Good morning, everyone, and welcome to the H.C. Wainwright twenty-sixth Annual Global Investment Conference. My name is Landon, and I'm a biotech equity research associate at the firm. We're glad to have you with us today, and it is now my pleasure to introduce our next presenter. Please join me in welcoming Sheldon Koenig, President and CEO of Esperion Therapeutics, a commercial-stage biopharmaceutical company developing new drugs for cardiovascular and cardiometabolic diseases. Sheldon, over to you.
Great. Good morning, and thank you, Landon, and on behalf of Esperion and all the employees, very grateful for the opportunity here at H.C. Wainwright to present our story. So thank you so much, and without any delay, we'll get right into it. Okay, awesome. Great. So first of all, let me go through our foundational growth pillars, and there's six of them. First of all, again, a very attractive market opportunity. This is a very large market, and it's something that, as everyone knows, cardiovascular disease is the number one cause of death, not only in the world, but of course, in the United States. We have breakthrough therapies with bempedoic acid, which is a first-in-class novel mechanism of action.
And this breakthrough therapy, again, keep in mind, is a result of also the CLEAR Outcomes study, which was presented back in April of 2023, which was 14,000 patients, of which we'll get into a bit later. We have a very promising pipeline. We won't discuss too much about our pipeline today, but what I can tell you is that sometime early, probably first quarter in 2025, we'll actually hope to have scheduled a research and development day to really talk about the excitement that's occurring currently in the pipeline. As you know, we have global partnerships with both Daiichi Sankyo, Europe, who I just had the pleasure to meet with while we were at the European Society of Cardiology last week, and also Otsuka, who currently is now registering their drug for approval in Japan.
They just completed their phase III studies. Our intellectual property is strong. We have IP protection through 2031, and we have a very highly experienced team. All of us have launched products. We've been in big pharma, we've been in biotech. We all have 25-plus years experience in these relevant areas. We have really shown strong growth. We've had successful execution, and that's something we've been stating that we would have since 2021. Now, I won't go back through the whole story, but essentially, we've shown double-digit growth and in the second quarter of that we just actually presented, we showed that we grew not only prescriptions from a double-digit perspective, but also total revenue.
We monetized our European royalties, and that was a very big accomplishment for us, as it removed much of our debt that we had. So very successful in doing that. And we also secured updated utilization management criteria, and I think this is what's very important. You know, one of the largest headwinds, hurdles for us was managed care reimbursement. Right now, we have over 133 million lives who have adopted our new label, and patients are being or I should say, prospective patients now are able to be identified by physicians, and it's easier for physicians to write the drug. And I'll go into, again, the new label a bit later. But again, the new label is a result of the CLEAR Outcomes study and the work that the team did to secure that.
We have significant international programs ongoing. As you know, Nilemdo and Nustendi, which are the, as they're known in Europe. We've shown double-digit growth there, again, with Daiichi Sankyo, our partners. I've already mentioned that Otsuka is currently filing their NDA. The one thing I do want to say about UM criteria, we just issued a press release last week, which was a big win for us, showing that we secured United and AARP. This was 13.1 million lives. This is one of the largest Medicare providers in the United States, and it actually brings our Medicare coverage up to and over approximately 85%. On the commercial side, it's 90%. So I mentioned this earlier, elevated bad cholesterol is a marker of cardiovascular disease. And again, keep in mind, this is the number one cause of death worldwide.
So even with the existing therapies that exist today, whether those be statins, PCSK9, ezetimibe, et cetera, this still is a disease that needs to be treated. There still exists a gap in treatment. And I mentioned this briefly, but I'll go into detail. With that said, as you know, bempedoic acid was developed by Roger Newton. This drug was launched in March of 2020, right in the area of COVID, so there was a lot of people that were unaware of the launch. And it really gave us time to think about, where do we want this company to go? What's our strategy, et cetera? So in October of 2021, we rightsized the organization, and we focused on three different things. One, growth. Two, control our burn rate. Three, was getting to the CLEAR Outcomes study and focusing on this.
