Good day, everyone, and welcome to today's Neurocrine Biosciences Report Second Quarter Results. At this time, all participants are in a listen-only mode. Later, you will have the opportunity to ask questions during the question and answer session. Please note today's call may be recorded, and I will be standing by should you need any assistance. It is now my pleasure to turn the conference over to Vice President of Investor Relations, Todd Tushla. Please go ahead.
Thank you, operator. Good afternoon, everyone, and welcome to our second quarter 2022 earnings call. With me are Kevin Gorman, our Chief Executive Officer, Matt Abernethy, our Chief Financial Officer, Eiry Roberts, our Chief Medical Officer, Eric Benevich, our Chief Commercial Officer, and Kyle Gano, our Chief Business Development and Strategy Officer. During our call, we will be making forward-looking statements. These statements are subject to certain risks and uncertainties, and our actual results may differ materially. I encourage you to review the risk factors discussed in our latest SEC filings. After our prepared remarks, we'll head into Q&A, where we'll try to get to everyone's questions. Now I'll turn the call over to Kevin Gorman.
Thank you, Todd, and good afternoon. As Todd said, we're going to all keep our opening remarks short to give us enough time for your questions. Ingrezza had a very good Q2, and coupled with our outperformance in Q1, we have had an excellent first half of the year. Eric is going to take you through the quarter in a bit more detail in just a moment. Now, in addition, I'm very pleased to say we continue to grow our pipeline, adding two new compounds with validated mechanisms of action in psychiatry, and Eiry will talk a bit about those two. Now, as you've seen in our press release, our signal-seeking essential tremor study did not yield a strong enough data set to warrant any further development of this compound in ET at this time.
While disappointing, we have a rich and diversified portfolio, and these resources will be rapidly redeployed. Now, finally, I'd like to say that I am very pleased with the overall performance of the company thus far this year. We and here I mean the larger we, all of business and society, are dealing with the transition out of a pandemic and into an endemic situation with COVID. Thankfully, in 2022, COVID much more rarely causes severe disease and death, but it is still highly disruptive to business as usual throughout the world. Increased absences due to testing positive stretches all resources thin at times. We see that in both our clinical and commercial businesses. Times are still uncertain, but we continue to move forward on behalf of patients, and for that I am very proud. I'd like to turn it over to Matt now, please.
Good afternoon. The Ingrezza team delivered $350 million in sales during the second quarter, capitalizing on the strong new patient trends from Q1 and high levels of patient compliance. With the first half of 2022 now behind us, we are raising our annual Ingrezza sales guidance range to $1.35 billion-$1.4 billion based upon the trends we have seen so far this year. As you consider Q3, we expect third quarter sequential growth to be lower as a result of both the acceleration of COVID cases and the typical summer dynamics that pressure growth. On the financial front, during the quarter, we were able to retire 55% of our convertible debt to reduce potential dilution and maintain the financial flexibility we need with over $1 billion in cash. Now over to Eric.
Thanks, Matt. Our team continues to do a great job executing on our commercial initiatives. Q2 Ingrezza performance was driven primarily by continued strong persistence and compliance rates for continuing patients, coupled with a record level of new patient starts. As Matt said, given the results through the first half of the year, we've raised guidance to a range that incorporates a couple of scenarios that may play out in the second half of the year. First, as it relates to internal factors, our ongoing direct-to-consumer advertising campaign called TD Spotlight continues to encourage patients and caregivers to help seek treatment for their TD. Thus far, we've been pleased with the response, and we plan to continue the campaign through the balance of the year. In addition, the newest members of our expanded field force have been trained and have been in the field now for about a quarter.
As we've highlighted before, we anticipate the benefit of our expanded sales organization to be tangible in the latter part of the year. Regarding what we've seen from an external perspective, new COVID variants continue to provide headwinds for our customers, while telemedicine is still being utilized by psychiatrists with roughly half of their patients. Over the past five years of the Ingrezza launch, we've seen a pattern of seasonal challenges in the third quarter, which has typically softened growth a bit relative to Q2. Therefore, given current dynamics, I would characterize the low end of the new guidance range to be more impacted by COVID, telehealth, and Q3 seasonal slowdown, and the higher end of the range to be less impacted by external factors, which we are working diligently to mitigate. In closing, we're making steady progress improving the diagnosis and treatment rates for tardive dyskinesia in the U.S.
