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Epizyme Inc (EPZM)
Q3Â 2020 Earnings Call
Nov 6, 2020, 8:00 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
[Operator Instructions] Hello and welcome to Epizyme's Conference Call. At this time, all participants are in the listen-only mode. There will be a question-and-answer session after the prepared remarks. Please be advised that this call is being recorded at Epizyme's request. I would now like to turn the call over to Alicia Davis, you may begin.
Alicia Davis -- Investor Relations
Thank you, operator. This morning we issued a press release outlining recent progress and our third quarter 2020 financial results. That press release as well as our most recent corporate presentation can be found in the Investors section of our website at epizyme.com. On the call with me is Rob Bazemore-CEO, Matt Ros-Executive Vice President and Chief Strategy and Business Officer, Paolo Tombesi-Chief Financial Officer, and Dr. Shefali Agarwal-Chief Medical Officer, will join us for the Q&A session. Today's discussion will include forward-looking statements related to Epizyme's current plans and expectations, which are subject to certain risks and uncertainties.
Actual results may differ materially due to various important factors, including those described in the risk factors section of our most recent Form 10-Q, 10-K, and other SEC filings. These forward-looking statements represent our views as of this call and should not be relied upon as representing our views as of any subsequent date. We undertake no obligation to publicly update these statements.
Now let me turn the call over to Rob. Rob?
Robert B. Bazemore -- Chief Executive Officer
Thank you Alicia, and thank you all for joining us today. 2020 has been an important year for Epizyme in terms of our significant milestones, with two accelerated approvals which are TAZVERIK in the U.S. and the transition to a commercial enterprise. In addition, we announced this morning that we expanded our loan agreement with Pharmakon advisors, enabling us to draw down $150 million from the $300 million loan facility to further support our continued growth and commercial, clinical, and research execution.
This has been a year of unprecedented challenges for all of us. Our team has been resilient, and I'm proud of our accomplishments. Since January, our primary focus has been the successful commercial launches of TAZVERIK for both epithelioid sarcoma and follicular lymphoma, ensuring a positive first experience and enabling seamless market access and rapid delivery to patients. So this in reaction to our label in both indication has been strong and key metrics that are important to TAZVERIK option tell us that even amid the COVID-19 pandemic, we are executing well and gaining traction in the patient segments we anticipated based on our label.
Our early launch experience reinforces our confidence in TAZVERIK's long-term market potential in these two indications, which we believe is reflective of the products attractive features, as a simple-to-take oral medication with meaningful efficacy and a well-tolerated safety profile. In the third quarter, we recorded total net product revenue for TAZVERIK of $3.4 million, with growth over the second quarter of 55% mainly driven by the approval and launch of TAZVERIK in follicular lymphoma in late June. We had solid performance with our ES launch which we were able to execute in a more traditional manner in the first quarter, with face-to-face position engagement and leveraging a high level of awareness among the small community of sarcoma specialists, particularly on the heels of a successful ODAC panel.
We saw a quick uptake curve in the early months, given the significant unmet medical need in this aggressive cancer and a lack of indicated therapies prior to TAZVERIK's approval. As anticipated, the uptake curve has started to normalize in recent months for this rare cancer population, but we continue to see new prescriptions and refill orders for patients in both the front line and later lines of therapy. In FL, once understanding the two unique indication statements, physician reaction to the TAZVERIK label has been very positive, and they related against them a great deal of flexibility in terms of how they intend to use TAZVERIK for their relapsed, refractory patients.
As a result of this, we are seeing prescriptions for both patients with EZH2 activating mutations and wild-type EZH2 as well as untested patients where physicians don't feel the need to test. Although prescriptions are mainly being written for third line and later patients, which is in line with our clinical data, we already see early signs of second-line utilization as well. And prescriptions are being written by both academic and community oncologists. With most prescriptions coming from the larger centers where the majority of patients are treated. Since launch, access to TAZVERIK has been seamless with payer coverage in line with our label supporting broad used by physicians. To date more than 50 published payer policies cover TAZVERIK for FL, representing over 150 million lives.
This was aided by the rapid adoption of TAZVERIK into NCCN guidelines, the two way option for both wild-type and EZH2 mutation patients. The vast majority of policies have no restrictive requirements or hurdles for TAZVERIK beyond the label. And, TAZVERIK is consistently delivered to patients within five to six days of a prescription being written. That said, we did observe a slower than expected adoption of TAZVERIK in FL, reflective of launching at the height of COVID-19. In the second and third quarters, many physician offices were either closed or FL patient visits were delayed. Independent data showed that cancer patient visits were down by as much as 60% to 70% in April and remained down by over 30% in July. This was likely even more exaggerated for indolent cancers like follicular lymphoma.
