Good morning, everybody, and thank you for joining us at the Citizens Life Sciences Conference. Second day of our first conference down here in Miami and great to have you all down here. Really excited to be joined by Esperion next. Obviously a company focused in the cardiovascular space. Just reported earnings yesterday. We'll run through that, and a really exciting acquisition we wanna talk about. Sheldon Koenig, CEO, let me turn it over to you and the team, and just give a quick 30-second intro.
Yeah. Great. Thanks, Jason. On behalf of Esperion, you know, very happy to be here at the Citizens Conference. I'm joined by our Chief Financial Officer, Ben Halladay, and our Chief Commercial Officer, John Harlow. Just a brief update. You know, it's kind of a double header for us because we did earnings, and now we're at the conference. We had a great earnings yesterday, just rounding out 2025 and talking about our progress. 38% growth year-over-year in total revenue. 34% growth year-over-year on TRx. You know, it's just amazing. It's one of the best years we've ever had at Esperion. To your point, also one of the best quarters, 11% growth on TRx, fourth to third quarter, so feeling really good. If you look at total revenue, $408 million, so not bad.
You know, really happy about that, and we see nothing but growth continuing, and an exciting acquisition of Corstasis. We've added that. We've always talked about the fact we were going to do business development, and we found this unique nasal loop diuretic, recently approved in September of 2025, and John will talk a little bit later about how the ongoing integration is happening. We expect that deal to close first week of April.
I'd love to start there because, you know, it's one of the easiest press releases I ever read. You know, it really made sense to you guys.
Yeah.
Just walk us through the adjacency, the nature of the asset. What appealed you to this transaction?
Yeah. I'll start, and I'll turn it over to John, but I think what really appealed to us was we've always said we wanted to do something in the cardiometabolic field, something that just made sense, a lot of synergies, a lot of overlap, and if you look at who we call on today, cardiologists, primary care physicians, some endocrinologists, this just made sense. Heart failure is. There's a very much of an unmet need. It's a big market.
Now we're in two big markets, with hypercholesterolemia and heart failure, and I think what was really interesting to us was that just the unique delivery system of this, the fact that you can take a drug like bumetanide, which is 40 times more potent than furosemide, deliver it nasally, to patients who essentially are resistant to oral diuretics because of gut edema, and with a number of patients that are constantly recirculating through the hospital and readmission rates, we felt we could make a dent in that unmet need. Maybe John can talk about some of the things we're thinking about as we go through the initial steps of integration.
John, just before you do, let me say two things to kind of frame this.
Yeah.
Loop diuretics are standard of care.
There's a massive drive now, even in the U.S., to push at-home treatment. You wanna start there or?
Yeah. Absolutely, Jason. A couple points there. You see these patients who are on oral loop diuretics that are getting consistently worse, right? Then they're admitted to the hospital, then one in four patients are readmitted to the hospital within 30 days. That impacts the, I'll call it, the hospital quality metrics and their reimbursement rates at the end of the day. In the home, what you see is these patients are escalating on dose, and we're excited about the opportunity with Enbumyst to be able to really intersect before that, those patients are admitted to the emergency department. That's where we would really leverage our existing commercial infrastructure.
We're also looking to expand to ensure that we have appropriate coverage in that hospital acute care discharge marketplace by having a team calling on the integrated delivery networks and major academic institutions and health systems because those health systems, in a closed loop environment, are responsible for the cost of that patient, whether it's the pharmacy benefit or the medical benefit, and a heart failure readmission is $12,000-$18,000, and so we're looking, you know, where we can really show value with Enbumyst.
Can you talk a little bit about why a nasal spray makes sense in this market?
Yeah. I'll do it more from the voice of key opinion leaders that we've already spoken to. It's very simple. It's easy.
It's just easy to use. For a patient to take this, you know, basically, it's similar to the NARCAN delivery system and just, you know, do a puff in the nose, and patient's able to pee. I mean, that's basically what you're trying to do, right? You're trying to unload fluid from the patient. We've talked to a few key opinion leaders already, and it's important to note that heart failure, it's a small community as it relates to key opinion leaders. You really need to partner the key opinion leaders, which is something that we're doing right now. It's really important to partner with nurses. Nurses play a big role in this. They sometimes choose the treatment. They administer the treatment, and what we've heard so far, feedback is very easy. You can, you know, do a puff in the nose.