This is still a mostly underdeveloped market, and we are well positioned to continue driving treatment rates higher to help even more TD patients than ever before. With that, I'll turn the call over to my colleague, Dr. Eiry Roberts.
Thank you, Eric, and good afternoon to everyone on the call. I'll start with a couple of updates from our late-stage clinical portfolio. We remain on track for the sNDA submission later this year of valbenazine as a potential treatment for Huntington's disease.
In addition, the phase three adult and pediatric studies for crinecerfont as a potential treatment for congenital adrenal hyperplasia are progressing well, in line with our goal of delivering data in 2023. Moving to the earlier stage clinical portfolio, we were very pleased to announce the FDA's recent acceptance of the IND for NBI-1117568, a selective orthosteric M4 agonist for the treatment of schizophrenia. This is the lead molecule in our muscarinic franchise collaboration with Sosei Heptares. I want to take a moment to thank the teams both at Neurocrine and Sosei Heptares for their hard work in successfully progressing this molecule into the phase two study, which will begin enrollment in the near future. Along with examining the opportunity to expand beyond schizophrenia with five six eight, our teams continue to work on advancing other novel muscarinic agonists into the clinic, including a potential M1M4 dual agonist.
In addition to moving forward with NBI-1117568, this month we will initiate phase one evaluation for a novel orally active small molecule, NBI-1070770, which targets a potentially important mechanism for the treatment of depression. If we are successful in progressing to phase two clinical development, we will divulge more about both the target. But I can say that this mechanism of action has already been validated clinically by parenterally administered molecules. If successful, NBI-1070770 would provide the first oral treatment approach for this target in depression. Now, I'd like to address the results of the signal-seeking study of NBI-827104 in essential tremor. The team completed a high-quality single-center study of NBI-827104 in 30 patients with essential tremor. The intent of this study was to identify potential signals of efficacy and determine the tolerability of NBI-827104 in this patient population. NBI-827104 was well-tolerated at all doses studied.
However, top-line efficacy results from the study were negative and failed to achieve statistical significance. The study produced a broad data set beyond the top-line information, and the team is continuing to evaluate this data with the intent of presenting it at a future medical conference. Based on the totality of data from this study, at this time, we do not plan to proceed further with the clinical development of NBI-827104 in essential tremor. It is important to note that these results do not impact the current phase two study of NBI-827104 in epilepsy with Continuous spikes and waves during sleep. Enrollment in this study is complete, and we remain on track to disclose top-line results by year-end. Finally, I'd like to congratulate our partners at the Mitsubishi Tanabe Pharma Corporation for all their efforts in getting valbenazine approved.
We look forward to supporting their launch of Dysval for the treatment of tardive dyskinesia in Japan. With that, I'll hand things back to Kevin.
Thank you very much, Eiry. Operator, now we are ready to take questions.
Reminder. At this time, if you would like to ask a question, please press the star and one on your touch-tone phone. You may withdraw your question at any time by pressing the pound key. We'll move first to Philip Nadeau with Cowen and Company. Please go ahead.
Good afternoon. Thanks for taking our questions, and congratulations on a strong quarter. Just two from us. First, on the Q2 results for Ingrezza, they're particularly impressive 'cause Q1 wasn't as impacted by seasonal factors as other Q1's in the past. I guess we're curious whether you can go into more detail as to what led to the increase in new patient starts in Q2. Was that strictly DTC? Were there any of those seasonal factors that did improve in Q2, maybe more than you had initially anticipated? And were there any one-time factors? It does strike us at the bottom end of your guidance, your renewed guidance suggest down quarters in Q3 and Q4 versus the Q2 run rate. Aside from COVID, we're curious how that could happen.
The second question is on ET. We're just curious whether the data put into question in your minds the T-type calcium channel blockers generally. Do you think that this was an issue with the disease, with the mechanism, or simply compound specific? Thanks.
Phil, this is Matt. We're gonna handle your first set of questions on the Ingrezza front, and then we'll handle ET as we get further into questions as we're gonna try to stick to one question per. You know, you're right. Q2 was an incredibly great quarter, reflecting great new patient additions and then also surprisingly very high compliance rates. I'd say the beat was both internal and then obviously external came from a nice step up in compliance and then also a continued trajectory of new patient additions that was fairly strong throughout the quarter. We wouldn't flag any one-time items such as inventory or bulk purchases by any pharmacies. It was a very clean, straightforward quarter.