Not surprisingly, this resulted in a roughly 20% to 30% decrease in new FL patient starts across the industry on all lines of therapy. We know physicians are hesitant to make a treatment change without the treatment change without actually seeing their patient in person and although FL visits to physicians are slowly returning to normal levels, many of these visits are still being conducted virtually. Despite this, we are seeing increasing adoption of TAZVERIK. Our commercial and medical affairs team have been incredibly resilient with their efforts and since launch, we reached 97% of our Tier one and Tier two accounts and 50%-60% of positions within those accounts.
We've achieved post-approval awareness of more than 80% among top tier physicians with the greatest depth of awareness among those physicians who have been in direct contact with our team. We've achieved the highest share of voice in detailing among relapsed, refractory FL brands suggesting that although access to physicians has been difficult, our virtual tactics have been successful in reaching them. And we've conducted numerous peer-to-peer engagements, educational, and promotional speaker programs, all virtually. All of this has translated into 60% of our Tier one accounts already prescribing TAZVERIK and traction in new patient starts. Since launched, we've been tracking new prescriptions closely through secondary data, which looks at new patient starts on a rolling three-month average.
The latest data from June was TAZVERIK was approved late in the month through August and so TAZVERIK captured 8% of new FL prescriptions in the third line and later setting and 1% of new prescriptions in the second line setting. While some accounts remain closed industry representatives and we haven't been able to get to everyone, we continue to adapt our launch efforts based on the current environment, which have resulted in an increased awareness, intent to prescribe TAZVERIK, and new patient start. We submitted and received approval from US Oncology for inclusion in their national practice guidelines for FL treatment, and we're doing the same with other large oncology practices.
We've introduced novel peer-to-peer scientific engagements, pairing a national opinion leader with a local opinion leader, and educational programs where our representatives had no direct access and participants in these programs indicate a high intent to prescribe TAZVERIK. We've introduced targeted outreach directly to patients and through lymphoma patient advocacy organizations to educate patients and caregivers on the importance of treatment, so they can proactively seek to reengage with their physicians. We published the results from our registrational trials in both ES and FL in The Lancet Oncology providing complete results from our Phase two studies, which can now be used by our field team to educate physicians.
And finally, just last month, we introduced our TAZVERIK branded promotional campaign after FDA preclearance following our accelerated approval. Overall, we are executing well on all aspects of our launches that we can control. Our ES performance has exceeded expectations, and despite a slower adoption ramp in FL than we had hoped, we are seeing month-by-month increases in new FL patient starts and are pleased to see prescriptions reflective of our broad label. Importantly nothing that we've encountered so far changes our view on the market potential for TAZVERIK in 2021 and beyond. The under commercial activities we're building on TAZVERIK's value proposition through additional clinical trials and ongoing development to produce new data and to support expansion into new indications.
Patient enrollment is nearing completion for the safety run-ins for our ES confirmatory trial evaluating TAZVERIK plus doxorubicin in frontline patients, and for our FL confirmatory trial, evaluating R-squared plus TAZVERIK in second line patients. Completion of these safety run-ins will enable us to initiate the efficacy portions of both studies early next year as planned. We are also on track with all post marketing commitments for ES and FL. In addition, we've completed enrollment, up to the full 800-mg dose of tazemetostat in the safety running of our metastatic castration-resistant prostate cancer study, which is showing combined ability of the full dose of tazemetostat with both enzalutamide and abiraterone, and we plan to move into the efficacy expansion stage early next year.
We anticipate reporting safety and clinical activity data from the safety run in 2021 if patients are still being followed. Financially, we closed the third quarter in a strong position with $280 million in cash and cash equivalent. Our total non-GAAP operating expenses for the quarter were $50.2 million, split fairly evenly between R&D and SG&A expenses. As we look at year-end, we are updating our guidance for full-year non-GAAP adjusted cash operating expenses to be between $215 million to $235 million from the previous $235 million to $255 million.
This is due to a reduction in travel and other expenses, as a result of our employees largely working virtually and a change in how our manufacturing expenses are recorded now that TAZVERIK is a commercial product, which are partially offset by an increase in commercially related expenses to address the COVID-19 challenges. Importantly to support our long-term objectives, we have expanded our loan agreement with Pharmakon advisors, an affiliate of Royalty Pharma. As a reminder, we entered into an agreement last November for a $70 million loan with Pharmakon to support regulatory milestones owed to Eisai. That agreement had an option to expand the loan to an additional $300 million after the FL approval, and we have elected to draw down $150 million. The terms are similar to the previous agreement.
With the repayments scheduled, it is favorably aligned with our expected revenue growth. This was a strategic decision to further strengthen our balance sheet and fund a number of critical growth initiatives for Epizyme. Our balance sheet of $200 million at the end of the quarter, combined with the $150 million upon closing, provide us with approximately $430 million capital, which we believe will extend our operating runway into at least 2023. In closing, our vision is to rewrite treatment for patients with cancer, and we're executing that vision today through TAZVERIK. While this year has presented us with a number of challenges that we never imagined, we have an incredible team that is unwavering in our belief and in the long-term value that TAZVERIK will provide in the future opportunities with our science.
