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Aerie Pharmaceuticals, Inc. (AERI) Q2 2019 Earnings Call Transcript

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Aeri Pharmaceuticals, Inc. (NASDAQ: AERI)
Q2 2019 Earnings Call
Aug. 7, 2017, 5:00 p.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:

Operator

Good afternoon, Ladies and Gentlemen. Thank you for standing by, and welcome to the Aerie Pharmaceuticals second quarter 2019 earnings conference call. At this time, all participants are in a listen-only mode. Later, we will conduct a question and answer session, and instructions will follow at that time. Today's conference call will be recorded. It is now my pleasure to turn the floor over to Aerie's Director of Investor Relations, Ami Bavishi. Please go ahead, Ami.

Ami Bavishi -- Director of Investor Relations

Thank you, Dawn. Good afternoon, and thank you for joining us. With me today are Vince Anido, Aerie's Chairman and Chief Executive Officer, Tom Mitro, Aerie's President, and Chief Operating Officer, Rich Rubino, Aerie's Chief Financial Officer, Casey Kopczynski, Aerie's Chief Science Officer, and John LaRocca, Aerie's General Counsel. Today's call is also being webcast live on our website, investors.aeriepharma.com, and it will be available for replay, as indicated in our press release.

Now, for forward-looking statements and non-GAAP financial measures. On this call, we will make certain forward-looking statements, including statements, forecast, and guidance regarding our future financial and operating performance, including our updated, full-year 2019 net revenue and net cash burn guidance. These statements will include observations associated with our commercialization of Rohopressa and Rocklatan in the United States. They will also include expectations regarding the success, timing, and cost of our clinical trials. Additionally, we will discuss progress regarding maintaining, requesting, or obtaining approval from regulatory agencies of our products and product candidates, including our [inaudible] national expansion.


Lastly, we will address our manufacturing activities and capabilities, the potential of our pre-clinical product candidates and research findings, our financial liquidity, and other statements related to future events. These statements are based on the beliefs and expectations of management, as of today. Our actual results may differ materially from our expectations. Investors should read carefully the risk and uncertainties described in today's press release, as well as the risk factors included in our filings with the SEC. We have no obligation to revise or update forward-looking statements, whether as a result of new information, future events, or otherwise. Please note that we will file our 10q by tomorrow. In addition, during this call, we will be discussing certain adjusted, or non-GAAP, financial measures. For additional disclosures relating to these non-GAAP financial measures, including a reconciliation to the most directly comparable GAAP measures, please see today's press release, which is posted on our website. With that, I will turn the call over to Vince.

Vince Anido -- Chairman and Chief Executive Officer

Thanks, Ami, and good afternoon, Everybody. Thanks for joining us. I recognize that all the current interest lies in the performance of our glaucoma franchise in the marketplace, and certainly, that's where we're going to spend most of our time today. You know, we haven't seen this level of volatility of tumultuous stock performance for our company since back in roughly 2015, the days when we missed a primary endpoint for Rocket 1. Certainly, that was a tough year, and certainly, we came back from that pretty strongly, and I certainly believe we're going to do the same thing now.

 Today, we're a lot stronger than we've ever been, with two innovative glaucoma products in the market that are performing very well on the patients that are trying it. We have expansion plans under way in Europe and Japan that are proceeding very nicely, and two exciting stay and release implant product candidates for Retina that are in our pipeline. And I personally believe that, and certainly, I'm more confident in our future today than in any point in our history. Certainly, we've de-risked the company, and plan on moving forward toward achieving our goal of becoming the next major ophthalmic pharmaceutical company.

Getting to the short-term concerns on Wall Street, as I'm sure you saw in our earnings release, we are lowering our full-year 2019 net revenue guidance range to $70 million to $80 million, down from $110 million to $120 million. The approach for the updated guidance was to anchor it only on the trends we've seen in our very short commercialization story. I view the updated guidance range as conservative case. It's calculated based on the recent historical growth rates. We obviously will be aiming to achieve revenue levels beyond the updated guidance range for 2019.

We will continue to provide regular updates. We'll talk about our Med B wins, we'll talk about shipments out from wholesalers to retail, et cetera, so none of that is going to change, on a going-forward basis.

We look at where we are today, we see consistent growth in our product line, and we're going to be talking about that during this call. In fact, as recent referent point, last week, our sales out to pharmacies achieved a new record of nearly 14,200 units, which is roughly about 1000 units more than we saw in the prior week. And so, we're very excited about many of the things that are happening, and we'll be talking about those.

Let's start by looking at second-quarter results and the associated commentary that will help further clarify what we're seeing in the market. Our combines Rhopressa/Rocklatan revenues in q2 totaled $15.8 million, bringing our year-to-date total revenues just shy of $27 million. As a reminder, we launched Rocklatan in May of this year, so we just have three months of experience, and we launched Rhopressa roughly about 15 months ago, so again, very new into the marketplace with both products.

As we said in our press release, our net revenues per bottle for the franchise was $94 for the second quarter, and $96, year-to-date. Not surprising that, if we continue to penetrate Medicare part D, as we said before, our net price will decline. Remember that the rebates are steeper in Medicare part D, plus, we're required by law now to pay the 70% pharma-funded portion of the donut hole. We expect that net revenues per bottle may continue to decline slightly, to the extent our Medicare part D mix continues to increase.

If you take a look at our latest corporate presentation, you look at slide four, and you get a feel for how much of our business is coming from Medicare part D, roughly 51%, versus commercial pay portion of it, which is about 34%. This is roughly in line with what's happening with other glaucoma products in the marketplace.

We internally view netarsudil as a franchise, and both Rocklatan and Rhopressa have specific segments to fill in that glaucoma market. Just as we haven't guided to revenues in Rhopressa versus Rocklatan, we also did not break out the actual net revenues for Rhopressa versus Rocklatan. It's very early in the US Rocklatan launch, and Rocklatan revenues are immaterial to this quarter.

But the pricing of each product is ultimately consistent. Remember, we priced the pretty darn close to each other, and so, as Rocklatan picks up additional coverage, we do expect the price difference between the two products to narrow. Of course, for those of you who are interested, you can look at our separate sales volumes to pharmacies, which we report on a monthly basis for both Rhopressa and Rocklatan, and you can see sort of which way the products are trending.

Over the last month or two, many of us, certainly Tom and I and others on the commercial side of the organization have spent an awful lot of time in the field, because we wanted to understand what the issues were that was keeping us from achieving some of the revenue projections that we have put out there.

The good news is that we didn't find that there were any issues related to the products themselves. The physicians and the patients are very happy with what they're getting with Rhopressa as well as Rocklatan. So, that's terrific, from a long-term perspective, because we do think that that allows us to continue viewing these products in the same light as we've always looked at, in terms of Rhopressa being roughly $350 million future revenues, and Rocklatan hitting that billion-dollar mark.

The majority of the feedback we're receiving from the field continues to be very positive as it relates to the performance of both of these products in patients. And some of you, and many others who have done independently performed physician surveys can also confirm this kind of feedback. And the products are doing what we expected them to do in the marketplace.

Physicians often tell us that the biggest hurdle to greater Rhopressa and Rocklatan usage is managed care coverage, not product performance, and we think this points to a very bright future because the coverage will come.

