Milestone Pharmaceuticals (MIST) TD Cowen 46th Annual Health Care Conference summary

Product overview and market need

• CARDAMYST (etripamil) approved December 12, now commercially launched for PSVT, available in pharmacies since January, with full commercial and marketing efforts underway.

• PSVT affects over 2 million in the US, with 200,000–300,000 new diagnoses annually; half of patients are commercially insured, aiding launch strategy.

• Existing acute treatments are limited; CARDAMYST offers a portable, on-demand nasal spray with rapid onset and robust clinical data.

• No branded competition exists, and the product is protected by patents through 2042.

Commercialization strategy and launch execution

• Focused on 10,000 high-volume HCPs treating 500,000 actively managed patients, using a 60-rep sales force.

• Retail distribution in 50,000 US pharmacies, with patient and HCP support programs to ease prescribing and access.

• Pricing set at $1,649 WAC, with co-pay mitigation to $25 for commercial patients and strategies to secure tier 2/3 coverage.

• Early launch metrics show scripts are building weekly, with all support systems functioning as planned.

• Main physician pushback is lack of awareness; once informed, adoption is expected to accelerate due to familiarity with drug class.

Financials and future pipeline

• Recent cash balance bolstered by a $75M royalty payment; updated financials to be released with the 10-K.

• Planning a Phase III trial for atrial fibrillation, targeting a market 3–4 times larger than PSVT, with a 2-year study timeline.

• Phase II AFib data showed rapid, durable ventricular rate reduction and reduced need for IV/oral meds.

• Ex-US expansion will be pursued via partnerships; a Greater China partner is in regulatory review following a successful Phase III.