Good morning, everyone. My name is Lei Huang. I'm with the Medical Device Research team here at Wells Fargo. It's my pleasure to host this session with management of, from Lantheus. Joining us from the company are Paul Blanchfield, President, and Bob Marshall, CFO and Treasurer, and Mark Kinarney, who runs IR, is in the front, as well as Andrea, Chief Accounting Officer, is also in the front row. In terms of format, this is a 35-minute fireside chat. If anyone has questions, please raise your hand, and we can get a mic to you. Paul, Bob, thanks for joining us. Thanks for having us. So Paul, to start, there's been a lot of interest in radiopharmaceutical diagnostics recently. Can you talk about why that's happening?
As part of that, just, you know, a little more background on the company for those of you who are getting up to speed.
Yeah, absolutely. Thanks for the question. Thanks for having us. Before we get just started, a reminder that we may make forward-looking statements during today's conversation. I would refer to you to our disclosures and our recent reports for all those must-dos. I think the radiopharmaceutical space has been incredibly exciting. We are amidst what we would call a true renaissance in this space, with analysts some saying it could be a $30 billion market by the end of the decade, or I should say the beginning of the following decade. But this has really been a space that's been around for 65 years, and Lantheus has been at the hallmark of that. Indeed, I believe we have more FDA approvals or NDAs than any other organization in the world with regard to radiopharmaceuticals.
Naturally, in the early days, things were developing, and I think we saw a lot of growth in the diagnostic space, whether that was technetium generators, whether that was one of the best all-time launches in Cardiolite, now known as Sestamibi by its generic name. But I think we saw the growth in this space from diagnostics for many years, mostly in cardiac indications. And then over the last few decades, we've really seen significant growth in the therapeutic side, where the understanding of how do we direct specific radiation in a targeted manner to specific cells, recognizing that what science has determined on different cancer cells are expressing different proteins or others, can be targeted through whether it's small molecules, through whether it's peptides, whether it's monoclonal antibodies.
And then through radiochemistry, we can bind specific isotopes to those targeting moieties and deliver either a low-energy isotope, like F-18, to be able to do a diagnostic image, or a high-energy isotope, like an alpha or beta emitter, which can actually go in and destroy the tumor.
And so I think what we've really seen over the last couple of years, and I think this has been proven out with the success of PYLARIFY, I think it's been proven with the last year of the success of Pluvicto, Novartis's PSMA therapeutic, and more broadly through development in more clinical trials being done and more venture capital funding ever gone in, is we're really entering this phase of personalized medicine for both a theranostic approach in oncology, where we can find a specific tumor, we can fight it with a radiopharmaceutical therapeutic, and then we can follow it to understand progress, not to mention what we've been doing for many decades in the diagnostic in non-oncology indications.
And so I think that's really what we're seeing and the excitement of both diagnostics advancing is what we've seen, and then therapeutically, what Pluvicto and Lutathera and others have proven, and then what we're excited to be a part of with PNT2002 and PNT2003.
That's great. We'll get into that. I apologize. One minute. Excuse me, the clock is not running up here. Just want to make sure that's working. Thank you. Sorry about that.
All good.
So Paul, you were promoted from COO to President in Lantheus. Maybe just in the context of the evolution of the industry and the company, talk about how your priorities have changed and your responsibilities.
Yeah, absolutely. So I did take on a larger role earlier this year. I think it's incredibly exciting for the company. Mary Anne, our CEO, split her role from CEO and President, and so she really focuses on working with our investor community on long-term strategy, people, culture, as well as naturally BD and M&A, with myself focused more on the day-to-day operations. I think this is an important inflection for the industry, but also for Lantheus, as we have to ensure that we are seamlessly working across our core functions. And for that, I mean, our commercial teams, our R&D teams, our technical operations, and our quality teams. And from a focus perspective, we really think about it in three major horizons.
