Phathom Pharmaceuticals' latest earnings call [Q1 2024 Earnings Call] buzzed with the usual launch metrics: burgeoning prescriptions, expanding payer coverage, and glowing physician feedback. But beneath the optimistic exterior, a fascinating and potentially game-changing trend is emerging: a silent wave of patients, disillusioned with traditional GERD treatments, is about to trigger a surge in demand for Phathom's innovative offering, VOQUEZNA.

While analysts are fixated on the company's reported 17,500 filled prescriptions, a closer examination unveils a far more compelling story. Phathom estimates that over 43,000 prescriptions have been written for VOQUEZNA, marking a staggering 150% increase in demand since their last report just nine weeks prior [Previous Earnings Call]. This discrepancy, a gap of over 25,000 prescriptions, isn't merely a lag in data reporting; it's a clear indication of a potent, pent-up demand waiting to be unleashed.

This burgeoning demand isn't spontaneous. Physicians are evidently impressed with VOQUEZNA's rapid, potent, and sustained acid suppression, commending its distinct mechanism of action. Patients, too, are echoing the sentiment, reporting life-altering symptom relief, particularly those who have endured years of discomfort. However, a critical hurdle remains: access.

Phathom is acutely aware of this bottleneck. Their patient support program through BlinkRx has been crucial in getting VOQUEZNA into the hands of eager patients, but it's a temporary solution. The real game-changer lies in securing extensive payer coverage, and here, Phathom is strategically maneuvering.

The recent inclusion of VOQUEZNA in Cigna's formularies, with a coveted single-step edit, isn't just a victory; it's a strategic masterstroke. This, coupled with their previous success in securing the same position on Express Scripts' national formularies, signifies that approximately 72 million commercially insured individuals now have access to VOQUEZNA [Q1 2024 Earnings Call]. More crucially, it validates Phathom's pricing and access strategy, signaling to other major payers that VOQUEZNA is a force to be reckoned with.

The Explosive Hypothesis: Unleashing the Demand

Here's where the hypothesis gets electrifying: As Phathom continues to secure favorable coverage from major payers, anticipate a dramatic narrowing of that 25,000 prescription gap. This silent army of patients, armed with prescriptions and now empowered by insurance coverage, is poised to fuel a dramatic surge in VOQUEZNA's uptake.

But the narrative doesn't end there. Phathom is sitting on another potential catalyst: the anticipated July approval for daily dosing in non-erosive GERD. This isn't just a label expansion; it's an entry into a market more than twice the size of erosive GERD, encompassing an estimated 15 million sufferers.

The brilliance of Phathom's strategy lies in its synergy. They've established a targeted sales force, cultivated strong physician relationships, and launched a robust consumer campaign. This existing infrastructure, coupled with the anticipated wave of patient demand, means the non-erosive GERD launch won't be starting from scratch. It will be propelled by an existing momentum, poised to catapult VOQUEZNA into blockbuster territory.

The Rise of VOQUEZNA: Tracking Filled Prescriptions

The chart below illustrates the significant growth in filled VOQUEZNA prescriptions since launch, highlighting the potential for exponential growth as access expands.

Recall the $3 billion peak revenue estimate? It's starting to look less like an audacious prediction and more like a conservative assessment. Phathom's launch isn't merely progressing; it's gaining momentum, poised for an explosive acceleration. The pieces are in place, the demand is palpable, and access is widening. The $3 billion time bomb is ticking, and it's only a matter of time before it detonates.

"Fun Fact: Phathom's name cleverly plays on the pH scale, signifying their focus on acid-related gastrointestinal diseases. It's a subtle yet effective reminder of their mission: to revolutionize the status quo and provide groundbreaking solutions for patients in need."