Operator
Good day, and welcome to the Hansa Biopharma fourth-quarter and full-year 2025 financial results conference call. All participants will be in listen-only mode.
Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions.
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We ask that you limit yourself to one question, please. Please note that this event is being recorded.
I would now like to turn the conference over to Hansa Biopharma CEO, Renée Aguiar-Lucander. Please go ahead.
Renée Aguiar-Lucander
Thank you. Good afternoon and good morning.
Welcome to the Hansa Biopharma conference call to review Q4 and the results for the full year of 2025. I'm Renée Aguiar-Lucander, CEO of Hansa Biopharma, and joining me today is Evan Ballantyne, Chief Financial Officer; Richard Philipson, Chief Medical Officer; and Maria Törnsén, Chief Operating Officer and President, US.
Please turn to slide two. Please allow me to draw your attention to the fact we'll be making forward-looking statements during this presentation, and you should therefore apply appropriate caution.
Please turn to slide three and today's agenda. Let's move on to page four, please.
In terms of key achievements in Q4, Q4 saw strong growth over the same quarter last year, with product revenue growth of almost 140% and total revenue growth of 135%. Total revenues for the year amounted to 222.3 million SEK, or about $25 million, a growth of 46% compared to total revenues in 2024.
In Q4, we successfully also closed an equity round of 671.5 million Swedish kronor, or about $71 million US dollars, which will fund operations into 2027. As planned, we submitted our BLA application to the FDA in December of 2025, and we await their decision to accept the filing and communicate a PDUFA date, which we expect to receive shortly.
We also announced the plan development for HNSA-5487, which we plan to take into GBS, Guillain-Barré, in a late-stage trial before the end of this year. Finally, we also reorganized the European commercial organization as part of a broader initiative to improve transparency, accountability across the organization.
Please turn to slide five. So 2025 really was a year of transformation for the company.
Driven by senior leadership changes, several initiatives were successfully implemented to strengthen the organization and make it fit for purpose in a competitive global environment. We renegotiated the existing debt facility, strengthened the senior management team and brought in key expertise, restructured the organization and streamlined reporting lines.
We also clarified the positioning of HNSA-5487 and financed the company with two equity capital raises, ensuring runway into 2027. Please turn to slide six.
A recent area of focus has been the European commercial organization. As I pointed out previously, the launch in Europe was quite unusual, as there was very limited clinical data, as well as clinical experience, in Europe at the time.
The challenge of launching a product under these circumstances, with a large Phase 3 trial as well ongoing, should not be underestimated. I believe that the upcoming European Phase 3 readout, in combination with the presentation of the ConfIdeS data and expected real-world data publications from Europe, will positively impact this situation.
In addition, we launched a number of initiatives which are being rolled out this quarter. I expect this to impact performance to some extent, as all change management implementation tends to do this.
I would therefore expect a relatively weak development of revenues in Q1, complemented by a strong second half 2026 as these changes take effect. Please turn to slide seven.
In the US, we're faced with a very different landscape to that of Europe. We've recently read out the very successful ConfIdeS trial, and we're expecting additional data to become available, as I've already covered.
We have a well-resourced and data-backed plan for our pre-commercial activities, managed by a highly experienced and well-integrated team. Structurally, the US market is quite different from the European market in terms of organ allocation systems, pricing and reimbursement, patient advocacy, and data availability.
We believe that we're well-positioned to successfully launch the product into the market later this year, subject to approval. With that, I will hand over to Maria, who will provide some more details on these topics.
Maria Törnsén
Great. Thank you very much, Renée.
Next slide, please. Before I comment on our progress in Europe and international markets, I would like to take a moment to discuss the opportunity in front of us.
In Europe, we have up to 11,000 highly sensitized patients waiting for a kidney transplant. Most of these patients have waited for years, sometimes up to as long as 12 years.
When Idefirix was conditionally approved a few years ago, it was the first and only treatment approved for desensitization of highly sensitized patients. This is still the case, and Idefirix has no competition in this space.
Over the years since launch, we have more than 200 patients treated with Idefirix across 40 centers, at the same time as the company has been running a large Phase 3 study with 50 patients, the PAES study. Today, we are in a different position with significant additional data being released for imlifidase.
In September, we released the US ConfIdeS data, which European KOLs are showing great interest in. We have also published our 5-year data in November in Transplant International, and we are expecting more data to become available in 2026, in particular the readout of the PAES study and real-world evidence from European transplant centers, as well as additional data from the US ConfIdeS study.
All of these clinical data combined puts us in a good position to continue to progress the commercial adoption across Europe. Please turn to the next slide.