A 14,000-patient study, unprecedented, and it's been a real game changer for us. Again, this is a new class of medication, as I've mentioned before. Over 14,000 patients in 32 countries. Half of those enrolled were women, 18% were Latin American, and we really wanted to ensure that this was something that, you know, because of it being unprecedented, that we get what we called a very big splash, and at ACC 2023, when Dr. Steve Nissen presented this, we had actually over 1 billion impressions, which represented close to $200 million of unpaid media, and essentially, we became an overnight success. One of our biggest issues was that, who knows Nexlizet? Who knows Nexletol? It was an awareness issue. Overnight, we saw the awareness, and we saw physicians and consumers actually latch on to the study.
What's most important about this study is that we are the first and only non-statin therapy to not only have secondary prevention, but have primary prevention. The only other therapies in cardiovascular medicine that demonstrate primary prevention are statins. If you look at ezetimibe, they do not have primary prevention. If you look at PCSK9, they do not have primary prevention. So we have spent much of our time educating physicians, healthcare providers, of this important differentiation. What's important about primary prevention? It's as simple as, you know, as Steve Nissen would say, "Wow, we're preventing events, or you can prevent an event before it happens." Our new label dramatically increases our addressable market. Initially, our addressable market was only 10 million patients. It was a very restrictive label. Before CLEAR Outcomes, the label was only for those patients with documented ASCVD.
Patients had to be on multiple statins. They also had to go through ezetimibe if they weren't getting to goal, and then they would go on our drug. The CLEAR Outcomes study significantly improved our label. Keep in mind what I talked about earlier for utilization management criteria. That label removed much of the headwinds that we had. You no longer need to be on multiple statins. The step edit of going through ezetimibe does no longer exist. A physician no longer has to provide detailed documentation. They can go back historically, electronically, and say, "Oh, yes, this patient was on a statin six months ago. I can move forward and prescribe Nexlizet and Nexletol." Now, a prior authorization is still needed, like most drugs, but it's easier to fill out that prior authorization. With plans like Aetna, no prior authorization is even needed.
It was nice to see that payers really received the data, the new label, as a victory, and they viewed bempedoic acid, Nexlizet and Nexletol, as needed therapies. That new label increased our TAM from 10 million to 70 million. We now have 70 million eligible patients for this drug. Remember what I said in one of the first pillars of our foundation in the beginning of the presentation, this is a large addressable market, and there's work that needs to be done to treat these patients who are not at goal. Therefore, as I mentioned, there is a existing gap in therapy. Statins are the cornerstone of therapy, but keep in mind, statins can be very difficult to take. They cause muscle ache, they cause essentially, you know, myalgia, et cetera.
Patients can only tolerate certain doses of statin. Keep in mind, if you increase your dose of statin, you're only reducing your LDL by an additional 6%. There's actually a recent study that showed that patients really can't tolerate these maximum dose of statins. So statins are the cornerstone of therapy, but they're very hard to tolerate, et cetera. We represent a way for the patients who are not getting at goal to be added to a statin or to be also used alone. So statin intolerance can be described as many different ways. One, those patients who can take a relatively small or, I would say, moderate dose of a statin, you can add Nexlizet to that patient. For those patients who can't take a statin at all, you can add Nexlizet or Nexletol.
We believe after a statin, the first product to be used are us, we're next. And again, it's because of that primary and secondary indication as well. I'm sorry, primary and secondary prevention indication as well. We would be the next product of choice. One of the questions that we get quite often are guidelines and where are guidelines, et cetera. I can tell you that we've been told that guidelines may not come until sometime in 2025, either early or mid-2025. I can tell you at the recent European Society of Cardiology, there were certain guidelines that were mentioned. One was peripheral arterial disease. Again, this was European, and we were recommended to be used with statins in peripheral arterial disease.
Just this weekend in the NLA, there is a consensus paper for those patients who are seventy-five plus years or older, where there's another need for this drug. We actually studied patients in that age group, and we were recommended in the guidelines to be used along with statins. No other therapies were mentioned. You do also, at the end, you have the injectable therapies with PCSK9. Again, these are higher costs. These are more difficult to use. Patients would rather choose a pill before an injectable, and we have the market research to show that. Physicians desire that as well because it's less callbacks from the patient, it's less instructions to the patient. So I mentioned this earlier, introduced the first oral non-statin, LDL-lowering therapy. But just again.
