Shield Therapeutics (LSE:STX) — Q3 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 could 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. I'd now like to hand you over to Anders Lundstrom, CEO. Good afternoon, sir.

0:31 Thank you, Lily. Hello, and welcome everybody to SHIELD THERAPEUTICS third quarter trading update presentation. So as you heard, my name is Anders Lundstrom. I'm the CEO. And together with me today is Santoshanbach, our CFO. Oh, and I have the slides. So here's our disclaimer. I understand you cannot read every word. This presentation will be posted on our website in the next couple of days. So not only so you can read the disclaimer, of course, so you can review any slides presented today as well. So, yes, as an as as in summary, so we at SHIELD THERAPEUTICS, we we're a fast growing mission driven specialty pharmaceutical company. We, commercialize on our own in The US and in the rest of the world, we have partners that commercialize our product.

1:24 So the market we're in is iron deficiency or iron deficiency anemia. It's in The US alone, it's about fifteen million people or patients who, have this medical condition. The challenge for patients and and, treaters are that about up to sixty percent of patients that use traditional oral lines often gets different type of gastrointestinal side effects, and they are intolerable, unfortunately. So it ends up being an an insufficient treatment. Our product, Acroferis is called in The US and and Feracru in Europe, is set to be the oral treatment of choice because we are formulated differently, and I'll come back to that in in the subsequent slide.

2:11 We approved in The US. We approved in Europe, UK by Swissmedic, and the last country latest country to get an approval was in Canada where we just launched earlier this year. We are poised to turn cash flow positive by the end of this year. We have strengthened our balance sheet with enough cash. So this is our goal big goal for the year. The peak revenue for aquifer is is about 450,000,000, so we have a very strong IP through 2045. So we have many years ahead of us with with growth. So this is our executive team that drives development, regulatory manufacturing, and and the whole commercialization we are running in The US. So the four individuals to the left are based in our Boston offices, and David and Jackie are based in our real headquarters in New Newcastle, UK.

3:11 So iron deficiency, there is a there is a challenge here, as I mentioned initially. And the challenge is that every other oral iron product is a salt is a so called a ferrous salt. And when after you swallow it, it dissociates in the stomach. And the unabsorbed iron then, causes irritation and damage to the to to the lining of the stomach, and that is the cause of the different side effects. So up to seventy percent of patients experience these type of side effects, which could be bloating, dark stone, nausea, distension, constipation. There's there's a whole slew of them. And and, unfortunately, up to sixty percent of these patients will then discontinue treatment. And, of course, if you discontinue your treatment, this will be there will be a lack of effectiveness.

4:05 Our product, on the contrary, is not a salt. Instead, the iron is protected by a maltol shield. So after you swallow the product, aquifer goes through the stomach and do not dissociate until it comes to the upper intestine. Where it dissociates, the iron is absorbed, and thereby, we are avoiding most of these gastrointestinal side effects as I just described. It also enable us to give a lower dose of iron because we get more of our iron absorbed to where it needs to be. So the the market today, and I I use US as my example, I mean, most patients start on an oral iron ferrous salt. Over ninety percent do that. So before we came here, the only other alternative, if you can tolerate them and you really need to be treated with for iron deficiency was to get an an infusion. The infusion is costly, sometimes inconvenient as well. So here is really our sweet spot in the marketplace.

5:10 So we could say we are second line treatment, but we've sort of as we've shown quarter over quarter, we have a very nice growth and very nice uptake and a lot of very positive feedback to our our treatment. Changing gears. So this slide describes our global footprint. So as I mentioned, in The US, we commercialize the product together with a partner, Viatris. It's a fifty fifty collaboration. And today, we have eighty eighty salespeople. We have 40, and they have 40. Canada, yes, launched. CHI Pharmaceutical is the company. They grow very nicely. They have about they have two out of three of the large commercial payers on board already and estimate to get the third one, on board as well this year. That would cover about 60% of the population, and later on, they move will move on to get the promises to reimburse the product as well.