Thank you all for joining us today. We'll now open the line for questions.
Questions and Answers:
Operator
Thank you. [Operator Instructions]. Our first question comes from the line of Mohit Bansal with Citigroup. Your line is now open.
Mohit Bansal -- Citigroup -- Analyst
Great, thanks for taking my question. May be I mean-so thanks for providing all these launch metric. So just thinking about the number you posted, and if I compare to the second quarter number, which is probably predominantly ES patient population, it feels like there is a $1.2 million incremental revenues and if I divide by price and everything, I get about 60 patients or so, on 30-patient average, just do the math, about 60 patient at the year-end-so quarter-end, so just thinking about it.
What is like when you say 8% patients, a new starts in third line plus, can you just help us understand how, what is the denominator and numerator there because if I understand it correctly, every three-month period, there should be about 1500 or so patients coming in there. And because there are 6000 every year, so 1500 coming in, and even if you take into COVID into account, it still should be thousand plus, so just trying to understand the math here.
Robert B. Bazemore -- Chief Executive Officer
Certainly, so let me start and I'll try to do to those questions in if I don't that Pat, you can jump in and help as well. The 55% growth that we generated in the third quarter, we think predominantly came from growth in prescriptions in follicular lymphoma over what we saw in the second quarter. It's actually in terms of generating an actual number of patients, many of those scripts go through the specialty distributor channel, so we don't have actual visibility to it, but it's a combination of the offset of new patients that we're getting for FL. Also patients been on treatment for epithelioid sarcoma who may be coming off, so if you lose some patients, remember the average survival of a patient with epithelioid sarcoma is only about eight months, so we expect that at some point, some of those patients would start to come off the therapy.
The 8% of the prescriptions just to put that number, in context. So of the total relapsed refractory patient population, that's a 10,000 to 12,000 patient population, but in third line specifically what we're talking about is 5000 to 6000 patients. But you don't have all of those patients starting new drugs within a given month. That number I gave you is a three-month rolling average, and really represent two months of launch effort for us because we won't approve until very end of June. So 8% new prescriptions that happen and just put that in context, that's the largest share of the new prescription share than we saw for R Squared, is about the --larger share of the new prescriptions of any of the individual PI3 kinases. It's a larger share of new prescriptions, and all of the Godiva combination put together.
But again, this is where the impact of patients coming in, you have to have new prescriptions. And one of the things that really impacted this market in the third quarter was patients not coming in to see their physicians, so those visits being delayed, but it just hasn't been there. We think that that's starting to correct itself. These patients had been a way now for some time. If you go to the slides that we posted in the corporate --, you could see that visits were down by as much as 70% to 80% back in April, but they remain down by about 30% and even with those visits, coming back to something more related to normal, many of those are virtual visit, and we've heard our physicians, spoken to a number of physicians myself, who tell me that on a virtual call, they won't change a prescription for patients.
They actually want to bring them in and examine them, for they make a treatment change. So all those have represents a great profile for a drug or especially in the COVID environment where they don't have to bring them in for testing, they don't have to bring them for pre-treatment, any of those kinds of things, they still want to see the patient and examine them before they start a new treatment.
And so that's the overall things that are influencing the uptake of TAZVERIK in these first few months of the launch.
Mohit Bansal -- Citigroup -- Analyst
So that means it is basically more of, matter of executing and this is early in the launch and you have this challenge. So in terms of looking at the month-over-month numbers, can you just give us some sense of what you are looking, which gives you confidence in the future here.
Robert B. Bazemore -- Chief Executive Officer
Yeah, it's a great question Mohit, but we're not giving guidance on sales beyond the period that we're talking about here in the third quarter, but we can tell you we've been pleased, two things, first of all, even in the third quarter, we saw growth that started to accumulate in half in toward the end of the third quarter. So the unfortunate part from a revenue perspective is you don't get refills on this patients as we just you get the initial scripts. But we've continued even since then to continue to see increases in the number of physicians and accounts that are writing TAZVERIK. We continue to see increases in the new monthly prescriptions of TAZVERIK and such that our view of the potential for TAZVERIK and FL in the 2021 and beyond hasn't changed at all.
So, this is the profile of this drug. And when they understand the label and the breadth of what the label allows them, how it allows them to prescribe TAZVERIK. They like this drug very much actually is ideal in a COVID environment after they've gotten the patient in, examine them, and made a treatment change. But I think the thing I'm most encouraged by when you ask long-term outlook is the fact that we're getting used in both wild-type and actually we're getting use of pre-groups, wild-type and untested. And the untested group is important because that means those are patients for which physician didn't feel that they needed to test.
