TherapeuticsMD, Inc. (TXMD) Q4 2018 Earnings Conference Call Transcript

TherapeuticsMD, Inc. (TXMD)
Q4 2018 Earnings Conference Call
Feb. 21, 2019 4:30 p.m. ET

Contents:

• Prepared Remarks
• Questions and Answers
• Call Participants
  
  See all our earnings call transcripts.

Prepared Remarks:

Operator

Good afternoon, ladies and gentlemen. Thank you for joining us for the TherapeuticsMD fourth-quarter and full-year 2018 financial results conference call. Following prepared remarks from the company, we will open the call for questions. As a reminder, today's call is being recorded.

I would now like to turn the call over to Therapeutics' Vice President of Investor Relations Nichol Ochsner. Nichol?

Nichol Ochsner -- Vice President of Investor Relations

Thank you. Good afternoon, everyone. Thank you for joining today to discuss our 2018 financial results and business update. This afternoon, TherapeuticsMD issued a press release announcing our fourth-quarter and full-year financial results.

The press release is available on the company's website, therapeuticsmd.com, in the Investors & Media section. On today's call from TherapeuticsMD are Chief Executive Officer Robert Finizio, Chief Financial Officer Daniel Cartwright, Co-Founder and Director Dr. Brian Bernick, and Chief Commercial Officer Dawn Halkuff. I would like to remind everyone that certain statements made during this conference call may be forward-looking statements.

Such forward-looking statements are based upon current expectations, and there can be no assurance that the results contemplated in these statements will be realized. Actual results may differ materially from such statements due to a number of factors and risks, some of which are identified in our press release and our annual quarterly and other reports filed with the SEC. These forward-looking statements are based on the information available at TherapeuticsMD today, and the company assumes no obligation to update statements as circumstances may change. An audio recording and webcast replay for today's conference call will also be available online in the Investors & Media section of the company's website.

For the benefit of those who may be listening to the replay or archived webcast, this call was held and recorded on February 21, 2019. With that, I'll turn the call over to TherapeuticsMD's CEO Rob Finizio.

Rob Finizio -- Chief Executive Officer

Thanks, Nichol. Thank you for joining us on our call this afternoon. I will begin with an overview of highlights from 2018, including our successful launch of Imvexxy and our key events planned for 2019 that we believe will continue to drive our growth. In 2018, TherapeuticsMD completed its most successful and transformative year to date and has positioned itself as the leading women's healthcare company.

We obtained FDA approval for three products, Imvexxy, Bijuva and Annovera. These products provide women with unique and highly differentiated treatment options to address the unmet needs in large patient populations of women's health. The approvals are crucial to our long-term growth, and we're excited that 2019 brings opportunities to unlock their market potential. In 2019, we are focused on continuing to execute on our commercialization strategies, and I'd now like to turn the call over to our Chief Commercial Officer Dawn Halkuff, to provide a review of Imvexxy's performance.

Dawn Halkuff -- Chief Commercial Officer

Thank you, Rob. Let's begin with Imvexxy on Slide 4. We are very encouraged by the initial commercial performance of our first approved product, Imvexxy. As judged by prescription trends and patient refills, we believe Imvexxy is viewed as an important new option for treating moderate to severe dyspareunia, a symptom of VVA, by addressing the unmet physical and clinical needs in the estrogen VVA category.

Looking at our Imvexxy prescription data, from launch in July 18 to January 31, 2019, approximately 86,000 prescriptions were dispensed to approximately 30,100 patients, and approximately 8,100 prescribers have written a prescription. This data still puts us on track with the Vagifem launch. Imvexxy prescription growth continues into 2019. We had a record month in January, and average weekly prescription volume for the first two weeks of February increased to approximately 5,800 as compared to our record average weekly volume of approximately 5,300 in January.

Regarding user adherence and compliance, as shown on Slide 5, our most recent data demonstrates that the average number of refills tracks well with the maximum number of refills possible. For patients who received their first prescription in August 2018, the average number of fills was approximately 4.9 out of a maximum of six. Average refills for all patients through January 31, 2019 were 2.85. Adherence with other VVA treatments is estimated to be on the order of only two fills a year.

We believe the strong adherence and compliance rates are a result of both the clinical and physical advantages that Imvexxy has over existing therapies, as well as our copay and patient education program. Going forward, we plan to provide monthly prescription and refill updates on or around the 10th day of each month. I am often asked to explain why the launch of Imvexxy has been so successful. As you can see on Slide 6, Imvexxy at four and 10 micrograms is the lowest approved dose of estrogen VVA therapy on the market.

We believe this resonates well with both clinicians and payers as the medical guidelines recommend starting with the lowest effective dose of estrogen, which is Imvexxy. Imvexxy is also clearly differentiated from other treatment options with improvements seen in some women as early as two weeks, PK data where systemic hormone levels remain with a normal postmenopausal range, ease of use, ability to be used any time of day with an applicator-free and mess-free administration, among other important attributes. Turning to our commercial payer update on Slide 7, in the fourth quarter, we had two additional major payers begin to adjudicate prescriptions for Imvexxy. This was a large contributor to our Imvexxy net revenue growth over the third quarter, in addition to the over 300% rise in script volume.

We see these trends continuing in Q1 as more commercial payers begin to adjudicate prescriptions for Imvexxy. I would like to congratulate the commercial team on securing contracts with seven of the top 10 commercial payers in the VVA market. In the majority of plan designs, we currently have unrestricted access with no step edits or prior authorizations with these seven commercial payers. This brings our covered lives to 33% of the commercial market, and looking forward, with United coming on board effective March 1, we will add another approximately 8% of the commercial lives covered in the VVA market.

The last commercial plans left are only Caremark, Aetna and Kaiser, and we are currently in negotiations with these payers. Looking at Medicare Part D on Slide 8, which represents approximately 25% of the VVA market, we initially anticipated coverage to start October 1, 2019. Due to Imvexxy's new lowest effective dose and the early interest of the Part D plans, we are happy to announce that we have already secured approximately 25% of the Medicare Part D market with both UnitedHealthcare, the largest Part D payer, representing approximately 21.1% of lives, and Kaiser, representing 3.7% of lives. UnitedHealthcare began adjudication for both the starter and maintenance packs on February 1, and Kaiser is currently adjudicating the maintenance pack.

