Hey, good afternoon. Welcome to day one of the Jefferies Healthcare Conference. My name is Dennis Ding, biotech analyst at Jefferies. I have the great pleasure of having CFO Jeff Farrow and CMO Aziz Mottiwala here from Tarsus Pharmaceuticals. Welcome. Why don't we kick things off by just giving a brief background around the company as it stands today and some of the progress that the company has made over the last one or two years, and just talk about the evolution of Tarsus? Sure. Thank you, Dennis, for having us. We're very happy to be here. Tarsus is a commercial-stage company focused on the eye care space. We were approved to go commercial in August of 2023, and we launched shortly thereafter. We've been on the market for about six quarters now. The launch has gone extremely well. We've shown underlying demand increase quarter over quarter, as well as the related revenues. It is for a disease called Demodex blepharitis. Our drug is called XDEMVY. It's a twice-daily eye drop that is for a course of six weeks that gets to the root cause of the disease. It kills the mites that are located in the eyelashes that cause the disease. It has resonated with the eye care community as well as the patient community. It's very efficacious. We saw about 85% of the patients see clinically meaningful improvement, and it's very safe. That has really been one of the hallmarks of the success. The other is it's very easy to diagnose. Everybody goes in for an eye exam and goes to the slit lamp where they look at the back of the eye. In this case, they ask the patients to look down, and you can see the hallmark of the disease, which are these collarets, this sort of scrub that grows around the eyelashes. That is pathognomonic for the disease. Very easy to diagnose. The treatment paradigm is very simple, and the efficacy and safety profile have been a real benefit for us. Beyond the on-market therapy, we also have a really interesting pipeline. We announced recently that we're going to be initiating a phase II study in the back half of this year for a disease called ocular rosacea. There's really nothing else out there from a therapeutic-approved perspective that treats ocular rosacea, and it's got a big unmet need. There's about 15-18 million patients that are impacted by this disease, the vast majority of which are caused by Demodex mites. We know we're very good at killing mites, and we think we have a good probability of success on that study. Finally, we also are looking at the same active ingredient in XDEMVY in a Lyme disease potential therapeutic. This is an oral prophylactic for the treatment of Lyme, and it kills the ticks before it can transmit the bacteria that causes Lyme. We showed some phase II data that was pretty compelling in that we killed about 97% of the ticks within 24 hours of that initial treatment. Very effective in terms of killing that tick there. That is our pipeline. We desire to be an eye care leader and are continuing to look for potential opportunities in the front of the eye as we think about becoming that eye care leader as well. Great. That's a great overview. If we can just focus on XDEMVY for a little bit, can you know what is the prevalence like in the U.S.? How big of an opportunity is this? I mean, we've all, I think, seen some of the commercials on TV, but it does not say anything about prevalence, et cetera, and just how much runway there is left. Yeah. When we look at Demodex blepharitis as a whole, it affects about 25 million Americans. You can extrapolate it to be like 1 in 12. I know people in the stream are starting to do the math, how many people might have it. Within that 25, we've really focused on an even more specific subset of about 9 million patients that are in the clinic today. These are patients that are coming in. They've either been previously diagnosed and hadn't been treated because up until a year and a half ago, there wasn't something available, or they have very specific diseases where there's a high overlap. These are the most common things that ophthalmologists and optometrists see in their clinic, things like dry eye. They're coming in for cataract surgery. They may have a hard time staying in their contact lenses, or they may have meibomian gland disease, which is a form of dry eye, where the oils in the eyes aren't produced well. These are all meaningful patient segments that if you looked at the total TAM in the clinic today that's available, it's about 9 million. To date, we've treated. We've had a great launch, but we've only treated a couple hundred thousand patients. We've only scratched the surface, and that's from our vantage point as well as the vantage point of what we hear from clinicians, right? Clinicians are having great experience. Over 15,000 doctors have tried the product. The vast majority of feedback we get is super positive, and doctors are just also scratching the surface in terms of who they think could be eligible and benefit from treatment. What's standard of care here? Are doctors, optometrists, and ophthalmologists, are they very keenly aware of what the disease is? Yeah. When we look at the awareness of the disease, it's quite high. People are very well aware of this. Prior to XDEMVY, oftentimes the number one thing that doctors would recommend is like a warm compress. In some cases, they would tell patients to use what are called lid wipes or lid hygiene, which is something that has like tea tree oil or some type of chemical in there to kind of debride some of that crusting. The problem with those is it doesn't get to the root cause, right? You're just kind of scrubbing the script that Jeff was talking about, but you're not actually killing the root cause, which is the mite, which