Our number of prescribers continues to grow, with a total of nearly 11,000 eye care professionals having prescribed either Rhopressa or Rocklatan, which represents roughly 75% of our total target audience of about 14,000 eye care professionals. Well over 3,400 physicians are writing netarsudil, that is, Rhopressa or Rocklatan scripts, on a regular basis. And by the way, just about a could weeks ago, that number was 3,000, and now we have 3,400, so we continue to grow the number of prescribers that are writing for one or the other on a regular basis, in this case, weekly. We have about 6,600 of our target audience that are now writing monthly, which means that, over time, these guys will continue to build the amount of prescriptions they're writing for our products in their practices, and they, too, will move toward writing on a weekly basis.

Focusing on Rocklatan, we have over 1900 physicians have already written a Rocklatan prescription. We also have over 300 writers of Rocklatan only. And interesting, about two-thirds of those have also become weekly writers. As part of that, of the 300 or so, we have about 200 of those physicians who have never prescribed a Rhopressa prescription that have written for Rocklatan. So, we do think that there's an awful lot of positive that's going on in the marketplace, in terms of what's happening, and I view this as an impressive sign, recognizing that it is early in the launch.

Another important metric is that approximately 17% of all prescribers are already writing prescriptions for both Rhopressa and Rocklatan, as they're now gaining experience with the netarsudil franchise, and learning how best to use our products in their treatment regimen. Netarsudil market share in the decile of practices is double what we're seeing in all practices, about 2 1/2% market share in the top decile, seven, eight, nine and ten, versus just about 1% or so everywhere else. These large-volume practices will continue to lead our volume growth, going forward, while smaller practices continue to make gains.

One other interesting note is that many optometrists are becoming early adopters of Rocklatan. We have roughly about 2,000, 2,500 of our call audience that represents optometry, so we're very excited about the fact that those are becoming early adopters for Rocklatan. All this leads to growth in prescription volume. Our franchise prescriptions grew 26% in q2 over q1, pretty nice growth, compared to the overall glaucoma market, which grew at only 2%. Each product simply needs time to settle in. We have guided, in prior calls, that once we get to complete coverage, you know, north of 75% Med D coverage of both Rhopressa a Rocklatan, that's when we're going to see these products truly beginning to find their niche, and settle into the prescribing habits of the physicians.

We'll be looking for examples that we can give you in terms of what we're seeing, and the closest example that we're experiencing now for Rocklatan is what we saw back in 2007 when Combigan was launched by Allergan. Alphagan, you may remember, was one of the flagship products for the company, it's an alpha blocker. Peak revenues about $350 million or so in the marketplace. It launched in 1997. For those of you who don't know, Combigan is a combination of Alphagan plus timolol. So, Alphagan was launched, 10 years later, Combigan was launched. And so, that is the only example that we can come up with that is close to the Rhopressa/Rocklatan story. What's interesting is, when Combigan launched, it took about 9-12 months for each of the products to find its place.

So, again, like we're seeing in the marketplace today between Rhopressa and Rocklatan, there's an awful lot of turn going on in the doctor's offices, so they find a place for both products. What's interesting, also, is that this is when Allergan was at its prime. So, this is in their heyday, and so, even they couldn't force any bigger adoption of Combigan, even though they thought that was a much better product, over Alphagan had been out for a long time. And so, we're seeing many of the same dynamics occurring, an awful lot of churn as the doctors try to figure out a home for both products. But this is as close to a good example as we can give you, as to what we see happening in the marketplace today between Rhopressa and Rocklatan.

Another important gate to demand that we look at, which is a valuable leading indicator, is the prior authorization volume, which is obviously part of the Medicare part D programs. Rocklatan has generated more than double the number of prior authorizations that we saw for the same period of time during the Rhopressa launch. This is an excellent indicator of demand and helps point to greater likelihood of gaining market access sooner, as payers try to minimize their costs. By that, I mean we get more and more prior authorizations written, you know, that certainly incents the plans to sign up contracts with us for rebates, et cetera, to bring their overall costs down.

From retail outlook perspective, we have now about 25,000 retail pharmacies across the country that have filled a Rhopressa or Rocklatan prescription, up from about 21,000 we reported for our first-quarter earnings call in early May. That represents nearly 45% of the retail outlets in the country. However, even with that growth in the number of dispensing pharmacies, inventory levels at retail are essentially the same today as they were back at the end of 2018. So, we've not seen any inventory build at retail, and some folks have tried to speculate, in terms of how we reach our revenue targets.

To give you some further statistics on this, at the end of 2018, the number of bottles in the retail channel was in the 45,000 bottle range. That's when we were -- At that time, we only had about 17,000 pharmacies that had filled a prescription for Rhopressa at the time. As of now, our products are being filled across 25,000 pharmacies, and then number of bottles in the retail channel remains right at 45,000.

Additionally, for Rhopressa, wholesale inventories remain two weeks in future demand, demonstrating our sales growth is real growth. Also, channel inventory for Rhopressa at the end of the second quarter was approximately two weeks of future demand, consistent with the beginning of the quarter. Rocklatan, of course, is consistent with what we saw with Rhopressa, in the second quarter of last year, in that there is more of a channel effect, which will diminish over the next quarter or two, as it did for Rhopressa.

So, what are the things we're hearing out in the field? Let me just point to a few of them. Physicians are gathering increased experience with Rhopressa, and they're impressed with the levels of intraocular pressure reduction they are seeing. Hyperaemia, while still occurring, does not appear to be a major issue with a large majority of patients, that is generally transient, mild, and not causing high levels of discontinuations.

Rhopressa is primarily being used as add-on therapy, where patients are already on one or more other drugs. There are some eye care professionals who are hesitant to change from their historic prescribing practice, or not as inclined to remove therapies.it came as a surprise to us, and as recent as a couple of weeks ago, I had dinner with a number of glaucoma physicians, and was really surprised that, once they get the patient under control, say, by adding Rhopressa, even on top of three other medications, they're not in a hurry to start decreasing the number of prescriptions that the patient's getting, because they're pretty happy once they get those pressures down as low as possible.

We believe this change in practice will happen, however, through time, as they gain confidence in Rhopressa's effectiveness, and also as the patients begin wanting to decrease the number of eye drops that they're subject to on a given day, on any given day. Those gravitating toward just Rhopressa on top of a PGA, which we believe is the ideal combination, are seeing good efficacy with just the two drops, along with less hyperemia, as the eye is exposed to fewer eye drops.

While Rhopressa has majority formulary access across both commercial and Medicare part D plans, we still have more to go. Some of this relates to plans with which we had contracted, but where the underlying formularies have not yet instituted coverage. This may include custom formularies or other instances where newly merged payers still don't have Rhopressa on all of their underlying formularies.

We experienced the latter with the recent contract with a large PBM, that recently merged with an insurance company, where we have yet to gain coverage in the legacy insurance company formulary. We do expect to obtain that coverage later this year, as we conduct separate discussions with that particular formulary team. So, we do have the contracts in place, but not all of the sub-plans are signing up for it. So, again, we think that that has something to do with some of the uptake issues that we have been seeing.

The experience, thus far, with Rocklatan has been very promising. Physicians are not only sampling Rocklatan and getting great results, but what's interesting is, and it's perhaps because they're only on one eye drop, or perhaps because the efficacy rates are so much better, there's not a whole lot of feedback that we're getting relative to hyperaemia, associated with Rocklatan. Since Rocklatan is in the early stages of getting formulary placement, after the Rocklatan samples are provided, and coverage is not yet available, we are seeing doctors wait for the coverage, or provide either sample or prescription of Rhopressa, to be taken on top of their favorite prostaglandin, on an interim basis, until the Rocklatan is covered. This is in addition to the prior authorization activity I discussed earlier.

