Negative Operating Cash Flow / Cash BurnPersistent, large negative operating cash flow (~-$175M TTM) reflects heavy burn from commercialization and limits optionality. If revenue cadence or payer wins lag, the company may need external financing, which can dilute shareholders and constrain long-term strategy execution.
High SG&A From Commercialization InvestmentsElevated SG&A to build field force and DTC programs creates structural cost pressure relative to current revenue. Until refills and payer access scale, sustained high selling expenses will compress operating leverage and delay durable profitability despite strong unit economics.
Payor Access Friction & Prescription AbandonmentSignificant prior‑authorization barriers (43% of covered lives) and ~22–23% abandonment materially reduce realized demand and create structural friction. Durable growth depends on sustained payer wins and lower abandonment; failure to convert coverage into fills constrains long‑term revenue conversion.