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TherapeuticsMD, Inc. (NASDAQ:TXMD)
Q4 2020 Earnings Call
Mar 02, 2021, 8:30 a.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:


Operator

Good morning, ladies and gentlemen. Thank you for joining us for TherapeuticsMD fourth-quarter 2020 financial results conference call. [Operator instructions] I would now like to turn the call over to TherapeuticsMD's Vice President of Investor Relations Nichol Ochsner. Nichol?

Nichol Ochsner -- Vice President, Investor Relations

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

The press release is available on the company's website, therapeuticsmd.com in the investors and media section. On today's call from TherapeuticsMD are Chief Executive Officer Robert Finizio, Chief Financial Officer James D'Arecca, Chief Commercial Officer Dawn Halkuff, and Chief Strategy and Performance Officer Mitchell Krassan. I would like to remind everyone that certain statements made during this conference call may contain forward-looking statements. Such forward-looking statements are based upon current expectations, and there can be no assurance that the results contemplated in these statements will be realized.

Actual results may differ materially from such statements due to a number of factors and risks, some of which are identified in our press release and our annual, quarterly and other reports filed with the SEC. These forward-looking statements are based on information available to TherapeuticsMD today, and the company assumes no obligation to update statements as circumstances change. An audio recording and webcast replay for today's conference call will also be available online in the investors and media section of the company's website. For the benefit of those who may be listening to the replay or archived webcast, this call was held and recorded March 2, 2021.

With that, I'll turn the call over to TherapeuticsMD CEO, Robert Finizio.

Rob Finizio -- Chief Executive Officer

Good morning. On today's call, we will review our fourth-quarter and full-year performance, progress made on strengthening our capital structure and our commercial plans. We delivered a strong year and a strong quarter with record total net product revenue for our company. We successfully executed on multiple priorities, demonstrating operational agility while maintaining a strict focus on commercial execution and financial discipline.

We've lowered our operating expenses, updated our net revenue covenants for the remainder of the term of our loan and strengthened our balance sheet through equity capital raises as we reduce our debt. Before I turn the call over to James to give you the detail on the transformative progress we've recently achieved, I would also like to mention that the vitaCare divesture process is still moving forward and has multiple interested parties. I will now turn the call over to James.

James D'Arecca -- Chief Financial Officer

Thanks, Rob. Before reviewing our fourth-quarter financial results, I would like to discuss our balance sheet and elaborate on updates with our lender. Turn to Slide 5. We have strengthened the balance sheet by raising over $180 million in net proceeds since last November, which after the recently completed offering earlier this month, brought our cash balance to over $200 million.

Our strong cash position has enabled us to work with our lender to reduce our future covenants for the remaining life of the loan, gain their consent on the terms on which we can divest the vitaCare prescription services and pay down $50 million of debt by the end of March. Paying down debt allows us to reduce interest expense as we move forward, and we believe it will also facilitate the refinancing of our remaining debt at more favorable terms in the future that will reflect the advancing stage of commercialization of our key products. As Rob mentioned, we have agreed with our lender to update our aggregate revenue covenants for ANNOVERA, IMVEXXY and BIJUVA. Our first-quarter revenue covenant is now $17 million, second quarter is now $20 million, third quarter is $23 million, fourth quarter is $26.5 million and first quarter of 2022 is $30 billion.

After that time, it increases $5 million per quarter. While not formal guidance, we believe these revenue covenants have been set at minimum levels that are sufficiently below our revenue expectations given the current state of the COVID-19 pandemic, and provide sufficient headroom to avoid further adjustment. We believe our deleveraging, along with our updated net revenue covenant, is transformational and we are now poised to focus solely on executing our commercialization efforts. Let's move on to a review of our financial results and key metrics from the fourth quarter. turning to Slide 7.

Our overall net revenue for the fourth quarter increased to $22.6 million, which satisfied our fourth-quarter revenue covenant. This was a 30% increase in product net revenue from the third quarter. This increase was driven most significantly by the 42% increase in net revenue from ANNOVERA, with the average net revenue per unit remaining in line with prior quarters at $1,336 per unit. Additionally, as you can see on the chart, IMVEXXY and BIJUVA also increased by 29% and 36%, respectively, compared to the previous quarter on a net-revenue basis.

