situations around the country, and so excited to be able to get some of that growth back and really grow from here. So here you see really the growth trajectory on the left-hand side of us getting to almost $74 million in revenues. And ultimately, what has been really most important for us is to drive bottom line. We've got to stop burning cash. We have done that. We've essentially maintained our cash balance and have built a really solid bottom line with almost $10 million of Adjusted EBITDA when you look specifically at the prescription business, which really is the core business going forward. So excited to see that growth. More excited about the bottom line improvement. Hold on, my screen just froze here.
I mentioned ADHD. The market is huge, 83+ million prescriptions annually, $20+ billion in sales, so it's a gigantic market. And the extended-release stimulants really make up a significant chunk of this market, and we compete in that marketplace with these two orally disintegrating tablet forms. And we're taking advantage still to this day of the fact that Adderall, Concerta, Ritalin, these products have been intermittently in and out of supply for various reasons. We've never had a shortage on our products, so we've been able to fill in the gap very nicely, grow revenues, grow prescriptions for these products, and it's really been a breath of fresh air for patients that have been struggling to get their ADHD medications.
The fluoride market, a significantly smaller market by every measure, but still a nice market for us to compete in, and we can very efficiently sell these products through a small sales team. Only about five or six folks really are responsible for our pediatric products, while we have about 40 folks on the ADHD side, so very efficiently selling the fluoride multivitamins, along with our antihistamine Karbinal, and excited to have those grow back. We do think we have the keys to the castle, so to speak, to get the coverage back in place, to get these patients covered from a reimbursement perspective, and ultimately excited about their growth trajectory. The biggest growth driver over the last year or so has been the ADHD portfolio. We had a really nice run-up earlier last year. We've maintained kind of a new run rate.
You know, if you look at really where the run rate was, say, July... June, July of 2021, and even into 2022, you know, you're looking at 20, 22, 25,000 prescriptions on a monthly basis, growing to kinda 30+. We're now at 35,000+ and growing, if you look at where we've sort of exited the academic year, which obviously is in sort of the May-June timeframe. We do slow down in the summer. Patients will often take a summer holiday, particularly kids, of course. And so the ADHD market comes down, and then it goes back up, and we're really heading into back-to-school season, as we speak today. Certainly get past Labor Day, September starts to run back up, and kids are getting back into school, and we're off and running.
So really nice trajectory for these products, and we're excited about their continued growth prospects. What we're most excited about is how these products are delivered. It is not enough today, and really has never been enough, to simply sell a better product. You simply can't say, "Well, we have an orally disintegrating tablet. It works quickly, it lasts a full 12 hours, it's easy to take, tastes great, very stable throughout the day. Patients really feel great." You've got to be able to present to a physician and to patients: "How can I access it easily? How is my insurance going to cover this?" That's where RxConnect steps in. RxConnect is a first-in-class, home-developed programs. This is not something that's off the shelf. This is not something that any other company does, but it's unique to Aytu.
We have aligned with a group of pharmacies, a large group of about 1,000 pharmacies, inclusive of a couple of regional grocery chains around the country. Ultimately, we have physicians that are interested in prescribing our products, and we simply say, through our sales force and through other resources, "If you'll prescribe our products and send them to one of our partner pharmacies, your patients will get a seamless, frictionless experience, and if they're commercially insured, they will pay no more than $50 on a monthly basis for their copay for our drugs." Full stop. That is literally as simple as that. Some physicians believe it's too good to be true. It's not. It's... We truly underwrite, we truly backstop, whatever expression you wanna use, our prescriptions.
Because we wanna make sure that patients can get our prescription products, that they can get them predictably, they can get them for a price not to exceed $50. And by the way, many times they're getting our products for a copay of $0. And it enables the physician to get back to practicing medicine, prescribing these ADHD medicines that he or she believes are appropriate for their patients, and not having to worry about the dreaded callback, the dreaded prior authorization. All of those things get handled on the back end through us, and through our network, and through our partner pharmacies, and it ultimately optimizes. Pull-through enables us to capture new patients, patients that had been on Adderall XR, for example.
They come to our product, they like the product, but they equally like the fact that I know I'm gonna pay no more than $50 on a copay. That's something you cannot say really for any product today. We largely control this network, in that we have most of our prescriptions, and you can see here, over 85%, 86%, 87%, depending on the month. Some months, it's as many as 90% of our prescriptions run exclusively through a partner pharmacy. And that serves for us to have great insights into exactly the prices patients are paying, exactly the prices pharmacies are being reimbursed, and exactly the refills that patients are getting. And so we have very high visibility into this entire channel for us to maximize retention for these patients, and enable us, ultimately, to keep more patients on board.
