Thank you so much for your patience tonight. I was having some IT issues with our main account, so I had to pop in on my second account here with my laptop. I want to thank everyone for coming tonight. I know we have a few more people expected to come in, but in the interest of time, to be respectful of everyone's time, we'll get going and start the recording. Recording in progress. So I wanted to introduce myself to anyone that may not know me. My name is Paola González. I am the president for PAs for Latino Health, and I want to welcome you to tonight's evening. Just briefly, wanted to give an update on what the organization is doing currently. We have our scholarship cycle that is quickly coming to an end on March 31st, 2024, so if you are a PA student or know of a PA student that could benefit from our scholarship, please direct them to our website at palh.org so that they can submit the application prior to the cycle closing. We will then proceed with reviewing of all the applications and aim to give our winners during the AAPA conference. We recently were at the Diversity in Dermatology conference, and there we were able to make some collaborations and alliances with some key sponsors as well as advocates for our diversity in our profession, so I'm looking forward to sharing that more as we continue. If you're not a member and you're here with us tonight, I would encourage you to join our organization. We aim to increase diversity in our profession, support our minority students as they enter the profession, and change advocacy, and legislative change rules to help support the Latino community. With that, I will go ahead and introduce Mitch Rosen. He's here to talk to us about a non-hormonal contraception option that is available to us as providers. I know when I went to PA school, we really didn't have a whole lot of options when it came to opportunities for contraception, and given today's climate about opportunities for our community to receive reproductive services, it is great to see that we have alternative options for our community. So with that, I will pass on the torch to Mitch. Thank you. Thanks so much for that intro, and nice to meet everybody virtually. Excited to talk to everybody about a non-hormonal birth control called Phexxi. And as you were saying with, you know, PA schools, if anybody is involved with a PA school, we are doing some outreach throughout the country doing trainings in, within PA training programs. So if that's something if that you're, working with, we're happy to support that. So, we're going to talk about Phexxi, why it's important, who the patients are, kind of how the product works, and the coverage. If everybody if you have a moment, if you can just drop a quick note in the chat of where you are located and what your specialty is. And at the end, I'll put my contact information out should you need anything. Because after this training, this is family now, so if there's anything I can do to support you, and the patients you serve, I'm here to help however I possibly can. So a few disclosures. This is a promotional program. Number one, I'm a little bit on the tail end of being sick, so hopefully I can get through this without a coughing attack. This is a promotional program. I'm the national director for Evofem Biosciences. Strange disclosure, I am also on the autism spectrum, so if I'm plowing along and I can't see your faces, if there's anything, this is super casual and informal. We're going to go through this, but if you need to stop at any point, if you have questions, jump right in. You can come off mute or put it in the chat. So, where I've been, I currently have been with Evofem since before Phexxi launched. I've also, and different products to market. I also work in the nonprofit space dealing with reproductive health, sex education, health equity, dealing with wonderful Planned Parenthood, dealing with reproductive health in Texas. So it's called Healthy Futures of Texas. Before we start, it's nice having a company that is for women that is run by someone who's truly amazing. So I just like to share I had, oh, am I able to share a screen? Yep. Give me one second. Sorry, I didn't do that before. No, it's okay. All right. You should be able to share now. Okay. Let's just do one quick intro. If you don't know Saundra Pelletier, she's truly an amazing human being. She ran the company as she was being treated for breast cancer. She's really a tireless warrior, and we're proud to call her boss. Just a little welcome. I was with her a few weeks ago, and I just wanted to bring her into the fold to create a video where you can just get a quick sense for who we are and what we're about. So this is Saundra. It looks like we lost your screen, Mitch. Yeah, I'm trying to. I think they changed. Well, let me know if you can hear this. My name is Saundra Pelletier, and I am the. Can you hear? Director of Evofem Biosciences. Yes, it's slow. If you can bring it up, that'd be great. To empowering women into embracing options and to deliver innovation in women's healthcare. That's why we brought Phexxi to the market every day despite and to ensure that healthcare providers, educators, and patients have access to the tools that they need to reduce unintended pregnancy. Our people are at the core of everything we do. Evofem is made up of individuals who genuinely care, but we can't do it alone. I am confident that with your support, we can create a compass in any of the rocky waters that exist. So today, I hope