Shield Therapeutics (LSE:STX) — Full year trading update

0:00 Good afternoon, and welcome to the SHIELD THERAPEUTICS PLC investor presentation. Throughout this recorded presentation, investors will be in listen only mode. Questions are encouraged and can be submitted at any time by the q and a tab situated on the right hand corner of your screen. Simply type in your questions and press send. The company may not be in a position to answer every question it receives during the meeting itself. However, the company can review all questions submitted today and publish responses where it's appropriate to do so. Before we begin, I'd like to submit the following poll. And now I'd I'd now like to hand you over to Anders Lundstrom, CEO.

0:31 Good afternoon, sir. Good afternoon, and good morning, depending on where you are. Welcome to the quarter four and full year twenty twenty four trading update for SHIELD THERAPEUTICS. I'll start, and then Santos Schrambach will continue. Our CFO will continue after a little bit. So this is the disclaimer. So so SHIELD THERAPEUTICS, we have a product called AccraFer in The US or Feracru in in Europe, and it's it's, indicated and approved for treating oral iron, deficiency with or without anemia. And And it's a very broad indication, so it doesn't matter what the person or patient's underlying condition, is is leading to the, iron deficiency.

1:18 The US market is a very big market as we will show you in a little bit, and and that's why we also chosen to commercialize on our own together with a partner, Viatris. We estimate The US to have a revenue potential for Aquifer. It could be up to $450,000,000 annually, and we have very, very strong IP through 2035. So this is our management team. We divide it up in two offices. So David and Jackie are in in Newcastle in The United Kingdom, and the rest of us are are just outside Boston, Massachusetts here in The US. So in in general, the management team, we have a very, very experienced management team who's a very, very experienced, especially when it comes to commercialization across across many different countries around the world.

2:06 So iron deficiency, as we also will show you in a little bit, is a is a very common and can be a very serious condition. So typical symptoms can include that you're very tired, you have headache, you're dizzy, and it can even lead to that the person or patient become cognitively impaired. And all of these symptoms kind of would, of course, impact the the person's or patient's quality of life. The prevalence is highest in women of childbearing age and in patients with different inflammatory conditions as you can see on the right side of this slide. And other causes could be malnutrition or malabsorption that could also, of course, lead to iron deficiency. So there is a problem, with most of the oral iron salts, because most the oral iron salts, are associated.

3:01 They break apart in the stomach. And the the the free iron can cause irritation or or damage to the intestinal lining of the stomach, and that leads to different gastrointestinal adverse events. So up to seventy percent of patient can can experience these adverse events, but they include they they could be they could feel swollen. They could be pain. They can feel sick. And that leads to that about fifty, sixty percent of these patients will discontinue their treatment. And, of course, if you discontinue the treatment, there's we there will be no effect to treat the the condition that should be treated for. So aquifer is different. It's different in the sense that we don't use a salt that is bound to the to the iron. We use multiple multiple sugar alcohol. What that does to the product is that it does not break apart. It doesn't dissociate in the stomach.

3:59 It breaks apart in the upper intestine. So thereby, we we avoid most of those gastrointestinal side effects I just mentioned on the previous slide. The other thing it does is we act we can actually also have a lower dose of iron because we have a better absorption as it is absorbed in the upper intestine. So this is what we could look at. This is the treatment algorithm for oral irons. So typically, most patients start on an oral iron salt. But as I said, quite a few of them over half fifty to sixty percent actually stop. That is where we come in. So we our as our product is much better tolerated and leads to very good can normalize the level and maintain the level of hemoglobin.

4:50 The patient can is this is the treatment the patient can take and stay on. And thereby avoiding that the person or patient would have to go and get an IV iron. We are continually expanding our global footprint. So in The US, we have a co commercialization collaboration with Viatris, and that has been in place. We have had a full sales team in place now about eighteen months. In Europe, where the product is called FerraCrew, it's Norgene who is in charge of the commercialization, and that was also for The UK. In Canada, it's CHI. CHI just got approval, and we expect to launch in Canada the first half year of of this year. In Korea, we we work with KP Pharma, and that, file is is currently being reviewed.