We remain positive that we can further expand our Medicare coverage in the next two quarters. To step back, our payer contracting process is well ahead of our expectations on both the commercial side, as well as the Medicare side and is starting to contribute to Imvexxy net revenue. We are aggressively working to finalize coverage with the remaining major commercial plans over the next two quarters. Our rollout of Imvexxy has followed a specific plan that unlocks commercial levers in a cadenced fashion.

Looking at Slide 9, at launch in late July 2018, we focused on the fundamentals of HCP education and patient affordability delivered through a motivated and talented sales team. In a short time, we have driven awareness and acceptance of Imvexxy with over 8,100 of our called-on targets having written at least one prescription. We believe that fast uptake is not only driven by our product profile, but also the patient affordability programs that have been in place since day one. We will continue to focus on the sales organization as a primary driver, with the expansion from 150 sales representatives to approximately 200 in March.

This will expand our reach to 25% more targets, providing expanded opportunity for Imvexxy. The second lever is growing payer access. As I just discussed, the majority of top commercial plans are already covering Imvexxy, and Medicare Part D coverage is starting to grow. Our sales force expansion that I just mentioned is timed with the increase in coverage at the end of the first quarter.

The third lever is focused on expanding our prescriber base through medical education of Imvexxy. To that end, we have rolled out several initiatives. The first is a promotional campaign such as email and direct mails that reinforces the sales representative's message delivered in-office. In addition, we launched our medical education programs across the country.

We have 70 speaker programs anticipated to roll out in Q1, with key opinion leaders providing disease awareness and medical education on Imvexxy, which results in increased understanding and familiarity with Imvexxy, which we believe will result in new prescribers and patients. We are very encouraged by the interest in these programs and attendance, which has been 6 times higher than the industry average. We have, on average, 14 healthcare providers per program, compared to the industry average of only 2.3. Programs are delivered in person and virtually.

We plan to continue to grow these programs throughout the year. The last lever is unlocking the consumer opportunity. This will happen in the second half of 2019. At that time, Imvexxy should be recognized broadly by our prescriber base across the country.

This enables us to begin our direct-to-consumer marketing campaign for Imvexxy, designed to accelerate adoption and activate new postmenopausal women to take action to discuss Imvexxy with their clinicians. This is a proven, cost-effective approach that is designed to increase awareness about the condition and encourage women to take action by having a discussion with their healthcare providers. With only 7% of symptomatic menopausal women being treated with prescription VVA therapy, we believe we have a significant opportunity to expand the market. Before I turn the call back to Rob, I want to end with this.

From my time at Pfizer when I worked on the Premarin franchise, including Premarin Vaginal Cream, I knew the VVA market was a promotionally sensitive market. The advantage that we have here at TherapeuticsMD is that Imvexxy, in my opinion, is a best in class in the VVA estrogen category, and the growth that we are seeing in phase one of launch was only the initial levers. Imagine the opportunity we will have when we unlock the full force of all the promotional levers. And the last lever we have not discussed is how the launch of Bijuva will further enhance Imvexxy growth when it reaches the market, with more targets to call on and more reach and depth in the offices we already target.

I will now turn the call over to Rob to discuss the Bijuva opportunity.

Rob Finizio -- Chief Executive Officer

Thanks, Dawn. As you know, Bijuva was approved on October 28 of 2018, and a great way to end the year. Turning to Slide 10, let's set the stage for Bijuva. Typically, hot flashes are one of the first indicators that a woman is going through menopause.

Average age of onset is 51, and these symptoms may last longer than 10 years. Menopausal women can also experience VVA symptoms like dyspareunia. The cause for both of these conditions is a reduction of estrogen that occurs during menopause. We see the common cause of these conditions as an opportunity for TherapeuticsMD to become the leader in menopause by offering two best-in-class therapies that satisfy a growing and underserved market.

Bijuva also gives an opportunity to connect with menopausal women early in the treatment paradigm that may allow for the transition from Bijuva to Imvexxy based on their symptoms. So why is Bijuva a large opportunity? As you can see from Slide 11, in the year 2000, which is before the Women's Health Initiative, or WHI, combination synthetic hormones were the standard of care. Post-WHI, women and healthcare providers have demanded bio-identical hormones and refused synthetic options like Prempro, that can be seen on this slide. Prior to the availability of Bijuva, bio-identical demand has been satisfied by the two-pill, off-label, separate prescriptions of estradiol and progesterone, filled annually in the United States, that are not FDA-approved, to be used in combination, in addition to the large compounded hormone segment.

Turning to Slide 12, you can see both of these segments are typically prescribed by healthcare practitioners that have patients who demand bio-identical products and refuse to take FDA-approved synthetic therapies. According to Symphony Health, as of December 31, the off-label, two-pill regimen alone is an approximately $850-million market opportunity for Bijuva. The two-pill, off-label regimen has not been evaluated in large, adequate and well-controlled studies and is not FDA-approved to be used in combination. Instead, these products are being used off-label to provide patients with FDA-approved bio-identicals, but their combined use lacks both efficacy and safety data, including evaluation of risks for endometrial hyperplasia or cancer.

We believe that there is no reason why healthcare providers and patients will continue to use this off-label workaround once Bijuva is available. Turning to Slide 12, you can see both of these segments are typically prescribed by healthcare practitioners that have patients who demand bio-identical products and refuse to take FDA-approved synthetic therapies. According to Symphony Health, as of December 31, the off-label, two-pill regimen alone is an approximately $850-million market opportunity for Bijuva. The two-pill, off-label regimen has not been evaluated in large, adequate and well controlled studies and is not FDA-approved to be used in combination.

Instead, these products are being used off-label to provide patients with FDA-approved bio-identicals, but their combined use lacks both efficacy and safety data, including evaluation of risks for endometrial hyperplasia or cancer. We believe that there is no reason why healthcare providers and patients will continue to use this off-label workaround once Bijuva is available.In addition, the compounding market, which represents approximately 12 million to 18 million prescriptions annually of unapproved compounded bio-identical estrogen and progesterone, have also not been proven safe and effective and are generally not covered by insurance. Bijuva offers a modernized bio-identical solution that is supported by strong efficacy data and safety data, including evaluation of risks for endometrial hyperplasia or cancer. Let's move on to the other reasons Bijuva is a compelling replacement for an unapproved solution.