that you will listen. I hope that you will learn. And most importantly, that we will share how we can provide service to you and to your patients. Thank you. So that is Saundra. So let's talk a little bit about Phexxi. So before we talk about the actual product, and I do want to show real quick that Phexxi is an applicator. They come individually packaged in boxes of 12. If patients need more, they can get it through a prescription. It is a bioadhesive gel. The one thing I just want to demonstrate real quick is the first thing that people when they hear gels, wonderful, when they hear gels is it's messy or drippy. That's not something I want to use. And this is the actual gel, and I'm going to leave this here throughout the entire presentation. It's not going to go anywhere. It's bioadhesive, and it is lubricated. So the first thing, why do we need another birth control product, right? We've got a lot of great options, and we do. I've worked with to bring IUDs to market, pills, other products. Through this presentation, if I say to patients, "You drop off," and yell at me, and never invite me back. But this isn't here to put Phexxi versus anything else, right? We know that the best birth control is the one that is the best for that patient at that moment. And that may change multiple times through their life. So that's where we know we still have a very high unintended pregnancy in the U.S., and it's different in every states, and it's different in every age range and demographic. But we know that Phexxi has really fit a piece of the market that has needed a different option that was non-hormonal. So let's talk about that a little bit. And again, if you have any questions during this, jump in, any clarification that you need. But when it comes to the patients, these are the buckets where Phexxi has really fit in. And when we brought it to market, we heard a lot, "Oh, this is really a niche product." Like, "Oh, patient yeah, we have some patients that don't want hormones or can't take hormones." But if you look if you add up all of the buckets where Phexxi is appropriate and where it really has been well received, it represents the majority of patients that you may see on a daily basis. So when we talk about patients that don't want hormones or can't take hormones, that's an excess of 20 million patients in the U.S., right? That's a large bucket of potential patients that is, they either can't take hormones because they may have an underlying health condition. They may be on concomitant meds, whatever it is, or they've tried hormones, and they it just hasn't been right for them. They don't like it. So that's roughly, you know, between one quarter and a third of all potential patients in the U.S. So that's a pretty big bucket. You look patients that may be breastfeeding or postpartum. One of the big, unique places where Phexxi has fit in. Oh, thank you so much for posting that. Is because Phexxi is a different mechanism of action that we'll talk about in a little bit. It doesn't have to be Phexxi or something else. This doesn't have to be Phexxi or a condom, Phexxi or a pill, Phexxi or a bridge to an IUD. This can be Phexxi in conjunction with other products. So the one that has been really unique, and a lot of insurance payers and Medicaid will cover it, and if anybody towards the end will talk about some coverage and prescribing, if you have any state-specific questions, I can kind of walk you through that as well. But a lot of plans will cover multiple products at once. So you think about patients that are maybe on a birth control, and they may be on a birth control pill. We know that the average patient is missing 2-3 pills per month, and that's fine. That's not saying it's a bad product. It doesn't mean it's not right for them or the right choice for them. You know, life gets in the way sometimes, though. However, if we have a prescription for, say, a pill and Phexxi at the same time, if someone happens to miss a few pills and they're about to be sexually active, they're not in a place where they're scrambling, "What do I do? Do I have emergency contraception handy? Do I have a ride to the pharmacy? Can I afford it?" This can often be covered in the same prescription with an oral contraceptive. Same thing with IUDs and implants. It's see, why would I, you know, why would I put in the most effective form of birth control, and need another option? Well, if you're not doing a same-day insertion for an IUD, you may need a backup for that patient, right? If it's not inserted on their menses, you may need a backup. If you're not doing a same-day insertion, that patient's going to come back 4, 6, 8 weeks later, and the last thing we want is an unintended pregnancy while someone is waiting for the most effective birth control out there. So again, this could be an option for while they're waiting for their LARC to be inserted or implanted. Same thing with a pill, right? If a pill is not a day-one start, then this could also be the backup while at before they're if it's not a day-one start. That other piece with oral contraceptives is that same patient may start an oral contraceptive today. Phexxi could be a valuable backup. However, we know a significant amount of patients will return a year later, and you may look at the chart and you say, "Oh, you're ready for your refill of whatever it is." A significant amount of patients will abandon their hormonal method within the first few months because of side effects, and they'll never tell their