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Biodelivery Sciences International Inc (BDSI)
Q1Â 2020 Earnings Call
May 9, 2020, 8:30 p.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Good day, and welcome to the BioDelivery Sciences First Quarter 2020 Earnings Call. [Operator Instructions] At this time, I'd like to turn the conference over to Ms. Terri Coelho, Chief Financial Officer of BioDelivery Sciences. Please go ahead, ma'am.
Terry Coelho -- Chief Financial Officer
Thank you, and good afternoon, everyone. Welcome to our first quarter 2020 earnings conference call. Leading the call today is Herm Cukier, Chief Executive Officer. We are joined by Scott Plesha, President and Chief Commercial Officer. Following our prepared remarks, we will conduct a question-and-answer session.
After the market closed today, BioDelivery Sciences issued a press release announcing its financial results for the first quarter 2020. A copy of this 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 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 information available to BDSI today, May 7, 2020, and the company assumes no obligation to update statements as circumstances change. An audio recording and broadcast relay for today's conference call will also be available online in the Investors section of the company's website.
With that, I'd like to turn the call over to Herm Cukier. Herm?
Herm Cukier -- Chief Executive Officer
Thank you very much, Terry, and welcome, everyone, to our company's first quarter 2020 earnings call. I recognize these are extraordinary and challenging times and hope you and your families are well and healthy. With regard to first quarter performance, I am very pleased to report that we once again established an all-time high for total company net sales of $38.3 million, representing growth of 94% versus the first quarter of 2019.
BELBUCA and Symproic prescriptions grew 52% and 19%, respectively, year-over-year during the first quarter. These strong results were fueled by positive momentum for both products through the early part of March, at which point we began to experience the impact of the COVID-19 pandemic. Nonetheless, through the hard work and dedication of our employees, we were able to rapidly transform our commercial approach and successfully finished the quarter with record level performance.
Turning to the COVID-19 situation. I am very proud of how our employees responded to this unprecedented challenge. Our focus has been and remains on our greater mission of helping support patients suffering from chronic pain, while also ensuring the health and safety of our employees and customers. As the pandemic materialized, our number one priority was to meet the needs of patients and the healthcare providers we serve. We acted quickly and swiftly on three fronts: first, we ensured constant supply of our products as they provide important clinical relief for patients suffering from chronic pain; second, we transitioned our customer engagement to virtual support and launched an array of new customer and patient service programs and third, we established an internal COVID-19 cross-functional committee to visually assess the market trends and dynamics, benchmark best practices across the industry and ensure hyper-focus to navigate through this unprecedented situation.
We believe these actions are having a beneficial impact based on the brand trends we've seen in the second quarter thus far and believe they will be important components for renewed momentum as our customers return to more normal operations. In addition to the successful customer initiatives and services, which we launched since the start of the pandemic, the organization continues to make important progress on many other aspects of the business. One of our stated objectives has been to expand BELBUCA access for Medicare, and major regional commercial plans with the aim to match the level of success we've achieved across commercial national plans. To that end, I am very pleased to share we have recently gained preferred position within multiple Medicare plans, expanding access to several million covered lives. In addition, we have expanded access within several prominent regional institutions, which offer both their own covered lines as well as potential influence on clinical practice within their metropolitan communities.
On the supply side, we have continued to increase our supply of finished goods to approximately four to six months of inventory on hand for all seven doses of BELBUCA. This represents a significant increase since the start of the pandemic. We have also secured sufficient materials to continue production into 2021. Our ability to make investments in the new customer programs, building further inventory of supply and continuing successful operations in the organization is the result of the keen immediate reorientation and action by the company as the pandemic surfaced. We began the year with a strong balance sheet, and were able to further strengthen our position with a very successful first quarter. Ensuring financial durability is a key strategic priority for BDSI, and we are prudently managing our spend during this period to protect and steer the business through this near term disruption, while continuing to invest toward long-term sustained growth.
