Catalyst Pharmaceuticals Inc (NASDAQ: CPRX) Q4 2020 earnings call dated Mar. 16, 2021.
Corporate Participants:
Alicia Grande — Vice President, Chief Financial Officer and Treasurer
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Jeffrey Del Carmen — Chief Commercial Officer
Steven R. Miller — Chief Operating Officer and Chief Scientific Officer
Analysts:
Joseph M. Catanzaro — Piper Sandler — Analyst
Charles C. Duncan — Cantor Fitzgerald — Analyst
Leszek Sulewski — Truist Securities — Analyst
Scott R. Henry — ROTH Capital Partners LLC — Analyst
Presentation:
Operator
Greetings, and welcome to the Catalyst Pharmaceuticals’ Fourth Quarter and Fiscal Year 2020 Financial Results Conference Call. [Operator Instructions]
It is now my pleasure to introduce your host, Ms. Ali Grande, Chief Financial Officer. Thank you. Please go ahead.
Alicia Grande — Vice President, Chief Financial Officer and Treasurer
Good morning, everyone, and thank you for joining our conference call to discuss Catalyst’s fourth quarter and full year 2020 financial results and corporate highlights.
Speaking on today’s call, we have Patrick McEnany, Chairman and Chief Executive Officer; Dr. Steven Miller, Chief Operating Officer and Chief Scientific Officer; and Jeffrey Del Carmen, Chief Commercial Officer. Joining in the Q&A, we’ll also have Dr. Gary Ingenito, Chief Medical and Regulatory Officer.
Before we begin, I would like to remind you that in the following comments and in the Q&A session, we will make statements about expected future results which may be forward-looking statements for purposes of federal securities laws. These statements relate to our current expectations, estimates and projections and are not guarantees of future performance. They involve risks, uncertainties and assumptions that are difficult to predict and may prove not to be accurate, especially in light of the effects of COVID-19. Actual results may vary. These forward-looking statements should be considered only in conjunction with the detailed information contained in our SEC filings, including the risk factors described in our 2020 Annual Report on the Form 10-K.
At this time, I will turn the call over to Pat.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Thank you, Ali, and thanks everyone for joining us this morning for our fourth quarter and year end 2020 results and business update call. I hope that everyone is staying safe and healthy during these difficulty times. This past year has been extremely challenging year for Catalyst, especially for our commercial organization.
So, with that backdrop, we are very pleased with the financial results that were included in our press release yesterday. Despite operating under very difficult conditions in the COVID-19 environment, we generated net revenue of $119.1 million and net income from operations of $41.3 million, which included a non-cash stock-based compensation expense of $6.3 million, which resulted in almost $46 million of additional cash and investments on the balance sheet at the end of the year compared to the end of 2019. Additionally, we ended the year with $140.3 million in cash and investments and no funded debt. Ali will provide you more financial details in a few minutes.
I know that I say this often, but I just want to say once again how proud I am of the team’s ongoing effort to demonstrate their steadfast commitment to the patients that we serve. We have shown a remarkable resilience and ability to continue to expand the number of patients benefiting from Firdapse to treat their LEMS condition.
COVID-19 continues to make it somewhat challenging for patients who have LEMS, who have not received a definitive diagnosis from their physician because of the difficulty in scheduling and in-person appointment or their personal concerns about in-person visits with their treating physician.
Last year, COVID-19 had a material impact on the number of new patient starts that we had projected for 2020. New patient starts in Q2 and Q3 of the past year were modest on a relative basis compared to the pre-COVID period. I’m pleased to report that we have seen a significant increase in new patient starts on Firdapse during the last few months and we’re continuing to see improvement in most all of our commercial metrics. We believe that you will see that we have well positioned the Company for future growth. Jeff will provide you with more details on our commercial operations shortly.
As you may recall, late last year, our U.S. patent for 3,4-diaminopyridine issued. This patent and four additional patents that are pending in the patent estate are expected to provide protection until at least 2034. This patent protection is in addition to our seven-year orphan drug exclusivity for Firdapse.
