Alpha Cognition (ACOG) Q2 FY26 earnings call: guidance and Q&A

What drives repeat prescribers to stick with Zunveyl, and what are their characteristics?

Repeat prescribers (76% of Q2 writers) are driven by positive experience with Zunveyl, specifically its tolerability, efficacy in cognition, and positive impact on behavior. They first confirm tolerability, then observe efficacy, and finally note behavioral improvements.

“What we're seeing is these are significant repeat rates. 76% of providers are writing again. That's some of the highest I've seen in my experience.”

asked by Raghuram Selvaraju · answered by Lauren D’Angelo

When will sales and marketing expand beyond LTC to neurologists, and when will formulary access become a tailwind?

Expansion into neurology is contingent on achieving operating profitability in 2027 and securing solid formulary coverage, as high co-pays would lead to abandonment in retail. Payer access is actively being pursued, with the IRA impacting Medicare Part D plans, but management believes it's a matter of 'when, not if' due to demand.

“You don't want to launch into retail without solid formulary coverage because you'll see significant abandonment rates in the retail setting when the co-pay is too high.”

asked by Raghuram Selvaraju · answered by Lauren D’Angelo

When will CONVERGE/RESOLVE data be available, what is the sublingual market opportunity, and will 2027 revenue/expense guidance be provided?

CONVERGE top-line data expected Q3 2026, providing quantitative retrospective data for publications in 2027 and pharmacoeconomic analysis. RESOLVE study completes Q2 2027, with data in summer/fall 2027. Sublingual opportunity is 10-20% of Alzheimer's patients (those with aphasia/dysphagia), with PK data expected Q3 2026. Expense guidance for 2027 will be provided late Q4 2026 or early 2027, but no revenue guidance yet.

“We believe that the opportunity represents about 10% to 20% of patients with Alzheimer's disease. Data indicates that about 10% to 20% of patients with Alzheimer's have either aphasia or dysphagia, meaning they cannot swallow or have difficulty swallowing, and the treatment choices for those patients currently are very limited.”

asked by Raghuram Selvaraju · answered by Michael McFadden

Was there outsized stocking in Q2, and what is the expected gross-to-net by year-end given slower reimbursement?

No material stocking occurred in Q2; sales reflect pure demand growth. The gross-to-net ratio is currently holding strong at 74%. If no significant formulary adds occur, it will remain consistent through year-end, with some IRA penalty impact.

“Our pharmacy and our wholesalers are now at a point where they're pretty much purchasing on demand. So what you see this quarter is pure demand growth, and we feel very strongly about that because we can follow the trends in the data.”

asked by Naz Rahman · answered by Lauren D’Angelo

What Q3 demand trends are being observed, and is it driven by commercial execution or payer dynamics?

Momentum from Q2 has continued into Q3. This growth is attributed entirely to commercial execution, as there have been no new formulary wins and the contracted open book of business remains consistent at 16%. Any future formulary wins represent pure upside.

“What I can tell you, I know we don't provide guidance, is that that momentum has continued. It is all, in my opinion, we have had no formulary wins. Our 16% contracted open book of business is consistent since last quarter.”

asked by Unknown Analyst · answered by Lauren D’Angelo

Where is growth concentrated, and what are the primary drivers for prescribers switching patients to Zunveyl?

Growth is seen across all regions, with largest volumes from key markets. Primary drivers for switching include new patients who failed previous generics and had no alternatives, and patients already on other drugs experiencing tolerability issues (insomnia, GI) or behavioral issues, where Zunveyl shows positive impact.

“We see a lot of new patients who haven't been on drug in a while because they had already failed donepezil. They already failed maybe 1 or 2 generics, and there's been no other alternative for them.”

asked by Ryan Deschner · answered by Lauren D’Angelo

What are the main reasons for patients discontinuing Zunveyl, and what is the remaining market opportunity in long-term care?

Patients primarily discontinue due to frailty (death) or temporary hospitalizations, not tolerability or lack of efficacy. Formulary changes or prior authorization issues can also cause temporary discontinuation. The long-term care market has significant upside, with about 5,000 top-tier homes and 3,000 top-tier physicians, indicating substantial room for growth beyond the current 1,000 writing physicians.

“What I can tell you, now it doesn't mean that it's not happening, I'm not speaking to the universe, but we have not had or heard of patients, especially within our data, that are coming off due to tolerability or lack of efficacy.”

asked by William Wood · answered by Lauren D’Angelo