The COVID-19 pandemic is an unprecedented and fluid circumstance with significant near-term uncertainty. We had a great deal of confidence in the growth momentum of our portfolio, which led us to provide full year guidance in November of last year. The performance during the first quarter, with some puts and takes, exemplifies the potential for sustained momentum in the brands. While we remain confident in the differentiated clinical benefits of our products, and the underlying demand we were seeing from physicians and patients, the near-term uncertainty around the pandemic leads us to withdraw our guidance for 2020. We remain hopeful that as states begin to remove stay-in-place orders, physician offices and clinics will resume more normal patient care activities with corresponding market performance. We look forward to providing updates as events in the country unfold over the next few months.
To conclude, I am very pleased by the success of the first quarter as well as how the organization has responded to the challenges presented by the COVID-19 pandemic. We have therapeutically important products a strong balance sheet and a talented and committed team of employees. We remain poised to successfully navigate through the short-term uncertainty and achieve our ambition of long-term sustained growth. With that, I will turn the call over to Scott to provide more details of our performance during the first quarter and our new promotional tactics in 2020. Scott?
Scott Plesha -- President
Thank you, Herm. As Herm mentioned, during Q1 2020, we reached another record for BELBUCA prescriptions of more than 99,400 retail TRxs. This represents a 52% increase in BELBUCA TRxs as compared to the first quarter of 2019 and a 3.5% increase over the fourth quarter of 2019.
We were building momentum during the quarter, and our trends supported BELBUCA exceeding expectations in the first quarter and beyond. The early momentum we built was slowed toward the end of the first quarter while social isolation measures began to be implemented nationwide in March. During this slowing of growth, BELBUCA Q1 TRx market shares increased to 3.6% from a Q4 2019 market share of 3.3%. It is also encouraging to see BELBUCA market share increase to 3.8% through the first three weeks of April. During the first quarter, BELBUCA's new-to-brand market share of 7.3% held steady from the fourth quarter and March finished at 7.8%, well above the TRx share of 3.6%, and there is still significant opportunity to grow total prescription share as these metrics historically converge. Our BELBUCA prescriber base continued to grow in the first quarter, a testament to the execution of our sales team. We grew our BELBUCA prescriber base in the first quarter by over 1,100 new prescribers, the fifth quarter in a row where we added more than 1,000 new prescribers, reaching over 7,600 total unique prescribers in the quarter, an the increase of 28% versus the same period a year ago.
As we entered Q2, we are able to improve BELBUCA coverage from nonformulary not covered to covered or preferred status in over two million Medicare Part D lives within Express Scripts, SelectHealth and UPMC Health. Furthermore, we believe that with additional work, we have the potential to add several million more Medicare lives as we head into 2021. On the commercial side, we improved our coverage within two prominent commercial plans, Highmark Blue Cross Blue Shield and UPMC. While we were previously covered within Highmark, patients will no longer be required to fail two long-acting opioids before accessing BELBUCA.
Importantly, UPMC has moved BELBUCA from a nonformulary not-covered status to covered with a typical class prior authorization. The BDSI commercial team has a proven track record of pulling through market access wins and is focused on maximizing these opportunities. This is displayed in the results we have seen in prime therapeutics since this win was put in place during Q4 and Q1. We have seen BELBUCA TRx market share within prime go from 3.9% in Q3 of 2019 to 4.7% in Q1 of 2020.
Symproic Q1 retail prescriptions reached over 16,100, representing a 19% increase year-over-year compared to Q1 2019.
During Q1 2020, we generated a 13.3% NRx share and 11.7% TRx share, representing the highest market share to date. We expect continued TRx revenue growth for Symproic and as its NRx share has consistently exceeded total NRx share since May 2019 and it was 13.8% in the month of March.
In the first quarter, we successfully added 1,170 new prescribers for Symproic, which helped the brand reach a new quarterly high of almost 5,000 prescribers. We continue to view Symproic as an extremely promising brand and believe our early 2020 market access wins within prime therapeutics and CVS will be catalysts for growth in 2020 and beyond.
The BDSI sales force has done a strong job taking advantage of these wins and has improved our TRx market share within Prime Therapeutics from approximately 20% in Q4 to 44% in Q1, and from 10.5% to 13.7% within CVS/Caremark. We are very proud of these results that our team generated during Q1, especially with the headwinds that we face due to the COVID-19 pandemic. While the influx of new patients to our products has slowed, much like we're seeing in the broader markets, we are encouraged by the refill rates we are seeing and steady TRx trends.