5:44 And, again, we we anticipate an an approval during this year. And in China, we work with a company called ASK, where we have fully recruited a bridging study needed to bridge between our phase three data in the Caucasian population and the and then they've done a similar study in the Chinese population. If that study is successful, we anticipate to file this year and and then the potential approval second half of twenty twenty six. And all these collaboration either come with this royalty or a milestone or royalties and milestones based on milestone based on sales or different regulatory events like a submission or an approval.

6:31 This is a picture describing The US iron deficiency market. It's a it's a very big market, and I walk you through this. What we call the addressable market is the total market. So it's about 12,000,000 prescriptions every year prescribed by over half a million healthcare professionals. We target what is here called the target market, which is about half of the total market with 6,000,000 prescriptions. This part of the market, we address with digital marketing efforts. We do it to the health care professionals. We did that last year. We continue to do this this year as well. What's new this year, we will also do digital marketing efforts through different channels and initiatives also to patients this year. So we will address about one point two million patients

7:23 that we know have tried an oral iron and have gastrointestinal side effects. That is how precise you can be these days. We also know that about seventy two percent of all prescriptions are written by primary care physicians and about twelve percent are by women's health specialists. So these are also the two groups our current field force focus on. With the current field force, which is the smallest of the blue circles, which has about 1,700,000 prescriptions prescriptions, we target about 10,000 health care professionals. We we 60% of our primary care and 40% of our our our women's health. And that is also roughly how AccraFer's prescriptions are divided. It's about sixty, forty.

8:15 And this group is about 220,000 patients in total.

8:24 So what we've done in The US, it's we we we have realigned our sales force starting this year. So we are focusing on the states and the territories where we have the highest potential, where the best coverage from insurance, and we have had historically the strongest aquifer performance. So what what happens with that is that the top five states for us is about 60% our total volume. And that's also where we will have about 50% of our Salesforce. That's Texas. It's New York. It's California. It's Florida and Georgia. So that goes into effect as we speak right now, to really optimize our Salesforce and have them placed where the where the business opportunity is the biggest.

9:16 So there are three key initiatives that are that are new for this year that will will help us to drive continued growth and lead us to profit profitability. So the first one we actually initiated already in the fourth quarter of last year and had actually with with very good results as we will hear very soon from from Santosh. We have decreased the impact of what we call the consignment business. Consignment businesses

9:49 I did not what happened to the slides?

9:56 Thank you. So the consignment business is the business where we either give away drug for free or have had historically loss making prescriptions. So we modify their pricing to decrease this the number of loss making prescriptions. And thereby, the the price per prescription, the average part per is is going up as you also will see in the numbers in in the the second thing is what I talked spoke about is the realignment of the Salesforce to territories where we have the highest potential, the best coverage, and the historically the strongest lack of our performance. And the third piece is that is the digital marketing initiatives. We've done it towards its physicians last year. We're We're gonna gonna do it to patients this year and the whole idea to drive awareness for AccraPay.

10:44 So, Sam, I will now leave leave over to Santos. So please, Santos. Thank you, Anders. Hello, everyone, and good morning and good afternoon, depending on where you are. I'm gonna spend a few minutes really talking about our q four and full year performance. I'm excited to report we had a a strong quarter in q four. Let me just orient you to the slide. You've seen this before. We have three key big priorities for full year 2024, growing Acrefer, revenues, prescriptions, and gross to net. Number two was making sure that we had a balance sheet that was strong and had allowed us to have operational flexibility. And then, of course, expanding global patient access of direct model.

11:30 I'm I'm happy to report that we made prog significant progress across all three. Let Let me me take take each one of them one after the other. From a total revenue perspective, we reported unaudited financials, 32,200,000 for the year. Of that, Acrefer represented 29,300,000. That's a 153% growth over full year 2023. The remaining portion, 2,100,000, was from ex revenue ex US revenues that includes royalties and milestones, predominantly driven by Nolgene. In q four, specifically, I prefer the 11,200,000 in revenues. That's a 56% growth over q three of twenty twenty four, primarily driven by our price, which we reported $237 of a net price in q four. That was a growth versus a $167 in q three.

