Madrigal Pharmaceuticals (MDGL) Goldman Sachs 47th Annual Global Healthcare Conference 2026 summary

Launch progress and commercial performance

• Rezdiffra achieved over $1.1 billion in sales in its first 12 months, with more than 42,250 patients treated by end of Q1 2026.

• Market penetration remains at about 10% in a rapidly expanding diagnosed patient pool, which grew from 315,000 to 460,000 in two years.

• Over 10,000 prescribers have written scripts, with breadth established across hepatologists, gastroenterologists, and endocrinologists.

• Focus is shifting from expanding prescriber base to deepening engagement and increasing prescription volume per provider.

• Continued launch execution, new data readouts, and further IP expansion are priorities for the remainder of 2026.

Market dynamics and future outlook

• The addressable market is expected to grow at double-digit rates for the foreseeable future, potentially mirroring other specialty markets exceeding $20 billion annually.

• Diagnosis rates are rising due to therapy availability, updated guidelines, and increased awareness from both the company and competitors.

• Five-year outlook anticipates higher treatment rates, deeper market penetration, and Rezdiffra moving toward mega-blockbuster status.

• The company is positioned as a foundational therapy provider in MASH, with a robust pipeline and first-mover advantage.

• Real-world evidence supports strong efficacy and safety, reinforcing prescriber confidence and adoption.

Financials and profitability

• Gross to net was favorable in Q1 2026 due to timing of commercial contracting, with expectations for mid to high 30s percentage for the rest of the year.

• Major impact from commercial contracting occurred in 2026; Medicare contracting will influence 2027, but specifics are not yet disclosed.

• Operating expenses will continue to grow to support top-line expansion and R&D, but net sales growth is expected to outpace OpEx over time.

• Full-year profitability is not expected in 2026, though some quarters may be profitable; divergence between sales and OpEx is anticipated soon.