Now, this creates a situation where the patients need to return to the physician's office a few times, not only to get their interim Rhopressa script, but also, ultimately, to get their Rocklatan script. The cycle time for this churn, as I call it, could take months, especially when you consider that some of the busy practices may not be able to schedule the patients for a return visit for up to 60 days. Herein lies the key reason why comparison of the Rocklatan launch to the Rhopressa launch is short-sighted and doesn't really reflect the ultimate potential for Rocklatan.

Launches are very different. Rhopressa was approved in December of 2017. We did a soft launch, including sampling to the top prescribers, in March of 2018, and physically actually launched the product in May of 2018, once our sales force was in place. Rocklatan was approved in March of this year, launched in May of this year, and with that, we sampled over the launch, and with Rhopressa already on the market. This causes a different launch dynamic, but the success of Rocklatan at 12 or so weeks after launch is premature, to say the least.

The single most important message here is the unique position of gaining coverage for Rocklatan while continuing to grow Rhopressa. We haven't had too many other companies try to do this in the glaucoma space, and as I said, the only example I can give you was roughly about 12 years ago. Physicians are learning the benefits of both Rhopressa and Rocklatan in their practices, and their experience with product performance has been quite positive, and that's why we believe so strongly that the ultimate value of this franchise is going to be as we've always talked about.

With that, the long-term promise of both Rhopressa and Rocklatan remain intact, and we continue to believe Rhopressa ultimately has the annual sales potential, as I mentioned earlier, of $350 million-plus in US annual sales, and we believe Rocklatan ultimately has a potential to reach over $1 billion in annual sales in the US. It's a first and only fixed-dose combination product in this country for the reduction of IOP that includes a prostaglandin, and the only fixed-dose combination product available in the United States that is dosed once a day.

Just look at our phase three data on how effective Rocklatan was in getting pressures down to low-normal ranges. In fact, in that data from our mercury trial, Rhopressa also performed even better than it did in its own clinical trials, and certainly, it did better than even Latanaoprost did, in getting patient's pressure down to really low ranges. Now, we need to be patient and work through the transitional phase, where Rhopressa continues to gain share, not only by additional coverage, but for the penetration of covered lives, but by physicians continuing to experience and see the positive aspect of where Rhopressa and Rocklatan fit into each treatment, into each patient's treatment paradigm.

Catalysts for growth for the remainder of this year and in the future will be formulary coverage for Rocklatan. We expect that by the end of this quarter, that commercial coverage for Rocklatan will be consistent with where we were, relative to Rhopressa, for the same period of time last year. Very importantly, as we progress through this quarter, Rocklatan Medicare pard D market access is exceeding where Rhopressa at the same period of time last year. We are pointing to 30% Medicare part D access for Rocklatan, compared to 12% that we had for Rhopressa at the end of q3 last year.

We're also aiming to have majority formulary coverage for Medicare part D for Rocklatan by the end of 2019, which would be significantly more accelerated than we experienced with Rhopressa. As a reminder, today we have about 75% Medicare part D coverage with Rhopressa, and about 90% coverage on the commercial side, and we did that about a year or so after launch. All of the aspects of the Rhopressa and Rocklatan launch I just walked through are the drivers for our revised guidance. Quite simply, while the franchise potential is unchanged, the volumes obviously are taking more time to build than we originally estimated.

The issue is simply time. When all the dust settles and the doctors have their experience with both products, we do believe Rocklatan will become the leader in the marketplace, with its proven efficacy and one-drop convenience, and we believe Rhopressa will settle in as the add-on, just on top of a prostaglandin. Those are the original positioning statements for both products. With that, I am confident we will achieve incredible long-term success.

I'm going to change topics briefly. As we continue to de-risk our supply sourcing. I'm happy to report that our own Ireland plant is making excellent progress in terms of readiness, and it's expected to be ready for commercial production in the early 2020 timeframe. This is on top of the FDA approval of a second drug contract manufacturer that I mentioned last quarter.

Turning to our initiatives beyond the United States, we expect to obtain European regulatory determination of Rhokiinsa, that's Rhopressa in Europe, the approval later this year, which, assuming it's positive, will result in us filing for Roclanda, which is Rocklatan in Europe, some time early next year. We also expect to read out top-line Mercury 3 results in the first half of next year. As soon as a reminder, Mercury 3 is a Rocklatan study only in Europe, comparing it to Ganfort, the leading combination product in Europe, and it's done primarily for pricing reasons.

The biggest positive surprise for us was the extraordinary level of interest in Rhopressa in Japan, which allowed us to enroll our Japanese phase two trial far faster than we ever anticipated. We now plan to read out phase two data by the end of this year on that Japanese phase two trial.

Moving on to our retinal implant programs, and in the spirit of brevity, I will say it is AR-1105, our sustained-release steroid program. It's progressing well in the clinic, and we expect our urokinase, protein kinase C inhibitor, AR-13503, to enter the clinic very shortly. Our early stage research initiatives are also advancing, as we explore our won molecules interesting the dry eye space and psoriasis, just two examples of what we're doing.

Now, before I turn the call over to Rich, I'd like to address one of the other concerns that investors have had, and that's our perceived need for financing. It's always our job to ensure that we are financed, and it's also our job to obtain financing at the lowest possible cost, and with the least amount of dilution possible. And so, as a reminder, let's just do some quick math. Our opening cash balance for 2019 was over $200 million, and our updated net cash burn guidance for 2019 is now between $160 million and $170 million. Now, when you add back in our available credit facility of $200 million, that leaves us with a projected year-end 2019 liquidity of over $200 million.

We've been spending roughly about $200 million to $220 million over the last couple years, and if we were to do that next year, we have enough cash almost to make it through the entire year, even if you assume we don't sell one bottle of either Rhopressa or Rocklatan. So, I do think that we have the liquidity that we need, and the financial capacity that we need in order to sustain ourselves and move forward, and continue building our company.

With that, I'll turn it over to Rich to cover the financials. Rich.

Rich Rubino -- Chief Financial Officer

Thanks, Vince. As Vince mentioned, we recorded $15.8 million of net revenues in the second quarter, a 46% increase over the first quarter of 2019. Our franchise net revenues reflect volumes of over 169,000 bottles for the second quarter. Our gross margin for the quarter ended June 30th, 2019 was 95.5%. Our normalized gross margin was approximately 94.5% when considering inventory costs that were expensed prior to FDA approval of our products.

Our second quarter 2019 GAAP net loss was $47.2 million dollars, or $1.04 per share. When excluding the $10.7 million stock-based compensation expense, our total adjusted net loss was $36.5 million, or $0.80 per share. Adjusted total operating expenses for the second quarter 2019 were $50.5 million, with adjusted selling, general and administrative expenses of $27.4 million, adjusted pre-approval commercial manufacturing expenses of $5 million, and adjusted research and development expenses of $18.1 million. For additional information regarding our second-quarter results and prior period comparisons, please refer to today's press release, and our form 10q, which will be filed by tomorrow.

Net cash burn for the six months ended June 30th, 2019 totaled approximately $92 million, with $109.4 million in cash and cash equivalents remaining on our balance sheet as of June 30th, 2019. Shares outstanding at quarter-end total $45.9 million. Vince already discussed our revised net revenue guidance at length. Also, as Vince just outlined, our net cash burn guidance has been updated as a result of the cash flow effects of the lowered revenue guidance.