provider. So by having a backup, this could be a valuable backup, but also if this is what they believe is best for them in the moment, the right choice, this could also be a good primary method for them. Another patient you may have someone that's not as sexually active. So Phexxi is only used when needed. So it's right before intercourse, never after. So if you have someone that's only sexually active one, two, three times a month, they may not want to be doing something every day if they're not as sexually active. Phexxi may meet them where they are by being a product that's only used when it's needed. Some patients may come off of hormonal birth control because of how it makes them feel. And they may be working with a mental health professional and coming off of a hormonal method because of mood irregularities. Whatever it is, this could be a valuable option. I think they're very interesting currently, and they're very hot topics that I wanted to bring to light. Number one, show of hands or if you want to come off mute. Is anyone familiar with stealthing in this group? With what again, Mitch? It's called stealthing. Mm-hmm. Okay. So I bring this up because I was at a sexual health conference a few weeks ago, and I hadn't I was not familiar with it either. And then I was talking to an expert in the field on it, and was just blown away by the statistics. So stealthing is the non-consensual removal of a condom by the partner. And the numbers on it are staggering. In some populations, one in three. In some younger populations in student health, it could be 50% or higher depending on partners. So and hear from it patients a lot. I mean, that's the thing that this is there was one recent survey where people that had six or more sexual partners in the survey, 50% had reported stealthing. At 10 or more sexual partners, 75%. I was at a different conference right out the week after I learned about this. I'm like, I need to ask if this is something that is on a lot of people's minds. The first two people I talked to, both had experienced it themselves. One had an unintended pregnancy as a result. Depending on the patients that you're seeing, I bring this up because this is a birth control that puts it in their control in the event like, this is traumatic enough if it happens, let alone having an unintended pregnancy as a result. Stealthing is now illegal in the state of California. It's recognized as sexual assault, hopefully soon to follow in many other states, but that trend is becoming alarming. I just bring it up. Even if it's not Phexxi or if it's a condom, I think it's an important public health thing to be aware of. The other thing that is very unique, and depending on the specialty you're in, the GLP-1 receptor agonists, obviously, there's tens of millions of patients a year being prescribed these injections for diabetes or weight loss. The one thing is that is unique and important that per the labeling in some of the ones specifically focused on weight loss is the potential impact on oral contraceptive absorption. So if you have someone that may be on the higher BMI side and they're losing weight, they're becoming more fertile, but also there's the potential risk of the oral contraceptive becoming less effective because of the delayed gastric emptying and the impact on absorption. And per the labeling of some of the newer ones, it specifically says the ones that studied and looked specifically at these products and birth control, those products will say, when you start the injection, the patient should be on a barrier method or a non-oral method for four weeks. And then every time the dose is increased, again, same thing, four weeks of a barrier method or a non-oral method. And this is becoming, this is coming to light a lot more in recent weeks, but I just bring that as awareness because there are so many people now that are on these products. And sometimes the patient gets in the middle of it because the person prescribing the GLP-1 receptor agonist isn't always the person prescribing the birth control. And the provider may not be as aware of this to ask the question, "Are you on birth control? Is it oral? Okay, let's talk about some different options." So I bring that up as well. And the last patient is perimenopausal. It's a nice option for that patient. And also, if you think about the postpartum patient or the perimenopausal patient, because the gel does have a lubricating property that as well. So that's kind of the basket of potential patients for the non-hormonal birth control, Phexxi. I'm going to pause. Any questions, thoughts? I just went through a lot in a little bit of time. What are your thoughts, questions, main remarks on the presenter, whatever you got, let me know. I just wanted to add that when how I came across with Mitch is that, we communicated via our LinkedIn. And when he started talking to me about this particular product, it was something that was not in my radar. I am a breast cancer PA, and so for our patients, obviously, we are not able to use a lot of hormonal-based contraception. So we end up doing a lot of injections for with that, things like this to control hormonally. And then for our females that are not able to have birth control options that are hormonally in time, this is a nice opportunity for us to use it. So it was kind of a great opportunity for him and I to connect, and I wanted to be able to bring that over to our members to be more aware of this product. Thank you, Mitch, for coming on that. No, I