You're good to go. Corstasis is also working on a auto-injector that would come later. We view that as just another alternative of choice to give physicians choice. At the end of the day, I think most physicians, though, auto-injector or not, are always gonna, you know, go for the nasal spray 'cause it's just easy to use.
Let me try and loop Ben in here. Can you walk us through the transaction details?
Yeah
... and how you think about the low-hanging fruit opportunity here and then maybe, like, you know, what could this be if you really drive success?
Yeah. I mean, in my mind, this whole thing was the low-hanging fruit, no-brainer. This was a very easy decision to go through this transaction once we got through diligence and had, you know, kind of beaten things up and down. Overall, the transaction's $75 million upfront, and then about $180 million in CVR milestones, which are a variety of. There's one that's a regulatory milestone based on a new FDA approval, and then the rest are cumulative sales-based. On top of that, there is a low double-digit royalty to the holders, but you know, we found that the Corstasis owners, they're very engaged, they're very bullish on the product, and they wanted to be a part of that success long term, but they wanted it in a commercial engine that they knew could execute, and that's why they went with us.
From the financing side, we are financing that $75 million upfront. It's a combination of expanding our existing term loan facility that we have in place, as well as monetizing a portion of our Japanese royalties. What I really like about that is it takes the success and strength that Bempedoic acid laid and lets us now enter into this new market in an incredibly de-risked way.
Yep.
You know, it's really all upside, and we see a very, very low downside in this transaction.
The product, Sheldon, like you said, was approved in September. Hasn't really had a commercial push behind it yet, and that's really you guys are gonna lead that? Just walk us through that integration piece that, you know, your plans to roll the product out.
Yeah, before I even get to that point, there's one other aspect I want to mention to follow up on, Ben's point, and that is we have global rights. Everything we've talked about so far is the U.S. We have rights to Europe, Asia, et cetera. We have a lot of options of what we could do there. You know, could we do it ourselves? Could we do a distribution model? Could we partner similar to what we do with Daiichi Sankyo? These are all things we'll evaluate in the future, but it's important to note we have global rights for the product. As far as what we're doing from an integration perspective, again, we're kind of in that 30-day period right now until the deal closes.
I'll have John talk about what the marketing team is thinking about as it relates to gearing up for when the deal does close.
Yeah, we're going through that pre-integration phase right now, and as Sheldon alluded to, you know, once the deal closes, we'll be off and running. The product is available on the market. Corstasis did launch it with a very small contracted team, if you will. We're spending some time with those individuals during this pre-close time period. We're building, you know, the launch machine, if you will, and getting it primed to go, and we're excited once the deal closes is to get, you know, some folks out there as quickly as possible, being able to drive awareness, as we build a full commercialization plan, and we look forward to providing updates throughout the year. Just last question on Corstasis. Can you just talk about the payer access, how you think about, you know, making sure patients can get drug?
That's another thing that we're doing right now in kind of, let's just call it the quiet period. There's actually a big meeting down in Orlando. I always get the acronym.
Yes, PCMA.
PCMA.
Yep.
Our whole team was down there.
Yep.
This was a big topic of conversation. I know they asked. They also met with the VA, which would be a, you know, very big-
Yep
segment. Corstasis, to their credit, has also done a lot of work. They've actually have already started up a relationship with the specialty pharmacy, Asembia. To your point, to your earlier question, they just didn't have the gestalt, if you will.
Yep
... the muscle. We've always said we wanted to lend our infrastructure, even getting back to your first question. That's what would really make any product we acquire a success.
Yep.
All that is in motion, and we feel good about where we'll be there.
You spent a lot of time in the recent history talking about, like, that future vision.
Yeah
We'll come back there.
You know, to your point before, let's talk about today and Bempedoic acid and 11% demand growth in the quarter. You know, it's going well. Let me frame it this way. You've been through a couple years where you've been trying to set up the opportunity to just go drive growth.
Yeah.
Now you're driving growth.
