Here are some nuggets of joy I discovered when investigating the sofdra update. I put them here in a seperate thread so they didn't get lost in the crap people are discussing.
1 - Why are there only 6,800 patients if there are 2,300 prescribers at the end of June. ( ie - only up to 3 patients per dermatologist )
There are approximately 13,000 registered, practicing dermatologists in the USA according to Grok who found the info somewhere,
There are approximately 4 million diagnosed hyperhydrosis patients in the USA seeking treatment also according to Grok,sounds about right,
If we assume the population turnover is 50 years, meaning 80,000 Newly diagnosed patients per year = 4 million sufferers at any given time
Some of them may not be diagnosed by a dermatologist, so lets say 75% are (60,000 New patients diagnosed or treated by dermatologists)
There are 60,000 new patients per year, and 13,000 dermatologists to treat them.
That means on average, each dermatologist treats 5 new patients per yearThis would mean per month on average you would get 1 new patient per 2 dermatologists treating.Look at Botanix data about how many prescribers there were per month
So Take June 2025 for example, 2316 prescribers, and according to my average rate based on 80,000 new sufferers per year, etc.... you would expect these 2,316 prescribers in June to only get access to 891 New patients. In June I calculated that patient numbers overall GREW by 964
This is what I think might be happening :
Close to all the new patients ( or a large portion of them ), are going onto Sofdra first. ( Up to 891 of them )
The surpluss increase are existing patients who for whatever reason have decided to change their existing treatments over.
The Biggest increase in existing patients would be the patients who either have no treatment that works, or can't stand the side effects so much that they are allways looking for something else, and this population would change over earlyer ( within the first few months of launch as they have been waiting for an option that works )
The others who have "been" treated are either satisfied with their previous treatments, or are simply putting up with the disease without treatment or need to go look for other treatment options.
So - In summary I think it's possible close to 100% of newly diagnosed patients are ending up trying Sofdra, particularly July onwards the majority of new sales will be newly diagnosed patients, with less existing patients switching over, and the good news is that as the prescribers grow then the new patients grow ( up to an average of 80,000 per year )
As of July though, with 2316 prescribers.... they will only get about 900 new patients per month.
What happens as the new prescribers continue to grow? Here is a plot that simply adds 300 new prescribers ( conservatively lower than the lowest increase observed so far per month ) per month to the 2300 of them.
In June they have just over 2300 prescribers ~ 900 new patients.
By Dec 25 at a reduced prescriber growth rate, prescribers have doubled to 4000 yielding 1800 new patients per month
By Dec 26 still at the reduced rate, prescribers penetrated are about 60%, or 7800 prescribers..... you would expect on average 3,000 new patients per month. ( 3x current growth )
In summary 80% of dermatologists today in the USA are not prescribing sofdra yetLet the sales team do their stuff and continue penetrating into the source base and we can expect very good things ahead.
If I take the June numbers, assume the prescribers will continue to grow by 300 per month thanks to the sales force and the safety / efficacy record which will get out there eventually, and purely base additional patients only off and average of Newly diagnosed patients only, this is the monthly sales curve I get. The dip post June as less pre-existing sufferers change over, and the gradual increase as more prescribers are using it for their new patients. Note that this chart predicts $113 million AUD 2025 gross and $488 million AUD 2026 gross purely based off new sufferers.
This sales curve below is the first curve I drew, purely based off a repeat of the same influx of patients we have seen so far without any % increase or maintenance or any other reasoning. ( around 1,000 new added per month ) Note this one represends 108 million AUD gross 2025, and 342 million AUD gross 2026.
2 - What is the price.
16,000 prescriptions, 25 million AUD in sales is approximately $1500 AUD per month per prescription or 978 USD per month as expected.
In June there were about 5,500 prescriptions, as about 20% of patients have stopped taking Sofdra at that stage ( 80% remain )
3 - Is the Arcutis comparison valid?
Initially - Arcutis Q2 sales with 80 reps of 129 prescriptions per rep..... is not quite as good as botanix who with 27 reps managed 500 prescriptions per rep.
I don't think that is necessarily because our sales reps are better, it's because the product at the moment is selling itself better. - particularly when patients are not paying anything.