As Renée mentioned, we delivered solid growth in Q4, with 61.1 million Swedish krona product sales and 139% growth versus the same quarter 2024. The sales came from multiple European markets, but it is worth noting that we had sales in all five large European countries, including Germany, as you know faced some challenges in 2025.
I will comment more on the German situation shortly. As mentioned in last quarter's report, we have been working on securing regional reimbursement in some key regions, and one of them being Catalonia in Spain.
In December, we received positive news that the temporary funding for Idefirix has been approved by the Catalan pharmacy department. They are currently setting up the logistical and invoicing process, and we expect this to take a couple of months.
In the meantime, we know that there are already several Idefirix requests that have been sent in from hospitals in Catalonia to CatSalut, the Catalan Health Service. We are, as a result, cautiously optimistic that we will see improved sales from Spain in 2026.
From a market access perspective, we also gained reimbursement in Slovakia in Q4, bringing the total number of countries reimbursed to 24. In addition, we learned in November that the French ANSM made the decision to reimburse Idefirix for use in connection with lung transplants.
As Idefirix is only approved for use in kidney transplantation, and this decision to reimburse in lung transplantation is a result of the French lung transplant KOL community driving the process and asking the ANSM to provide special reimbursement for use in this patient population. As I mentioned on the previous slide, having access to clinical data is critical to drive further adoption of Idefirix.
In November, we arranged a large scientific event with 72 transplant experts from 17 countries. This meeting created a forum for the KOLs to discuss the latest data and facilitate best practice sharing between centers and countries.
In Germany, we faced some challenges in 2025, as mentioned in the last couple of quarterly reports. Germany decided to pause the participation in the Eurotransplant priority program for highly sensitized patients.
We have worked diligently across public affairs and medical affairs to understand how and if and when this program can potentially be reinstated. At this point in time, it is our assessment that it will take some time before the German Bundesärztekammer has decided whether to continue participating in this program or not.
We do not believe there's a path for us to speed up this process as it is an administrative process driven by the Bundesärztekammer. At the same time, we also know that the majority, approximately two-thirds of highly sensitized patients, are on the normal ETKAS wait list in Germany, and German transplant centers can transplant patients with imlifidase in this program.
In Q4, German KOLs started writing new guidelines for the ETKAS program. We hope that these guidelines will be published in the first half of 2026 to help guide German transplant centers on how to delist highly sensitized patients to enable transplantation with Idefirix.
The German KOLs believe that this is the best path forward to facilitate future transplants. Finally, we made some operational changes to our European organization in Q4.
In December, we appointed Max Sakajja to lead our European and international organization. We have also made some other changes to our operations in Europe, which we believe will, in the long term, enable the region to perform better.
Please turn to the next slide for the US market. Turning to the US market and the opportunity in front of us, assuming FDA approval.
We know that there is a high unmet need in the US as there is currently no approved desensitization therapy for highly sensitized patients, and these patients wait for years to have a matching kidney, which may never arrive. In the US, there are approximately 15,000 patients who are highly sensitized, meaning they have a cPRA over 80%.
In the category above 98% cPRA, there are 7,000 patients, and in the most highly sensitized patients, the population studied in ConfIdeS, there are 3,500 patients waiting for a transplant today. Each year, thousands of patients die or become too sick to transplant, and the wait list continues to grow, again, confirming the unmet need that exists in this population.
We know this not only from published statistics, but also from both KOLs and patients, as they reach out to our medical affairs and patient advocacy team almost on a weekly basis to ask when imlifidase will be available in the US. It is with these patients in mind that we move swiftly to prepare for potential US launch and bring imlifidase to the US market.
Please turn to slide 11. Our launch preparations are ongoing, and we will be launch-ready at PDUFA.
There are 200 transplant centers in the US, and 100 of these centers drive 80% of the transplant volume, and the 25 centers who participated in ConfIdeS represent 25% of the volume. From a launch perspective, our current assumption is that the initial uptake will come from larger centers with clinical experience, and we believe we are in a great position with the clinical knowledge that exists already today in the US.
From a reimbursement and access perspective, imlifidase will be an inpatient treatment covered by the patient's medical insurance. Hospitals are reimbursed via DRG payments and outlier payments for kidney transplants.
That is something that they are familiar with today. We will apply for NTAP, New Technology Add-on Payment, which, if granted, will provide a separate Medicare payment to hospitals when imlifidase is used.
Most large and academic hospitals have experience in this form of reimbursement from adopting new therapies such as the CAR Ts for the inpatient setting. Our market access leader is very experienced, and he is in the process of bringing in a field access team in Q1.
This team will be charged with working with the transplant centers' financial stakeholders to ensure access for patients post-approval. We also have US pricing research ongoing, and we are in the process of defining our supply and distribution network.
