HLS Therapeutics Inc

TSX:HLS

Earnings Call Transcript 2022-Q2

[Operator]

Good morning, and welcome to the Q2 Fiscal 2020 Financial Results Conference Call for HLS Therapeutics. On this morning's call we have Gilbert Godin, Chief Executive Officer; and Tim Hendrickson, Chief Financial Officer.

Earlier this morning, HLS issued a news release announcing financial results for the 3 and 6-month periods ending June 30, 2022. This news release along with the company's MD&A and financial statements will be available on HLS' website and on SEDAR. Please note that slides accompanying today's call can be viewed via the webcast, a link on which is available in the company's earnings press release and at its website on the Events page.

Certain matters discussed in today's conference call or answers that may be given to questions could constitute forward-looking statements. Actual results could differ materially from those anticipated. Risk factors that could affect results are detailed in the company's annual information form which has been filed on SEDAR at www.sedar.com. During this conference call HLS will refer to adjusted EBITDA. Adjusted EBITDA does not have any standardized meaning prescribed by IFRS. Adjusted EBITDA is defined in the company's press release and annual filings that are available on SEDAR and on the company's website. Please note that all financial information provided is in U.S. dollars unless otherwise specified.

I now would like to turn the meeting over to Mr. Godin. Please go ahead, sir.

[Gilbert Godin, executive]

Thank you, operator, and good morning everyone. Thank you for joining us. On our call today I will start off with a review of our recent highlights. Tim will follow with a more detailed look at our financial results and then we will hold a Q&A session.

The second quarter results reflect the reliable performance from our foundational products and our ability to generate positive adjusted EBITDA and cash from operations all while investing in the significant growth potential of Vascepa. Revenue for the quarter was $15.5 million and given the strength of the U.S. dollar that would have been almost $16 million on a constant currency basis. Adjusted EBITDA was $6.2 million and cash from operations was $3.5 million.

Turning your attention to the first slide. The most significant event of the second quarter was the signing of the letter of intent or the LOI with the pCPA for Vascepa which paved the way for public reimbursement of Vascepa in Canada. We believe this will be the single greatest catalyst to realize the growth potential of the product. Shortly after signing the LOI we signed reimbursement agreements with Quebec, New Brunswick, the Northwest Territories and the noninsured health benefits program for First Nations and INWIT people.

Then just a couple of weeks ago we signed agreements with Ontario and Saskatchewan. Of note, Ontario alone has been responsible for more than 50% of all Vascepa prescriptions since launch. So this is obviously a key development for us. As a result with 5 months to go in the second half of 2022 we now have public reimbursement for Vascepa for approximately 70% of Canadians on public plans and as well as for more than 95% of Canadians on private plans who are in labor.

With the onset of public reimbursement the catalysts are now all in place to generate prescription growth of Vascepa. While all these catalysts shown here are necessary to achieve the product's full potential, public market access is the most significant development to drive growth of the product. It effectively doubles the market size and it provides universal access and what we mean by that is that both private and public payers reimbursement thereby simplifying the message that can be conveyed to physicians and helping to remove any inhibitions that certain physicians may have when faced with reimbursement uncertainty.

On the next slide we're working closely with our partner Pfizer to wrap up our outreach efforts to the physician community. The frequency of interactions with physicians is key for driving adoption and sales execution is a key focus right now as we work to make this important medication accessible to all Canadians who need it. The slide shows a call activity with physicians for Vascepa over the past 10 months. It begins last August which was the month before the co-promotion agreement took hold followed by September where their first few calls were made.

Note, this chart includes all calls made by both sales force in aggregate. On this graph, we can see the initial calls ramp up into November before we got hit with the impact of the Omicron lockdowns from December through February curtailing call volumes by about 40%. Secondly, we see call volumes rebounding in March as pandemic restrictions were lifted. Importantly, the number of in-person calls also started to increase during that period.