6:09 In Europe, it's NordGen who is our partner. They mainly sell in Germany, UK, and the Nordic countries. We are looking for a decision in Korea. We, hope to to have that decision before this year ends and approval with the subsequent launch in 2027. And finally, in China, we have our partner there. We are looking forward to a regulatory filing by the end of this year. We have, as we shared previously, we have new data in in pediatrics. So in The US, the the submission is divided in two parts. The first part is with chill children or or adolescents that are 10 to 18. And this submission, we we they will be able to use our capsule. This is the first part of our submission, and we got a priority review decision here and hope to have the final approval early next year. The second part

7:09 in The US will to be will to be will be filing for those 10 and under with a new formulation a suspension. In Europe, we've also filed everything goes in at the same time for all all ages. Here, Nordion is the partner, and they are still evaluating what they will do if they will take that up or not. Our latest market to where we partner is Japan. So in Japan, we have taken it we're taking a different route. They will go for an orphan indication, pulmonary arterial hypertension. This is based on that we have data today in cardiac heart failure, actually. And this is a similar similar disease in in that sense, but as a smaller smaller disease.

7:57 We it's been shown in patients with with the cardiac heart failure, if they are on an iron, actually, their six minute walk test, which is an exercise test, improves. So this is what they will do in Japan, and we they will are to start their first studies, a phase two in 2026. So this is The US market. So as I said, there's about fifteen million adult patients with iron deficiency or iron deficiency anemia. We, which is the smallest circle in in an orangey color, we target with our field force together with Viartist about 10,000 prescribers. We focus primarily on primary care physicians and in women's health. And we estimate these 10,000 prescribers, they have about two hundred and fifty thousand patients that have had side effects on a on an oral oral iron before and would be, eligible to get our product.

9:03 The next lighter blue circle is what we aiming to reach with our prescriber and direct direct to consumer marketing. Here, we are targeting 50,000 health care professionals. And here we go wider outside the primary care and women's health. We also target nephrology, hematology, and gastroenterology. They combined have about one point three million patients that have had side effects and will be set to, you know, receive AcreFer. This year, we're taking we've gone one step further, with our direct to consumer marketing. We are actively targeting those who we can those who those we can identify online are seeking an oral iron treatment.

9:51 And here, that's these are these groups combined represent about 5,000,000 people or patients that are seeking this treatment. And I'll show you in a few slides what what we are doing. So here you can see what our consumer related marketing efforts, can be. We we we have social media influencers, and these eight influencers have already reached over a million potential patients. They use the different channels you see in the middle, would be Facebook, Instagram, different search engines, Google, Bing, and you see what type of medical conditions they they sort of come from and what they do discuss.

10:37 And the the third piece here is a digital advertising where we go directly to advertise about AcreFER to and here we reach another three point nine million patients. The whole idea here is to drive awareness about AcreFER. We also do digital marketing towards our prescribers. As I mentioned, our sales force, which is the circle to the left, they focus on either primary care or women's health. But as I also mentioned, when we when we do the marketing, we target more specialties. And here you see the breakdown. We target, as I said, nephrology, oncology hematology, and gastroenterology to capture other groups as well.

11:26 We know from from that this marketing actually works. And what I'm sharing here is a rolling three month of new prescribing of Acrefour. So these prescribers is the first time they prescribe. So the top blue line is article new prescribers that our field force have, have visited. The yellow line represents new prescribers that never had a visit from a salesperson. So as you can see, as this goes on, there's we almost generate as many new prescribers from our digital marketing efforts as we do from our Salesforce. And as a matter of fact, if you combine the two, we actually see even better results than what you see here.

12:18 So then in summary, I mean, there's three parts to drive our growth. The first part is to increase the awareness of Acrefer. And as I as I as I shared, we do that with with our Salesforce, but, of course, also then with our digital marketing initiatives. The second piece is that we have enhanced our Salesforce output. So this year, we starting this year, we redesigned our sales territories, and this redesign and optimization of the Salesforce has resulted in in strong prescription growth. Our six key states are are New York, California, Texas, Florida, Georgia, and and North Carolina, and there we continue to drive demand as well. And the third piece, which sort of happens outside marketing and outside what the sales force is doing, you know, the sales force are focusing on increase the number of prior authorizations submitted.