The scientific data shown on the next few slides is one of the most exciting features of Bijuva, and it's how our technology innovation, the solubilization of estradiol and progesterone, has led to significant improvements in a number of secondary endpoints. As shown on Slide 13, Bijuva also demonstrates desired favorable lipid parameters. On Slide 14, you can see there were no significant changes seen in coagulation parameters. And as illustrated on Slide 15, there were no significant changes in metabolic profiles, as well as improvement in both quality-of-life measures and sleep parameters.

This data is unique to Bijuva, and it's not been documented for compounded products. Bijuva will give women and prescribers exactly what they're looking for a well-studied, scientifically compelling combination bio-identical solution in a single daily capsule. Now moving on to Slide 16, the introduction of Bijuva is coming at just the right time. A few years ago, this category of compounded bio-identical hormones was reimbursed, and compounding pharmacies could make a profit.

That's changed, and most payers consider compounded hormones unapproved drugs, and for the most part, do not reimburse for hormones. Compounding pharmacies will now have an FDA-approved and bio-identical option with Bijuva that will be reimbursed. Let's move on to commercialization on Slide 17. Bijuva will follow a similar commercialization path to Imvexxy that focuses on first building healthcare professional education and patient affordability while simultaneously building payer coverage before embarking on Bio-Ignite and consumer expansion.

We're on track for launch in the second quarter, and upon launch, intend to draw our second $75-million debt tranche. Phase one of our launch of Bijuva will focus on the traditional prescribers in the off-label, two-pill regimen. Since there's little to no promotion in the FDA-approved hot-flash category, TherapeuticsMD, with Bijuva, will be one of the only voices presenting opportunity to reshape this category and reinvigorate this therapeutic area. Now moving to Slide 18, phase two.

Once our payer coverage is established, we'll focus on maximizing the compounding channel known as Bio-Ignite. Bio-Ignite is an innovative program that allows us to engage compounding pharmacies. I am very happy to announce that we have already launched Imvexxy in the Bio-Ignite network, now that we have payer reimbursement to pave the way for Bijuva. Now turning to Slide 19, as you can see, our first wave of compounding pharmacies are live, and Bio-Ignite has approximately 22 women's health compounding pharmacies dispensing Imvexxy today.

We anticipate another 25 compounding pharmacies will be live and dispensing Imvexxy in the next 30 to 60 days, with the anticipation of dispensing Bijuva once it gains reimbursement. In addition, on Slide 19, we recently partnered with the second-largest group of compounding pharmacies that has over 100 locations in the United States. What's clear is that the value of distributing Imvexxy and Bijuva is resonating with the compounding pharmacies. Our goal is to have at least 150 compounding pharmacies live by the time Bijuva obtains commercial reimbursement.

Our compounding strategy is working, supporting Imvexxy's growth while setting the groundwork for a fast uptake of Bijuva.I'd like to point out a very important fact. Out of approximately 700-plus of the top compounding pharmacies, that represents over 50% of the bio-identical compounded volume of 12 million to 18 million prescriptions. I'll now turn over the call to the Co-Founder and Director, Dr. Brian Bernick, to provide an overview of Annovera.

Brian Bernick -- Co-Founder and Director

Thank you, Rob. Starting with Slide 20, let's talk about Annovera that was approved in August 2018, which we view as an emerging opportunity that may not be fully appreciated by our shareholders. Annovera is the first and only product approved in the new class of contraceptives designated as the vaginal system that is a patient-controlled, procedure-free, long-acting, reversible prescription birth control product that provides a full-year of protection from pregnancy. Like Imvexxy and Bijuva, Annovera is a highly differentiated opportunity and large market representing the high-growth segment of the prescription contraceptive market, and it's complementary to our women's health portfolio.

Most women's health providers prescribe contraception, which we believe will expand our reach and depth in the offices we call on as we promote Imvexxy and Bijuva. The reversible birth control market encompasses approximately 29 million women of child-bearing age. As seen on the slide, reversible contraception is made up of multiple methods, including oral contraceptive products, rings, patches, injections and long-acting reversible contraception such as IUDs and implants. The long-acting segment of the market is growing in response to the medical societies' and CDC recommendations that long-acting reversible contraception is the most effective reversible contraception option for most women.

Moving to Slide 21. As a reminder, Annovera is a small, soft, flexible vaginal system in the form of a ring that prevents ovulation for an entire year and can be inserted and removed by a woman at her discretion in repeated four-week cycles. Annovera offers lower doses of contraceptive hormones, and with its controlled-release delivery via the vaginal route, it avoids daily fluctuation in hormone levels with excellent cycle control. And with the unique progestin-segesterone acetate, it is highly effective in preventing pregnancy and lacks the androgenic, estrogenic or glucocorticoid side effects that are often associated with other contraceptive products.

Slide 22 shows some of Annovera's unique physical characteristics. In the phase three study, Annovera had an overall satisfaction rate of 89%. The study also demonstrated high rates of adherence and continuation. Looking at Slide 23, as things exist today, there's a large well-established contraceptive ring market that is represented by Merck's monthly NuvaRing, that was responsible for approximately $1 billion in gross revenue last year.

We believe Annovera has a competitive advantage over NuvaRing and will target prescribers and women that have already embraced this form of contraception. Annovera is a softer and more pliable ring option, and with segesterone acetate that provides contraceptive benefits for an entire year versus just one month, it doesn't require refrigeration and will be priced more favorably on an annual basis. Additionally, we believe Annovera will take market share from oral contraceptives. Annovera represents an easier way to be compliant, given that it is a ring that lasts an entire year, and ideal for those women who forget doses due to breaks in their routines, travel or for those who may be burdened by monthly trips to the pharmacy, like those that are away at college or in the military.

We also plan to target patients and providers who desire long-acting contraceptives where IUDs and implants are not a good fit, including those healthcare providers who do not want to do procedures or purchase and manage inventory, as is usually required for IUDs and implants. In addition, IUD and implant use is limited by the number of healthcare providers that perform those procedures. As most healthcare providers are not proficient in those procedures, Annovera now enables all prescribers, regardless of specialty or training, including the primary care providers, to finally be able to provide long-acting reversible contraception. We have committed to pricing Annovera responsibly, ensuring a competitive price point between $1,800 to $2,000 for a one-year vaginal system.

This pricing is at a discount to other birth control products on an annual basis. However, given no other contraceptive vaginal system offers protection for an entire year, we believe there is a significant chance the FDA will determine Annovera constitutes a 19th class of birth control that, under the Affordable Care Act, or ACA, would require private health plans to cover with no out-of-pocket costs. We plan to have a limited launch of Annovera as early as the third quarter of 2019. The launch will be limited as we ramp up inventory to meet the demand for Annovera, trigger the FDA decision on ACA and allow us to start conversations with payers.