The first is obviously the here and now of continuing to expand the PSMA market, of leading with PYLARIFY, of continuing to grow that. As no doubt, I've spoken to many of you about that over the last couple of months. And then the next wave of really innovation of coming through with 2002 and 2003 of our real full entry into the therapeutic space. And that requires a tremendous amount of involvement of our commercial teams, of understanding how we're going to go to market, of our technical operations and quality teams, recognizing that unlike traditional pharmaceuticals, where those functions can be a little bit more separate because you make a product, you put it on the shelf for 6 or 12 months, and you think about distributing it as you see fit.
Here, in the case of PYLARIFY, we're making product every day at 48 sites around the country. We'll be making PNT2002 with our partners, POINT, and they'll be distributing a product that has three or four days of half-life. That's a very different ecosystem and dynamics, where you need those functions very close together. Similarly, for quality, unlike a normal a pharmaceutical, where you do a batch of production, you do the testing, and then you release it, in this case, in PYLARIFY's case, the half-life is such that you're actually testing simultaneously as you're releasing it because it's already been injected to a patient by the time full stability data is available.... And so there's a lot of the ecosystem that we have internally that needs to work quite closely.
And then I think the other third horizon, in addition to working with PNT2002 and PNT2003, is really that next generation of innovation, and that would be agents like our MK-6240 and Alzheimer's, that really are a tremendous opportunity, to advance the space, similar as we've seen in PSMA from an imaging perspective, to complement therapeutics, albeit not radiopharmaceutical therapeutics, but traditional therapeutics. And then obviously working, with Bob and members of our BD and other teams to really help, identify external innovation that we can continue to bring in-house and be the partner of choice.
Excellent. Very helpful. So maybe just start with PYLARIFY and talk about what it is, what it does, and why has the launch been so successful?
So PYLARIFY is a PSMA PET imaging agent, and so, the vast majority of prostate cells, about prostate cancer cells, about 90% express PSMA imaging, on the external portion of the cell. And so what PSMA image, PSMA PET with PYLARIFY is, is it targets specific PSMA cells, targets that are expressed by prostate cancer cells. It is bound with an F-18 isotope, which is a relatively low-energy isotope that is manufactured on a cyclotron, which has been around for decades, and indeed, FDG has about 2 million doses, so this is a tried and true manufacturing process. It is made at these 48 centers around the country every day, and we produce doses that come off with an individual patient's name, with a location where they will be dosed at and with a time that they will be dosed.
Those are then delivered from a PET manufacturing facility around the country. Indeed, there's one just north of Boston here, that would distribute to all the relevant hospitals and imaging centers that have a patient scheduled for that day. It would be administered. There's a waiting period where we wait for the drug to uptake and for the PSMA to target the specific cell. Then that patient would undergo a PET imaging agent, a PET image, which would then scan the body and identify the photons that are being emitted from that agent to identify prostate cancer cells. This has been game-changing for the industry. Indeed, some KOLs have said this is the biggest innovation in prostate cancer since the development of the PSA serological test in the 1980s. And what this really does is it allows us to find and to follow prostate cancer disease.
Prior to PSMA imaging, we had other imaging, non-PSMA PET, we had bone scans, we had CT, which to some extent would help you identify where disease is. But with the arrival of PYLARIFY, we can see the extent of disease as well as the location, more so than we ever have before. And this has dramatic change in patient management, as we've seen by some of our data, where two-thirds of patients have a change in intended management. Because the expression of PSA from a serological level will tell you to the extent of disease, but it won't tell you whether you have one large metastasis on your collarbone or whether you have 10 smaller mets, which are going to require a very different treatment. If you have one met, you may undergo surgery. If you have oligometastatic disease, you may go under localized radiation.
