AbbVie’s migraine drug franchise suffered a rough start to 2022, with one launch posting a surprising quarter-over-quarter decline in revenues. For investors at rival Biohaven Pharma—who were already on edge—that’s unwelcome news.
AbbVie’s oral CGRP inhibitor Ubrelvy brought $138 million sales in the first quarter, which missed Wall Street’s expectations by 18% and marked a 25% decline from the fourth quarter of 2021. Newly launched Qulipta generated $11 million in its market debut, but analysts had anticipated $20 million.
Biohaven investors would have cheered had AbbVie’s poor showing indicated market share gains for the company’s own oral CGRP med Nurtec ODT. But Biohaven’s stock price dropped roughly 9% Friday because AbbVie’s numbers suggested the entire class is facing pricing pressure. However, analysts at Piper Sandler are asking everybody to “just take a chill pill.”
Ubrelvy’s sales indicate a gross-to-net price discount rate of 66% in the first quarter, meaning the company is offering a steep discount off its list price for favorable coverage. That's up from 50% during the last three months of 2021, an SVB Securities team led by Marc Goodman said in a Sunday note.
Still, the 66% figure wasn’t so different from the 64% in the first quarter of 2021, suggesting a typical seasonal net pricing change.
Noting that year-over-year gross-to-net in the first quarter was “relatively flat,” AbbVie Chief Financial Officer Rob Michael recently asked investors to “think about it that way for the full year as well.” For 2021, SVB Securities calculated a gross-to-net ratio of 52% for Ubrelvy.
As for Qulipta, AbbVie is taking an aggressive approach to pricing during the launch, offering an estimated 85% gross-to-net in the first quarter, Goodman said.
Demand for Ubrelvy continued growing in acute migraine, and Qulipta showed “exceptional uptake” in migraine prevention, Jeff Stewart, AbbVie’s commercial chief, told investors during a Friday call. AbbVie has predicted Ubrelvy will reach $800 million in sales this year, and Qulipta will deliver $200 million.
Meanwhile, Biohaven investors were scared after AbbVie’s numbers dropped because Nurtec’s gross-to-net in the first quarter of 2021 was about 76%, Goodman noted. So, a repeat in that ballpark would mean significantly lower sales than consensus estimates.
While admitting that predicting first-quarter dynamics has always been difficult, Goodman pointed out that Nurtec’s gross-to-net in full-year 2021 was 59% and figured 2022 will be the same. Based on that, he estimates Nurtec’s 2022 sales will reach $925 million and its U.S. peak sales will come in above $2 billion, thanks to “very strong CGRP market increases driven by aggressive marketing from two players.”
Similarly, the Piper Sandler team led by Christopher Raymond reminded investors in a Friday note that Nurtec has been gaining popularity among both neurologists and primary care doctors. So the team argued that AbbVie’s experience “should actually provide comfort to [Biohaven] investors, rather than concern.”
For preventive migraine, Biohaven is rolling out a two-pack box—versus one for the initial acute indication—which is still counted as one script, Raymond and Goodman noted. Calculating IQVIA’s dispensed tablets data, Raymond found Nurtec actually had 13% more scripts quarter over quarter.
Despite potential first-quarter pricing pressure, the Piper Sandler team thinks Nurtec could reach $3.9 billion in sales by 2030.