In addition to our access team, we are also expanding our field-based medical team in Q1. Our current team have significant transplant experience, and we are looking to add additional team members with similar expertise.
Finally, on the commercial side, we hired a Senior Vice President in December, and she joined the organization in January. She joined Hansa with transplant and nephrology experience, and she will be charged with building up our commercial team prior to PDUFA.
With that, I would like to hand it over to our Chief Medical Officer, Richard Philipson, who will provide an update on our pipeline. Richard?
Richard Philipson
Thanks very much, Maria. I'd like to take a few minutes today to summarize the outcomes of the company's Phase 3 study in anti-GBM disease, or Goodpasture's disease.
I'll also briefly discuss next steps for the project. Next slide, please.
As a brief recap, this Phase 3 clinical trial was conducted at 48 centers in 14 countries in Europe, the UK, and the US. Enrollment began in the second quarter of 2023, and all patients were enrolled by the fourth quarter of 2024.
The study recruited patients aged 18 years or older with a diagnosis of anti-GBM disease based on serological testing of anti-GBM antibody levels, with an eGFR of less than 20 mls per minute calculated using the modified diet in renal disease formula. Patients with a diagnosis of anti-GBM disease made more than 10 days prior to randomization were excluded.
A total of 50 patients were randomized in a one-to-one ratio to one of two treatment arms. Patients randomized to the control arm started treatment with plasma exchange, or PLEX, within 24 hours of randomization.
Subsequent treatment with PLEX was determined based on anti-GBM antibody levels and using a schedule defined in the study protocol. In addition, cyclophosphamide was administered for a minimum of six cycles and a maximum of 10 cycles, and glucocorticoids were also given.
For patients randomized to the imlifidase treatment arm, imlifidase was administered as a single intravenous infusion as soon as possible after randomization, along with cyclophosphamide and corticosteroids. After an interval of at least 48 hours, patients started treatment with PLEX using the same approach as described for the control arm.
The primary endpoint in the study was renal function as evaluated by eGFR at six months, and the key secondary endpoint is the proportion of patients with functioning kidneys at six months, defined as no dialysis events within four weeks prior to the assessment. Next slide, please.
Now moving on to the results. A total of 50 subjects were randomized to the study.
However, one subject was excluded from the efficacy analysis following a diagnosis of hantavirus infection as the primary cause of illness made after randomization. Therefore, 49 subjects were included in the full analysis set for the evaluation of efficacy, and of these, 47 subjects, or 96%, completed the trial.
In brief, 49% of subjects were male, 88% were white, and the mean age of the trial population was 59 years. At the time of enrollment, 45% of subjects were dialysis-dependent, and 57% had a history of smoking.
Next slide, please. Turning to the study outcomes, the primary endpoint, which was eGFR at six months, and the key secondary endpoint, which was proportion of patients with functioning kidney at six months, were not statistically significant.
There was no difference between treatment arms in the proportion of patients with end-stage kidney disease or death within six months. It is noteworthy that anti-GBM antibodies declined as expected following imlifidase treatment, and the safety [profile was consistent with previous experience?]
. Since the announcement of the results of the study at the end of last year, we've taken time to understand the study outcomes in more detail.
That work is ongoing, and we're particularly interested in determining whether any particular subgroup of patients derived benefit from the treatment. It's clear that the control arm of the study, the design of which reflected feedback from regulatory authorities, performed much better than anticipated.
This likely reflects the rigorous administration of standard-of-care therapies, including PLEX, to patients in the study, and may not be achievable in real-world medical practice. We do not plan any further clinical trials in anti-GBM disease, but will, of course, present the outcomes of the study at a forthcoming conference.
With that, I'd now like to hand over to our Chief Financial Officer, Evan Ballantyne.
Evan Ballantyne
Thank you very much, Richard. Next slide, please.
Sales performance. For the fourth quarter, total revenue reached 222.3 million SEK, up 30%, or 51 million SEK, year over year.
Full-year product sales were 204.7 million SEK, representing a 46% increase, or 64.6 million SEK, compared to the prior year of 140.1 million SEK. Fourth-quarter performance was particularly strong, with total revenue of 76 million SEK, up 135%, or 43.7 million SEK, year over year.
Idefirix product sales in Q4 were 61.1 million SEK, increasing 139%, or 35.5 million SEK, compared to the same period last year. Fourth-quarter contract sales, primarily from AskBio, were 14.9 million SEK.
As we've previously noted, while full-year Idefirix sales were strong, quarterly results can fluctuate due to the inherent variability of the European kidney allocation systems. Next slide, please.
SG&A expense. SG&A expense totaled approximately 101.6 million SEK for the fourth quarter, compared to 88 million SEK in the fourth quarter of 2024, representing an increase of 14 million SEK, or 15%.