The average net revenue per unit increased to $54 for IMVEXXY and $52 for BIJUVA. As of year-end, wholesaler inventory levels for our products were within normal levels of three to five weeks. Moving on to Slide 8. Let's review some key financial statement items.

Our product gross margin of 75% in the fourth quarter decreased 6 percentage points over the third quarter. Our fourth-quarter gross margin was adversely affected by write-offs of finished goods inventory for ANNOVERA of $800,000 and $500,000 each for IMVEXXY and BIJUVA, which were attributable to the pandemic. The results of our previously announced cost savings initiatives and our focus on strict cost discipline allowed us to reduce operating expenses and to achieve our goal of $80 million in opex for the second half of 2020. Excluding noncash items and a performance incentive of $6 million to enhance employee retention across the organization.

Net cash used in operating activities decreased by $3.7 million from $34 million for the third quarter to $30.3 million for the fourth quarter. While we plan to maintain an efficient cost base that can be leveraged as revenue grows, we expect to make investments this year to improve our supply chain, enhance marketing and strengthen digital capabilities related to commercial initiatives. With these investments, we expect our cash opex per quarter to average $45 million to $48 million in 2021. Turn to Slide 9.

In conclusion, I have been pleased with our financial and operational accomplishments over the previous two quarters since I joined TXMD. Over this short time, we have reduced operating expenses and cash burn by successfully meeting our goal of $80 million in cash opex for the second half of 2020, strengthened our balance sheet by raising $180 million in cash and committing to pay down $50 million in debt, revised our revenue covenants to what we believe are minimum levels given the current state of the COVID-19 pandemic. We believe we are well-positioned to execute on our commercial plans and poised for continued growth in 2021. I would now like to turn the call over to Dawn to discuss our payer progress and commercial plans.

Dawn Halkuff -- Chief Commercial Officer

Thanks, James. I will start with a quick overview of payer status and then review the performance seen across our product portfolio in this quarter. Let's start with payer access and updates on Slide 11. We have maintained all major payers across the product portfolio.

Improvement in commercial unrestricted coverage moved ANNOVERA to 70%, IMVEXXY to 76% and BIJUVA to 75%. Let's move to ANNOVERA performance on Slide 13. Quarterly total prescriptions filled by patients is on the left-hand side. As you can see, ANNOVERA continued to grow with total prescriptions increasing 15% over the third quarter, coming in at approximately 6,000 total prescriptions for the fourth quarter.

Net revenue per unit remained strong at $1,336, and net revenue grew 42% quarter over quarter. Turning to Slide 14. To provide a bit more understanding of our progress, let's look at leading indicators across prescriber and consumer metrics. I'll start with prescribers.

Growth in the prescriber base for ANNOVERA is a key lever for launch trajectory. As we have mentioned, prescriber access has been limited during COVID, but we are navigating this and continue to see growth in the total number of prescribers writings, as indicated by the green bars, and growth in-depth of prescribing, as seen by the total prescription shown on the blue line, growing faster than the total number of writers. Turning to Slide 15. We have leaned into consumer activities given that 60% of birth control decisions are made by the consumer.

In December, we launched our celebrity spokesperson portion of the consumer campaign with Whitney Cummings. The program is called, Just Say Vagina. The interest has been significant with 2.7 billion impressions generated and placement in multiple significant media outlets, as shown in the column on the left. In addition, the early impact results are encouraging.

Click-through rates from our advertising to the website are above industry norms, traffic to the website is growing with over 10,000 visits to the website today. And then, live test on multiple platforms, after seeing our advertising, intend to request ANNOVERA rises significantly to 60%. In other words, all leading indicators show the consumer strategy is working and we believe it will increase the trajectory of ANNOVERA prescriptions in 2021. Turning to Slide 17.

As you can see, we have figured out how to affordably attract consumer interest in ANNOVERA. Where we need to improve and create the next step is converting this consumer interest to build prescriptions. This progression from interest to conversion is a typical learning process during launch, and we believe we are on the right track to improve the conversion over the next month and quarters. Turning to Slide 17.