12:26 You can see that in q four, while we had 41,000 total prescriptions, only 22% of them were consignment, while 37% was consignment in q three. Now what do I mean by consignment? Consignment business is the part of the business where we actually give prescriptions for free or at a significantly subsidized price to patients who there cannot afford them or are waiting for their insurance companies to make a decision on coverage. Now as a net revenue, that actually has a negative impact on revenue because net of fees and and, and any other, costs that are that are included with the with the prescription, we actually lose revenue on every consignment script.

13:11 So by changing that consignment program in q four, we still allow patients to have access to our to our prescriptions. It's still at a subsidized price, so we still make it available to them. We we reduce the impact that it has on on the net revenue from a negative perspective. So we actually are able to increase the price per prescription and, hence, increase the revenue on a lower prescription count. So that is what that is what we have done, and that is what Anders alluded to in his prior slide. We took a significant step forward in that in that direction, reduced our consignment business, and hence increase our overall price and hence revenue. From a balance sheet perspective, as we've reported through the course of the year, we have raised nearly $31,000,000 in new financings, new monies in 2024.

14:03 We have we ended the year with 6,500,000 cash on hand. This excludes the $10,000,000 that we received from AOP on the subscription that was received on January 3. So we feel pretty strong about our financial strength entering 2025. As you had heard from us previously in late q in early q four, we also reset our operating base in q four and into 2025. We announced a 10% reduction in our base operating cash in our base operating cost to help us get to cash flow positive by the end of twenty twenty five. That is a constant theme you'll hear from SHIELD through the course of the year. We aim to be cash flow positive by the end of

14:45 twenty twenty five. And then finally and importantly, expanding our global patient access of THERAPEUTICS. We've had significant progress across multiple programs across the globe in 2024. As we had indicated earlier, China, our partner, recruited fully recruited their phase three program and now are moving into finishing up the trial and will hence transition into a regulatory phase later this year. Health Canada has pro provided an approval, and we expect to launch in Canada in early part of this year. We also announced and are excited about the pediatric pivotal trial being very successful. We are making progress on the regulatory front, both with in the in Europe as well as in The US associated with that. And South Korea, our partner, is ready for the final approval, and submission and is waiting and and is chatting with the Korean authorities to be able to get an approval for our product in South Korea as well. So across the globe, significant progress in both regulatory

15:55 processes as well as getting the clinical trials, across the line. On the next slide, let me walk you through some of the details of our Acrefor progression in The US throughout the course of 2024 as well as in q four. You can see on the left hand side, the Acrefor net revenues has grown quarter over quarter. We started the year at $4,100,000 in Q1 twenty twenty four, ended the year with $11,200,000 in Q4 twenty twenty four. Very excited about that progress, and we expect that to continue to progress in 2025 as well. Net price per script, I I alluded to this in my prior slide. We started the year at a $139 price per script net price per script in q one twenty twenty four. We ended the year at $237 price per script in q four twenty twenty four. That is a significant progress that an increase that we have seen through the course of the year, predominantly in q four driven by the changes in the consignment business that I just talked talked about.

16:59 And on the extreme right, you can see our total prescriptions. The the gray bars on the prescription, it represents consignment, and the blue bar represents the non consignment or retail. So the retail prescriptions are the ones where the revenues those are revenue generating prescriptions, while the gray bars are consignment where we actually give it for free or is at a significantly subsidized rate and net of fees, we actually end up losing money on those prescriptions. So with the changes that we've addressed in q four twenty twenty four, you can see the blue bar continues to grow, which is the revenue generating prescriptions, while we are shrinking the gray bar from q three into q four. We expect this trend to continue. We expect that the consignment business will will be a part of our business going forward.

17:48 However, it will be a much smaller portion of the business in 2025 as well. And finally, 2025. Again, this should look familiar. We are, again, focused on three key areas. We wanna make sure that we grow accurate for net revenues. We are we are seeing all the right ingredients in place to make sure that that happens. We wanna make sure that we turn cash flow positive by the end of twenty twenty five and become a self sustaining business. We see that we have incorporated all the right initiatives in place to make sure that that happens. And then ex US, we expect to launch in Canada with our partner, Kai Pharmaceuticals. We are looking forward to that. We you should hear from us pretty soon on how that when and where.