On a full-year basis, SG&A expense of 357 million SEK was 13 million SEK, or 4%, higher compared to the same period a year ago of 344 million SEK. Excluding a 21 million SEK restructuring charge recorded in the second quarter of 2025, SG&A expenses were slightly favorable compared to the full year 2024.
R&D expense. 2025 R&D expense totaled approximately 304.7 million SEK for the full year, compared to 376 million SEK in 2024.
This represents an improvement of approximately 71 million SEK, or 19%, compared to the prior year. In the fourth quarter of 2025, R&D expense of 74.4 million SEK was 27 million SEK, or 26%, favorable compared to the fourth quarter in 2024 of 101 million SEK.
With the completion of enrollment for both the ConfIdeS and the PAES clinical trials, R&D expense should continue to decline. Operating loss.
For the full year 2025, the company's operating loss of 521 million SEK was an improvement of 116 million SEK, or 18%, compared to the operating loss of 637 million SEK in 2024. In the fourth quarter, the operating loss of approximately 125 million SEK was an improvement of 49 million SEK, or 28%, compared to the same period in 2024 of 174 million SEK.
The year-over-year improvement in operating results is driven by strong revenue growth and a continued focus on controlling operating expenses. Next slide, please.
Cash. Cash used in operations for the fourth quarter totaled 149 million SEK and 140 49 million SEK for the full year ended December 31st.
As previously mentioned, the company completed a direct share issue of approximately 671.5 million SEK, or approximately $71.3 million US dollars, for the fourth quarter. At December 31st, 2025, cash and cash equivalents totaled 100 701 million SEK.
Now I'd like to turn the call back to Renée for closing remarks and Q&A.
Renée Aguiar-Lucander
Thank you, Evan. Please turn to the next page.
In summary, during 2025, we have built a strong foundation to capitalize on the strong science, competitive advantage, and deep expertise in Hansa Biopharma. We've developed a clear roadmap with clear strategic imperatives reflecting the many key inflection points in 2026.
This includes the communication of our PDUFA date, readout of the PAES trial, presentation and publication of ConfIdeS data, agreement with the FDA regarding our development program in GBS, and the potential approval of imlifidase in the US and launch into the US market, as well as the filing for full approval in Europe. The entire organization is now highly focused on execution, leveraging the agility, clarity of vision and mission, strong expertise, and highly integrated cross-functional teams.
We value accountability, transparency, and strong horizontal communication, and we are driven by our overarching ambition to deliver novel treatment solutions to patients with unmet medical needs. Please turn to the next slide.
I cannot emphasize enough the value of the highly experienced team in Hansa. This is only the most senior level on this page, but I can assure you that the level of experience and expertise runs deep in the organization, and I truly believe that the importance and value of highly motivated and clearly aligned human resources cannot be overestimated in this industry.
We all look forward to delivering on our hopes and dreams in 2026, and we hope that you will continue to support us on this journey. With that, I will hand over for Q&A.
Operator
Thank you. We will now begin the question-and-answer session.
To ask a question, you may press star then one on your touchtone phone. If you're using a speakerphone, please pick up your handset before pressing the keys.
If at any time your question has been addressed and you would like to withdraw your question, please press star then two. If possible, please restrict yourself to one question, please.
At this time, we will pause momentarily to assemble our roster. The first question today comes from Farzin Haque with Jefferies.
Please go ahead.
Farzin Haque
Hi, thank you for taking my question. For the US launch, you talked about the launch preps underway.
It's a bit early, but do you have any initial feedback from payers on what reimbursement policies could potentially look like? Then on EU commercial operations, quickly, you provided some color on the broader impact going forward based on operational changes, but any color on revenue guidance for the year?
Renée Aguiar-Lucander
We're not going to provide any revenue guidance for the year at this stage, but I will hand over to Maria to address the question on reimbursement.
Maria Törnsén
Sure. Thank you for the question.
As I mentioned before, this is a well-established pathway in the US. It's an inpatient drug covered by the patient's medical insurance, and we know that the majority of patients are on Medicare in the US.
The concept of getting reimbursed for kidney transplant with the DRG code is well-established, and so is also the outlier payments that the hospitals can apply for anything not covered by the DRG. The other path we're taking is, as I mentioned, the the NTAP path.
We're going to apply for NTAP that would allow, if approved, an extra payment from Medicare. That pathway has been well-established with the CAR Ts.
The pathway itself is not really an unknown thing for US, for the healthcare system. As part of the pre-launch work, what we are doing is obviously engaging with each hospital's financial stakeholders to understand their particular expertise in doing this, and if they have expertise as an example in applying the NTAP from CAR Ts, you know.