But if you have many small mets and the cancer is far more developed, that's going to dramatically change your treatment, potentially to systemic therapy and potentially bypass what had been a common procedure of prostatectomy, which, if you already have metastatic disease, could actually be unnecessary and not only create the traditional complications of impotence or incontinence, but actually miss some of the other disease that you need to actually treat. And so I think that innovation, we think and our CEO likes to say, this was a significant unmet medical need with a great innovation, that really was a great marriage. And then the execution that our teams have really focused on being able to get this available, reimbursed incredibly quickly and promoted and educated the community, has really led, to the success that we've seen over the last couple of years.
Very helpful. Can you talk a bit about the plan for PSMA PET imaging? You know, just given the results that we're seeing in Q2, you know, the market seems to be about 70% penetrated. What's the right way to look at kind of opportunity?
Happy to. We talk about this a lot. We talked about it a bit this morning. I think to start, if I go back in history, before we launched PYLARIFY, we highlighted a specific total addressable market. It was close to $1 billion. Many people said we were crazy. It was nowhere close to that size. Why would you put out a number like that? Tides have turned a little bit now and people are saying, "I think your TAM is understated. You probably need to raise it again." I think the TAM is really total addressable market, is really more of a current addressable market. And our guidelines, the way we characterize our current addressable market of $1.6 billion is a combination of what our label says, which is incredibly broad.
As an example, it says, for risk of metastases, it doesn't define what that level of risk it could be used for. Indications, I should say, guidelines, what NCCN, what SNMI, what the AUA say from a guideline perspective, where it should be used. In the example of initial staging, it's recommended to be used in intermediate, unfavorable, high risk, and very high risk, which is more narrow than our actual label says, and then what medical practice is. And so we've raised the TAM, now current addressable market, three times in the past few years. We currently estimate it to be about $1.6 billion or 350,000 scans. Other players in the market have suggested just recently that it could be over $2 billion. And so we still think there's ample room.
While we think the current addressable market is about $1.6 billion. There is still significant opportunity, not only in disease prevalence and incidence, which continues to grow, but in major adjustments that could be coming, including with the launch of radioligand therapies, PNT2002 or Pluvicto, in earlier line therapies, meaning first or second line. That could unlock potentially 70,000 patients that could be eligible for those treatments, and based on those labels, at least with Pluvicto, you would require a PSMA scan to demonstrate that you are avid for the disease. And then you may see additional scans to monitor progress, as well as a new baseline.
And so between that, potentially between the addition of intermediate favorable over the medium term, and then continued physician practice that evolves on the frequency and numbers of scans, we think the $1.6 billion could be much bigger, but we've currently said the current addressable is about $1.6 billion.
Got it. So as you think about, you know, guideline updates and indication, disease expansion, et cetera, you look ahead, do you see the similar, I guess, similar magnitude of step-up? You know, you went from $1 billion to $1.6 billion. Could that go up by similar magnitude or perhaps even more?
I think it could certainly go up by a comparable magnitude. Like I said, other players have come out and said it's roughly $2.3 billion already. I think we spend a lot more time in these types of settings talking about the CAM and the TAM than we do internally, recognizing we're very focused, that there's a significant opportunity. We're only 2.5 years, if you will, into launch. It takes a lot longer for us to fully penetrate a market, as seen by everybody else. And while we think our team has done a fantastic job, we don't think we've maximized the opportunity in 2-3 years when the vast majority of our industry takes 6-7 to even see peak sales potential.
And so we still think there's significant growth, going forward, but that growth will not necessarily be linear in a straight line. There will be lumpiness as those new patient populations become available.
I think that's important. To the POINT is the fact that, particularly like the radioligand therapies, those are like, call it 2025, 2026 kind of developments. And so what it does is gives us confidence as we look forward, over the next years, to see that sort of CAM grow, if you will, within the broader TAM.
Very helpful. So maybe you can talk a little bit about the competitive landscape, what you're seeing in the marketplace, and how do you think about that growth trajectory over the next few years?