If you take a step back and think about our guidance range, you know, it really reflects an over or around $300 million growth year. That's a pretty incredible feat coming out of COVID and then still dealing with the environment that we're dealing with right now. As Eric mentioned in his prepared remarks, really the downside is very specific to COVID. I think we all see it popping up regionally, and that could cause some disruption at the bottom end of the range. At the top end of the range, it's all about execution on the sales force expansion side. Hopefully that addresses your question, Phil. Thanks.
I'll take our next question from Brian Abrahams with RBC Capital Markets. Please go ahead.
Hi. Thanks. This is Leon Wang for Brian. I just wanna go back to 104. You know, I guess, you know, can you just talk a little bit about, you know, why you think that, you know, it might still be active in some of the epilepsies, and I guess the decision to discontinue, was that, you know, insufficient efficacy across all the endpoints? Or, you know, is there any signals that you might be able to tease out as you continue to look at the data? Or was it just more bigger picture view on the therapeutic window? And then I guess, you know, as we go back to the epilepsies, are there any epilepsies where you know you might continue thinking about bringing this drug in as well?
Yeah. Couple of questions in there. On the first question, I think the patient populations, if you look between essential tremor and the epilepsy population that we're studying within CSWS, those are very different populations. I don't think you can infer directly from one population to the other. Also, to answer the question I think that Phil asked as well around what do we believe about this in the context of T-type calcium channel antagonist in essential tremor, it's really hard for us to comment on the other molecules in development. But what I can say about the trial that we ran was that it was a high quality, single-center trial, well controlled, and that as we looked at the data, the trial design and the way in which the trial played out actually were not responsible for the negative results.
It was not a failed trial, it was a negative trial. We saw some evidence of activity, but the signal was not sufficiently robust to hit statistical significance or to hit clinical relevance, either on the accelerometer or on the TETRAS endpoints that we looked at. In particular, the other thing I will say is that we had central assessments as well as local assessments on the TETRAS, and there was high concordance between the two sets of assessments. It was a robust data set. We'll continue to evaluate the data in more depth, but at this point in time, I think we are clear that we will not be moving forward with Essential Tremor for one zero four.
We'll take our next question from Paul Matteis with Stifel. Please go ahead.
Hey, thanks so much for taking my questions and congrats on the quarter. Over the past few years, you've been super conservative with just the upfronts that you've offered in business development. I think you've also been clear that, you know, your pipeline is high risk and CNS is difficult. I guess given the failure of the ET program, given that there have been a number of setbacks, I'm wondering now, given your position of strength with Ingrezza, if there's any consideration that you could incorporate a bigger transaction, if you have the capacity to do so. Maybe just give us a little bit of an update on your thinking there and whether we could see something more meaningful over this year or next. Thanks.
Thanks, Paul. I'm gonna put that question to Kyle.
Thanks, Paul. I know we've talked about this in the past. I think you know, firstly on the outset, for business development versus internally discovered assets, we view them similarly in terms of probability of success. I think that's fair for all organizations to view it from that perspective. When thinking about things that are strategic versus in-licensing, I'd also add that we're really agnostic to structure and the scope of opportunities that we're looking at today. I think the issues are that in the CNS space, we see the assets that are available bifurcated in either extreme in terms of being a late-stage commercial, higher value, higher expense items and those that are higher science that are in earlier stage development.
I think we continue to evaluate those to see where their place would be in our own pipeline. In a nutshell, those strategic types of deals are possible, and we look at those just as much as we see on in-licensing front. In closing, if you look at the pipeline today, you see about a dozen assets in mid- to late-stage development, a balance there with the new programs that we brought in from phase one to phase three, and a balance of targets that are validated and those that are novel. Those are the types of things that we look at when we create the pipeline and manage to sustain it over time.
Question from Tazeen Ahmad with Bank of America. Please go ahead.
Yeah. I'd like to just go back to the Ingrezza results from the quarter and your view for the rest of the year. You know, when you gave your thoughts about what 2Q was looking like on your 1Q call, you were pretty adamant that you wouldn't expect to see, you know, the level of sequential growth that we've been accustomed to. Are you saying that compliance improved after that time, which was about, I don't know, five weeks into the quarter? Why would compliance meaningfully change? I know you've talked about COVID, et cetera, but, you know, frankly, we've already had several COVID surges throughout 2Q, and that didn't seem to impact. You had a great quarter.
