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BioDelivery Sciences International (NASDAQ:BDSI)
Q1 2019 Earnings Call
May 6, 2019, 4:30 p.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:

Operator

Greetings and welcome to BioDelivery Sciences First Quarter 2019Earnings Call. At this time, all participants are in a listen-only mode. A question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press *0 on your telephone keypad. As a reminder, this conference is being recorded. I would now like to turn the conference over to Terry Coelho, Chief Financial Officer for BioDelivery Sciences. Please go ahead.

Terry Coelho -- Chief Financial Officer 

Thank you and good afternoon, everyone. Welcome to our first quarter 2019 earnings conference call. Leading the call today is Herm Cukier, Chief Executive Officer. We're joined by Scott Plesha, President and Chief Commercial Officer. Following our prepared remarks, we will conduct a question-and-answer session.

Earlier today BioDelivery Sciences issued a press release announcing its financial results for the first quarter of 2019. A copy of the release can be found on the investor relations page of the company's website. Before we begin, I would like to remind everyone that certain statements may be made during this call, which may contain forward-looking statements. Such forward-looking statements are based upon current expectations, and there can be no assurances that the results contemplated in the 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 information available to BDSI today May 6, 2019, and the company assumes no obligation to update statements as circumstances change. An audio recording and broadcast replay for today's conference call will also be available online in the investor section of the company's website.

With that, I'll turn the call over to Herm Cukier. Herm?

Herm Cukier -- Chief Executive Officer

Thank you very much, Terry. It is my pleasure to welcome everyone to BDSI's Q1 2019 Earnings Call. We had a very successful start of the year highlighted by record growth performance of our core strategic asset BELBUCA and the acquisition of Symproic further expanding our commercial portfolio of leading and differentiated brands. The ability of our team to make such a significant acquisition through a competitive process while continuing to achieve record level growth in BELBUCA is truly admirable and a testament to the hard work and dedication of all employees across the organization. I would like to thank each and every one of them for their efforts and contribution to the continued success of BDSI as a leading, rapidly growing commercial state company. We are dedicated to patients suffering from chronic pain and associated conditions and proud to bring important and leading treatment options to that community.

Even since closing the Symproic deal, I've been thrilled by the energy and enthusiasm of my colleagues to quickly prepare for the commercialization efforts of the new product. In fact, Scott will go into more detail, but we have already trained the sales force and have them in front of customers as of last week. While this is exciting and important, we all recognize that continuing to drive growth for BELBUCA is and remains our number one priority and core strategic focus. I am highly confident we are well-positioned for sustained growth on these two leading brands throughout 2019 and beyond.

For BELBUCA during the first quarter, I was very pleased to see that the directed growth on a year over year basis was once again accomplished with substantial breadth and depth at this stage of the product launch. The product experienced significant growth over prior years during each of the three months and even saw a considerable acceleration of growth during March versus February. In fact, that trend has continued since with April thus far showing substantial further growth momentum. As we have previously mentioned, it is important during these early stages of the launch cycle to see growth coming universally across the entire landscape. To that end, BELBUCA once again experienced growth across all dosage strengths, across all physician deciles, across all regions of the country, from both contracted and non-contracted accounts etcetera. No matter what aspect of the launch we analyze, we continue to see a positive trend. This gives me great confidence that this growth momentum is indeed sustainable.

In particular, I was very excited to see that a record number of healthcare providers wrote scripts for BELBUCA and that we experienced the greatest quarter over quarter growth for this important metric several years into the launch. Scott and the entire sales team continue to do an outstanding job of bringing value to clinicians and helping them understand how BELBUCA can be a prudent consideration in treating their chronic pain patients. Having said that, and while we are pleased by the growth seen to date, we recognize that we have just over 2% TRX share, meaning there are substantially many more potential patients that can benefit from BELBUCA. There is still a lot of hard work day in and day out in front of us and we will remain focused and diligent on our efforts.