is what XDEMVY does. Those things are also pretty abrasive. There's data that shows they can actually cause damage to the eye. While that was what was available, it's not very well accepted or very well tolerated by patients. I would say when we look even a year and a half in, the standard of care, if you ask most doctors, would be XDEMVY. The real opportunity lies in helping the physicians understand the true prevalence of the disease. We talked about 1 in 12, 25 million Americans. That's about half of the patients coming into an eye doctor's office. I think where our educational efforts focus are on increasing the awareness of how prevalent this disease is. A lot of doctors, even when they're looking for it, they still might miss it if they don't look close enough. It's about changing the behavior and getting them to start every exam by looking at the eyelids and looking for that debris, which is a telltale sign of the disease. All of our physician-facing education is around, hey, make sure you're looking at the lids. Make sure you're taking a closer look if you're seeing a cataract patient or dry eye patient. Those are patients where you have a high likelihood to diagnose this patient type. Vis-à-vis, we're doing a lot of work on patient education as well in DTC, which is if your eyes are red, crusted, itching, talk to your doctor because it's going to be blepharitis. Sure. And you guys are making efforts on all of those things, right? What about something like guidelines and having XDEMVY be a part of guidelines? Is that kind of in the cards, or do you think that sort of thing can happen? Yeah. So when it comes to physician education, we've taken a very thorough and robust approach here. We started that work even a couple of years before launch. I think that's one of the keys that's been one of the keys to our success in commercialization is we started the educational efforts very early on. We started educating the doctors around the prevalence, the impact of the disease. That allowed us actually to impact some of the guidelines. XDEMVY is featured from last year in the American Academy of Ophthalmology Preferred Practice Guidelines. Those are updated only every so often, and we were included in the most recent update, which was last year. It's also included in the American Society of Cataract and Refractive Surgeons. They have a workup guide of what are all the steps you should take prior to cataract surgery, and examining the lids for blepharitis is now one of those steps. There are a lot of other guidelines that are sort of tertiary to any major society, but are out in the publications and in case studies that doctors are sharing. Here's my algorithm. Here's the algorithm to triage this type of patient. That is well established. It is well established. I think the opportunity is, okay, you know it is out there, getting everybody to do it consistently every time, every exam is where the opportunity continues to lie. I think our educational efforts are continuing. We have one of the largest sales forces in eye care, actually. I think at this point, we have the second largest eye care sales force in the front of the eye. That's our primary lever in which we educate doctors today. We've got a medical affairs team. We think about that direct promotion. We also think about the consumer, as we mentioned with DTC. The other pieces we think about is evidence generation. Continuing to generate data on the utility and impact that this drug has. We did that last year when we released the MGD data. That was very well received. It continues to be well received by the eye care community. We're going to look for ways to continue to enhance that evidence base to give doctors more reasons to look and more reasons to treat. Okay. Good. Among your prescriber base, do you see more optometrists prescribing this or ophthalmologists? Do you see any kind of trends over time since launch? Yeah. Our call point is ophthalmologists and optometrists. We talk to about 15,000 of them on a consistent basis, and that is roughly equal split of ophthalmologists and optometrists. Who we talk to, it is about equal. When we look at the prescribing behaviors, what we have seen, and we sort of knew this was going to be the case, is that optometry was going to be a little bit more heavy in terms of utilization. If we look at our script base today, it is about 60% or so optometry in terms of script volumes, and then the remainder ophthalmology. With that said, when we look at our top prescriber base, it is pretty mixed, right? It is not like just optometrists are high prescribers. There are a lot of ophthalmologists that are very high prescribers as well. I think we see real good feedback from both segments. It's just optometry. We know this in the anterior segment. They tend to do a little bit more prescribing than the ophthalmologists do. Yeah. Okay. Now remind us of Q1. What was the revenue and just kind of the outlook through the year? Yeah. So we recorded $78 million in revenue for the quarter, and that represented about 72,000 bottles dispensed for the quarter. We've been thoughtful about providing guidance just because there really isn't a good analog that we can reference that we feel comfortable giving sort of longer-term guidance. So we've given one-quarter-ahead guidance there. And our guidance on the bottles dispensed represents about 85,000-90,000. And then our gross-to-net discount, we ended Q1 at a gross-to-net discount of approximately 47%. And we expect that in the second quarter to be in the range of 45%-47%. We do expect that to tick down in subsequent quarters to an exit rate in the fourth quarter of somewhere in the low 40s, say 42%-43%. That'll be more or less our