Recently, we announced an expansion in the Company’s strategic focus to include acquiring or in-licensing innovative technology platforms and earlier stage programs in other therapeutic categories outside of neuromuscular disease. To accomplish these priorities, Catalyst is prepared to invest more heavily in research and development, including acquiring earlier stage opportunities and innovative technology. We believe this strategic expansion will better position the Company to build out a broader, more diversified portfolio of marketed product and/or drug candidates and expect that this will add greater shareholder value over the near term and the long term.
To spearhead this investment, we have commenced a national search for a senior executive to lead this more progressive strategy. This individual will likely be an M.D. or Ph.D. with 15 to 20 years of relevant pharma experience in innovative drug discovery. This person will be responsible for leading strategy development, portfolio planning and medication development from early stage through marketing authorizations.
As part of this strategic plan, we will continue to focus on developing our current pipeline, which includes the development of the long-acting formulation of amifampridine phosphate; a proof-of-concept study evaluating Firdapse as a treatment for Hereditary Neuropathy with Liability to Pressure Palsies, or HNPP; and discussion with the FDA for potential path forward with our MuSK-Myasthenia Gravis program. Steve will have more to say about these programs in a few minutes.
On the litigation front, in our appeals of the U.S. District Court’s decision in our lawsuit challenging the Food and Drug Administration’s interpretation of Firdapse orphan drug exclusivity under the Orphan Drug Act, the briefs have been filed and the Eleventh Circuit Court of Appeals has granted our request for oral arguments, which is currently scheduled for March 23rd, or next Tuesday. With this schedule, we anticipate a decision by the court sometime in the second quarter of this year.
Our previously announced patent litigation against Jacobus Pharmaceuticals and PantherRx, Jacobus’ sole specialty pharmacy provider for Ruzurgi, is proceeding as expected. These types of cases, however, take some time to develop through discovery and other pre-trial activities, so no trial date is expected for the near future.
As we have stated previously, it is important to note that these litigation activities in no way impact Catalyst Pathways, our patient services programs, market access for Firdapse, or our ongoing marketing efforts for Firdapse to adult LEMS patients, which represent about 99% of the LEMS patient population. Catalyst intends to continue to aggressively take all steps necessary to protect Firdapse exclusivity under the Orphan Drug Act, which is specifically intended to encourage and ensure the development of drugs for patients with rare diseases.
At this point, I’d like to turn the call over to Jeff Del Carmen, our Chief Commercial Officer, to provide you with further details on our commercial operations.
Jeffrey Del Carmen — Chief Commercial Officer
Thanks, Pat, and good morning, everyone.
I will now walk through 2020 Firdapse performance in more detail. We are very pleased with the full year U.S. net sales of $118.7 million, which represents a 16% growth year-over-year. Specifically, Q4 was a very strong quarter, delivering $30.8 million in U.S. net sales, our best net revenue quarter since Q3 2019, despite the resurgence of COVID-19.
I want to take this opportunity to thank the entire Catalyst team for their outstanding performance in 2020, a true testament to our ability to be agile, while maintaining our commitment to the LEMS community.
Growth in 2020 was driven primarily by a recovery in new patient enrollments in Q3 and Q4, continued favorable reimbursement dynamics and a stabilization with compliance and persistence rates. In October, new naive to 3,4-DAP patient enrollments were higher than any other month since May 2019. In Q4, new enrollments outpaced Q3 by 30%. The 90-day discontinuation rates are less than 15% and discontinuation to Ruzurgi continued to be minimal and relatively flat since Q1 2020. We expect continued growth in 2021 versus same quarters last year as we build upon the momentum generated in Q4 and the COVID-19 vaccination rate continues to increase, allowing for more in-person patient visits.
While the combined effort of our rare disease experience team, non-personal promotion and inside sales enables efficient coverage for close to 20,000 health care professionals that potentially treat adult LEMS patients, more in-person sales representative visits will lead to an increase in new patient enrollments. Based on early observations, new patient enrollments will achieve new highs as the impact of the pandemic subsides. In fact, we are proud to say that over 700 patients have now received the Firdapse prescription. Discontinuations in January were 65% lower than January of 2020.
