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Biodelivery Sciences International Inc (BDSI) Q1 2021 Earnings Call Transcript

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BDSI earnings call for the period ending March 31, 2021.

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Biodelivery Sciences International Inc (BDSI)
Q1 2021 Earnings Call
May 6, 2021, 8:30 a.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:

Operator

Greetings. Welcome to BioDelivery Sciences' First Quarter 2021 Earnings Call. [Operator Instructions]

I would now like to turn the conference over to Terry Coelho, Executive Vice President and Chief Financial Officer. Thank you. You may begin.

Terry Coelho -- Executive Vice President and Chief Financial Officer

Thank you and good morning, everyone. Welcome to our first quarter 2021 earnings conference call. Leading the call today is Jeff Bailey, 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.

Earlier today, BioDelivery Sciences issued a press release announcing its financial results for the first quarter of 2021. A copy of the release can be found on the Investor Relations page of the Company's website. Before we begin, I would like to remind everyone that certain statements may be made during this call which may contain forward-looking statements. Such forward-looking statements are based upon current expectations and there can be no assurances that the results contemplated in 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 6, 2021, and the Company assumes no obligation to update statements as circumstances change. An audio recording and broadcast replay for today's conference call will also be available online in the Investors section of the Company's website.

With that, I'd like to turn the call over to Jeff Bailey, our CEO. Jeff?

Jeffrey A. Bailey -- Chief Executive Officer

Thank you very much, Terry and welcome everyone to our Company's first quarter 2021 earnings call. I'm happy to report that our business remains healthy and well positioned as we manage through the pandemic, I would like to focus your attention on three main takeaways from today's call. The first key takeaway, our overall business remained solid in the first quarter with sales growing 7% including BELBUCA TRx volume growth of 8.9% year-over-year despite two challenges. A notable challenge, like other pharma companies are reporting, COVID is having a market impact in Q1 with patient visits being down across a number of therapeutic areas. This includes a long-acting opioid market that saw prescription volume decline of 5.8% compared to Q4.

Furthermore, we saw one-time disruptions to our business from the February winter storm, Uri. The storm had both regional and national impact. Recently in the South Central area where we have a strong presence, pharmacies and physician offices were closed for multiple days. More specific to BDSI, we encountered national impact as our Tennessee distribution facility was not able to ship product due to the storm for approximately two weeks. We mentioned these headwinds previously in our Q4 2020 earnings call. Despite these challenges, our businesses performed well. With weather-related issues behind us, it's been encouraging to see an increase in sales representatives face-to-face calls with healthcare providers or HCPs, as well as stronger prescription trends.

We're also seeing the highest weekly NBRx market shares on a year-to-date basis in April, along with an all-time record high TRx market share in our most recent data week. Scott will cover this in more detail. These trends give us confidence in our growth going forward. Additionally, we know that much of our loss revenue in Q1 was due to a weather related disruption to prescription fulfillment rather than decreased customer demand.

The second key takeaway, our product portfolio remained strong and profitable as we continued to build our balance sheet ending the quarter with approximately $116 million in cash. In the first quarter, we generated $9.2 million in EBITDA with an attractive 22% EBITDA margin. This was accompanied by approximately $11 million of operating cash flow generation which enables us to invest in our brands, while positioning us well to maximize shareholder value through a thoughtful business development at the appropriate time.

The third key takeaway, we remain confident about our growth in 2021 as we see three important developments going forward. First patients are returning to physician offices at a higher rate and weekly shares in April are all time highs. Second, we are seeing increasing face-to-face interactions by our sales representatives with HCPs as offices are reopening access, which is critical to promoting clearly differentiated products like BELBUCA and Symproic. Third and most importantly, we are reiterating the financial guidance we issued last quarter. We are still on track to achieve full year total revenues of $170 million to $180 million including BELBUCA net sales of $155 million to $165 million, and $40 million to $50 million of EBITDA.

I also want to share one additional update about our business. Our three-day bench trial with Alvogen related to their Paragraph IV Patent challenge concluded on March 3. Post-trial briefs in the parties are due to the courts by mid May. We have a strong patent position while we remain very confident in the strength of our IP. We can neither predict the decision the court will reach nor the timing of the court's decision. As you would expect, we are not be able to comment further regarding the ongoing litigation.

With that, I will turn the call over to Scott to provide more details of our performance during the first quarter. Scott.

Scott Plesha -- President and Chief Commercial Officer

Thank you, Jeff. As Jeff mentioned, during Q1, BELBUCA prescriptions grew by 9,200 year-over-year to over 112,700, retail, mail order and long-term care TRxs combined. This represents a solid 8.9% increase in BELBUCA TRxs compared to the first quarter of 2020 and a slight sequential decline of 5.1% compared to the fourth quarter of 2020. The year-over-year growth from Q1 2020 was meaningful due to the challenging comparison to a pre-COVID market in January and February of 2020, and then an elevated level of prescriptions in March 2020 when patients could stock up on their medications as stay-at-home orders were implemented.