Net cash burn for the full year 2019 is now estimated at $160 million to $170 million, compared to the previous guidance of $130 to $140 million. Once again, we have $109 million in cash and cash equivalents on our balance sheet, as of June 30th, 2019, plus we have the $200 million undrawn credit facility, giving us total liquidity, as of June 30th, 2019, in excess of $300 million.

And now, I would like to turn the call over to the operator for questions. Dawn?

Questions and Answers:

Operator

Ladies and Gentlemen, if you have a question at this time, please press the *, and then the number 1 key on your touchtone telephone. If your question has been answered, or you wish to remove yourself from the queue, please press the # key.

Your first question comes from Annabel Samimy, from Stifel. Your line is open.

Annabel Samimy -- Stifel Nicolaus -- Analyst

Hi, guys, thanks for taking my questions. I have a few, so I'm gonna ask the obvious question first. So, when you think about the original guidance that you gave, I guess, what were some of the assumptions that went into that trajectory, and why do you think it's so much stronger than what you're experiencing now? And I guess, with the $92 million burn and $109 million left, clearly that should attenuate over time, as you have increased sales. So, how should we think about coming out of the year, and into next year, and where that cash might take you? So, that's the first question.

And maybe you can help us understand, also, on price, I understand that price can sometimes get below 90, I imagine. It's clearly about the Medicare/commercial mix. But what's gonna allow you to bring that back up to that 100-level that you targeted?

And then, lastly, just on some recent work that we've done, a good majority of docs who were using Rocklatan has used Rhopressa in probably less than 50% of their patients, and you also mentioned that you're reaching new targets of them being optometrists, and maybe even lower decile physicians. So, do you have any plans to expand your target audience beyond just the high deciles, and maybe take advantage of some of that interest from the optometrist population, that could be a vast audience for you? Thanks.

Vince Anido -- Chairman and Chief Executive Officer

All right, let me see if I've got all this straight.

Annabel Samimy -- Stifel Nicolaus -- Analyst

I can repeat them if you want.

Vince Anido -- Chairman and Chief Executive Officer

I've got these. So, on the sales assumption stuff, and like you, we did a lot of market research, and everybody else did, too. And if you sit our there and you start showing these doctors the product profiles and the difference between Rhopressa and Rocklatan, everybody tells you immediately that they're gonna use an awful lot of Rocklatan, and maybe they'll find a home for Rhopressa.

Nowhere in the market research, and nowhere that we've done or anybody else has done, did anybody ever get into this churn thing. It was more of a yes, as soon as I get it in my hands, I want to use it. Some of you have had physicians on some of your panels, and they talk about immediately moving all their patients over to Rocklatan that were on Rhopressa, et cetera, et cetera, so it always leaves you with a feeling like it's all gonna move very, very fast, and in reality, as we've talked about before, what's happening in the marketplace, a lot of it is attenuated considerably by managed care coverage. And so, that certainly gives you a dose of reality.

And so, when we put the assumptions together, you know, it was trying to do a balancing act between the fact that no new product had been introduced in the category for over 20 years, plus the enthusiasm that we saw for the kind of data that we were showing in the clinical trials. And so, we certainly felt very good about the uptake here.

When reality hit, and we started seeing the managed care impact, where we were doing really well in some of the markets and not so well on others where we didn't have the coverage, even if they were writing prior authorizations, only about 40% of those prior authorizations, even though almost 80-90% were approved, only 40% of the ones that were approved were actually picked up, because the copays were too high, so the patients were coming back. So, that started creating an awful lot of churn.

So, again, the basic assumptions that we made didn't factor in as much of this reality picture as we're now seeing. We thought that the product profiles themselves, and the enthusiasm that the doctors had, especially the high-end glaucoma guys, that we would move through some of this stuff pretty quickly, and just, reality hit, and it just didn't happen. So, those are the basic differences in the assumptions, and now we're just going back to only doing what we've already accomplished, which is just watching our own growth patterns, and forecasting off of that, and if they accelerate, I guarantee we'll be the first ones to tell you. That's on the sales assumptions.

On the price, we do expect that we'll get back to, again, the guidance that we provided, a roughly $100 per bottle price over time, as we take price increases, because again, when you first get hit with all these rebates and the covering the donut hole, et cetera, et cetera, the Medicare part D coverage takes the biggest whack out of the rebates. Those are the highest rebates we give, versus the commercial side, where we can use copay cards. And so, over time, as we take further price increases, remember we took one in late fall of last year, and so, as we take other ones, we'll start seeing the price start hitting a floor, and then start bouncing back up.

We do currently have all the sales force that we need to move forward. You know, reaching lower-decile doctors over the years just hasn't been particularly fruitful for any company, and so, expanding just to get more of those just don't make much sense. And, as I mentioned during the call, or during the prepared remarks, about 2,000, 2,500 of our current call audience at 14,000 are already optometrists, and so, those are the high-volume guys. That's why they're on our call list. And so, we expect that that's going to continue.

On the cash side, which I think was actually your second question, I'm gonna turn that over to Rich so that he can give you some more details.

Rich Rubino -- Chief Financial Officer

Thanks, Vince. Hi, Annabel. So, as you mentioned, we do have the net cash burn in the first half of the year of $92 million. The second half of the year will be less, by definition, because we will have increasing revenues over the next couple of quarters, while our gross cash burn remains fairly even in the back half of the year. In fact, gross cash burn may be slightly less in the back half of the year than the front half of the year.

So, remember, we gave a new ranger for net cash burn of $160 million to $170 million. For this year, if you just pick the midpoint, $165 million, if we're already at $92 million in the first half of the year, then you're gonna end up with about $72 million in net cash burn, in the back half of the year. So, you can see a declining first half, from $92 million, to, say, about $72 million or so, in the back half of the year.

And also, Vince gave some math toward the end of his prepared remarks, just to address liquidity. We started 2019 with $203 million in cash and equivalents on the balance sheet, with a net burn, in the mid-range of the current guidance, of $165 million. That leaves you with about $38 million of cash at the end of the year, end of '19. Then, you have the credit facility for $200 million that you can add on top of that, and you end up with a year-end '19 liquidity of about $238 million. The point that Vince was making was, even if we had zero revenue next year, that $238 million in liquidity could carry our gross expenses through the entire year next year.

Annabel Samimy -- Stifel Nicolaus -- Analyst

Great, thank you.

Rich Rubino -- Chief Financial Officer

Thank you.

Operator

Your next question comes from Ken Cacciatore from Cowen and Company. Your line is open.

Ken Cacciatore -- Cowen and Company -- Analyst

Hi, thanks, guys. Thanks for all the different metrics. For the first time in a long time, I had to put my pen down, there were so many. But I just wanted to cut through a little bit of what you're trying to say about the managed care, and taking a little bit more time. Can you talk about how you're supporting those patients? So is your Rocklatan sampling program a little bit heavier than you would have thought?

And also, similarly, we've been doing doc checks and hearing back that the hyperemia with Rocklatan is surprisingly lower than Rhopressa. Just actually curious as to why. Sounds like that's what you're hearing as well.

And just lastly, can you just remind us, I think you gave us the information, but, by the end of the year, where the coverage should stand for Rocklatan. Thank you.

Vince Anido -- Chairman and Chief Executive Officer

Hey, Ken, it's a good thing that we're taping this so that you can follow up on some of those numbers, right? But I'm gonna answer one of the two questions that you asked, regarding the hyperemia rates and et cetera, because we're pretty excited about what we're seeing in the marketplace. And then, I'm gonna let tom talk a little bit more about the commercial side, or the commercial question that you asked.

