Insmed, Inc. Morgan Stanley 24th Annual Global Healthcare Conference

Thanks for having me here.

Yeah. Well, I will just start out by saying this launch has blown away all our expectations. We started out, I remember vividly describing that we were going to use a basket of other specialty respiratory launches to help benchmark whether or not we thought the launch was going well, and we took from that basket of best performers a first-year revenue production of about $500 million-$700 million. And at the time, I got a lot of heat for that because people thought, "Well, why would you set yourself against the best launches out there?

You might not be able to achieve that, and you would set yourself on your back heel. Today, as you know, we sit with an estimate for the first full year of $1.25 billion to $1.4 billion, which is just staggering, and it now places us on track to be one of the top 20 commercial launches of all time in any therapeutic category. So by all measures, this launch has outperformed. The team has just done an exceptional job, and I think that bodes well for the future. What we've learned from that, a number of things, actually. I think we know that this is now a highly promotion-sensitive drug. That doesn't surprise us. That's what we expected.

But to see that now play out with a year under our belt, we have really good understanding of how we can activate patient and physician interest, what channels through a media perspective are most effective and most efficient. And we can pull those levers to the extent that we need to help re-energize certain parts of the country as we move forward. But we've just upped our guidance. We think peak sales for this drug will be north of $7 billion US, and that does not include any contribution from the COPD or asthma comorbid populations. So this is going to be a very, very big drug, and we're super excited about the success that the team has produced to date.

Yeah. Well, we gathered more confidence in our own commercial effectiveness estimates. We obviously have an extensive dashboard that we track every little metric within the launch very carefully. And shout-out to the commercial effectiveness team. We've now tracked along those metrics. We're either at or ahead of pretty much every one of them across the board since launch. And that gives us not only confidence that that team is doing an exceptional job, but it allows us to lean into the forward forecast where they think we're going to go. And that's why we had this guidance raise in terms of both the target for the year and the overall peak sales estimate. And the peak sales estimate, just to comment about that because I've gotten a number of questions about it.

We upped that guidance in August because every year in August, we not only have a board meeting and an earnings call, but we take about a day and a half for a strategic offsite with the board where we do a 10-year forward view. What do we think is going on with the company? Where are we going? Big-picture stuff. To inform that discussion, we go back and we redo all of our market access, all of our forecasting with the latest data. Since we had shared that with the board and it was very clear that our TPIP estimates were out of date, BRINSUPRI was stronger than expected, it was time to update, and we thought that was appropriate.

You know I knew that that was going to come back to haunt me to provide that level of clarity. No, August is always a good time to ask us how we're feeling about things, as is the beginning of the year. Those are natural break points for us. As and when we get information and get a real sense of clarity and conviction, that's when you can expect us to update.

I think what's exciting about this is that we have gotten such strong performance as I just was reviewing in terms of revenue generation. The breadth and depth have been very good. We still see opportunity, though, both for breadth and depth of prescribing behavior. There are literally more than 25,000 physicians we call on for BRINSUPRI prescription writing. Of those, it is a small fraction that have actually written one or more prescriptions. There are some that have written none. There are some that have written a handful and are, as you say, trialists. Then there are some who are higher prescribers. What is the breakdown? We are not giving the exact percentages, but what I would say is if you were involved in the clinical trial and you know the drug, you are much more inclined to write and write in large volume. That is not surprising. What we are trying to do is spread that knowledge and that experience base across the balance of physicians that we have reached.

Those who are trialing are now hearing back from patients, and as a result of that positive feedback loop, are writing more. Those who have never written before are hearing through speaker bureaus or events that they attend at American Thoracic Society meeting or the upcoming CHEST meeting about the progress with the drug. The bottom line here is the message across the board is very positive. We have tens of thousands of patients who have now taken the drug. We have many physicians, thousands of them, that have written the drug. If you want to think about this as a log-normal distribution, there is a huge bolus of physicians that are now able to be aware that everyone around them is writing this prescription.