13:13 Many times, the physician or prescriber needs to submit the prior authorization to be able to prescribe Acrofur. We also collaborate with pharmacies that can help the offices with the actual prior authorization approval process. And we also leverage case managers in our patient services to contact patients to actually go and pick up their unfilled prescriptions. So those three three there's sort of three pillars to to continue to drive growth. And this combined has now led to whether we are the number one branded prescription oral iron for iron deficiency iron deficiency anemia in The US market. So by that, I'd stop and will introduce Bis Santos to take over.

14:01 Thank you, Anders. Appreciate it. Exciting to be the number one branded prescription order line in The US ID, IDEA market.

14:10 Let me walk you through the key business priorities. Many of you have probably seen the slide shared with you multiple times before, but we have three key, business priorities for 2025. The first one is obviously growing Acrefor net revenues in The United States. Number two is turning cash flow positive by the end of twenty twenty five. And number three is ex US growth. So launching in Canada, executing our regulatory processes in Korea, China, as well as label expansion with the pediatric population. Let me dig into each of these key business priorities and how we fared on in q three twenty twenty five. In q three, we achieved 13,100,000 AccraFord net revenues. This was through, 54,000 prescriptions and a net selling price of $237.

14:59 So the revenues, grew 86% year over year. Our prescriptions, 54,000, grew 24% year over year, and our net selling price, 237, grew 42% year over year. So overall, we are pretty excited about, what this means and the,

15:16 trajectory and the direction of travel for Aquifer net Aquifer in The United States. From a cash flow perspective, we reported 8,600,000 cash and cash equivalents. That results in a net burn of 3,000,000, excluding the 2,000,000 placing that we, put in place in q three twenty twenty five. The 2,000,000 placing, we're excited about that. That was done at seven and a half peak per share, which represents a 5% premium to the thirty day VWAP. And the net result of all of this and managing our balance sheet has been we are confident of, turning cash flow positive by the end of this year in q four twenty twenty five. And last but not least, on the Ex US and global expansion for AcreFire, we did receive a priority review by FDA for Acrefor, like Anders mentioned, in children with iron deficiency with or without anemia.

16:13 So we are excited about that. We expect the approval decision to come through by the FDA in the first half of next year. We also announced positive efficacy and safety results for Aquifer in heart failure and iron deficiency anemia. Again, to Anders' point, a lot of this data will be leveraged by some of our global partners. And, again, it substantiates that Acrefer has a pretty broad, label and, usage in the, in the patient population today.

16:46 You've seen this slide before. This represents the Acrefer weekly prescription numbers. You can see on the top right, you know, we are clearly, you know, beating 4,500 prescriptions a week trending right now. We are excited about that. You can also see that in q one of this year, in January and February, the numbers were started to drop down, and that was a a very concerted effort. It was the impact of the new consignment strategy that we put in place where we reduced the, prescriptions that were not generating, revenue or were actually generating loss for us. And so these prescriptions that you see, all through this year are, are revenue generating prescriptions predominantly, reducing the impact of loss generation on our top line.

17:38 Let me go to the next slide. We've had a lot of questions, come in, either during calls, on prior calls, or post call in terms of how does revenue get recognized, and what is the difference between dispenses and revenue recognition units. So let me give you a a very brief overview of the of the distribution mechanism and and where we recognize revenue and where and when we say dispense is what we really mean. So you can see from the left hand side, we've got a three p l or third party logistics. Those are the holders of our inventory. That gets then shipped over into what is called a title model provider. So the title model provider is where SHIELD transfers title from us to the title model provider.

18:24 That is the point at which revenue gets recognized. And when we said we recognize 13,100,000 in q three twenty twenty five, Those are the units that got transferred into the title model provider at that point in time.

18:37 From there from the title model provider, there is a distributor. There are pharmacies that order Acrefer, And all of this is based on the inbound, which you can see on the top right hand corner, which is physicians and patients discussing Acrefer and physicians sending an Acrefer prescription to the specialty pharmacy. The prescription then gets dispensed by the pharmacy to the homes of the patients. And this is what I mean by saying Rx dispensed in q three twenty twenty five being 54,000 prescriptions. So the prescriptions that get dispensed is usually a a pretty good indicator of demand that then flows through the distribution channel all the way back to the title model provider, which allows us to, transfer title of units into the title model and help us recognize revenue.

