Alpha Cognition (NASDAQ:ACOG) reported second-quarter financial results on Thursday. The transcript from the company's second-quarter earnings call has been provided below.
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Summary
Alpha Cognition reported $6 million in net product revenue for Q2 2026, marking a 71% growth from Q1 2026, with a GAAP gross product margin of 94%.
The company continues to focus on commercializing Zunvale, an Alzheimer's treatment, with increased prescriber and nursing home adoption and positive clinical data from studies such as Beacon.
Alpha Cognition reduced its full-year 2026 operating expense guidance to $50-$54 million, reflecting confidence in balancing growth investments with expense management.
The company maintains a strong cash position with $41.4 million in cash and cash equivalents and a strategic move to eliminate future royalty burdens.
Management remains optimistic about achieving operating profitability by 2027, with continued focus on expanding prescriber reach and payer access, despite current slow formulary activation.
Full Transcript
OPERATOR (Operator)
Greetings and welcome to the Alpha Cognition earnings call. At this time, all participants are in a listen-only mode. A brief question-and-answer session will follow the formal presentation. Should anyone require operator assistance during the conference, please press star-0 on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Henry Du, Interim CFO, VP, Accounting and Finance. Thank you.
You may begin.
Henry Du, Interim CFO and VP, Accounting and Finance
Thank you, Sachi. Good afternoon, everyone, and thank you for joining us today for Alpha Cognition's second quarter 2026 financial results conference call. Today, after the close of market, the Company issued a press release announcing these results. On the call with me are Alpha Cognition Chief Executive Officer Michael McStadden and Chief Operating Officer Lauren D'Angelo. Today's call is being made available via the investors section of the Company's website at www.alphacognition.com.
During the course of this call, management may make certain forward-looking statements regarding future events and the Company's future performance. These forward-looking statements reflect Alpha Cognition's current perspective on existing trends and information. Any such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, including those noted in the Risk Factors section of the Company's latest SEC filings.
Actual results may differ materially from those projected in these forward-looking statements. For the benefit of those of you who may be listening to the replay, this call is being held and recorded on August 13, 2026. Since then, the Company may have made additional announcements related to the topics discussed. Please reference the Company's most recent press releases and current filings with the SEC. Alpha Cognition declines any obligation to update these forward-looking statements except as required by applicable securities laws.
I'll now turn the call over to Michael.
Michael McStadden, CEO
Thank you, Henry. Good afternoon, everyone. Welcome to today's call. The second quarter of 2026 represents another important quarter of commercialization for Zundell, the first new oral Alzheimer's treatment approved in more than 15 years. It was a strong quarter of execution with clear sequential growth in Zymbel, demand expansion and prescriber adoption, increased nursing home penetration, and continued progress with evidence generation to clinically support Zembel.
We continue to execute with discipline and confidence, and I believe this quarter demonstrates that Zenville's commercial trajectory is tracking well with our expectations as we continue to scale the brand and the long-term care segment. In Q2, we generated approximately $6 million in net product revenues, representing approximately 71% quarter-over-quarter growth versus Q1 2026. While we're pleased with Zunvel's trajectory, we're still in the early phases of the product's commercial phase and remain optimistic that we'll continue to see signs of sustained product performance and adoption in the long-term care setting.
Looking at the quarter, monthly prescription volumes strengthened consistently, with high single-digit sequential growth each month. All KPIs were positive, including prescriber number increases, nursing home prescriptions, and repeat prescriptions. Overall, we believe we're on track with our 2026 strategic priorities as we continue to drive prescription growth and build a durable path toward operating profitability in 2027. Turning to our clinical and medical programs, we continue to advance our evidence generation priorities in Q2, which we believe will strengthen Zonbel's positioning with both payers and healthcare providers over the long term.
During the second quarter, the Company reported positive top-line results from the Beacon study. We initiated Converge, a retrospective data review in long-term care, and we initiated RESOLVE with sites selected, sites activated, and initial patient enrollment underway. Of note, the Beacon study demonstrated that following initiation of Zumvel, providers observed improvements in cognition, improvements in neuropsychiatric symptoms, and improvements in activities of daily living, along with reductions in polypharmacy.
These are all meaningful outcomes for long-term care practitioners treating patients with mild to moderate Alzheimer's disease. Based on these positive findings, our medical team has submitted the data for presentation at several upcoming medical meetings. We look forward to announcing additional details as presentations are accepted and confirmed. We expect Converge top-line data in Q3. We believe this will provide the Company two nursing home data sets that can be utilized to inform stakeholders of the changes in cognition, neuropsychiatric behaviors, and ADLs they might expect to see when utilizing Zumbel in the nursing home setting.