Our Catalyst Pathways patient services team did a tremendous job in 2020, providing personalized support to adult LEMS patients, caregivers and healthcare professionals. Throughout the pandemic, LEMS patients had confidence that they had access to Firdapse without disruption. Prescription approval rates remained over 90% across all payers, government or private commercial insurers. Furthermore, 98% of re-authorizations have been granted thus far, which shows the value of Firdapse is recognized by payers. Patients enrolled in Catalyst Pathways, including those who are covered by Medicare and accessing foundation assistance, have an average co-pay of less than $2 per month. In 2021, we remain committed to making Firdapse affordable and accessible to all adult LEMS patients to the extent allowed by applicable law.
As I mentioned on the Q3 earnings call, we remain confident in our assessment of the remaining potential adult LEMS addressable market. Besides the already diagnosed LEMS patients not yet on Firdapse, there are significant number of patients that are unfortunately misdiagnosed or undiagnosed. We will continue to invest heavily in robust LEMS educational resources directed towards both patients and healthcare professionals to help shorten the diagnostic journey. Additionally, approximately 50% of LEMS patients are tumor LEMS patients. However, less than 20% of patients currently in Catalyst Pathways are known to be tumor LEMS patients. We are actively conducting market research, ad boards and working groups to better understand how we can help identify and serve these adult tumor LEMS patients.
In closing, we are very optimistic about the growth potential for Firdapse in 2021 and beyond. Our team is deep in rare disease experience and passionate about serving the LEMS community.
I will now turn the call over to Dr. Steven Miller, our Chief Operating Officer and Chief Scientific Officer, for an update on R&D activities.
Steven R. Miller — Chief Operating Officer and Chief Scientific Officer
Thanks for the commercial update, Jeff.
I’ll now provide an update on our clinical pipeline to develop Firdapse for additional indications. Catalyst previously announced that our multi-center Phase 3 trial for the symptomatic treatment of MuSK-Myasthenia Gravis, or MuSK-MG, with Firdapse did not achieve statistical significance for the primary and secondary endpoints. We have concluded our detailed analysis of potential reasons why this trial did not meet statistical significance on its influence.
Also as reported previously, marked persistent clinical improvement was observed in patients and by investigators during the initial dose-titration period and during the safety follow-up study of this trial. At this point in time, about half of the patients from this trial remained on therapy in a safety follow-up study and they have stated the Firdapse is providing clinical benefit.
Additionally, significant clinical improvement was also seen in the previous proof-of-concept trial. Our analysis of the clinical trial data revealed that there is a large degree of symptom variability during the double-blinded withdrawal period. Further, MuSK-MG patients appeared to exhibit significant symptom variability from day to day. These sources of excessive unexpected short duration variability adversely affected the power of the trial, resulting in a lack of statistical significance. We believe these sources of variability can be dealt with in a redesigned trial that may better demonstrate the observed efficacy.
We plan to present our hypothesis and a new clinical trial protocol to the FDA for discussion during the first half of 2021. Specifically, we will be — we will discuss the differences in the design of the new trial relative to the design of the completed trials and whether or not the agency would be willing to accept a new passing trial of a different design as adequate evidence of efficacy. We anticipate completing this meeting with the agency in the first half of this year. In parallel with this meeting, we will evaluate new clinical trial sites and discuss the new trial design with investigators. After completing these activities, we will determine whether or not to proceed with a new trial that incorporates the new design and report our decision after receiving FDA meeting minutes.
Catalyst will be initiating a Catalyst sponsored proof-of-concept study to evaluate the treatment of Hereditary Neuropathy with Liability to Pressure Palsies, or HNPP, with Firdapse during the third quarter of 2021. The scientific basis for considering this indication is that leakage of neuron potassium channels is observed in HNPP. And Firdapse is a potassium channel blocker and may mitigate the pathological effects of the potassium channel leakage in HNPP patients.
HNPP is an autosomal-dominantly inherited demyelinating peripheral nerve disease caused by a heterozygous deletion of PMP22 gene, leading to a reduction of PMP22 proteins by 35% to 50% of normal level, which results in disruption of the myelin sheaths of motor and sensory nerve axons. Patients with HNPP often present with focal sensory and motor deficits, including numbness and focal paralysis. The events may be triggered by mild mechanical compression innocuous to healthy people. In addition, HNPP patients are also afflicted by fatigue. Catalyst believes that HNPP affects about 6,000 patients in the Unites States.