You have the guidelines set. You have, you know, the clarity on the exclusivity runway. Just walk us through what's happening today just from the blocking and tackling in the field perspective.
Yeah, I'll start and turn it over to John, but I think what's important to note, and we emphasized this again, yesterday. We talked about it at one of your bank, another bank conference. Our goal is to maximize Bempedoic acid, and obviously now the Corstasis acquisition. We really believe that these products alone are $1+ billion opportunities in the United States. It's important for us to maximize the NEXLIZET, NEXLETOL. Guidelines, we should hear more about them in the next two weeks or so, and we think that's gonna provide us a pretty, you know, good tailwind.
Yeah
Because this will be the first time a third party is out there saying, "This is where and why you should use Bempedoic acid." We're excited about that, and that's gonna be a huge awareness event for us as well. As it relates to the everyday blocking and tackling, I'll have John comment on that.
Yeah, Jason, you know, in your question, you kind of set it up well. It's very much about execution, right? We have a very robust commercial plan that we look to continue, and NEXLIZET, NEXLETOL is our priority for 2026 to maintain that growth that we've seen over the past few years. We will continue to invest, obviously, in the field force, in digital tactics, as well as consumer tactics, and looking to drive growth. To Sheldon's point, you know, we're anxiously awaiting the guidelines, and we've got a robust plan all ready to go as soon as the guidelines hit. That will continue to be our top priority for the remainder of the year.
Two oral drugs, great efficacy, great tolerability.
Just what is the key message that you're out there in the field now delivering to healthcare providers?
As it relates to NEXLIZET, it's really around all the data from our outcome study, and that's very important because, you know, we hear about competition that's coming out, et cetera. Yesterday, even during earnings, it was more about what are we doing, not what the competition is doing. The fact that we have the CLEAR Outcomes data behind us, even with the future competition coming out, their outcomes data, Merck, for instance, isn't until 2030. We'll see what happens with NewAmsterdam. We're out there talking about risk reduction, the risk reduction in fatal and non-fatal MI, risk reduction of close to 20% revascularization. We have a new ad out there that talks about hsCRP. That's important because the AHA came out and talked about that hsCRP is a biomarker that represents inflammation and should be measured for every single patient.
We reduce hsCRP by 46%, the only non-statin to do that, so extremely important. I think those would be our main messages out there. It's really about risk reduction to a patient.
The other thing is you're now in a position financially to make sure that you have the investment and the assets that you want. Can you just talk about, you know, is the field force the right size right now? How do you think about, like, making sure you're reaching the right people?
John?
Yeah.
We evaluate that on a routine basis. You know, we wanna continue to drive awareness of the franchise, as well as how we integrate and, for lack of a better term, relaunch ENBUMYST . We will look to expand to support ENBUMYST , but that also gives us an opportunity to put NEXLIZET and NEXLETOL into that team's bag, as well as putting ENBUMYST into our current [inaudible] bag. You know, we wanna continue to leverage and grow where it makes sense, and we evaluate that on an ongoing basis.
the other pieces beyond field force, like digital, you mentioned digital marketing, just where do you think you're getting the best ROI right now in terms of the marketing spend?
It's a great question. Our best ROI beyond the people, right, in the sales organization is certainly on the digital tactics. We're seeing a significant number of TRx prescriptions coming from digitally targeted only tactics, especially in geographies that, you know, we don't currently cover 'cause it just doesn't make sense to put a, you know, a person in that geography. We will continue to double down on those digital tactics to support what the sales force does.
What's your sense of the kind of patients that are being, you know, prescribed NEXLETOL, NEXLIZET right now? I guess specifically, how many of those primary prevention patients do you think you currently have? That's the biggest market opportunity, right?
Yeah. We know that primary prevention really resonates with primary care physicians. We don't have any data yet. We're working on some market research that will explore the amount of, you know, patients that are primary prevention versus secondary. Primary prevention, though, by far is one of our greatest opportunities, and that's also one of our key messages, as well. That's something that also competition doesn't have, et cetera. That's something that the CLEAR outcome study really demonstrated. The patient type is really the patient who doesn't want to take a statin, can't take a statin because of different side effects, et cetera, or can also take a low dose statin. You know, that's still viewed someone that's statin intolerant, they can't escalate. By the way, that's an opportunity also for our triple combination.
which we reinforced yesterday that's in development, and we hope to have in the market by 2027. That's really the patient type that you're looking at. It's really that statin intolerant patient, and I think the guidelines, once they come out, we haven't seen them, similar to the European guidelines, are going to reflect, you know, that statin intolerant patient. We're the only company that studied statin intolerance as well in an outcome study.