Henry will provide financials in detail in a moment, and Lauren will provide a more comprehensive commercial update thereafter. But first, let me make a few high-level remarks on our financial position. Our operating spend of $13.5 million this quarter continues to reflect a deliberate investment in our commercial capabilities and in studies that support our positioning with healthcare providers and payers. As I said last quarter, I want to be direct about the way we're thinking about this investment.
Our net product loss this quarter reflects the Company's intentional scaling. We're deploying capital against our highest return opportunities in the business, including expanding prescriber reach, building real-world evidence to support Zenville, and unlocking additional payer access. These are investments that will drive the Company to achieve operating profitability in 2027 and beyond, and we continue to remain on track with these targets. I'll now turn it over to Henry.
Henry Du, Interim CFO and VP, Accounting and Finance
Thank you, Michael. Good afternoon again, everyone. As I review our second quarter 2026 financial results, please also refer to today's press release and 10-Q to be filed this afternoon. For the second quarter of 2026, Zenvale generated approximately $6 million in net product revenue compared with approximately $3.5 million in the first quarter, representing approximately 71% sequential growth quarter over quarter. Total revenue for the quarter was $6.1 million compared to $1.7 million in the prior-year period, driven primarily by Zunvale product sales.
From a margin perspective, GAAP gross product margin was approximately 94% for the second quarter, based on net product sales of $6 million and cost of product sales of approximately $0.4 million. Regarding spending, total operating expenses for the second quarter were $13.5 million, including $11.5 million of SG&A and $2 million of R&D expense. SG&A reflects continued investment in the commercial infrastructure, payer engagement, marketing resources, and public company operations, while R&D reflects continued investment in evidence generation and development programs required to build Zenvale for the long term.
Net loss for the second quarter was $8.8 million, or $0.40 per share, compared with a net loss of $13.2 million, or $0.82 per share, in the prior-year period. As of June 30, 2026, the Company had $41.4 million in cash and cash equivalents and $57.9 million in total current assets. Total current liabilities were $6.4 million, resulting in working capital of approximately $51.5 million. During the quarter, we also completed the early settlement of ORC Atlanta's former royalty obligations.
This transaction simplifies our capital structure, eliminates future royalty burden on the product economics, and increases our long-term participation in the value created by Zenvale. We believe this was a prudent use of capital and a strategic step that improves the future cash flows and strengthens the economics of the franchise as the brand continues to grow. We continue to believe our current capital position, together with expected future sales of Zenvale and potential milestones and royalties, can support our plan towards operating profitability in 2027.
Lastly, based on the strong commercial performance of Zundale and our continued focus on operating discipline, we are lowering our full-year 2026 operating expense guidance from our previous range of $54 million to $58 million to a new range of $50 million to $54 million. While we remain committed to the growth of Zundell and advancing key evidence generation initiatives, we have identified opportunities to operate more efficiently across the organization.
This revised outlook reflects our confidence in our ability to balance growth investments with prudent expense management. With that, I will now turn the call over to Lauren to discuss commercial progress.
Lauren D'Angelo (Chief Operating Officer)
Thank you, Henry. I'm pleased to provide a detailed update on our Q2 2026 commercial performance. Building on the momentum we described last quarter, Q2 was a period of meaningful execution across prescriber adoption, nursing home penetration, and payer engagement, and the data tell a compelling story of durable and accelerating commercial traction. Let me start with the headline: Q2 demand generated approximately $6 million in net product sales, representing 71% sequential growth over Q1.
That result was driven by approximately 8,294 bottles, up roughly 37% quarter over quarter. Turning to adoption, in Q2 the commercial team reached 8,194 total customers and called on 3,905 prescribers, reflecting the reach of our now right-sized, approximately 60-person, productive field organization and the continued refinement of our targeting approach. HCP prescribers who wrote at least one Zunvale prescription grew 27% quarter over quarter to 1,000, and cumulative life-to-date writers reached 1,908.
This keeps us firmly on track to meet or surpass our 2026 goal of approximately 2,000 cumulative writers. As I've said in the past, depth matters as much as breadth. Of our 1,024 Q2 writers, approximately 76% placed repeat prescriptions, and productivity per writer continued to climb, rising to approximately six prescriptions per writer — evidence that adoption is deepening, not just widening. That sustained repeat behavior is one of the strongest signals that Zunvale is moving from initial trial into routine clinical practice.