And we always knew that there would be some patients treated that way and that we're already getting used, in fact it is showing up on the charts, in terms of market share, we're already getting second line, which we have expected that we would get some that it will be modest. But we're already seeing that is occurring as well.
Mohit Bansal -- Citigroup -- Analyst
So, this is very helpful. Thank you.
Robert B. Bazemore -- Chief Executive Officer
Thank you.
Operator
And our next question comes from the line of David Lebowitz with Morgan Stanley, your line is now open.
David Lebowitz -- Morgan Stanley -- Analyst
Hello, thank you very much for taking my question. I guess my first question is how much insight, I understand you're getting used in those three different FL populations. But how much insight do you actually get back from physicians exactly how they're using it, do you know for certain, I guess, the percentage, the breakdown by those groups or is it more from just casual feedback from sales personnel, and what types of patients are being prescribed?
Robert B. Bazemore -- Chief Executive Officer
So, I'll start and then perhaps I'll allow Matt to add to my comments but in terms of actually quantifying it, again most of the follicular lymphoma prescriptions that we see go through the specialty distributor channel, so they sell into an account, and we don't have immediate visibility into the type patient that's being treated. We will get that, you can get it in a retrospective basis, but we need more than three months of launch runway to be able to have that.
We do spend a lot of time with physicians though, and we understand that a lot of the use is in patients who have wild-type patients who are untested. This is not a drug that's being predominantly used in the EZH2 mutation patient population. So, we're comfortable with what we're seeing in terms of the split between them, although I can't give you a number.
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
Yeah, David, yes, it's Matt just to just to support Rob's comments absolutely this feedback is very consistent and really does reflect the broad nature of the product label, and so it is being used broadly across the segments that Rob just introduced.
David Lebowitz -- Morgan Stanley -- Analyst
The other thing I would ends abruptly
Robert B. Bazemore -- Chief Executive Officer
David, your question. Just another part of the answer to your question is the awareness that we created has been I think very good considering this has been the launch we've done entirely virtually so to have reached 80% awareness among our top-tier physicians is a good thing, but we also know that the depth of awareness varies whether we've been able to get to a person to person and so much of what companies like ours are doing right now, interacting with people virtually but understanding the label, it's important.
And when we're able to speak with physicians person to person, it becomes much more clear what the second part of that label allows and universally, almost universally, they're very favorable, and they understand how much discretion gives them to prescribing TAZVERIK, and it changes how they use the drug. So our focus right now is just making sure that we can get to every position we can, person to person.
It's not likely to be face to face because many of these accounts still allowing industry representatives in, but even if it's on a phone call or a Zoom call or however we get to them, it takes more time, it's definitely more work, and that's a bit that is reflected a bit in what we've seen in the first quarter. This is, it just takes longer to do it that way, but when we do, the physician reaction to the TAZVERIK paradigm has been universally positive.
David Lebowitz -- Morgan Stanley -- Analyst
Thank you for that. Also given that certainly can number of cases have been spiking substantially in recent weeks, has that dynamic of improvements been holding or has a trajectory been changing as you move into the early fourth quarter?
Robert B. Bazemore -- Chief Executive Officer
No, in terms of my commentary, -- month increases in use, we've seen month-by-month increases in use even through that. I think what's happened is those early months, the April, May, and June timeframe where I showed you that the visits were down substantially, a lot of patients didn't come in at all, and now physicians are realizing they need to get these patients in, and they need to see them if these patients can go forever without being seen and treated, and so they are starting to bring them back in, even though about a third of those visits are virtual. And if that's the case, they, if they feel the patient is progressing or they have an adverse event, they still want to see them, but they are, they are bringing them back in.
I had a physician I spent time, Shefali, Matt, and we actually speak live with these physicians in these large accounts. I had a physician that told me last week that he had two, diffuse large B-cell lymphoma patients that came, that he sent directly to hospice with no treatment, and he has never done that in his career, the reason was he hadn't seen that patient in about four or five months because they were told not to come in and he progresses beyond the point that treatment could help them. So I think physicians are starting to realize now, this can't go on even with COVID not going away.
They need to see these patients, and they're trying to find ways to do that, and we're spending our time trying to find ways to make sure we can access these physicians, even though that dynamic hasn't changed much because we don't know that it will change between now and end of the year. So we're doing more and more things to make sure that even if access for us doesn't improve, we can still get the message to physicians about TAZVERIK.
David Lebowitz -- Morgan Stanley -- Analyst
Thanks for taking my questions.
Robert B. Bazemore -- Chief Executive Officer
Thank you, David.
Operator
Thank you. And our next question comes from the line of Michael Yee, Jefferies. Your line is now open.