It is hypothesized that functional demyelination in HNPP patients is excessive outward current through internodal voltage-gated potassium channels. Application of a potassium channel blocker, like amifampridine, is expected to improve action potential propagation in HNPP, thereby alleviating sensory deficits, motor deficits and fatigue in HNPP. This hypothesis is supported by research in HNPP animal model with PMP22 heterozygous deletion.
Moving on to other markets and research opportunities, we previously reported that we have reached agreement with the Japanese PMDA on a regulatory pathway to seek approval for Firdapse in Japan, initially for the treatment of LEMS. Firdapse would be a new chemical entity for that market and as such would be granted 10 years of market exclusivity. As a reminder, Japanese market is about 40% of the size of the U.S. market with about 1,200 to 1,300 patients. There are also no therapies in the Japanese market for MuSK-MG and HNPP.
Regarding our Firdapse LA product that is under development, we have developed the first group of candidate long-acting formulas and have also completed a pharmacokinetic, or PK, study of those candidate formulations. These PK results would form on the design of future formulations with the ultimate goal of providing patients with an effective medication they need to take only once in the morning and once in the evening. We have also interviewed numerous physicians and LEMS patients to get input into the design of an optimal product that they feel would be superior to the current Firdapse product offering. That input is the basis for our design goals for the new Firdapse LA product.
Catalyst has also made significant progress on developing an intellectual property estate to protect the Firdapse franchise. Last October, we reported the issuance of U.S. patent number 10-793-893, methods of administering 3, 4-diaminopyridine, expiring April 7, 2034. Catalyst has also begun to protect the Firdapse franchise and has filed suit in federal court against Jacobus Pharmaceuticals and PantherRx for induced infringement of our issued patent. A number of the documents related to this case are publicly available for anyone interested in learning more about the case.
In addition, Catalyst has four other pending patents related to the use of Firdapse that were recently published. All four of these patents are being prosecuted under Track One status at the U.S. Patent and Trademark Office and we are hopeful that most, if not all of them, will be issued in 2021. Assuming issuance of these patents, Catalyst also anticipates taking appropriate legal action to protect this new patented intellectual property.
I will now turn the call over to Ali Grande, our Chief Financial Officer, to review our financial results.
Alicia Grande — Vice President, Chief Financial Officer and Treasurer
Thanks, Steve.
As Pat mentioned, we are very pleased with our 2020 year results. Despite the difficulties from the COVID-19 pandemic, we remained steady in our performance. Our continued revenue growth and prudent expense management allowed us to the cash flow positive in every quarter in 2020. We believe our cash position is sufficient to achieve self sustainability without the need for any future dilutive financing.
Yesterday, we filed our 2020 Form 10-K with the SEC and reported our detailed fourth quarter and full year financial results in a press release. Let me highlight a few of those results now.
For 2020, we achieved total revenue of $119.1 million compared to $102.3 million for 2019, which represents a 16% year-over-year increase.
We reported GAAP net income of $75 million for 2020, or $0.72 per basic and $0.71 per diluted share, compared to a GAAP net income of $31.9 million, or $0.31 per basic and $0.30 per diluted share, in the year 2020 [Phonetic]. Net income for 2020 includes $33.1 million, or $0.32 per basic and $0.31 per diluted share, of tax benefits from recording the deferred tax assets, including the reversal of the valuation allowance during the third quarter of 2020.
For 2020, non-GAAP net income, excluding $6.3 million of expenses related to our non-cash stock-based compensation, was $81.2 million, or $0.78 per basic and $0.76 per diluted share. In comparison, 2019 non-GAAP net income, excluding $3.8 million of expenses related to non-cash stock-based compensation, was $35.7 million, or $0.35 per basic and $0.34 per diluted share.
Cost of sales of $17 million for the year 2020 and $14.8 million for the year 2019 remained consistent at 14% as anticipated. As a reminder, our cost of products in 2020 and 2019 benefited from inventory expense prior to FDA approval of Firdapse.