I'm just trying to understand, you know, what part of this dynamic you're most concerned about for this quarter or this half of the year that you were still able to overcome in the first half. Thanks.
Yeah. Tazeen, just to be clear on the compliance front, I wouldn't call it a huge surge of better compliance. That's something that you can only really take a look at over longer periods of time. So it's not something you have clear sight on, you know, a couple weeks into the quarter or five weeks into the quarter. We typically look at it on a quarterly basis to really get an understanding on what refill rates per patient looks like. Slight changes in refill rates per patient definitely drives a large revenue contribution. The good thing is patients are staying on medicine, and that's something that we've seen ever since the beginning of launch. I think that's a testament to the medicine itself and our clinicians.
You know, I would say in respect to COVID and we don't want this to be a COVID centric call. We do see sporadic instances of COVID that are taking you know, reps, doctors, patients out of the office and you know, it just has caused some level of disruption. You know, our view is to always shoot as high as we can within every quarter, but on calls, give a really balanced view as to what the potential scenarios could look like. Eric, do you have anything to add here?
Yeah, maybe just to chime in a little bit. You may recall, Tazeen, that on the Q1 call that we said that we flagged that as a quarter that had a record number of new patient starts. Then now in Q2, we set another record. I think that the new patient starts are a huge contributor towards the results in Q2. But you know, we carried a lot of momentum coming out of Q1 into Q2, and those new patients that started in Q1, of course, as Matt said, you know, we saw really good persistence and adherence in Q2.
Of course, you know, when you have small changes in those measures of compliance, that can really add up when you've got a patient base as large as ours is now. You know, I would just flag the new patient starts as an important contributor. With regards to Q3, you know, sort of the balance of the year, you know, we have said that Q3 historically has been a slower growth quarter for various reasons over the five years of the launch. We wanna make sure that investors understand that this year we don't expect to be any different than in years past. The COVID factor is relatively newer compared to the early phase of the launch.
In general, Q3 has been a slower growth quarter, whereas Q2 has almost always been a really strong growth quarter for us.
Move next to Neena Bitritto-Garg with Citi. Please go ahead.
Hey, guys. Thanks for taking my question, and congrats on the quarter. I was just wondering if you could talk a little bit about how much of an impact you think the new sales reps had on the 2Q number and how we should think about the impact there moving forward. I know, Matt, you did talk a little bit about that earlier, but just seems like at the lower end of the guidance range, you're essentially assuming kind of no growth the next few quarters, and at the high end, you're assuming essentially similar level of growth from a dollar perspective to second half of last year. Just trying to understand how the new sales force factors in. Thanks.
Yeah. Let me just take a step back and say that you know, we've raised our guidance, and what is now the bottom end of our range was the top end of the range at the time that we issued guidance at the beginning of the year. You know, we feel very good about the trajectory that we've been on thus far in 2022. We're not expecting the second half of the year to be a no-growth scenario. But we do have a range, and we wanted to make sure everyone understands where we expect to end up by the end of the year.
That being said, with regards to the first part of your question, which was about the sales force, you know, what we've guided externally is that it's gonna take a bit of time for all these new people to hit their stride. Everyone's working really hard to get integrated into their territories, to meet their customers, et cetera, but it takes a little bit of time for folks to, you know, to really get up to speed. We've hired very experienced people in LTC and in neurology and the backfills in our psych team. But just because they're experienced doesn't mean that they've got experience in TD and with Ingrezza.
I think we're doing all the right things to set everyone up for success, and we're doing a really great job in terms of teamwork and collaboration, handing off customer relationships, sharing best practices, et cetera. In terms of when we start to see a more tangible impact from the expanded field sales team, it's our belief based on our prior experience with field expansion that it would be towards the latter part of the year. In summary, we're doing all the right things. We think they are making a contribution, but it's early yet to gauge the degree of that.
We'll take our next question from Jay Olson with Oppenheimer. Please go ahead.
Oh, hey, congrats on the quarter, and thank you for taking the question. Can you talk about how your five, six, eight selective M4 agonist will be clinically differentiated from other muscarinic programs like Karuna and Cerevel? What sort of read across do you expect from the EMERGENT-2 study of KarXT, which is gonna read out soon? Thank you.