Ultimately, this is a great way for us to ensure that patients are getting the brand, they're not getting switched to a generic amphetamine or methylphenidate. By the way, the same applies for our prescription multivitamins, as well as our antihistamine, which is also often filled through our RxConnect pharmacy partners. So we are significantly, we're very, very excited about where we have arrived, having really focused the company on our prescription business. Revenues, again, almost $74 million on the prescription side. Consumer business, again, meaningful revenue, but that revenue was coming at a cost, so we've cut that business out and are squarely focused on the prescription business.
But even when looking at the business as it stands today, with the consumer business still intact through our fiscal 2024, you can see here that through the first three quarters of 2024, the company was still EBITDA positive to the tune of $7.7 million. And so ultimately, and that is the go-forward business as you think about as you think about where the company has been. We are now going to be exclusively focused on the Rx segment, and that is essentially, call it a $10-$15 million annualized EBITDA business, and so excited about really where we go from here. I alluded to the fact that we were doing this growth, we were generating this level of revenue growth, in the face of decreasing expenses. We've cut back on sales and marketing. We've decreased our G&A line.
We've taken R&D down to a de minimis amount, particularly when you look at sort of any meaningful pipeline spend. This has all been enabled through the strategic shift to focus on the Rx business, to get out of anything that's materially burning cash. Ultimately, we're excited about how we're positioned as we move forward here on not just growing our business, but growing our business with an eye towards driving, driving EBITDA. Cash at the end of March was almost $20 million. We had $20 million at the end of December. We had roughly $20 million at the end of September. So we're not in a cash burning mode. We brought on a significant shareholder last June in the form of a financing we did, and we brought in Nantahala Capital, as well as Stonepine Capital.
Nantahala Capital took a board seat, and so it's enabled us to align with a great, strategic financial partner, and one that has really helped us streamline the operation. We also significantly reduced our debt, and we announced that, back, a couple of months ago. We were able to refinance our note that was coming due in early 2025. We have, refinanced our $15 million note down to $13 million. We've made it a fully amortizing note, such that we're paying not just interest, but principal along the way. It's a four-year note, so we pushed maturity out to June 2028, and we will, at that time, assuming we go to the full term, we will have paid the principal down to about $5.5 million.
So that's very meaningful, such that there's not gonna be a large bullet payment sort of hanging over us. So, excited about being able to really put the company in a good spot with respect to its financial health. We fully expect that to remove any going concern language. The only reason, from my perspective, that we had any going concern language in our last filings, was by virtue of the fact that this note was coming due. It was becoming current within the twelve-month period. You're probably familiar with how that works, so really the auditor put a going concern on our financials. But with this being kicked out materially, and frankly, with our EBITDA and our eye towards cash flow, you know, we believe we're positioned such that we don't need to raise any more capital as we move forward.
So, really excited about the momentum that we've captured. The share price is up materially, but it still, I think, has a ways to go when we think about really the intrinsic value of the company that's generating $10-$15 million in annualized EBITDA, with the opportunity to improve on that going farther. You know, a typical EBITDA multiple for a business of ours would be 6x-10x. And so if you're talking about a $10-$15 million annual EBITDA rate, you know, you're talking about significantly more value to be created here, if we simply normalize to kind of where we are with respect to real intrinsic value. So with that, I think I'm up against time in terms of my allocated presentation time.
Why don't I stop here and maybe ask Alex if you've got any questions, and then happy to take any additional questions that have come in through the chat.
Absolutely. Well, Josh, thank you very much, you know, for sharing the story. Great presentation. We have a lot of questions piling up from the audience, so let me jump in. The first is, could you talk about, you know, RxConnect and how important that is in differentiating Aytu, and how important that is to growing the business?
Yeah, it's a great question, and, and really what I would say, Alex, is RxConnect is a critical piece of what drives value for us and our customers. It is not enough to have products that are effective, safe, and perhaps even better. Physicians need to have an assurance that it's going to be covered, and if it's not gonna be covered, how can we make it right for our patients and really remove the friction? And so RxConnect. And by the way, it's, it's a platform. You know, RxConnect is not something specific to these two products or four products or whatever products are being sort of prescribed through the program. Any product could be put on this platform, ours and even other companies. And so there's the ability to drive value through bringing on additional assets.