appreciate that. And that's the nice thing, interesting thing with Phexxi, that it does span so many different specialties for that exact same reason, because you may be seeing patients, whatever your specialty is, that may not be a good candidate for a certain birth control method. So to have a non-hormonal method is something that might be valuable to you for your patients. And even if not, it's good to know what's out there because you have a community and family and friends, and especially for something that's. I won't say this is newer anymore. It's been on the market for about 3.5 years. But because we're so small, a lot of our outreach is through programs and trainings like this because we are, you know, just a small startup. Excuse me. All right. So let's talk about how Phexxi works. So everything within Phexxi is essentially a food-grade ingredient, items that are generally recognized as safe by the FDA. So with that, if you look, most package inserts for a birth control are about 30 pages long, and you need a magnifying glass to kind of see all the ins and outs. This is the entirety of our package insert. It is 4 pages. The font is normal size, and 1 full page is how to use it. Goes in like a condom. Excuse me, like a tampon. Not like a condom. I'll talk about my condom analogy in a moment. So with that, because you have items that are generally recognized as safe, you have the only birth control that can be prescribed that does not have a contraindication and does not have a drug-drug interaction. So let's talk about how it works. So everything in this gel so this gel is vaginally placed immediately before intercourse or up to an hour before the start of intercourse. And it's used before each active intercourse. But how it works is Phexxi is not a spermicide. It is not going to kill the sperm. It is not going to create microabrasions in the vagina where you have concerns about STI. The vagina is a naturally acidic environment. And all Phexxi does is maintain the acidity of the vagina even in the presence of semen. So with that, it is not going to kill the sperm as a spermicide would. It works on the tails of the sperm through the calcium ion channels to immobilize the sperm. And this let me share this. This is an in vitro slide of what that looks like. So on the left side, you have sperm present without Phexxi. On the right side is with Phexxi. So if you see there's one little straggler at the end, and you see just look at the tail, and you see it's going and it completely stops. And once the tails stop moving, they do not return to activity. So that is how it works. So it is not a spermicide. It's a pH modulator. Again, this is indicated to prevent pregnancy only. It is not effective after intercourse. This is before and not after. And let's talk about that timing again. So it's immediately effective. There is no waiting. You can place it. Some people are discreetly freshening up or using lubrication before discreetly. This can be done in that same manner. So as long as the act of intercourse starts within an hour. So if it's put in right now and the act starts within an hour, that is fine. As long as there's no disruption, it's not like you need to change, put in another applicator after an hour if it has started within an hour. And you would use it for each act. So even if you have multiple sexual acts within a short amount of time, say an hour, you would put in another applicator before each act of intercourse. So essentially, semen is trying to increase the pH, which helps the sperm to swim. So we want an applicator of Phexxi before each individual act of intercourse, to prevent the pH from increasing and helping the sperm to swim. The easiest thing to explain this to a patient is you treat it like a condom, right? Most patients hopefully know you do not use a condom after intercourse, only before intercourse. And even if you're having sex twice within an hour, you wouldn't reuse that condom. You would put on another condom before each individual act. Same thing with Phexxi, a new applicator before each act. If you look at our clinical trials, very robust in patients and sites, and racial distribution, our sites were in the U.S. There were no exclusions for BMI. So from a population standpoint, it looks as close to you would see with the patients that you are treating in your practice, as any contraceptive on the market. From an efficacy standpoint, and this is important, I just want to make sure everyone is clear because this was studied a lot differently than other birth control. So Phexxi is the first birth control that was studied and brought to market. And this was eye-opening to me too, especially having brought 10 different products to market. I didn't know this, that actually required patients to be sexually active to be in the trial. So you could have someone that went an entire clinical trial, 13 cycles, was not sexually active. Efficacy is, of course, going to be 100%. So in our clinical trials, we can say that we had over 26,000 acts of intercourse in our clinical trial. The data was robust to support FDA approval. So when use as directed, Phexxi is with typical use, Phexxi is 86% effective. So that includes people that don't use it, people that aren't using it correctly, people that are using after intercourse. When use as directed, again, just when you need it right before intercourse, Phexxi is 93% effective when use as directed. So I'm going to stop there because often there's like, I can't see your faces, but