19:29 So the dispensers are a leading indicator while the title model is what is the unit used to recognize revenue on. That brings me to the the trend over the last multiple quarters in terms of revenue, price, and total prescriptions. You can clearly see that we are growing across all three metrics. There are definitely there are definitely cycles within the year through which revenue and prescriptions grow. You can see that with 13,100,000 is what was recognized in q three twenty twenty five compared to 12.8 in q two twenty twenty five, so a quarter over quarter growth, and also compared to 7,200,000 in q three twenty twenty four, so a year over year growth as well.

20:19 Similarly, on the pricing side,

20:22 there are cycles to the pricing. You can see in q three twenty twenty five, we we we we believe our number is $237 in net price per script. That is compared to 231 in q two twenty twenty five and a $167 in q three twenty twenty four. Again, growth and going in the right direction. And then last but not least, total prescriptions. In q three twenty twenty five, we had 54,000 prescriptions. 22% of them or 12,000 prescriptions were consignment. These are prescriptions that are dispensed at a low cost or significantly subsidized price for patients who are awaiting reimbursement decisions by their insurance companies. 43,000 prescriptions were nonconsignment, so these are prescriptions that we received insurance reimbursement from, either from commercial or Medicaid.

21:15 And you can see both the the 43,000 is a growth in prescriptions on quarter over quarter or year over year, while we have tried to maintain our consignment

21:25 prescriptions, which you can see is 12,000, relatively flat through, q four, q one, q two, and q three of twenty twenty five. So we are excited about the strategies that we have put in place and what that means to our prescription growth, our pricing, as well as our net revenues. And then finally, I wanted to share our projections and our direction of travel in turning cash flow positive. Based on the based on our internal assumptions and based on expected growth of aquifer in The US, along with managing effectively managing our working capital, we believe, we should turn cash flow positive in q four twenty twenty five. When we say cash flow positive, you can see what these bar charts represent are the net cash burn in a in any given quarter, and and this is net of new financing.

22:16 So we have removed any impact of new monies coming in into the cash burn. So this is a net burn at the end of the day in terms of what the quarter ref reflects in in cash burn. We expect that to flip in q four twenty twenty five to being a net cash generation in q four twenty twenty five. Similar to what you see on the slide in q two twenty twenty five, where we did generate cash in q two twenty twenty five. However, we do not consider that to be a sustainable cash flow positives scenario only because that was impacted by one time milestone payments. However, q four twenty twenty five, we do expect to turn cash flow positive, And that again is the net cash burn for the quarter. So with that, I will hand it back to Anders.

23:05 Thank you, Santosh. So, yes, in in summary, so what we wanted to describe is this the iron deficiency market is a very big market, and we are so far, I mean, we have had great growth over this year. We're still scratching the surface. It's a huge market, and that's why you continue to see growth. And and as I said initially, we you there's a years of growth still in front of us. The global partnerships continue to progress, so we are happy with the Canadian launch and and hopefully

23:38 to to see, you know, new launches. Korea, expect next year, and then also to file in file in China by the end of this year. Yep. Santos just described to you what we mean by the cash flow positivity by the end of this year, and we are actively looking for partnership opportunities to to expand our product portfolio as well. So by that, let let us share a snippet of what our social media activities look like in a short video that will come up soon. Please, Lily. For my patients who have tried lifestyle interventions but still have iron deficiency, AcreFer is great a option because it's formulated with a maltol shield. AcroFer shield protects the iron as it travels through your stomach so it's absorbed where it's needed in the small intestine. No one has time for the nausea, stomach upset, and all the GI drama that comes with traditional iron supplements.

24:34 And that's where AcroFer comes in. I wish my doctor had known about Aquifer sooner, especially when infusions and supplements didn't work for me. As a certified personal trainer and busy mom, raising my iron levels with Aquifer has made a huge difference. Talk to your doctor about Aquifer to see if it's the right option to boost your iron levels. So that is just sharing a small snippet on what our you know, some of our eight influencers are posting online for us. So by that, that concludes, the formal part of the presentation, and we will now move into q and a. And, Sandvos, 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 right hand corner of your screen. Just 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. As you can see, we have received a number of questions throughout today's presentation.

