Ardelyx, Inc. 12th Annual Cantor Fitzgerald Global Healthcare Conference

Sure. Prakhar, thank you, and thank you for Cantor for inviting us. We are at an important juncture for the company. If you look at our guide for IBSRELA this year and XPHOZAH, it gets us to a place where we are on the cusp of profitability, which we have guided to in 2027. The business has continued to grow, contribute, and provide the benefit that we have always expected out of both of these indications, and excited for what we will accomplish this year as we enter 2027.

Sue, anything? Yeah, the one thing I would like to talk to is, with our company, we have put out our capital allocation priorities because, as Mike said, we are on the verge of profitability, so we want to make sure everybody is clear on where we are going to spend that money.

When you think about our currently marketed products, IBSRELA and XPHOZAH, spending money behind them and really trying to ensure that we continue to grow. Also importantly, our pipeline, so both our internal assets that we have announced are preclinical and are phase III, as well as pediatric trials, and then opportunistic M&A. And then finally, just the work we do around the financial discipline, whether it is refinancing and just doing the right uses with all the cash that we have.

Sure. Well, the simple answer is we got noticed. I think the success that we've seen with IBSRELA, where we grew 73% plus, 2025 over 2024, $274 million that we generated last year, moving into the guidance that we had of roughly 50% growth this year. The attention was being paid by the payers. As we saw dynamics beginning to change a bit in retrospect in Q4, we recognized the hurdles that payers were putting in place for our patients as they went through from the top of the funnel to ultimately getting a prescription fulfilled.

When we changed our guide during the second quarter earnings, it was based upon those frictions that we were seeing and the beginning of conversations that we're having with the payers to do what we can to lessen the burden of what both the patients and the healthcare practitioners have to go through in order to get a prescription filled.

Sure. Yeah, I think it's both.

We have seen step edits a lot of times going from LINZESS and having to then go back onto a generic lubiprostone, was one thing that we saw. Then also instead of a prior authorization, more of an easy access to a checkbox, it was, let's see your chart notes, and things like that. We heard that from the physician offices through our reps and everything else. Certainly being able to hear that then gives us the opportunity to act. That's what we're doing right now to help alleviate that as we go forward.

One of the things that we had actually started last year, which is helping with this, is the doubling of our field reimbursement managers. If you think about the journey that patients go through, I go to you as my physician saying with all my complaints, you say I have IBS-C. You prescribe IBSRELA for me, and that's the top of the funnel. Then ultimately the step edits, the pressures on prior authorizations that go through will determine how many actually come through the bottom. So we had doubled the number of people in the field helping with field reimbursement efforts to educate the offices on what it actually takes, and then other support that we have to help facilitate that. A really important one is the attempt to move, and we will over time, the prescriptions to go through our specialty pharmacy network called the IBSRELA Pharmacy Network.