this looks a lot a little different than you're expecting when we hear, oh, 99% for, you know, a LARC or a pill patch or ring, when in reality, we know that typical is closer to 90% for most of the short-acting methods. But when you think about this product and who it's for, right, a lot of patients for Phexxi, if they can't take hormones or don't want hormones, they're not using a lot of those methods. They're using condoms or withdrawal or natural family planning, which obviously aren't perfect in themselves. And this can be used instead of them or with them. And same things, pills patches or rings. You know, if someone doesn't want a LARC and wants to increase efficacy, the nice thing is Phexxi, like I was saying earlier on, is this can be layered with other methods. So I'm going to pause right there and see if there's any questions regarding this because, you know, obviously, Phexxi now that has gained national traction, this was the hardest part to explain because it looks different. And we really had to kind of educate on why our clinical trial is different, why things look differently, and make sure everybody understands and is comfortable from this standpoint. Any questions on this? Okay. So when it comes to birth control, so let's transition from efficacy to satisfaction because for every patient has a different need in birth control, right? Some people, their desire is to be on the most effective method. For some people, their satisfaction, what they like using, what they're comfortable using, that is the most important thing for them. So what we can say with Phexxi based on the data is we have 94% patient satisfaction with Phexxi, right? People are comfortable and confident using it. 87% of people in the trial wanted to continue using it, high continuation rate, and 93% of the patients in the trial would recommend it to a friend. So this is something that, you know, people are comfortable and like using. That patient satisfaction is there. And the flip side of the satisfaction, let's also talk about kind of side effects, right? Because not every you want something that you're comfortable using as well. So when it comes to the side effect profile and how to counsel on it, itching and burning are going to be the top two side effects that we saw with Phexxi. It's similar to what we see with other vaginal gels. It's similar to what we see with condoms. The one point of clarification is discontinuation due to adverse events overall in the entire clinical trial for all the adverse events reporting, the overall discontinuation in clinical trials was 1.6%. And if you look at those top two buckets of vulvovaginal itching and burning, the discontinuation for those two items was 0.8%. So one thing I'll call out just from a counseling standpoint, again, similar to what we'd expect from condoms or potentially other products, this happened and was seen more often with people that were more sexually active in a short period of time, right? So if someone's using no contraception at all, increased acts of intercourse are going to cause increased reporting of vulvovaginal itching and burning. That's what we saw here that was most commonly reported in people that were more sexually active within a day or within a few-hour window. And the itching and burning was seen as mild to moderate. And within a few uses, it was no longer reported on their daily diaries. So again, that discontinuation. But it is important from a counseling standpoint that the patients understand that this is certainly something that is out there. And the last piece okay, so I will stop there. So that's the product itself. So you've got a product that, you know, is now FDA approved, that has high patient satisfaction, that has low discontinuation, has no contraindications, no drug drug interactions, can be used as a primary method or layered with other methods. Any questions about how Phexxi works? Nope. Okay. So the last piece oh, what was that question? Was there a different? Was there a different sensation versus none? So are you is Evofem, can you come off of mute, and share what that oh, hello. Hi. So no, I was just asking if there was a if there was a any complaints about, you know, it was a there was a different type of sensation during the intercourse with the gel applied versus not applied. And then there's another question in reference to insurances because I deal with a large, self-pay population, a large Medicaid population. So is this is this covered? And where are you located? Plano. Plano, Texas. Oh, Plano. Absolutely. Yep. Okay. And I'm in Houston. So when it comes to sensation, I mean, this is something we hear it certainly was not kind of recognized as a whole in clinical trials about different sensation, and that wasn't something that was specifically pulled out. But some patients, that that sensation is favorable to them, right? Like, you think of a lot of things that are sold over the counter as far as, like, warming gels, right? So some people will share that, you know, there's a fine line between they, you know, burning and something that they found pleasant in a different sensation. So some people have reported a different sensation, not necessarily negative. Otherwise, we would have a much lower, patient satisfaction reporting. So that is certainly something that we have seen anecdotally, that has not been negative. The other piece is coverage. So in most states, I would say so we've got California, we have New York, we have Florida, we have Texas. So