So everyone knows Nexletol is bempedoic acid on itself, and Nexlizet is bempedoic acid plus ezetimibe. So what are we really focused on? Right now, we're focused on sales execution. Managed care efforts, I mentioned a hundred and thirty-three million lives. There's actually a hundred and forty-four million lives. Greater than 80% of payers have already updated their utilization management criteria. We have preferred coverage in 92% of all commercial plans, and we have greater than 65% preferred Medicare coverage. And again, with the addition of United AARP, that actually makes it higher. We are really excited how payers gravitated to this new label and made these changes quickly. And just to give you perspective on that, Medicare, usually Medicare, when they make changes in plans, they make that change, they make that decision today for the following year.
Medicare providers are making the decision to provide Nexlizet today, and they're changing the criteria tomorrow. So they're not waiting. There's no waiting here. This is happening right now as we speak. All the utilization management criteria and these new prior authorizations aligned to it are active now. So great job by the team on the managed care side. On the sales and marketing side, now we're working on how do we pull through these managed care wins? Well, we talked about in second quarter that greater than twenty-one thousand physicians are already writing our drug, and we still have a long way to go. I think one of the biggest questions I get, going back to, I believe, slide three, is: Have we reached our... Are we in the inflection point? Are we growing? We absolutely are growing.
I always say you can't take a protractor out and look at the slope of that growth, but if you did, it's a pretty steep angle and there's no arc in sight. As a matter of fact, if you go to slide 10 on our corporate site, we have the mountain graph that shows the ascent, if you will, of our curve, and we feel really good about our growth trajectory and again, sticking to our commitment of growth, so this is the slide I referenced. Again, disciplined execution allows us to have this continued growth. We showed 14% growth quarter over quarter from quarter one to quarter two.
I don't have a pointer, but if you look and I address your attention to the right, you can see the angle, as we continue this almost 45-degree angle up and to the right as relates to RPE trends. We've had great strides in expanding our international reach. I wanna focus a little bit on Canada and Australia. We're preparing ourselves at Esperion to file in both Canada and Australia. Canada represents a substantial market, Australia also a substantial market, and this is something that we have taken on our own, as of now. We're also filing in the country of Israel. Daiichi Sankyo, again, is responsible for Europe and also the ASCA region. These are regions in, or these are countries such as Vietnam, Korea, Thailand, Philippines, et cetera. Otsuka just finished, as I mentioned, their phase three study.
It was a successful study and are currently filing in Japan. And keep in mind, with the filing, that opens the door for an additional $140 million of milestones that are due to us. Those milestones are not paid right away. These are all based upon other achievements that Otsuka will need to accomplish as they go through their process of filing. And the international growth continues at a very strong pace. I know that, while I was at the European Society of Cardiology, their head of that division said to me, "We just reached the country that has double-digit market share." That's Belgium. They have over 40,000 patients, and they've shown over 20% growth.
So really, the drug is very well received, and I think if you think about the European market, similar to the U.S. market, these assets have more than $1 billion potential in both of these markets, both the U.S. and also if you think about in Europe, very broad markets. Strong intellectual property. Again, we have our IP through 2031. Something I didn't mention earlier, but keep in mind that Daiichi Sankyo is also working on a triple combination therapy. They're currently deciding whether or not this will be using a rosuvastatin and atorvastatin or just using one, but they're in the infancy of that planning. We feel really good about where they are in planning for the triple combination therapy. That might allow them for additional IP protection as well.
So we're currently going through that. We extend them beyond 2031. I can tell you, in the United States, we have a strategy in place where we believe also we have the ability to potentially extend our patent from 2031 into the 2040 time period. So stay tuned, and we'll update you further. And that is the end of my presentation. So just again, I wanna thank H.C. Wainwright. Sorry for the technical difficulties in the beginning, and again, really appreciate the time. Thank you.