Vertex Pharmaceuticals is painting a rosy picture of its new non-opioid pain reliever, Journavx. During their recent Q3 presentation, they touted impressive prescription numbers and hospital adoptions. But a closer look at the revenue figures suggests the launch might be more sizzle than steak. Let's dive into the numbers and see what they really tell us.
The headline number that jumps out is the $20 million in Journavx sales for the quarter. That's not exactly a disaster, but it's $3 million short of the analyst consensus. And it's not alone. Alyftrek and Casgevy, two other key Vertex launches, also underperformed expectations, with Casgevy missing by a significant margin ($17 million actual versus $42 million expected). This pattern of falling short across multiple launches raises a red flag. Are Vertex's projections overly optimistic, or is there something fundamentally hindering adoption?
Vertex is highlighting the 300,000 prescriptions filled for Journavx this year (170,000 in Q3 alone). And they're making sure to emphasize the diversity of prescribers: orthopedic surgeons, plastic surgeons, dentists, the whole nine yards. They're also reporting that 750 of their 2,000 targeted U.S. hospitals have added Journavx to their formularies, along with 90 of 150 targeted healthcare systems. That sounds great on the surface. But here's where the math gets tricky.
If 170,000 prescriptions generated $20 million in revenue, that works out to about $117 per prescription. Given the reported price of $15.50 per 50-mg dose, that implies an average prescription of only 7.5 doses. Is that enough to treat "moderate to severe acute pain," as they claim? I've looked at hundreds of these filings, and this particular data point is unusual. Either patients aren't refilling prescriptions, or the initial doses are very small, or something else is at play here. And this is the part of the report that I find genuinely puzzling.
Vertex has secured reimbursement policies for 170 million people in the U.S., up from 150 million just three months ago. They've also gained coverage from two of the three major Pharmacy Benefit Managers (PBMs). And 19 states are providing Medicaid access without prior authorization, a nice improvement from 16 states. These are all positive steps, no question.
But coverage doesn't equal utilization. Just because a drug is covered doesn't mean doctors are prescribing it or patients are taking it. The real test is whether these coverage gains translate into actual sales. So far, the $20 million in revenue suggests that conversion rate is still low. They need a major rally in the fourth quarter to reach Citi’s 2025 sales projection of $110 million from earlier this year. Can they pull it off?
The elephant in the room is the price. At $15.50 per dose, Journavx is significantly more expensive than generic opioids (around $0.50 per pill). Vertex argues that there's a "significant unmet need" for non-opioid pain relief. And they're probably right, given the opioid crisis. But are doctors and patients willing to pay a 30x premium for it? The early data suggests that many are hesitant, or at least cautious.
The company blames the government shutdown for delays in Medicare coverage due to the NOPAIN Act. This is a valid point, since expanded Medicare coverage would undoubtedly boost Journavx sales. But even with that tailwind, the price discrepancy will remain a major hurdle.
Vertex's overall revenue for the quarter was solid, $3.1 billion (an increase of 11% year over year), thanks to strong sales of Trikafta. But that success shouldn't overshadow the challenges facing Journavx. The cystic fibrosis stalwart Trikafta topped consensus by nearly $50 million. And with the result, Vertex narrowed its 2025 revenue guidance to a range of between $11.9 billion and $12 billion.
Vertex is clearly betting big on Journavx, positioning it as a future "multibillion-dollar franchise." But based on the Q3 numbers, that's a long way off. The high prescription numbers are encouraging, but the low revenue per prescription suggests that something's amiss. Either the drug isn't being used as intended, or the price is a major barrier, or both. The company needs to address these issues head-on if they want Journavx to live up to its potential.
