Milestone Pharmaceuticals (MIST) H.C. Wainwright 4th Annual BioConnect Investor Conference summary

Market need and product launch

• PSVT is a burdensome condition with unpredictable, symptomatic episodes, and CARDAMYST offers patients control and reduces emergency department visits.

• CARDAMYST, a nasal spray calcium channel blocker, was launched within six weeks of approval, with a sales force operational in eight weeks.

• Early physician and nurse practitioner adoption has been strong, with over 600 prescriptions written by 400 unique prescribers in the initial months.

• The product is the first new therapy in this space since 1989, requiring changes in entrenched treatment patterns.

• Patient and prescriber feedback has been positive, with real-world experiences mirroring clinical trial results.

Commercial strategy and coverage

• Initial focus is on commercial insured patients due to faster contracting and the ability to mitigate co-pays.

• Express Scripts provided early coverage, with ongoing efforts to secure contracts with other major PBMs for broader access.

• Coverage expansion is expected to further facilitate prescribing by reducing administrative burden for physicians.

• Early refills are promising, with patients seeking multiple prescriptions for convenience, and insurers generally accepting reasonable quantity limits.

• The product is priced and contracted to support a handful of uses per year, aligning with payer expectations for cost offsets versus emergency visits.

Prescribing dynamics and growth plans

• Early adoption shows both breadth and depth, with a strategy to first build awareness and trial among physicians before activating patient demand.

• Patient testimonials and word of mouth are emerging but physician awareness remains the primary driver at this stage.

• The company is piloting patient activation tactics in 2024, with plans to ramp up these efforts in the following year.

• CARDAMYST is being used as an alternative to daily oral medications, "pill in the pocket" strategies, and as a bridge for patients awaiting ablation.