Esperion Therapeutics: A Promising Play in the Cardiovascular Prevention Market

Esperion Therapeutics, Inc. (NASDAQ: ESPR) reported its fourth quarter and full-year 2024 earnings on March 4, 2025, showcasing robust revenue growth and a strategic vision for continued expansion. The company's focus on three key pillars—continued revenue growth, operating profitability, and portfolio expansion and pipeline advancement—positions it well for long-term success in the cardiovascular prevention market.



Revenue Growth and Market Dynamics

Esperion's revenue growth trajectory in the U.S. and Europe has been impressive, driven by strong prescription demand, increasing physician adoption, and expanded payer access. The company reported a 48% year-over-year (YoY) growth in U.S. net product revenue for the full year 2024, reaching $115.7 million. In the fourth quarter, U.S. net product revenue grew 52% YoY to $31.6 million, while retail prescription equivalents grew 45% YoY and 12% quarter-over-quarter (QoQ).

Esperion's European partner, DSE, also contributed to the company's overall revenue growth. Royalty revenue from DSE increased 116% YoY to $32.6 million in 2024, driven by strong revenue momentum and the ongoing tech transfer for NILEMDO and NUSTENDI.



Payer Enablement and Prescriber Enthusiasm

Esperion has successfully expanded its payer access, with updated management criteria now covering more than 173 million lives across commercial insurance and Medicare and Medicaid plans. The company's products, NEXLETOL and NEXLIZET, were added to the U.S. Department of Defense Uniform Formulary as preferred agents, covering nine million lives. This expansion has led to increased prescription volume, with approximately 8% growth in new to brand prescriptions and a 12% increase in total retail prescription equivalents in the fourth quarter compared to the third quarter of 2024.

The company has also expanded its prescriber base, with 10% more healthcare practitioners writing prescriptions in the fourth quarter, now totaling over 25,000 prescribers. This growth in prescriber enthusiasm and payer enablement has driven durable revenue growth for esperion.

Gross to Net Trends

Esperion's gross to net trends have been positive, with the company achieving double-digit quarter-to-quarter prescription growth since the launch of the expanded label. This growth is driven by broader adoption and increased prescriber confidence in the company's products.

Global Expansion and Portfolio Expansion

Esperion's global expansion is a key driver of its growth and profitability. The company's partner in Japan, Otsuka Pharmaceutical Co., Ltd., has submitted a New Drug Application for the manufacture and sale of bempedoic acid in Japan for the treatment of hypercholesterolemia and familial hypercholesterolemia. Otsuka expects approval and National Health Insurance pricing in the second half of 2025.

Esperion's European partner continues to successfully market NILEMDO and NUSTENDI in Europe, contributing to the company's overall revenue growth. The company's significantly strengthened balance sheet and capital structure support plans to expand its portfolio with the potential acquisition or in-licensing of cardiometabolic products that are synergistic with its commercial call point.



Triple Combination Products

Esperion is developing two triple combination products in the U.S. with bempedoic acid, ezetimibe, and either atorvastatin or rosuvastatin. Based on published literature, these products may offer LDL-C lowering in excess of 60%, rivaling existing and emerging therapies. The company believes these next-generation combinations represent the future of preventative cardiovascular care, as supported by clinical publications that highlight their enhanced efficacy.

Conclusion

Esperion Therapeutics' Q4 2024 earnings call highlighted the company's strong revenue growth, strategic vision, and promising pipeline. With a focus on continued revenue growth, operating profitability, and portfolio expansion, Esperion is well-positioned to become a blockbuster company in the cardiovascular prevention market. The company's global expansion, triple combination products, and strong financial position make it an attractive investment opportunity for those seeking exposure to the growing demand for cardiovascular prevention therapies.