Got it. Let me try and ask another Ben question here.
I'm happy to be irrelevant here. That's fine by me.
Can you just talk a little. This is John maybe, but can you talk about contracting, and I'll tie it into gross to net. How do we think about the long term? You know, you've had the drug's been in the market now for several years.
You've established a, again, let's say gross to net that's you know fairly predictable. How do you think about now planning for the next 10 years that you can have the drug on the market?
I mean.
exclusive for?
I'll start on the gross to net side. We've done the contracting that we need to do at this point.
Yeah.
Right? We've got 90% commercial access, 90% Medicare access, and we're at a great place. At this point, we're done. We don't see needing to go back to that well to, you know, either enhance rebates or change rebates with the payers, because we have not just the breadth of access we need, but the quality of access that we need. A lot of plans don't even have a prior authorization, or if they do, it's minimal. It's, you know, electronic look back. It's nothing that's a burden to the prescriber. We don't really see that changing anytime in the near horizon. I think if you look at where we were in Q4, that's where we'll be for as long as we forecast out, to be honest.
Got it. U.S. going great. You also have some great partners outside the U.S. Can you just talk about, you know, a couple of those different markets and how, you know, you see those factors contributing to the value of the, you know, the company?
Yeah. I'll start with Daiichi Sankyo Europe, then transition to Otsuka in Japan. Daiichi Sankyo is just you know, they're knocking it out of the park. We reported yesterday they treated over 700,000 patients. They're well on their way to having another amazing year in 2026. Some of the countries are really contributing to their growth are Germany, where in Germany you cannot use a PCSK9 unless you've actually failed Bempedoic acid.
Yep.
Belgium is doing very well. The market that's doing the best, which is really a surprise, is the U.K.
Typically, and you know this, it's hard to market and be successful in the U.K. market. They've taken a full statin intolerance strategy in the U.K., and they're beating all the other European markets. Daiichi Sankyo is doing great. They're also working with us, collaborating with the triple combination, so great partnership. Otsuka in Japan, the most recent data we had was back from November, and I think we've mentioned this before. They sold more in November than they had predicted to sell in all of 2026. They're off to a great start. They have over 700 employees, 700 representatives, twice the amount of the employees we have in the U.S. at Esperion alone, out there selling the drug in Japan, which is the third largest market. That's gonna be a big market. I think they're gonna be very successful.
Ben and I were out there in December and visited them as they were going through their launch, and so we're excited about what they're doing. Obviously we have Canada that just launched NEXLETOL, Australia and New Zealand, smaller markets, but they'll be launching soon, and Israel will be launching by the end of the year. Small market.
The only thing I'd add onto that, with Daiichi Sankyo Europe, they just added France in January this year, which is the second largest market.
Yeah
In Europe. Phenomenal reimbursement for France. You know, that was a big question mark. That's with any drug, whether or not you get good reimbursement. They did, and they've really hit the ground running with France. That growth, to be adding a market that size, call it six years into the launch here, that's. You're gonna keep that growth rate going really well.
Let me ask about that. We talked about the exclusivity, durability. You made a lot of groundwork done last year, a lot of success with those settlements. Just walk us through now where you think you have clarity on durability.
Yeah, I mean, we've started planning the business past 2031.
Yeah
At this point. You know, we still have four people left in the ANDA process to settle with, but we're very confident that we'll reach a positive resolution with all four of them. You know, we think that there is a long, long roadway for Bempedoic acid to be in our hands well into the 2030s, and, you know, we'll keep everyone updated as we kind of narrow in on exactly when in the 2030s. I mean, there's a reason we call it Vision 2040.
Before we get into the details now.
Yeah
... let's just keep Ben working here.
Yeah.
