Acadia Pharmaceuticals Q4 2024: Contradictions in Gross to Net, NUPLAZID Sales, and Patient Dynamics

These are the key contradictions discussed in Acadia Pharmaceuticals' latest 2024Q4 earnings call, specifically including: Gross to Net Evolution, NUPLAZID Sales Trajectory, DAYBUE Patient Dynamics, and Gross Margin and Gross to Net Expectations:



Commercial Brand Revenue Growth:
- DAYBUE generated revenue of $96.7 million in Q4, up 11% year-over-year and 6% sequentially, finishing the year with $348.4 million.
- Revenue growth was driven by increased bottle use per patient and a stable patient base, with over 62% having been on therapy for over 12 months.

- NUPLAZID's Q4 sales reached $162.9 million, up 13% year-over-year, and full-year sales were $609.4 million, up 11% from the prior year.
- This growth was primarily due to volume increases, driven by direct-to-consumer and unbranded campaigns and expanding market share.

Pipeline and New Indications:
- Acadia's pipeline now spans neuroscience, rare disease, and intersection of both, with programs covering all stages of development.
- The company submitted a marketing application authorization for trofinetide to the European Medicines Agency, expecting approval in Q1 2026.
- New programs like ACP-101 in Phase III for Prader-Willi syndrome and ACP-204 targeting Alzheimer's disease psychosis and Lewy Body Dementia Psychosis are advancing, with significant milestones anticipated in 2026.

Regulatory and Financial Guidance:
- 2025 revenue guidance includes $1.03 billion to $1.095 billion, with DAYBUE U.S. net sales expected in the range of $380 million to $405 million.
- R&D expenses are projected to be between $310 million and $330 million, and SG&A expenses between $535 million and $565 million.
- The company sold its priority review voucher for $146.5 million, impacting cash flow positively.

Expansion and Strategy:
- Acadia plans to globalize its business, with managed access programs expected to generate revenues outside the U.S. in 2025.
- The company is expanding its commercial leadership and field force to increase engagement with more treating HCPs and patients to support DAYBUE's growth.
- Acadia is also exploring investments in adjacent rare disease areas, aiming to deliver long-term growth and value-creating milestones.