18:34 On the regulatory side, both in Korea and China, we see significant progress with through our partners in Korea and China. And then last but not least, the pediatric population. We expect to, announce, the progress on the regulatory front both in The US as well as in Europe, with our

18:53 our pediatric population. So with that, I'll hand it back to Anders to, close the, prepared remarks, and then we can open it up for questions. Thank you, Santosh. So what we want to share with you that, this morning or this afternoon is that we wanted to share with you what the big market opportunity we have in The US. And just to remind you, we had about a 150,000 total prescriptions last year. And our sales force is focusing in the market segment where the total number of prescription is 1,200,000. So I mean, we have a there's a lot of growth opportunities still. And as you have seen in our partnership with Viatris, we have been driving growth, very healthy growth over last year, and we have a very good jump off point with a strong fourth quarter as we saw. Our global footprint continued to progress as a steady pace.

19:53 And with that progression, we also anticipate milestones and double digit royalties to continue to come in.

20:00 Our financials are a good place right now, especially since we got the extra 10,000,000 from the AUP investment and also some additional cash from some of our retail investors as well. So our goal is to be cash flow positive by the end of this year. And that ends the prepared remarks, and we are ready to go to questions. Anders, Santosh, thank you very much for your presentation this afternoon. Ladies and gentlemen, please do continue to submit your questions just by using the Q and A tab situated on the top right hand corner of your screen. While the company take a few moments to review those questions submitted today, I'd like to remind you that recording of this presentation along with a copy of the slides and the published Q and A can be accessed via investor dashboard. Alice, could I please hand back to you to read out the questions and give responses where appropriate to do so, and I'll pick up from you at the end.

20:53 Fantastic. Thank you. Thanks, Sanders and Amtosh. So I'm gonna start with the presubmitted questions, and then we'll run through those that were submitted throughout the presentation. So number one, can you please tell me how US sales reached $11,200,000 in q four from US sales when the calculation of 41,000 prescriptions by $237 equals $9,720,000. Where does the other 1,500,000 come from in US sales come from? That that's a great question, and and I appreciate the math behind these numbers. Well done. The 41,000 prescriptions represents demand. That's the prescriptions that were picked up by patients after a physician wrote them. We do not use the 41,000 prescriptions in terms of revenue recognition.

21:47 We recognize revenue when a title is transferred from SHIELD to to the wholesaler.

21:54 And so when you think about the revenue that is associated with the title transfer, we take the title transfer number as the as the basis for calculating what our price is. So the $237 that we shared with with you as the net price, that is the price based on the sale of the units from SHIELD as a title transfer to our wholesalers. And then you take the revenue associated with that to get to $2,237. Hopefully, that's helpful. Thank you, Santosh. Second question, how are ex US sales going? Are you seeing a marked uplift in cash inflows from this part of the business?

22:37 Anders, I I can take that and Yeah. You do that. Yeah, please. Yeah. Yeah. We have a partnership with multiple ex US organizations. The one that is commercial today is Norgene in Europe, and we expect to launch in Canada, as I mentioned in my prepared remarks, very soon. So most of our revenues come through royalties from Norgine, and there are a few milestones that we achieved in 2025 as well. Overall, like I said in my prepared remarks, the red the royalty revenue and milestone revenue in 2025 was 2,100,000 in 2025 compared to 1,500,000 in 2023. Oh, so sorry. 2.1 in 2024 versus 1.5 in 2020. '23. So we do see growth, and we should anticipate to see additional growth, especially through the launches in the additional countries.

23:33 Yeah.

23:36 Great. Can you please give us some insight into what the current cost base is and what sort of quarterly sales revenue is required to achieve cash flow breakeven?

23:48 Yeah. Maybe I can take that, Anders, and feel free to chime in as well. We have not yet released our total financials, including operating expenses for the year 2024. You should expect to hear from us pretty soon on the full year audited financials. However, what we have said, though, in early q four is that we have reduced our operating cost base, and we did that by about 10%.