25:40 Now please ask you to read out the questions and responses where appropriate to do so, and I'll pick up from you at the end. Sure. And I'm the designated reader today. So so, we have a question here. Can you give any detail on how you plan plan slash expect to reduce the prolonged high levels of free product being dispensed? And yes, hold your like, I'm holding your breath because there there's this other question that's why are the free discounted percent of prescriptions still so high and and so forth. So let me start by answering that question. First of all, we made a huge correction to decrease the number of free or discounted prescriptions in the fourth quarter of last year. And since then, it's been below our internal benchmark, which is under 25%.

26:28 So why does it continue to be about the same, you know, 21, 22, 23% of of the total number of scripts in the given quarter? And and that is because the number of new prescribers, that we attract every month is a fairly high number in relation to our current prescribers. It's about sometimes almost as many as half of the prescribers are new prescribers. So that's that's one reason that we see a continued use of that. The other reason is also is that we use quite a few of these free, samples to be used by patients to get them on therapy as quickly as possible with with our patient services.

27:14 So when they have a prescription, it may take a little time to get everything cleared with insurance. We put them on free drug for a month, and then they they show you know, everything goes through with insurance, and they have the three to four iterations after that. So that's sort of a means to get patients treated quickly. We also subsidize pricing to underinsured or uninsured patients, and that's an that's the third part. And in The US, I mean, there are three types of insurance. There's there's the commercial insurance, there's the Medicaid, and there's the Medicare. So, in a given doctor's office or in in or in a practice, of course, they might see all three types of patients. It's we we cannot discriminate, to be perfectly honest.

28:01 What we did when we we we changed it in the fourth quarter of last year was to change the out of pocket pricing for some of these groups. So we estimate this to stay, I think, around in the twenties low low twenties percent of the total number of prescription. In the in the end, it's it's a it's a way of of actually increasing the total number of procedure thrust. Santos, you wanna add anything there? No. No. I think you you hit everything there, and there's nothing to add on my side. Yeah. Let me go back to do that one. Here's what resulted in the steep change in September revenue or 4% of revenue for the quarter is a material amount?

28:47 Does any that of that relate to restocking cycles? Santos, you wanna address that? Sure. Yeah. Sure. No. I think I think this is a good testament of how the revenues continue to grow month over month and prescriptions continue to grow month over month. So we are excited about that. There is obviously some level of, you know, ups and downs in terms of buying patterns. As you as I think we have said in last year and we said it again this year, usually, during the July time frame, there's a bit of a buying pattern that favors June and offsets July. And and typically, that resets in August and September. So the reset usually happens in August, so we like that. So between June and August, they even out July.

29:34 But I think September was a true was actually a true demand driven growth. I don't believe we saw anything extraordinary there in terms of buying patterns shifting. I I do think that this is coming out of summer. We have seen now that being a cycle where in q three coming out of summer, you you do see a, an increase in demand. Just like you see in q two as well, you start to see an increase in demand after a slow q one. So clearly, after two years now, we are starting to see a a reasonable where we see q one is a little slow, q two bumps back up because of the buying pattern as well as, demand. Q three, usually, at the end of the quarter, you see a a a pickup, and then q four is a reasonable standard quarter. So, again, this is consistent with what we have seen, and we're excited that we saw a nice jump in in September, especially because it actually sets the right momentum for us to enter q four and supports our internal assumptions that we will generate the reasonable amount of revenue to turning cash flow positive by the end of this year. Anders, anything to add there? No. No. Absolutely. Yeah. Yeah. You know, that that you're you're spot on.

30:50 What's been the growth in sales for each of the markets or or, I would call them maybe specialties, primary care, oncology, hematology, etcetera? So as I said, I mean, our main focus is on on primary care and and women's health, and those are also contributing to the majority of the growth. What we've seen, the and it's it's a it's a function of our digital campaign market digital marketing campaign towards the prescribers is we see an increase in prescribing also in hematology, nephrology, and gastroenterology. I don't have the the exact as we have not broken it out like that. The the reason we see an increased uptake with the marketing campaign towards the other specialties is that they are tougher to access for a salesperson.