We actually just brought on a small ADHD brand, and that's not even promoted by our sales force, but it's in the channel, and we have essentially enabled that brand to come back, such that patients don't have to pay a high copay if it comes through our network. So this network it's just that, it's a network of pharmacies, but it's so much more. It is, it is a program that enables patients to get a predictable price, to get a branded medication, and to get it consistently at that same price, time after time after time, at a friendly neighborhood pharmacy or regional grocery chain that they know and trust. Enables them to have that all-important predictability, and that predictability feeds into the into the physician's life as well.
He or she is extremely busy throughout the day, fielding calls, getting prescriptions rejected or flipped at the pharmacy. So they love the notion of being able to write a prescription for Adzenys or Cotempla or the multivitamins and not have to worry about the dreaded call back, and so that is, frankly, that is gold in this business, and we are one of the very few... Frankly, we're the only company that does it this way, but one of the very few that truly underwrites prescriptions to ensure that that physician can tell his or her patient with confidence that you're going to get this brand, and you're going to get it at $50, and it's gonna be no more. There's no fine print. So it's very powerful and drives a lot of value for us.
Great context. Thank you. And let me sort of combine a few questions. Could you talk about, you know, where you see the evolution of the ADHD telemedicine market going? And there's some questions about, you know, companies that have been overly prescribing online, and then-
Mm-hmm
... shortages, and then sort of how the ADHD diagnosis might be trending.
Yeah, ADHD diagnoses have continued to go up, particularly coming out of the pandemic. Diagnoses and prescriptions have gone up significantly. It's, you know, speculated that it's largely in part, largely due to the increase in work from home, but I think it's more than that. It's that people are just, I think, recognizing that they may have these symptoms. There's a focus on mental health. With respect to some of these telehealth providers, some have, frankly, overstepped, and I think caused some issues, so it has caused the DEA and the FDA to scrutinize some of those outfits.
It has really caused companies like ours, brands that are prescribed more the traditional way through a traditional pharmacy, I think to benefit from the fact that people recognize an in-person visit, someone who's very experienced in diagnosing and treating ADHD should really be doing that. It shouldn't be left to someone who you don't know well, who doesn't know you well, and so I think that actually serves to benefit companies like ours, brands like ours. But make no mistake, this is a large market that continues to grow at a rapid rate, and we're just scratching the surface with our brands, and we have the opportunity with our program, RxConnect, to really infiltrate and make it easier in a time when it's not always easy for patients to get a branded medication or, frankly, even a generic medication at a predictable, consistent price.
That's where we can really win. In the face of increasing prescriptions and increasing opaqueness in terms of how patient access and pricing works, we can really wear the white hat and be the source for these patients.
Great context. Thank you. And maybe for the last question, we can just sort of, you know, zoom out and sum up the value proposition for investors who may be looking broadly, you know, across mental health, telemedicine opportunities, or, you know, specifically ADHD and related.
You know, we exist, I think, at a perfect time in the in the current ecosystem in the U.S., and you might even say more broadly than that, but just particularly given some of the challenges, particularly the challenges that payers put on patients, but most importantly, on physicians. It limits choice. It limits patients' ability to get the brand that they need. And at a time when mental health is so critically in focus for people, and you would... ADHD, you would take as an extension of, of, you know, of, of a mental, of a mental illness. All eyes are on making sure patients have what they need to function effectively day to day, but not all eyes are focused on how to get these patients branded medications, any medication, predictably, affordably, and that's where Aytu comes in.
We can be a leader in this space. We can and we are. We view ourselves as an innovator in terms of how patients access our medications, on top of being a leader in, you know, innovative oral, orally disintegrated tablets, microparticle technology. So we are really well-positioned to take advantage of where the world is today, which is focused on getting patients mentally right and treating conditions and meeting them where they are, which means getting them the medications they need timely and affordably. And so we're, we're excited about RxConnect today and what it could mean in the future as we add additional products onto that platform.
Yeah, it's certainly very exciting. And with that, you know, we are at time. So Josh, I'd like to thank you for sharing the Aytu story with us, and also thank everybody listening for spending time with us today.
Thanks very much, Alex. Thanks to everyone for joining. Have a good day.
You too.