We believe this should bring adjudication for Annovera approximately six months after launch. Moving to Slide 24 for a medical update, we have a busy year ahead of us in 2019 with numerous upcoming publications, as well as presentations at both national and international medical meetings, including the International Society for the Study of Women's Sexual Health, held in March, where we will present data related to Bijuva and Annovera. We will present secondary endpoints from the Replenish trial that demonstrate that Bijuva has a positive effect on vaginal health. Additionally, we will present data on sexual outcomes and acceptability in Annovera users.

Later in March, at the Endocrine Society meeting, we will present three publications highlighting the key attributes of Annovera, including its high efficacy, excellent bleeding profile and lack of androgenic side effects. Also at the Endocrine Society meeting, we will present for the first time Bijuva reduction in hot flashes and night sweats resulting in sleeping improvements. In May, at the American College of Obstetricians and Gynecologists meeting, we will present novel data across all three products, and likewise, we will be presenting additional data at the European Menopause Society meeting held later in May. I will now turn the call over to Dan Cartwright, our CFO, to discuss fourth-quarter and year-end financial results.

Dan?

Dan Cartwright -- Chief Financial Officer

Thanks, Brian. Fourth-quarter and full-year 2018 financial results are included in the press release issued today. Let me summarize a few key points. Net revenue from the company's prescription prenatal vitamins business was approximately $4.2 million for the fourth quarter and $15 million for the full-year 2018, compared with approximately $4.1 million for the fourth quarter and $16.8 million for the full-year 2017.

For the year, the decrease was mainly attributable to a lower number of prenatal vitamin units sold and higher utilization of prenatal vitamin coupons in 2018. As shown on Slide 25, for the fourth quarter, approximately 47,500 units of Imvexxy were dispensed by pharmacies and paid for by 22,200 patients, compared with approximately 14,900 during our launch in the third quarter, which is a threefold increase. The average WAC sales price was approximately $219 for the fourth quarter. As insurance companies start covering Imvexxy, we expect our copay assistance to decrease and our net revenue to increase proportionally.

As such, in line with our expectations, net revenue for Imvexxy was approximately $0.9 million for the quarter, which is a fourfold increase from our net revenue during our launch in the third quarter. Again, this quarter revenue was significantly impacted by our copay assistance program, driven by our maximum out-of-pocket cost to the patients of $35 per prescription. We expect copay assistance for Imvexxy to decrease substantially over the next few quarters. In 2018, we completed the contracting process with the majority of the large payers in the VVA commercial space.

We believe this change will translate into higher revenue as insurance companies begin to pay for Imvexxy through the adjudication process, thereby reducing our copay assistance. We expect that you will see this change improve our net revenue throughout 2019. Keep in mind, Q1 net revenues also are impacted by the resetting of high-deductible insurance plans. Total operating expenses for the fourth-quarter and full-year 2018 increased compared to the fourth-quarter and full-year 2017.

These changes primarily reflect an increase in commercialization expenses for the launch of Imvexxy during the periods. SG&A expenses for the fourth-quarter and full-year 2018 were approximately $35.4 million and $116 million, respectively, compared with approximately $14.2 million and $57.7 million for the prior year's quarter and full year. This was primarily due to higher sales, marketing, personnel costs to support the launch and commercialization of Imvexxy in the fourth quarter. R&D expenses for the fourth-quarter and full-year 2018 were approximately $6.8 million and $27.3 million, respectively, compared to approximately $11 million and $33.9 million during the prior year's quarter and full year.

Turning to the bottom line. Our net loss for the -- excuse me, for the fourth-quarter and full-year 2018 were approximately 33.9 -- excuse me, $39.4 million or $0.17 per basic and diluted share and approximately $132.6 million or $0.59 per basic and diluted share, respectively, compared with approximately $21.4 million or $0.10 per basic and diluted share and approximately $76.9 million or $0.37 per basic and diluted share for the fourth-quarter and full-year 2017. Our cash position remains strong. We finished 2018 with approximately $161.6 million in cash, compared with approximately $127.1 million at December 31, 2017.

For the fourth quarter of 2018, our cash utilization for operations was $30.7 million. As of December 31, 2018, we had approximately $75 million in debt from our nondilutive term loan financing with MidCap Financial with an overall effective interest rate of approximately 11%. Following our planned launch of Bijuva, before the end of May 2019, we have the option to draw down an additional $75 million as part of the second tranche of our term loan with MidCap. We are currently working on a similar vehicle for the Annovera launch.

Now back to Rob for his closing comments.

Rob Finizio -- Chief Executive Officer

Thanks, Dan. To summarize today's call, Imvexxy's prescriptions and refills are in line, and we expect this growth will continue. Seven of the top 10 payers will all be adjudicating Imvexxy on March 1, in line with expectations. Part D is ahead of schedule, with United and Kaiser adjudicating now.

We expect the remaining three large commercial payers and Part D payers to move forward and do not see any significant outstanding issues. Bijuva is on track and set to launch in Q2. Annovera is lining up to launch in Q3, and this can add significant upside potential revenue with the existing sales force and little needed new infrastructure and expense. And most importantly, this will start the payer clock earlier than expected.

As Dan said, we're also currently evaluating a debt vehicle for Annovera, and I also want to take this opportunity to let you know that we will be holding our annual analyst or investor day in New York in the second quarter of this year or the summer. We are planning a day that will be informative and include speakers from the senior management team, compounding pharmacies, leading physicians in women's health, and others. We will provide you with additional insight and details into our launch strategy for Bijuva and further frame the market opportunity for Annovera and why we are confident in the significant opportunities and promising outlook at TherapeuticsMD. I'd like to thank you for your time today, and we will now take questions. 

Questions and Answers:

Operator

[Operator instructions]Our first question comes from Ken Cacciatore with Cowen and Company. Your line is open.

Ken Cacciatore -- Cowen and Company -- Analyst

Hey, guys. Congratulations on all the progress. Everything sounds great. Just a couple of quick questions around the pricing.