31:41 And sometimes, also, some of these prescribing, they are physicians come out of, areas where we don't have or Viatis have any, system. There are we have white space, I mean, as as well because we focus our sales force on the highest potential territories. So we haven't looked into that. We've only looked at the total so far. It's absolutely do it's doable, and it it's it's a good it's a good good question, and it's something we definitely can continue to, you know, start to look into. Next question. Are there any material safety regulatory reimbursement risk you foresee? It's a very broad question. I'll start. Well, safety wise, and you should never say never, of course, but, I mean, knock on wood, Aquifer is a very, very safe product.

32:35 We what I see every month is the number of complaints we get, which is is a super, super small number. So we we don't see any new side effects. It's typically product related in in a few, few cases, which you almost can count on your on your 10 fingers. So in in relation to having, and this is globally, of course, because the database is global, but we have 54,000 prescriptions, in in a quarter, and the number of reports we see for anything is it's super low. It's in the it's in the ten ten I mean, you know, one two three four five six seven eight nine. So it's it's very, very few. Regulatory wise, yeah, I mean, of course, we we we don't know if if anything will will be approved. Everything looks good.

33:25 I mean, in The US and pediatrics, we're very optimistic, as well. And, I mean, Korea, we haven't received any more questions. So so those are indicators that we are, you know, fairly confident that those things will will go through. If you're thinking regulatory wise from from other factors, tariffs, things like that, yeah, we we don't know yet how that will play out. We do manufacture in France. On the other hand, we have enough product in in store in in this country, so we have about twelve months inventory. So there's time for us if if we saw decided to to to move our, you know, production over to The United States. So things like that, but we we haven't seen the final thing of that. Well, how it would play out, what they will do, and and so forth.

34:21 And if tariffs come in any shape or form, you also have to remember that it it goes on the value of the product when it leaves manufacturing. And, leaves manufacturing. And that value, for instance, is is relatively low or very low in relation to price, that that we have here in in The US, for instance. Anything you wanna add, Santosh, there in the end of the regulatory landscape or or so? No. I think I think you hit on it. I think the the biggest challenge that we are all facing as we look into the next year is just the volatility with the policies and and the and the impact it may have on on the industry in general and and how we navigate through that. But I think everything that we have heard up until now has minimal or no impact on us as a business. But, you know, it there's always a risk that something comes up over the next day, hours, weeks, months, years. So we'll keep an eye on it. And if there is anything that comes up, we'll obviously communicate that to the market.

35:29 But as of now, we don't see any any huge headwinds that can interrupt our, progress. Yeah. So here's a question for you, Santosh. Would you expect the ceiling price to eventually top up on per prescription? Yeah. I I don't know if there's a ceiling price, but I I do think there will be a point where Aquifer continues to grow rapidly, and then we get on more and more insurance companies' radars where where we would have to potentially because of the size of the population that they're covering, we may have to have additional rebates and things like that. But but at this point, you know, that's a good problem to have, I think. You know, that that may be a ceiling impact that we may have on pricing, but we don't foresee that any any kind of a restriction to our pricing at this point. I also would say that we have already implemented a couple of strategies to improve our pricing a meaningful way. We we announced that in q four of last year with the consignment market shift.

36:35 We don't expect to be doing something like that in the near term. So the price that you're seeing right now is probably gonna remain consistent to what you're seeing right now over the next, you know, three, four quarters. Yeah. So here's a slew of questions for you, Santos, to answer. So what is our you know, what's the prognosis for sales this year? Will we reach 54,000,000? What do we expect in '26, '27? Yeah. What is that? Yeah. Yeah. We have not we have not provided any guidance on revenues either for this year or for next year. So, you know, we are focused we are hyper focused right now in making sure that we turn cash flow positive. We are generating cash. That is that is the key metric that we are measuring ourselves on internally and with the board. So that's the focus.