Now I would like to talk about the value of each patient for ANNOVERA. Each woman on therapy creates a significant amount of revenue value for TXMD because the full year of revenue is 13 cycles and is earned when the product is dispensed. As you can see by the slide, the cumulative value of ANNOVERA continues to grow with almost 16,000 women on therapy. In addition, we believe our strong refill rate of approximately 50% will create a strong compounded future revenue opportunity.

Now let's move to the larger future opportunity for ANNOVERA on Slide 18. ANNOVERA fills a void in the marketplace, and we believe it can create a new segment in birth control. It is well understood that IUDs and implants are not for everyone. Close to half of women reject the offer of an IUD implant because they do not want to undergo a procedure.

In addition, almost half of OB/GYNs don't conduct procedures and, therefore, are in need of a long-acting option to provide their patients. The solution to both of these issues is ANNOVERA. Turn to Slide 19. A growing trend in the marketplace is procedure-free, at-home solution.

One successful example of this is ColoGuard, a procedure-free, at-home solution for colorectal cancer screening. It will move the barriers to entry from many people reluctant to undergo a procedure. In fact, of the 3 million people screened with ColoGuard, half of them have been previously untested. We believe ANNOVERA can expand the long-acting segment for the birth control category in the same way.

We're moving the barrier to entry for those that want a long-acting product, but are reluctant to undergo a procedure. Turning to Slide 20. Let's look at the contraceptive continuum. On the left-hand side of the chart are daily and monthly options that are procedure-free, but short-acting and declining, and on the right are options that provide the benefit of long-acting but require a medical procedure and are growing.

ANNOVERA, to the left of the long-acting segment, sales to market void of a long-acting product that does not require a procedure. And still in that market void, we believe ANNOVERA will create a new segment in birth control as ColoGuard did for colorectal cancer screening. Turning to Slide 21. And the evidence for ANNOVERA to become a new segment in the marketplace is in the data.

On the left-hand side of the chart are the main segments of birth control. Moving to the middle column, here you see actual patient data from vitaCare, in which birth control women were on prior to switching to ANNOVERA. Moving to the right-hand column, this is survey data on where prescribers claim they switch patients from given the multiple benefits of ANNOVERA. The main takeaway from both sets of data is the same.

Over half of prescriptions are coming from products that are not NuvaRing as the benefits of ANNOVERA are more than the birth control form. Moving to Slide 22. Before closing on ANNOVERA, let's spend a few minutes grounding us in the larger financial opportunity. Birth control is a large market with 18 million women and 28 million new prescriptions annually.

To put ANNOVERA's opportunity in perspective, traditionally leading products in this category over time have achieved 4% to 5% market share. As you can see in the middle column, Lo Loestrin launched in 2011 and achieved this share in approximately four years. ColoGuard, which is in a different market, but offers the procedure-free, at-home benefit, achieved the same share of 5% of the screening market in five years. If ANNOVERA achieved this level of success seen in the column on the right, it would mean approximately 720,000 prescriptions annually.

Now let's review our menopausal products. Turning to Slide 24. IMVEXXY quarterly total prescriptions filled by patients is on the left-hand side. Total prescriptions decreased 5.6% to approximately 123,000, a result of NRx decline in previous quarters, which was attributable to the pandemic.

In good news, new prescriptions have begun to recover and increased 2.5% for the fourth quarter over the third quarter. Net revenue per unit improved to $54 and net revenue improved 29% Q4 over Q3. Moving to Slide 25. Our primary goal for IMVEXXY in 2021 is to improve the gross to net.

To support net revenue per unit growth, effective January 1, our cash pay program and high-deductible patients co-pay increased from $50 to $75. The expected positive impact on vectors gross to net is significant. The cash flow program change was expected to put pressure on volume, but at the same time we rolled out the cash pay program change, we also gained preferred status for IMVEXXY with a top PBM that covers approximately 20% of lives to counterbalance. In January, the PBM removed key branded competitors, including Premarin, which currently has 17% total prescription market share.

