Okay, let's go ahead and get started. Welcome, everybody, to the second day of Evercore ISI's healthcare conference in Coral Gables. With me today, I have the pleasure of hosting LENZ Therapeutics. With me is Eef Schimmelpennink, CEO of LENZ. Eef, welcome. Thank you so much for coming down and spending time with us. Very successful year so far. You had a lot of the product just got approved. But before we delve into Q&A, we'd love to kind of get your overview of the business and what we could expect in the next, perhaps, 6 to 12 months.
Absolutely. Thanks, Marc. Thanks for having us here. Always a pleasure to be here at the Evercore conference. Like you said, very exciting year. Got our product approved a little early, actually, end of July, leading into a launch early October of this year. And for those, and I know many of you in the room here, but for those who are not familiar, LENZ Therapeutics has developed a presbyopia eye drop. So it's a once-daily eye drop that you put in in the morning that restores your near vision for the full workday. So a highly efficacious product for a huge market. Everyone over the age of 45 pretty much becomes ultimately presbyopic. You'll recognize us as we hold our phone far away from our faces, or we've got our reading glasses on and off.
This product brings your vision back to what it was before the age of 40, 45.
Got it.
So it's a drop that, like I said, you put in in the morning, restores that near vision, and we've launched that early October. Q4, so this quarter is really focused for us on exiting the quarter with a very solid base of ready-to-prescribe doctors. That's really the aim of this quarter. Because in Q1, and I'm sure we're going to talk about that, that's when we'll turn on our DTC campaign. This is a very DTC-sensitive population or product. So you want to make sure that as you start sending patients in, you have doctors ready to actually welcome them. So what that means is that we're focused in these months on driving awareness, so making sure that people, our doctors, are aware of this product.
The next thing is to drive confidence and give them the confidence in the product, which means that we've put a lot of samples out in the market already, and we'll continue to do that. First thing that these doctors do is open up a pack, use it on themselves, open the second pack, use it on a couple of their staff members, really to get that experience of what does this product do, and a third one is to ultimately have them to write prescriptions, so just to finish that piece off, which is where we left it at our earnings call in November, so that was after just four weeks of launch, we shared that the awareness is very, very high already.
We have over 90% awareness for this, which is unheard of, I think, for a product that has just launched and the brand has just been announced a couple of months before. If you think about the confidence of the samples that were out there, we already had samples at 7,000 doctor offices. So that's about 8,000-9,000 doctors that had access to samples. And even after just four weeks, that already translated into 2,500 doctors writing scripts, over 40% more than once, totaling, again, in just those four weeks, over 5,000 paid and filled scripts. So great numbers in our minds to start off with.
So yeah, even though it's still kind of early in the launch, it's a very heavy sampling quarter. You want to drive awareness. At the end of October, you had more than 2,500 doctors who've already prescribed this. I mean, I got to think that that's a pretty good comparator to if you think of all the analog launches that people use to compare, that stacks up pretty nicely, right?
Absolutely. Yeah. Now, just getting, like you said, 2,500 doctors to that point where they're willing to prescribe, and that many already more than once in our minds signals a very clear foundation. That number is obviously growing. That's not where we stop. I can't share those numbers yet, but you would expect from us to see a good growth in that number.
Got it. So there's been some talk on different channels of distribution, e-pharmacy versus the conventional retail channel. As DTC comes online in Q1, as the coverage broadens, do you have an explicit plan to prioritize one fulfillment channel over the other? And kind of what mix between these two channels are you kind of predicting by end of next year, possibly?
Yeah. No, great question. So if you think about our commercial strategies, three-pronged. I spoke about the first one, getting doctors to recommend us. The second one is drive patients and get them to request us by name. That's a DTC campaign. The third one is easy access to the product. So easy access means for us, one, easy to get a sample. We spoke about that. And then also easy to get your script filled. So to get that done, we've made sure that we have two channels, and both are now up and running. Initially, we only had the e-pharmacy up and running in the first four weeks. That's just a logistical on the back end with the wholesalers to get the retail pharmacy up. That's up and running now as well.
So it's really the choice of the consumer to say, "I'd like to get my script filled at the e-pharmacy." Now, there's a couple of advantages there that we'll make sure they know of. It's fixed pricing, guaranteed pricing. It's also the only place where they can get a three-pack, which is slightly better priced for the consumer. But they might also say, "No, I'd prefer to just go to my local CVS like I do for my other medicines," and that's fine as well. So for us, from a bottom-line P&L perspective, there's no difference on either of the two channels, or whether it's a one-pack or a three-pack. It all works out to effectively the same net price.
For those of us who are essentially tracking launches, we go to IQVIA IMS prescription data. The e-pharmacy volume, that won't be trackable, right, in IMS? Is that correct?