Michael Yee -- Jefferies -- Analyst
Hey guys, thanks for the question. I had two-part question, but the related first IS a follow-up on Mohit's question and looking at the chart about 8% share and trying to connect that with slide eight, which actually shows by months, how many new people are starting. Can you just clarify, you think there is about 1,200 people starting follicular lymphoma therapy per month? And so, therefore, actually when we do the same math, we could do about 70 to 80 patients.
I guess you divided by the cumulative in the quarter, 3000 new people starting, that's around 3% to 8%. So do you actually think there's 1000 people starting per month. And if they are, 900 people out of the 1000 are getting something else, maybe just connect them, is that surprise you? And then the second part is if, what we're seeing is COVID is part of the impact here and takes time to bring people in, do you just think that we just need a lot more resolution around COVID to really start to get a better ramp, maybe just connect those two dots, thanks.
Robert B. Bazemore -- Chief Executive Officer
Certainly. So let me explain the chart that looks at a number of new visits. That does not represent the total number of new follicular lymphoma patient prescriptions in a month-by-month basis in the footnotes if you read it. This is actually a survey that's done its syndicated data that we purchased. But it's based on a sample of physicians, and they basically feel that they have a high enough sample to be able to project changes as they do here with the reductions in prescriptions. But it doesn't mean this is only of the sample of I think it's 179 physicians that they sample, so that's not the total number of new FL patient starts in the country each year. It's a sample that gives them enough sense of being able to protect at a macro level.
In terms of the 8%, we've always said, and I think we've had in our corporate at four slides that show the actual use of individual drugs and it's a fragmented category. That's what we've always said, it's a, it's a group of patients where there is no real standard of care. Each of the other independent PI3 kinases have between eight or lower percent share. Our share of the 8% that we reported in the third line and later setting is actually higher than R Squared, which is impressive in the third line setting. A lot of the R Squared use had actually been in the third line is starting to move up a bit earlier, but it has been in the third line, is better than because I have combinations combined, it is as good or better than any of the PI3 kinases.
And again, that's with just really two months of launch activity because that was data that was cut in August, on a three-month rolling average, so again, that's not the number that we expect will be out eventually, but for two months of launch on a three-month rolling average, we feel very good that that represents a strong adoption early on.
Michael Yee -- Jefferies -- Analyst
So do you think it's actually higher than that because that's a sampling of those, you think it's higher than 1,000 per month. And again if it's higher than, that you think that 92% of these people are getting something else. And they're coming in and getting something, because it's just a start, so we just got the interpretation I think that's what we have seen. They're getting the different drug.
Robert B. Bazemore -- Chief Executive Officer
So I think what that means. I don't actually know what the number of that, I don't think anyone knows what the actual number of new FL starts is per month. Again, this is based on a sampling, and they try and project percentage changes that's really what this is focused on. I think what happens, Mike in reality in a third-line market in the 3rd line patient and Shefali can speak to this from a clinical point of view as well, is these patients are on something, they are on something in many times it's an off-label drug, it may be ibrutinib, it may be Venetoclax, they're on something and in many cases the drugs that they get treated with, actually only go for a certain period of time and then they end and then they monitor them until they progress.
So a good example is R Squared that is used for a year, they stop it and then they monitor those patients until progression. And so many of them are actually being treated with something, but until something triggers the physician or the patient to diagnose themselves is not doing well, being symptomatic, and say I need to go back in and see the physician, a treatment change isn't made, but it's not that they're sitting there on nothing unless it's just because the treatment cycle for the drug ended in there waiting to see when they progress.
Shefali Agarwal -- Chief Medical Officer
Yeah, So this is Shefali. Good morning. I think it is very different than aggressive tumor, follicular lymphoma is different as Rob mentioned rightly that patients, if you are third line and beyond on something, but unless there is some dramatic, they don't come to physicians, and the physicians don't have the patience, they won't do scans and they won't know that the patient is progressing to make it to treatment change. So it's important that the come, and it's very different from aggressive tumors like breast and others where they see them often because all DLBCL, because it's more aggressive.
Michael Yee -- Jefferies -- Analyst
Okay, got it. Thank you.
Robert B. Bazemore -- Chief Executive Officer
Thank you.
Operator
And our next question comes from the line Peter Lawson with Barclays. Your line is now open.
Peter Lawson -- Barclays -- Analyst
Great, thank you so much. I just wanted to thank you to verify that. So you'll see in these trends get essentially better through 3Q toward the end of 3Q and into October, as well.
Robert B. Bazemore -- Chief Executive Officer
That's right and we hear it anecdotally as I said, Matt, Shefali, and I, and others are on the phone with these physicians quite a bit. They are telling us the same thing, that they've gone long and enough, they want to see these patients, they back in and so we, yes we expect that the rate of the patient visits IS starting to improve, some of it is virtual, about a third of it is virtual because in the case these are elderly patients, remember so they fall into a high-risk category, when it comes to COVID.