BELBUCA scripts grew year-over-year despite the impact of the pandemic, a continued decline in the overall long-acting opioid market and the negative headwinds from winter storm Uri, as Jeff described. Given the confluence of events this quarter, we were pleased with BELBUCA's continued revenue and script growth and a stable Q1 TRx market share of 4.5%.

During the first quarter, BELBUCA's new-to-brand market share of 6.7% declined by 1.1% from 7.8% in the fourth quarter, but remained significantly above its TRx share of 4.5%, which means there is still a meaningful opportunity to grow total prescription share as these metrics have historically converged. NBRx accounts and share in the first quarter were adversely impacted by HCP office and pharmacy closures in high market share areas for us as well as pharmacy level fulfillment failures related to winter storm Uri and the disruption at our Tennessee distribution facility. We know that there were over 4,000 pharmacy orders that weren't fulfilled for these reasons in February and early March, and also believe there was a downstream effect that others did not get refilled a month later.

During this time of disruption, BELBUCA's NBRx market share fell to as low as 5.7%, but has subsequently improved to 7.5% during the past 4 weeks ending April 23. We also saw our TRx share reach a record 4.7% with our most recent data. Our commercial team quickly pivoted to increased geographic targeting efforts using both in person and digital tactics into the affected areas. Moreover, our sales representatives continue to implement the national rollout of our First Start NBRx program, which continues to meet or exceed our expectations.

For those HCPs participating in the program, we have seen a 32% lift in NBRxs, while TRxs have improved by 16%. First Start allows healthcare providers to easily prescribe BELBUCA to appropriate commercial patients for the first time by providing convenient access to BELBUCA while HCP's staff is securing prior authorization approval. We believe that this program can continue to generate incremental growth in 2021.

We are pleased to report that BELBUCA's prescriber base increased in the first quarter by 6% year-over-year. As mentioned, the winter storm impacted some of our most productive regional territories. Sequentially, our prescriber base remains stable, largely due to the impact of these territories, which represent approximately 21% of BELBUCA volume.

Our market access with BELBUCA has improved greatly over time and has been important to our success. BELBUCA currently enjoys strong commercial coverage with over 90% of lives covered, of which 60% are covered at a preferred level. While in Medicare, BELBUCA is covered in 33% of lives. We believe our current level of coverage provides a significant opportunity for growth, which is supported by our consistent year-over-year TRx growth across all payer types. We continue to be committed to improving access to BELBUCA while balancing payer coverage and rebate levels, especially in Medicare.

Symproic Q1 prescriptions dipped to approximately 16,800, remaining flat year-over-year compared to Q1 2020, with a 10% sequential decline from Q4 2020. The PAMORA market is historically weaker in the first quarter of each year, which is more apparent in Symproic's trends due to its growth since we acquired the brand in mid-2019. The decline was magnified by the negative impact of winter storm Uri and the disruptions to our distribution center in February. We are encouraged to see Symproic's March TRx count increase by over 1,000 prescriptions or close to 21% from February. We expect renewed growth in revenues and total prescriptions for Symproic as its new Rx share has consistently exceeded total Rx share since May 2019 when BDSI began active promotion.

Like BELBUCA, Symproic is well-positioned with covered status for 89% of commercial lives with 60% of preferred status. We believe our early 2020 market access wins with Prime Therapeutics and CVS will drive additional growth for the remainder of 2021. The BDSI sales force has done an outstanding job pulling through these wins. We expect to reach new TRx count and share highs throughout the year.

The commercial team took a proactive approach to overcoming the challenges we faced in Q1. This included precision targeting of specific geographies with increased and enhanced digital marketing with areas that were most impacted by winter storm Uri as well as the launch of new programs to interact with potential patients via social media. It was encouraging to see increased face-to-face interactions our sales team had with healthcare providers in Q1, which reached their highest levels in over a year and approximately 15% below pre-COVID levels.

We believe that our sales representatives' ability to interact with our customers is essential to having robust growth, and our recent increase in face-to-face interactions will have a positive impact for the remainder of 2021. Our resourceful and effective commercial organization has now been tested through both the pandemic and seasonal disruptions that impacted our business. The team continues to demonstrate significant resilience while driving growth and results for our brands. I could not be prouder of our team. With more individuals being vaccinated, we are optimistic that most physician offices will return to previous access levels in the near future. We believe this is essential to driving the growth of our portfolio. We are extremely committed to building upon our history of successful sales performance and growth and look forward to demonstrating this during the remainder of 2021.