steady-state gross-to-net discount absent sort of the typical Q1 dynamics where we provide a little bit more payer support because of copays resetting, deductibles resetting, things like that. In terms of seasonality, we have guided the street to expect that Q3, just given the summer dynamics, and we're essentially an NRX product right now. Each is a new script. We don't get the benefit of the sort of refills at this stage, but we anticipate that coming as longer term. It tends to be in the eye care space, relatively flat growth in the summer because the doctors are on vacation. People go on vacation. We have guided to continued growth in the third quarter, but not just as much robust growth as we saw, say, from Q4 to Q1 and Q2 to Q3. On the other side of Q3, we do expect it to pick up again in the fourth quarter. That's typically an area where patients want to go in, use up the rest of their deductibles, use up their FSA account. We expect that growth to ramp up in the fourth quarter as well. Okay. So essentially sequential growth through the year. Sequential growth with a little bit more tempered growth in the third quarter and then ramping up in the fourth. Yes. Okay. You mentioned this business being NRX-driven, right? There is some debate around refills and how that plays into the market, not today, like you said, but in three, four, five years. Maybe elaborate on that a little bit and why the refill dynamic may matter. Sure. I think you go back on what's the evidence you've seen in the clinical studies, which is at 12 months post-treatment, about 40% of the patients recur. That's because the drug is very effective at getting rid of the mites in the eyes, but the mites live in other parts of the body, in the face, and they migrate back to the eyes. We actually expect that at some point, every patient will recur because whatever predisposed you to the disease doesn't go away, so you're likely to get it again. We really focus on that 12-month period that we saw in our clinicals, and that's that 40% recurrence rate. What we've said is once you account for real-world dynamics, right, patients coming into the office maybe once a year, some six months, some 12 months, some people waiting till it's a little bit worse than it was, we've discounted and said, okay, that's probably about a 20% annualized retreatment rate at steady state. Now, what we're seeing today is when we look at the data sets available to us, on any given week, we see a high single-digit rate of refills, which if you were to do some math thinking about that patient that's in a refill, probably was treated a while back. And when you think about that cohort of patients, that percentage of retreatment is probably north of the single digits, and it's trending eventually to that 20%. I think heading in the right direction in terms of seeing that market dynamic of patients getting retreated, I'd say that that 20% is something we're still pretty confident in. Obviously, if we see anything else, we'll update that. That's our projection, that annualized 20% retreatment at steady state. It's moving in a positive direction that way, and we're seeing that pretty significantly in our data progress over the last couple of quarters. Right. Because patients, when they get treated with this, I think it's how many weeks of treatment is it? Yeah. The course of treatment's a six-week course. It's twice a day for six weeks, and one prescription is a full course of treatment. Right. And we've seen the data. It looks very compelling, very strong. Most people respond. It's not like they respond and then they get another refill. It's not like a chronic treatment, right? That's right. That's why your comments around NRX-driven kind of make sense. In terms of guidance, you guys mentioned that you guys aren't giving annual guidance. At what point do you think that that would start making sense? At what point do you feel like you're comfortable enough with the base business and the growth that you can kind of put some bookends for investors? Sure. We actually look at it every quarter. I think what we want to ensure is when we give guidance, it's really good guidance and that people can rely on it. I think the big unknown, just given the fact that there's really not a good analog here, is the uncertainty of the impact of the DTC campaign, particularly in the network TV. We've just started that recently, and we expect that to really hit in the back half of this year. I think once we get past that time frame, we'll be in a better position to provide annual guidance from there. Okay. How much are you spending on DTC this year? We've guided to about $70 million-$80 million in the year. That sort of surrounds around DTC. It's not just network TV or streaming TV, but it's also social media, other aspects that we're looking at. I think the important thing to highlight here is we anticipate a multiple on that investment. If we see that we're not getting that return, we have costs gated as we go down this year that we could either pull back on or redirect into different areas there. Maybe we move less into network TV and maybe more into streaming or vice versa. There's optionality there, but it's very much gated costs where we want to see a multiple on that investment before we spend that money. How is that ROI calculated exactly? Yeah. We look back, and obviously, we look at forward-looking, we look at what are all the metrics that would lead us to see that scripts are coming. We think of things like website visits, what people do on the websites. These are all indicators of scripts to come, if you will, right? Every week, we have thousands of people take the quiz on our website, for instance. That is a correlative sign