of all of those states, Medicaid covers Phexxi at no cost. So that is the nice thing with Phexxi. In, I would say, 40 of the states we have, Medicaid covers it. Seattle, Washington just lifted and Washington had always had it covered. They did their prior auth requirement this year. So in all of the states we're talking about, it is 100% covered, no prior auths, no step edits. And in some cases, in most cases, they will cover multiple boxes in the same prescription. So like in Texas, Texas will cover a pill and Phexxi at the same time. They'll cover Phexxi as a bridge to an IUD. I don't want to say so in the states that it's not covered, I don't want to say it's not covered, but it may require a prior auth. In most of the states Tiffany, can I ask what state you're in? Yep. So New York, absolutely covered, no prior auth, step edits, no issue. In the states where we're not we don't have 100% coverage with no prior auth or step edits, we do have a high fill percentage. It just may require a little legroom through a prior auth or a step edit. But they do go through. But in all the states we're talking about here, no prior auths, no step edits, they should go through. And again, multiple boxes, right? Because some people, the difference with this, you may have someone that comes in boxes of 12. You may have someone that needs more than 12 applicators a month. We had someone in our clinical trial that averaged 55 acts of intercourse per month. 12 is not going to cut it. So when it's prescribed, you can prescribe it in 12, 24, 36 applicators. Like, I know for a fact, Texas and Florida and New York, I believe, all cover up to three boxes per month under the same $0 copay. So as long as you write 36 applicators and you note that that's a 30-day supply, those plans will often cover it, most often cover it at $0. And then for those patients and commercial insurance as well, in most states, we're exceeding 80% or 90% coverage on commercial plans. I don't want to say anything is 100%, and some may require prior auth. That's normal for any birth control. The one thing I will say with that too is we do have some resources because the government has come out three times in the past 18 months very sharply discussing the Affordable Care Act and that the spirit of the Affordable Care Act is every single birth control, any any FDA-approved birth control should be covered by law for free at $0 and with no prior auths or step edits. And we know that that's not happening, that not every insurance plan is doing that. So we also have some resources. Absolutely, still get pushback that we see it all the time. So the government has said they're they're looking into and they're wanting to know who these plans are. So we have some resources. There are links that the government has provided. They're saying, if so if you want that it and so I will put my email at the end. If you want to reach out to me, I can give you the letter that you can provide to patients. It essentially arms your patients with three opportunities to report their insurance company to the government. First thing is report it to the State Department of Insurance, and then Health and Human Services and CMS. These are all guidelines coming specifically from the government three separate times over the past 18 months because it is frustrating that, you know, we're, you know, 15 years from the Affordable Care Act and we're still dealing with this, that should be law. You've got the Medicaid coverage for most states and all the states that you're in. Commercial coverage is high. If you reached out to me, if you wanted specific information on the plans that you're dealing with locally, I have the reports. I can share those with you. The other piece is we do have some pharmacies that we work with that can help get it to patients. The issue we find cover it, it's the pharmacy doesn't want to stock it or that they don't always want to use the copay card that we have because the boxes of Phexxi are larger than you'd expect from, you know, other short-acting methods. And patients can get multiple boxes. The shipping, they don't want to put it on the shelf. So we work with some pharmacies that will deliver straight to the patients at no cost. And we also have a pharmacy that if you have a cash pay patient, we do have a cash price. It is $99.50 for a box of 12. And as we become larger as an organization, I'll be working with the CEO. We'll keep bringing that price down. That is the goal. But that $99.50 really depends on how often someone needs it, right? If someone's not sexually active every day, that box of 12 may last three days or it may last three months, right? If they're using it as a backup and it's their safe spot if they happen to miss a pill, right? And they may have gone to the pharmacy and picked up emergency contraception before, and that might be $30-$50, right? So if that's something that they've done more consistently, you know, leaning on emergency contraception, this also may be something that $99.50 may be reasonable depending on their specific needs. So we do have the option for a cash price, current. Thank you for those questions. I have another question, if that's okay. Please. I was wondering if there's an increased chance of yeast infections, UTIs with the use of Phexxi. Great question. So we didn't study Phexxi on patients with a history of three or more UTIs. So that specific piece is more of provider discretion when it comes to UTIs specifically. There were 0.36% incidence, so 