With that, I'll turn the call over to Terry to provide an update on the financials. Terry?

Terry Coelho -- Executive Vice President and Chief Financial Officer

Thank you, Scott. Total net revenue for the first quarter was $41 million, an increase of 7% compared to $38.3 million in the first quarter of 2020 and a decrease of 3% compared to $42.2 million in Q4 2020. Revenue from continuing operations, including sales of BELBUCA and Symproic as well as royalty revenue grew sequentially 3% quarter-over-quarter. As a reminder, BUNAVAIL, which was discontinued in 2020, recorded net revenue of $2.4 million in the fourth quarter of 2020 resulting from the release of certain sales returns reserves.

BELBUCA net sales in the first quarter of 2021 were $36.4 million, an increase of 9% compared to $33.5 million in the first quarter of 2020, and an increase of $800,000 or 2% compared to $35.6 million in the fourth quarter of 2020. BELBUCA gross to net deductions improved in the first quarter as compared to the fourth quarter of 2020, as anticipated, primarily due to typical decreases seen for Medicare coverage gap as well as lower Medicaid deductions.

Net sales for Symproic in the first quarter of 2021 were $4.4 million, which reflects 5% growth year-over-year and 20% sequential growth compared to the fourth quarter of 2020. Symproic gross to net deductions improved in the first quarter due to the typical decreases seen for Medicare coverage gap as well as updates to our gross to net channel estimates.

Total gross margin for the first quarter was 86%, in line with the first quarter of 2020 and above the 80% margin during the fourth quarter of 2020. Total operating expenses in the first quarter of 2021 were $27.8 million compared to $26.7 million in Q1 2020 and $21.4 million in Q4 2020. As expected, the sequential increase in the first quarter is mainly attributed to planned marketing investments in our core brands, which are typically higher in the first half of the year as well as elevated legal fees of approximately $3 million in the quarter, primarily associated with the ongoing Paragraph IV litigation.

GAAP net income for the first quarter was $5.2 million or $0.05 per share in line with the GAAP net income in the first quarter of 2020, and below GAAP net income of $10.2 million or $0.10 per share in the fourth quarter of 2020. EBITDA in Q1 2021 was $9.2 million or 22% of net sales compared with $7.8 million or 20% of net sales in Q1 2020, and $14.3 million in the fourth quarter of 2020.

Non-GAAP net income for the first quarter was $8.5 million or $0.08 per share and reflects GAAP net income, excluding stock-based compensation and non-cash amortization of intangible assets, as compared to non-GAAP net income of $8.3 million or $0.08 per share in the first quarter of 2020, excluding the same items. In the fourth quarter of 2020, the Company reported non-GAAP net income of $13.7 million or $0.13 per share.

The Company has a strong balance sheet with cash and cash equivalents as of March 31, 2021 of $116.4 million as compared to $111.6 million at year end 2020. The operating cash flow generation of $11.1 million in the first quarter was partially offset by $6.1 million used to repurchase shares and $300,000 of fixed asset additions, resulting in a net increase in cash on hand of $4.8 million. Our share buyback program initiated in the fourth quarter of 2020, and we have repurchased approximately 1.6 million shares through Q1 2021 at an average price of $3.87. The $6.3 million in share repurchases to date represents 25% of the total authorized amount of $25 million. This reflects the continued confidence of the Board and the management team in the strength and value of our business. The Company will opportunistically utilize the share repurchase program, weighing the benefits of doing so with business development initiatives.

We are reiterating our full year 2021 guidance and continue to expect net sales in 2021 for BELBUCA in the range of $155 million to $165 million. And 2021 total Company net revenue in the range of $170 million to $180 million. As previously discussed, these estimates incorporate the impact in Q1 from the winter storms. We estimate our total operating expenses to be in the range of $115 million to $120 million in 2021 as we continue to invest behind the growth of our brands. And we expect EBITDA to be in the range of $40 million to $50 million in 2021. We anticipate remaining operating cash flow positive throughout the year.

I will now turn the call back to Jeff for some concluding remarks before we open up the call for Q&A. Jeff?

Jeffrey A. Bailey -- Chief Executive Officer

I want to take a moment to thank our employees who continue to perform strongly when faced with the ongoing challenges of the pandemic and the unprecedented weather-related conditions in some of our key regions in February. Despite these challenges, the team delivered solid results in the first quarter, and we expect to build upon the momentum we have experienced in the first few weeks of the second quarter.

Moreover, we are looking forward to increasing interaction between our sales force and healthcare providers for the balance of 2021, especially in-person, with products which make a difference in patient lives and a strong balance sheet to consider select business development opportunities. I believe BDSI is well-positioned to drive shareholder value.

We will now take your questions. Operator?

Questions and Answers:

Operator

[Operator Instructions] Our first question is from Brandon Folkes with Cantor Fitzgerald. Please proceed.