Research and development expenses were $16.5 million for 2020, down from $18.8 million for 2019. The approximately 12% decrease in research and development expenses year-over-year is primarily due to increases in expenses for medical, regulatory affairs and quality assurance programs and reduced expenses from our ongoing Firdapse clinical trials and studies as we closed out the MuSK-MG and SMA Type 3 trials.
We expect that research and development costs will continue to be substantial in 2021 as we begun our proof-of-concept study for HNPP, continue our access — our expanded access program, our long-acting formulation program for Firdapse, continue our regulatory path to seek approval of Firdapse for the treatment of LEMS in Japan and begin to evaluate Firdapse as a treatment for other neuromuscular diseases.
SG&A expenses for 2020 totaled $44.2 million compared to $36.9 million in 2019. The 20% increase year-over-year is primarily attributable to the expansion of our sales force in the first quarter of 2020. The cost of contracting with a rare disease experienced in telesales agency, increases — increased costs related including the litigation, Investor Relations and additional G&A supporting personnel to support our expanding operations. We expect that SG&A expenses will continue to be substantial in 2021 as we continue our efforts to increase revenues from Firdapse and take steps to expand our business.
On December 31, 2020, Catalyst had cash and investments of $140.2 million and no funded debt. More detailed information and analysis may be found in the Company’s annual report on Form 10-K, which was filed with the Securities and Exchange Commission yesterday, March 15, and can be found on the Investors Relations page of our website, www.catalystpharma.com.
And with that, I’ll turn the call over to Pat.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Thanks, Ali.
I’d like to close our prepared remarks today by providing you with an overview of our corporate objectives for 2021. First and foremost, emphasis continues on the strong commercial launch of Firdapse for LEMS patients, which represents the cornerstone of our business. As we are beginning to move back to more normalized times post pandemic, we anticipate a more accelerated rate of growth in revenue as the year progresses. We believe that our work has just begun, as we believe there are many more LEMS patients who have not yet been diagnosed or have been misdiagnosed that can be effectively treated with Firdapse.
Next, an aggressive initiative to build through acquisition or in-licensing a portfolio of additional potential therapies to treat rare unmet medical needs. This will include bringing on board a Chief Product Development Officer to leading strategy development, portfolio management and execution of the plan. This executive search is currently underway.
Third, continue to protect and prosecute our patent and statutory exclusivities for Firdapse and any other assets that we may acquire. We will continue to file additional patent applications as we develop new intellectual property surrounding our assets.
Next, we will continue our development efforts for Firdapse by commencing soon a proven concept study for HNPP and meeting with the FDA in the second quarter to discuss our findings from the MuSK-MG trial, and determining if there is a reasonable regulatory path forward for this life-threatening disorder. Also, we will continue to work at a good pace for developing a long-acting formulation of Firdapse.
Lastly, we will manage our Company for growth and to build shareholder value while continuing to operate with fiscal discipline.
I just want to say once more how pleased we are with the operational results that our team delivered during 2020. We look forward to continuing our efforts to assist adult LEMS patients and their treating physicians find ways to gain access to an FDA approved therapy for this disease.
We believe that 2021 will be a transformative year for the Company with multiple ongoing development programs and a strategy to build our clinical and commercial portfolio. This expansion plan along with the continued global commercial execution of Firdapse means Catalyst is well positioned for a strong success in 2021 and beyond.
I’ll now turn the call over to the operator that we may — so that we may now take your questions.
Questions and Answers:
Operator
Thank you. [Operator Instructions] Our first question is coming from Joe Catanzaro of Piper Sandler. Please go ahead.
Joseph M. Catanzaro — Piper Sandler — Analyst
Hey, guys. Thanks so much for taking my questions here. On your 3Q call, you mentioned that on October and November the new patient enrollment starts were the highest you’ve seen since July of 2019, but weren’t quite ready to call it a trend. It seems like based on your comments, now that maybe that was in fact the trend, and I’m wondering if you could speak a little bit more to that, and whether you have any expectations to issue guidance at some point in 2021?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Joe, thanks for the question. Let me first address guidance. We’d like to see another quarter or two as the country starts to open again and physicians are actually seeing patients in person before we give guidance. So, we’re not prepared today. I think that another quarter or two, we should be prepared to provide guidance at that time.
The first part of your question, I’ll let Jeff address in terms of trends that we are now seeing versus our forecast back in Q3.