Yep. So we've certainly seen more competition come into the marketplace. We've anticipated this. There are now four gallium agents that are approved for PSMA, two academic, two commercial, one by Telix and one by Novartis. And there are now, as of the end of May, two F 18 PSMA agents, naturally PYLARIFY, and then Blue Earth came out with POSLUMA. We've anticipated this. I think, first and foremost, better choice for the patient and physician community is a benefit for all. And indeed, greater awareness helps raise the tide for everybody to go out and to demonstrate the benefits. We're only two and a half years, if you will, from first approval.
And so while we talk about PYLARIFY every day of the week and twice on Sunday, there are still physicians out there that are not using it, or using it for all their potential patients, and that could be within radiation oncology, oncology, urology, understanding guidelines specifically of how they're going to use. And so we think that broader education helps us, and really helps the overall marketplace. We do think we are very well-positioned. We do believe that there are inherent benefits from the scalability of F 18, given that we're effectively building on the backbone of what makes 2 million doses from FDG on an annual basis. So that's an existing infrastructure. We don't have to go out and build PET manufacturing facilities. Those have existed for decades. They already have relationships with customers. They're used to bringing those customers' doses.
The ordering mechanics are already in place. So we do think there are advantages there. Overall, when we look at PYLARIFY versus our competition, we also see what we believe are sustainable, differentiators, both commercially, whether that's our PET manufacturing network, whether that is our first-mover advantage, whether it's the relationship that we've already built in some of those relationships, whether it's the benefits of F 18 versus Gallium-68, as well as clinical differentiators. We believe that while the indications of the vast majority, other than patient selection for radioligand therapy, are the same, there are clinical differentiators that we think are evident in the trials, and we believe physicians are starting to understand, more in practice.
That's helpful. So it sounds like there's a lot of momentum in the industry and the business. You did see growth slow sequentially in Q2. Bob, maybe you can just touch on that and then talk about, talk about what happened there, and then how do we look at second half 2023 and beyond?
So we had... You know, obviously, people were focused on our Q1 performance, growing sequentially 22% for PYLARIFY specifically, and then I think, going to 8%, on an unadjusted basis, as it were. We actually were very pleased with the performance. As Paul just mentioned, you know, growth is not always going to be so, so directly linear. And so as we think through, even through the balance of this year, we have learned a lot about how this business is growing. You know, but still, you know, the first couple of years, the first 18 months were with a rocket ship. And so as you think through some of the dynamics that happen on an interquarter basis, we, you know, we have better insight into that as we look forward.
As we noted on the call, and have talked about more extensively in these last couple of months around the thing about, we call it seasonality or vacationality or whatever we want to call it, but we do see impacts around holidays. And so as we think through the year, the first half of the year has basically one sort of major holiday in Memorial Day. But as we look forward into a July 4th, Labor Day, and then you get into Thanksgiving and Christmas, we know that the second half has a larger impact than you see in the first half from just that kind of a dynamic. In the past, that was shielded by the fact that we were just growing exponentially by adding new PMFs, new customers.
And so now we're into a phase where the addition of new customers, you know, we've added up, you know, we do continue to add, but not at the same pace as we were earlier on. And we've, you know, we're bringing the the PMF sort of network to more fulsome coverage. So now it's about market expansion and getting back to referring physicians and so forth. So we're very confident about, you know, how the balance of this year looks. If you take our 8% and annualize it, which is, you know, 30%+ on an end or year-over-year basis, we're very pleased with the, you know, the continued growth in the product and its potential for the future.
Great. Paul, on the earnings call, you mentioned that CMS is looking for some comments on some proposals. Maybe you can just expand on what's going on there and how do you think about the process?
Yep, absolutely. So another key topic that we talk a fair amount is the passthrough dynamics. So the current construct for radiopharmaceutical diagnostics is that CMS pays in the traditional hospital outpatient setting for Medicare fee-for-service. They pay a distinct rate. They pay for the procedure of PET, and then they pay for the radioisotope distinctly, for a three-year period known as passthrough. Our passthrough period started January 1, 2022, and then would expire at the end of those three years, January 1, 2025, and so that would be the three-year period. This is a bit of an artificial construct but has been in place for many years because PET-CT radioisotopes are considered medical supplies, largely because you cannot perform a PET-CT without a radioisotope.