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Hi. Thanks for taking my questions and congratulations on the solid execution. Maybe just three from me, I guess. Maybe just firstly, I know I heard about the Alvogen update. But can you just remind us if there are any added challenges [Phonetic]? And should you be successful in Alvogen, anything else we should be watching? Secondly, how do you think about the urgency for business development in the current state? Obviously, you're buying back shares. The business is doing well. I think maybe wrapped in that, do you have any change in your thinking about investing in R&D? So would it still just be commercial stage assets you're looking at? Or would you look at earlier stage things? Thank you.

Jeffrey A. Bailey -- Chief Executive Officer

Hey, Brandon, it's Jeff. Hope you're doing well and thanks for the questions. First of all, just kind of a general just perspective on Alvogen. Again, not too much has changed. I think just to reiterate the fact that we had the three day bench trial that took place and concluded on March the 3rd related to the Paragraph IV patent challenge. While we remain very confident in the strength of our IP, we can't predict the position on the court nor the timing of the court's decision. Our hope is that the decision will be rendered earlier than later in the second half of the year, is our perspective. Post-trial briefs from the parties are due to the course by mid-May. And the decision from the court will be expected subsequent to the filing of those post-trial briefs. So I hope that gives you the perspective. That's what we know at this time. Not too much has changed, Brandon. So let me just pause there, and I'll cover what you needed on Alvogen.

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Yeah. And maybe just quickly, at this stage, would you say settlement completely off the table? We're just too far in? And then secondly, can you just remind me if there are other companies that also have challenged the patents at this stage? Thank you.

Jeffrey A. Bailey -- Chief Executive Officer

So if we take a look at -- on the settlement front, I can't really comment on that, but it's one where the settlement can always happen, as you know, through a process anytime. So it's one where that's the case there. So nothing to comment on relative to settlement. And the only other challenges out there was Chemo coming from a different perspective, but that's it on the legal front.

And then on to urgency of business development. I guess, maybe taking it just a little bit more abroad as far as -- yeah, to date, what we're doing with business development has been -- we've been completing thorough diligence, very important cross-functional, really good process and collaboration as far as making sure we're looking at all the things that could make sense to us from a business development standpoint. So I'm really pleased to report that this is something that an awful lot of work's going into, regular venues every week and making sure we're keeping our finger on the pulse when it comes to business development and playing through this.

As you'd expect at this point, we make sure we have really discerning taste here with the way that we're focusing on some things that we've rejected quite a few assets at this point, and we continue to assess a number of what we find to be interesting assets at this point. And when you take a look at just from a strategy standpoint on that front, that's one where it's really -- we have a tremendous commercial infrastructure. And of course, we would aim to leverage that and play that through all the way. When you talk about -- so just to say, look at -- really good process and really good intense effort as far as looking at all the BD opportunities.

On the urgency front, it's one where it's really about -- from a timing standpoint, it's about the right deal at the right time that really brings shareholder value. We're going to maximize shareholder value. There are some things that really do potentially make sense as far as -- based on the backbone of our company with the commercial footprint and making sure that all the right things are being focused in on there. But we're going to make sure we continue to show that this is a really thoughtful and judicious process evaluating the opportunities. And again, just bringing back the shareholder value.

So from a timing standpoint, yeah you're right, we've been doing the buyback, which could be configured in different deal constructs and things like that. It would be helpful on that end, of course, if we decided to go that way. But from a timing standpoint, it's one where it's the right deal at the right time. And so I just want to make sure that -- assure you also that this is something that's front and center for the company, top priority as far as the work that's going on. And a lot of good work has been going on, on that end. So let me just pause there before I get to your R&D question, Brandon.

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Yes. You answered my -- that question.

Jeffrey A. Bailey -- Chief Executive Officer

Excellent. All right. And then on the R&D front, it's something where it continues to be very much the mindset that we're a company that really -- our -- later day -- excuse me, later stage, our product, something more like a Phase III type of product are currently commercialized, that's kind of our sweet spot based on the company. So as far as anything early stage, Brandon, that's not something that's at the top of the list, it -- we went out completely, but we're not a deep R&D organization.

So I think that's just important to point out. And so nothing has really changed that perspective, what we shared in the past on that. But just one where really one's looking for the right asset that really fits the perspective that I described before.

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Great, thanks so much. I appreciate the comprehensive answers.

Jeffrey A. Bailey -- Chief Executive Officer

All right, Brandon. Thank you.

Operator

Our next question is from Gregg Gilbert with Truist. Please proceed.

Gregg Gilbert -- Truist -- Analyst

Good morning. I have a couple, a few. Scott, first with you. It looks like we're seeing a slowdown in the decline rate for long-acting opioids overall. Do you think that's a real trend? Or is it premature to call it, given the sort of weird comps in the markets over the past year?