( My theory that prescription rate for dermatoligists is extremely high, and they are basically prescribing it to every new patient they can, but there are not that many new patients per year per dermatologist ~ 5 )
Articus appear to have made 3.6 million AUD net in Q2
Botanix appear to have made 2.19 million AUD net in Q2 ( Based only off June sales, that is 10+ million NET AUD per annum already)
Pricing of Articus product is very similar to Botanix at around $1,000 USD per 60 gram tube, lasting 1 to 2 months depending on how bad the condition is ( so similar to botanix product really )
I can only come to the conclusion here at least for Q2, Botanix has a lot of price variation with different providers, co pay, and zero pay, and so as they mentioned in the webinar , I have calculated net must be closer to 10% for Q2 with all the initial insurance onboarding rules. but expected to move up into somewhere between 30 and 40% over Q3 and into Q4 for the patients already joined, before dropping down again in the copay cycle 2026.
I get 10% by adding up Apr-May-June gross sales ( approx 20 million ), and botanix comparaison to Arcutis was Q2 Net was 88K per rep
2.19 million for 27 reps, out of 20 million in sales, is 11% net.
Now the good news is, The non discounted figure could have easily been double ( 20% net ) or tripple ( 30% ), or they even mentioned they expect 40% as the discounts are removed. which is a significant outperformance of Arcutis, but I do understand why the company is doing it for product growth and that's the way the insurance cycle works on new product uptake, it's part of the reason the numbers are high, and prescribing doctors are sky rocketing so quickly, but net is down
Notice with Zorve that the comparison quarter Q2 had maximum 33% net from insurers, and Q2 2023 was more of a comparison to us where the net dropped to 20% on the cycle reset. That means effectively for comparisons sake, Zoryve would had of Netted 2.4 million using a 20% net Q2 rate, where BOT netted 2.19 using a 11% net Q2 rate.
Put simply if Bot manage 30% net in Q3 of current patients, that means trippling Q3 net to 6.6 million just for that 1 quarter ( The net is non linear, new customers push the net down, and towards the back of the year pushes the net up, customers retention pushes the net down )
Market size - The diagnosed sufferers that would be prescribed Zoryve are in the order of 10 times the ammount of new hyperhydrosis sufferers based off current diagnosis rates ( That could change with telehelth ). This does not seem to be that much of an issue, as the prescribers in a previous BOT survey almost all had Sofdra listed as a first line 2 treatment after the smelly can alternative was used, and perhaps you can see it in the sales reps figures from Q2 where Sofdra sales reps are selling 4.5 times as much as Zoryve sales reps
Year 3 Q1 comparison - Zoryve managed 97.8M AUD NET
Year 3 Q1 for BOT would be Q1 2027
BOT based on their own advice of trending shortly towards 30 - 40% of gross = NET , would require $244 to $326 million in Gross Sales in Q1 to achieve the same Net as Zoryve.
If you look at my first sales graph ( prescriber penetration based gross sales forecast), my December 2026 forecasted Gross sale is 62 million AUD
The following 3 months would be 66.5 million, 71 million and 75.4 million ( Jan / Feb / Mar 2027 ) for a total of 212 million gross in Q1 - 27 ( OR 63 to 84 million AUD NET expected ) and around 60% of dermatoligists prescribing it. ( This is not 60% of sufferers, it's 60 % of dermatologists prescribing it to new sufferers only, without any penetration into existing sufferers accounted for ).... or a maximum of 2% total market penetration per year when 100% of dermatologists are eventualy prescribing it ..... by about 2030 using my metrics. I have not back calculated any of these figures, and they are based on what could be a conservative assumption that the 27 sales reps only continue pulling in about 11 new prescribers per month each, and BOT doesn't lift a fingure to hire more reps, advertise or do anything to get more doctors / prescribing derms onboard.
My second sales graph was somewhat brainlessly constructed purely based on the number of additional patients per month staying at 1,000 forever as it likely was close to in June. Even that scenario nets about 50% or 112 million in sales ( for about 40 million Gross in 2027Q1 )
4 - Where from here.Excuse the spellin, gramma, and punctuation.
Writing my thoughts out is therapy for what was a massive kick in the nuts thismorning.
If my hunch is correct about most dermatologists only prescribing Sofdra to new patients or existing patients specifically failing or looking for alternatives.... then the next 6 months ( now that we have enough prescribers onboard to start ramping ), will be very telling.
Add to that , eventually some of the pre-existing sufferers will inevitably hear about it and try it out at some point. They may be waiting to change health coverage over for this to happen.
Pretty clear that some holders / manipulators maybe calculated the 11% net Q2 and ran for the hills, I don't think they really understood why.
Q3 and Q4 25 will likely be double or tripple Net, and if they are not it can only be because of massive growth ( so many new customers coming in that require copay setups for the initial few prescriptions ). I think they are on track for somewhere between 10 and 15 million AUD net for 25 if they are comparing thier net with the likes of Articus. and multiples of that in 26.
Anyone want to discuss or can see any holes or questions about the logic, fire away.
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