Jeffrey Del Carmen — Chief Commercial Officer
Sure. Thanks for the question, Joe, and you are right. In Q3 and Q4, specifically October, November, very strong new enrollments. As you know, there is a little bit of a resurgence of the pandemic on November and December, which kind of slowed that trend a little bit, but thankfully, we’re seeing the country open up a little bit. And in Q1, so far, we are tracking to have our best new enrollment quarter since Q2 of 2019, so — and that’s for new naive patients, which is very significant. So, the team is doing a fantastic job.
The other thing I wanted to add in there is, Ali mentioned it too, we have an expansion, 80% expansion, of our sales force that happened right before the pandemic. We have yet to fully realize that expansion and see that the true potential. We know we will see that and patients will be able to see their physician. So, all those things combined, we expect significant growth in new enrollments in 2021.
Joseph M. Catanzaro — Piper Sandler — Analyst
Great. Thanks. And if I could just ask one follow-up. So it sounds like your 90-day discontinuation rates have held largely steady. I’m wondering if you’ve seen any impact from the pandemic to those numbers? And if you expect that number to potentially maybe also improve as things open up and patients begin to start seeing their physicians in person?
Jeffrey Del Carmen — Chief Commercial Officer
It’s a good question, Joe. And so, in response to that, the 15 — the 90-day discontinuation rate is very strong at this point, less than 15%. We don’t see the pandemic — we see that continuing to be stable, maybe decreasing a little bit. Right now in Q1, I can say that our discontinuations are also tracking to be the best quarter that we’ve had since the second quarter of launch. So, we are seeing some positive upside there too.
Joseph M. Catanzaro — Piper Sandler — Analyst
Okay. Perfect. Thanks so much for taking my questions.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Thanks, Joe.
Operator
Thank you. Our next question is coming from Charles Duncan of Cantor Fitzgerald. Please go ahead.
Charles C. Duncan — Cantor Fitzgerald — Analyst
Yeah. Good morning, Pat and team. Thanks for taking our question and congrats on a nice quarter. I had one commercial question and then maybe a couple of pipeline questions.
With regard to the commercial question, I think Jeff mentioned tumor LEMS patients being relatively underrepresented in your patient population, if you will, that are taking Firdapse. And so I guess are there any specific endeavors or initiatives that you are pursuing to identifying more tumor LEMS patients? So, it would seem to me in some ways to be an easier putt to accomplish with that. And could we see more tumor LEMS patients taking the drug going forward?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Charles, good morning. Thanks for the question. I’ll turn that over to Jeff to address.
Jeffrey Del Carmen — Chief Commercial Officer
So, Charles, you’re absolutely right, significant opportunity with the tumor LEMS patients. From data that we’ve seen, up to 50% to 60% of LEMS patients have tumor LEMS. So, what we want to do? It’s underrepresented right now. Those patients are underrepresented in our current patient population and [Technical Issues] out of our Catalyst Pathways. So, we are doing ad boards, working groups, market research to better understand the needs there, how we can identify those patients. We can use claims data to identify those patients and we are doing so. We purchased the claims data and we will continue to do so on quarterly basis. So, that will help provide us leads.
Now, the number one key here is we want to provide information to focused — to oncologists that are treating, for instance, for example, small-cell lung cancer. Small-cell lung cancer has — it’s the highest — has the highest rate of tumor LEMS are small-cell lung cancer patients. So, we will focus on those treaters and provide educational materials to those oncologists, and then we will direct those physicians to either refer out to neurologists and neuromuscular or give those physicians an opportunity to diagnose on their own and also prescribe. So that’s our approach and then we’ll also expand that out to other tumor types that are associated with LEMS over the course of the third and fourth quarter of this year and then also into 2022.
Charles C. Duncan — Cantor Fitzgerald — Analyst
Okay. That’s helpful. I appreciate the additional color on that.
Now turning to the pipeline. I guess, question for Steve. With regard to MuSK-MG, has the FDA meeting actually been scheduled or is there a hope to see in the second quarter?