That's indeed correct. What we saw early on, so we expected it not to be tracked at all, zero. When we looked at the first couple of weeks, we actually saw that Symphony picked up some what they call mail order, which is our e-pharmacy. It wasn't correct, but at least directionally, it was trending a little bit. So we shared with the street that we were surprised, but just wanted to make sure that everybody realized that they were tracking somewhat. We don't know where they got the data. It's probably some EMR feed that they pipe into. That has actually become less well from a less validated, if you will. So we're back to don't look at the Symphony data, don't look at the IQVIA data. It's off. We'll do our best to continue to provide updates as we have them and as they're relevant on script data.
Got it. So I mean, in lieu of actually looking at this hard prescription data through either Symphony or IQVIA, what other qualitative metrics do you plan on providing investors on quarterly updates to help them get a better sense of how the launch is going?
Yeah. So I think initially, we'll continue to update on some of the key metrics that we started to talk about in our November earnings call. So what are the amount of doctors that are prescribing? What are the amount of doctors that are prescribing more than once? What are the total scripts that have been filled? I think that's going to continue to be the focus, especially in Q1, as we turn on DTC. So what most people and us definitely want to see here, and let's call it the first half of the year, is that once we turn that DTC on, we see a nice steady growth in your NRx. So the amount of new patient starts needs to continue to grow very well. Now, you need to realize that we will turn DTC on in Q1, as we've mentioned.
That will take a couple of months to really take its effect and really see the impact. Patients need to see that ad a couple of times, need to make the decision that they want the product, schedule an appointment with an optometrist, mostly an ophthalmologist, then get the samples, get the product, so there's a little bit of time that goes over it, so that's really the focus of the first half of the year, and the second half is where we're all starting to look at, great, you've established this growth rate of new patients. What's the refill rate on it? How many patients are refilling and how often?
I see.
So that's then where we'll transition more into those metrics.
And so I guess in the back half of the year, once you do kind of get a better handle on refills, you'll start communicating metrics like that to investors.
Absolutely. So that's when we'll start to share what's refill rates, what do we see in the one-month pack versus the three-month pack. That all needs to stabilize a little bit out, stabilize a little bit before it makes sense to really look at that data.
Got it. And just forgive me, for folks less familiar with the story, maybe just spend a minute or two just kind of explaining how VIZZ is better than the market incumbents and why doctors are kind of choosing it over what's available currently.
Yeah. No, because it's great, and we see that in many of our meetings here and elsewhere is that we immediately jump into the numbers now, but stepping back, we're very enthusiastic about the numbers. We're happy with what we're seeing. We're obviously seeing a lot more than what's currently out there, but what's making us, even what's pleasing us even more is that the product profile that we saw in our clinical trials is playing out in the real world. I know that many of you in the room here and elsewhere are doing dozens of doctor calls, and we're hearing a lot of your feedback now, and the feedback is very consistent. The product works, and it works really, really well.
So like I mentioned earlier, you can pretty much guarantee if you put a drop of this in somebody's eye and they're a presbyope, they'll be able to see up close again in usually 10-15 minutes. And the duration is there. What we saw in our clinical trials is at 10 hours, still 70% of patients at least 20/40. We see that in the real world as well. Anecdotally, we're hearing 11-12 hours. So that duration is there. And it's very consistent in the feedback. It's what doctors see with pretty much every one of their patients.
Got it.
The distance vision also improves. We saw that in our clinical trial as well. The trial wasn't set up to do that. We're hearing it anecdotally here as well. So people notice that that distance vision improves. They usually describe it as it's more crisp, it's more vivid. It's just better for them in distance as well, and it continues to be a very comfortable product in its use. We were focused on one of the key headache or key AEs for miotics can be that they drive a little bit of a headache. We saw just a little bit of that in the trial. We're actually not seeing a whole lot of that in the real world now, so very pleased with that. The two AEs that come up is that it's a drop that on the first day, first instillation might sting a little bit.
If you put it in, it's a very short lift, 10, 15 seconds, and it will go away. Day two, day three, a lot less, and it just goes away after the third day of use, and some people might see a little bit of hyperemia, eye redness, same thing. That's mostly a day one issue if it is an issue at all, and then day two, day three, it's a lot less, so what we're focused on now is making sure that doctors set those expectations well. That was always the plan, and tell people to, or tell consumers to use this product for a couple of days. You'll notice that on day one, your near vision improves. If you have any of those side effects, they'll be gone by day three.
Got it. And you said something that actually triggered a memory. It's almost counterintuitive to think that it would also improve long-term vision. You think presbyopia and near-term vision, why would it also improve long-term vision?
Yeah. No, it's actually the same mechanism. So if you think about it and you ask how is the product different from other products, and I'll answer that as well, because it all comes down to creating a small pinhole pupil, and how small is good enough? It needs to be below 2 mm. There's ample data out there, and obviously our clinical data supports it. Frankly, the Vuity data supported it as well if you parse it by pupil size. It's not until you're below 2 mm that your near vision, your depth of focus really increases. For distance vision, it means that what's called higher order aberration. So most of the flaws are on the outside of your eyes. If you have a smaller pupil, you effectively block those off. So the light rays that normally would get refracted there no longer get that.