that scripts are going to follow. Obviously, once we execute and see the scripts, we're actually able to model those back out. We actually do look at true raw contribution of scripts coming from that effort over time. We have the models to do that. To Jeff's point, we look at that pretty closely and say, okay, if we spent this much, are we getting that multiple? Is it progressing the way we'd want it to? To date, we're seeing all the positive signs. If we continue to see that, obviously, we'd feel that this is a good investment to be made. With that said, I do think at the thresholds that Jeff is talking about in terms of our expense, that's sort of what we'd want to spend. I don't see us expanding that expense a lot more beyond that. That's sort of the right amount to do this. Obviously, if we're getting a good multiple, we'll do that. If for any reason we're not seeing the returns that we want, to Jeff's point, we could redirect those pretty quickly. Right. Okay. If I can ask a question just on your sales force, can you remind us the size and do you think it's an optimal size at this point? I mean, you talk about 9 million patients, thousands of doctors. At what point would you entertain the idea of expanding the sales force just to drive a little bit more touch points? Yeah. So I think it's important to look back in how we approach this. When we launched, we launched with 100 sales reps. A few quarters in, the end of last year, end of the third quarter, beginning of the fourth quarter, we actually expanded by about 50%. We went from 100 to 150. At 150, we've got one of the largest, probably the second largest front-of-the-eye sales forces in eye care. We're very much the right size organization that we need to be. We don't expect expanding again for a long time. If you do the math, it makes a lot of sense, right? We talked about 15,000 doctors, 150 reps. It's about 100 doctors per rep. We can get to these doctors at least once a month, and some of them we're getting to them multiple times a month, which is the right frequency for us as well. I think we're really well-suited on that front. I would say the only other thing I'd add there is the quality of people we have is really great. We've been able to attract some really good talent. We had a great sort of first batch of sales people. When we expanded, because the launch was going so well, we were able to attract some really high-quality talent. Not only the largest sales force, but probably one of the most talented and best-performing sales organizations I've seen. Okay. So the expansion happened in Q3. The end of Q3, and they were fully deployed toward that end of that quarter and the beginning of the fourth. Okay. They were trained already and they hit the ground. Did you see a benefit from those incremental sales reps in Q4 and Q1? Yeah, it's a good point. When we did that last year, we did indicate that we'd expect to see an impact pretty immediately. We did see an impact in Q4. We saw an impact in Q1. I'd expect us to continue to see that. Reps are really good. They can get out there and make an impact right away. If you give them more time to build relationships and get in front of the doctors multiple times, that actually progresses really nicely. I think we're just getting to the point now where those reps are really hitting that optimal stride. I'd expect to see more and more. They hear from me all the time that I expect to see more and more. Yeah. Yeah. I mean, I feel like if you're expanding the sales force by 50%, there's such a large prevalence pool that at some point, revenue growth should accelerate year over year. I'm not sure what consensus is for this year or even next year, but is that something that you guys are thinking about as well? Yeah. No, consensus right now is around $400 million for the year. We do think that we'll continue to see growth for several years, right, as we continue to move down that pipe because of some of those initiatives, both the sales force getting out there, interacting, talking about getting into the depth of those different segments. As we highlighted, the DTC campaign should really start to take effect into the back half of this year. Further evidence generation will continue to add more reasons to prescribe as we think about the different segments: cataract surgery, contact lens, dry eye. All of those things will add growth for many years to come. Yeah. To your comments around having one of the largest eye care sales force, that's a very valuable asset to have. I'm just wondering, as you think about the business over the next several years, could Tarsus do additional BD to kind of leverage that sales force for other eye products? That's our goal. We want to be an eye care leader. I would say we've got the best sales force out there in the eye care space. We might be the second largest, but probably the best. I think we can leverage that, right? I think what we can do is potentially add another product into the bag. We're looking at everything from on-market commercial assets to earlier stage assets, even going back to preclinical stage, knowing that it takes time to add more and more of these products to the bag. There are some interesting assets out there, both on the commercial side as well as on the anterior segment. We're taking a very hard look at those opportunities, knowing that right now it's all about executing on XDEMVY and making sure that's our true focus at this point. As time goes on, I think we can execute on some of these BD opportunities and bring them in-house. Sure. What about outside the U.S.? Outside of the United States, we're looking at two territories in particular: Europe as almost everybody else does, and Japan. We are in