Release Date: July 30, 2026
For the complete transcript of the earnings call, please refer to the full earnings call transcript.
Positive Points
- Record Q2 2026 total revenue of over $950 million, up nearly 40% year-over-year, driven by strong performance across INGREZZA, CRENESSITY, and VYKAT XR.
- INGREZZA delivered record quarterly sales of $716 million, up 15% year-over-year, with all-time highs in new patient starts and total prescriptions, leading to raised full-year guidance to $2.825-$2.875 billion.
- CRENESSITY continued its strong launch with $184 million in Q2 sales, steady new patient starts, high persistence, and a prescriber base that has nearly tripled year-over-year, with only 15% of the diagnosed patient population treated.
- VYKAT XR, acquired via Soleno, contributed $54 million in Q2 (pro forma $94 million), with integration progressing well and expectations for sequential growth exiting 2026, positioning it as a potential third blockbuster.
- Pipeline progress remains on track with Phase III readouts for osavampator (MDD) and direclidine (schizophrenia) expected in 2027, and a strong muscarinic franchise with multiple assets in development.
- The company ended Q2 with approximately $500 million in cash and no debt, providing financial flexibility for continued investment and strategic opportunities.
- Positive long-term data presented at ENDO 2026 for CRENESSITY (2-year) and VYKAT XR (3-year) reinforce durability and safety, supporting continued growth.
- INGREZZA continues to outgrow the VMAT2 market, maintaining leadership with strong access (70% of Medicare lives covered) and expectations for continued growth through 2027-2028.
Negative Points
- VYKAT XR sales were roughly flat sequentially, with discontinuations from the initial launch bolus expected to impact Q3, and growth only anticipated to resume in Q4 2026.
- The company faces potential pricing and access pressures from the IRA implementation in 2029, with uncertainty around the impact on INGREZZA's revenue and earnings.
- CRENESSITY's growth is limited by a fragmented market with many prescribers treating only one or two patients, and the company is not yet ready to provide formal guidance.
- The Soleno acquisition incurred approximately $150 million in acquisition-related costs, including $130 million recognized in Q2, impacting near-term GAAP earnings.
- VYKAT XR's ex-US strategy is on hold, with the EMA filing withdrawn, and international expansion is deprioritized until US integration is complete.
- The company faces competitive threats in the CAH market, with a potential competitor's acquisition signaling a large market opportunity, but Neurocrine must defend its position.
- Future launches in large markets (e.g., MDD, schizophrenia) will require significant SG&A investment, potentially leading to earnings variability in 2028-2029.
- The company is still learning about the VYKAT XR market, including managing discontinuations due to edema and other factors, which could impact long-term growth.
Q & A Highlights
Q: As it relates to INGREZZA, how much visibility do you have on pricing dynamics next year, and any insight into access dynamics with the NASHP MFP being enacted?
A: Kyle Gano (CEO) stated that 2026 access is strong with about 70% of Medicare lives covered under existing contracts, and pricing is expected to remain consistent through the second half of 2026. For 2027, discussions with payers are ongoing, and he sees a path for MFP-adjacent products, expecting strong access through 2027 and 2028 given Neurocrine's market leadership in the VMAT2 category. He also noted the market continues to grow double-digit year-over-year.
Q: On CRENESSITY, the quarter was strong with revenue up 20% quarter-over-quarter. Were there any one-time issues in Q2 that made it particularly strong, or is this pace of revenue growth reasonable for the next couple of quarters?
A: Eric Benevich (Chief Commercial Officer) characterized Q2 as an extension of the steady and consistent pattern of new patient adds seen earlier in the launch. Adoption continues across all segments, including pediatric endocrinologists, adult community endocrinologists, and centers of excellence. He noted that approximately 15% of the addressable patient population is now on treatment, and the company expects continued strong momentum.
Q: On VYKAT, the $94 million in sales is roughly flat sequentially. What are you doing to accelerate the launch trajectory now that the franchise is fully under your control?