While we weren't necessarily in need of adding another product, we had said that if something came along that made operational, strategic, and financial sense we would be opportunistic and strike from a position of strength. With Symproic we believe we found the right complimentary aspects to promote alongside BELBUCA. To begin with, the operational synergy is extremely strong. We have approximately 90% of future scripts are expected to come from the same physicians we call on today for BELBUCA. Scott will go into more detail, but that means no need to expand the sales team any further. From a strategic perspective, opioid-induced constipation or OIC is a persistent reality for more than 40% of chronic pain patients taking a C2 opioid. That can interfere with the effective management of the underlying disease. Symproic has many clinically relevant differentiating features enabling it to potentially become the leading drug of choice by pain specialists for this condition. And finally, from the financial point of view, we were able to extensively leverage our existing organization to achieve the expected growth of Symproic. Meaning it becomes financially accretive beginning early next year. We are very pleased to be adding such a clinically differentiated product that has exclusivity until 2031 to our portfolio and with it look forward to bringing even more value to the chronic pain community.

In all, the start of the year has been a very exciting and successful time for our company. We continue to deliver very strong growth results and are poised for sustained momentum and success. With that, I will turn the call over to Scott to provide more details about the BELBUCA performance and Symproic commercial readiness. Scott?

Scott Plesha -- President and Chief Commercial Officer

Thank you, Herm. As Herm noted, we experienced a very strong first quarter of 2019 with BELBUCA continuing to exhibit record levels of prescriptions and revenue. BELBUCA's strong growth resulted in our reaching an all-time high during the quarter at over 65,000 prescriptions. We have continued to reach all-time consecutive quarterly highs ever since we relaunched BELBUCA and due to our consistent growth, prescriptions in Q1 2019 were up 38,000 or 141% over Q1 of 2018. This represents the largest year over year growth BELBUCA has ever experienced.

Per our previous guidance, January and February prescriptions grew at a slower rate but we once again saw accelerated growth as the first quarter closed. In March, TRXs increased over 3,000 from February to just under 24,000 TRXs. This strong finish to the quarter has continued into April as we have seen BELBUCA prescriptions surpass 6,000 per week multiple times during the month. We continue to be encouraged by our strong execution and believe there are key drivers supporting the growth of BELBUCA. Since early 2018, we've seen a consistent increase in our new prescribers as well as the number of total prescribers each quarter.

During the first quarter, we saw the trend continue and even accelerate. During the quarter, there were nearly 6,000 unique BELBUCA prescribers and over 1,260 new prescribers. Both metrics represent a meaningful increase over Q4 2018 and surpass the previous all-time highs that were set during that quarter. We believe that these record increases in our prescribing base are due to our expanded sales force as we've seen an increase in prescribers and in prescriptions in every new territory. This gives us confidence that the size and structure of the expansion that we completed at the end of 2018 were effective and appropriate.

In addition to increasing our prescriber base, we saw TRX share growth across every decile HCP which demonstrates the growing acceptance of BELBUCA. Also, all of BELBUCA's dosage strengths exhibited growth during the first quarter with an average growth of over 19%. This not only demonstrates that the comfort HCPs have in prescribing BELBUCA across all dosage strengths but also how having seven dosage strengths importantly allows the patient's care to be tailored to the lowest efficacious dose.

During the first quarter, we greatly increased the number of patients that received BELBUCA for the first time. As we exited 2018, there just under 4,000 chronic pain patients per month being prescribed BELBUCA for the first time. By March, the number of new BELBUCA patients had increased to over 4,900. This resulted in BELBUCA new to brand market share increasing significantly from 5.2% in December to 6.3% in March. This increase in patients receiving BELBUCA for the first time demonstrates the rate by which healthcare providers are identifying patients that are appropriate to receive BELBUCA is increasing. This is critical for the continued growth of the brand.

During the quarter, we improved our market access when BELBUCA was moved from "not covered" to the preferred formulary of CIGNA Healthcare. This went into effect in February and provides improved access to BELBUCA for over 7.3 million lives. For this reason, BELBUCA is now covered or better in 92% of commercial lives. Importantly, the BDSI commercial team has done an excellent job of executing against these winds and has driven consistent prescription growth in each PBM or plan since the contracts were executed. We continue to see strong interest and acceptance by the government and commercial payers of BELBUCA and the differentiating qualities, and we are very optimistic about adding more wind. While difficult to predict when these winds will occur, we are confident that over time the number of lives having access to BELBUCA will continue to rise. We are excited about the progress we continue to make with BELBUCA and are confident that we can continue to build upon our current growth.