Scott Plesha -- President and Chief Commercial Officer

Gregg, I appreciate the question. Yes, we actually felt last year it would have slowed down and starting to flat, and we had modeled that actually. We had started to see, for example, even the NBRxs were really stabilized, which tend to drive some of the TRxs. And it does appear that the market's come back. If you look at how it performed early in Q1, I think it was in our initial comments, but there was quite a falloff. And now we've seen a bounce back in March and April.

One of the things we think that drove that was patient visits. When you look at IQVIA data around patient visits, there was a sharp decline in early 2021, actually below -- probably below any other time period since COVID hit as far as face-to-face visits. So we're starting to see that kind of dampen and then come back a little bit. So yes, we do believe it's the rest of the year, we should start seeing face-to-face visits increase. And also as we -- as far as us individually as we're able to get in front of more doctors with the right reach and frequency, we should see script trends start turning around as well.

Gregg Gilbert -- Truist -- Analyst

Have there been any access wins or changes of note for your portfolio since the last quarter?

Scott Plesha -- President and Chief Commercial Officer

No, nothing substantial or meaningful to report at this time. Still ongoing conversations as always.

Gregg Gilbert -- Truist -- Analyst

Got it. And then maybe for Jeff and Terry. On capital allocation, the stock's well below where you had been buying it. Is it a no-brainer to keep buying it at these levels? Or is it more important to keep powder dry to sort of diversify the portfolio? And is that realistic in light of legal uncertainty, right? Is that uncertainty -- does that uncertainty prevent you from even transacting if you wanted to right now? That's a multi-part capital allocation question. So what are your thoughts?

Terry Coelho -- Executive Vice President and Chief Financial Officer

Yes. Gregg, thanks for that. Yes, it's an important question and one that I and Jeff spent a lot of time, and it's really important for us to be considering and weighing those -- exactly the variables that you're talking about. In terms of the share buyback, as you might imagine, when we're in quiet periods, we -- the only way that buying can happen is through kind of a 10b5 plan. So I think you'll be able to see whether it's continued or not. But we are weighing it with the business development.

And we want to make sure that we can balance it. I do feel pretty confident that given, I guess, the credibility that I feel we've established in our performance over the last couple of years that we'll have access to the financial markets under a variety of scenarios, if and when the time is right. So we are looking at that. I think the -- while the trial is certainly something that's out there, that wouldn't preclude us from being able to proceed on certain types of transactions before then.

Gregg Gilbert -- Truist -- Analyst

And maybe I could just wrap up with a legal question for Jeff since I know you like talking about litigation predicting outcomes so much, but perhaps I'll ask you in a more helpful factual way. So if you go to the MAT and get a decision and win against the first challenger, for example. Can you help us understand to what degree that affects the odds or does not as it relates to the Chemo challenge, just so people understand the relevance of Decision 1 and how it could affect eventual Decision 2, should you play it all out?

Jeffrey A. Bailey -- Chief Executive Officer

Yes. Thanks, Gregg, for the question. Yes, chemo elected not to contest the validity of the patents at the March trial with Alvogen. Instead what Chemo did was they agreed to be bound by the court's decision from the Alvogen trial concerning the validity of the three orange patents. On the Chemo front, there's this stuff we just don't know, as you may have picked up on that. The FDA has not reported, Chemo is having a tenant of approval for its generic pupil film products. So that's what we have to report at this point as far as the perspective on both trials.

Gregg Gilbert -- Truist -- Analyst

Thanks a lot. Appreciate it folks.

Jeffrey A. Bailey -- Chief Executive Officer

Okay, great. Thank you.

Operator

Our next question is from David Amsellem with Piper Sandler. Please proceed.

Zach Sachar -- Piper Sandler -- Analyst

Hey everyone. This is Zach on for David. Thanks for taking my questions. Apologies if I missed some of this color, but I was just hoping you get a little bit more insight into the pace of recovery for BELBUCA as '21 progresses in normalization? So I guess, in other words, just to what extent will it return to physicians' offices, impact prescriptions, in your view, given that BELBUCA generally has been fairly resilient? Thanks.

Jeffrey A. Bailey -- Chief Executive Officer

Scott, do you want to go first? And maybe I'll follow up as well, but please go ahead, Scott.

Scott Plesha -- President and Chief Commercial Officer

Yes. Yes. Thanks, Zack. I appreciate it. So I kind of mentioned earlier that the face-to-face visits, which we view as critical. So patients actually going into offices because a lot of times in the opioid space, they will not make a change unless they see the patient. So that could be either adding our product to it or switching. So again, early in the quarter, we saw a decline in face-to-face visits, actually the pain space and rheumatology, when you look at the data are pretty aligned, but they're probably the ones that were hit the hardest early in 2021. That's going to stabilize now. It's coming back. And again, it was probably 10 points less visits than there were as we exited 2020.