A PET-CT picks up the photons that are being emitted from those radioisotopes, and absent that, a PET-CT scan wouldn't show anything. But because it's effectively a required part of the procedure, CMS has reimbursed it as though it is a bundled part of that procedure. And the challenge that could be on the horizon is that with 2 million FDG doses done at approximately $150-$200, that would bring the weighted average post passthrough in a bundled environment significantly down. And so hospitals for that select group of patients could have a financial incentive to skip to different PSMA PET imaging agents as they come on and come off passthrough. Now, what came out in the middle of July, which was incredibly exciting, was that CMS came out for the first time in 15 years, and I...
Recommended, I should say, put forth five potential rules regarding radiopharmaceutical diagnostic reimbursements, three of which are specifically pertained to the passthrough dynamic. One relates to clinical trials, and the other relates specifically to Alzheimer's. Based on feedback that they've heard, they recognize that there is a challenge where there is an artificial dynamic that could really impact patient access, meaning a hospital could be incented to use a different product for no other reason than there's a rolling three-year reimbursement dynamic. They put forth three specific rules. They put forth five, three of which would particularly address the passthrough dynamic, two of which are codifying separate payment for radiopharmaceutical diagnostics above a specific threshold. One would be $140, which is effectively what they do in the therapeutic space with regard to passthrough.
The other would be at a predetermined rate of which they're collecting feedback, and the third would be to create effectively disease area APC bundles, where they may, as an example, bundle all PSMA imaging agents and create that as a bundle and pay for that on a weighted average basis. All three of those would work. We are working with industry, as well as other stakeholders like the American Hospital Association, like the Society of Nuclear Medicine, with patient groups and with other members of the industry, to provide comments to CMS, which would be due next week, and for them to rule in November and December, which would be the roughly timing that could go into effect, January first of next year, based on their rules. I think this is incredibly exciting.
For the first time in 15 years, they've clearly seen this as an issue. It doesn't cost CMS very much at all. The only difference is they'd be paying plus 6% because it's effectively a different bundle. We estimate it would cost CMS between $40 million and $60 million, which, if you've seen the CMS budget, that's effectively a nominal amount of money. And it's an exciting avenue that could effectively fix this artificial construct as of January first, 2024.
It's also related, and some of the language is very similar to what we see in the FIND Act, which is legislation that is on both the floor of the House and the Senate and has bipartisan support, that from a legislative perspective, would do something very similar to the CMS rules, providing for separate, distinct payment rather than this artificial take all PET-CT agents and many other medical supplies and pay for them on a weighted average basis. And so we think this is an exciting development.
We obviously talked about it at our second quarter call and then are working extensively with our coalition partners to ensure that CMS receives common guidance as to what industry, patients, the broader community would benefit from and are hopeful and optimistic that they'll take action in November and December to come out with rules that would negate this artificial construct beginning January 1, 2024.
... Very helpful. Let's move on to PNT2002. Can you just talk about the prostate cancer, cancer therapeutic, its partner with the POINT Biopharma? You have a phase III study ongoing, maybe a little bit on the timeline for the data.
Sure. So I think when I talked at the very beginning about kind of this renaissance in radiopharmaceuticals, I think some of the success that we've seen with Pluvicto has been a big driver of that. Pluvicto is Novartis's approved agent. It was approved about a year and a half ago. This is the first full year that it's been on the market. It is approved in the post-chemo post-taxane therapy, in other words, third line. Even with some supply constraints this year, where they have not been able to add new patients for a number of months, Novartis has said publicly that it'll do over $1 billion in sales in a post-chemo, third-line setting with supply constraints. And overall, I think we think that demonstrates the potential of radioligand therapy more broadly, but obviously specifically in prostate cancer.