the process of doing stability studies in a single-use preservative-free formulation that generally the European authorities require. That requires 12 months of stability before we essentially are able to file our NDA equivalent. We could see potential approval in the second half of 2027. No incremental clinical studies are required. We're going into this eyes wide open as there's some unusual dynamics or maybe not so unusual anymore in terms of pricing. We are taking a look at the pricing dynamics, but also recently MFN, Most Favored Nations, which could impact some of the countries that we're exploring, including Germany and the U.K. Fortunately, we've got time to see how that dynamic plays out given our approval time frame. We're taking a look at that. If it's not going to be an issue, does it make sense for us to commercialize ourselves, or do we partner with that? In Japan, we're going to have a meeting in the second half of this year with the Japanese regulators to see if an incremental clinical study is going to be required. That could be also another interesting opportunity for us from a commercial perspective as well. Okay. Very good. In the last five minutes, I guess maybe we can talk about the pipeline because XDEMVY is obviously doing really, really well and has a tremendous amount of growth ahead. I would argue you kind of have to also diversify away from it and try to figure out what the next leg of growth will be from a second product. You recently announced ocular rosacea as a new indication. Talk a little bit about that, the market, and why you have confidence that your asset could work. Sure, Dennis. Yeah, we are excited about ocular rosacea. Just as a reminder, we had phase II data last year in something called papillary pustular rosacea where we hit the primary endpoints, a reduction in pustule size as well as a reduction in redness. This type of rosacea is caused by mites. When we were initially thinking about this program, much like Lyme, we were thinking about partnering it with a derm company. Several of the eye care professionals and KOLs came to us and said, "Have you thought about ocular rosacea? I see this in my practice all the time. There's nothing out there from an FDA-approved therapeutic perspective. I would love to have something in this area." We did some market research, and it really is a unique opportunity given there's nothing else out there from an FDA-approved perspective. It's about 15-18 million patients that are impacted by the disease, and more than 50% are caused by Demodex mites. We know we're very good at killing mites, these Demodex mites. We're in the process of essentially developing a sterile topical gel that would be sort of put around the eye area there as opposed to the eye drop formulation with XDEMVY. We're developing scales based on discussions with the agency, and eye care professionals are really what resonates with the doctors and the patients. It's a reduction in the redness around the eyes as well as a reduction in the vessels that are prominent in patients that have ocular rosacea. Since there's never been a study done in ocular rosacea, we're really establishing this scale. We're making sure that we invest a lot of time and effort in this because we want to make sure it's very reproducible from clinician to clinician at each of these clinical sites. If somebody says, "This is a scale three out of five," we want the next doctor to say, "This is a scale three out of five." Once we have those two scales done and established, we will initiate the phase II study in the back half of this year. Top-line proof of concept data will be in the second half of next year. Okay. In terms of the market opportunity, it seems like it's kind of similar to XDEMVY. Exactly. No, we think about this as another category creating a potential opportunity here with no competition currently and an opportunity to really make a real big impact on the patient community. Okay. Very good. Lastly on Lyme, just where are we there? Yeah. Lyme is also based on the same active ingredient in XDEMVY. It is an oral pill. We showed in the phase II study that we killed about 97% of the ticks within 24 hours. The transmission of the Lyme disease bacteria typically happens between 24-36 hours. We are in the process of having a study developed, and we plan to initiate that in 2026 in the summertime. In the meantime, we're identifying potential areas for the study. We have high endemic areas and things like that. The study will be ultimately based on some biomarkers to see if the patients develop Lyme disease. We anticipate, based on the conversation with the agency, that a phase III study will likely be a disease prevention study. In that scenario, it would be 78,000 patients in a call point that would be typically a GP call point. Fundamentally, we think this is better suited in a bigger company's hand. We plan to partner that ahead of phase III program, which could be a nice source of non-dilutive capital. Okay. Okay. That makes sense. Lastly, in the last minute that we have, remind us of your cash and just talk a little bit about profitability. We ended Q1 with about $408 million in cash. We have not provided time to cash flow positive yet because we have not provided revenue guidance yet. I think once we have that in hand, we will be able to provide that sort of cash flow guidance. That cash is a healthy balance sheet that can allow us to continue to execute and perform in the commercial side, but also complete those clinical studies that we highlighted. Very good. That's all the time that we have. Thank you guys so much for being here. It's good to see you. Have a great rest of the day and meetings. Thanks, Dennis. Thanks, guys.