Madrigal Pharmaceuticals (MDGL) TD Cowen 46th Annual Health Care Conference summary

Strategy and performance update

• Rezdiffra launch is annualizing at $1.3 billion, with the market growing 50% over two years and 50% of diagnosed patients at targeted physicians.

• Sales for 2025 are projected close to $1 billion, with over 36,250 patients on therapy by year-end.

• Pipeline expanded from a single product to over 10, including oral GLP-1, DGAT2 inhibitor, and siRNA programs.

• Secured IP for Rezdiffra through 2045, positioning for long-term growth.

• Combination therapies and new mechanisms are being pursued to enhance response rates.

Financial outlook and risk management

• Comfortable with 2026 consensus revenue of $1.48 billion, reflecting continued market momentum.

• Q1 revenue typically declines mid-to-high single digits due to insurance re-verification and contracting effects, but net patient adds are expected to grow steadily through the year.

• Gross-to-net expected to stabilize in the high 30s for 2026, with a step up in 2027 as Medicare negotiations progress.

• Profitability is anticipated after 2026, with recent quarters already cash flow positive excluding one-time charges.

• Majority of commercial payer contracts are secured, with first-line access and minimal restrictions.

Market dynamics and competitive landscape

• GLP-1s are not negatively impacting Rezdiffra; increased awareness benefits the product.

• Less than 12% market penetration into the initial 315,000 patient pool, indicating significant growth potential.

• Endocrinologists are increasingly interested in prescribing, with efforts to expand detailing to this group underway.

• Prescribing remains focused on specialists (hepatologists, gastroenterologists, endocrinologists).