So I think we're encouraged that we'll see that go back. Obviously, a lot of things are opening up here in the United States now, and we do feel that, that's going to be a key trend for us. The thing I think we're encouraged by, though, is our actual ability to get in front of HCPs and have a meaningful conversation. So when we look at our data, we opened up our sales force last July, and we saw a steady increase in the ability to have face-to-face interactions with our HCPs. And that kind of peaked in October, then we hit the holiday period, January -- November, December, January, and then February is a short month. We also had some weather in there and a national sales meeting.

So it kind of dropped down again. But then March, we reached kind of an all-time high for the amount of time we've been in front of HCPs really since pre-COVID. And that was a 25% jump over October even. So we're already starting to see in our numbers now where, in recent weeks, our share is up to 4.7%. We did 4.5% in Q4. The NBRx shares also rebounded, 7.5% in the last four weeks. So we're already starting to see that recovery and even more granular as we look at some of our pharmacy demand that isn't publicly available. We can start to see some trends coming back there as well. And so we're very encouraged and feel like the rest of the year, we can get back to some more of our historical growth rates.

Jeffrey A. Bailey -- Chief Executive Officer

Zack, if I could just go ahead and build on Scott's comment there that I think is really important, your question is a really important from the standpoint of -- look, the overall market dynamic we have here is that we're really the only a Schedule II that's actively promoting in the market. And it's one where that's just a great situation for us. Then in pandemic, as you can imagine, with face-to-face being down, that's something that's in this market, with this market dynamic is one where we really have our bet placed on our sales force, that -- those face-to-face interactions mean everything to us. And one thing that doesn't change about this business is one where the fundamentals of this business, which is the right doctor, the right prescriber, the right message, the right frequency -- right doctor, right message, right frequency. That doesn't change. And so that frequency has been missing during the pandemic and also the storms didn't help in the first quarter as well.

So similar to what's the message by some other pharma companies, but it's also one where look as we're hoping that things were coming out of the pandemic here that we're seeing a trend now that patients may be getting back in the offices or we looked at the IQVIA data that Scott was referencing before, and that was one where -- that's very helpful to see that there's a trend back with patients getting back in the office. But also, we're seeing our face-to-face call activity going up in March and into April here. That's huge to us, especially the attributes. We have two clearly differentiated products with BELBUCA and Symproic. And it's so important that our reps get that face-to-face time with prescribers. It makes a big difference.

So we want to really make sure that we're seeing this through all the way. It's an important part of the way that we view the world. So it's one where we want to make sure. So I would also -- I think I misspoke that we're Schedule III. By -- actually, I said Schedule II earlier. So I just want to reiterate that, that market dynamic that we are the only Schedule III promoting in the marketplace. I want to make sure that it's known that it's for the only Schedule III pain product out there. And that's a great dynamic for us, but getting back to face-to-face is huge to us.

Zach Sachar -- Piper Sandler -- Analyst

Great. No, that's very helpful. And then if I could squeeze one more in Symproic, too. Just looking at prescription data, it seems like share has sort of stayed relatively stable over the past year or so. So anything you're doing there to sort of change the trajectory of the asset over time?

Scott Plesha -- President and Chief Commercial Officer

Yes, Zack, I appreciate that. So we -- when you look year-over-year, it was flat, but we actually had quite a bit of growth throughout 2020. Early this first quarter, we actually had a negative impact within a couple of plans that we grew the most in. What I mean by that is we grew our share significantly last year, grew our business there. Actually, we're approaching 50% for example in Prime Therapeutics. But what happens every year and that plan is the business just -- Q1 is really soft. So for example, last year, there's a 23% drop in business, this year, it was 21% in that plan. And then it comes back throughout the year.

So because we've grown our business there so much in the last year, it had a negative impact on our overall share. But the good news is within that plan, and CVS, for example, our two wins last year, you see similar dynamics. They usually are kind of at the low point in Q1 and then build throughout the year with Q4 being their highest TRx count. So actually, we feel pretty confident we can grow share and keep growing it. We have pulsed in different digital marketing that we hadn't done before with Symproic in recent months. So we believe that we'll get back on track here shortly. Part of it was some market dynamics and payer dynamics that we typically see in this space.

Zach Sachar -- Piper Sandler -- Analyst

Okay, great, thanks so much.

Scott Plesha -- President and Chief Commercial Officer

Thanks Zack.