0.36%, adverse reaction for cystitis, pyelonephritis, and other, you know, upper urinary tract infections. But that is, it was not studied in that population. What was the other? So you brought up UTI, and what was the other? Yeast infections. So yeast specifically is not at an incidence over 2% in clinical trials. As far as UTIs also, and I say this with—I think this is a good counseling tool as well—that sometimes patients will see things or hear, "Oh, you know, Phexxi," and I—you know—they may see UTIs as a risk? So what would your expectation be of UTIs in your population? How often would you expect to see that in your practice? I'm a student right now, so I can't really answer the question well. Okay. Yep. So the interesting thing is, so we see it, so we obviously have to list it as a side effect. It is not indicated to treat or prevent. We probably expect UTIs in, you know, 11+% of sexually active patients. We saw it in 9% of clinical trial participants. The same thing the one thing that does come a lot because you bring up a good question because patients, they sometimes hear, "Oh, Phexxi is going to change the pH of the vagina." And the one thing from a counseling standpoint is important to know that Phexxi is not really changing the pH of the vagina. It's maintaining the pH of the vagina. But sometimes patients will hear pH, and they're really not sure which side is good or bad for certain things. But they may hear pH and UTI and, you know, and think of a negative implication. Same thing with BV, right? We list we are not indicated to treat or prevent BV. BV is expected in roughly 29.2% of sexually active population. We saw BV not indicated to treat or prevent, but important to know that from a statistic standpoint, there's certainly nothing in it that is going to increase the risk other than they may higher than they would have had before, if that makes sense. Great question. Thank you. So Mitch, for those you were saying the cash price, and you were saying, obviously, the coverage for Medicaid and stuff like that. What other ways does the company help for those, communities that may be, you know, lacking on resources to come up as an example for those $99? Is there anything more affordable from that standpoint? Is there any patient resource opportunities? So currently, no. Only because of the size of our company, and we can't financially afford it right now. That's where everything we do, all of the dollars that are in from prescriptions through commercial insurance and Medicaid, those will all help as we go down the road to help us actually have not just a cash price, but a true patient assistance program. Like, that is my main goal, having worked in reproductive health and health equity and access for so long. That is one of my main drivers is to be able to have that. It's just not financially possible at the moment. But hopefully, within the next 6 to 9 months, like, I'm hoping that we can at least take some next steps towards having a meaningful option for those type of patients that you're referencing because it's too important, right? We need something to help those patients. So hopefully sooner than later. In that regard, for that community being, you know, a lot of times being majority Spanish-speaking, are the patient handouts, the instructions, are all those available in a culturally, you know, in language-based, friendly for the patients? I believe we do have everything in Spanish as well. Excuse me. So that's where if anybody so I put my email and my phone number on the chat, call, text, email, whatever you need. If you need specific resources and a specific language, we can do our best to get everything to you. And we're trying to. I know we did at one point have Spanish brochures, and we've kind of transitioned away from brochures more into a QR code where everything is linked through a QR code. I need to check if we have that in Spanish as well. But whatever you need. If you need additional information after this call, if you need resources, get in touch with me. And in all of the areas that you've reported you're in, we have representatives in all of those areas. So we can certainly help to get you in touch with the perfect person. Who else is on your mind? So it looks like Rafael put his email on here, so he would like to have a wrap-up in Plano. And I know they're a fairly large group in that area. Okay. I will do that. And what I can do is, Mitch, if you can share with me the I think I have some from when I did the so I will say Mitch also supported our Houston Health Community Fair when we did it in combination with the National Hispanic Medical Association here in Houston. He provided us with some clinical information about Phexxi so we could have it at our health fair. I'll try to see if I have the QR code there. I believe I do. And I'll be happy to send that out to our members today because I saw your message, Martha. Amazing. And if anybody is having programs or things that you need, we're always if we can do something, we are happy to support. Tanya. Hi. Yeah. So actually, I wanted to ask about that. I'm sorry. I may have missed that in the beginning. So I wanted to see if are you the right person to reach out to if I want to invite you to talk to my program with my school? Well, can you repeat that? I think my mic now, of course, my internet is unstable. It might be my internet. Sorry. I was wondering, are you the right person to reach out to, to invite as a for an invitation to talk to my program, my PA