Thank you, Jay. We're very excited about our NBI-1117568 program, and we're really pleased to be able to rapidly get to a point with the FDA that they cleared us to start the phase two study, which will be beginning enrollment very soon. This is a phase two dose-finding study in patients with schizophrenia. I think just to remind you, NBI-1117568 is an orthosteric agonist, selective agonist of M4, and so it is the first molecule of that nature to go into this disease area. I think we were very encouraged by the validation of the M4 mechanism by both Karuna and Cerevel in acute psychosis.
Clearly the profile of a direct agonist versus a positive allosteric modulator versus a non-selective muscarinic agonist, it's difficult to predict right now the differentiation between those molecules. For us, the most important thing is for us to get going with our phase two study. We believe it's a well-designed dose-finding study that will allow us to answer some key questions in this disease area, and we'll be progressing as rapidly as possible to enroll that study.
Great. Super helpful. Thank you very much.
We'll move next to Carter Gould with Barclays. Please go ahead.
Great, guys. Thanks for taking the question. Wanted to come to the DTC campaign. It's what now? Over a year. I wanna you know, if you could help kind of suss out how you think that's contributing, the extent that you know, the magnitude there, and if there's been any thought to expanding that or how you see that kind of evolving going forward. Thank you.
Yeah, we're really pleased with the DTC campaign. It's meeting our expectations in terms of the behaviors that we're looking for in the target patient and care partner population. You know, we've consistently seen high rates of people visiting the website, lots of downloads and page views and of course people registering to receive information from the company. You know, ultimately it's an important contributor towards new patient starts. You know, we continue to look at key performance indicators and assess the return on investment of the DTC campaign. As I mentioned in my prepared remarks, we're pleased with it, and we're gonna continue through at least the end of the year.
We'll reevaluate when we get a little further down the road what the plan looks like for 2023. In terms of how much of a contributor it is to our success, you know, obviously, we've got a lot of different initiatives at any given time. We think it's an important contributor along with other marketing programs with the expanded field force, et cetera. All of these things together are what's really driving the strong growth that we've seen this year, the raising of our guidance and our expectation that, you know, we've got a lot of headroom here in terms of this market opportunity, and we're gonna continue to invest as we see appropriate.
Question from Anupam Rama with JP Morgan. Please go ahead.
Hey, guys. Thanks for taking the question and congrats on the quarter. Matt, I'm sorry if I missed this in your opening comments, but maybe you could highlight a little bit about the R&D expense increase for the year and what's really driving that and which programs specifically. Thanks so much.
Yeah. Hi, Anupam. Nice to hear from you. On the R&D expense, that is $30 million, and it's a milestone associated with the Sosei Heptares muscarinic program. When we triggered that milestone with the acceptance of the IND and initiation of the phase two . It's purely a milestone-related expense. Thanks.
We'll move next to Brian Skorney with Baird. Please go ahead.
Hey, good afternoon, everyone. Thanks for taking the question. I was hoping to get any thoughts on sNDA for Huntington's chorea. I know it's about a year before you would launch, given the timeline. I just wondered if you started to do any work to understand how this might accelerate growth. Do you think this will be a switching market from deutetrabenazine, or will this be targeting VMAT2-naive patients? Just trying to think ahead based on what are the current needs in this market, where you would anticipate drawing patients from, and how much of an inflection that can drive.
All right. Well, yeah, you know, we're certainly excited about the opportunity. We're very excited about the data. Obviously, we have to see what the labeling looks like, but we're pretty far along in our planning. One way to think about this is that this is completely incremental to our TD market. You know, there's very little off-label prescribing of Ingrezza. We think that Ingrezza offers a differentiated treatment option for patients with Huntington's disease that are suffering from choreiform movements. As you may know, the majority of patients that have Huntington's chorea are not treated with VMAT2 inhibitors for various reasons. The majority of our growth opportunity is really to tap into that untreated chorea patient population.
You know, certainly there will be some patients that are treated with current treatments that may choose to switch to Ingrezza. We don't view this as primarily a switching market opportunity. Our aim is to really address the majority of patients that aren't being treated for various reasons. We think that the profile that we have in TD lends itself well in terms of those product attributes that make us the most prescribed, preferred product in TD, hopefully will translate well into the HD market. We're looking forward to that opportunity next year.
