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7th Annual Evercore ISI HealthCONx Healthcare Conference

Dec 3, 2024

Umer Raffat
Equity Research Analyst, Evercore

For the delay, we'll jump right into it. Thank you, guys, for being here. I'll turn it over to you, Terry and Marshall, to kick things off with Royalty Pharma.

Terry Coyne
CFO, Royalty Pharma

Thanks, yeah, thanks, Umer . Thanks to you and Evercore for hosting us. It's been a really great year for Royalty Pharma in terms of investments. We've added some great products to the portfolio. And very excited to talk to you about everything that's been going on.

Umer Raffat
Equity Research Analyst, Evercore

Excellent. I feel like for a long time there were two sets of constructs on Royalty Pharma. One was, oh, rates should correlate with stock performance. And we've kind of seen rates start to pull back, and it didn't necessarily do that. But I think there was another component, which was folks taking a much more fundamental look at it and seeing where some of the core royalties could actually track ahead or behind versus where the expectations are at. I know we're going to talk about the Vertex royalty and where that stands and where you guys are on that. But in many ways, I feel like that's been part of investor conversation for perhaps over a couple of years at this point. But then there's a lot of exposure on some newer royalties into next year as well.

So maybe I'll let you sort of approach it from a more portfolio perspective. Truly needle-moving royalties, what are the new ones that may not be fully expected? For example, Lp(a), there's some exposure into next year, et cetera. So if you could characterize that, and I want to go down each one of them a little more specifically.

Terry Coyne
CFO, Royalty Pharma

Yeah, so I guess sort of big picture, and maybe I'll let Marshall talk about some of the specific ones that are going to happen in 2025. But big picture, since our IPO, we've added some, and our IPO was in June of 2020, we've added some amazing products to the portfolio and had overall some really great outperformance from products like Tremfya and Trikafta, to name a few. And those products still have a lot of growth ahead of them. And we've added probably 30 in the 30s in terms of new products to the portfolio. And we're kind of doing that every year. We're adding eight-ish, eight to 10 new assets into the portfolio every year. And overall, we have this consistent track record of outperformance when we make investments, particularly when we make the larger investments.

Just this past year, we made an investment in a product that's marketed by a private company called Voranigo for low-grade glioma. We think that's a product that's going to do really well. And we're excited to sort of, at some point, start tracking how the sales are progressing and the royalties, et cetera. But we also have an exciting pipeline. And we don't feel right now like that's getting much appreciation. And it's a diverse pipeline with some really potentially transformational products in there. And maybe I'll turn it to Marshall to kind of get into some of the details there.

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

Sure, so like Terry mentioned, we're proud of the kind of pipeline we've built of things that are unapproved or that will soon be approved and/or launched, and so you mentioned Lp(a). I'm sure we'll talk a little bit more about that. We have royalties on the first two in class, Novartis' pelacarsen, which will have data next year, and Amgen's olpasiran, which will complete phase III the following year, so we're excited about that one. We did another transaction for a Sanofi product in the CD40 class, which is a class that's definitely progressing. We've seen some positive data for it in lupus, but Sanofi has shown some exciting data in phase II for MS. That data is probably 2027 or 2028, so still a little bit to wait.

Cytokinetics, aficamten, another company we partnered with, did a deal with them this year that was a follow-on to deals we've done in the past. So that has a PDUFA date next year. And then I just finished with a couple of other recent deals we did, which have launches. So we just did a synthetic royalty to partner with a company, Geron, that's launching a new product, Rytelo, for low-risk MDS. They announced a strong first quarter and look forward to see that launch. And then we'll have the launch of. We'll have actually two more launches. We'll have the launch of Niktimvo, which is a new drug for chronic GVHD that Incyte and Syndax are launching, and then as well as Ascendis with Yorvipath for their PTH drug, which launches next year as well, which are all synthetics we've done recently.

So I think we're excited about what's in the pipeline, both near-term and longer-term.

Terry Coyne
CFO, Royalty Pharma

Is it reasonable to think, Marshall, that this bucket we just went through, Lp(a), Sanofi, Cytokinetics, Geron, Syndax, and Ascendis, is over $1 billion in sales aggregate?

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

In sales?

Terry Coyne
CFO, Royalty Pharma

Sales to Royalty Pharma.

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

Oh, in royalties to Royalty Pharma? I'm trying to think.

Terry Coyne
CFO, Royalty Pharma

Haven't looked at those in that bucket.

Umer Raffat
Equity Research Analyst, Evercore

Haven't thought about it that way?