As the impact of COVID-19 grew, our primary focus was to support our HCPs and their patients. We accomplished this by enforcing the many resources available to patients and HCPs and the unique attributes our products possess. As Herm highlighted, our commercial team rapidly pivoted to a new virtual promotion environment in the quarter. We continue to implement new ways for our territory managers to remain engaged with their target physicians and office staff and for doctors to maintain a dialogue with the company and their peers about BELBUCA and Symproic. We have now implemented a new virtual engagement platform, an enhanced email communication portal and virtual speaker programs. These initiatives have resulted in the sales force having over 5,500 touch points with HCPs and their staff each week, a meaningful increase over the typical number of interactions in any given week.
It's also been encouraging to see the high interest HCPs have exhibited and learning more about BELBUCA from their peers through our virtual speaker program, where we have averaged well over 15 attendees per program. We also promptly recognize that patients may face disruptions in insurance coverage and income during the pandemic and have created initiatives to help secure and preserve access. First, we are in the process of implementing a hub service, which should be fully functional by the end of May or early June. This service will assist with prior authorizations at a time when pain practices we support may be short staffed and not have the same capacity to assist patients with the prior authorizations their insurance providers may require.
Secondly, recognizing that current patients and potential new patients may experience changes in their insurance coverage during this challenging time, we have recently expanded the co-pay assistance program for BELBUCA. We've begun offering a maximum out-of-pocket amount for commercial patients that may now be uninsured or underinsured. Our goal is to make BELBUCA more accessible during these difficult times. Taken together, we hope that these initiatives will keep our brands relevant and available to our customers and patients, and we'll maintain our position as a key partner in the treatment of chronic pain and opioid-induced constipation.
We had a very successful Q1 that resulted in another record quarter for revenue and many other important growth metrics for BELBUCA and Symproic. Our Q1 results supported the growth trends we had in place prior to our momentum being slowed by the impact of the COVID-19 pandemic. We also believe that our recent market access wins for both brands and our successful track record of executing against these wins will support the growth of BELBUCA and Symproic.
In concluding, I'm particularly proud that our sales and marketing team pivoted so quickly to effectively implement new initiatives to support our healthcare professionals and the patients they support during these challenging times. With that, I'll turn the call over to Terry to provide an update on the financials. Terry?
Terry Coelho -- Chief Financial Officer
Thank you, Scott. As Herm and Scott discussed, we are very excited to report outstanding first quarter results, which have once again exceeded expectations across the board for both sales and profitability. Total net revenue for the first quarter 2020 was $38.3 million, an increase of 94% compared to $19.8 million in the first quarter of 2019.
In addition, total revenues in this first quarter increased by 21% compared to $31.6 million in the fourth quarter of 2019. BELBUCA net sales in the first quarter were $33.5 million, an increase of 79% compared to $18.7 million in the first quarter of 2019. The net sales growth of 18% in the first quarter versus the fourth quarter of 2019, was primarily driven by the continuing growth in prescriptions, which Scott shared, favorable gross-to-net deductions and higher average price, driven by the favorable dose mix and the impact of the price increase enacted in January.
Symproic has been an ideal complementary product for BDSI as we were able to effectively integrate it into our product portfolio and take advantage of the substantial overlap in the target prescriber base. Symproic net sales in the first quarter ended March 31, 2020, were $4.2 million, an increase of 54% versus the fourth quarter of 2019, driven primarily by favorable gross-to-net deductions and the impact of the January price increase.
We were pleased to see that we were able to end the first quarter with wholesaler inventory levels comparable to previous quarters for both BELBUCA and Symproic. BUNAVAIL net sales for the first quarter were $100,000 compared to $1.1 million in the first quarter of 2019. In March of this year, the company announced the planned discontinuation of marketing of BUNAVAIL in 2020. Royalty revenues for ex U.S. sales with PAINKYL and BREAKYL totaled $563,000 for the three months ended March 31, 2020, a decrease of $600,000 when compared to the fourth quarter of 2019. Total gross margin for the quarter was 85% as compared to 80% in the first quarter of 2019 and 77% during the fourth quarter of 2019. The increase versus the fourth quarter of 2019 was primarily due to the fourth quarter onetime impact of approximately $3.8 million in costs associated with the planned discontinuation of marketing of BUNAVAIL.