I'm also excited to share that due to strong planning and execution, the majority of our commercial team completed Symproic training and certification last week and is actively promoting and sampling Symproic. We billed Symproic as a complementary product to BELBUCA and allows us to leverage our high-performing sales force within our target audience. Importantly, the addition of Symproic will not require further expansion of the sales force or a change in our target audience. While we are extremely early in our promotion of Symproic, we are encouraged by the reception we are receiving to our promotion of it. We are finding the HCPs that have experience with Symproic appreciate the predictable efficacy Symproic provides. We also believe that there is an opportunity to educate our targets on significant improvement in market access that has occurred in recent months and that our proven ability to pull through market access winds will be important to the growth of Symproic.

We had a strong first quarter with BELBUCA and are encouraged the BELBUCA growth has continued in Q2 resulting in weekly all-time TRX highs in April. As we go forward into 2019, we'll continue to focus on improving market access, growing the number of patients receiving BELBUCA for the first time, and expanding our prescriber base. We're also confident that our commercial expertise and execution will have a positive impact on Symproic sales and look forward to updating everyone on our progress with it in subsequent calls.

With that, I'll turn the call over to Terry to cover the financials in more detail. Terry?

Terry Coelho -- Chief Financial Officer 

Thank you, Scott. First quarter financial results exceeded both fourth quarter 2018 and prior year quarterly results as well as exceeding the high-end of the expectations that we recently provided.

Total net revenue for the first quarter ended March 31, 2019, was $19.8 million an increase of 10% compared to $18 million in the fourth quarter of 2019 and an increase of 75% compared to $11.3 million in the first quarter of 2018. The total net revenue growth was primarily driven by BELBUCA which comprised 95% of our total net revenue in the quarter. BELBUCA net revenue in the first quarter ended March 31, 2019, was $18.7 million an increase of 17.6% compared to $15.9 million in the fourth quarter of 2018 and an increase of 134% compared to $8 million in the first quarter of 2018. BUNAVAIL net sales in the quarter were $1.1 million a reduction of $700 thousand in the first quarter of 2018 driven by market factors and our prioritization of BELBUCA. Additionally, there were $1.5 million of ex-US royalties in the first quarter of 2018 while there were no ex-US royalty revenues in the first quarter of 2019.

Gross to net deductions in the first quarter were 48.7% for BELBUCA in line with our expectations and slightly above the fourth quarter 2018 deductions of 47.9% primarily reflecting additional coverage and utilization mix across plans. Gross profit for BELBUCA was 85% in the first quarter, also in line with expectations, while total gross margins from both commercial products were 81% in the first quarter, in line with the fourth quarter of 2018.

Total operating expenses in the quarter reflect our continued investment in our commercialization efforts balanced with remaining fiscally prudent. For the first quarter ended March 31, 2019, total operating expenses were $17 million compared to $16 million in the first quarter of 2018 and $18.5 million in the fourth quarter of 2018. The reduction in spend as compared to the fourth quarter relates primarily to timing expenditures.

The net loss for the first quarter was $3.8 million or $0.05 per share, an improvement when compared to a loss of $7 million or $0.10 per share in the fourth quarter of 2018 and a net loss of $10.7 million or $0.18 per share in the first quarter of 2018. At March 31, 2019, BDSI had cash and cash equivalent of approximately $41.3 million. This compares to cash and cash equivalence of approximately $43.8 million at December 31, 2018. The quarter over quarter reduction in cash usage from $5.7 million in the fourth quarter to $2.5 million this quarter is consistent with the trend we expected to see and is a result of the continued revenue growth coupled with lower operating expenses in the quarter.

In April, as previously announced, we concluded the acquisition of the exclusive commercialization rights to Symproic in the United States and Puerto Rico effective April 4th. Under the terms of the agreement, BDSI paid Shionogi Incorporated an initial payment of $20 million at closing and will pay an additional $10 million in 6 months. In addition, Shionogi is eligible to receive tiered royalty payments based on net sales of Symproic. Additionally, on April 15th, BDSI closed an underwritten public offering of 12 million shares of common stock together with the selling stockholder at a public offering price of $5 per share. BDSI sold 10 million shares with gross proceeds from the offering of $50 million and approximately $47.5 million in net proceeds after deducting the underwriter discounts and commissions as well as other offering expenses. BDSI will not receive any of the proceeds from the sale of the shares of common stock by the selling stockholder. We intend to use the net proceeds from the public offering for working capital and other corporate purposes.

In the coming months, I will continue focusing on identifying opportunities to further improve our cash position and profitability as well as driving improvements in our business processes and our financial capabilities to ensure we are well-positioned to invest in and fully capitalize on the growth potential of both BELBUCA and Symproic.