We'll move next to Chris Shibutani with Goldman Sachs. Please go ahead.
Thank you very much. Congratulations on a very strong quarter. I wanted to ask Kevin, in particular, your point of view on a bigger picture topic that's come across this week, especially to the commercial pharmaceutical companies, and that is of the potential for legislation that would involve potential for Medicare drug pricing negotiations. Discussions from different companies talk about the implications on certain types of drugs, small molecule versus biologics, exposures to different payer groups, impact on how people are thinking about investing in innovation pipeline strategy. Could you share your thoughts from your vantage point, and also remind us what any implications you feel might be for Neurocrine specifically?
Yeah, Chris, it's a very timely and important question, maybe a little too timely. There's a lot of moving parts that are taking place right now. If you read the press reports as early as this morning, as well as our own Washington, D.C. team, suggests things still appear to be very much in flux. As such, it would be premature for me to talk about that or speculate on the impact on our company, or whatever ultimately ends up in the bill. When there is clarity, we will be talking about this, and we will be giving specific thoughts on that. I'm sorry that I don't want to speculate now.
I think the term is the sausage still appears to be being made, and so we'll wait and see how that turns out.
We'll take our next question from Myles Minter with William Blair. Please go ahead.
Hey. Congrats on the quarter. Just on NBI-1117568, are you planning alongside the phase two study to run a separate study, monitoring cardiovascular effects of that mechanism? Maybe within the phase three studies, do you plan to do an adjunctive therapy arm? Thanks.
We don't have plans for adjunctive therapy in the current study. The current phase two study is focused on understanding dose responsiveness in acute psychosis. We will have extensive safety measures throughout the study, including cardiovascular assessments. At this time, we are not planning a separate cardiovascular study. We really intend to see what the information looks like from the current ongoing phase two study, and then decide how to proceed from there, given that obviously this is a selective M4 agonist rather than the molecules that have been in the clinic before.
We'll move next to Danielle Brill with Raymond James. Please go ahead.
Hi, guys. Good afternoon. Thanks so much for the question. I just have a quick follow-up about the contribution of the new sales hires, and I guess maybe I'll ask a little differently, but has the prescribing mix shifted at all, or is it still 80% contribution from psychiatrists, 20% neurologists? Thanks.
Yeah. You know, we're still seeing in general that the mix of prescribers is pretty similar to what it was a quarter ago. Like I said, they've been very recently deployed. We are seeing positive signs in terms of both the activity and the response to the promotional efforts. I would caution everyone from attributing the strong Q2 to the fact that we, you know, deployed an expanded field sales team. Those were essentially simultaneous events.
You know, ultimately, you know, we do expect that with the expansion of the field sales team and the deployment into three distinct segments, that we're gonna be able to go deeper in psychiatry, neurology, and of course, LTC is essentially an untapped market for us previously. We'll be able to provide, I think, more detail when we get further along in the year in terms of how things are shaping up. We're very optimistic about the opportunity that we have with this larger of a field organization to be able to support and reach more customers.
We'll take our next question from Laura Chico with Wedbush. Please go ahead.
Good afternoon, and thank you for taking the question. I guess, you know, back to Ingrezza. How do you think directionally about the peak run rate at this point? I guess I'm just trying to understand how the outlook may have changed in recent quarters following not only the adjustments to the field force, but also in terms of how you might be thinking now about the exclusivity runway for Ingrezza. Thank you very much.
Hi, Laura, this is Matt. On the exclusivity front, we feel very confident with the strength of our patent estate that we'll have protection into the mid-2030s. We feel very good about that. As it relates to the peak, we've not given any commentary associated with what we think the peak will be. But I think the growth that you've seen so far this year just really reflects how much of an opportunity we still have in the tardive dyskinesia market.
When you think there's only 25% of patients that have received a diagnosis and only half of those being treated at this point, we look at this market as continuing to be untapped, and the growth is even reflective of an environment where telehealth is still 50%. Eric, anything to add there?
Yea h. The only other things that I would point out is that in addition to you know the majority of patients still being as yet undiagnosed about half the time when patients are diagnosed with TD they're not offered a VMAT2 inhibitor. There's a significant amount of progress still to be made in terms of making sure that people with TD get diagnosed and they get offered effective treatment. The other thing I would point out and it somewhat relates to the last question as well is that we've seen tremendous growth in the number of advanced practice providers that are now diagnosing and treating TD. They're an important part of the care system both in neurology and in psychiatry.