So if they can all arrange to see them virtually, they're doing it that way and then let's say detect that there is an issue, patients says I'm not doing well for symptoms, then they'll bring them in, in order to you, but it's just one more step to get to the treatment change. Ultimately physicians like this drug and they like it, particularly for these patients who they don't want to continue to bring in for pre-treatment or infusions it works really well but they have to get to that step of making a treatment change in.
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
And Peter it's Matt just to build off of Rob's point, we continue to see and are pleased that we see month-over-month increase in adoption despite the challenges with COVID and I think that's very much reflective of the broad nature of the label and the impression that physicians are having in the context of how they can use the drug, which reflects not only the third line and later use that Rob articulated that even the opportunity now that's presenting itself in second line where we would we've observed prescribing as well.
Peter Lawson -- Barclays -- Analyst
Okay and how much visibility do you have, I mean how much of this is it blocks because it's kind of third party and then, do you feel you have enough data to get comfortable about what 4Q could look like internally at least?
Robert B. Bazemore -- Chief Executive Officer
Yeah, well the vast majority of the data or the prescriptions are going through the specialty distributor, so at the forefront of that we were, we don't have the availability or visibility into where these scripts are growing, so what we'll be doing is actually following those through patient claims databases, those lagged essentially about two months or so, which is why qualitatively know we're continuing to see the right types of improvements in prescription growth, but we'll have a more formal number with regard to that as those databases come true when we have the ability to see exactly where they were.
Peter Lawson -- Barclays -- Analyst
Right I did just a final question around that with this kind of dynamic you've seen with new patient starts from COVID, should we kind of look at 3Q as kind of a new base to grow from or is it still uncertain?
Robert B. Bazemore -- Chief Executive Officer
I mean, 3Q is a base to grow from in the first place, because it's the first quarter of launch. So we really didn't have a baseline, and what I would say is as a baseline number, that number has been, it's been more difficult because of the challenges that COVID has presented, just in terms of the initial uptake. I think all of the things that we pointed to in terms of how we're executing, we're very pleased with, particularly the types of patients that are being treated, but we expect that this will only get better as the dynamics around COVID get better as physicians, I need to see these patients, and patients demands go in, one of the other things that we're doing Peter is we're directly going to patients now with educational programs to help them understand they can't stay away from the physician office, they have, they have a malignancy, it needs to be treated, they need to be seen, and they need to be cared for.
So we're pushing on both the patient side as well as on the physician side, and we're pleased to see that that happens, even though there's their guidelines by cash guidelines that came out that talked about being more prudent with indolent lymphoma. Many physicians now are starting to say that's not, we can't do that anymore, we have to see these patients, and so we think that our ability to continue to access these physicians is important. We're even with COVID, we're doing everything we can to make sure we can access them, but I do think that we see improvement coming as the COVID pandemic starts to have less of an impact because these patients just need to be seen. And we're seeing that in the prescriptions as well.
Peter Lawson -- Barclays -- Analyst
Great. Okay, thanks so much. Thanks for taking the questions.
Operator
Thank you. And our next question comes from the line of Yaron Werber wherever with Cowen line is now open.
Yaron Werber wherever -- Cowen -- Analyst
Yeah, hi, good morning.
Robert B. Bazemore -- Chief Executive Officer
How you Yaron?
Yaron Werber wherever -- Cowen -- Analyst
Hi, good morning. A couple of questions. Number 1, it seems like 60% of accounts have prescribed -- the first year. What about the second tier, what some you can, kind of, is it that these are very small practices that you just don't have a lot of patients or what thoughts and if you could share some of those stats in that here.
Robert B. Bazemore -- Chief Executive Officer
I'll start. I mean I think first of all, I'll explain with the tiers are and then Matt can go into a bit more detail. In Tier one and Tier two together, when you take them combined, it's probably around 800 accounts. So these are, it's a large number of accounts that these are the accounts are tiering this based on the volume of FL patients that they actually see. And so when our access has constrained, we've really put a heavy emphasis on making sure that we can I get to these Tier one and Tier two accounts because these the once managing the bulk of the patients. So we feel good that we've done a good job in terms of achieving awareness there and a fairly high level of those accounts are already having prescribed a patient. I'll let Matt explain more about the tiers and answer your question
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
Yeah. I know Rob. Right. I mean it's certainly with regard to the success we've had thus far. We're focusing really in the top level prescribers, we've seen adoption in both areas, in both Tier one and Tier 2. Of course, the Tier ones are areas where there is the greatest volume. So naturally, that's where the organization is focusing, but we've certainly seen adoption in both tiers and will continue and will be closely monitoring that, if I look forward into the fourth quarter and into 2021.
Yaron Werber wherever -- Cowen -- Analyst
Okay. But I assume is to sort of in the 30%. Is it sort of half of Tier one or, and any sort of hint?