And so, on the hyperemia rate, yeah, that's kind of interesting. So, again, we've been out in the field, talked to a lot of docs, and some of these guys are surmising the following: Rhopressa's position with a lot of the high-end glaucoma guys has always been sort of max medical therapy, then they add Rhopressa to it. Those patients may be on three of four medications already, and their eyes, that's an awful lot of preservative that's hitting those eyes to begin with, much less the fact that some of these drugs are also irritants to the eye, on top of that. And so, by the time you add the fourth one, they're already pretty sensitive, and so, they may have been seeing a little bit more of a sensitivity reaction to the vasodilation caused by Rhopressa. It wasn't pain, it wasn't irritation or anything like that, it was just the vasodilation causing the eyes to get a little bit redder, and it became a little bit more noticeable for them.

And so, what's really interesting about all that, and again, what we're seeing from an attrition rate, when they do get the hyperemia, after adding it to a prostaglandin, or after max medical therapy, is that the IOP goes down. The same number of patients that we always talked about, roughly about 10 or 15% of them just really can't tolerate it, so they're basically saying, "Hey, look, I know my pressure's lower, but I just can't do this red-eye thing." That means that the balance, roughly 90% of them, are pretty happy with their lower pressure, and with whatever incremental hyperemia they're getting, and they're saying, "Well, it's worth it, given that my pressure's lower." So, we like that.

In the case of Rocklatan, we think that it's simply because, in many cases, they're not adding it to a lot of stuff, they're just using it by itself, so it's just one eye drop, one load of benzalkonium chloride, or BAK, which is our favorite preservative in the industry, and therefore, they're not seeing some of those effects, and also balanced out, by the way, with really low pressures. And so, I think it's the key. I think the hyperemia's a problem if you don't get a good pressure drop, and if you get a great pressure drop, they're willing to live with hyperemia, and they just don't talk about it as much.

So, let me turn over the first question to Tom.

Tom Mitro -- President and Chief Operating Officer

Sure, Ken, well, thanks. I'll talk a little bit about the commercial aspect of the managed care costs. Here's what we find: first off, we're quite happy with our coverage for Rhopressa, where it's been really in the first year of having the product on the market with a brand new company. We've actually done very, very well. The thing I'd say that really drove that was the PAs that our field force was able to encourage the physicians to prescribe, because PAs really, in essence, made managed care really pay attention to Rhopressa. So, anyway, that was very good.

But what we find, on the other side from managed care is that many of them, as you know, have gone through consolidations and acquisitions, and when you put two organizations together, usually what happens is all formulary movements as additions stop, until the organization's come together. That certainly happened to us earlier this year, with the second-largest payer in the marketplace, who has suggested to us that we were going to get Rhopressa on their formulary early in the first quarter, and it turned out to be the middle of the second quarter, as a good example.

Nonetheless, I think managed care is still a very good story for us, if you look at Rocklatan, you'll see that, as Vince said, we're running toward 30% there. We're just shy of that now, and we already have the number one plan in the nation that is covering Rocklatan. We think others are going to come as the year progresses. So, that's kind of our answer, Ken. If I can help with anything else, please let me know.

Ken Cacciatore -- Cowen and Company -- Analyst

Thank you.

Operator

Your next question comes from Serge Belanger from Needham and Company. Your line is open.

Serge Belanger -- Needham and Company -- Analyst

Hi, good afternoon. Question for me on Rocklatan and Rhopressa. You mentioned it was a matter of time, but you still believe in the long-term prospects of both products. You expected to see a big bump, or a bump in Medicare coverage at the end of q3 here. When do you expect to see an inflection in Rocklatan? Should we see that starting in the fourth quarter?

Vince Anido -- Chairman and Chief Executive Officer

Well, with the current win, the most recent win, in terms of Rocklatan occurred earlier this month. And so, toward the back end of this month and beginning of September, you start seeing some inflection point there. Obviously right now, because of vacation and all that B.S. it sort of gets attenuated a little bit, but in fact, we think that some of the growth that we're seeing in the marketplace in terms of shipments from homestead or retail, it simply could reflecting not only more uptake for Rocklatan, but also, because of the better coverage, but also just a normal increase we would see, because it is covered much better than it was just a few months ago. So, it's a regional issue, the plan that we sign, when it's a national plan, it is concentrated on parts of the country, so, you know it's not in every state, but it's certainly in many of the states. And so, we're seeing some nice bumps there.

But if this win, meaning getting to roughly 30% after three or four months, relative to Rhopressa getting to about 12% in the same period of time, is any indicator, then hopefully we'll be able to speed up our race to get to about 75% Medicare part D coverage, and do it sooner than we did with Rhopressa. Remember, Rhopressa took us about a year. And so, if we can get there, then say, as we exit this year, beginning of next, is when we'll start seeing both products in the marketplace, and the physician being able to write for either one, depending on which one he prefers.

Serge Belanger -- Needham and Company -- Analyst

Okay, and maybe this next one's for Tom. Can you just comment on any recent changes to the sales force, and at this point in the launch, do you think it's adequately sized and staffed to promote both Rhopressa and Rocklatan?

Tom Mitro -- President and Chief Operating Officer

Yeah, first off, to answer your second part of that question first, yeah, we definitely think that we're adequately sized to handle the people that are writing the most glaucoma prescriptions in the marketplace. As Vince said, that includes about 2,500 or so optometrists, the rest being ophthalmologists, so we don't see any material change in the size there.

The other question, what we think is going on here is we think that our sales force is doing a really nice job. We've certainly had our changes in the sales force, which is common when you put in an organization in your first year, you'll find some people that say, "I really want to be with a small company, and I really want that spotlight every day," and sometimes, they don't. Sometimes they come, and it's quite natural for them to say, "Actually, I'm much better with a larger company, where I probably don't have as much attention on me." But we've gone through those growing pains, and we think our sales force, from a quality standpoint, is in fantastic shape right now, and we're quite happy with their productivity and what they are able to do with both products, at this point.

Serge Belanger -- Needham and Company -- Analyst

Okay, and I guess one last one. Vince, you walked us through some of the cash burn projections and expected cash balances. I think some of the retinal programs are expected to read out either late this year or early 2020. Does this higher cash burn kinda change your strategy with advancing these programs to phase three trials?

Vince Anido -- Chairman and Chief Executive Officer

It really doesn't. When you think about the timing related to some of the programs that we've currently got going, so the retina programs, you know they actually will be reading out a little bit later this year, sort of in the first part of next year, so by the time we sort those out and actually get more clinical trials back out, having talked to the FDA, et cetera, et cetera, et cetera, we're looking at those things impacting more the second half of next year, so their impact is not dramatic as perhaps you would expect it to be.

It's much like what we're seeing with the Japanese study. I mean, we were able to accelerate it, so we'll actually get results this year, and then we'll sit back and kind of formulate, based on the results, what the protocol should look like, go back to the FDA version of, in Japan, the PMDA, and go talk to them. But New York the time we get back out into the clinic there, it could be in the back end of next year. So, as a result, we'll have plenty of runway by then. We think the products will continue growing, and certainly, we're decreasing our cash burn, because we'll be selling more. So, I don't' think it impacts the phase threes, because we don't have anything scheduled to come out, where the huge phase three program would start early next year. Everything's sort of back-end loaded.

Serge Belanger -- Needham and Company -- Analyst

All right, thanks for taking the question.