We're talking about nurse practitioners and physician assistants here. With the expansion of our field organization, we're gonna be able to reach and educate more of those important healthcare providers. Even though we're five years into the launch, we feel like there's a long way to go in terms of continuing to develop the TD market and to help as many patients as possible.
We'll take our next question from Charles Duncan with Cantor Fitzgerald. Go ahead.
Hey, it's Avi on the line for Charles. Thank you for taking our question. We were wondering if this past quarter's performance was primarily driven by new prescribers or I guess an acceleration in the growth of prescriber base or if it was more from greater depth amongst current prescribers. Thank you.
Yeah. What we've long said is, a lot of the opportunity that we have left with the Ingrezza and the development of the tardive dyskinesia market is really going deeper with existing clinicians. We did see new writers this quarter, and we are starting to call on a new segment in LTC as well as with more focus in neurology. Over time, we would expect that we will have a nice increase in the prescriber base. I'd say by and large, the biggest majority of our scripts came from existing prescribers going deeper.
Yeah. Just to tack on to that. It's not so much about the new writers as about the new patient starts. As Matt said, not just increasing the breadth, but the depth of our business is important. You know, we'll continue to see new prescribers get added over time, especially as we tackle new market segments like LTC. You know, ultimately, most of the patients that have TD are within the practices that we're already calling on, and we continue to focus on helping people recognize TD to make the appropriate distinction between TD and other drug-induced movement disorders and, of course, to offer effective treatment with Ingrezza when it's diagnosed.
We'll move next to Evan Seigerman with BMO Capital Markets. Please go ahead.
Hey, guys. Keith on here, for Evan. Thanks for taking our question. Just wondering, if you could provide any color on the Ingrezza inventory build. To that end, does the DTC program impact channel dynamics, or revenue recognition cadence? Thank you.
Yeah. On the inventory front, we've been at a very stable inventory position, so nothing to flag there. And I believe I commented on that earlier. The results were fairly clean this quarter. As Eric mentioned on the direct-to-consumer advertising campaign, all the indicators are pointing towards a very successful DTC program at this point with what we're seeing in all the website metrics and call center metrics. I would say it's performing at our expectations.
The only other thing I would add, Keith, is that in terms of does DTC impact channel dynamics, no, it doesn't. Ultimately, you know, we have a limited pharmacy network. It's a large limited pharmacy network, and we think that it you know meets the needs of our customers from a access and flexibility perspective. Any prescriptions that are written for Ingrezza are gonna get filled through that channel.
Move next to Marc Goodman with SVB. Go ahead.
Yes. Hi. I joined a little late, so I'm not sure if you actually answered this question about gross to nets and average selling price in the quarter, if you could answer that. More importantly, I was curious. I know you're probably finishing up on the payer contracting for next year. If you can give us a sense of how you're thinking about ASPs into next year as well for Ingrezza? Thank you.
Yeah. For the quarter, we saw a rebound in net revenue per script, as we had expected, a bit above $5,400, and would still lead everybody to a guide for this year of $5,400 net revenue per script. It's a bit premature for us to cover 2023 in terms of both coverage as well as net revenue per script, but it's something that we will obviously give some insight to as the year progresses.
You know, if we did see markup at this time, something structurally that was gonna change, that would give us a lot of concern over our ability to continue to allow patients to have access to this medicine or a significant impact to our price, when we're thinking about 2023, we would give everybody as much of a heads-up as possible. Sitting here today, that's not our expectation.
Move next to David Amsellem with Piper Sandler. Please go ahead.
Thanks. Sorry if you addressed this, but on Ingrezza, can you just go through the extent to which you're getting contribution from the long-term care setting? I know this is an opportunity you talked about in the past. Maybe looking ahead, what's your view on how big of a portion of the mix that could be over time? Thank you.
Our long-term care team has been very recently deployed into that setting. It's very early in the process yet in terms of being able to you know generate that business. We certainly feel very confident about the opportunity, otherwise we wouldn't have you know built a dedicated sales force there. You know, we recognize that in nursing homes and other types of residential facilities that care for patients that there is a significant use of antipsychotics and other medicines that could cause TD. This is a care segment that we were very interested in and attracted to at the time that we were planning to launch.