That's some some of the work that is ongoing currently, but it's not a it's not a new it's not a new reimbursement pathway. I think, that's the best way I can answer it.
The work is ongoing at the moment to really understand on a center-by-center, what what is their sort of expertise and experience in doing this.
Farzin Haque
Perfect. Thank you so much.
Maria Törnsén
You're welcome.
Operator
The next question comes from Suzanne [Cam Voorthuizen?] with Kempen.
Please go ahead.
Suzanne van Voorthuizen
Hi, good afternoon. This is Suzanne from Kempen.
Looking a bit ahead on the potential launch of imlifidase in the US, can you elaborate a bit more on the opportunity? One, if you can help drill down the actual addressable patient population on an annual basis.
You mentioned a couple of thousand patients in the higher cPRA subset on the wait list, but there's also a certain number of transplantations that occur in any given year at targeted centers. Second, on the pricing, what kind of flexibility you see there for the US, noting that there is a price point in Europe and there is, of course, the most favored nation elements.
Last, how do you believe we should think around the trajectory of sales in the first years of a launch? Thank you.
Renée Aguiar-Lucander
Why don't you start, Maria, and take the question in terms of the market opportunity, and I will address some of the questions around MFN, etc.?
Maria Törnsén
Sure. The big benefit we have in the US is that the data available in terms of how many patients are at each center is remarkable.
We know, center by center, how many patients are listed for kidney transplant, how many are highly sensitized, their cPRA score, how long they've been on their wait list. That is data that is readily available in the US, so that again gives us a lot of confidence as we approach the launch.
If you want to think about the addressable patients on a national level, you have 15,000 patients on the wait list today above 80% cPRA. As I mentioned, if you go up to 98%, you have 7,000 patients, and in the most sensitized patients, the population to be studied in ConfIdeS, there are today 3,500 patients in the US in that group.
As I mentioned, we know where they are, center by center. The other thing I would say that each year in the US, there are 27,000 transplants going on.
Again, we know also, center by center, how many transplants are happening at each center. That goes back to my comment earlier on, 100 centers represent 80% of the volume, and we know that from statistics.
I think, at the end of the day, we don't know what our label will look like, but if you look at how the product has been used in Europe, where we don't have any cutoff on the cPRA, it's been used down to 80% as well. I think we'll see when we get the final label, but again, the market opportunity is significant in the US.
Renée, do you want to comment on the pricing and MFN, maybe?
Renée Aguiar-Lucander
Yes, I'll certainly take the MFN question, and maybe you can address something around the launch expectations. I guess the other things I just want to add is obviously that today, as Maria said, there are 100,000 patients on this waiting list, but we also know, obviously, that this particular kind of patient category, really quite a few of the kind of nephrologists or physicians may not put these patients on the waiting list today at all, because they would say what is the point of putting you on the waiting list, we know already that you're not going to get an organ offer, it's very, very difficult for you to do that.
I think that there is a gray area there in terms of which we are not going to really kind of know much more about until we actually have an approved product and can launch this into the market, but I'd like you to keep that in mind. Secondly, obviously, we know that there are about 45,000 or so patients added to this list every year, and about 20% of those are highly sensitized.
Again, you're having a very significant number of kind of additional patients being added, and that is again obviously without kind of having a real sense of what that kind of potential gray area looks like today. With regards to MFN, I guess that the price point in Europe today in terms of list price across most of these countries in Europe is around $350,000 per treatment.
As you also know, obviously, these prices are really based on kind of health economic analysis, and so are considered to be either kind of cost-neutral or cost savings to the systems, since they are set by the actual kind of countries themselves and not by the company. Knowing obviously that dialysis and comorbidities and other kind of costs in the system in the US are probably higher than what they are in Europe, we would not expect kind of to have a price in the US that are lower than what it is in Europe.
However, as Maria said, we are having price discussions, pricing research is ongoing, and obviously we will take all of that into account before we actually kind of set a price in the US. With regards to MFN, I guess my view would be that I think that, without kind of getting into any kind of political statements, but I do think that MFN is probably not the thing that I worry about the most in terms of this particular kind of rare disease area with limited kind of patient populations really that have really no alternatives today at all, and who face the most severe consequences of not being treated.
I'm sure we will hear more about this in the future, but again, I don't think that this is the area that would kind of be initially addressed or even be considered to be relevant to address in kind of the first or even second or third wave of any kind of future discussions on MFN. Do you want to talk a little bit, Maria, about potential kind of expectations around the launch or what we anticipate?
Maria Törnsén
Sure. I would start by saying, there's a lot of learnings we can take from Europe in terms of the launch that happened several years ago, but there's also some differences obviously in the US market.