37:24 When we are ready to share what we think next year's revenues or metrics can look like, we will obviously bring that to the bring that to you. In terms of market expectations, yeah, I think there is a there's a range in terms of what analysts are saying in terms of what we can do. I I think we will fall within that range based on what we have seen. Things continue to change. I've seen some analyst reports this morning where they are going to be looking at those numbers again for the full year. And I I do think based on what they have seen in in the first three quarters of this year, they will most likely tweak that a little bit. But I I think we'll be well within the range of what the analysts are expecting us to do for this year. Since we're talking about that, what what if you reach breakeven in 2025, do you think there will be a slowdown in quarter one twenty six as quarter one is often lower? Is there enough money to cover this extra cash burn, Santos?

38:21 Yeah. I I I think I think we have fortunately transitioned as a company where we were looking at cash runway in the in last year to now, we are looking at cash generation. So I don't think this is a cash enough money question anymore for us. Obviously, we'll be looking at it very closely and we're looking at continuing to make our balance sheet more efficient. Q one, I think, like we like I said in my prepared remarks, and you've seen the trend over the last two years, q one is typically a softer quarter for Acrefer. It's just is. That is the way The US system works. It is the it is the January 1 is when insurance resets, and and a lot of patients who are on current insurance plans, they see a premium hike or they change see a change in insurance policies.

39:12 Insurance companies may buy out another insurance plan. So there are a lot of changes that happened in q one. I don't think that is specific to Acrefer or SHIELD. I think that is that is applies to the entire industry in general. So we do see a bit of a slowdown in q one. But with that slowdown, I don't anticipate having a a balance sheet concern in in q one at this point in time. Yeah. Thank you. Shift shifting gears. Are the Internet influence having the financial impact you hoped for? The short answer is yes. And these days, you can measure everything. You can identify who answers to your, you know, digital advertising. You can identify physicians who who prescribe and all of these good things. So the short answer is yes. That's why we do it.

40:02 We we do it increasingly because we know it has a positive return on investment. So so, yes, the the short answer is yes. And and we've already now see that even though we stepped up significantly this year compared to compared to last year. So the the short answer is yes. Have you had any health care professions professionals market I prefer to colleagues within the health care profession? One of the influencers we actually saw in the short snippet in the video is a physician that is also an influencer. And and so yes. And we also see that, you know, we haven't asked, but we've seen it anecdotally in clinics and so forth as well. So so, yes, that that comes through too.

40:49 It it's a a a big question here. What impact will the Medicaid cuts from Trump's new bill on revenue received from the insurers? You know, basically, what what will happen if if the government cut the subsidy to Medicaid? And do you still have Medicaid coverage? Yes. We do. We we have very good do we still have? We don't have any Medicare coverage. We don't have that. We have good coverage in Medicaid. So this is one of the this is why the government has shut down, basically. It it is about the subsidies to people who have health insurance. And let's try to sort of untangle this a little bit. Medicaid is a shared responsibility between the the federal state the federal government and the states, typically for any care and and also for pharmaceuticals, it depends on the state, but, federal the federal parties could be half or it could even be higher depending on the financials financial situation in in the state.

41:58 There are what's what's what they predict will happen is that in some states where they haven't had an increasing number of people enrolled in the Affordable Care Act or Obamacare, which would be, for instance, in Georgia or in Florida, that could potentially have an impact on the Medicaid part for us. Luckily, in our situation, our Medicaid prescription in those states are super low, very, very low, way lower than than our what what our average is. Average for us in the country is 60% commercial, 4% Medicaid. So so but so and the government says that they're gonna save a trillion dollars over ten years. So if you try to do some math here, so that's about a 100,000,000,000 per year if it's an even split saving.

42:55 The Medicaid budget for the government is almost 700,000,000. So they say they're gonna save about 60 ish, 70 ish percent or something like that. Right? We don't know what's gonna happen. We don't know what's gonna happen with the subsidies because they what the government has done so far has given subsidies to those people who have the lowest income. So this is why we have a government shutdown. Democrats wants the subsidies in the new budget. Republicans do not. And there are also other new demands they wanna put in that you need to work and so forth. So at this point, we don't foresee even if they were wouldn't continue to be subsidies to these lower income people any major effect on our Medicaid business because of the what I just said, the two states where it's really increased is in the number of recipients.