school? Absolutely. Okay. Great. I'll send you an email then. Please. Yeah. And that's, I would say, whether it's virtual like this, virtual like, I do a lot of residency programs, PA, nurse practitioner, midwifery programs. And it could be in person. It could be virtual. Yeah, I can definitely assist with that. Which program are you with? I'm with MEDEX in Washington State. Amazing. Yep. I got you covered. Thank you. And for those of you guys that are coming to AAPA, I believe Mitch is going to be present at the conference to be able to provide additional information at that time as well. The last thing I want to share is I talked about the multiple boxes and if patients are more sexually active or need more. This is specifically what this looks like. Again, if you need QR codes, resources, whatever you need, I can also email you our preferred pharmacies depending on what area you're in. Also some of the things I can mail like this, How to Prescribe. Let me just show. This is the How to Prescribe. One applicator intravaginally immediately before or up to an hour before each active intercourse is needed. This says so again, each applicator is there are 12 in a box. Each applicator is 5 grams. Each box of 12 is 60 grams. In your EMR, it may look differently. Your EMR may show, you know, dispense 12 applicators. It may say one box. It may be 60 grams. You may need to tweak that. If someone needs more, you know, this could be 2 boxes, 12 applicators, 120 grams, 3 boxes, 36 applicators, 180 grams. But we can definitely send that out. The last thing I'll share is we're almost 50 minutes in. This isn't going anywhere. The one note on this just from a counseling standpoint, right, this is going to stay in place. This is not going to be messy or drippy. The partner is going to be the one that is going to distribute it in the vagina. It will distribute evenly in the vagina during sexual activity. So from the one thing that we do hear is if you have patients that are transitioning potentially from condoms to Phexxi, they may not be as used to actual, you know so just being able to discuss that, you know, there's not going to be much of a difference as far as cleanup with Phexxi versus normal. But if someone is transitioning from condoms to Phexxi, that may not be something that, you know, they've been familiar with before. So just a good counseling point there. Is that better? Can you try that one more time? Can you hear me? I couldn't hear your question before. Oh. Yeah. Yeah. I think it's right here. Right here. I have some lagging of internet. Let me type. I'm going to call in real quick. Hold on. I'm sorry. Okay. Can you hear me now? No. Can you hear me now? No? Okay. So transitioning from condom to Phexxi, so some of those patients may not be as familiar with dealing with the cleanup or, you know, following ejaculation if the partner's been using condoms. So sometimes it may come up, "Oh, I'm not used to, you know, the cleanup following intercourse with ejaculation and no condom." So just having that conversation with the patient if they're transitioning because that's not necessarily sexy. Phexxi is really not going to change the cleanup experience, you know, for that patient. But if they are transitioning, that's going to be a little different for them in general. Good questions. Everybody has my contact information. And like I said, now this is family, and we want to help however we can. So whether it's myself, whether it's training, additional information, resources, at the end of the day, we all have the same goal, right? We want patients to be successful on their contraceptive. We want to make sure we're reducing unintended pregnancies across all age ranges, that we have all the tools possible to educate, you know, whether in your practice or in general. So just know that, you know, I'm here and Evofem is here to support however we can. Everything that we do, and that goes to the video, you know, looking at Saundra, our CEO, this really is about the patients. We want to make sure that if this is what is best for them, that they have the information, that they have the counseling and the resources because this is really about kind of society and supporting each of you as clinicians to do the best we can to support you. I appreciate everybody and all you do and this organization and being able to follow it for so long. I'm hoping I'll see some of you in Houston in May. But again, please, anything, anything, anything, call, text, email, reach out. I'm here to help support you and your patients. I appreciate you dealing with my lingering cough and sore throat and, of all days, to be recorded. You're going to do it while I've got a sore throat. That's fine. I appreciate it. This was an absolute pleasure. Please keep in touch. I'd love to keep this conversation going after this. Awesome. Thank you, Mitch. I really appreciate your time and sharing this with us. I think everybody here tonight, I will definitely send out the QR code and information that Mitch provides to us regarding his contact information for anybody that didn't catch it in the chat. Again, feel free to join us for our next upcoming CME event. It is going to be on mental health by our president of NCCPA on April 11th. So you're welcome to join us for that. With that, I want to thank everybody and hope that you have a great night in whatever part of the country you are in. We will see you soon. Thanks, Mitch. Thanks, everyone. Appreciate you. Have a good night. See you at AAPA, Martha.