Terry Coyne
CFO, Royalty Pharma

But yeah, I mean.

Umer Raffat
Equity Research Analyst, Evercore

It's in that ballpark, would you say?

Terry Coyne
CFO, Royalty Pharma

Yeah, I think that we said that the Lp(a) is on consensus estimates. I think olpasiran was around 250, and then pelacarsen was around 150, if my memory serves me correctly.

Umer Raffat
Equity Research Analyst, Evercore

Terry, remind us again the size of the Vertex royalties. Could you just remind us what it is? Even in the worst-case scenarios, how much can you possibly lose at Vertex?

Terry Coyne
CFO, Royalty Pharma

Yeah, yeah. So last year, the Vertex portfolio receipts to Royalty Pharma were in the mid-700s.

Umer Raffat
Equity Research Analyst, Evercore

Correct.

Terry Coyne
CFO, Royalty Pharma

And they're expected to, under a status quo where there isn't sort of this controversy, they would grow into a little over 900 or so.

Umer Raffat
Equity Research Analyst, Evercore

Got it, and then I remember you ran sensitivities. It was a nice slide you guys showed at one point.

Terry Coyne
CFO, Royalty Pharma

Yeah.

Umer Raffat
Equity Research Analyst, Evercore

Some of the ways of running that sensitivity is what your base case is on the legal side. But let's say we go with an extreme case where the deuterated is not counted as ivacaftor.

Terry Coyne
CFO, Royalty Pharma

Right.

Umer Raffat
Equity Research Analyst, Evercore

How much lower could that royalty go? Because it doesn't go to zero, so good.

Terry Coyne
CFO, Royalty Pharma

It doesn't, yeah. So just to remind everyone, the royalty that we get on Trikafta is a little over 9%. The royalty that we think we're entitled to on the new Vertex triple should be 8%. But there's a debate over one of the components there. And so if we're wrong, then the royalty would be 4%. And if it's only 4% and there's significant switching, 50%- 75% of patients switch to the new triple, we've said that that 900 would go to 600 or 700. So $200-$300 million headwind towards the end of this decade. So I think you sort of hit the nail on the head when you compare it to some of the.

Umer Raffat
Equity Research Analyst, Evercore

You get to $400 million regardless of the outcome. Is that right? Is that what you just said?

Terry Coyne
CFO, Royalty Pharma

$600 or $700 million is.

Umer Raffat
Equity Research Analyst, Evercore

No, but if 800 gets cut into 400, wouldn't that mean roughly half?

Terry Coyne
CFO, Royalty Pharma

Yeah, but that's only assuming 75% of patients switch.

Umer Raffat
Equity Research Analyst, Evercore

OK, got it.

Terry Coyne
CFO, Royalty Pharma

We don't think that it's hard to imagine that there's an area where everyone would.

Umer Raffat
Equity Research Analyst, Evercore

This may not be 100%.

Terry Coyne
CFO, Royalty Pharma

I mean, there's not a lot of precedent for a switch to be 100% in a drug that works.

Umer Raffat
Equity Research Analyst, Evercore

Right, right, right. Mid-70s is the upper limit, so got it. So realistically speaking, even in a scenario where your interpretation is not adopted, the cumulative size of the move is $300 million-ish on the Vertex royalty.

Terry Coyne
CFO, Royalty Pharma

Yeah, 200 to 200, 300.

Umer Raffat
Equity Research Analyst, Evercore

Some of the pipeline we just discussed may add up to something in the order of $1 billion or so.

Terry Coyne
CFO, Royalty Pharma

Yeah, yeah, yeah. I mean, we highlighted a slide, a pipeline slide in our deck that using consensus estimates is $1.2 billion.

Umer Raffat
Equity Research Analyst, Evercore

Got it. So on the flight over to Miami, one of the things I was doing was reading your 10-Q very, very carefully. And I was specifically looking for language on arbitration, because you guys are in that process with Vertex, is that right?

Terry Coyne
CFO, Royalty Pharma

We haven't said specifically, but that is.

Umer Raffat
Equity Research Analyst, Evercore

But he's nodding yes.

Terry Coyne
CFO, Royalty Pharma

Arbitration is the dispute resolution mechanism under the contract. But we haven't discussed the specific timelines there.

Umer Raffat
Equity Research Analyst, Evercore

OK. I mean, presumably, whatever happens, just based on the launch timelines would dictate how the courts or an arbitrator would have to proceed as well. And again, this is not to put you guys on a spot on arbitration happening or not or where it's at. But whatever the visibility is out of that, we should have that by the time of launch. Or is that not the case?