What we have done is, last November, we announced a partnership with POINT Biopharma, where we licensed global rights, ex some APAC markets, to PNT02, for prostate cancer, as well as PNT03 for neuroendocrine tumors. PNT02 is being studied in the pre-chemo setting, effectively first and second line metastatic castrate-resistant prostate cancer. That is done through the SPLASH trial, which is our phase III registrational trial that is being run by POINT. That is a partnership, and so POINT is responsible for the R&D development and for the manufacturing. We are responsible for the end-customer logistics, as well as the commercial and any future lifecycle management. And they've said publicly, and we've said, that we would expect top-line data from that SPLASH trial to come out in the fourth quarter of this year.
Now, from an overall dynamics perspective, Novartis is also pursuing lifecycle management for their Pluvicto agent in a comparable setting. They have a PSMAfore study, which is also pre-chemo, effectively first and second line. At a high level, they released that they met their—they had positive outcomes or met their primary endPOINTs in December of last year. They have not yet released data from that. The anticipation or the rumors would be that that could happen sometime later this year. Then PNT2002 would go head-to-head effectively with Pluvicto in the pre-chemo setting. There would be a comparison of PSMAfore data, which again, could come out this year, versus the SPLASH trial, which could come out this year. Similar patient population, somewhat similar approaches in terms of targeting moiety, both use lutetium-177, a beta emitter isotope.
However, there are differences from a dosing dynamic. And so PNT02 is being studied 4 doses every 8 weeks, whereas Pluvicto is being studied 6 doses every 6 weeks. And so it's not exactly like for like, but we're optimistic to see the data, to understand what PSMAfore's data looks like, and to really begin the foray into a very large, exciting market, and to complement what we've been doing in diagnostics in PSMA to complement therapeutics.
Great. Can you just touch on the TAM for the opportunity?
We've said publicly, when we announced the deal in November, that there was approximately a $3.5 billion+ current addressable or future addressable market for this. We highlighted most recently on our earnings call that we think that could be conservative, given Pluvicto's already doing $1 billion+ in their first year in the post-chemo setting. Clearly, this is orders of magnitude larger than what it could be in the diagnostic setting. We haven't come out and said exactly what that's going to be. Characterizing that is ultimately going to come down to how many of those prostate cancer patients are likely to be eligible for therapy, but it does open potentially 70,000 additional patients to undergo a course of therapy.
And so it's a very large market that could be meaningful, clearly, for Novartis, and if it's meaningful for Novartis, it could be even more meaningful for Lantheus.
Of course. Makes sense. Let's talk about another pipeline product, MK-6240. Maybe you can just touch on, you know, Lantheus's interest in the Alzheimer's space and why this product?
Well, I'll start by just... The interest in MK-6240 really kind of came from a genesis of building on our pharma services business. This is where we have some of our novel assets. We use PYL in this particular setting with PYLARIFY being used in other clinical studies by generally large pharma or other partners in their trials. And so it's a great way for us to not only advance our understanding of how these products can be used in the different clinical settings and different trials, but it also gets us data. And so the opportunity to be able to obtain the asset in terms of MK-6240, you know, it's a tau tangles imaging agent for Alzheimer's.
You know, that in and of itself is a very interesting space. It's a second-generation diagnostic and it with, you know, a lot of good sort of industry pickup. It's being used in more than 60 trials at the moment. So from a inclusion in these in our pharma services business, which you can see from some of the guidance, I even increased the guidance in terms of its overall revenue contribution for the year, increasing it based on the great uptake we're still seeing with it. Now, it could have, you know, we'll advance it continuously this way, but it could have commercial applications, particularly as you see it being used in a lot of therapeutic clinical trials by large pharma.
I don't know if you want to add to that, Paul?