Finally, we see the strong pace starting in March continuing through April and May and then another increase in June on the heels of signing the first of the public listing agreements. The level of in-person calls progressed all along the second quarter settling now close to 80%. We're targeting more than 10,000 physicians to date and expect this higher pace of call activity generated in the second quarter to continue throughout the year perhaps with the usual vacation impact during the summer months. Overall, we're catching up towards our annual 2022 objectives in terms of the frequency of physicians targeting making up for the pandemic-related hurdles that were in place for much of the first quarter of '22.

The next slide shows the evolution of physician groups and their relative level of prescribing volumes for Vascepa. Specialists, cardiologists and endocrinologists denoted here in blue and dark gray, in particular, were very important initially as we set out the key opinion leaders in the field of cardiovascular disease prevention to adopt usage of Vascepa. Over time, general practitioners who make up 80% of our physician targets will become the greatest source of prescription volumes for Vascepa.

And you can see here on the green line that this transition is already starting to occur as they are now the highest prescribing group in absolute numbers even though our coverage of GPs is more recent and intensifying now. During the second quarter, GPs accounted for 43% of new prescriptions and 34% of total prescriptions. These are early indicators of the positive impact being realized from the expansion of our commercial footprint with our partner Pfizer. And GP engagement will accelerate further now that public reimbursement agreements have begun to be completed.

The chart on the next slide represents our progress after 9 quarters of commercialization, a curve that until now has shown the steady and steady prescription growth of Vascepa since its launch despite the pervasive impact of the pandemic during that time and limited market access. This is changing.

As you can see on the chart the national prescriptions progress during the month of July has started to reflect the public access uptake being experienced in Quebec even though it has barely started and that the demographic weight of Quebec is only 22% of the country's population. That should accelerate further with Quebec getting to standard claim progressing time and Ontario's large public market coming online.

Talking about Quebec as you can see on this next slide, I'm pleased to report that while the reimbursement are very recent they are still driving an acceleration of the uptake in [indiscernible] of 29% for the 2 months period since access was granted when compared to the 2 prior 2-month period. Now it's important to mention that after the inception of reimbursement we observed Quebec claim processing delays of 4, 5 and even 6 weeks which is longer than expected but apparently not unusual when a new product hits the formulary. And we now expect this claim processing time to revert to a more standard period of let's say 2 to 3 weeks. And my point here is that in spite of those delays, we've recorded TRx acceleration in Quebec that could track to exceed 30% on a normalized quarter-over-quarter basis.

If we come back to the second quarter through June 30 we saw strong growth in annualized key metrics related to Vascepa. The number of prescriptions year-over-year was 88% while the number of physicians prescribing Vascepa was up 131% and the number of patients having used the product was up 107% year-over-year. Promotional efforts right now are focused on continuing to expand the base of potential prescribers.

As the process goes, combining reach and frequency is the key to product trial and adoption. At this point, the strategy and desired outcome is relatively simple. More calls on more doctors at the time of broadening reimbursement will equate to more usage of the product and more cardiovascular prevention for Canadians. We're finally entering a powerful stage in the commercialization of Vascepa with public reimbursement now in place for 70% of the market. We believe we'll see an acceleration of our uptake that will further steepen our TRx curve.

Starting in Q3, we believe that our sequential quarter-over-quarter prescription growth will now evolve from the recent 18% to 20% range to more than 30%. With that, I'd like now to take a look at other products in the portfolio. [ PERSERIS ] again contributed to solid cash flow in the second quarter and we grew our patient count at an annualized rate of 2% in the quarter, reflecting 4 straight months of patient growth following the Omicron lockdowns.

The growth while modest continues to exceed the growth of the broader market meaning we're maintaining and at times adding market shares to our already leading position. This is a testament to our team, our CSAN network and our focus on innovation with solutions such as CSAN Pronto. New patient initiations and revenue levels have begun to return to more normal levels following the most recent lockdown. As discussed previously, lockdowns or other Covid restrictions pose a significant and fairly unique challenge for the mental health setting of care. We think prescription patterns will continue to normalize if we're able to avoid any new disruptions in the fall.