Let's first look at the number of transplant centers. You have 200 centers, and as I mentioned, 100 of those represent 80% of the volume.
Our initial focus with the market access and medical team will be those top 100 centers. What we will do is, going back to what I mentioned before, we will both sort of understand the reimbursement pathway and their expertise, who are the people in each center that are involved in sort of applying those outlier payments and managing the reimbursement for kidney transplant.
Then the other path we will also obviously examine with our medical team is their clinical knowledge, do they have awareness of desensitization, are they doing that today, and to what extent. Our initial focus will be on those 100 centers.
I think the key learning is that having clinical experience will matter. That's why I made the comment earlier that we believe that the initial uptake will come from high-volume centers that are used to doing many transplants and that have clinical experience.
Going back to the fact that we have 25 centers in the US that have participated in ConfIdeS, I would expect those centers to be among the early adopters, but not limited to those 25 obviously. I think that's the way we're currently looking at the market is focus on those 100 centers, and those that have a clear knowledge of the reimbursement pathway and clinical knowledge, I think will be the early adopters.
I think what we need to keep in mind also is that we're launching into a new space, there's no other product in the US approved for desensitization that have the same mechanism of action as imlifidase and can do the same thing. There's a lot of interest from KOLs and from the patient community.
I mentioned it earlier that we get multiple requests already today from the community around when will the drug become available, when can I have access, I have a patient that I'm thinking about. I think the potential is clearly there, but as I mentioned, we'll take a very focused approach as we sort of prepare for launch in the US.
Operator
The next question comes from Douglas Tsao with H.C. Wainwright.
Please go ahead.
Douglas Tsao
Hi, good morning. Thanks for taking the questions.
I guess just in terms of following up on the reimbursement, Maria, you mentioned both the opportunity, this larger reimbursement through DRG for Medicare patients and the access of both, eventually apply for the NTAP, and I agree with you, institutions are generally very familiar with it. I'm just curious, you did note that before the NTAP, that hospitals would be able to access the outlier payments.
How much would that outlier payment cover the cost of imlifidase in the early going?
Renée Aguiar-Lucander
Do you want to take that, Maria?
Maria Törnsén
Sure. Very good question.
First, I would say that the concept of outlier payment exists already today. As the DRG codes are an amount that has a retrospective lookback at the costs for kidney transplant.
Hospitals are today applying the outlier payment for anything sort of addition that they may be doing for these patients. Then when it comes to how much will they be covered, that's a quite interesting mathematical exercise that it really depends on multiple factors: where the hospital is based, the cost of living of that state, as an example; and it also depends on what they are submitting to CMS.
A hospital could, in reality, submit a long list of things that they think they need coverage for and say, "I need an outlier payment for this." The CMS then has a mathematical formula that they apply, again, going back to, as an example, in which state the hospital is located, and look at what they determine are the appropriate costs for all of these things that the hospital has submitted for, and then they will do their mathematical calculation and they will go back to the hospital and say, "You know what?
This is what we will reimburse you for." It's hard to say.
It's not a precise number. It depends on sort of what they charge CMS for and this mathematical formula, but as I said, that is something hospitals are doing today.
They do outlier payments with DRG-tied Medicare reimbursements. I can't answer fully the question, but I hope that gave you some insight into how it works.
Douglas Tsao
No, no, no. I guess because so this would be kidney transplant with complications in terms of the DRG, and they submit a lot, and when you think about sort of typical DRGs or the outlier payments, because I think CMS typically kind of buckets them or thinks of them in roughly the same range.
Do you think you'd be able to cover a fair amount with imlifidase? Then I guess just as a follow-up, to the extent that there are patients in the early going who maybe reimbursement is not easily accessible, how are you thinking about sort of free goods and just the value of getting clinicians used to using the product in that early clinical experience versus maybe not sort of optimizing revenues in the early going and obviously free goods would impact your gross-to-net?
Thank you.
Maria Törnsén
I would say, first, to answer your question on getting outlier payments to cover a drug, and I would say that I'm confident that we will work with the hospitals to ensure that they can use imlifidase. As I mentioned, as part of the pre-launch work we're doing right now is sort of to understand what are they doing today, what does their P&T committee look like today.
I would not say that that is going to be something that is going to prevent us from having a successful launch. We will make that work, and I think one of the early learnings is that that sort of may look different from center to center in terms of how they today manage DRG payments and outlier payments.
I would not say that that is something that is going to prevent us. Then your comment on free goods, we don't have a policy for that right now.
I think that is something that we would assess as we come to launch. I'm obviously aware of the fact that companies tend to have a sort of policy around access to free drugs when they launch, and we'll have that as well when we have imlifidase, hopefully, approved in the US.
