Cytokinetics' Aficamten Faces Competitive and Regulatory Challenges: Hold Rating MaintainedWe recognize afi may have distinct benefits, including a more flexible initiation, with its recent clinical wins another potential differentiator (see our ESC takes). That said, our KOLs continue to think price/ access is likely to be the main commercial driver. And with reasons to believe Bristol may have the upper hand negotiating formulary position—an edge it can leverage with its CV commercial experience, infrastructure, first mover status, and Camzyos’ own advantages—the space may be more competitive than initially thought. To review the different launch scenarios, we are hosting a prescriber (10/21 @ 9:30am ET) and a payer (10/22 @ 10am ET) call REMS still likely to be the biggest drag on launch, uptake In our view, FDA’s move to approve afi with a REMS (see our PDUFA takes) remains an overhang.