Further, as in-person interactions returned to more traditional levels we expect new patient access to the treatment should improve and that the market could trend back towards its historical growth rate of 2% to 4%. CSAN Pronto our point-of-care safety blood monitoring device replaces venous blood draws which is the #1 barrier to clozapine treatment.

We continue to make progress with this rollout with 81 CSAN Pronto devices up from 69 at the end of the first quarter that have now been deployed and are being used for more than 1,000 patients up from 800 under the care of more than 325 physicians also up from 280. I'm also proud to report a great milestone and that is the 10,000 point-of-care test that was performed earlier this week. Our deployment efforts remain focused on larger institutions and on getting the devices implemented and user strength.

Regarding PERSERIS in June, negotiations with the pCPA concluded without an agreement as it relates to public reimbursement for the product. This was a disappointing outcome given that [ CADET ] had made a positive listing recommendation on terms that the pCPA was unwilling to accept.

The most reasonable way forward for the product is to pursue public listing agreements individually with only those provinces that are interested in the product. PERSERIS is unique subcutaneous long-acting delivery formulation of risperidone, is a valuable treatment option to patients and practitioners in a challenging set of disease states. Our direct discussion with provinces should be gained later this summer.

Our launch of the MyCare therapeutic drug monitoring diagnostic technology is progressing as planned. So therapeutic drug monitoring diagnostic technology that are summarized as TDM. We're engaging with 2 distinct audiences regulating supply and demand for that technology. And they are for to psychiatrist that need to learn how to apply the benefits of TDM in dosing their patients with the right drug and at the right level. And institutional lab specialist, and these are chemists and biochemists that will integrate those tests in their laboratory so they are available and can be performed diligently when prescribed.

The current phase of the launch consists of ongoing educational programs to highlight MyCare's value for precision medicine and working collaboratively with physicians around specific clinical cases. The response at this early stage is very enthusiastic.

With that, I will turn it over to Tim for a closer look at our second quarter financials.

[Tim Hendrickson, executive]

Thank you, Gilbert, and good morning everyone. I will start with revenues and product sales. Overall Q2 revenues were $15.5 million up 4% year-over-year. Drilling down within this the company's product sales in Canada were up 11% in Canadian dollar terms driven by the growth of Vascepa net sales and were up 87% year-over-year, again in Canadian dollar terms following increased sales activity and where results were largely driven by patients with private insurance access as Vascepa has covered for more than 95% of privately insured patients in label. With public reimbursement agreements now in place with provinces and territories covering nearly 70% of publicly insured Canadians we now expect that the sequential and annual growth rates for Vascepa will accelerate.

During the quarter Clozaril sales were very stable, off just 2% in Canadian dollar terms from very strong levels a year ago. Compared with the same period last year the U.S. dollar had appreciated 4%. So reported results for Canadian products were up 7% year-over-year when translated to U.S. dollars. For the U.S. market there is a small $0.1 million decrease in Clozaril net sales, reflecting modest volume erosion offset in part by pricing changes.

Royalty revenue was $2.3 million in Q2 up $0.1 million or 5% from Q2 last year. Year-to-date royalty revenue from the 3 currently commercialized products in the royalty portfolio has grown 6% to $5 million. The fourth product in the portfolio [ Sanofi's Alglucosidase alfa ] has yet to be commercialized but we were very pleased to find out at the end of June that this product was approved by the European Commission which followed a similar approval in Japan earlier this year. Sanofi had shared that the target date for an FDA response for the U.S. market will be in the third quarter of this year.

Operating expenses in Q2 increased 12% from Q2 2021. The increase in cost of product sales was driven by the year-over-year increase in Vascepa sales while the increase in other operating expenses were led by increased selling and marketing costs for Vascepa as well as initial introductory spending related to MyCare. Those increases were partially offset by modest reductions in medical, regulatory and patient support activities while general and administrative costs were relatively flat year-over-year.

On a sequential quarterly basis, selling and marketing expenses increased in response to the removal of pandemic-related lockdowns at the end of Q1 and a resumption of a higher level of sales-related activity that is more indicative of the combined level of support going forward for Vascepa from both the specialists and primary care teams.