Finally, looking ahead to 2019 and based on the strong momentum with which we entered the year, we see 2019 BELBUCA net revenue to be in the range of $83 million to $88 million and total company net revenue to be in the range of $92 million to $100 million including $7 million to $9 million of Symproic sales. As we communicated recently, as a result of the higher net revenues along with our ability to leverage our SG&A expenses as we grow, we continue to expect that we will be operating cash flow positive by the end of 2019 including the impact of Symproic product acquisition and associated start-up costs.

In the longer-term, we believe our sustained momentum will allow us to achieve annual sales in the range of $325 million to $400 million as BELBUCA continues to evolve into the therapy of choice for the management of chronic pain and including the impact of Symproic in the range of $75 million to $100 million.

At this point, I'd like to turn the call back over to Herm for some concluding remarks before we open the call for Q&A. Herm?

Herm Cukier -- Chief Executive Officer

Thank you, Terry. To summarize, the start of the year has been a very successful and exciting time for our organization. The first quarter was highlighted by the record growth of BELBUCA and adding a great complimentary asset to our portfolio in Symproic. Our momentum has continued since with seamless commercial integration of Symproic and further strengthening in BELBUCA performance. We have the utmost confidence for continued success throughout 2019 including having raised our expectations for BELBUCA net sales and becoming operationally cash flow positive. Our trajectory as a rapidly growing commercial-stage pharmaceutical company continues, and we look forward to sharing more successful updates throughout the year. I will now turn the call back to the operator for Q&A. Operator?

Questions and Answers:

Operator

Thank you. If you'd like to ask a question, please press *1 on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press *2 if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the * keys.

Our first question is from Brandon Folkes with Cantor Fitzgerald. Please, proceed.

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Hi. Thanks for taking my questions and congratulations once again on a great quarter. In terms of growth going forward for BELBUCA, how should we think about adding additional unique prescribers versus increasing the number of prescriptions written by the current prescriber base? I know you talked about unique prescribers, but it looks like you also increased the number of prescriptions in the quarter.

Scott Plesha -- President and Chief Commercial Officer

Hi, Brandon, it's Scott. Thank you for the question. We think it will continue to go as step by faction like we're seeing right now. If anything, we saw an acceleration in new prescribers as we went into Q1. We averaged 418 new prescribers per month in Q1 up from 226 last year in Q1 as an average each month. So, we just finished the sales force expansion in Q4, so they are up and running. I think that points to that expansion. Actually, Q4 was 367 on average. A really nice increase in prescriber base and we still have work to do. We'll keep adding new prescribers and we did see growth across our prescriber base as well and the number of prescriptions per prescriber.

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Maybe one additional question, if I may. Can you talk about the consistency that you're seeing with patients on BELBUCA? I know in the past you've talked about the growth in the higher strength potentially coming from patients who have been on the product longer and been titrated up. So, is this something you are seeing an increase in persistency?

Scott Plesha -- President and Chief Commercial Officer

Yeah. We are over time, a slight increase in persistency. It's been in line with the market. There's nothing that's remarkable about it. As we look to the higher strength and the growth there, it does point to patients being titrated up over time as we saw in our clinical trials. It really has mirrored that.

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Okay. Great. Thank you very much.

Scott Plesha -- President and Chief Commercial Officer

You're welcome. Thank you.

Operator

Our next question is from Matt Kaplan with Ladenburg Thalmann. Please, proceed.

Matt Kaplan -- Ladenburg Thalmann -- Analyst

Hey. Congrats on the progress during the quarter. I just wanted to drill in a little bit more deeply into Symproic. Can you help us understand the competitive landscape there for that product and what that looks like?

Scott Plesha -- President and Chief Commercial Officer

Sure, Matt. It's Scott again. Appreciate the question. Yeah. So, the market itself has been relatively flat, slight growth to it year over year. Really, MOVANTIK is the market leader there with just under 80% of the market. And then Relistor if you bundle their oral tablet and their injection together it's a little bit over 10% and Symproic has been around 10% as well. So, it's really about taking share from MOVANTIK and then obviously we'll take share from Relistor as well.