A: Eric Benevich (Chief Commercial Officer) said Q2 results aligned with expectations from diligence. The company is still learning about the hyperphagia market opportunity, which reaffirms conviction in the product's blockbuster potential. Kyle Gano (CEO) added that VYKAT XR is a first-in-class, first-in-disease medicine for Prader-Willi syndrome with a durable IP estate extending to the mid-2040s, and the acquisition provides both strategic and financial fit, expanding the endocrinology franchise.
Q: Can you clarify how much of VYKAT's discontinuations are from edema, and what are you doing to help patients and practitioners manage through that to minimize discontinuations?
A: Kyle Gano (CEO) declined to break down discontinuations by cause but emphasized the opportunity to improve messaging and education for caregivers, patients, and physicians. He highlighted the unique weight-based titration schedule and the need to set appropriate expectations, noting that unlike pain medicines, hyperphagia improvement can take months. The company is working through these educational efforts as it integrates the Soleno team.
Q: Given the recent acquisition of a potential future competitor in CAH, can you talk about the clinical plan and timelines for your next-gen CRENESSITY assets?
A: Kyle Gano (CEO) discussed NBIP-1435, a next-generation peptide therapeutic that could be dosed once weekly or less frequently. Phase I data has been positive, and a Phase II study is expected to start shortly. He emphasized that CRENESSITY has set a high bar with strong efficacy, safety, and a broad label, making it difficult for competitors and even their own pipeline programs to surpass.
Q: With data readouts for osavampator and direclidine expected next year, do you have the commercial infrastructure to launch those products, and how are you thinking about building out that organization?
A: Eric Benevich (Chief Commercial Officer) said the company has a strong foundation in psychiatry and long-term care, and the recent INGREZZA sales force expansion was designed to set up for future launches. Kyle Gano (CEO) added that a positive osavampator readout would require a step-up in SG&A investment in 2028-2029, particularly for primary care expansion, but near-term focus remains on executing with INGREZZA.
Q: For your obesity efforts, what do you expect for monotherapy weight loss and muscle preservation for the CRF2 asset in Phase I, and when will we get the first full data cut?
A: Sanjay Keswani (Chief Medical Officer) said the CRF2 agonist is the first obesity molecule in the clinic, with Phase I data accumulating. A signal-seeking study readout is expected next year, focusing on both weight loss and lean mass preservation. Additional molecules in the obesity portfolio are expected to enter the clinic shortly.
Q: How are you thinking about smoothing top and bottom-line growth through the 2029 INGREZZA IRA implementation year, and does that depend on Phase III readouts next year?
A: Kyle Gano (CEO) said MFP discussions will start next year, but the company expects continued top-line revenue growth through the end of the decade driven by other growing portfolio medicines. Matt Abernethy (CFO) noted EPS variability will depend on IRA implementation and potential pre-launch investments for osavampator, but the North Star is long-term revenue growth with strong earnings growth expected into the 2030s.
Q: On CRENESSITY, what proportion of target practices are still not using the drug, and what are the barriers at this stage of the launch?
A: Eric Benevich (Chief Commercial Officer) said the market is "an inch deep and a mile wide," with most prescribers having treated only one or two patients. The company is still seeing substantial new prescriber adoption each quarter, and the long tail of the market means many practices have only a handful of patients. Growth is driven by both expanding prescriber breadth and increasing depth from existing prescribers.
Q: On VYKAT, should we expect sales to be roughly the same in Q3 as Q2, then show incremental growth in Q4?
A: Matt Abernethy (CFO) confirmed that Q3 sales are expected to be roughly flat, with sequential growth anticipated in Q4 and beyond. This is a function of getting through the bolus of discontinuations from the initial launch and implementing strategies to drive additional patient adoption. Kyle Gano (CEO) added that the integration process can be noisy, but the company has a strong track record of successful sales force expansions.
For the complete transcript of the earnings call, please refer to the full earnings call transcript.
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