Do you still feel, as you're going through all the negotiations, that Imvexxy is going to kind of normalize at around $100 per script? And then similar question for Bijuva. Can you give us where you think the per-script value is going to eventually normalize? And I guess starting with Imvexxy, when do you think we'll start seeing that normalization? Would it be closer to Q1 of next year or exiting Q4 of this year that we should start thinking about that? And then also on the Bio-Ignite, which is already doing better than you expected, just the profitability mechanism. Is a prescription through Bio-Ignite the same to you all as it is kind of through normal distribution? Thank you.

Rob Finizio -- Chief Executive Officer

Ken, that's a lot. I'm going to try to answer them all, and if I miss anything, please let me know. So yes, I think for the maintenance pack, I think you're certainly in line. The starter pack has a $405 WAC price, and you can certainly get more revenue there, and it's -- since we're doing a lot of market take from current women that are stable on a competitive product, they're switching them right to maintenance pack and there's less starter packs.

We expect or hope that will improve in the future. So as far as the Bio-Ignite question goes, it's roughly the same. So that's a different class of trade that has to qualify for. So as we talked about just signing the second largest -- as everyone knows, we have -- we've had the largest kind of signed up in a partnership for a while, but now that we have the second largest, they go through a vetting process where we actually make sure their licensure is in good standing, make sure they qualify for the class of trade.

It could be a little bit more expensive on the distribution because you go through smaller distributors there, but it's not that significant. We just want to make sure everything -- remember, they're in a cash-pay environment today. They don't need any more cash-pay products. They need reimbursed products where they can get a discount off of WAC and sell it appropriately.

I hope that answers your questions.

Ken Cacciatore -- Cowen and Company -- Analyst

It does, yes. And then if I could speak one last one, as we think about Annovera and the potential size, just -- it seems that utilization might be for women who want to have a continuous use and actually not remove it often. Can you just talk about that segment of the market? And maybe give us a stab of how large this product, do you think, could be in some kind of context? We understand the advantages, but can you frame your expectations on how large this product could eventually be? Thank you.

Rob Finizio -- Chief Executive Officer

Sure. So I'm going to take a stab at it first and then turn it over to Dr. Bernick. This is really his baby.

So the numbers are significant, and people -- we really haven't put the data out on Annovera for people to go out and do their own surveys and build their own models yet. And that's going to come on our investor day. And we're starting to put more data out, as you can see, now, that we'll get more and more out. But in that sense, the market is very large.

As we said, it's -- if you just got 5% of the market, it's a multibillion-dollar opportunity. The key here is, is what does Annovera do? Annovera is really a new tool for OB-GYNs. There's a lot of -- as you know, the oral contraceptives, kind of the dominant, short-acting product line that's oral, is decreasing about 5% or 4.5% over the last seven years, while the long-acting IUDs or implants are increasing at about a CAGR of about 14% over the last seven years. The issue here is, when I use an IUD, and I'm a female, I give up control.

I give up control of my fertility, my menses, I give up everything, and I need a surgical procedure to put it in and take it out. What Annovera does is, it gives back to the doctor the control to give a long-acting product to a woman and not have to be a specialist in that procedure, and it gives the woman the control to control her fertility over an entire year. So I can't tell you how many OB-GYNs do not implant IUDs or implants, or PCPs that are never trained to do it, and really, really want this flexibility. But maybe even more importantly, on the woman's side, is the short-acting products, they don't -- they give all the control, but they don't offer long-term benefits.

So having a one-year ring, and all the upside, but keeping the control with the woman, is really the cross-section across these different product lines that we're going to identify. So it's just really, really attractive. I think we can do very well, a lot better than people think we can do, and the key here is if we can get this out in Q3, we start the six-month payer clock. So as we go into 2020 early on, we could have reimbursement and adjudication in place for all three of our drugs.

And remember, Annovera adds so much upside because now, like with Imvexxy, they can use it throughout the year and you get a monthly payment throughout the year. Annovera, you get it all upfront. So as you know, it costs us in the $50 range, and we told you how we're going to price it, so the potential cash flow upfront is significant, and that is just so attractive. So the sooner we can get it out to start that payer clock and get reimbursement is what we're going to do, and it's on track and in line to get out in Q3.

Brian, anything to add?

Brian Bernick -- Co-Founder and Director

Yes. So back to your question about the potential to use the product continuously. So just to be clear, that's not how the product was studied, and it's off-label. Of course, that's how we use most of our birth control products.

Pills -- as a clinician, I've encouraged my patients for many years to use their birth control pills continuously, but that requires them getting multiple refills of their product, and here you have a product that empowers women to be in control of their cycle and have the flexibility to individualize their menstruation. And so some women will want to use the product and have a period once a month, others maybe every three months, some twice a year and some just continuously to keep it in to avoid a period. For similar reasons, and again off-label, there's a lot of interest in this product for both endometriosis and fibroids, given its long-acting controlled release, instead of using a birth control pill that is the frontline therapy in those conditions. So a lot of potential and a lot of interest in this product.

Thank you.

Operator

Our next question comes from Louise Chen with Cantor Fitzgerald. Your line is open.

Louise Chen -- Cantor Fitzgerald -- Analyst

Hi. Thanks for taking my questions here. I had a few. My first question is -- thank you.

What is the net price trend that you expect over 2019 for Imvexxy? And then what percent of Rx's are written to people that have insurance that's currently covering Imvexxy? And the last question I had is, how many Rx's are written as 90-day prescriptions? Thank you.

Rob Finizio -- Chief Executive Officer

I'll do my best to answer those, Louise. So the trend will be dictated solely by the payers and how fast we can get them on. So if you think about it, we are -- and I'm really happy with my team. We really didn't see any Part D coming on until -- starting to pay until October 1.

Somehow we got United in the door and Kaiser, and they're already paying as of very recently. Those other large payers will drastically impact that trend. You guys know what our WAC price is, you know what our goal is. On the commercial side for net margins, we don't have a clear picture on net margins for the Part D side.

We know it is typically lower. And then on the other side, next quarter, we'll have a very good assumption on the commercial front, because we have seven of the top 10. As of March 1, we'll have great coverage there. But we don't see any delays that will stop us from contracting with, in essence -- we call it three, but it's really two.

Aetna and Caremark are now one, for the most part, and then you have Kaiser. And we are deep in discussions with both. And I don't see any reason why both won't get done. So if we could answer that trend, it would completely dictate when that payer comes on and what that net percentages are in those contracts, and I just don't have those yet.

What was your next question? Sorry. I went long there.