 Matt Kaplan -- Ladenburg Thalmann -- Analyst

Okay. That's helpful. With respect to your guidance for the year in terms of the updated guidance of now $92 million to $100 million for the full (and you gave detail on BELBUCA and also Symproic), how should we think about BUNAVAIL and the other parts of the business that comes up with your guidance about $2 million? Does that make sense?

Terry Coelho -- Chief Financial Officer 

Yeah. I've looked at what everyone seems to be estimating from the analyst perspective, but it is our estimate as well. I would say using that kind of number, $2 million, is probably a good number to use. The reality is that it does fluctuate. It is not a steady stream every single month. You may see one quarter up, another quarter down. But that range is probably realistic.

Herm Cukier -- Chief Executive Officer

Hey, Matt, it's Herm. Just maybe to add onto Terry's commentary referring to the ex-US royalties. We said all along, with regard to BUNAVAIL that BELBUCA was, is, and will remain our core strategic focus. It's where Scott's team has dedicated all of their time and I think we've seen the fruits of that strategic decision that we made about a year ago. That market has changed a lot. At this point, we've reduced our expectations for BUNAVAIL. Together with the royalties that we expect, we should be in the mid-single digits combined, but it will vary quarter by quarter depending on the performance of BUNAVAIL, as Terry has pointed out when we actually will have shipments outside of the United States to recognize the royalties. If you look at it aggregately for the year, it remains a nice complimentary royalty stream for our business. But now, especially with the performance of BELBUCA and now Symproic, it will be less and less a dimension of our company moving forward.

Matt Kaplan -- Ladenburg Thalmann -- Analyst

Okay. That's helpful. One or two more questions. In terms of the R&D for the quarter, it's the lowest R&D I've seen you have. How should we think about that going forward as you continue to work?

Terry Coelho -- Chief Financial Officer 

Starting this year, Matt, we've basically said we're not an R&D organization. We're a commercially focused organization. We don't have true R&D spend. So, beginning in Q1 2019, any spend that would be in some places classified as R&D, post-marketing requirement studies, those kinds of things will just be rolled into G&A. So, you would see them bedded in those numbers.

Matt Kaplan -- Ladenburg Thalmann -- Analyst

Okay. Got it. Last question, just to make sure I fully understand the capital structure right now following the offering. At the end of March, you had about 71 million shares and then it looks like there are another remaining 17.2 million from the series fee that converts, and then the 10 million shares that were just issued, and then another 2 million shares as well for options and stuff. Does that make sense? About 100 million total.

Terry Coelho -- Chief Financial Officer 

Yeah. Your 71 million is more of the Q4 2018. I think we ended Q1 with 75 million. And then you could add the 10 million on top. So, your fully diluted is going to be over 100 million. 110 million.

Matt Kaplan -- Ladenburg Thalmann -- Analyst

Thank you. Thanks, guys.

Terry Coelho -- Chief Financial Officer 

Sure.

Herm Cukier -- Chief Executive Officer

Thanks, Matt.

Operator

Our next question is from Esther Hong with Janney. Please, proceed.

Esther Hong -- Janney Capital Markets -- Analyst

Great. Thanks. My first question is on BELBUCA. For patients new to BELBUCA, are these largely patients that physicians are switching from opioids or are they opioid naïve patients? On Symproic, can you discuss how you see the OIC market over long-term given the shift away from C2 opioids that are prescribed for chronic pain and responsible for OIC? Thanks.

Scott Plesha -- President and Chief Commercial Officer

Hey, it's Scott. I'm happy to help you with those. So, the new to the brand over 80% of those prescriptions are coming from patients that are currently on C2s, but they are short-acting C2s. Sometimes we're being added and sometimes we're being switched for them. Honestly, it's been consistent, and it comes from all the different C2s. So, it's really not a switch campaign for us. It's really about us being used prior to other long-acting C2s. Hopefully, that helps on that.

The OIC market, we're actually encouraged when we were looking at the product that the market has actually had a little bit of growth in 2018 and early 2019. If you think about it, the market is down but there are still well over a million prescriptions being written for long-acting opiates. Patients that are on short-acting opiates chronically are also candidates. So, the long-acting opiates only make up about 10% of the prescriptions, actually less than that. There is this huge number of patients out there and I do think our competitors have raised awareness over the last three to four years around this problem. We anticipate it staying relatively flat going forward. Again, it will be a lot about getting market share from the current market that we're in.

Esther Hong -- Janney Capital Markets -- Analyst

And then just a follow-up. Though it's still early days, how has physician response been to Symproic? Thanks.