Gross margins for both BELBUCA and Symproic were approximately 87% in the quarter, in line with the fourth quarter of 2019. Total operating expenses in the first quarter of 2020 were $26.7 million compared to $17 million in the first quarter of 2019 and $23.8 million in the fourth quarter of 2019. The year-over-year increase is primarily driven by the impact of expanded sales force and market access teams as well as the establishment of the medical affairs and MSL team, together with the introduction of Symproic in to the company's portfolio. The quarter-over-quarter increase reflects the impact of planned marketing investments and the phasing of key initiatives. GAAP net income for the first quarter was $5 million or a net income of $0.05 per share compared to a GAAP net loss of $3.8 million in the first quarter of 2019 or a net loss of $0.05 per share. The first quarter's net income reflects our overall revenue growth coupled with improving gross margins as well as our improving operational efficiencies.
EBITDA in the first quarter of 2020 was $7.8 million or 20% of net sales compared with $100,000 in the first quarter of 2019 and $4.1 million or 13% of net sales in the fourth quarter of 2019. Non-GAAP net income for the first quarter was $8.3 million and reflects GAAP net income, excluding stock-based compensation and noncash amortization of intangible assets. This compares to non-GAAP net income of $6.4 million in the fourth quarter of 2019, excluding stock-based compensation, non-cash amortization of intangible assets and the onetime nonrecurring impact of discontinuation of marketing of BUNAVAIL.
At March 31, 2020, BDSI had cash and cash equivalents of $70.6 million as compared to $63.8 million at December 31, 2019. Operating cash flow in the first quarter was $6.4 million, with overall cash flow in the quarter of $6.7 million compared to $8 million in the fourth quarter of 2019. We are pleased to have entered 2020 and the second quarter with a held balance sheet. This strong financial foundation positions us well to manage through the current period of uncertainty. As Herm shared already, we are managing our expenditures prudently, ensuring continuation and prioritization of key initiatives. I'm very proud of the BDSI finance team who rapidly transitioned to remote working and closed the quarter seamlessly. Overall, as a company, we are proud of our resilience and the team's ability to very effectively adapt over the past quarter and look forward to continuing to bring meaningful clinical value to our patients. We'd now like to take your questions. Operator?
Questions and Answers:
Operator
[Operator Instructions] We'll go first with Brandon Folkes from Cantor Fitzgerald. Please go ahead.
Brandon Richard Folkes -- Cantor Fitzgerald & Co. -- Analyst
Hi, thanks for taking my questions and. Congratulations on the quarter. Firstly, maybe one on the quarter. You talked about a favorable gross-to-net this quarter potential for the increased co-pay assistance for the rest of the year.
Can you just help us think about gross to net for the remainder of the year? And then maybe can you provide some color in terms of what you're seeing in April with new-to-brand patients start?
And secondly, are you seeing any signs of persistency creep up as patients push off elective surgeries or could you maybe provide any color in terms of what percentage of patients on BELBUCA may be managing their pain ahead of an elective surgery?
Terry Coelho -- Chief Financial Officer
Brandon, thanks for the questions. I'll start out, and then I'll pass it over to Herm to build upon that. So first of all, on the gross to nets, I think we do see, typically in the first quarter of most years, you have some favorability. You don't have the Medicare donut hole impact, which tends to increase as the year moves along. So that's certainly one of the drivers as we look at the phasing throughout the year. I think overall, our gross-to-nets have been pretty stable now for about a year. And I would at this point, that it would probably stay in or about that same range, knowing that as the year progresses, you do have the Medicare, in particular, of the Medicare donut hole impact. I guess, Herm, do you want to take the second part of his question?
Scott Plesha -- President
Actually, Terry, I think I'll take it. This is Scott. Thanks for your question. So first, regarding the new-to-brand, great insight because, obviously, the exposure the amount of patients going into offices now has been reduced. What we're seeing is a new-to-brand impact that's comparable to the marketplace. It's basically down 20% to 25% at this point in time.
