Ardelyx's Q4 2024: Key Contradictions in XPHOZAH Access, IBSRELA Growth, and Gross to Net Dynamics

These are the key contradictions discussed in Ardelyx's latest 2024Q4 earnings call, specifically including: XPHOZAH patient access and reimbursement strategies, IBSRELA sales guidance and expansion strategies, XPHOZAH's gross to net expectations and the impact of bundling, and IBSRELA's growth expectations:



Revenue Growth and Product Performance:
- Ardelyx reported total revenues of $116.1 million for the fourth quarter of 2024, driven by growth in product sales.
- On a full-year basis, the company reported $333.6 million in 2024 compared to $124.5 million in 2023, reflecting strong year-over-year growth for IBSRELA and the successful launch of XPHOZAH.
- The growth was attributed to strong patient demand, the completion of field-based sales team expansion, and favorable gross to net deduction improvements.

IBSRELA Expansion and Sales Increase:
- IBSRELA net product sales revenue was $53.8 million in Q4 2024, nearly double the same period of 2023 and an increase of over 32% quarter-over-quarter from Q3.
- Annual IBSRELA revenues were $158.3 million in 2024 compared to $80.1 million in the previous year.
- This significant growth was supported by the completion of a sales force expansion, increased patient demand, and favorable gross to net deduction improvements.

XPHOZAH Launch and Market Impact:
- XPHOZAH generated $57.2 million in net product sales revenue in the fourth quarter, an increase of 11% over Q3.
- Annual U.S. net sales were $160.9 million in 2024 compared to $2.5 million in a partial fourth quarter of 2023.
- The strong performance was due to the medication's crucial role in treating dialysis patients, satisfying a longstanding unmet need, and its effective market strategy.

Financial Position and Strategic Investments:
- Ardelyx finished 2024 with a strong cash position of $250.1 million, supported by operating cash flows and a term loan agreement with SLR Capital.
- The company plans to increase SG&A expenses by approximately $10 million per quarter in 2025 to support strategic investments in commercial growth and patient assistance.
- These investments are aimed at further expanding the commercial team and patient services, enabling continued growth and a strong financial position.