In addition, we are continuing to focus on patient adherence through retail partnerships to drive higher refill rates across distribution channels. Turning to Slide 26. Performance in January based on the combination of changes is as expected. In January, we saw a short-term impact on volume.

However, early indicators for February show that volume is beginning to recover. In addition, we are seeing improvements in adjudication rate, net revenue and net revenue per unit. To date, an approximately $17 improvement in cost per fill is being realized for those who use the co-pay program. Turning to Slide 27.

Finally, a driver of growth is consumer demand. During the first quarter, we launched patient testimonials to help women better understand that symptoms of menopause are common and normal. Moving into the second quarter, we plan to launch a new consumer campaign grounded in healthcare that is designed to educate menopausal women on their overall vaginal health and encourage them to take charge during this new life stage with IMVEXXY. Moving to Slide 29.

I would like to quickly touch on BIJUVA. Even with our decision to deemphasized BIJUVA, and with only seven sales representatives promoting BIJUVA in the field, we continue to see slight growth in TRx for the quarter at 3.3%, while maintaining NRx. For the fourth quarter, net revenue per unit improved to $52 and net revenue increased 36% over the prior quarter. I would now like to turn it over to Rob for closing remarks.

Rob Finizio -- Chief Executive Officer

Thanks, Dawn. Let's move to Slide 30. We've transformed our capital structure. We've improved our balance sheet, updated our revenue covenants and have the framework in place to accelerate both ANNOVERA and IMVEXXY adoption throughout 2021.

Last but not least, our vitaCare divestiture is moving forward, and we believe we are very well-positioned to continue our growth to anticipated EBITDA breakeven in the first half of 2022. Thank you, all, for joining the call today. And we'll now open up the call for questions.

Questions & Answers:


Operator

[Operator instructions] Our first question comes from Louise Chen, Cantor.

Louise Chen -- Cantor Fitzgerald -- Analyst

Hi, congratulations on the quarter. So first question I had for you is on vitaCare. Any update about how you think about valuation, you had given us some thoughts before? And then, the timing of the sale, could we see something this year? Is that what is anticipated? And then, the second thing is, how should we think about gross margins in 2021? You gave us some good metrics for sales and opex. And then, last thing is, how much of an impact do you anticipate COVID to have in 2021? The reason I ask is, as we think about 2022, should we expect a step-up in sales? Thank you.

Rob Finizio -- Chief Executive Officer

Yup, hey, Louise, this is Rob. So as far as vitaCare goes, yes, absolutely. I would expect something this year, assuming it divests, which we have multiple parties interested in, and things are progressing very nicely there. I would definitely expect it this year.

As far as gross margins go, we try to put out at the JPM presentation very clear expectations around nets for the first time, even including IMVEXXY. So what we did with ANNOVERA is we had 1,050 to 1,200, and that was based on the back half of the year, the government channels opening up and additional rebates related to government or commercial related to ANNOVERA, and that's, obviously, assuming COVID lifts. I know we stayed ahead in 2020. I know we were going down to about 1,200 and we closed the year 1,336.

So again, it's that government channel starting to open up. Medicaid, DoD and places like that. I think for IMVEXXY, we put a clear quarterly progression out there. And then, BIJUVA, I think we gave a little bit of color as well.

As far as COVID goes, we actually put a step-up in scale, where the first half of the year is vaccines begin to take hold. There's certainly a headwind for our sales force in getting into new offices that we believe in the back half of the year will start to lift and be getting whatever to this new normal will be in 2022. So we expect strong revenue growth throughout this year and next year. And we think it will accelerate quarter over quarter with COVID lifting.

But the other big thing, and I'll turn it over to Dawn. This procedure-free, long-acting product, as you can see, we have over two quarters ago, we were just starting to learn. But now the marketing department has over 10,000 women coming to ANNOVERA's site a day. And the ability to get a lot of volume moving at low-cost with interest that they've just knocked it out of the park.

The next step is the conversion initiatives that she's working on. And that also will bring a strong revenue stream with it that we're just starting on right now. Dawn, anything to add?