Adjusted EBITDA in Q2 was $6.2 million just 6% lower year-over-year as revenue growth was offset by increases in Vascepa cost of product sales and the renewed selling and marketing costs. We have kept a close eye on costs throughout the pandemic while still making the necessary investments to support the growth and potential of Vascepa. Medical, regulatory and patient support costs and even general and administrative costs have remained essentially flat were declining both this quarter and year-to-date.

Even in a quarter like Q2 where we notably increased our sales and marketing activities for Vascepa, we continue to generate solid adjusted EBITDA results. Of note there are 2 items in Q2 that are included in transaction and other costs. Following the June 22 conclusion of pCPA negotiations without an agreement for public reimbursement of PERSERIS, a disappointing outcome given the earlier favorable listing recommendation from the Health Technology Agency.

We are expecting this to result in a delay in commercialization with a corresponding $3.1 million noncash partial impairment charge related to the PERSERIS intangible asset as we'll now seek to negotiate separate public listing agreements directly with provinces. Second, we had a onetime $1.3 million charge related to the retirement of the Executive Chair of the company and the elimination of the Executive Chair role.

In Q2, we generated cash from operations of $3.5 million up from $1.7 million in Q2 last year. Year-to-date cash from operations is $9.3 million compared to $8.9 million in the same period last year. Cash and cash equivalents were $21.2 million at June 30 which is essentially unchanged from cash at year-end. With solid fundamentals in place, increasingly diversified revenue, sustained adjusted EBITDA and reliable cash from operations we have continued to deleverage the business from $185 million of debt at the company's inception down to $97.1 million at year-end to $91.1 million at June 30, 2022.

In addition to the cash balance and positive cash from operations the company is able to request incremental loans up to a maximum of $70 million to support acquisitions and other growth opportunities as well as a revolver facility that was undrawn at June 30. The approval of Alglucosidase alfa by the European Commission at the end of June is a positive development that brings us much closer to the start of royalties on global sales of this product. That approval also triggered a $10 million regulatory approval milestone. When the portfolio of royalty interests were purchased in September 2020, a $10 million increase in the revolver facility was put in place to support that milestone payment in July borrowing on that revolver facility was used to fund the milestone payment as originally contemplated and the remaining $25 million facility remains undrawn.

There are no further regulatory or pre-commercial milestones for Alglucosidase alfa or any of the royalty interests. The company has a normal course issuer bid in place to allow us to repurchase company shares. Through June 2022, we have spent $0.4 million this year purchasing shares for cancellation under the NCIB, a significant increase over previous levels. While there is no guarantee we will continue to be active on the buyback going forward. We view this as an appropriate use of capital in the current circumstances.

Finally yesterday, the Board of Directors declared that the subsequent quarterly dividend of CAD 0.05 per outstanding common share is to be paid on December 15, 2022 to shareholders of record as of October 31, 2022.

With that, I'll pass it back to Gilbert for his closing comments.

[Gilbert Godin, executive]

In summary, for almost 8 quarters now we've been staying focused, keeping our head down, dealing with challenging market conditions. This is the moment we've been working for and waiting with Vascepa. And similarly, it's a return to a more favorable environment in our CNS business which will allow for a resumption of our stream performance. That's why we are very excited with the opportunity in front of us.

The catalyst for Vascepa have come together and with public access at nearly 70% today, we're poised for strong and steady increases in prescription. In the near term, we will continue to work on securing public reimbursement in the remaining provinces and territories but our primary focus otherwise will be on sales execution to continue our work on raising awareness for Vascepa among the physician community and to translate that awareness into adoption. That concludes my prepared remarks.

At this point, I will ask the operator to please provide instructions for asking questions.

[Operator]

And your first question will be from Justin Keywood at Stifel GMP.

[Justin Keywood, analyst]

I'm wondering if there's any change in the Pfizer partnership given the public access that has been recently achieved if there's an acceleration of any efforts on Pfizer's behalf or greater outreach to physicians across Canada?