Scott Plesha -- President and Chief Commercial Officer

Limited. Full promotion for all of three days. We are out talking and at least letting them know that we had it and were able to provide some samples. It's been positive. I think they view as complementary to BELBUCA and not competing with our message there. It is nice to have samples. That's a nice resource for them to have for their patients and I do think that those that have experience with it have been impressed by the efficacy and the durable efficacy that it provides compared to some of the other products.

Herm?

Herm Cukier -- Chief Executive Officer

I would just add to what, Scott, you just commented on. When you and I were taking a look at that, we've been mindful of how promotionally sensitive to the market and this product has been. We saw that when it launched. It gained a very rapid and appreciated amount of new brand share. When there was turbulence in the amount of promotion behind the product, that dropped. But when Shionogi put more resources behind it, we saw that actually climb back up again. That gives us a lot of confidence that once our team is really out there with the product as they are now, we're expecting it to respond quite favorably to the promotional efforts of our organization.

Esther Hong -- Janney Capital Markets -- Analyst

Great. Congrats on the quarter. Thank you.

Herm Cukier -- Chief Executive Officer

Thank you, Esther.

Operator

Our next question is from Scott Henry with Roth Capital. Please, proceed.

Scott Henry -- Roth Capital -- Managing Director

Thank you. Good afternoon. A couple of questions on Symproic. A lot of times when a product transitions from one company to another share may dip for a little bit during that transitional period. It looks like you are kind of blowing right through that based on the weekly trend. I'm just curious what your take is on that. Do you expect to see any kind of transitional dip or do you think you can continue the growth trajectory?

Scott Plesha -- President and Chief Commercial Officer

So, Scott, you're right. It's early and we are encouraged by the early prescriptions. We've seen some growth there in the early weeks and we're just getting started. I think we need to get a couple of weeks and months even under our belt to be able to speak to that. Again, we think it provides value in the space. We have proven our ability to execute. It looks very much like BELBUCA when we brought it back in-house. We were able to accelerate the growth there, so we'll work toward doing that going forward.

Scott Henry -- Roth Capital -- Managing Director

Okay. Great. From an accounting perspective, I believe you make a payment is it the first 6 months of the transition for marketing efforts for the prior holder. Is that going to be contra revenue booking? Should we just assume kind of a lower revenue per script for the first perhaps two quarters? How should we account for that?

Terry Coelho -- Chief Financial Officer 

Okay. We have an agreement in place for the first 90 days, basically a distribution agreement where we have a fixed gross to net and cost level. So, I don't think you need to consider anything as contra revenue. We will actually reflect the revenue. It will be at a fixed gross to net and obviously our gross to net will probably be different once we take on the product. It will be reflected normally.

Scott Henry -- Roth Capital -- Managing Director

Okay. Should it be a lower revenue per script for the first quarter and then increasing thereafter? Is that how we should think about it?

Terry Coelho -- Chief Financial Officer 

I think it might even be slightly higher.

Scott Henry -- Roth Capital -- Managing Director

Okay. Thank you for that color. Looking quickly at the income statement, I saw some contract revenue. It was a very small number in there. I'm just curious what that's related to and is that just a one-time event?

Terry Coelho -- Chief Financial Officer 

A very, very small number, right?

Scott Henry -- Roth Capital -- Managing Director

Correct.

Terry Coelho -- Chief Financial Officer 

That was just a prior period adjustment on something. I think it was $2,000 or something like that.

Scott Henry -- Roth Capital -- Managing Director

Okay. Great. Thank you for that color. Thank you for taking the questions.

Scott Plesha -- President and Chief Commercial Officer

Thanks, Scott.

Terry Coelho -- Chief Financial Officer 

Good to talk to you.

Operator

As a reminder, use *1 on your telephone keypad if you would like to ask a question.

Our next question is from Tim Lugo with William Blair. Please, proceed.

Tim Lugo -- William Blair -- Analyst

Thanks for the question and congratulations on the growth we're seeing from BELBUCA. I know it's early on with Symproic but how should we think about the growth opportunity around contracting? Obviously, you're very successful with BELBUCA on contracting and this is also a competitive space. It seems like there is plenty of market share to gain in this area. What are your initial thoughts around contracting?