Dawn Halkuff -- Chief Commercial Officer

Yeah, and maybe I'll just -- Louise, maybe I'll just add about the COVID impact. I mean, I think what's really interesting here is that what we're seeing despite COVID is ANNOVERA growing quarter over quarter at 15% and net revenue increasing 42% quarter over quarter. And what's really nice about ANNOVERA, and if we could go to Slide 17 is that during this environment, what's fantastic is that the value of every script, the realized value of every script for ANNOVERA and the aggregate amount of women on therapy, creates a lot of value for us for TXMD, which is really nice in this COVID environment as we navigate it. So essentially, we are an annual product living in this monthly data world.

And so what that means is that every time a prescription is written for ANNOVERA, we receive a full year of revenue versus the one month of revenue for other monthly products. So every time you see an ANNOVERA prescription, it's actually 13. And again, that's really helpful for us during this time. And as Rob said, in terms of how are we going to accelerate growth with COVID, what's the impact? Rob already mentioned the first part.

When COVID recedes, the sales force access will normalize. Which will naturally help us accelerate. And then, because we've generated the significant interest in ANNOVERA, and I'll tell you that the procedure-free, long-acting message resonates, it resonates with prescribers, it resonates with consumers. Right now, we're just focused on conversion, and we can reach consumers digitally in a COVID world.

And so that's going to be really helpful. But ultimately, we believe that the access restrictions will lift in the back half of the year that will allow us to accelerate.

Rob Finizio -- Chief Executive Officer

Does that answer your question?

Louise Chen -- Cantor Fitzgerald -- Analyst

Yes, it does. Thank you.

Operator

Our next question comes from Annabel Samimy with Stifel.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Hi, guys, thanks for taking my question. I had, first, something pretty simple, simple math here. If you just take your prescriptions and multiply it by the net price that you've laid out in your press release, we're not getting to the number. So are there any other variables that we need to be thinking about? And when we think about this, where are the variables that we should think about going forward when you talk about net price ranges for both ANNOVERA and IMVEXXY? And then, I guess, the next question is if there's any update on discussion between us and the FDA regarding hormone therapy.

We haven't talked about by BIJUVA much because of COVID. But as things stabilize for the other franchises, are you going to plan on reinitiating marketing there? Thanks.

Rob Finizio -- Chief Executive Officer

On the question about the difference between gross to net and the usage of the channel. Our demand in the channel for the quarter was very strong. An illustration of Symphony does not pick up all the sales from certain channels where our patients fill their prescriptions, resulting in under reporting of units. Second, we maintain better-than-expected net revenue per unit for all of our products.

And we accomplished this growth, in sales was accomplished by maintaining typical inventory levels of approximately four weeks into the channel.

Does that answer that piece of it?

Annabel Samimy -- Stifel Financial Corp. -- Analyst

I mean, the net price that you're listing and the prescriptions that you reported, are you saying that there is other prescriptions in the channel that you're reporting revenues on or recording revenues on rather?

Rob Finizio -- Chief Executive Officer

What we're saying is there's a mismatch between the numbers reported by Symphony and the units into the channel versus what our sales are.

James D'Arecca -- Chief Financial Officer

Yes, if you take our net time to units, you get the revenue that's reported. The reason that that's so high, we think Symphony is reporting low.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

OK. Do you have a sense of the percent that they're reporting low?

Rob Finizio -- Chief Executive Officer

It's hard because there's so many new channels. That's something we are really working on. It's hard to say at this point. I would hate to guess and be wrong, but we're working on that one -- with them.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

I mean, how do you record your revenues then if you're guessing at the underreporting in the channel?

Rob Finizio -- Chief Executive Officer

You take here revenue? Let me turn it over to finance guy.

James D'Arecca -- Chief Financial Officer

Yes, hi, Annabel. So I think what you're hitting upon is our revenues are done on a GAAP basis. And so that's when we sell onward to wholesalers. And I think the numbers that you were looking at, you were trying to take like scripts that you see being dispensed to patients and multiplying that by the average $1,336, right? Is that what you were intending on doing?

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Well, I mean, that's just reporting -- what you reported in the press release. So I mentioned that would be the accurate number. But mean we can take that offline. I guess, if that's the case, and how should we think about net price and applying that going forward, if there's variables that are unknown, I suppose? How should we think about that?