Unfortunately, you know, we didn't feel like we were in a position to introduce Ingrezza into this care segment during the initial launch phase because really because of capacity constraint issues. So we prioritized focusing our go-to-market approach on outpatient neurology with an emphasis on movement disorders as well as private practice psychiatry and community mental health clinics. That's really represented the focus for the first few years of the launch. Then when we got into last year, you know, we revisited our readiness to take on long-term care, and we made the decision to reorganize and expand our field sales team, and we felt the time was right to tackle this.
From a scale perspective, it's probably not as large of an opportunity as the other segments that I've described, but it's meaningful and it's significant. There's a large number of patients that could benefit from Ingrezza, which is the most important thing. As we get further down the road, I'll be able to provide more color in terms of how things are shaping up, not just with the long-term care team, but also our new dedicated and expanded focus in neurology with our neurology sales force. Stay tuned.
Move next to Ami Fadia with Needham & Company. Please go ahead.
Hey, thank you for taking the question. This is Amman on for Ami. I was wondering if you can give some color on. Obviously, you created a dedicated sales force for the neurology side of Ingrezza's business. What are the early feedbacks that you are seeing there? How should we think about the impact of this expansion of the sales force for the remainder of the year?
Yeah. With regards to neurology in particular, the feedback's been very positive. You know, we've said that neurology has represented about 15%-20% of our business for Ingrezza. Certainly, we think that it could be more. You know, we did the analytics to support the case for expanding our focus in neurology with a dedicated sales team. Really, we've got a team that has two products with Ingrezza and Ongentys that they can bring into neurology. We think that, frankly, they work well together. Meaning, for example, that Ongentys can really help the neurology team get access to some of these movement specialists. We're very pleased with the early feedback.
About three-quarters of the team, you know, we hired from outside the company, so they're still learning the ropes, so to speak, but they're quick learners. We've started calling on a broader set of neurologists than what we were calling on previously with our smaller sales organization. Ultimately, you know, we feel good about the investment. All the early signs are very positive. As I said before, we think that there's a lot of growth opportunity in neurology that we couldn't really tap into under the old structure. As we get later in the year and into next year, I'll be able to provide a lot more color in terms of how things are going really across all three of those care segments.
We'll move next to Yatin Suneja with Guggenheim Partners. Please go ahead.
I have a question on NBI-921352. Could you talk about the expectation from the adult focal onset seizure study that you are running? I understand it is a dose-finding study, but in terms of the product attribute, in terms of the signal from efficacy standpoint, like, what would you like to see that would warrant further development in a bigger study? Thank you.
Yeah. Thank you. Yeah, we're very excited about the NBI-921352 program, both in focal onset epilepsy and in the rare disease epilepsy, SCN8A, and we have those two phase two programs going on in parallel. For the focal onset seizures, that is a dose-finding study in adults, and we are evaluating as the primary endpoint the seizure frequency using a diary approach. That will be the primary endpoint at the end of the study. We also obviously will be looking at tolerability, the adverse event profile, and the exposure to the drug in that setting, in addition to other quality of life and other measures that are described, I think, in our posting around this study.
Obviously, we'll be looking at the totality of the data from this phase two dose-finding study in order to understand whether or not to progress. To date, based on the phase 1 data from this program, we've been very encouraged by the profile of the molecule, and we intend to read out the data from this study sometime next year.
It looks like we got to the end of all the questions now. I would now like to turn things back to Kevin.
Thank you very much, Chloe. Thank you everyone today, especially for the focus of your questions. It allowed us to get through everyone, and I hope you found our answers to be transparent and to be helpful. We've had an extremely good first half of the year, and I'm really looking forward to continued growth in the second half of the year. We've made significant investments in Ingrezza over the last 6-12 months, and we expect those to increase our reach to our patient population as the year progresses. I'm also very optimistic about our pipeline that we've built to date. Over the next 18 months, we have a number of important clinical readouts.
To remind you, we have five pivotal programs, we have seven phase two programs, and we're adding a new and very interesting phase one program that we'll be talking about all of those more in the coming months. Overall, I think in what is still a challenging environment, Neurocrine has done an outstanding job here, and we are looking forward to getting together with many, if not all of you, throughout the remainder of the year. Once again, thank you very much for your attention.
This does conclude today's program. Thank you for your participation. You may disconnect at any time. Have a wonderful evening.