We see the same pattern at the facility level. Homes with Zunvale prescriptions grew 20% quarter over quarter to 1,095, including 346 new homes added during the quarter. Of homes with prescriptions, roughly 81% placed repeat orders, consistent with the durable facility-level adoption we described in Q1. The monthly trajectory shows how momentum built through the quarter, each month delivering sequential growth, with June our strongest demand month to date.
That exit velocity establishes clear momentum as we move into Q3. Payer access remains our most significant near-term opportunity and, candidly, our most significant near-term friction point. Implementation across the downstream plan clients in Q2 was roughly consistent with Q1 — we want to be very direct about that. The broad formulary activation we anticipated has not yet materialized at scale, and access expansion is tracking slower than the access curve we outlined last quarter.
Critically, we view this as a timing dynamic, not a demand constraint. The clearest evidence is that our Q2 demand grew approximately 37% in bottles and 71% in net sales, even without any expansion in payer access. Underlying prescription growth and an 81% facility repeat rate are being driven by genuine clinical pull, not by a formulary tailwind. That means payer conversion remains almost entirely ahead of us as upside. Reinforcing that access work is our real-world evidence program — Beacon, Converge, and Resolve.
We expect these studies to deliver meaningful promotional value, supporting peer-to-peer education, strengthening payer discussions, and building physician confidence around tolerability, polypharmacy management, and caregiver burden. That evidence base is already fueling our education efforts. Since March, we have conducted more than 240 peer-to-peer programs, reaching 1,058 attendees and 325 prescribers. We also maintained a strong scientific presence at key congresses, including NADONA and MPA, reinforcing Zunvale's credibility among high-value prescribers.
In summary, Q2 2026 reflected strong commercial execution with growing demand, improving conversion, high repeat utilization, broader prescriber adoption, and deeper facility penetration. While payer access has not yet expanded, the strength of demand underscores the clinical pull behind Zunvale and the opportunity ahead. As access improves, we believe we are well positioned for continued acceleration. I'll now hand it back to Michael for closing remarks.
Michael McStadden, CEO
Thank you, Lauren. Let me briefly summarize what I believe are the key takeaways from the quarter. First, Zunvale is growing — we delivered approximately 71% sequential growth from Q1 to Q2, and monthly prescriptions increased from April through June. The commercial trajectory is accelerating. Secondly, adoption is deepening. We had over 1,300 HCP writers, over 1,000 repeat writers, 1,000 nursing homes with prescriptions, and almost 900 homes with repeat prescriptions.
Repeat utilization remains one of the most important indicators of good product adoption. And third, we're executing on our commercial and company strategy with discipline. Our commercial organization is in place, our focus is on deploying capital against high-return opportunities in the business, and our evidence generation continues to advance. The company is enrolling Resolve, Converge is underway, and Beacon was completed ahead of schedule, and the company will have publications from that study to present to the medical community this fall.
So we're excited about the balance of the 2026 year. The foundation we built for Zunvale is strengthening, our commercial indicators are moving in the right direction, and we remain focused on disciplined execution. With that, operator, we'll now take questions.
OPERATOR (Operator)
Thank you. We will now be conducting a question-and-answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment please, while we poll for questions.
The first question is from Ram Selvaraju from H.C. Wainwright. Please go ahead.
Ram Selvaraju, Analyst at H.C. Wainwright
Thanks so much for taking our questions, and congratulations on a very solid quarter. I was wondering if you could comment on the following three aspects at this point in the launch. Firstly, when you look at the repeat prescribers and the percentage of repeat prescribers that you have seen write prescriptions in multiple months, can you give us additional granularity on that specific element of prescribing behavior? Particularly, what it may be that converts a repeat prescriber into not only writing more than one script, but sticking with the product over a lengthy period of time, and if at this point we have enough data to indicate what the characteristics of that group of prescribers are. Secondly, I was wondering if you could give us a sense of, at this point in time, given where you are with the launch, when you believe you might expand sales and marketing outreach beyond long-term care into the specialist neurologist population. And then lastly, with respect to formulary access, I was wondering if you could elaborate a little bit further on when you anticipate that emerging as a tailwind above and beyond the pull-through demand that you're seeing.
Thank you.