Just talk us through the financial piece now. How do you feel about, you know, cash on hand, cash runway, as well as leverage now with thinking about the Corstasis acquisition?
Yeah, I mean, we ended the year with $168 million in the bank. Though candidly, we have more in the bank now than we did at year-end.
Yeah.
We are in excellent shape from a cash standpoint, which the balance sheet gets better and better every single year. We'll continue to make the balance sheet better and better every single year. One thing that when we went through the Corstasis kind of started coming up with ideas on how we tackle the upfront financing, we didn't wanna just completely relever the entire company, right? We've done a good job of chipping away at that.
Yeah
Especially relative to market cap, relative to just general company size, and so we'll continue to do that, right? We've paid off a $55 million stub last November and made a big step forward in that so far, and we'll continue to do that as we turn to cash generating company this year. You know, that's a priority, is to continue to delever.
Vision 2040, clearly Corstasis is not the end, right? Just walk us through what the pipeline today, but like again, big picture, the vision for the company and the products that you wanna bring into the organization over the coming years.
Yeah. When we unveiled Vision 2040, we did the J.P. Morgan conference. We talked about the fact that the company's built on three pillars. One, growing the Bempedoic acid franchise. Pillar number two is business development. We just did that with Corstasis. Pillar number three is the ACLY pipeline. We've already talked about Bempedoic acid. We've talked about Corstasis. We've been getting the question of, "Well, what's next from a business development perspective?" Well, this is good for now, so we're good for now with this. Integrate this, grow this, as I said, to the opportunity that it can be, which is a blockbuster status. That leads us to our pipeline where we have a lead candidate, ESP-2001. This is a drug for primary sclerosing cholangitis. Everything with that compound is going very well.
We have a really good partnership also with the community in PSC. We've actually been receiving letters from family members, et cetera, of, you know, is there any way they can help, and people are desperate for a treatment here. There's no real treatment for the disease, only treatment for symptoms. We will be in the clinic with this drug by the end of the year. What we haven't talked about is our kidney program, and if you think about heart failure, there's a direct relationship with heart failure and kidney function and chronic kidney disease, et cetera. That was the other thing about Corstasis is nice complement to the kidney side of our pipeline, which we haven't really discussed, but we will later in the year.
We've kept that under wraps, but some of the things we're looking at in kidney are chronic kidney disease, polycystic kidney disease, et cetera. It's an exciting program, and I'm just gonna put a quick commercial in. I've always said this, I'll say it again. There's not many companies that are commercializing products, especially in the areas that we're doing, you know, acquiring a product that we just did, and we got on really good terms, as Ben just talked about, and we have an exciting pipeline.
Yep.
I realize this is a show-me story, and we've shown everyone every time, and we'll keep doing it.
You really have, because if you look at it, you know, it depends, what about chipping away at the leverage ratio or dealing with the IP piece. You've given yourself that opportunity now to just go give John the opportunity to just sell the drug, right?
Exactly
Just walk us through this year. How do you think about the growth rate? How do you think about, like, your key goals for 2026?
Do you wanna start with growth rate, Ben or John? Yeah.
I'll talk about it.
If you wanna give guidance, that'd be great.
Yeah.
It's not gonna happen.
Yeah, yeah.
Yeah, I mean, look, we think that, I mean, if you wanna kind of peg it to guidance, we're comfortable with what guidance is or consensus. I always flip those.
Yeah.
Consensus is out there. You know, we don't see an end in sight to the growth rate we've been showing. This is a large market with a large opportunity, and you know, we continue to execute on that opportunity. Yeah, we think that the growth rate that we've shown and the growth rate that we've seen so far is sustainable for the long term.
Yeah. We've seen the same seasonality in January and February that we saw last year, that everyone's seen. The storms didn't help either. March, we're already seeing March pick up, which has given us, again, that momentum going into the second quarter. I have no doubt this is gonna be a successful year for us, and I hope to be here next year in 2027 saying 2026 was our best year ever, as we just said for 2025, no doubt in my mind.
Fantastic. Well, Sheldon, Ben, John, thank you. Really appreciate you being here today.
Thank you. Yeah, awesome. Thank you.
Thank you.
Great to be here. Thank you.
Appreciate it.
Thank you.