Terry Coyne
CFO, Royalty Pharma

I wouldn't.

Umer Raffat
Equity Research Analyst, Evercore

On whether you guys would be getting royalty?

Terry Coyne
CFO, Royalty Pharma

We just haven't really elaborated. What I can say is that arbitration is unlike if you were going to court, arbitration is a more expedited process.

Umer Raffat
Equity Research Analyst, Evercore

Is it?

Terry Coyne
CFO, Royalty Pharma

It is. It's not as long as one party sues another party.

Umer Raffat
Equity Research Analyst, Evercore

If the parties don't agree, I'm not talking about this case in particular, but if the parties of both sides don't agree, then it formally heads towards a court case in the district court?

Terry Coyne
CFO, Royalty Pharma

No, no, no, it doesn't. It's arbitration.

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

But it will not be arbitration.

Umer Raffat
Equity Research Analyst, Evercore

No, no. Can't you just say we don't agree on anything?

Terry Coyne
CFO, Royalty Pharma

No, no, no. There is no. It's sort of all laid out in the contract.

Umer Raffat
Equity Research Analyst, Evercore

OK, got it. All right, excellent. Maybe using that then to transition to some of the launches into next year. So Lp(a), I know that's an important category. There's a lot of investor interest in that as well. But I guess the risk factor I foresee on that, I think the clinical risk to me is very, very low. It's really on the commercial side. And there's two of them, one being broad-scale adoption away just from bad cholesterol, more towards Lp(a) tracking as well. And presumably, we'll make progress. Cardiologists seem very focused on that. But if you could speak to that. And then secondly, could we envision a scenario where Lilly's oral Lp(a) just leapfrogs both of these? And given their scale with the glips, maybe that becomes a standard. So could you speak to both of those then?

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

Sure. So I think on the market, we're excited for the market, as you kind of referenced, a lot of the pieces are there, right? Cardiologists, there's a high level of awareness of this as a risk factor. The test, it's very easy to test for, right? You can go to your doctor today and ask for it and find out what your Lp(a) is. So cardiology launches always take time. But I think shifting people over to have this as an additional risk factor is something that I think will happen with interventions and positive data, right? I think the difference here, we don't think of it as a shift from focus on LDL cholesterol so much as you're identifying a high-risk subgroup of patients who have a genetic risk factor for high Lp(a) and having this as a driver of your cardiovascular disease.

And so it's a little bit of a different story than we've thought about historically. In terms of the competitive landscape, I mean, we'll see, right? I think the injections that are monthly or quarterly versus an oral, right? I think there's going to be patients who kind of self-select either way, depending on kind of the product profile that they like. So we don't see it as a winner-take-all market.

Umer Raffat
Equity Research Analyst, Evercore

OK, got it. So it's not a winner-take-all. As it relates to the Cytokinetics program, so early into the launch, Bristol was genuinely very much struggling with the mavacamten launch. I know the dynamics have improved. Now they're starting to put up a real sales run rate as well. I guess, how do you see that product evolution on the Bristol side? And how does Cytokinetics tie into the broader picture as well?

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

Yeah, so I think the mavacamten/Camzyos launch, I think for a lot of reasons, we expected to sort of proceed the way that it did, right? This is a new disease. It was a drug with a REMS. And so it's going to take some time to get together. But I think they've kind of reached some momentum right now. And it seems like things are going well. We've all seen the ads on TV and everything else for Camzyos. And so having, and that was part of our thesis in investing with Cytokinetics, was that Bristol was going to do a lot of the hard work to get this up and going. And then you're going to come with a second product that has some advantages as well. And so I think we're excited and looking forward to seeing what.

Umer Raffat
Equity Research Analyst, Evercore

Can you speak to that, the profile and the differentiation?

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

Yeah, I think the titration profile, we'll see what the REMS ultimately looks like. I think Cytokinetics is the best people to ask about that. But I think the idea that it will have some differences in terms of physician and patient burden, we'll certainly be a help as the product launches. And we're excited to see what Cytokinetics and team do with the launch.

Terry Coyne
CFO, Royalty Pharma

Marshall, would your estimates still be the same if Cytokinetics themselves have to do this launch and it's not a large pharma launching it?

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

Yeah, no, it's a good question. So whenever we make an investment, we have to invest on the base case that our partner is going to be launching the drug, right? We don't invest sort of assuming the company is going to get bought. It seems like if you're waiting for a company to get bought, it probably won't. And so we always were, under our base case, was that the Cytokinetics team would be the one launching it. So that was the basis of our estimate. So no, it would not change.