Douglas Tsao
Maybe, Doug,
Renée Aguiar-Lucander
one of the things I would just add is obviously just the Medicare reimbursement received for hospital care is not capped at DRG, right? DRG is a guaranteed kind of base payment that the hospital can expect to receive.
If you actually look at something like CAR T, which I think is a fairly good analog here, if you look at Kymriah, it was launched with a price of, I believe, just under $500,000 per treatment, and the assigned DRG had a base payment rate of $36,000 at that time. There was a pretty robust uptake of that, and I think certainly even hospitals were reporting that they were kind of profitable when they were providing CAR T treatment.
Again, I think that there is certainly kind of familiarity with the hospitals around these situations, and I don't think that one should get too kind of carried away with kind of the actual kind of DRG number per se, because it is more of a kind of guaranteed minimum, I would say, than a kind of this is the amount that the hospital actually receives, because I would probably bet you that that is probably not what a lot of the hospitals receive at the end of the day, depending on the patient, what they had to use, and again, as Maria said, the way that CMS looks at this. Anyway, hopefully, we've covered that for you.
Douglas Tsao
Great. That's very helpful.
Operator
The next question comes from Thomas Smith with Leerink Partners. Please go ahead.
Thomas J. Smith
Hey guys, good morning, and congrats on the progress, and thanks for taking the questions. Just on the US commercial launch preparations, you referred to some work you're doing refining the supply and distribution plans for Idefirix in the US, can you just elaborate on that and update us on the manufacturing and how you're thinking about distribution of the drug product in the states?
Then as a follow-up, I was hoping you could elaborate a bit on this interesting decision in France to expand reimbursement to include lung transplant. Are you expecting that we could see similar decisions in other European countries, and when it comes to the US, how are you thinking about potential adoption in other solid organ settings beyond kidney transplant?
Thanks so much.
Renée Aguiar-Lucander
Do you want to start off, Maria,
Maria Törnsén
with distribution and
Renée Aguiar-Lucander
supply?
Maria Törnsén
Sure. Sure.
Some more details on the supply and distribution. Our drug, imlifidase is is manufactured in Europe, and the work that we're doing now is selecting our 3PL and also deciding on our specialty distributors and what the network is going to look like.
Really the the question that we we are we are solving for is how do we get the drug into the US, and then when it comes into the US, the 3PL, what is the distribution network going to look like, what type which specialty distributors are we going to use, and then how are they going to purchase, the hospitals are going to purchase the drug from the SD. That's a very typical US sort of launch prep that we're doing.
When it comes to France and the lung transplant program, there is a KOL in France that has, I think a year a few years ago, used imlifidase in a compassionate use in a lung transplant patient. That is really how it started, that obviously saw the benefit of of using this, despite the fact that we don't have an indication in lung transplant.
This KOL and the other KOLs in the lung transplant community in France, they went to ANSM in in France and asked them to consider a special reimbursement for lung transplant. I would say that that that particular pathway is is has happened for other drugs in France as well.
ANSM has this pathway to, if a drug is approved in one indication, they can approve special reimbursement in other indications. That's what happened.
Obviously, this wasn't an approved indication for us, so, we don't we haven't generated any clinical data. That is sort of the the pathway that has been established in France since November.
You asked also about US, adoption across other transplants, I think that is a bit too early to say. I think if you, Renee, may want to comment on it, but if you look at the mechanism of action, you can understand why why, the French KOL decided to try imlifidase.
I think it's, something that is hard to tell at this point in time in the US. There is another publication from a center in the US that used imlifidase in a heart and liver transplant, that is a published case study.
It's sort of hard to judge at this point in time how and if, it will be used. I don't know, Renée, if you want to comment anything further on on on that sort of other organ transplant.
Renée Aguiar-Lucander
Sure. Yeah.
As Maria said, this is kind of tricky to kind of discuss off-label use when we don't really have an approved product at this point in time. I would say that subsequent to potential approval, obviously it would make sense for us to kind of revisit this whole area of potential label broadening with the FDA in terms of understanding what would they like to see, how did they look at this, and is there anything that we could do to try and facilitate some of this.
I think depend a lot on what regulatory advice we get regarding this potentially. I think, for now, we're really kind of just focused on getting the approval and launching in kidney, which is a very, very substantial opportunity.
We are aware, obviously, that there's a lot of perceived unmet medical need in all of these kind of transplant settings. I think we will kind of take one step at a time at this point.
Operator
The next question comes from David Nierengarten with Wedbush Securities. Please go ahead.
David Nierengarten
Hey, thanks for taking the question. I just had one on the future GBS study, just similarities or differences or other guidelines you could point to with other trials in the field like Annexon's in GBS, and just if there were key differences or similarities you were looking for when you talk with the FDA about that design.
Thanks.