And then, with regard to the observations that you made, appreciate all the color on this, I would have expect the randomized withdrawal protocol that you have with MuSK-MG to be relatively high power. And so can you provide us any color on the symptom variability that you alluded to and what drives that? Is that something that you can identify upfront, and perhaps deal with the longer screening period or what can you do to reduce the impact that potentially confounding variable on the outcome of this study going forward?
Steven R. Miller — Chief Operating Officer and Chief Scientific Officer
Okay. Well, that’s a whole bunch of questions, Charles. Let me try to answer and hopefully I’ll remember them all.
With regard to the meeting, we can’t provide any more detail than we’ve already provided. But I can assure you the meeting will happen this half.
And second, with regard to the variability contribution, the exposure period during the randomization phase of the trial was a very short period of time, and it consumed — it involves the collection of just one data point at the beginning and one data point at the end. The answer to resolving the variability is really deceptively simple. It’s just collect more data, and just average out the effects of the within patient variability that we observed. And so that’s essentially what the plan is and will collect blocks and data through telemedicine.
Charles C. Duncan — Cantor Fitzgerald — Analyst
Okay. So you are not anticipating an additional trial. I thought you referred to an additional trial. Are you saying more observations within a new trial?
Steven R. Miller — Chief Operating Officer and Chief Scientific Officer
Correct. We are going to be presenting to the FDA a new trial design and part of that design includes the collection of more data.
Charles C. Duncan — Cantor Fitzgerald — Analyst
I got it. Okay. And then with regard to HNPP, appreciate the outline on that opportunity, can you tell us anything about the design of the trial that you would like to run as a proof-of-concept trial within HNPP? And would you be starting that in the second half of this year?
Steven R. Miller — Chief Operating Officer and Chief Scientific Officer
Yeah. As I said, we anticipate starting in the third quarter. I can’t provide any details on the trial design at this time, because we’re still completing the design with the investigator, who is an expert in HNPP.
Charles C. Duncan — Cantor Fitzgerald — Analyst
Okay. Last question for Ali. With regard to cash flow positive, congrats on that great stuff. But when you think about the current cash, do you believe that it is sufficient to fund not only the commercial efforts, but also perhaps two additional trials, one in MuSK-MG, one in HNPP, at the second half of this year? Is cash good there, or would you perhaps raise additional funds to fund the pipeline?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Charles, this is Pat. I’ll take that question. We ended, as Ali pointed out, last year with $140 million in cash. We’re generating somewhere between $10 million to $15 million a quarter right now and I expect that will increase as the year goes on. So, I think that we are well positioned. Our balance sheet is solid. We got the cash on hand to conduct these studies that we’ve talked about today. And actually, we believe that we have enough cash to entertain looking at other opportunities, which we’re currently doing.
With the balance sheet that we currently have and the cash that we’re generating on a quarterly basis, as well as debt that is — has been available to us for quite some time that we’ve not had to avail ourselves of, thank God, but for the right asset and right opportunity, we would certainly take on some debt. So, I hope I’ve answered your question, but I think we’re in good shape with the balance sheet and our corporate objectives for this year.
Charles C. Duncan — Cantor Fitzgerald — Analyst
Yeah. That addresses it. Thanks for the added information, Pat and team. Congrats on a good quarter.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Thank you, Charles.
Operator
Thank you. Our next question is coming from Joon Lee of Truist Securities. Please go ahead.
Leszek Sulewski — Truist Securities — Analyst
Yes. Good morning. This is actually Les on for Joon. Thank you for taking my questions. First on the — I just wanted to get an update on the partnership starts in Japan, and also an update on the commercialization efforts in Canada, and what would you be expecting on the near term in revenue contribution there? Thank you.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Sure. As we said on our — in our press release and our 10-K, we are in discussions with a partner for Japan. These discussions have been ongoing for quite some time as we negotiate terms. We hope to have something to say with regard to a partnership next quarter, in Q2. And we are optimistic that once that definitive agreement is signed, that our partner will be moving quickly to get the drug registered in Japan.
With regard to Canada, we view that opportunity as representing about 10% of the U.S. market, just based on population the most part. We’re hoping that that can wind up being a meaningful contributor to our P&L going forward. We’ve had a bit of a roadblock there, as you know, with Health Canada’s decision to approve Ruzurgi 10 days after our approval, which is currently in litigation. And that case was litigated in early December, and we are hoping for a decision any day now. So the outcome of that trial could certainly make a big difference in the Canadian market.