Operator

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

Scott Henry -- ROTH Capital -- Analyst

Thank you, and good morning. Just a couple of questions. The first one, when I look at reported revenues and total prescriptions for the quarter, obviously, you can back out revenue per script. And the past couple of years, we've seen revenue per script, very strong in Q1 and then perhaps coming off that a little bit the rest of the year, which -- somewhat counterintuitive, I would expect revenue per script to be lower in Q1 because of the resets. I guess the question is, do you expect that trend to continue this year where revenue per script is highest in the first quarter. And as well, why do you think we're seeing that trend?

Terry Coelho -- Executive Vice President and Chief Financial Officer

Yes. Maybe I'll jump in first, Scott. So actually, it is what we would expect. We typically see the coverage gaps, those have -- Medicare coverage gap does have an impact for us. And it is quite low in the first quarter, and it does increase as the year goes on as people start to hit their deductibles and so on. So in fact, it is a trend that I would expect the gross to nets should increase as the year proceeds.

Scott Henry -- ROTH Capital -- Analyst

Okay. So you would expect revenue per script, not gross to net, to decline sequentially quarterly through the year? Just want to make sure I understand that correct?

Terry Coelho -- Executive Vice President and Chief Financial Officer

Yes. Exactly. All other things being equal. There's no other movement, but yes.

Scott Plesha -- President and Chief Commercial Officer

Scott, the only other movement that kind of counters out a little bit, it doesn't easily outweigh it is just the blend of strength and some stuff over time, sometime. And as patients -- we see our higher strength as being a bigger percentage of our scripts. So -- But it's pretty flat on the gross to net side of things.

Scott Henry -- ROTH Capital -- Analyst

Okay. Excellent. And were there any price increases in the quarter?

Terry Coelho -- Executive Vice President and Chief Financial Officer

Yes. We took...

Scott Plesha -- President and Chief Commercial Officer

Yes. Go ahead, Terry.

Terry Coelho -- Executive Vice President and Chief Financial Officer

Well, we took a price increase January 1.

Scott Henry -- ROTH Capital -- Analyst

Okay. And what amount?

Terry Coelho -- Executive Vice President and Chief Financial Officer

5%.

Scott Henry -- ROTH Capital -- Analyst

Okay. And then just a final question for Terry. Legal fees of about $3 million in the first quarter. Should we expect a similar number in second quarter or higher or lower? And then should we -- assuming we get a conclusion, should we expect that to decline in the second half of the year?

Terry Coelho -- Executive Vice President and Chief Financial Officer

Yes. So the $3 million was the increase over the prior quarter, just to clarify that comment. And I wouldn't expect it to continue to increase by any means. We have, as we shared before, submitted the -- or the briefs are being submitted as we speak. And hopefully, the cost would taper down as the year goes on.

Scott Henry -- ROTH Capital -- Analyst

Okay, great. Thank you for taking the questions.

Terry Coelho -- Executive Vice President and Chief Financial Officer

Yeah thank you.

Scott Plesha -- President and Chief Commercial Officer

Thanks Scott.

Operator

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

Lachlan Hanbury-Brown -- William Blair -- Analyst

Hey, this is Lachlan on for Tim. Thanks for taking the questions. So I was wondering in terms of the new start program, the impact of the weather this year obviously showed that you've got a pretty good business concentration in some regions of the country. So is the new start program looking, I guess, is that focused on the regions where you already have a strong presence? Or are you trying to use that to kind of diversify geographically or can you talk about a little bit...

Terry Coelho -- Executive Vice President and Chief Financial Officer

Lachlan, it's a little bit hard to hear you. You were cutting out. But I think that was a question for Scott that was about the first start program and whether we are selectively using it in regions and so on, is that right?

Lachlan Hanbury-Brown -- William Blair -- Analyst

Yes. Yes. It is.

Scott Plesha -- President and Chief Commercial Officer

I think I picked up most of it. So Lachlan, what I would say, so that the NBRx First Start program, we actually went on a national level. We had piloted in the middle of last year and then went completely national, kind of mid-Q4, October, early November. So we're encouraged, again, we've seen a 32% lift in the HCPs that are participating in NBRxs and then a 16% in TRxs. I think one of the things, though, might answer to your question is we've -- one of the important things our marketing team has done over, let's say, the last 1.5 years and really dialed it in the last 6 months to a year, is on the digital side, we've built infrastructure now that if we see a weather event or there's issues -- issues in certain areas where we see a share drop or business drop, we can actually pulse in -- the system actually almost does it automatically, pulses in additional digital marketing and kind of an increased communication with HCPs and potential patients in those areas. So hopefully, that's helpful to you.

Lachlan Hanbury-Brown -- William Blair -- Analyst

Yes. Definitely. A question...

Scott Plesha -- President and Chief Commercial Officer

I'm sorry, we can't hear you.

Jeffrey A. Bailey -- Chief Executive Officer

Sorry, Lachlan. Thank you for the question.