James D'Arecca -- Chief Financial Officer

So I mean, the thing is that there's a difference between the scripts that are dispensed than what we sell ex-factory, right, from us to wholesalers. So that there's always going to be ebbs and flows and wholesaler buying patterns and so forth. So they will never exactly match up one-for-one. But just in terms of an overall framework of doing it.

For us, I think, I think you assume that that kind of normalizes over time. And that's the way I think you'd go about doing it if you wanted to model that way.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

OK. Well, then maybe we can just move on to the next question regarding NASEM and any progress there in terms of their discussions with FDA and compounding and what you're doing with BIJUVA?

Rob Finizio -- Chief Executive Officer

Yes. So goal is to get EBITDA breakeven. First half of '22. We're on track for doing that.

And at that point, we can reevaluate BIJUVA. Also, you're right, the COVID overcast can certainly create tailwinds or headwinds as it lifts or move forward. And then, we'll see what the FDA does with NASEM on top of that, so we've got to wait and see how each card flips over. But certainly, it's a great product.

And you see, we only have seven people behind it, and it's moving upwards. So there's definitely a market there. That's a matter of resources for us and shareholder goals, right? So we'll get it going now.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

All right Great. Thank you.

Operator

[Operator instructions] Our next question comes from Douglas Tsao with H.C. Wainwright.

Douglas Tsao -- H.C. Wainwright -- Analyst

Hi, good morning. Thanks for taking the questions. Just on the balance sheet, just curious if and it sounds like it's going to be more like a when, you're able to divest the vitaCare business. Will you plan on paying down more debt? Is that an option for you? Or what are your thoughts in terms of the use of proceeds? Thank you.

James D'Arecca -- Chief Financial Officer

Yeah, thanks for the question. Yeah, so when I first started, we had expensive venture debt here, whose covenant package was set long before COVID. The paydown that we just did really creates optionality to keep our current debt structure or allow us to pursue lower cost of debt in the future as market conditions allow. Whether or not we do further pay downs, I think that's subject to a bunch of different analysis here, but we like the optionality that we have.

Additionally, now with that consent to sell vitaCare, which you brought up, that improves our focus and allows the vitaCare business to maximize its value in which we plan to retain an interest. So I really like the setup here that we now have, and I think we are in a much better position balance sheet-wise.

Rob Finizio -- Chief Executive Officer

Yeah, Doug, I don't think we'll be paying down any more debt in the near future to current expectations, to answer your question.

Douglas Tsao -- H.C. Wainwright -- Analyst

OK. And then, just in terms of the gross net, Rob, if you're, obviously, seeing some improvement, especially for IMVEXXY. Sometimes things get a little squirrely in the first quarter with just deductible resets and you see greater utilization of plans, but I know you made some changes. So should we see further improvements in the first quarter? Or will that come perhaps later in the year? Just trying to make sure we get everything straight from our modeling standpoint.

Thanks.

Rob Finizio -- Chief Executive Officer

So I'll turn it over to Dawn and Mitch. But the co-pay card and the up -- the increase in the cash pay price was an immediate impact. The next piece that you would see unfold during the year would be the high-deductible plans and things meeting their goals and more insurance coverage kicking in. So I don't -- I would expect it to continue throughout the year.

OK, Mitch, anything you want to add?

Mitch Krassan -- Chief Strategy & Performance Officer -- Analyst

I would. When looking at that, I would really look at quarter over quarter. So first quarter of 2021 versus first quarter of 2020. And from that regard, typically, you see a decrease in the cost of net revenue.

And we may see one this year, but we don't think the impact will be significant given the changes we made with insurance and co-pay card.

Rob Finizio -- Chief Executive Officer

So pretty positive.

Douglas Tsao -- H.C. Wainwright -- Analyst

Great. Thank you.

Operator

Our next question comes from Dana Flanders with Guggenheim Partners.

Devin Geiman -- Guggenheim Partners -- Analyst

Hi, this is Devin on for Dana Flanders. I just had two quick questions. One was just regarding the new preferred PBM position for ANNOVERA and IMVEXXY. Just wondering how, I guess, share gains are tracking.