Scott Plesha -- President and Chief Commercial Officer

Hi, Tim, it's Scott. Thanks for the question. You're right. It's probably a little bit more of a competitive marketplace so we need to be thoughtful about the contracts we write. We don't want to hurt our gross to nets long-term. So, we're going to be thoughtful. It's more about providing access without having to step through other products versus being preferred. We actually were really encouraged by some of the work that Shionogi had done on the backend to see these in color as last year kind of wrapped up. Really, they only had about 12% of the Medicare lives covered. As we sit here today, it's actually 42%. So, access has changed greatly on the Medicare side just recently. We'll look to capitalize that.

Again, we've proven that we can do that with BELBUCA, so we'll look to do that here. And the same on commercial. Not as dramatic of a change but over 74% of lives where it's covered. Again, preferred is about 31%. It's not as high on the commercial side as BELBUCA but it's higher on the Medicare side. Bottom line is we'll work to pull that through. We need to get our arms wrapped around the environment there a little bit more and actually start having clinical meetings with payers. We're committed to opening up access in a thoughtful manner.

Tim Lugo -- William Blair -- Analyst

Understood. You mentioned 90% of future scripts should come from BELBUCA prescribers already. Can you give us a flavor of what the BELBUCA prescribers are currently using to manage OIC? Are they using MOVANTIK? Are they using OTC? How much is Symproic kind of embedded within that base already?

Scott Plesha -- President and Chief Commercial Officer

So, Tim, the over the counter it's really a standard of care and payers actually demand that patients try and fail OTC. I think what's interesting about Symproic and differentiates it is that Shionogi did a really nice job with their clinical package. In the PI you can actually add Symproic right to an OTC product. Other products are actually by label required to come off the OTC product prior. In fact, we believe that's an advantage to us going forward.

Tim Lugo -- William Blair -- Analyst

That makes sense. All right. Thanks for the questions.

Operator

Our next question is from Gregg Gilbert with Suntrust. Please, proceed.

Gregg Gilbert -- Suntrust -- Managing Director

Hi. Good afternoon. Scott, I was hoping you could help us with the breakdown of payer types for BELBUCA as people consider certain proposals being floated around Washington. Secondly, it seems that many physicians view Buprenorphine as less efficacious than the C2s. Other than the growth in your prescriptions, which is evident, of course, that could be helped by safety and abuse potential too, is your team making inroads on the efficacy message that's specific to your preparation of buprenorphine versus the historically available ones? Thanks.

Scott Plesha -- President and Chief Commercial Officer

That's a great question and good insight around the historically available ones. One of our key initiatives, Gregg, in the last year and a half or two has been to try to shore up the efficacy message. All of the other attributes are great but if it doesn't work to treat chronic pain then it doesn't matter. I think we're overcoming that over time and what we've found over and over again is if HCPs actually use the products enough and get enough clinical experience with it, they don't see it differently. I do think that their experience with Butrans, I think what's your getting at, had affected their belief about buprenorphine in general previously. Obviously, that's a lot lower dose of buprenorphine.

On your first question, could you give a little more detail around payers and government? Are you saying the regulations that are affecting that or policy?

Gregg Gilbert -- Suntrust -- Managing Director

Just a factual question about the mix that is Medicare/Medicaid, commercial or however you breakdown the different buckets of payers.

Scott Plesha -- President and Chief Commercial Officer

We're still skewed toward commercial as far as the prescriptions going through. The share of our business coming through Medicare has improved. And actually, as we sign commercial contracts the Medicare side is also improving in those same books of business. It's still 35% Medicare, about 55% commercial, and then about 10% Medicaid. The Medicaid really drifts between 10% and 11% depending on the month.

Gregg Gilbert -- Suntrust -- Managing Director

Okay. Thanks a lot.

Scott Plesha -- President and Chief Commercial Officer

You're welcome.

Operator

That does conclude our conference today. You may disconnect your lines at this time and thank you for your participation.

Duration: 40 minutes

Call participants:

Terry Coelho -- Chief Financial Officer 

Herm Cukier -- Chief Executive Officer

Scott Plesha -- President and Chief Commercial Officer

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Matt Kaplan -- Ladenburg Thalmann -- Analyst

Esther Hong -- Janney Capital Markets -- Analyst

Scott Henry -- Roth Capital -- Managing Director

Tim Lugo -- William Blair -- Analyst

Gregg Gilbert -- Suntrust -- Managing Director

More BDSI analysis

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