Operator

[Operator Instructions] Our next question is from Tim Chiang with Northland Securities. Please proceed.

Tim Chiang -- Northland Securities -- Analyst

Hi thanks. Scott, I had a question for you on sort of how marketing for BELBUCA and Symproic will change once we get to the other side of this pandemic. I had heard anecdotally from some physicians like in the state of Florida, for instance, that during the pandemic, it was that a lot easier to actually prescribe opioids because patients couldn't come into the doctor's office. The state of Florida, basically -- they basically changed the rules so that they could get opioids without -- the patients could actually get the opioids. And I'm sort of wondering, when those state rules revert back, will BELBUCA benefit largely because it's a Schedule III product? I just wanted to get your thoughts on that.

Scott Plesha -- President and Chief Commercial Officer

I appreciate the question. Yes, they did change some of the regulations around how they can be prescribed and lighten them up somewhat for patients, again, to increase access because it could be more difficult during this time. And honestly, we -- I mean, it's always been fairly easy to prescribe or convenience to prescribe BELBUCA. As a reminder, you can write refills for it. You've always been able to call it in, things like that.

So for us, that won't change. I'm not sure how long they're going to -- those regulations will persist though, Tim. We really haven't heard any -- about any changes upcoming or reverting back to anything anytime soon. So we really haven't modeled anything around that. I think anything that differentiates us is helpful, I think, going forward.

Tim Chiang -- Northland Securities -- Analyst

Okay, thanks for the commentary. And Jeff, obviously, you're waiting for this decision on the legal front. Is there any way to sort of handicap or sort of put bookends on what the impact of -- yes, let's just say, I mean in a worst-case scenario, you get a negative decision. I mean, have you already started to prepare for -- or do you have a contingency plan set up in that scenario? And even if it is a negative decision, I would imagine you would appeal it. I just wanted to get your thoughts on that.

Jeffrey A. Bailey -- Chief Executive Officer

Yes. Tim, so just to reiterate that we feel strongly about our case that we've laid out there. And just like any good leadership team and our responsibility to really be great stewards of the business. You think about things from all different angles. So we think about it from all different angles. But just to reiterate that we feel strongly about our case and where that stands. So this -- the whole answer is probably is just one where the dislike -- you always look at for whatever the topic is within our world as far as making sure we're ready for all different types of scenarios that would play through.

So -- but I just want to assure you that we're on top of our game looking at all different sorts of BD options that fit under different scenarios and everything like that. So I'm hoping that answer your question, Tim.

Tim Chiang -- Northland Securities -- Analyst

Yes. No, that helps. And obviously, you guys are in a pretty good financial position, right? So you -- I guess you're going to wait for the court decision, obviously, before you make any sort of BD decisions. Is that sort of how you guys are thinking about it?

Jeffrey A. Bailey -- Chief Executive Officer

Naturally, Tim, there's a link between outcome trial in certain BD approaches, but not all. So it's one where probably you'll read between the lines there that's how granular we are as far as when it comes to our BD work and the way that we're thinking about the world on that end. So it's -- there's a number of different approaches that feed through. But there is a link with certain BD approaches, but not all BD approaches tied to the trial.

Tim Chiang -- Northland Securities -- Analyst

Okay, great. Thanks so much.

Jeffrey A. Bailey -- Chief Executive Officer

Thank you, Tim.

Scott Plesha -- President and Chief Commercial Officer

Thank you, Tim.

Operator

We have reached the end of our question-and-answer session. I would like to turn the conference back over to management for closing remarks.

Jeffrey A. Bailey -- Chief Executive Officer

Thank you, Sherry. As far as -- just to reiterate, as far as -- we're really proud of the effort of our team, our employees here in the first quarter with some of the dynamics of the first quarter, but really a business on solid footing. Really -- we're very fortunate. We have differentiated products that play out in the marketplace. And you can tell from our look forward, we're feeling really good about just our guidance and the world that's in front of us. But it comes back to just really good operational excellence and executing day in and day out. And really, that's the mantra of our team and our focus really to execute really well, to really deliver here in 2021. And so at that point, very much want to thank everybody for participating today, and look forward to speaking to you soon.

Operator

[Operator Closing Remarks]

Duration: 50 minutes

Call participants:

Terry Coelho -- Executive Vice President and Chief Financial Officer

Jeffrey A. Bailey -- Chief Executive Officer

Scott Plesha -- President and Chief Commercial Officer

Brandon Folkes -- Cantor Fitzgerald -- Analyst

Gregg Gilbert -- Truist -- Analyst

Zach Sachar -- Piper Sandler -- Analyst

Scott Henry -- ROTH Capital -- Analyst

Lachlan Hanbury-Brown -- William Blair -- Analyst

Tim Chiang -- Northland Securities -- Analyst

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