Louise Chen -- Cantor Fitzgerald -- Analyst

No, it's OK, thank you. How many prescriptions are written as 90-day prescriptions?

Rob Finizio -- Chief Executive Officer

I don't know that question. Do you know, Dawn?

Dawn Halkuff -- Chief Commercial Officer

I don't believe any of our prescriptions right now are 90. I believe most of them are 30.

Rob Finizio -- Chief Executive Officer

Yes. So Dawn doesn't believe we're having any 90-days, but I can check on that and get back to you. I'm not sure.

Louise Chen -- Cantor Fitzgerald -- Analyst

OK. Thank you.

Rob Finizio -- Chief Executive Officer

You're welcome.

Operator

Thank you. Our next question comes from Annabel Samimy with Stifel. Your line is open.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Hi, guys. Thank you for taking the questions. I have a variation of the same questions, but maybe you can indulge me.

Rob Finizio -- Chief Executive Officer

All right.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

So I guess there was some beginning of adjudication in the fourth quarter. It doesn't seem like the net price changed that much. So what should we really expect for the first quarter in terms of net price? Should we assume more normalization, given that you're going to have about six or seven out of 10 of these payers adjudicating and presumably paying, or is it still going to be a significantly slow-stage rollup of this net price into the end of the year when there's full coverage? So that's the first question. The second is around Bio-Ignite.

So now you have two of the major -- of two networks that were contracted. Are those networks signing up right now, of those two networks? Are you holding back on any of them? And are you specifically holding back until Bijuva is available and adjudicated? And with the Bijuva approval, has the interest in signing up accelerated? And then finally, on Annovera, when might we have a decision from the FDA that this is actually a vaginal system, and if it's its own class, in fact, its own class, did I hear correctly that there'll still be a six-month lag until adjudication? Thanks.

Rob Finizio -- Chief Executive Officer

All right, I tried to take notes, Annabel. If I don't have it, can you help?

Annabel Samimy -- Stifel Financial Corp. -- Analyst

I took notes. I can repeat them.

Rob Finizio -- Chief Executive Officer

All right, thank you. So coverage. So in Q4, as you saw, we had one payer come on, and at the very end of the quarter, we had another one come on, so we really only had -- I don't know if it's two. But in Q1 at the -- and we even put the dates out there for you.

You have coming on throughout the quarter different payers starting to adjudicate. So for -- it's very hard for me to tell you what to expect based on the mix and when they come on, and what that mix is. I think at the end of Q1, we still believe you're going to have a very strong and solid step-up, even though there are kind of the low to -- high-deductible resets, I still think you're going to see great progress. And I think it'll be much easier for you to draw some conclusions, because we will -- we should have the additional large commercial payers on board, and hopefully, I expect more progress on the Part D side as well, which is way ahead of schedule.

So I wish I could give you a lot more, but that's all we have now. Because realize, when you sign those contracts, you know what your rebate percentage is, you know when they start to pay, and you can figure out what your net's going to be. And we're just not there with everybody yet, but as you see, during this quarter, we've got lots coming on. Does that help answer your question on that one?

Annabel Samimy -- Stifel Financial Corp. -- Analyst

I guess so, yes. In a vague sense.

Rob Finizio -- Chief Executive Officer

All right. So the two large networks, so for Bio-Ignite. So what we do is, we, in essence, while they're in the vetting stage, partner -- we have a partnership with them. The contractual agreement as they're vetted will actually go between the distributors and the pharmacies.

And what the current plan is, as you can see, is we just launched Imvexxy into these networks. Twenty two pharmacies are now promoting Imvexxy and adjudicating Imvexxy as opposed to compounding their own VVA product. That is getting new women into this space based on the technological advantages of Imvexxy. We have another 30 in vetting, and then the next one that we'll start vetting, the next cycle, will be this next second-largest network of 100.

We expect they will all carry Imvexxy now, and as we -- as you saw, possibly, in the slides, we've identified a couple hundred thousand scripts just right there, OK? So it's -- that's for VVA. So it's pretty significant. Now, if we give them Bijuva now, there's no reimbursement, and we're just getting a copay card -- copay of $35. That won't change once reimbursement comes on.

So that actually puts them at a disadvantage because they're in a cash-pay environment now. So this Imvexxy groundwork should have at least 150 compounding pharmacies that are high-decile prescribers and kind of the thought leaders within the compounding pharmacy world dispensing Imvexxy. So once Bijuva does get payer coverage, it's ready for us to launch right into it. And remember, the top 700 pharmacies have approximately 50% or more of the 12 million to 18 million bioidentical hot-flash scripts.

So that 150 is significant, and we don't see any reason we can't significantly grow that over the next two years. And our goal in the first two years is to get all 700 of those pharmacies. That is our goal. OK?

Annabel Samimy -- Stifel Financial Corp. -- Analyst

OK. And then the last question regarding Annovera? The decision by the FDA or the class?

Rob Finizio -- Chief Executive Officer

Yes. Sure. So Annovera we priced strategically between $1,800 and $2,000. We did that for two reasons.

Number one, it's priced at parity or a discount to competitive products to ours. The reason we did that is that we, no matter where we're slotted, have a shot at having no copay. As it stands today, under ACA, there are 18 classes of birth control. Payers are mandated by law under ACA to pick one.

Each class, they have to pick at least one product and have no out-of-pocket expense associated with that product. OK? So you would think birth control pills, say one's a package of 90 and one's a package of 30, you would think they'd be in the same class; they're not. Those are actually separate classes. So given our design of being the only one-year reversible patient-controlled product, we don't see it fitting into any of the existing classes.

We've also gone out to third-party research and almost everyone we interviewed agreed with that. And given the FDA guidelines out there, we think there's a good chance. It's not for sure, but we think there's a good chance that we will become the 19th class. And we do have the vaginal system designation in our label, and we are currently the only product with vaginal system in the label.

It's mentioned about 52 times. So when do you know? The FDA triggers when you launch it. They can see it in the channel. And our goal is as early in Q3 as possible to do that.

And they typically make a decision within 30 days. There is no specific regulation, though, that requires them to do it. They typically have done it in the past in 30 days. OK?

Annabel Samimy -- Stifel Financial Corp. -- Analyst

OK. And then the adjudication, when does that start? If you're the only one in that class. Don't they have to pay for it?

