Milestone's CARDAMYST Launch Hits 50% Coverage — But the Real Story Is AFib-RVR
Early commercial traction meets a second indication catalyst
MIST · Earnings Call · 2026-08-12
A Launch in Motion
Milestone Pharmaceuticals reported its first full quarter of CARDAMYST sales, and the numbers tell a story of early traction. In the second quarter, more than 600 unique prescribers wrote scripts, bringing the half-year total above 800. Total prescriptions reached 1,500, with over 1,300 patients having filled a script since launch. As CEO Joseph Oliveto noted: “More than 600 unique health care professionals wrote prescriptions for CARDAMYST in the second quarter compared with approximately 200 in the first quarter.” — Joseph Oliveto, Chief Executive Officer · 2026-08-12 The breadth — not just depth — is notable, with a healthy mix of cardiologists, electrophysiologists, and nurse practitioners. Unique prescribers are a forward indicator, and the company is only halfway through its target call list of 10,000 high-value practices. The mix matters: electrophysiologists, who are typically ablation-focused, are writing earlier than expected — a sign that the product fills a real unmet need.Coverage Inflection
The more consequential move came after the quarter closed. Coverage for commercial coverage jumped from roughly 25% to over 50% of commercially insured lives, driven by UnitedHealthcare and other insurers using Express Scripts or Optum Rx. Chief Commercial Officer Lorenz Muller explained: “At the end of Q2, we had secured coverage for an estimated 25% of commercial lives, which primarily accounted for the early win we achieved at the end of Q1 with Express Scripts.” — Lorenz Muller, Chief Commercial Officer · 2026-08-12 The step change in July and August is critical because coverage has been the gating factor for patient activation and for improving average selling price. During Q2, low coverage meant heavy co-pay mitigation and denial conversion, which depressed revenue. As Joe put it: “Our strategy was to allow for a fair amount of co-pay mitigation... That really swamps out your average selling price over that period while coverage is low.” — Joseph Oliveto, Chief Executive Officer · 2026-08-12 With coverage now above half, the company expects to see better gross-to-net and a pull-through effect on scripts.The AFib-RVR Catalyst
While the launch is early, the bigger story may be the expansion of etripamil into atrial fibrillation with rapid ventricular rate (AFib-RVR). The Phase III ReVeRA-301 trial has begun, using the same 70-mg dose and repeat-dose regimen approved for PSVT. Joe highlighted the opportunity:The addressable population is estimated at 3–4 million patients, and the trial leverages much of the operational infrastructure from the PSVT program. Two key risks differentiate this study: the secondary endpoint is a patient-reported outcome, and patients may misidentify their episode — a 20% mischaracterization rate in the PSVT program. The company has incorporated these into the trial design.We believe AFib-RVR represents a substantially larger opportunity for etripamil to help patients than it has for PSVT.