And so as we look at that, I think tying it into things like persistency. I think persistency right now, it's you have to look at persistency over three to six months, typically. So we really don't have the data to look at that long-term and know if it's going to be stickier over time.
One things that are encouraging is that the new-to-brand has been pretty flat within the market and for BELBUCA over the last four weeks. So it's been steady, much like our TRxs. The thing we are seeing is repeat prescriptions actually staying fairly well on trend at this point. So kind of the refill rates staying in line and being consistent as well. One thing another thing you might be thinking about is adherence. One of the things we're seeing across the entire pharmaceutical industry as a higher adherence rate for brands. We don't have data yet down to our level to look at that. So but in fact, patients are not abandoning scripts at the rate they used to. So they're more likely to get them filled.
Brandon Richard Folkes -- Cantor Fitzgerald & Co. -- Analyst
Thank you very much and congratulations to everyone on the quarter.
Scott Plesha -- President
Thank you, Ben.
Operator
We'll next go with Greg Fraser from SunTrust. Please go ahead.
Greg Fraser -- SunTrust -- Analyst
It's Greg Fraser on for Gregg Gilbert. I'm not sure if I missed this, but was there any stocking of note in the quarter for BELBUCA?
Terry Coelho -- Chief Financial Officer
So no. Actually, as I commented, we were really pleased to see that the quarter ended with very consistent wholesaler inventory as we've seen in the prior in all the prior periods for the last year or so.
Greg Fraser -- SunTrust -- Analyst
Got it. And then you mentioned that you expected gross-to-net to stay in the same range. I guess that means you're not anticipating material pressure on gross nets from the new patient support programs?
Terry Coelho -- Chief Financial Officer
I mean I guess what I would say is we've looked at it. Certainly, Scott and I have spent a lot of time on it, and we think it will balance. And when I say consistent, remember, as I mentioned before, you do have a little bit of inching up as the year goes on because of the Medicare impact. But overall, we've talked about low 50s for BELBUCA and low 60s for Symproic and I still feel that those are good ranges to be thinking about.
Greg Fraser -- SunTrust -- Analyst
Okay. Got it. Then on expenses, you're managing expenses prudently. Can you speak just generally about expense cadence in the coming quarters? So not a guidance question, but clearly, some costs are coming down for you and others. Others' costs may be going up. Just is there any additional color you can provide on spending? That would be helpful.
Terry Coelho -- Chief Financial Officer
Yes. I think, Greg, what we've indicated for this year and what we put in place our plans for this year has been spent in the, let's say, the mid-20s on average. With some fluctuation always when you move from quarter-to-quarter, I think you're right, that it's most likely that our T&E spend in the second quarter will be lower than we would have planned. But we're also obviously investing in some of the virtual programs that we're doing. So overall, I think that's still a good range to be thinking of. We do have fluctuations from one quarter to the next, but those mid-20s is the right way to be thinking about it.
Greg Fraser -- SunTrust -- Analyst
Got it. That's helpful. And my last question is on business development and whether you're still actively evaluating opportunities? Or have things sort of slowed down on that front, given all the uncertainty with respect to COVID?
Herm Cukier -- Chief Executive Officer
Greg, this is Herm. Thank you very much for your questions. And obviously, as we said during our presentation today, our primary focus is on patients and the customers that we serve. And we've been hyper-focused on ensuring that they have everything they need to get through this extraordinarily difficult time. I think over the long-term for this organization, we continue to be one that focuses on continued growth. As Terry highlighted, we have a very strong balance sheet. We're going to continue to find ways to invest in driving top line growth, and that will remain our focus. But to your point, right now, I think everyone is appropriately focused on navigating through the uncertain times of the pandemic and ensuring that our customers have what they need and that we can service them as best as possible.
Greg Fraser -- SunTrust -- Analyst
Thank you.
Operator
We'll next go with Tim Chiang from Northland Securities. Please go ahead.
Timothy Chiang -- Northland Capital Markets -- Analyst
Really just two questions. Obviously, you guys have had a strong history of execution. And it looks like you had another strong first quarter. Just and obviously, you've taken guidance away. And I guess my first question is sort of how do you sort of see this year progressing?