24:14 Yeah. I'm looking at all the initiatives that were put in place to help us get there. I feel pretty confident that we will achieve that, and we have mostly achieved those cost savings. Those cost savings have come across across the board, across every function in the organization, including headcount and expenses that we incurred through external suppliers. And all those initiatives had are in place, and we should expect to see that 10% reduction through the course of 2025.

24:46 That leads us to the key objective that we have set for ourselves, which is we wanna be cash flow positive by the end of twenty twenty five by implementing not just the cost base change, but also growth in that. Anders, anything to add on that? No. I think it's worth mentioning also that with the initiatives the three key initiatives we we mentioned, they they are, of course, fully funded with with the budgets we have. But we also we we stopped some initiatives where we didn't see, you know, the return on investment as we wanted to see, and and that's why why we sort of refocused the resources where we see the, you know, the biggest opportunity to grow continue to grow as as we have done in the past. So that I think that's important to note as well. So so we are investing more behind those three things that I mentioned and especially then in the on the digital channels and the new things that we go to go towards patients this year. We haven't done that at all in the past. And and as I also mentioned, that this has shown us that when we've done it with physicians, we that's the ROI, and that is is very, very good.

25:54 And we believe if we can now address patients as well to drive up awareness, it will help our sales force, and it will help the company to to grow even further.

26:05 Thank you. You've already answered the first half of this next question. When do you expect to breakeven, and will there be any further dilution to shares?

26:15 Yeah. I I think we, you know, we are hyper focused on making sure that we get to cash flow break breakeven by twenty end of twenty twenty five. We have not commented on any dilution of shares at this point. Thanks, Santosh. How do you feel about meeting your covenants on the SWK financing going forwards? Yeah. You know, based on our 2024 financials, clearly, we are we have no concerns or issues with the covenants. As we look forward into the future, again, we have not commented on that, but we don't see, based on our internal projections, any reason to be concerned. And we work very closely with SWK on this front anyway. So we we feel pretty comfortable with with our current position on that on that topic.

27:07 Thank you, Santosh. What level of insurance coverage do you have, and should it expand? So, yes, it is actually expanding. So we I mean, the market access team, which is which is, by the way, run by the is they constantly work with the different PBMs and plans to expand our coverage. So, yes, we we added another 7,000,000 lives just in the beginning of this year, but getting another plan, Prime Therapeutics, to

27:44 to approve to reimburse. So that that happens constantly. That never stops, actually. And and the what is and I think we've tried to explain this before. The reason why you continue to actually support even prescriptions where we lose revenue is that if you don't have any demand, if you don't can't show there's demand, they will never reimburse you. So you have to do that. Now we limited it because we are at the point where we have shown there is good demand, but there's still, like, a continuum of trying to get more and more lives covered. So on the and as we said before, commercially, we we have strong coverage. I think it's just about 60%.

28:34 For Medicaid, we have very good coverage in general, but for Medicare, not at all, actually. So that's the the sort of the market environment we work in. But as I just said, I mean, we just expanded. We we added another 7,000,000 lives with with the plan that we have just approved. You, Anders. Can you explain the net selling price in more detail? Does the majority of revenue come from reimbursement from insurance companies? If so, is to fixed price, or does it vary per insurer? Does Medicaid pay the similar? In previous RNs, you mentioned things like wholesalers, bulk buying, etcetera. Why does this impact the price SHIELD receive? Maybe I could take a stab at it, Anders, and then start. Yeah. You start. Yeah.

29:22 You can do that. Yeah. Yeah. I think we may have to set aside a few hours to walk through the insurance process in The US, but let me try and take a stab at it at a very high level. Think about our business as consisting of two pieces. We mentioned the consignment business a few times on this call. 22% of our business in q four was consignment. The price there, like I said, was either it was given away for free or at a significant discount. The net price was negative on that part of the business. Now you look at the non consignment side of the business. You can broadly classify them as commercially covered, or government covered, such as Medicaid. Right? So there are two real pieces there. Within commercially covered, there are multiples to of insurance plans and insurance programs that an individual may have, that we try and, work with to help them get coverage for those prescriptions. So and the pricing can vary across each one of them depending on the size of the patient population and and and how how open they are to covering our product.

