OptiNose, Inc.

OptiNose reported third-quarter 2024 XHANCE net revenue of $20.4 million, up 3% year over year from $19.8 million. Estimated average net revenue per prescription was $320 in Q3, up 36% from $236 in Q3 2023. SG&A plus R&D expenses were $20.4 million in Q3, up about $1 million from $19.3 million last year. For the first nine months of 2024, XHANCE net revenue was $55.8 million, up 9% from $51.1 million, and average net revenue per prescription was $285, up 45% from $197. Full-year 2024 guidance was reduced to $75 million-$79 million of XHANCE net revenue, with implied Q4 revenue of about $19 million-$23 million; average net revenue per prescription is now expected to be about $270 for 2024, and operating expenses are guided to $90 million-$93 million, including about $6 million of stock-based compensation. Management said existing cash and cash equivalents should be sufficient to fund operations and debt service for at least the next 12 months if covenant requirements are met or adjusted.

Ramy Mahmoud framed the quarter as slower than hoped but emphasized a larger long-term opportunity for XHANCE in chronic sinusitis, saying peak annual net revenue of at least $300 million remains achievable. He highlighted changes made during the launch, including sharper HCP targeting, updated messaging, better payer access, and hub/pharmacy improvements, and said recent data suggest a clear inflection in new prescription demand. His tone was cautious but constructive, repeatedly stressing that the company is learning from the launch and believes the business is moving onto a better growth trajectory.

Terry Kohler focused on the financial bridge between launch investments and updated guidance. He cited Q3 XHANCE net revenue of $20.4 million, a 3% increase year over year, and average net revenue per prescription of $320 versus $236 last year, driven by co-pay program changes and channel inventory build; he also said Q3 SG&A plus R&D was $20.4 million, up about $1 million from last year. For 2024, he lowered revenue guidance to $75 million-$79 million, raised average net revenue per prescription guidance to about $270 from an earlier expectation above $250, and cut operating expense guidance to $90 million-$93 million from $95 million-$101 million, saying the company expects at least $5 million of expense favorability. He added that cash should cover operations and debt service for at least 12 months, subject to debt covenant compliance or modification.

Analysts focused on why Q4 guidance could imply a sequential revenue decline despite improving script trends, and management said Q3 included about $3 million of channel inventory stocking that lifted revenue. They also discussed insurance coverage, with Ramy saying most plans have likely updated coverage to include both approved indications, though some changes are reflected in prior authorization language rather than explicit policy updates. On 2025 profitability, Terry said the company is not giving 2025 guidance now and is removing prior guidance so it can reassess after Q4, while Ramy said the recent inflection makes next year harder to project. Other questions centered on cost structure and prescriber behavior; management said spending remains tightly controlled, incremental specialty investment may still be ROI-positive, and the main hurdle is educating prescribers on XHANCE’s differentiated efficacy rather than outright pushback.