Michael McStadden, CEO
Thanks, Ram. Very solid. Good three questions there. I'll start with your first one around our repeat prescriber rate — what we're seeing, in terms of what's causing that repeat group to continue writing Zunvale. I think it really comes down to their experience with the drug. We've talked previously on many quarters that, you know, you start out with breadth — you call on a significant amount of physicians. Once you convince them to try the drug, it takes two to three months for them to really get that experience to monitor the one or two patients, and then of course they'll start repeating once they've experienced positive effects from Zunvale.
What we're seeing is these are significant repeat rates — 76% of providers are writing again. That's some of the highest I've seen in my experience. And we believe, based on all of the feedback we've gotten from our customers, that it's really three things. First, they want to make sure this drug is tolerable, because obviously their experience with the generics in the decades past has not been great as it relates to tolerability. Once they see that Zunvale is a very tolerable drug, they're then looking obviously at the efficacy, and they see significant cognition — that core foundation of why they use these drugs in the first place.
And then, as we've talked about in the past, they're seeing significant benefit across the behavior. So those are really the three things — those are the three factors that are causing these physicians to write again. And that feedback is consistent across the board. As it relates to when we'll step outside of long-term care and potentially go into retail or that neurology space, we're really focused right now on maximizing the long-term care opportunity.
We obviously believe there's tremendous upside and opportunity in the long-term care space. And as we get to operating profitability next year, that's when we would look to start evaluating whether it's time to go into the neurology space. Another key aspect of that expansion into neurology is the payer, which obviously goes to your next question. You don't want to launch into retail without solid formulary coverage because you'll see significant abandonment rates in the retail setting when the copay is too high.
So it's really operating profitability and payer coverage that would determine at what point in time we will expand into neurology. And then finally, your question around payer — you know, we are again actively engaged with all of the key payers that really matter to the long-term care business. We're having consistent conversations. We're focused on increasing our demand so that, you know, we increase the likelihood that we can gain formulary coverage.
What we're seeing across the board, not just specifically to Zunvale, but really across the industry in the Medicare Part D space, is the impact of the Inflation Reduction Act that is having a significant impact on the plan and the additional cost that they have to pick up. So that's why we've got to continue driving demand. We're hopeful that we will see something, as we've always communicated, the second half of the year. But it's not a matter of if, it's a matter of when, because the payers definitely recognize the demand and the growth that we're driving.
And we will continue to have those conversations to make sure that obviously we start to obtain formulary coverage.
Ram Selvaraju, Analyst at H.C. Wainwright
And then just very quickly, I was wondering if you could maybe provide us with your sense of when Converge data becomes available, to what extent that constitutes a potential game-changer in sending the curve upwards, as well as when you anticipate being able to provide data from the Resolve study. I know you've guided towards when the study would be completed, but when data would be available. And then if you could also comment on the size of the market opportunity that you expect to be addressable with the sublingual formulation, and whether you would consider the possibility of instituting a revenue guidance range for 2027, along with possibly also instituting expense guidance range for that year.
Michael McStadden, CEO
A lot to unpack there. First, I'll start with Converge. So we anticipate top-line data for Converge in Q3 of 2026. The significance of Converge is a quantitative retrospective data analysis on the entire Alzheimer's market and it will provide data on persistence, adherence, polypharmacy with all drugs, as well as a number of other elements like ADL improvement, tolerability, types of patients that are being profiled for each of the drugs, et cetera.
That data will result in multiple publications. They likely will not be public until 2027. We'll begin writing data post study and then submitting those for publication thereafter. We also believe that with Converge quantitative data and Beacon qualitative data that there's an opportunity to analyze that data pharmacoeconomically, which will provide additional information that we believe will be useful for payers and decision makers that have a financial interest in how Alzheimer's drugs are used.
Resolve study's underway; it's recruiting to our expectations. We anticipate that study will complete in Q2 of next year. We'll have data in the summer/fall, depending on when in Q2. The data Resolve is provided from a sublingual perspective. We're really excited about the sublingual opportunity. We believe that the opportunity represents about 10 to 20% of patients with Alzheimer's disease. The data indicates that about 10 to 20% of patients with Alzheimer's have either aphasia or dysphagia, meaning they cannot swallow or have difficulty swallowing, and the treatment choices for those patients currently are very limited.
So we believe a sublingual has the opportunity to take significant share from existing therapies and from a patch that's often used on the torso or the arm of these patients, which is quite difficult and challenging to administer and for the patients to utilize that drug. We have a gating item for the sublingual product. We're running a comparative PK study this quarter. We anticipate that data will be available in Q3 and that will determine timeline for clinical program for sublingual and then for revenue guidance.