30:37 As you can imagine, there are certain authorizations that need to be put in place. They're called prior authorizations that a physician needs to fill out. And that those those things like that have an impact on what the price is. So that price can be varied across those commercial plans. On the Medicaid side, they have a a standard formula. The formula is actually a pretty complex standard formula. We apply that standard formula, and there's a discount that's applied based on on that formula to all Medicaid patients. So that price is constant across all Medicaid patients. The combination of these three pieces of business, so the consignment, the commercial plans, and Medicaid, then eventually lead to what we would call the average net selling price per prescription for a specific period.

31:24 Hopefully, that's helpful. Our objective is to maximize the commercial part of the business that then relates to what the Medicare price gets set at and while converting the consignment patients over into the commercial side of the business so that they can get access to Acrefer and get covered by insurance companies. Andres, feel free to add to that. I I mean, maybe we can try to construct a slide to show what it is. It it it's it's it's both complex and complicated, actually. Because with each commercial well, with the the different pharmacy benefit managers, you also have different contracts.

32:10 You have to give different discount and different fees. So so there it becomes a lot of different prices that comes together to the net selling price. So it's it's predictable for us at this point, but as I said, there is a lot of moving parts to that. And and we, as as Santos mentioned earlier, we get paid when our wholesaler buys from us. And that that is a discrepancy between that and the number of prescriptions that are filled. And that discrepancy, that difference will increase the bigger we get because they always keep, you know, a stock that is constant about two to three weeks of stock. So so that so that difference that somebody asked about, you know, why doesn't the 41,000 prescription times the the, you know, the the the average price per prescription add up to 11,200,000, That that's if we as we continue to grow, that difference in in pure money will actually continue to grow as well.

33:14 So, yeah, I mean I mean, I hopefully, it's helpful. Otherwise, you know, maybe write write us an email, and we'll try to try to put, you know, something graphic together as well. Thank you both. Next question. There are large milestone payments due in the future from the at $30,000,000, and Norgeen, €50,000,000. What triggers these payments, and when do you expect them? So the Viatris milestones are sales based milestones. I I know and I must say, I don't even know if we publicly disclosed what what the numbers are, but I honestly don't know that. So I'm sorry if I I'm not that's I'm not gonna say it. If if if it is publicly disclosed, I mean, I know the number. But I I yeah.

34:03 Yeah. I think I think the Beatrice one is disclosed. Okay. And we haven't again, we haven't provided any timing on when we expect to achieve them. We do we do expect to achieve them. That's that's the reason we put the deal here and structured the deal. And the same thing with Nordging. We haven't provided any timing or quantified exactly when we will get that. Great. Thank you both. There's a lot of focus on marketing. The projected possible revenue increase represents 12 to 15 times current levels. Is the organization capable of meeting this demand? Well, I don't know if we ever given a projection of what is revenues we are supposed to reach this year, first of all.

34:48 So I assume I don't know I don't I don't know what the 12 to 15 times comes from, what what the starting point is, and what what is sort of the sum of that is. So, I mean, we we I don't I I can't answer the question. It's not that yeah. We we I mean, I don't I actually I mean, I don't I don't know what where the numbers are coming from. But maybe maybe, Anders, if you wanna hit on the excitement that we have around the marketing side of the business, the marketing part of the business in addition to sales because I think that's that's exciting for us right now. No. No. It it is, of course. And, I mean and that's that goes back to the slides with the three circles where we our digital marketing, I mean, with different via different channels and initiatives can actually address them up to half the market, which which will represent the the one point two million patients, which then has about 6,000,000 prescriptions.

35:40 Yes. You can be very, very focused, I mean, with with that. And and I also mentioned we have five key states. We can geo target, which means we can focus our digital effort on those five key states, for instance. So we would have unproportionately more initiatives towards those five states. So we we can do that. And as I also mentioned, we haven't done anything towards patients as of yet, and that's the new thing for this year. But you can find them. There are the reason we know it's one point two million is that you can identify the number of patients who've been on an oral iron salt and has have had adverse events. And that's that is so you can be very precise with these type of efforts. And and we think that will be a very interesting, you know, initiative we have this year. We know from on the on the health care professional side, actually gives gives us a positive ROI for and then, again, we can target very clearly.