Renée Aguiar-Lucander
I guess I'll have Richard comment on this shortly, but I guess that we're kind of internally at the stage where we are looking at a variety of different options to kind of bring to the FDA, and we will very shortly decide upon which way we're going to take this forward. Obviously in all of these kind of conversations with KOLs, various kind of trials have come up.
Also, like most drugs and most trials, they all have their benefits and drawbacks, and we should all learn from each other in terms of how to best kind of optimize for the benefit of the patient. Richard, I don't know if you have any specific comments on that.
Richard Philipson
Sure. I think there clearly are opportunities to learn.
Other development programs, other clinical trials are being conducted in the field, as Renée says. We're still at the stage of looking at different development program options, different clinical trial options.
I think it's also important, we do have evidence from our mechanism, from a previous study that we did. I think that provides us with useful information that we can use when we are designing our program for our molecule, 5487.
I think that's an equally important area of information that we're using along with, as Renée has said and you've indicated, learning from what other companies have done. I think the critical step really is to take our preferred design option, which we will very shortly identify, and take that for discussion with regulatory authorities, in particular the FDA.
I think that feedback will be critical in terms of determining the optimal way forward.
Operator
The next question comes from Richard Ramanius with Redeye. Please go ahead.
Richard Ramanius
Hello, good afternoon. I have one question.
When do you recognize revenue, and how long on average does cash conversion take from the time of the sale?
Renée Aguiar-Lucander
I'm sorry, you're breaking up a little bit. Can you repeat that question?
Sorry.
Richard Ramanius
When do you recognize revenue, and how long on average does it take to convert into cash?
Renée Aguiar-Lucander
Evan, do you want to take that question?
Evan Ballantyne
Sure. Great question.
We recognize revenue, as you would guess, under IFRS 15. We recognize revenue when the product ownership has been transferred from Hansa to the hospital.
As you're probably aware, some of the hospitals pay us based on an actual transplant, and some hospitals pay us could be 30, 60, or 90 days later. There is sometimes a timing difference between revenue recognition and the collection of cash in accounts receivable.
Operator
The next question comes from Erik Hultgård with Carnegie. Please go ahead.
Erik Hultgård
Yes, hi. Congrats on the quarter.
Two quick questions, if I may. First, on the Sarepta collaboration, you say in the report that you're actively reviewing the data and discussing the next steps.
When will you expect to communicate the outcome of these discussions? Then a short one for Evan on the annual costs for the full US organization when reps have been onboarded.
What's a rough number for that full organization? Thanks.
Renée Aguiar-Lucander
Thanks for that. In terms of the Sarepta collaboration, as I'm sure you're aware, Sarepta's having quite a lot of regulatory interactions at the moment with regards to their core business, and so that's really kind of where their focus is at the moment.
I think that the only thing that I can say is that we are continuing to have very constructive and good interactions, but we're also mindful of the fact that this program is probably not at the very top of the list at the moment for Sarepta, and so it's difficult for me to give you an exact timing of when we'll be able to kind of fully communicate exactly what the next steps are going to look like. That really is not, unfortunately, really under my control at the moment.
I can assure you as soon as we do, we will communicate it, and, as I said, we're kind of in ongoing kind of discussions and communication and conversation, but it is hard to kind of give an exact time at this point in time, and that has nothing to do with the interest in the program or any kind of anything else. I think it's just really a matter of priorities at Sarepta at this point in time.
Evan, do you want to take the second part?
Evan Ballantyne
Sorry, you broke up on that second part. Did you repeat that question, the second question?
Erik Hultgård
My second question related to the annual costs for the full US organization when the 20 reps have been onboarded.
Evan Ballantyne
Oh, sorry. Yeah.
We've baked that into our budget, and as Renée mentioned earlier, we have cash into 2027. We've anticipated those costs.
We haven't reported them or broke them out specifically, but if the US is a very, very large market, and I think to address that market with 18 to 20 different reps is a really good use of capital. Yeah.
Erik Hultgård
Sorry, Evan. My question was more about sort of how we should model costs on an annual basis when you have the full organization in place.
Evan Ballantyne
You should model them I think including the sort of 15 to 20 different reps we'll have in the commercial team under Maria, we'll probably have an equal number of support staff, including some SG&A and MSLs in the organization. Then I would take an average salary and wage for a US employee.
Erik Hultgård
All right.
Operator
This concludes our question-and-answer session. I would like to turn the conference back over to CEO Renée Aguiar-Lucander for any closing remarks.
Renée Aguiar-Lucander
Thank you very much. Thank you, everybody, for listening in to this presentation, and we hope to see you again soon.
Thank you.
Operator
The conference has now concluded. Thank you for attending today's presentation.
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