Yeah, no, I think that's really the next leg that I referred to early on. I think we're incredibly excited about radiodiagnostic imaging for Alzheimer's. I think we've finally seen some progress from a therapeutic perspective, which is fantastic for the patient community. Now, to be transparent, we're never gonna treat Alzheimer's with a radiopharmaceutical, but from a diagnostic perspective, to be able to understand, either with existing agents from an amyloid plaque perspective or tau tangles, we believe that it would be appropriate, and I think trials are already being developed, to identify who may be eligible for these therapeutics. And then as CMS and Medicare and others are looking at payments, to track progress in what could be multiple years of treatments for tens of thousands of dollars per year, potentially, that they're gonna wanna understand what a baseline looks like, what response looks like.
From a strategic perspective, we think the Alzheimer's PET imaging or imaging market could be quite significant, when you think of the number of patients that are suffering from Alzheimer's today. Strategically, this fits very well into what we do well. MK-6240 is an F-18 isotope that is manufactured at PET manufacturing facilities around the country and indeed around the globe. It is delivered to PET-CT centers, where scans are being done. As we talked earlier about our overall business being largely diagnostic now, we're focused on therapeutics in O2 and O3 and other things we might be looking at, but we also recognize there's a significant marketplace for diagnostics. We have a partnered asset with GE, Flurpiridaz F 18, in cardiac imaging, where they have the rights and we receive a royalty.
We look at MK-6240 in Alzheimer's. There are other applications of radiopharmaceuticals in the diagnostic space that is certainly a very nice potential contributor for a company the size of Lantheus, even if large pharma remains focused on the therapeutics. We'd be very comfortable with multiple PYLARIFYs over the next couple of years to contribute to the business.
Makes sense. Just a few minutes left, remaining. Bob, just maybe on margin, quickly, your operating margin's been in the more mid-40% range. How do we think about that as, over the next few years? Is that steady state?
Yeah. So I think you're referring to, yeah, our EBITDA margins that we had-
Sorry.
Yeah, that's fine. Which have been running sort of in the mid-40s. I want to say it was last January, we had sort of updated our expectations that we would see it over the next 5 years as a 45%+ kind of opportunity. Now, what that takes into consideration is the build-out and investment ahead of PNT2002. For instance, from a commercial perspective, some of the learnings we've had from PYLARIFY is that you, you know, you invest ahead of the curve with the opportunity to really sort of hit the ground running, as opposed to incrementalizing your way into a launch.
So the opportunity is there, and, you know, I'd see gross margins, for instance, moving towards that 70% range, you know, with EBITDA margins down at, you know, like I said, that 45+. And what's really important with these kinds of numbers is that we're generating free cash flow at a significant pace. And, you know, currently, it's been running over the last, I don't know, three, four quarters at $100 million a quarter. So what it's doing is allowing us the opportunity to build liquidity and access to liquidity, not only through expanding EBITDA, but also through cash on the balance sheet, to be able to continue to execute against this strategy that the company has been engaged in for the last, call it, four years.
Great. Thank you. Paul, any last word?
I think we're incredibly excited about what we've done, but I think we're even more excited about the future. The renaissance in radiopharmaceuticals is very real. We've been speaking about it for four years. It took a little while for it to come to fruition, but I think what we're seeing in this space, both diagnostically and therapeutically, is incredibly exciting. And I think what gets us even more excited is that we are incredibly well-positioned. This is not a core set of capabilities that any traditional company can copy. There are barriers to entry. There are specific skill sets from a development perspective, from a radiochemistry perspective, from a regulatory perspective. It's not just the FDA, it's the NRC, it is the Department of Transportation in being able to manage this supply chain.
We look at market access, we look at commercial, and then we look at the manufacturing, and we think there are differentiated capabilities that will continue to make us the leading radiopharmaceutical-focused company going forward. That gets us really excited to keep going on the journey that we've been on.
That's great. Paul, Bob, thank you so much.
Thank you for having me.
Appreciate it.