Rob Finizio -- Chief Executive Officer

There's still a six-month block. They do have to pay for it in this class of therapy. So there is a six-month block, but after that, the adjudication should come on board very quickly, is our expectation today. But there still is the process in place, right? You still have to -- during that six months, as you've seen what we've done with Imvexxy, we will go through that contracting process.

Just we will be in a much stronger position with Annovera than we are with Bijuva or Imvexxy, and I think both of those are pretty good.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

OK. Great. Thank you.

Rob Finizio -- Chief Executive Officer

Thank you.

Operator

Thank you. Our next question comes from Jay Olson with Oppenheimer. Your line is open.

Jay Olson -- Oppenheimer -- Analyst

Hey, guys. Congrats on the progress and impressive script growth for Imvexxy. Can you maybe talk about what percent of your target physician prescriber audience your sales organization has reached, and how that reach may grow over the course of 2019 as you increase coverage, grow your sales organization and launch additional products?

Dawn Halkuff -- Chief Commercial Officer

Sure, Jay. Hi, it's Dawn. So on average, we reach, every month, over 50% of our targets. So over the course of months, we've reached virtually all the targets that we have out there today.

In terms of how reach will increase, it's really not about reach at this point; it's about the frequency and sort of building that momentum to get people that are writing two a month to three a month and so on and so forth so that we can build that more loyal prescribing base. So we've kind of gotten through the first number of months where all that reach needed to happen, and then again, we're going to build that frequency so that we can build the loyal prescribing base. And as I mentioned before, when we expand the sales force, then we're going to get to about 25% more targets, so we'll start that reach game again as we're building frequency with the existing targets.

Rob Finizio -- Chief Executive Officer

To give you a rule of thumb, each rep has approximately a hundred doctors in their territory. So that would be about 20,000 doctors that 200 reps will be reaching out to. The key is getting the top-decile prescribers to shift from what they've been doing and make you their go-to or standard.

Jay Olson -- Oppenheimer -- Analyst

OK, great. That's super helpful. Thank you. And then congrats also on the refill rate for Imvexxy.

Rob Finizio -- Chief Executive Officer

Thank you.

Jay Olson -- Oppenheimer -- Analyst

Only having been on the market for a few months, already averaging more refills than other products in the category. How high can that go? Where do you think the refill rate will max out?

Rob Finizio -- Chief Executive Officer

I'm not sure, to answer your question. I think the best way -- so what we have to do is, we're going to go to, like, a monthly cadence on scripts. So at the end of February, we will compile all of our data as it comes in, say by February 27, and then give us a couple days, two or three days, to get it out to you guys. So we'll go to a monthly cadence here.

And we will give updated compliance numbers here in early March for February. And expect that going forward as the new cadence, as a side note. But to answer your question, look, I personally think we can still do better than we're doing today. I don't know that to be fact, but if you look at it, we've almost doubled the industry average.

So if you look at -- if we continue to grow that, continue our reach with 25% more physicians, increase our frequency with more writing and then start to implement Dawn's plans -- because remember, we're literally pulling our first lever. We just have the most low cost, showing up in the doctors' offices and asking for a business model. Now, this doesn't count Bio-Ignite, activating new women, DTC, larger sales force. We have a number of new levers to pull this year, and I expect growth to continue throughout the year, and I'm hoping the refills will continue to improve.

Because we're getting so many switches, and women are staying on drug, that's a really good sign. All of the signs you look at-the refill rate, the growth trajectory. We're still right on spot with Vagifem. And you look at how little money we've spent and how basic the program is.

It's telling you as we get more advanced, our upside is -- could be significant. And that is, you put the additional products out into these same offices with these same reps that don't cost you any additional money, our upside is going to be significant, guys. And if we can get Annovera out in Q3, look out, here we come. Because that will be reimbursed with a big price point.

It's going to be great. Dawn, do you have anything to add?

Dawn Halkuff -- Chief Commercial Officer

Yes. And Jay, just to add, so I agree with Rob that obviously we're going to watch the refill rates, but I feel incredibly encouraged by seeing what we're seeing month on month. And if you remember, so the average for the category is two, but there are products, and I'll just compare us to Vagifem for a second, that were achieving 3.5. I believe that we are -- have advantages over Vagifem.

So the fact that we're at 2.85 right now, I think there's no doubt that as we gain more experience and seeing the trends, that we can at least reach that. But again, can't predict, but that's really where we're headed.

Operator

[Operator instructions] Our next question comes from Chris Schott with JP Morgan. Your line is open.

Chris Schott -- J.P. Morgan -- Analyst

Great. Thanks very much for the questions. Just a couple here. I guess first on Imvexxy, can you just remind us where you see the balance between the maintenance versus starter packs shaking out over time as we think about how we should be thinking about kind of net, kind of pricing per script? And I've got a couple of follow-ups here.

Rob Finizio -- Chief Executive Officer

Sure. So our guess is 30-70. As we continue to take market share through switches, that is challenging right now. It's more along the lines of 80-20.

But we expect as we activate new patients into the segment, and we think we can do that effectively with Dawn's DTC, we think it could be 70-30 or better, 30 being the starter pack. So that would be our goal, and as we refine our techniques, the label does say even if you start from another therapy to start with a starter pack, so we -- but we have not been pushing that, and that's certainly another lever and some detail we didn't want to get into on this call that we could pull. So I think we can do a lot better than we're doing today, to answer your question.

Chris Schott -- J.P. Morgan -- Analyst

OK, great. And then the second question was just, how are you thinking about balancing sales resources and prioritization for the Bijuva launch and Annovera, and now that they're fairly close timelines? It sounds like Annovera might be more limited this year, so it might be more Bijuva, Imvexxy and then switching it over to Annovera next year. But can you just give us a little more color of how you're thinking about those coming in pretty close succession?

Rob Finizio -- Chief Executive Officer

Yes. I'm going to turn it over to Dawn, but just want to be clear. Annovera would be a very -- with what inventory we have, a launch this year, where really in 2020 is when you're going to see this thing come on in a big way and be covered. But Bijuva and Imvexxy should do well this year.

Dawn, do you want to turn that over?

Dawn Halkuff -- Chief Commercial Officer

Sure. Chris, thanks for the question. So I think the first thing I want to say is that I'm fully confident in our sales force that they can effectively detail two products at once, and the reason that I'm confident is not only the success of Imvexxy that we've seen, but because we are calling on the same prescribers and the same offices with Bijuva that we've done with Imvexxy. So our -- in working with our VP of sales, we've talked a lot about keeping the focus on Imvexxy, where we're seeing the momentum, but bringing in Bijuva to those top E+P prescribers to get that same momentum with Bijuva.

