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

Strategy and performance update

• Rezdiffra launch is annualizing at $1.3 billion, with market growth of about 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 new mechanisms and combination therapies.

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

• Ongoing trials expected to read out in 2027 (F4C) and 2028 (outcomes trial).

Revenue outlook and market dynamics

• Consensus for 2026 is $1.48 billion, with continued momentum expected from 2025.

• Q1 revenue typically declines mid-to-high single digits due to insurance re-verification and commercial contracting, but net patient adds are expected to accelerate growth in subsequent quarters.

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

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

• Commercial contracting for 2026 is largely complete, with first-line access secured and most business locked in.

Competitive landscape and risk mitigation

• GLP-1s are not negatively impacting Rezdiffra; increased awareness from competitors is seen as beneficial.

• Market penetration remains low at under 12% of the initial 315,000 patients, indicating significant growth potential.

• Specialist prescribing remains the norm, with endocrinologists being newly targeted and showing early positive engagement.

• Expansion into endocrinology is built into internal forecasts for 2026 and 2027.