[Gilbert Godin, executive]

I would say that the change is definitely in the level of excitement. The idea originally and plans are made to be deployed and reassessed. But originally, when they joined in the fall our hope was that the public reimbursement was to be a bit more imminent. It took more time for reasons that are related to the negotiation.

But the idea was to expand as the access was expanding and to combine those 2 elements in forceful fashion. So it didn't happen in that perfect chronology. But nonetheless, we're now at the point where those elements are freeing up our field resources from those constraints. So I would say that they're definitely excited. The change is that it enables a different dialogue one that is much more rooted in action.

And I wanted to say it's equally true for our sales representative, right? So I think that while we were catering to the needs of specialists for the most part we were also at times in those provinces confronted to the limitations of the reimbursement. So I would say that this is probably the most important element. Otherwise, what they were trying to do remains the same. Task at hand is the same, broadening the target, reaching the frequency that will eventually allow for a trial and hopefully down the road in adoption of the therapy.

[Justin Keywood, analyst]

And then on the increase in the sales and marketing spend. Did that include any additional sales hires to support the launch of Vascepa now that the public access is in place?

[Gilbert Godin, executive]

There has been and there were no such plans. In other words we tried to get ahead of that curve. And I would as Tim pointed out, after the last lockdown in Canada with the activity resuming it also enabled the pursuit of, call them continuous medical educations or product theaters or activities that are quite productive but also have a cost. So I think it's more the reopening of field-related activities and interaction with physicians that's conducive to better activities but also a somewhat higher level of spending.

[Justin Keywood, analyst]

And then maybe a question for Tim. I'm just wondering at the time when we see the script data for that to be realized into revenue in the financials for HLS, if there's a lag, I assume there is?

[Tim Hendrickson, executive]

There is. As the business grows that lag should become less noticeable just given the business but it does take some time. And then there's also the time between when a prescription is issued and then when it's filled when the insurance coverage is granted and then a regular pattern of repeats and refills and then it becomes kind of a more normalized thing after that. But as the business starts to accelerate now you should see that more directly translate from one to the other.

[Justin Keywood, analyst]

Just in broad terms, any indication of what that lag could be as far as weeks or months?

[Tim Hendrickson, executive]

I'm going to give you I guess a piece of information that it's more of an opinion and deeply rooted in fact. What we've observed I think we made a comment in Quebec. We're surprised to see that it was taking so long to precede the initial scripts and then kind of realize that getting a new product on the formulary has somewhat of a learning curve and that this would boil down.

But I think thinking in terms of a few weeks to a month appears to be a reasonable assumption. It usually is something that will impact the initial prescription. The product is regulated by a number of criteria. And most payers will make sure that those criteria are met. And therefore, it takes the form of a prior authorization for the first script and that could take a couple of weeks or a month. And it appears that in Ontario is much faster from what we can tell, it could be within a week. But on average private payers or public payers will take let's say a couple of weeks, it could go to a month before the first script is approved.

And then, of course, the renewal are not subject to the subsequent preapproval. So that's the kind of lag. It makes the growth less apparent when the overall business is small like it is still the case today. As we grow it becomes I would say fairly immaterial, a month's growth on a mature product is much less visible than it is on a product that is still technically speaking in its launch phase.

[Operator]

Next question is from Rahul Sarugaser at Raymond James.

[Rahul Sarugaser, analyst]

Congratulations again on the public investment this quarter. So I think maybe we on the Street might have been little bit exuberant in terms of our estimates on the flow-through from that into revenue this quarter, particularly because maybe we thought that private reimbursement would have lifted more just given the announcement while you've got the different provinces formularies [indiscernible] different formularies. So could you give us a sense for how private insurance scripts are tracking relative to how you perceive your guidance of the 30% quarter-over-quarter increase for the public?

[Unknown Executive]

First of all, we're putting out their views here that again are not always rooted or coming from a perfect algorithm. Some of that is related to past experiences and intuitive in nature. But to try to answer your question, Rahul, I would say that what we've attended to is the demand on coming from the private side of things in the environment that we were in that has been about bumping around throughout the pandemic between 15% to 25% last quarter was 18-ish percent.