Leszek Sulewski — Truist Securities — Analyst
That is helpful. Can you also discuss pricing strategy against efforts in Japan and Canada versus the U.S. market?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Yeah. We’re not prepared to talk about pricing yet for Canada and Japan. Both of those markets, as you know, their pricing is different and typically based on international baskets. And so we expect that the price in Canada will be lower than U.S. price and certainly the price in Japan will be lower.
Leszek Sulewski — Truist Securities — Analyst
Great. Thank you.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Thank you.
Operator
Thank you. Our next question is coming from Scott Henry of ROTH Capital. Please go ahead.
Scott R. Henry — ROTH Capital Partners LLC — Analyst
Thank you. Good morning and congratulations on the positive momentum.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Thank you, Scott.
Scott R. Henry — ROTH Capital Partners LLC — Analyst
I have a couple of questions. First, which is a little different, I came across an international patent which was for 3,4-DAP to treat sexual dysfunction. Can you talk about what you may have seen to motivate that patent filing?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Sure, Scott. Thanks for the question. I’ll turn that over to Steve.
Steven R. Miller — Chief Operating Officer and Chief Scientific Officer
Well, Scott, that’s an interesting question. And there are only a few things I can say about it right now. After Firdapse was launched, our pharmacovigilance program detected a few unexpected cases of improvement in resolution of sexual dysfunction issues, primarily in female patients. Based on these reports, we filed a patent for the treatment of sexual dysfunction with Firdapse and that patent application was published on February 11th of this year, and it’s obviously the patent you ran across recently. Catalyst is consulting with experts in evaluating the potential value and probability of clinical and commercial success for the patent and possible development pathways for this as a potential new indication for Firdapse. And if we decide to explore this potential indication further, we’ll update the investment community at that time.
Scott R. Henry — ROTH Capital Partners LLC — Analyst
Okay. Great. Thanks for the color on that, Steve. I did have a couple of other questions. First, from a modeling standpoint, how has pricing been on a sequential basis? Should we assume stability as far as revenue per patient, or just curious if there are any changes with that?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Scott, price is stable. And we’ve had a price increase that is basically in line with our peers that are selling rare diseases — rare disease drugs, and certainly in line — right in line with inflation.
Scott R. Henry — ROTH Capital Partners LLC — Analyst
Okay. Speaking of inflation, obviously, you’re generating a lot of cash and you have a lot of cash on the balance sheet, which some would say is a depreciating asset or at least the purchasing power is. Would you consider take — as you look at other companies, would you consider investing in your own Company perhaps through a share buyback, at least with a small portion of that?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Scott, I would say that everything is on the table as we look around to make investments and to acquire potential therapies and/or companies. We do believe that our stock price, our market cap is extremely low based on our financial results, and the opportunities that are in front of us. So, I would say we wouldn’t take that off the table as a consideration at this point.
Scott R. Henry — ROTH Capital Partners LLC — Analyst
Okay. Great. Pat, final question. Just the collaboration revenue line, it showed up in third quarter and fourth quarter, how should we think about that number going forward at least prior to Canada and Japan coming in?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Scott, I’ll let Ali answer that.
Alicia Grande — Vice President, Chief Financial Officer and Treasurer
Actually our collaboration from — our revenue from collaborations in the third quarter and the fourth quarter is related to Canada
Scott R. Henry — ROTH Capital Partners LLC — Analyst
Okay. So, we should expect that to continue then at similar levels? I don’t know if there is some timing related there perhaps initial shipments or any color on that?
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
I think the resolution of the court case will have a lot to do with that number going forward, Scott.
Scott R. Henry — ROTH Capital Partners LLC — Analyst
Okay. Great. Thank you for taking the questions.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Great. Thank you.
Operator
Ladies and gentlemen, that concludes today’s question-and-answer session. I would like to turn the floor back over to management for closing comments.
Patrick J. McEnany — Co-Founder, Chairman, President and Chief Executive Officer
Thank you for joining us today and I look forward to future calls. Have a great day.
Operator
[Operator Closing Remarks]