Currently we haven't commented on when we'll provide revenue guidance. We will provide expense guidance for 2027 and we'll likely do that at the very beginning of 2027 or the latter part of Q4.
OPERATOR (Operator)
The next question is from Nav Rahman from Maxim Group. Please go ahead.
Nav Rahman, Analyst at Maxim Group
Hi everyone. Congrats on the quarter and the progress, and thanks for taking my questions. I just have two quick questions. In the quarter, did you ever see any outsized stocking or material stocking in the quarter that could have impacted sales? And also, if securing reimbursement and coverage is going slower than anticipated, what do you expect your gross-to-nets to be by the end of the year or through the year? Thanks.
Lauren D'Angelo (Chief Operating Officer)
Yeah, both really good questions. So, as it relates to material stocking, no, we did not have a significant increase in stocking. Our pharmacy and our wholesalers are now at a point where they're pretty much purchasing on demand. So what you see this quarter is pure demand growth, and we feel very strongly about that because we can follow the trends in the data. As it relates to our reimbursement, obviously right now we're holding strong at about 74%.
So, if we do not see any significant formulary adds by the end of the year, we would stay pretty consistent. We'll pick up some of the IRA penalty, but it will stay within a pretty similar GTN by the end of the year.
Nav Rahman, Analyst at Maxim Group
Thanks. Thanks for taking my questions.
OPERATOR (Operator)
The next question is from Chase Knickerbocker from Craig-Hallum Capital Group. Please go ahead.
Jake (for Chase Knickerbocker), Analyst at Craig-Hallum Capital Group
Good afternoon everyone. Thanks for taking the questions. This is Jake on for Chase. We've seen another nice month in scripts in July. Could you maybe just speak a bit to what you have seen from a demand perspective so far in the third quarter, and what level is plan pull-through and payer dynamics playing a role here versus just— is it just commercial execution from your team?
Lauren D'Angelo (Chief Operating Officer)
Sure. So Q2 results and demand were increasing month on month, and June was our strongest demand as of Q2. What I can tell you— I know we don't provide guidance— is that momentum has continued. It is all, in my opinion, commercial execution. We have had no formulary wins. Our 16% contracted, open book of business is consistent since last quarter. So we believe that the strong demand in Q2 is pure commercial execution. We've gotten a lot smarter with targeting the right customers.
We're now at the ideal 60-person customer-facing salesforce, so we believe that that is really what's driving the demand. That's why we like to say that any formulary wins that will come in the future are all upside for us, because we've got strong growth and we continue to have strong growth in Q3.
Jake (for Chase Knickerbocker), Analyst at Craig-Hallum Capital Group
Thanks for that color, Lauren. And then lastly, could you just speak to how adherence is trending now that we're more than a year into launch? How have you seen this change over time, and what do you calculate patient retention is at 6 or 12 months, however you want to present it?
Lauren D'Angelo (Chief Operating Officer)
Sure. So we're still tracking adherence rates because long-term care is a little bit different in how you look at the data, so it's hard for me to give you a number in terms of the average time on drug, how much is new business versus refill business. But what we do see is patients do stay on drug longer in the long-term care facility versus a retail segment, obviously because they're being cared for every day. I hate to give you a number because we're still working through that adherence rate, but what I can tell you is Q2 was driven by significant new growth as well as those refills from previous quarters.
Hopefully in the future I'll be able to give you a more accurate number around adherence.
Jake (for Chase Knickerbocker), Analyst at Craig-Hallum Capital Group
Yeah, that would be very helpful. Thank you for taking the questions.
OPERATOR (Operator)
The next question is from Ryan Deschner from Raymond James. Please go ahead. Ryan Deschner, your line is open.
Ryan Deschner, Analyst at Raymond James
Hi, can you hear me?
OPERATOR (Operator)
Yes, we can hear you, Ryan.
Ryan Deschner, Analyst at Raymond James
I apologize for that. Two quick questions for me. The first, can you comment on specific geographies or types of prescribers or really any other attributes where you're seeing the most growth this quarter and going into next quarter? And then, as you're collecting feedback from prescribers who switch patients over to Zunvale, what have the primary drivers for switching over been as of recent, and how refractory are the patients that you're putting on drug in terms of the number of therapies that they've already been on?
How is that looking so far? Thanks.