Vince Anido -- Chairman and Chief Executive Officer

Thank you, Sir.

Operator

Your next question comes from Esther Rajavelu from Oppenheimer. Your line is open.

Esther Rajavelu -- Oppenheimer -- Analyst

Hi, thank you for taking my question. I have a couple. Vince, for you, can you expand a little bit on the trend of optometrists who are prescribing the portfolio of products, and what's driving that? It sounds like you were a little surprised by that, and so, just kind of curious to see how that compares to optometrist prescriptions for other glaucoma products, historically.

Vince Anido -- Chairman and Chief Executive Officer

Well, typically, we have a situation where glaucoma specialists, or I'm sorry, an optometrist who focuses on patients and sees a lot of glaucoma in their practice tends to say -- they're the first ones to identify it, and to diagnose it. And in many cases, we'll ship it off and send it off to a local glaucoma doc. And so, that's relatively common, and then we'll start picking up prescriptions from them later on, a few months later, when the glaucoma doc has actually got the patient on a prescription, and then the patient comes back to the optometrist, and the optometrist is following up. And so, you'll see a little bit of that dynamic.

What's interesting is, and I take it back to the optometrists that we know, and especially the high-end guys, who are really more clinical optometrists than anyone else, view themselves as the patient's advocates. And so, what we may be seeing here is that, for those optometrists, for those doctors that -- they view something like Rocklatan, where they can just give them one eye drop and get two powerful drugs, get their pressures down really, really low, decreasing their copays, et cetera et cetera, they may be seeing it as their perfect answer for what their patients are really looking for.

They may be more than willing to do that for a number of different reasons. Maybe they get to keep the patients longer, they don't have to refer them up, because the pressures are under control, and again, some of these guys are really high-end, from a clinical point of view. So, I think it's -- there's 55,000 optometrists, so I'm not sure I can take our 2,500 and project that out to the full 55,000. Materially, the guys that we're talking to, that are writing these scripts are the highest-end optometrists that write glaucoma meds, and so it's a hell of a start for us. But, again, it's surprising that they just popped out that quickly. I have to admit that.

But again, as we've thought about it and talked about it internally, I happened to visit with one of them in the Fort Lauderdale area, and he was all over Rocklatan. And he had not had much experience with Rhopressa, but then, he sort of told me what I just told you, which is, he viewed himself as patient's advocate, and so it was a perfect drug for them.

Esther Rajavelu -- Oppenheimer -- Analyst

Gotcha, and then, in terms the churn, you had mentioned that about a churn of about two to three months. Do you anticipate a step-up for doc visits among the patients who walked away with a sample, let's say, in 2q or early 3q later this year, and how does that kinda work itself off over 2020?

Vince Anido -- Chairman and Chief Executive Officer

So, we think that the, what we're seeing with the higher-decile doctors that are supporting us the most, that they're accommodating for more patient visits, and they're trying to get these patients back in a little bit sooner. Some of them try to sort of bypass it by giving the patient a sample of Rocklatan and saying, "Hey, if you don't have any troubles, call me and we'll set up something later on, if you can tolerate it, et cetera, et cetera." Other ones want to see them back in a shorter period of time, because maybe their pressure isn't under control, and it's sorta spiking and they're worried about it, so they're making room of them. But I think every practice is different, so not everybody can bring them back on a short basis.

So, it could very well be that the high-volume guys have such a big turnover in their practice, meaning a lot of their patients on any given day, that maybe, for some of them, it's easier to slot these patients in because of other opts not showing up, et cetera, et cetera. But we are seeing quite a bit of that churn, but it's very practice-specific.

Esther Rajavelu -- Oppenheimer -- Analyst

Okay. Thank you.

Operator

Your next question comes from Elemer Piros from Cantor. Your line is open.

Elemer Piros -- Cantor Fitzgerald -- Analyst

Yes, good afternoon. Maybe a couple of numbers-related questions to rich, if I may. Rich, I presume that the pre-approval manufacturing line item would disappear, beginning in the third quarter. Would you be able to confirm that, please?

Rich Rubino -- Chief Financial Officer

It will basically get smaller over time, and it will be pretty much gone when we get into next year.

Elemer Piros -- Cantor Fitzgerald -- Analyst

Okay, so it's a declining number.

Rich Rubino -- Chief Financial Officer

That's correct, mm-hmm.

Elemer Piros -- Cantor Fitzgerald -- Analyst

Okay. So, if I'm correct, if I remember correctly, your first-half revenue was $26.7 million, and I also see $25.7 million in accounts receivable. Would you please tell us what is the trend, in terms of days sales outstanding, as we move into this year?

Rich Rubino -- Chief Financial Officer

Yeah, so, you really have to look at account receivable, not so much from the beginning of the year to the end of this quarter, but you have to look at how we progress in the course of the year. So, at the end of the first quarter, our accounts receivable were about $14.8 million. Now, it's $25.7 million. From a DSO, or days sales outstanding perspective, you're really dealing with just a few wholesalers, or distributors, if you will, each of whom has their own terms. The terms can range to about 60 days, give or take. Some a little bit more, some a little bit less. So, there's not an issue, with regard to collections. Everyone's paying in accordance with their individual contracts, and you should just, Elemer, just follow the trends, again, not using the starting point of the year, but follow the quarters and follow the revenue growth, and going forward, you'll see a more consistent relationship.

Elemer Piros -- Cantor Fitzgerald -- Analyst

Okay, thank you for that, Rich. And Vince, I was wondering if you could address how you're going to address the first potential sustained release of eye drops that might come to the market next year. The amount of product...

Vince Anido -- Chairman and Chief Executive Officer

You mean the amount of process R? So, we've known about this drug for quite a while, and so, it is a surgically induced procedure that's gonna have to take place. We are aware of a number of different things, specifically, that there are some doctors that will try it and, for some patients, the procedure itself, and the kind of patients that are likely to be able to take advantage of something like this are -- It's not the entire market. It's certainly not all prostaglandin-taking patients, because the size of the angle that is required for that insert to fit is gotta be pretty big. So, only certain patients can even qualify for it.

Number two, if you take a look at the clinical trial results, and while they were able to achieve what they wanted to achieve, they're not as good as if you did the same thing with an eye drop version of their drug. So, it's purely for convenience's sake, so, for compliance sake. And so, a lot of it's going to be determined, in terms of their uptake, by the patient's willingness to do a surgery, and the copays associated with that, relative to taking a once-a-day eye drop, and the copays associated with that.

Especially by the time that this product gets out the door, bimatoprost will be genericized. And so, it's gonna be an interesting little reimbursement fight for them. And so, from our perspective, again, they were shown to be non-inferior to timolol, not as good as their own eye drop, and yet, our drug, Rocklatan, was actually shown to be better than latanoprost. And so, I think I'd rather have our drug than theirs.

Elemer Piros -- Cantor Fitzgerald -- Analyst

Okay, thanks for going to treat that.

Operator

Your next question comes from Difei Yang from Mazuho Securities. Your line is open.

Difei Young -- Mazuho Securities -- Analyst

Hi, good afternoon, and thanks for taking my questions. Just a few here. So, the first question is with regards to Rhopressa commercial coverage that I think you have talked about at 90%. I'm just curious, out of these 90%, what percent are all the way flow through to the participant plan level?

Rich Rubino -- Chief Financial Officer

Difei, it's Rich. Could you clarify, are you asking how much of it ultimately goes to the benefit of the patient?

