ARS Pharmaceuticals Q1 Earnings Call Highlights
ARS Pharmaceuticals (NASDAQ:SPRY) reported first-quarter 2026 revenue of $22.7 million as executives said the company is working to expand access, reduce prescribing friction and build momentum for neffy, its needle-free epinephrine treatment for allergic reactions including anaphylaxis.
Co-founder, President and Chief Executive Officer Richard Lowenthal said the company generated $17.5 million in U.S. net product revenue for neffy during the quarter, with prescription volume tripling year over year and revenue more than doubling. He characterized the quarter as a “strong start” to 2026, particularly because the first two months of the year are typically the lowest-volume period for epinephrine products due to the reset of health insurance deductibles.
Lowenthal said ARS is focused on three priorities for neffy: access, affordability and adoption. He noted that epinephrine is a mature, refill-driven market, with about half of prescriptions typically coming from renewals that may be written electronically without an office visit. As a newer entrant, neffy has relied more heavily on new in-office prescriptions, but Lowenthal said improved payer access, reduced prescribing friction and the maturation of refill cycles should support more scalable growth over time.
Access Efforts Center on Prior Authorization
Lowenthal said ARS ended the first quarter with about 90% commercial coverage for neffy, with 57% of covered lives having access without prior authorization. He said the company views prior authorization requirements and misperceptions about out-of-pocket costs as key barriers to prescriber adoption.
The company is awaiting a potential formulary decision from CVS Health, which Lowenthal said includes Caremark, Aetna and Anthem. ARS submitted an updated proposal in late April seeking to add neffy to commercial formularies without a prior authorization requirement, targeting a July 1 effective date. Lowenthal said the proposal is in the final stages of the formulary approval process and that the company expects to provide a more definitive update in the coming weeks.
Chief Commercial Officer Eric Karas said during the question-and-answer session that CVS represents about 15% of covered lives, Anthem about 5% and Aetna about 4%. He said ARS feels confident based on its conversations with CVS Caremark and that a July 1 start would align with the company’s back-to-school marketing and field-force plans.
On Medicaid, ARS said Florida has added neffy to its unrestricted formulary effective July 1, bringing the total to nine states covering the product under Medicaid. Karas said Florida is among the top five states in the epinephrine market and that ARS is in active discussions with multiple states and state pooling groups. He said the company expects to achieve unrestricted coverage in the majority of Medicaid programs by early 2027.
New Retail Cash Price Program Aims to Reduce Abandonment
ARS also launched a program designed to ensure patients whose commercial insurance claims are rejected at retail pharmacies can access neffy for no more than $199. Lowenthal said the $199 cash price had previously been available through specialty pharmacy and telehealth channels, but patients filling prescriptions at retail pharmacies could sometimes be quoted the wholesale acquisition cost plus pharmacy markup, resulting in out-of-pocket costs above $1,000 in some cases.
Lowenthal said the new retail program is intended to reduce confusion for patients and prescribers and align provider perception with the company’s stated maximum cash price. During the Q, he said the program was implemented at the pharmacy level during the week of the call and should automatically convert certain rejected commercial claims to the $199 price.
Karas said three vendors involved in the process cover about 90% of pharmacies and already work with ARS on its copay program. He said about 55% of neffy prescriptions are currently going through retail, with the remaining 45% going through the company’s patient assistance program. He also said abandonment in the category is similar to neffy, at roughly 22% to 23%.
Commercial Expansion and Back-to-School Season
ARS said approximately 120,000 patients are using neffy in the U.S., including 29,500 patients added during the first quarter. Karas said more than 28,000 health care providers have prescribed neffy, with about half demonstrating repeat use. He said prescribing is concentrated among the highest-decile accounts, where adoption is most meaningful for volume.
The company expanded its sales organization in May to 148 representatives and area sales managers. Karas said the larger field team is focused on high-volume practices, prior authorization support, electronic refill requests and back-to-school preparation. ARS is also increasing direct-to-consumer media aimed at parents, including linear and connected TV, digital platforms, social media and testimonials.
Lowenthal said refill activity should begin contributing more meaningfully during the summer, as families seek prescriptions that will last through the full school year. He said initial launch lots expire around the end of the year and beginning of next year, but many parents are expected to renew prescriptions earlier to avoid having product expire during the school year.
Label and International Updates
Lowenthal said the Food and Drug Administration removed the minimum age restriction from the neffy label at the end of March, enabling pediatric patients who weigh more than 33 pounds and are under 4 years old to access treatment. He said ARS believes pediatric adoption will accelerate as the broadened label takes hold.
The company also highlighted its neffyinSchools program, saying more than 200 successful uses of neffy in anaphylactic episodes have been reported by school nurses, with positive feedback. Lowenthal said these reports may help build familiarity among patients, caregivers, school nurses and prescribers.
Outside the U.S., Lowenthal said Health Canada approved neffy in April as the first and only needle-free emergency treatment for allergic reactions, including anaphylaxis. Commercial launch in Canada by partner ALK is expected later in 2026. In March, the European Commission granted marketing authorization for neffy 1 mg, expanding access for younger children in Europe.
Financial Position and Outlook
Chief Financial Officer Kathleen Scott said first-quarter revenue consisted of $17.5 million in U.S. neffy net product revenue, $2.5 million in collaboration revenue and $2.7 million in supply revenue from international partners. The collaboration revenue was tied to a $5 million milestone payment from ALK triggered by approval of neffy 1 mg in the European Union, with most of the remaining balance recorded as a financing liability.
Research and development expenses were $4.3 million, while selling, general and administrative expenses were $72.2 million, reflecting commercialization investments across direct-to-consumer marketing and field execution. Scott said the company expects its 2026 SG run rate to be slightly higher than the run rate in the second half of 2025, while shifting spending toward higher-return commercial activities.
ARS ended the quarter with $201 million in cash equivalents and short-term investments. Scott said the company remains focused on progress toward cash flow breakeven. In response to an analyst question, Lowenthal said current company projections call for cash breakeven by mid-2027, with losses expected to decline over time as revenue becomes more weighted toward the second half of 2026.
Lowenthal said ARS expects neffy prescription growth to expand as new initiatives reduce provider and patient friction. He said a favorable CVS Caremark decision would further accelerate the company’s trajectory.
About ARS Pharmaceuticals (NASDAQ:SPRY)
ARS Pharmaceuticals, Inc, a biopharmaceutical company, develops treatments for severe allergic reactions. The company is developing neffy, a needle-free and low-dose intranasal epinephrine nasal spray for the emergency treatment of Type I allergic reactions, including anaphylaxis. It serves healthcare professionals, patients, and caregivers. ARS Pharmaceuticals, Inc was founded in 2015 and is headquartered in San Diego, California.
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