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
Yeah, it's still -- we're still tracking that performance in the -- all of the accounts that we're calling on at the moment, but certainly we've seen adoption across all of the tiers with -- with the ball is really being in that Tier one setting.
Yaron Werber wherever -- Cowen -- Analyst
Okay. And then you have coverage for about 150 million lives, obviously it's about half -- half the country. I'm not sure any sense as to, is this sort of more on the Medicare and supplemental, is it sort of more senior denominated or what's the plan to kind of expand our coverage?
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
Well, that we've been very pleased with the coverage to date as Rob pointed out in his comments over 50 plans covering and writing policies for TAZVERIK's policies. As you know, you're on the coverage for FL in the population is a more Medicare-based population, but we've been successful in implementing these policies. We believe that's very much consistent with the awareness that we created well before the approval, and we continue to have success in that regard. So there's been no barriers to access for the brand, which we're continue to be very pleased with, and we just continue to move down that that path with the payer community between now and the end of the year.
Robert B. Bazemore -- Chief Executive Officer
Our metric that we're tracking on and if you recall the epithelial sarcoma launch by six months end, we had 90% of coverage of all plans, those lives were covered, were metric and something very similar for follicular Lymphoma that we would have approximately 90% of lives that would be covered in around six months or so after, but if they don't have a public policy, it doesn't mean they're not covering TAZVERIK. Those plans that don't have a published policy most of them have interim plans in place that allow for coverage for TAZVERIK, and because of that we're really not seeing denials of claims for FL, whether it's a plan that is published, their policy or one that's still in words.
Yaron Werber wherever -- Cowen -- Analyst
Okay, great. And then Shefali just for you, metastatic prostate cancer. It's all, if you can have data from the Phase 1b to run in safety data next year, is it potentially at ASCO GU. And is there going to be efficacy in that look? Thank you.
Operator
Shefali, you might be on mute.
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
I'll jump in, it could be that, sometimes she has connectivity issues, it could be she dropped. So further castrate-resistant prostate cancer study, we've been very pleased with, actually a number of things on this. We've been pleased with the rate of enrollment despite COVID, we've never seen a slowdown in enrollment that you just been a high degree of interest by the physicians, who've been a part of it. We are, we've completed enrollment, all the way up to the 800-mg dose.
As I said in my opening remarks, we've not seen any dose-limiting toxicities with either enzalutamide or abiraterone, and based on that safety result and activity, we've already made the decision to move forward to the efficacy portion of the study. So we'll have more on that as we start the study next year, and we would look to present these data, yes, at a medical meeting next year, so that you could see both the safety and the activity that we've observed so far, but we've not talked about those numbers because we actually still have patients actively on treatment.
Yaron Werber wherever -- Cowen -- Analyst
Great, thank you.
Operator
Thank you. And our next question comes from the line of Andrew Berens with SVB Leerink. Your line is now open.
Andrew Berens -- SVB Leerink -- Analyst
Hi, thanks for the listens. Hi Rob, two from me, please. The first one has to do with the existing treatment paradigm for FL. I think one thing, we've heard consistently from the KOLs, is a classed FL, is an indolent disease and in many patients are indolent and their willingness to seek and accept treatment at this point in our life. I'm wondering if there's any way to actually change that or is this a case that FL opportunity could remain somewhat elusive until the drug can get earlier treatment stages of the disease.
And then I just have one about the label. We're hearing that most centers, especially in the community, don't have stand-alone EZH2 testing and most doctors don't know who is EZH2 positive in their practice. How long do you think it will take to implement stand-alone testing in the communities as a treatment paradigm.
Robert B. Bazemore -- Chief Executive Officer
It's a good question. I'll feel the first and then I'll let Matt answer the second question with regards to testing. Your point about some of these patients, you're right. In fact, we've talked before about the fact that in research that we've done, when we tried to size the opportunity, we uncovered in this is through actual chart audits, this physician reports, physician perception, through chart out, it's about 10% of patients come off treatment at every line of therapy, and they don't go back on treatment and predominant reason for doing that is they're not satisfied with the options that are offered to them. They either don't want to perhaps tolerate the toxicities. They can't tolerate the toxicities
It may be something there are contraindicated to and so at every stage about 10% of patients come off drug and essentially been sitting on the sidelines. And so we think that that is an opportunity for TAZVERIK. I launched ZYTIGA in the prostate cancer market, we saw the exact same thing happened there, many men have decided they didn't want another round of chemotherapy, they came out. Many of them went to hospice, and they were choosing no treatment until abiraterone came along and enzalutamide had actually expanded the market. So we think that that potential exist here as well, and that the profile of TAZVERIK well-suited to them because it's oral, they can take it at a home, it's safe. It's one that doesn't require a lot of monitoring and going back to the physician.