Obviously, it's kind of hard to predict how BELBUCA and Symproic will do. But it looks like you've got a lot of momentum behind both products. You're getting good insurance coverage. What can you do in this type of environment to sustain this type of growth?
Herm Cukier -- Chief Executive Officer
Thank you very much for the question. Maybe I'll start with that, Scott, and maybe you can build upon that some, maybe emphasizing some of the programs that we put in place because I think some of the programs that Scott highlighted and maybe we'll emphasize in the second component of the answer to this question are ones that are very acutely important now, but actually, we believe have real value and merit to our customer base and ones that we were looking at in terms of elements of helping us continue to drive further growth into the future. And so a lot of these programs, we think we'll have quite a bit of runway, even as hopefully, the country begins to come out of the acute pandemic situation.
But to your question, yes, I think right now, we are very pleased by the momentum that we saw in the first quarter of this year, especially heading into the early part of March, where we're really seeing quite a pickup as we typically see in the cadence of the script patterns with a product like BELBUCA and Symproic. Obviously, the pandemic, Scott correctly pointed out, has had somewhat of an impact. But we are very pleased by the script patterns relatively that we're seeing during the other part of the pandemic. And again, we're very hopeful that as the country begins to open up as states begin to remove or let expire their stay in place orders that our doctors can begin to have the same traffic flow of patients that they had previously and begin to provide the same kind of service to patients and that market performance follows accordingly. So we absolutely believe that our products provide very important therapeutic value to our patients. And we remain very optimistic about the long-term opportunity of these products.
Scott, maybe you want to talk just a little bit about some of the other programs that we believe we'll continue to add value moving forward as well.
Scott Plesha -- President
Yes. Thank you, Herm. I had mentioned in my prepared comments that we initiated a virtual speaker program. And we are already considering putting speaker programs back in place in the back half of the year. So very quickly pivoted and pulled out that forward and obviously are doing them virtually now. And as I mentioned, to have over 15 HCPs on a call, just speaks to the interest of the product. The other thing we've looked at is providing the PA support prior authorization support. And I think right now, it makes a lot of sense with, again, short staffed offices that may be stretched that cannot do all the work right now. Maybe they would have been able to previously help patients attain product. And then the other thing is looking to pull down abandonment rates for commercial pay patients, and especially if they're being stretched right now economically or maybe are underinsured or uninsured as we go forward here, I think those are going to be really important. I think also there's the right thing to do for patients and for HCPs.
I think the other thing as far as growth goes, we have been very focused on the mid- to high deciles. And as we look at our prescriber base, our top prescribers, in fact, are holding up very well during this pandemic. And the other thing I think is interesting is, as we look at our the states that are opening up by this weekend, basically 2/3 of our prescriptions come from those states and then another a total of about 80%. When you look at the states, at this point, anyways, are looking to open up by mid-may or end of May, about 80% of our prescriptions are captured there. So as those open up, our programs layer on top of all this, I think it would be helpful for our brands going forward.
Timothy Chiang -- Northland Capital Markets -- Analyst
That's great. I know you guys just one follow-up. You mentioned two regional plans. What parts of the country do those two regional plans cover?
Scott Plesha -- President
Yes, I'm happy to answer that. So they're UPMC and then HighMark Blue Cross be Shield. They're very prominent and I guess, I'll use the word prestigious plans within the area of Pittsburgh, specifically. So they're predominantly New York, but the Pittsburgh market, in particular, is influenced greatly by them.
And as Herm mentioned in his remarks, they're not only meaningful as far as number of lives, but they also have an influence just on how things are perceived if they're covered. They're not easy to attain formulary coverage. So we're pleased to be able to move them, improve their coverage and build those plans.
Operator
We'll next go with David Amsellem from Piper Sandler. Please go ahead.
Zachary Sachar -- Piper Sandler & Co. -- Analyst
This is Zack on for David. Herm, I was hoping that you could speak to the importance that BELBUCA is on the Schedule III product if you have that data and what in your market research has revealed? And what the market research has revealed regarding the extent to which this Schedule III designation has improving prescribing behavior lately.