43:49 It's in Florida and Georgia. So that's that's my best answer at this point. Do you wanna add anything, Santos, to that? No. I I I think I think you hit on all the critical elements there. And I think this is what I meant by the volatility in the market when it comes to policies and bills is something we're keeping an eye on. I know at some point, there was a a big push by the Trump administration to to impact the Medicaid pricing. But I do believe that since then, there have been some conversations with some of the big pharma in the country and and administration, and I think that problem has been resolved, at least to our knowledge. But it can come back up. And so I I think we'll keep an eye on it. As we speak today, we don't think it has an impact to our to our business or our growth trajectory.

44:42 Has SHIELD THERAPEUTICS done any price l elasticity work on its drug to see how price increase or affect demand? Santosh, have you done that? Yeah. I mean, you know, we've got a we've got an interesting setup with consignment. Right? Because consignment is is where we are actually reducing the price because that's what the patient pays. We reduce the price either to zero or we give it at a certain another discounted price. So we have been playing with different price points in the market over time and have seen that there is that there is a price elasticity. Now I I I do believe it depends on the type of patient that we are that we are measuring here. You know, a Medicaid is patient is gonna be very different from a Medicare patient.

45:36 It's gonna be different from a commercially covered patient. So it depends on the type of patient that helps us define what price points we'll set. But at the end of the day, you know, to add to Anders' point, a vast majority of our prescriptions comes through commercially insured or Medicaid insured. And so there, we really don't have to play with price price elasticity. It it is really a question of what you know, how do we get access to a large patient, population through those insurance plans. The price elasticity really comes into play only within the consignment business where we try and manage the pricing so that we don't lose money on prescriptions, and at the same time, price it so that a patient can afford to pay for it depending on the type of, patient that they are.

46:24 I don't know. And is there anything else you would like to add? No. No. I I think that that that's very good. We'll move into Nasdaq option in regards to avoid tariff costs. Unfortunately, not. That hasn't been served up as as as as an alternative. What companies do is they hear if they don't have production in The US, they they buy a plot of land, typically in North Carolina or or, you know, which is the state that has a lot of manufacturing and and then put the shovel in the ground and say we're gonna build a manufacturing plant, and that typically can put them off. So that that's is that's that's not a way of of doing it. I think we have an interesting question here. So many people who receive regular IV infusions in hospital would benefit from having Aquifer after infusion to help keep iron levels high. Yes.

47:14 We we agree with that. That would reduce cost and so forth. This was identified a few years ago, but does not seem to be an area where we have focused on why not. There's a couple of things here sort of trying to untangle. You're you're a 100% right. It it would, and and we see examples of that. And, actually, again, one of the patient advocates actually experienced exactly that. If we if we, for instance, think about the chronic kidney disease population that are more severe and would require regular infusions, they have a separate reimbursement. We are not reimbursed in that bundle. So we actually we we we can't be there. If other hospital in host in some hospitals, depending of if there are so called IDNs, we are not reimbursed either. So if but if this happens in an outpatient clinic, yes, that that that is an area.

48:11 What we actually are doing now, and that is a result of the digital marketing we've done to health care professionals where we now target more nephrology, more hematology, and so forth, is that this is a place where we see that this we could push this part as well. You're right. We haven't pushed it as much as of yet, but this is basically been the reason because of access to these type of physicians. They are harder to access because they won't cease they won't meet us. They won't beat our salespeople. So now we are getting traction via digital marketing. And thereby, if one of these, prescribers or physicians then are part of in one of our territories, yes, we do follow-up with salespeople. So it it is it's a it's a good question. It's a viable, you know, strategy for our salespeople, and it's something we are continue to working on as well.

49:10 Anders, Santosh, thank you for answering all those questions you can from investors. And, of course, the company can review all questions submitted today, and we'll publish those responses on the Investor Meet company platform. Just before redirecting investors to provide you with their feedback, which I know is particularly important to the company, And, Jessica, please just ask you for a few closing comments. No. Thank you for all of those who who took the time and and listened today, and thank you for all your thoughtful questions. That's an ex ex excellent questions, you know, trying we our best to describe the market conditions and and where we are heading with that. So thank you so much, and hope to see you in about three months. And, Santosh, thank you for updating investors today. Now 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.

49:56 This may 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.