Umer Raffat
Equity Research Analyst, Evercore

Got it. And remind me again, the peak sales expectation for consensus on aficamten is I'm trying to remember.

I don't have it on my end.

OK, I don't have it on my end. We can go back and look into that. But whatever the sales number is, the base case in your modeling is that there will still be a REMS. It may be a little less onerous, but there will still be a REMS. Is that right?

Terry Coyne
CFO, Royalty Pharma

I think that's probably a better question for Cytokinetics. But our assumption was, yes, we did not. If your question is, did we assume that this was a risk-free product?

Premise for the deal?

No. The premise of the deal was that this would have a REMS.

Umer Raffat
Equity Research Analyst, Evercore

OK, got it. Excellent.

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

We made the initial investment years ago.

Terry Coyne
CFO, Royalty Pharma

Correct, correct.

Marshall Urist
EVP and Head of Research and Investment, Royalty Pharma

Correct.

Terry Coyne
CFO, Royalty Pharma

Makes sense.

Umer Raffat
Equity Research Analyst, Evercore

Yeah.

OK, excellent. And I know we have limited time left. So let me just transition very quickly to the balance sheet. Terry, one of the things I was looking at, and I was just reading this very carefully, was there's some Financial Royalty Assets listed. And so if you haven't gone through the whole structure of Royalty Pharma, you can just say, well, if those are the assets, those are the assets. The valuation should be the assets. But the Financial Royalty Assets listed in your balance sheet don't include a bunch of other royalties as well. So could you just remind us of that dynamic?

Terry Coyne
CFO, Royalty Pharma

Yeah, so a lot of our royalties are characterized as financial royalty assets. And that's how they show up on the balance sheet. We also have a disclosure of what the fair value of those assets is. And that's a different number than what is on the balance sheet. That's a footnote number. Within that footnote number, it doesn't include anything that we've expensed along the way. So for example, things that came through R&D funding, like Trodelvy or Nurtec, those are not included in that number. It also doesn't include some of the more structured investments that we've made. We created what we call development funding bonds with, sorry, MorphoSys. That's now Novartis. But that's not in that number. So there's a lot of things that are not in those numbers.

Got it.

But a lot of our core assets are considered Financial Royalty Assets.

Umer Raffat
Equity Research Analyst, Evercore

Got it. And in doing the valuation for those users to a standard discount rate out to the terminal year on consensus estimates, are they under-capturing the value?

Terry Coyne
CFO, Royalty Pharma

It's a pretty complex methodology. And you have to look at it asset by asset. So it does not reflect the diversity of the portfolio. And so the discount rate that you're going to get for a single asset is going to be higher than the discount rate that you're going to get for the entire portfolio. And so that is a major factor when you look at that valuation.

Umer Raffat
Equity Research Analyst, Evercore

I see. OK, got it. And then the last point being, I mean, I think you would agree, given where the stock is and given where the valuation stands, especially the performance since IPO, one of the questions that comes up is, if management truly does think stock's undervalued, the repurchase could happen at a much more accelerated pace than it has. So I know you guys authorized $1 billion in March 2023. And stocks had these lows, but only $500 million of that billion's been spent so far. So you could argue there's a scenario in which Royalty Pharma does a $2 billion, $3 billion repurchase. Was that something that's a possibility? Or is that not a possibility?

Terry Coyne
CFO, Royalty Pharma

So I mean, look, I think when we see the stock where it is, obviously, it's been surprising to us. And I think that we are very happy that we have the ability to repurchase the stock at these levels. Obviously, we think the stock should be much higher. But it's a tool that we can use to return capital to shareholders. And I think that it's something that we'll continue to look at and balance against making royalty investments. And we obviously have the dividend. But we do have a lot of financial flexibility right now. Our leverage is pretty low. We have a lot of cash. We're generating a lot of cash every quarter. And so we have to weigh all of those things, as you can imagine, that we would.

Umer Raffat
Equity Research Analyst, Evercore

What was the cost basis for this $500 million repurchase you guys did in the last 18 months?

Terry Coyne
CFO, Royalty Pharma

We were buying some most recently, we've been buying in the sort of mid-20s. I think the overall is probably around $29 or so.

Umer Raffat
Equity Research Analyst, Evercore

OK, so you've been buying between the range of $30-$25?

Terry Coyne
CFO, Royalty Pharma

Yeah.

Umer Raffat
Equity Research Analyst, Evercore

OK, got it. Excellent. Anything we didn't touch up on, Royalty Pharma? OK, excellent. Thank you.

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