So as far as sort of the traditional, what's in the first position, what's in the second position, we don't look at it that way. We've got a lot of great data that allows us to make sure that we put the product that's going to be most effective first and that we always have time for the second. And so that's how we're setting it up for the launch of Bijuva.

Rob Finizio -- Chief Executive Officer

And the great news is they're both menopause, right? It's very unique. You don't see this too often.

Chris Schott -- J.P. Morgan -- Analyst

Yes. And the final one, just coming back to that capacity on Annovera. Just any more color in terms of how much actual capacity you have at launch? And then when we think about capacity ramping, I guess as we think about 2020, is capacity a rate-limiter at all, or will you be in a position that that's not going to be an issue for the company?

Rob Finizio -- Chief Executive Officer

No, no. I don't see that being an issue at all. So we inherited, from the Population Council, a very basic, basic, non-commercial-oriented -- they're a nonprofit, and as it should be, right? They did a good job -- process there, where literally it's a manual injection into the molding of hormones and curing and things of that nature. We've invested a few million dollars, as you've seen in our R&D line here, to get that process duplicated and sped up and a little bit automated.

And we think the initial stuff that lands will be limited, but as you get into Q4 this year, capacity will not be an issue whatsoever. In essence, our investments start to pay off and things expand. So we're just trying to get it there, going, as soon as possible, because it starts that payer clock, and it's such a big-ticket item for us, and it really extends our reach of the menopausal products as well. So come Q4, capacity will not be an issue.

We're very confident in that.

Chris Schott -- J.P. Morgan -- Analyst

Great to hear. Thanks so much.

Rob Finizio -- Chief Executive Officer

Thank you.

Operator

Thank you. And our last question comes from Dana Flanders with Goldman Sachs. Your line is open.

Michael Scott -- Goldman Sachs -- Analyst

This is Michael on for Dana. Just two questions here. The first one is, given what we know now about Imvexxy, how has, like, the go-to-market strategy changed at all for Bijuva in terms of mimicking its launch? And then secondly, as you see the adjudication flowing through, how should we expect the volume data per IMS to trend going forward?

Rob Finizio -- Chief Executive Officer

So the basics -- so I'll leave it to Dawn on how our Imvexxy experience is going to impact Bijuva. But in essence, remember, Bijuva is an environment of two second-best workaround solutions, right? So as we showed you with the data, as the WHI came out, women just refused synthetics. We saw the fate of paroxetine, came out a non-hormonal approach, and it didn't make it. Sebastian developed Duavee at Pfizer, spent over $1 billion, another non -- or a new neural approach, synthetic approach.

They just don't sell, right? So what we want to do is we want to go in and limit the doctors' liability with an off-label solution, right? Make sure the effective copay or cost-containment strategy is in place, and offer something that has great data. We think that $850-million, two-pill, low-hanging fruit is where we're going to start until we have commercial reimbursement, and then take it out into the compounding market. I just want to be clear on that before I turn it over to Dawn. That market of -- is almost exclusively, that two-pill market, OB-GYNs, and it's almost -- directly overlaps with where our sales force is today.

Dawn?

Dawn Halkuff -- Chief Commercial Officer

Sure. And Michael, I guess the only thing to add here is, what we've learned about the launch of Imvexxy is actually that the strategy and sort of those rollout of levers is working. And so I would do, and we are planning to do, exactly the same thing, which is call on those high-writing prescribers, make sure we have a focus with the sales organization, who's done a brilliant job, and again, do that same thing where the levers that we would unlock later follow that same pattern. And I believe, because we're not doing everything at once, it allows us to get it right.

Get adherence right, which you're seeing in Imvexxy. Get the momentum with the prescribing. And then once that's done, you unlock the other levers, and then they become that much more productive. And so again, I would roll it out exactly the same way.

Rob Finizio -- Chief Executive Officer

And if you look out at the VVA space, you still have a little bit of Premarin out there being promoted, not much, but sampled everywhere. You have Intrarosa, who's out there doing a pretty good job. You have Osphena out there as well promoting. When you get to the hot-flash space, there's nobody.

It is literally crickets. We will be the only voice. And that's another very attractive thing. We can shape the narrative and reinvigorate this segment without any distractions or counter-selling going on, which we really, really like.

And that's another even, I'd say, more attractive part of this segment than the VVA segment. Oh, did you have another question, Michael? Adjudication?

Michael Scott -- Goldman Sachs -- Analyst

Yes.

Rob Finizio -- Chief Executive Officer

Sorry, I didn't hear that part.

Michael Scott -- Goldman Sachs -- Analyst

No problem.

Rob Finizio -- Chief Executive Officer

Could you repeat it, please?

Michael Scott -- Goldman Sachs -- Analyst

Sure. So as we see the adjudication flowing through, how should we expect the volume data on IMS, the trend going forward?

Rob Finizio -- Chief Executive Officer

Oh, excellent question. So Symphony and IMS, we've been working with directly on this. And so if you take a look at the Symphony progress that we've had, Symphony -- some of the large retail pharmacies, and if you go back a year, I know Walgreens, as well as Walmart, in essence, blinds their data. So some of the pharmacies want to sell their data and they don't want to share it with Symphony unless they want to buy it.

So what we've done is we've directly connected some of these retailers that are not sharing data with Symphony today, directly with Symphony. We think in the next month to 60 days that it will be 70% to 80% accurate within Symphony. We're working on the same thing with IQVIA. It's just a little further behind.

But it's just a matter of some of these larger retailers, 3PLs and folks like that, sharing their data directly with Symphony, and we're literally holding the hands so you have a third party giving data on a regular basis. And we think in the next 30 to 60 days, it'll be 70% to 80% accurate.

Duration: 68 minutes

Call Participants:

Nichol Ochsner -- Vice President of Investor Relations

Rob Finizio -- Chief Executive Officer

Dawn Halkuff -- Chief Commercial Officer

Brian Bernick -- Co-Founder and Director

Dan Cartwright -- Chief Financial Officer

Ken Cacciatore -- Cowen and Company -- Analyst

Louise Chen -- Cantor Fitzgerald -- Analyst

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Jay Olson -- Oppenheimer -- Analyst

Chris Schott -- J.P. Morgan -- Analyst

Michael Scott -- Goldman Sachs -- Analyst

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