I know it's early in the year, but you guys have guided to about 10% to 20% share gains back in January. So just seeing if you would still expect that to be a tailwind into 2021? And then, I just have an additional follow-up.

Rob Finizio -- Chief Executive Officer

Yeah, we absolutely do. I'll turn it over to Dawn. So far, it's early to track that, but we are, as we showed in the slides, ahead of pace. So when we raised the cash pay from $50 to $75, we expected a fall off, as we said back at JPM, through February and then to return in March back to growth.

That fall off kind of stopped at the end of January, and we've kind of returned to growth about two or three weeks sooner than we thought. So we -- that is trending well. We expect that to accelerate with that contract throughout the year for sure. We feel good about that.

Dawn Halkuff -- Chief Commercial Officer

Yes, hi, Devin. And the only thing to add is that, as Rob said, it's early, what we would expect to see or gain more in the second quarter and forward. But as Rob said, given that we're not seeing as much of an impact from -- especially with IMVEXXY with the co-pay change, we're confident that some of that is because of the preferred coverage at PBM.

Rob Finizio -- Chief Executive Officer

Yes. Well said.

Devin Geiman -- Guggenheim Partners -- Analyst

OK, great. And I just had one additional one. I know there's been, I guess, more recent launch of NuvaRing Generic at the latter half of 2021. And I know there's also a new generic launch of Xulane.

Just seeing how you guys expect that to kind of impact switches for ANNOVERA in 2021?

Rob Finizio -- Chief Executive Officer

Yes. So as you can see on Slide 21, that if you see -- if you ask the physicians, two-thirds of the scripts aren't coming from NuvaRing. And if you go to the patients, about 40%, 44% are coming from NuvaRing. So we're just not seeing the impact.

What really -- what ANNOVERA was developed to be was not NuvaRing 2.0. What the population council wanted was a long-acting product that was procedure-free, that lasts for a full year. And that's been something for women that didn't want or couldn't have IUDs or implants, a lot like Dawn mentioned, ColoGuard, right? They removed the procedure aspect of colon cancer screening, and it worked very, very well. Well, ANNOVERA does the same thing for IUDs and implants.

It removes the need for a procedure. And we are seeing that in the data. So as much supply that comes out there as we need, I think you'll see the NuvaRing contribution, our previously ring users contribution, to our overall revenue shrink, not grow. I think you'll see other sources continue to grow because what we're finding is the way we're positioning it, the way that doctors see the void in the market and the void in the market that we are currently filling, and that's where all of this web interest and web traffic come from with women that we've been impressed by is truly that long-acting, procedure-free, which the Pop Council developed it to be.

So I don't think supply, to answer your question, of NuvaRing is going to impact ANNOVERA's trajectory at all. There is always going to be a subset of ring users. We have that in the long run, probably 33% to 24% of the overall, whether you're looking at their market share or our ultimate market share. So we expect these numbers of NuvaRing users to go down, then up, and we'll continue to track them, OK?

Devin Geiman -- Guggenheim Partners -- Analyst

Great. Thank you very much.

Rob Finizio -- Chief Executive Officer

You for it. Thanks for the questions.

Operator

And I'm not showing any further questions at this time. I would like to turn the call back to Rob for any closing remarks.

Rob Finizio -- Chief Executive Officer

Thank you, everybody, for joining the call today. I'm really excited about how we're positioned for the future with the revenue covenants, the strength in the balance sheet. Our progress, the vitaCare situation moving forward and progressing. So thank you all.

We'll see you all next quarter, and thank you for your interest.

Operator

[Operator signoff]

Duration: 37 minutes

Call participants:

Nichol Ochsner -- Vice President, Investor Relations

Rob Finizio -- Chief Executive Officer

James D'Arecca -- Chief Financial Officer

Dawn Halkuff -- Chief Commercial Officer

Louise Chen -- Cantor Fitzgerald -- Analyst

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Douglas Tsao -- H.C. Wainwright -- Analyst

Mitch Krassan -- Chief Strategy & Performance Officer -- Analyst

Devin Geiman -- Guggenheim Partners -- Analyst

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