Herm Cukier -- Chief Executive Officer
So I'll go ahead and take that question. One of the first things we did, the first week of the pandemic after we had pulled our sales force is we wanted to make sure that the HCPs that we support, were very aware of the attributes of Schedule III products specifically, the ability to call in prescriptions. So anything they could make their lower their burden during this time. So the ability to call in prescriptions, the fact that they can actually get five refills as well was very important. And then also, we provided them with all the phone numbers and contacts for all the mail order pharmacies as well, the larger chains. And so they had that access available to them. Something that all these attributes that would separate us from the Schedule II.
There's really no specific market research we've done at this time during the pandemic to pull out Schedule III versus Schedule II as far as prescribing habits.
Operator
We'll next go with Matt Kaplan from Ladenburg Thalmann. Please go ahead.
Matthew Lee Kaplan -- Ladenburg Thalmann -- Analyst
Just wanted to dig in a little bit more to the market access wins you've had. It seems like you've had really good success there lately. And can you give us a sense in terms of where you think you could continue that momentum in terms of gaining either more Part D lives or more commercial lives to really help facilitate the uptake in uptake of BELBUCA?
Scott Plesha -- President
Matt, it's Scott, again. I'll take that question. So as you know, we've done a really nice job. The team's really executed on the market access side. To be able to improve BELBUCA coverage on a national level. So we pretty much checked all the boxes on the larger payers on the commercial side of the business. And I think we've stated for the last few quarters that we're really going to start focusing in on some of these tougher regional plans. And in fact, we've done that with this announcement with UPMC and Highmark. So we have that. And then within the and as we benchmark and we go back, we're about 60% preferred and 95% covered now on the commercial side. So we've done a really nice job there.
So where we can, we'll continue to try to work to even improve our status maybe even against the other buprenorphine products.
And then the other thing, we've basically stated is that the Medicare side is an important focus for us going forward. So that's why we're excited to announce that almost one about over 2.1 million lives or close to 2.1 million lives were added on the Medicare side through ESI and then UPMC again and SelectHealth, and these plans were not formerly not covered previously. So and about 70% of them are at a preferred level. So we've done a nice job here in pulling them through. We're having very meaningful and I think productive conversations with other Part D payers, hard to time when things are going to happen. As you know, I think typical adds happen in January for Medicare. So we'll do everything we can to pull things forward like we did this ESI win. But again, we're encouraged by the conversations we're having. But our focus, our number one priority is opening up access to Medicare going forward, and we'll continue to focus on the market access side.
Matthew Lee Kaplan -- Ladenburg Thalmann -- Analyst
Okay. That's helpful. And then in terms of Symproic, it seems like you had really good success versus fourth quarter, 54% growth. What do you see driving that growth? Where are you taking market share from in this constipation market?
Scott Plesha -- President
No, Matt, it's Scott, again. so specifically in my prepared comments, we've done a really nice job in pulling through our market share in both Prime Therapeutics, which was our win that we announced in Q4, but majority of the lives are in Q1. And then CVS Health was the other one.
And so we've done a really nice job in those. And really, the market leader here is Movantik. So they have mid-70% of market share. So it's really for us to grow, the business has to come from Movantik to really have meaningful growth. So that's where we're focused on trying to gain share.
Matthew Lee Kaplan -- Ladenburg Thalmann -- Analyst
That's helpful. And then just last question. In terms of you mentioned that there were price increases taken early in the quarter. What were the magnitude of those price increases? And do you expect additional price increases throughout the year?
Scott Plesha -- President
Do you want to take that, Terry?
Terry Coelho -- Chief Financial Officer
Yes. So thanks, Scott. Matt, so I think what you can assume is about a 5% net price impact across both the products, BELBUCA and Symproic that we took January 1.
Matthew Lee Kaplan -- Ladenburg Thalmann -- Analyst
And then any plans for remainder of the year? Or is this kind of near term?
Terry Coelho -- Chief Financial Officer
No plans. We feel it's that was the appropriate level that places us appropriately in the marketplace.
Matthew Lee Kaplan -- Ladenburg Thalmann -- Analyst
Thanks for taking the questions guys. Thank good luck to you.
Operator
We'll next go with Esther Hong from Janney. Please go ahead.
Esther Lannie Hong -- Janney Montgomery Scott -- Analyst
Congrats on the quarter. Wanted to ask what you're seeing in terms of patients losing commercial healthcare coverage, how are you thinking about this moving forward?