Difei Young -- Mazuho Securities -- Analyst

No, how much actually, I think Vince was talking about, when you sign these... management... right.

Rich Rubino -- Chief Financial Officer

I got it. Yeah, you're asking, with regard to the 90%, which is overall contract access, what is the underlying specific formulary access?

Difei Young -- Mazuho Securities -- Analyst

Exactly, so, to what extent the patients...

Rich Rubino -- Chief Financial Officer

They're very close, actually. It's, as I recall, in the 80+% range. So, in that case, it's fairly narrow. What happens, you know, remember with Rhopressa, we started getting our coverage very early, so you get that contract coverage, and then it takes you sometimes a few months to get all of the underlying formulary coverage, as Vince explained in his prepared remarks. So, right now, those two numbers are very close, on the Rhopressa commercial side.

Difei Young -- Mazuho Securities -- Analyst

Okay. What about for Medicare side?

Rich Rubino -- Chief Financial Officer

Medicare has got a little bit more to go. Using the example that Vince also used in his prepared remarks, but we do have the majority for Med D for Rhopressa covered. So, the contract coverage is 75%, as we've said, and over 50% is already covered in the formularies. And again, that spread will narrow over time.

Difei Young -- Mazuho Securities -- Analyst

Yeah, so, then, as you gain access to all these coverages, more specifically with regards to the Medicare coverage, we went from 40% to 75% on May first. Do you think we have seen the inflection point from prescription perspective, or are you expecting to see that inflection point?

Vince Anido -- Chairman and Chief Executive Officer

So, we've started seeing some of the inflection points, if you go back into the April time frame, may time frame, remember we were sort of stuck halfway through the first quarter, things weren't moving well. We were expecting a big win, we didn't get in q1. It ended up trickling into q2, and then, as soon as we got it, we started seeing a nice bump. We're starting to see another nice bump now, and so just, it feels like it's going to be not as dramatic of big steps as we had with Rhopressa, where we went up to 12%, and then, all of a sudden, three, four months later, we jumped up to 40%, and then another three or four months later, we jumped up to 75%. I think it's going to be a steadier growth rate to the ultimate target of in excess of 75% Medicare part D.

Difei Young -- Mazuho Securities -- Analyst

Yeah, thank you.

Vince Anido -- Chairman and Chief Executive Officer

So, it's kind of hard not to believe that the increase that we just had, that I was talking about from last week, and shipments from wholesale to retail have jumped 1,000 units in one week, was in part due to the incremental coverage we received. We see Rocklatan continuing to grow really, really nicely, relative to the market, and yet, we still see Rhopressa growing. So, I think it's both sides are just winning, which is a great thing for is.

Difei Young -- Mazuho Securities -- Analyst

Okay. Thank you, Vince, for that clarification. Then, changing subject to Rocklatan, so when you go out to have these coverage, or managed care coverage discussions, how is Rocklatan viewed as a class of a drug? Is it viewed as a rock inhibitor, or is it viewed as a PGA, or maybe something else?

Tom Mitro -- President and Chief Operating Officer

Yeah, I can handle that. This is Tom, by the way. So, every managed-tier organization may do it a little bit differently, but in most of the time, they look at it as a fixed-dose combination product. So, neither a Rho kinase inhibitor, nor as a prostaglandin, but as a fixed-dose combination product.

Difei Young -- Mazuho Securities -- Analyst

So, it's a category by itself.

Tom Mitro -- President and Chief Operating Officer

In many situations. I can't say all, but certainly in many situations.

Difei Young -- Mazuho Securities -- Analyst

Okay, thank you for that clarification. Then, my final question, with regards to liquidity needs. So, given the increased cash burn, do you still feel comfortable that, with your current liquidity, you are able to get to break-even point?

Tom Mitro -- President and Chief Operating Officer

Yeah, so, there is no increasing cash burn, right? So, the gross cash burn now is still expected to be $210 million to $220 million. That's what it was when we gave guidance. Remember, Difei, there is an offset to that gross cash burn, to get us down to net cash burn, and that's basically the collections of accounts receivable from revenue, offset by some rebate payments. That cash, that net cash burn rate is going to decline. I tried to explain this earlier. So, we had net cash burn in the first half of this year of $92 million, but the full-year range is net cash burn of $160 million to $170 million. So, by definitely, in the back half of the year, that net burn declines, and so should be the case, as our revenue continues to build over the next several quarters.

Difei Young -- Mazuho Securities -- Analyst

Okay, thank you.

Tom Mitro -- President and Chief Operating Officer

Thank you.

Operator

Your next question comes from Elliot Wilbur from Raymond James. Your line is open.

Elliot Wilbur -- Raymond James -- Analyst

Thanks, good evening, just following on that line of questioning real quickly. So, based on all the commentary around cash resources and expectations for performance of the franchise, doesn't really sound like there's gonna be any real changes to the game plan over the next four to six quarters, at least in terms of trying to become a little bit more fiscally prudent or cash conservative.

Vince Anido -- Chairman and Chief Executive Officer

Well, we're obviously going to keep watch on everything that we're doing Elliot, and by the way, welcome back. I think we look at these things, and we want to continue growing the business. We want to make sure that we're prudent with the cash that we do have, and we feel pretty comfortable, obviously, with the guidance that we provided, and are comfortable with our liquidity. But it also, we know the timing of things that are going to be happening, and so, it's not because we plan it. It just happens. Sometimes you get lucky, and from a planning point of view, we know that, as I mentioned earlier, that some of the biggest expenses that aren't for clinical trials aren't going to start kicking in until the back end of next year. And so, that does help us feel pretty good about not having to scale back a whole lot. I mean, we're always cautious about adding heads. We're cautious about capital expenditures, cautious about all sorts of different things. But you know, I wouldn't say that we're gonna do it any differently than we've done in the past.

Elliot Wilbur -- Raymond James -- Analyst

Thanks, Vince. And then, I just want to ask a few questions, going back to your comments at the beginning of the call, regarding peak sales expectations for Rhopressa and Rocklatan, and you're consistent with the numbers you've put out there historically. The question really is more about time to realization. I guess, if you look at historical launch models, most products sort of reach a peak number, kind of in the five to seven-year time frame, but it just seems like, interesting the current environment, launch curves just seem like they're a little bit more compressed, kind of on the front end. So, I just want to get your thoughts around timeline to realization of the peak numbers that you put out there.

Vince Anido -- Chairman and Chief Executive Officer

Well, as I said earlier, we always thought that the uptake would be a little bit better than it obviously has been, mainly because of everything that we're hearing, everything that the docs were feeding us back, relative to their expectations of how quickly they would start writing for one or the other product, et cetera, et cetera. And so, I think that the normal trend would be, based on what we're seeing now, you would expect it to see a little bit of a delay. And so, if we thought that we were gonna get to peak sales in five, maybe it becomes a six or seven-year kind of time horizon.

The difference is, which is what I've been trying to point to, which is that assumes certain trajectory in terms of your managed care uptake. And so, if we are able to accelerate our managed care uptake, and we are as successful if not more successful with Rocklatan as we were with Rhopressa, getting into that, again 75% Med D coverage after a year, 90% commercial And so, if we can move that up a little bit for Rocklatan, that could allow us perhaps to start bouncing back from sort of this churn period and things like that, to where we can get back to more an accelerated timeline, or back to our original timeline.