This will be augmented by the volume coming now from the market opening on the public side of things. And the private patient themselves should also be subject of I would say more prescriptions because doctors are kind of freed up from that reimbursement consideration.

So I think that there's going to be eventually a component coming from the nascent public market starting to open. When the market is small the growth can be high but it's compounding on small numbers. And over time, as we get to more level of materiality the rate may go down but it's compounding on a higher number of patients.

So that's why we've allowed ourselves to talk about this quarter being a quarter. We think it's going to migrate towards 30% and hopefully north of 30%. The data that we will experience during that quarter will give us a better chance at assessing how the following quarter will be, right? It's very dynamic. There's a few moving parts here that we ourselves are also trying to capture and integrate into the overall picture but the growth is coming from different directions.

Market expanding, more physicians due to coverage and more physicians acting more frequently due to the reach upon them. So I think you'll have to bear with us where we're a little hard-pressed to give ultra-clear indications of what that will yield because it's very complicated.

But they're all trending in the red direction, right? So that's the exciting part of it is that finally rather than having a plus on one side and 2 minus on the others and trying to figure out the net effect of it. Now we're essentially seeing the flow increasing as a result of those positive catalysts.

[Rahul Sarugaser, analyst]

[indiscernible] analysis and I feel like I'm back in engineering school. So now maybe coming back to sort of to follow on from one of the questions that Justin had around the lag between scripts to revenue. And you alluded to it being sort of a few weeks to month potentially quicker in Ontario. Could you also give us a sense for the lag between once you've announced the formulary add to when we should expect that 30% quarter-over-quarter growth to start kicking in, particularly as we carve into our model, the addition of Alberta in B.C. eventually and some of the other provinces.

[Unknown Executive]

Again, opinions rather than facts. And as operational people, we try to follow in how the rubber meets the road and how these things happen, right? So from a reimbursement agreement which is essentially a news and an access we need to take it to the relevant actors and those actors are physicians. So the first step is we take the news to those doctors. Those doctors are now appraised of the availability of a product for a [ satin ] patients. Then the second phase is that those doctors don't see all those patients in the same week or in the next day, right? So there will be the normal course of those patients now going back to their physicians and their physicians being aware of the prescription possibility and enacting that if those doctors are really ready to do so, if access was the only remaining hurdle.

So I guess what I'm describing here is why these things they don't always move on block but they move nonetheless. And they move in a way that at some point almost becomes exponential in nature, right? Because this is happening at the scale of 500 physicians in a given region or a given province and it's in part related to how effective we are at conveying the news.

We use all kinds of means not only knocking on the door. We try to reach those doctors through other informational means. So that's the reason why I think that we announced reimbursement. We typically see movement departing from the previous trends within the first month. And then we can appreciate the velocity and the magnitude of that movement in the following couple of months.

So I would say that by the third month we should get a pretty good idea of the run rate of the impact, right? So Quebec happened essentially at the end of the second quarter. We got a little bit of it possibly in June. But to the second quarter we should see in Quebec a clearer extent of the impact. Ontario was official, I think July 21, right? So we're now in that first month and we're seeing some of the movement.

And I think that by the end of August and leaching into September we'll see the kind of the magnitude, the thrust of this big province coming online and having access to the product. So here again, I'm more illustrative of the phenomenon behind the numbers because it's hard at this stage to tell you precisely what that wave will be in terms of its amplitude. I think we'll know better especially if you have access to prescriptions or IQVIA data. We see this starting to happen week by week.

[Rahul Sarugaser, analyst]

And I think we're all looking forward to that inflection point. And into just one quick last question. [indiscernible] seems to be growing at a good sort of modest to steady rates. Clearly, your sales team there is quite effective. And given that we've seen sort of the other assets be relatively small and the write-down of it was, again, also relatively small. So could you maybe speak to the potential for looking for another large franchise neuro asset to put into that franchise given the strength of your team in that space.

[Unknown Executive]

We're always looking for those are. They're not common. If they're commercial stage they can have a value and a price that doesn't necessarily make them affordable but we're always looking nonetheless. Companion assets are easier to find.