And then, Scott, can you speak on specific details on the program you mentioned with regard to these patients, what sort of assistance are you providing to these patients?
Scott Plesha -- President
Esther, I appreciate the question. So I think it's really early now to truly understand the impact on commercial insurance. I think it will go down. We may see a little bit of a migration to even some Medicaid as that happens. But I think there are going to be people who just are kind of uninsured for a while. And I think one of the reasons we wanted the situation was to help and make sure people have access to BELBUCA, if all possible. So we did implement it. It only has to we can only do, within the commercial side of the business, any kind of co-pay card assistance. But basically, it's a pay-no-more-than type situation. And we're at a point where we feel that patients would still be able to afford it and be able to go forward with it.
So and then the prior authorization side of things, there are patients that still have to do PAs. We've done a really nice job of adding market access. So the hurdle is fairly low across most plans, but there still remains some challenges. It makes it a little bit harder like in Medicare, for example, where we still have almost 75% of lives are not covered, and there may be step edits. We feel that, that will be an area that will be very helpful until we can secure future Medicare assistant Medicare access.
Esther Lannie Hong -- Janney Montgomery Scott -- Analyst
Great, thank you.
Operator
We'll next go with Tim Lugo from William Blair. Please go ahead.
John Boyle -- William Blair & Company -- Analyst
It's John on for Tim. I was just wondering if you guys are seeing any pull-through in numbers of customers may be ordering two versus one that do ongoing pandemic and how you guys are kind of thinking about how prescribing patterns might change as we move into the summer? And do you think this return to some sort of normalcy?
Terry Coelho -- Chief Financial Officer
Tim John, I apologize. Could you it was a little bit hard to hear your full question. You mind repeating it?
John Boyle -- William Blair & Company -- Analyst
Sorry. I was on a Bluetooth headset that wasn't working very well. This is John on for Tim. I was just wondering if you guys are noticing any pull-through in numbers with customers maybe ordering two versus one scripts to the ongoing pandemic and how you might be thinking about how prescribing patterns might be changing as we start to return to normal throughout the summer.
Scott Plesha -- President
John, it's Scott again. So we haven't really seen a two versus 1. I think most plans will only allow so many scripts filled at one time. So what we have seen is a slight increase, I mean, very, very minimal in the average script size, we'll say. So the number of films or tablets per prescription has gone up. And I think that's consistent with what the whole market is seeing, I think we've seen some numbers from IQVIA that they're seeing a general if patients will get a forward script, if possible, instead of maybe say usually we got would have gotten 40 and they're allowed 60, but were allowed 60, they may more likely to get to 60 now.
So they are filling bigger scripts. And I think that's not just us, it's across the whole industry. And as far as getting back to prescribing, I think we are hearing we have obviously strong relationships with our customers, and we do believe that there is some pent-up demand out there for new patients that just haven't been able to get into offices to see HCPs. And I think, and especially in the opioid space, it's important, a lot of times for the HCPs to have them first time, especially pain management to if they're going to initiate therapy, change therapy for seeing a patient for the "first time" the more likely to do it face-to-face versus over telemedicine. So I do think that, that is something to keep an eye on as we go into the rest of the year and how it might impact prescribing and our brand specifically.
Operator
There are no questions at the moment.
Terry Coelho -- Chief Financial Officer
Okay. We can end the call operator. Thank you, everybody, for joining.
Herm Cukier -- Chief Executive Officer
Thank you very much.
Operator
[Operator Closing Remarks]
Duration: 47 minutes
Call participants:
Terry Coelho -- Chief Financial Officer
Herm Cukier -- Chief Executive Officer
Scott Plesha -- President
Brandon Richard Folkes -- Cantor Fitzgerald & Co. -- Analyst
Greg Fraser -- SunTrust -- Analyst
Timothy Chiang -- Northland Capital Markets -- Analyst
Zachary Sachar -- Piper Sandler & Co. -- Analyst
Matthew Lee Kaplan -- Ladenburg Thalmann -- Analyst
Esther Lannie Hong -- Janney Montgomery Scott -- Analyst
John Boyle -- William Blair & Company -- Analyst