But I think this is an opportunity, we believe that we'll have more potential to tap into after we get through this COVID pandemic. It is for patients who already are coming into see their physicians, and they have active disease, these patients are likely not seeing their physicians as often now. So we think this is a 2021 opportunity and beyond more than in the fourth quarter of this year, but we clearly see it as an opportunity, we think the profile for TAZVERIK is ideal suited for those patients. And then I'll let you address the choice of testing.
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
Yeah, good morning. So with regard to testing. We continue to here from the physician community, from our field-based teams as well as our own research, that the test is not a barrier to use at all given the broad nature of the label as physicians are considering TAZVERIK if they are to test, they will test their patients to help just effectively manage the dialog that they'll have between themselves and the patient-provider given the differences in the objective response rates. But by and large right now, for those who wish to test, they've been able to test at the local level, albeit perhaps in their academic centers or in local labs, and those had been reimbursed for. But we don't see testing getting in the way of adoption at this point.
Andrew Berens -- SVB Leerink -- Analyst
Do you have a number of how many patients that have prescribed the drug have actually been tested?
Robert B. Bazemore -- Chief Executive Officer
Yeah, that's something that still we're tracking very closely and when we have a greater level of granularity around that with more quantitative measures, will be sharing that.
Andrew Berens -- SVB Leerink -- Analyst
Okay, thanks. Thank you.
Operator
And our last question. Thank you. And our last question comes from the line of David Nierengarten with Wedbush. Your line is now open.
David Nierengarten -- Wedbush -- Analyst
Hey, thanks for taking my question. Going into the launch in detail.
Robert B. Bazemore -- Chief Executive Officer
Hi David.
David Nierengarten -- Wedbush -- Analyst
One question I have, is there any potential to change that doctors viewpoint that they need to see the patient and examined him or her before treating TAZVERIK, so let's say in a community practice for one physician and prescribed it to the patient who is a colleague, see the results and then forgo an examination or it's really necessary for all patients to get on a script. I understand if it would be, but I'm curious if there's any leeway there going forward with more physician experience, thanks.
Robert B. Bazemore -- Chief Executive Officer
It's a really great question, and it's hard to speculate on whether that would change. I do expect that a big part of this is based on what you said it's physician experience, this is so on top of everything else that we talked about with the dynamics. Oftentimes when physicians aren't seeing their patients, writing something new that they are unfamiliar with, and they're not accustomed to what might happen is just one additional element to think about for a physician. Fortunately for us, the safety profile is actually very favorable, but it's still one that's unfamiliar. So it could be that once physicians have experience and they're willing to do, they're willing to use TAZVERIK without seeing the patient, but I don't think it even has much to do with with the drug itself.
It has to do with knowing where their patient is and how they're doing. And so I've asked this question and again this is or at least, this may change in two or three months, but as I'm on the phone with physicians, I specifically asked the question. If you're seeing a patient virtually, would you ever-would you use TAZVERIK or make any treatment change unless you bring the patient in and almost universally, the answer is, I want to see the patient, I want to physically examine them, I want to understand where they are because that could affect the way I think about treating them, what they may tolerate, and so forth. So I think that it's more about understanding the patient and the condition of their disease. And there are other health status before deciding which treatment to give them.
Shefali Agarwal -- Chief Medical Officer
Yeah, I think [Multiple speakers]. Yeah. So I think, yeah, so I think one of the things that physicians actually are doing now as an offset is they are reaching out to the patients, they are trying to help them understand that there is, there is the need of treatment initially when COVID hit, there was a big, people didn't know how to react, and I think people are encouraging physicians than encouraging patients to come, however, I think we just have to remember that this is an indolent cancer, it's-patients unless there are symptomatic, it's very just different and aggressive cancer, it's just hard for them to get them to the clinic.
David Nierengarten -- Wedbush -- Analyst
Understood. Thank you.
Operator
Thank you. This does conclude today's question and answer session. I would now like to turn the call back to Rob for any closing remarks.
Robert B. Bazemore -- Chief Executive Officer
Great, well thank you all for joining us today. Thank you for the really great questions. We look forward to keeping you updated on our progress, and we hope you all have a safe and healthy day, and we'll talk again soon. Take care.
Operator
[Operator Instructions]
Duration: 47 minutes
Call participants:
Alicia Davis -- Investor Relations
Robert B. Bazemore -- Chief Executive Officer
Matthew Ros -- Executive Vice President and Chief Strategy and Business Officer
Shefali Agarwal -- Chief Medical Officer
Mohit Bansal -- Citigroup -- Analyst
David Lebowitz -- Morgan Stanley -- Analyst
Michael Yee -- Jefferies -- Analyst
Peter Lawson -- Barclays -- Analyst
Yaron Werber wherever -- Cowen -- Analyst
Andrew Berens -- SVB Leerink -- Analyst
David Nierengarten -- Wedbush -- Analyst