It's almost as if the quality of the light that hits the back of your eye is better. Again, that's a very noticeable effect for people. In our clinical trial, we saw that 41% of people actually improved at distance vision by at least a line, which is especially impressive if you realize that these people were all 20/20 or 20/25. Distance corrected. Either they were emmetropes that were 20/20 by themselves, or they were distance corrected, and they just wore that distance correction. They still improved the line.
More about your marketing strategy. You built the DTC launch, the future DTC launch, I should say, around a highly defined metropolitan female early adopter profile, Sarah Jessica Parker. How do you think about evolving that messaging to kind of reach, broaden that, to reach the broader presbyope segments as awareness builds?
Yeah. So we're very happy to have Sarah Jessica Parker, or SJP, as she likes to be called, we've learned, as our spokesperson for VIZZ. She was the number one on our list for a long time. And there's a lot of work that goes into bringing somebody like that on. That's not us deciding who we like best, but there's a lot of research that goes into it. And she consistently scored the highest for if you think about what our target population is. The other thing is that we wanted somebody that actually enjoyed using the product. So we didn't sign her up until early October because that's the first time that we had samples available. So one of the first packs was sent to New York. She tried it, immediately texted back that this works.
She's an avid reader, as I think many of us know, and she was really impressed by it and continues to use it. So if you think about the profile of our consumer, and we see it in the data now as well, it skews slightly female, like 60-40, and we see that exactly in our script data now. It's used in all ages. We've seen people ordering it at their 75th year of age. But definitely, there's a larger group between 45 and 55, then the second largest is 55-65, and then 65 and over. So if you think females in that 45-55 age range, more affluent, urban-based, she relates very well with that. So again, stoked to have her on. Ultimately, yes, we'll broaden that. That's a large part of the population, but there's a lot more to be had. But that's the common later stages.
Do guys just simply have less of a problem wearing glasses?
I think that's part of it. Maybe it's a little bit more the aesthetic piece. It's still, it's 60-40. It's not like it's 90-20. So it's different than a Botox population, but it just skews a little bit that way.
Got it. Got it. How do you view your path ahead in terms of potentially funding growth internally versus raising additional capital at this point? I know you think in the past you said that given the seemingly great launch trajectory, you're probably good until break even. How should we think about that?
Yeah, we've been guiding that actually from the moment that we went public over a year and a half ago now. And when we went public, we had about $200 million of cash. We're now 18 months further, and we actually have about $325 million when we launched the products. So we have a very, very healthy cash balance. So that guidance that we gave off earlier that then cash could get us to cash flow positivity, obviously that message has become even stronger. We're not guiding to what that time point is, but most analysts, all analysts actually have that inflection point in 2027. So we don't see ourselves raising any additional capital. We definitely don't need it to fund the launch. The launch is very well funded. We're doing everything that we want to do.
And then we have a lot of cash left to double down on things that we see working.
Excellent. I want to touch upon the ex-U.S. market a bit. You build meaningful ex-U.S. momentum in China, Korea, Canada, and Europe is kind of in process right now. How do you see, I guess, these external partnerships contributing strategically over the next couple of years?
Yeah. Now, logically, there's a huge market in ex-U.S. as well. There's 1.8 billion presbyopes globally, 128 million of them in the U.S. So huge opportunity speaks for itself. So we licensed China early about three years ago now because they had to do their own clinical trial that read out over a year ago now and formed the basis of the submission that went in in June of this year. They had identical data coming out of that trial, which was obviously, again, highly validating that in a different race with different company, different country, exactly the same data. So that's China. Then we licensed Southeast Asia. You might have seen that this Monday, last Monday, we actually announced that the submission for South Korea went in. So again, obviously a key market with a lot of potential there.
The other markets that will follow, we've licensed Canada with Théa. For Europe, we're actually driving the submission ourselves. We're no longer, or we never were actually in a hurry to get territories licensed. We don't need it from a non-dilutive capital point of view, and we strongly feel that as we progress the launch in the U.S. and as we start to show publicly what we see internally already, obviously the value of a product like that will go up in those markets, and similarly, that goes for Latin America, so you'll continue to see us license markets as we feel opportune to do.
Excellent. Maybe in the last 40 seconds we have left, Eef, and I ask this of all my companies that I host, what would you say is maybe the one or two things that, or nuances, I should say, that the street may not be appreciating fully that you would like to tell folks out in the audience about?
Yeah. No, I think if we in all the meetings with the investors, they get it really well. There's clearly a strong cohort that is in the stock. We've really seen our investor base move to more mutual funds, more long-only funds, and it's been a little bit refreshing in ways, that to hear them talk is a slightly different view, and to quote one of them, it's a, "Okay, let me get this right," so you got a product that works, and all my doctor calls confirm that, and you got 128 million population that can need the product. Somehow you're going to connect those dots. You'll be able to make hay out of a product like that, so thanks for that.
Unfortunately, we're at time, but this has been very informative. Thank you so much, Eef, for spending time with us.
Thank you. Thank you for having us.
Okay.