36:42 We can even see we can link, like, digital activities to an individual physician. So we can see if these activities actually lead to prescription. So that that is those are the type of initiatives. We're very excited about this team. Thank you, Anders. We've had a couple of questions about the prescriptions in q four being lower than in q three and whether there's a reason for this, and do you expect stronger growth to resume in 2025? I think as Santos mentioned earlier, this is by design. I mean, the the portion that is decreasing is the portion where we lost revenue per prescription. That is why we that we are actually we're happy with that result.

37:29 And so that as you see the as the net selling price per prescription goes up rather significantly, that was the intention with that. So we we also again, coming back to these three initiatives and especially on then on the Salesforce sites and and the the five five p states, that's why we're investing the most where we foresee to have the biggest return, where the biggest opportunity is. So and as I also said, if you just look at the number and compare many total prescriptions we had last year versus how many total prescriptions there are in the segment of the market which we target with our Salesforce. I mean, if every prescription came from that part of the market, we have about 8.8889% market share. Right? So there's a lot to grow from still.

38:20 And that and I think the third piece there is time. Right? We've been out with the full sales for eighteen months, so we are not that old in the market. And then again, haven't done any patient awareness, which we're also initially in initiating now. So that's why we're very optimistic to see continue to see good growth in the retail part, which is the blue bar that we show that that is growing constantly over over last year. And as I said, again, the consignment piece, we we actually we we probably would see that flattening out on on a constant level, that is also what we wanna see. Thank you, Anders. So I think we're coming to the end of the questions. There was a lot along kind of similar themes, so I've tried to kind of condense them all.

39:08 If a clinician is given AccraFer at a discount, is this for a limited period only? Afterwards, do they pay the maximum price? There still seems to be a number of cheap and free prescriptions. That number seems quite high. The short answer to that is no. It doesn't work like that, first of all. The way it works is for about half the market, we work with a company called Blink. They help us within to to help the patient get through insurance. So while that's happening, we give them Aquifer for free. So all of these administrative things can sort of which takes time. It it can take weeks sometimes or even longer. Sometimes it's fast. It it all depends on the plan, and and it it all it all all depends on if that plan then actually would be asked to prove aquifer or if the physician needs to write a prior authorization proving that the patient has had an oral iron salt before, had side effects, and now need this to be able to actually tolerate and and and actually take the therapy. So it all depends. So that's how it works.

40:20 So all consignment isn't bad in a way. So we're happy to give away drugs for free when it is, for instance, when they are handling that prescription. We're also happy to give away drugs for free to you know, if there are patients who have no no insurance at all, but we're trying to limit that part. Right? If this is a fine balance. So the if the price for a patient doesn't change after they fill the first prescription that we get paid for, that's constant. That that's it. That that plan has a price. But then, of course, 10 patients in this that comes up from the same health care professionals can be on ten ten different plans and 10 different prices. That's just the the the nature of the market.

41:12 Fantastic. Thank you. There are a number of questions. We will we've I've tried to answer kind of everything that we can, and we will review the questions after the presentation as well, and provide written answers to any that we can. But I think that kind of concludes the questions for now. Thank you, Anders and Santosh. Anders, Santosh, thank you thank you for answering all those questions you can from investors. And, of course, the company can review all questions submitted today, we'll publish those responses on the investor meet company platform. Just before redirecting investors to provide you their feedback, which I know is particularly important to yourself and the company, Anders, could I please just ask you for a few closing comments? Yeah. Thank you for all who took the time to listen live to us today, and thank you for all, you know, very it's a very good good questions. I hope our answers bring a little bit more light to the complex system we are living here within The U. S. Especially.

42:05 We'll take a look at questions we haven't been able to answer and see if there are any of those that we, you know, can provide a written answer to as well. But again, thank you and thank you to those who listen to this on the recording as well. So thank you for attending. Thank you for updating investors today. Can I please ask investors not to close the session as you'll now be automatically redirected to provide your feedback in order that the management team can better understand your views and expectations? This will only take a few moments to complete and I'm sure will be greatly valued by the company. On behalf of the management team of SHIELD THERAPEUTICS PLC, we'd like to thank you for attending today's presentation, and good afternoon to you all.