And I think they bring the benefit of diversifying the source of the revenues. One thing here that I want to kind of stick my neck a little bit is that licensing assets in Canada is not as simple as it used to be. And that's in part because of this whole environment where reimbursements are becoming defining in the career of a product. And the reimbursement is not only being granted the reimbursement, it's also about the terms of that reimbursement.

So I think that in a world where we were licensing products and the main hurdle was gaining the approval and then we had a path forward. It seems that there's a couple more years to wait to see if the product will have the kind of overall conditions to succeed that are the result of the reimbursement and pricing decisions being made. So I think that in Canada that makes it more difficult to find assets that can justify an investment because it's only 3 or 4 years on the road that you'll figure out if you have the economic conditions where you [indiscernible].

[Operator]

[Operator Instructions] And your next question will be from Noel Atkinson at Clarus Securities.

[Unknown Analyst]

This is George [indiscernible] on behalf of Noel. Just a few questions here. With respect to Vascepa is there a potential to expand the Pfizer sales force beyond current levels? And can you also remind us what the compensation structure of your deal with Pfizer looks like?

[Gilbert Godin, executive]

Very rapidly, yes, there is always a possibility to expand our presence in the Canadian territory. We will make those assessments periodically and make the determination on the merit of the outcome we could be getting. There are no constraint or limitations but it would be either our decision or a joint decision. Tim, do you want to comment on the question?

[Tim Hendrickson, executive]

Happy to provide some color around that. Just stepping back the agreement is for primary care coverage or primary care physician coverage. Most of the calls, the overwhelming majority of the calls being performed are primary or first position calls and there are calls on physicians that are key prescribers or key targets for the Vascepa franchise. So this is really the effort that is most beneficial to getting the message out for Vascepa.

And in terms of the compensation or the structure of the agreement it basically blows down to kind of sort of 2 components. One is an activity fee that is compensating for the delivery of exactly that. Those primary details on the key prescribing targets that have been identified. So we're making sure that it's very targeted and focused on what will drive the business forward. And then secondly, there's also an incentive fee that ensures that our partner like us is very much focused on ensuring that we achieve the net sales growth on Vascepa. And so there's really those 2 components making sure that the activity is targeted and focused and then also that it's delivering to net sales growth.

[Unknown Analyst]

With regards to the potential new right drug rates acquisitions or any other M&A opportunities. Could you talk a little bit about the competitive environment that you guys are seeing on that front?

[Unknown Executive]

Yes. If you're talking of products in particular, I think when it comes to Canada I wouldn't say that the competition is not high. There's always a few products in a few therapeutic classes where the competition is high. But I think when you look at the confirmation of the industry we tend to focus on segments. I don't like the word niche. I think cardiovascular is not a niche, it's a big segment. And psychiatry is a big segment, too.

But when you look at the players that are interested in licensing products in Canada in psychiatry, they are either very large because they're catering to a very large market. Depression being a good example or they're smaller. And they're catering to a small subset of physicians and of patients that would be the case of schizophrenia and that's where we are for the most part.

I could have taken a similar example in neurology where we have large indications and small indications and that sometimes delineates where certain players want to be and want to play and can be competitive in doing so. So long-preamble, just to say that when we're looking at assets I would say fairly rarely [indiscernible] places where it's going to be about the competition for the asset. It's much more about the fit. And it's in part because we have a culture of discipline here.

We try to be selective and judicious in our investments and that defines assets of a certain size and shape and duration of exclusivity or that have a potential to provide certain detailing economics. To sum it up, I would say the level of competition is always there. I wouldn't say that it's a dog fight. I think that the players are trying to find the right assets for their need. And unless you're in a very catch-all category the competition is not intense. It doesn't mean that the assets are all worth up taking.

[Operator]

And at this time, Mr. Godin, we have no further questions. Please proceed.

[Gilbert Godin, executive]

Thank you very much, and thank you all for being with us participating on today's call. We look forward to speaking with you again in the very near future.