So, again, it goes back to how fast can we get to that 75% Medicare part D component? And the sooner we do it, the better off we're going to be and the sooner we'll get to those peak revenue numbers. And by the way, while we're talking about all this, looking at the uptake on managed care for some of the other glaucoma products that have been launched in the same relative period of time, whether it was us or Rhopressa, I'm sorry, or Xiidra, or Vyzulta, or any of those, getting to where we did with Rhopressa in one year, the 75% Med D and 90% commercial, stands out pretty nicely for us. And so, it's certainly not happening across the board that quickly. So, we like that.

Elliot Wilbur -- Raymond James -- Analyst

Good, fair enough. And then, last question. Any updated data points you can provide, with respect to Rhopressa and more specific metrics, in terms of combination use of the products? I think it's the reason I ask the q. I always assumed that Rhopressa was obviously being used extensively in combination therapy, and most likely in combination with latanoprost, so it was really just sort of a Rocklatan proxy, and when Rocklatan launched, I obviously thought that there would be a strong uptake, but there would be a much greater cannibalization of Rhopressa than there has been thus far. So, maybe that impression is not correct. Maybe, in fact, utilization in combination with latanoprost has just been a little bit lower than we had anticipated. But, I'm just curious on thoughts as to why Rocklatan, perhaps, hasn't cut into the Rhopressa franchise as much as we would have anticipated. And you can sort of see that in the fact that, at least, as of the latest week, the launch is still a little bit behind where Rhopressa was treading at a similar point in time. Thanks.

Tom Mitro -- President and Chief Operating Officer

Yeah, Elliot, this is Tom. I'm happy to take a stab at a couple of your questions there. First off, we do know that about 15% of Rhopressa's current business is for initial therapy, or treatment-naive patients. So, those are people that, for some reason, are not candidates for prostaglandins, are, because that's what normally people would start off with. So, by the way, we're quite happy with that.

The second thing is, when Rhopressa first came out, it was added on to therapy, meaning it was what we call maximum medical therapy, or the end-of-line therapy, prior to surgery, so the patient may already be using three products. They throw in Rhopressa just to see what happened. Many were impressed with the results that they got, because they certainly did not expect much, and found out that they were getting a lot. So now, what they're doing is they're moving it up in their treatment paradigm, and in many cases, are replacing therapies with Rhopressa, meaning they're using it as a second or third line, but not the fourth line, that sort of thing. So, we like that.

The other thing we'll see is, it's interesting because you talk about the trade-off with Rhopressa and Rocklatan in there, and how Rocklatan, you assumed, might eat into the Rhopressa business. Quickly, I can give you this fact: since the launch of Rocklatan, which of course was just in May, we have picked up 1400 new prescribers of Rhopressa. And we believe the primary driver for that is the physicians get infatuated with IOP lowering of Rocklatan, they tried Rocklatan, found out that it wasn't covered, had a high copay to it, brought the patient back to the office, and then they gave them Rhopressa, because they, in essence, now just have to use two bottles. They'd rather use one in Rocklatan, but it's that they just use two bottles. So, we like that. I mean, we like the fact that we've picked up more, 1400 new Rhopressa prescribers since May, even in the face of having what we consider to be there most efficacious IOP lowering agent on the market.

Elliot Wilbur -- Raymond James -- Analyst

Okay, good color, thank you.

Tom Mitro -- President and Chief Operating Officer

You're welcome.

Operator

Your next question comes from Oren Livnat from H.C. Wainwright. Your line is open.

Oren Livnat -- H.C. Wainwright -- Analyst

Thanks for the question. There's been a lot, obviously. I just want to follow up on the combination product answer, with regards to the reception you're getting for Rocklatan from some payers. It occurred to me that maybe, and you can confirm this is or isn't the case, are any papers sort of treating Rocklatan like it's in a vacuum, and not really thinking about, "Hey, you're the Rhopressa guys coming with your second product," such that they're looking at, "Hey, Rocklatan's just a combination of two drugs that are out there, and we have a policy, for a long line of companies before you that have tried to do line extensions and convenience plays, and we say no on all of those things, or we push back pretty hard." And are you seeing that? And, if that is the case, is it possible that you won't be able to get any premium over Rhopressa, in some number of plans? Thanks.

Vince Anido -- Chairman and Chief Executive Officer

Really, the answer to that really is no, that nobody is really putting us into a vacuum of thinking, or are they just thinking this is just like any other combination product. There's really two reasons for that. First off, this is the first time they've ever had a company come in and say this product is statistically better at IOP lowering than the top-selling product in the United States, in fact, the world, latanoprost, right. So, this is a whole different playing field for them.

The second thing, remember the pricing strategy that we took forward with Rocklatan was to price it very minimally above Rhopressa. So, at the end of the day, it doesn't really make a material difference to them, whether they're going to use or reimburse Rocklatan or Rhopressa. It's not a monetary issue for them. So, because of that, they were quite willing to accept where we are with Rocklatan.

Elemer Piros -- Cantor Fitzgerald -- Analyst

All right, thanks. That's it.

Vince Anido -- Chairman and Chief Executive Officer

Thanks.

Operator

At this time, I would like to turn it back to Aerie's Chairman and Chief Executive Officer, Vince Anido, for any further comments.

Vince Anido -- Chairman and Chief Executive Officer

Thanks. I want to thank everybody for joining us this afternoon. We tried to give you some clarity about why we made the guidance changes, et cetera, and hopefully, we've achieved that. And more importantly, however, hopefully, you're walking away from the call with a clear understanding about how we feel about the long-term prospects for both of these products, Rhopressa and Rocklatan. There's nothing that we have seen in the marketplace that gives us any pause at all, that wouldn't want to continue to make us bullish about. The future for both of these products, everything that we're seeing is positive, from a patient and doctor interaction point of view.

This is all about two things: number one, that we get enough managed care coverage, and as we've pointed to in the past, trying to get to about 75% Medicare part D, 90% commercial, is really sort of the trigger where just about every doctor out there can write either product, Rhopressa, Rocklatan, to their heart's content, for specific patient needs, and that's what we're trying to strive for. Number two is, until we get there, we're seeing an awful lot of churn in the practices, and that's what's taking an awful lot of time, to finally get those prescriptions out to show, or into the retail market, et cetera.

The good news is that we are making that progress. We are getting the managed care wins, and they're coming, and so hopefully, over time, the churn will decrease, and in the not-too-distant future, we'll start seeing the physician practices around the country find the true homes for both Rhopressa and Rocklatan.

So, and while that's not the entire story of the company, certainly that's where we wanted to focus today, and hopefully, we've answered everybody's questions. So again, I want to thank everybody for listening, and sorry that we ran a little bit long today, but have a good evening. Thanks.

Operator

Ladies and gentlemen, this concludes this conference. Thank you for your participation, and have a wonderful evening. You may all disconnect.

Duration: 75 minutes

Call participants:

Ami Bavishi -- Director of Investor Relations

Vince Anido -- Chairman and Chief Executive Officer

Rich Rubino -- Chief Financial Officer

Annabel Samimy -- Stifel Nicolaus -- Analyst

Ken Cacciatore -- Cowen and Company -- Analyst

Tom Mitro -- President and Chief Operating Officer

Serge Belanger -- Needham and Company -- Analyst

Esther Rajavelu -- Oppenheimer -- Analyst

Elemer Piros -- Cantor Fitzgerald -- Analyst

Difei Young -- Mazuho Securities -- Analyst

Elliot Wilbur -- Raymond James -- Analyst

Oren Livnat -- H.C. Wainwright -- Analyst

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