Lauren D'Angelo (Chief Operating Officer)
Sure. So as it relates to the growth across the nation for Q2, we've seen growth across every region. Where we're seeing the largest volume is coming from those key markets that have the largest opportunity. But overall I'm pleased to say that across the country we're seeing pretty significant growth, and there's not one specific area that's doing far better than another area of the country. I think we're finally getting to a point with our 60-person sales team where we're gaining momentum.
Every region is gaining traction, so that's really exciting. Your second question around what is the feedback, and what's causing that reason for shifting— so there are several reasons. We're talking to customers every day and the feedback continues to overwhelm us with the positive impact that Zunvale is having on patients. We see a lot of new patients who haven't been on drug in a while because they had already failed donepezil. They already failed maybe one or two generics, and there's been no other alternative for them.
So the physician is re-energized to try something else for these patients because they were not able to tolerate some of these drugs previously. We also see a significant amount of switching, and I think some of that is due to tolerability— which obviously is insomnia on some of the other drugs— it could be the GI issues on some of the other drugs, but also the behavioral impact. Physicians have started to get experience with Zunvale; they're seeing a positive impact across behaviors.
And so patients that are on another drug— they've seen behavioral impact with patients already on Zunvale— so it's causing them to switch those patients over to Zunvale just from their peer experience with other patients. I don't know if that answers your question, but those two areas are probably the biggest reasons to switch or to try Zunvale.
Ryan Deschner, Analyst at Raymond James
That's very helpful. Thanks so much.
OPERATOR (Operator)
The next question is from Dave Storms from Stonegate. Please go ahead.
Dave Storms, Analyst at Stonegate
Afternoon. Thank you for taking my questions. Just wanted to start with maybe some of the prescribers that have only been one-time prescribers thus far. Do you feel the need to maybe go back and retrace your steps there, or is there still so much runway in front of you that you're more focused on the white space there?
Lauren D'Angelo (Chief Operating Officer)
That's a great question. So one of the challenges with long-term care data is we call them ghostwriters. So even though it might show in the data that they've only written one prescription, they've actually written more— the order was just entered under another doctor. We don't have a lot of physicians who have tried one and dropped off and they're not using the drug anymore. What I can tell you, though, that I think ties to your question is that we have segmented the market and we have obviously bucketed our physicians and our writers into our first tier, our second tier where they've written several scripts but they're maybe not writing it for 30% of patients, and then we've got a third tier. And the good news in what we're seeing in Q2 is that every single tier is improving. So if you'll remember, in previous quarters, we talked a lot about those early physicians who have only tried one or two— they need two to three months to get experience with the drug. We're seeing that wave of physicians now move into significant repeat writing. And so it's kind of a constant cycle where we'll continue to call on a tier three, where they're getting that two to three month experience with the drug, they will move into the next tier.
And so in every single tier, we've seen significant improvement. It's just time and experience with Zunvale, and we expect that that trend will continue.
Dave Storms, Analyst at Stonegate
That's really great color. I appreciate that. And then maybe just one more modeling question. With the SG&A expense guidance decreasing, is there any more you could give us there— just maybe how sticky that might be, how much of it could be applied into 2027? Any more color there would be helpful.
Henry Du, Interim CFO and VP, Accounting and Finance
I can comment on that. We anticipate some consistency, Dave, into 2027, but we haven't finalized our 2027 numbers. We have a number of studies ongoing this year which increase expenditures. Those will be concluding in Q2 of next year, but our commercial efforts and opportunities may offset that into 2027. So I ask you to bear with the company as we finalize our 2027 spending plan, and we'll provide those data, but it'll be in a similar range for next year.
Perfectly.
Dave Storms, Analyst at Stonegate
Thank you for taking my questions.
OPERATOR (Operator)
The next question is from William Wood from B. Riley Securities. Please go ahead.
UNKNOWN Analyst
Hi, thanks for taking our questions. So, just a couple from us. So I was curious, in terms of the patients that don't or come off drug and so on, that churn where they don't continue persistence, what is the main driver for the patient to either to get off drug, is it adverse events or just lack of efficacy? Or alternatively, what's driving the prescriber to stop prescribing it? And then also in terms of long term home care base, it looks like you've got a continued very nice expansion there.
But I was curious in terms of percentage of total base that you can potentially building into. I know it's still early times, but just curious how much of an expansion you have sort of room to grow on that sort of top line, full expansion there.
Lauren D'Angelo (Chief Operating Officer)
Thank you. Sure. Both of those are really great questions. So now I can tell you that we're talking to customers daily. We're getting significant feedback and we are following those patients that display continued Zunvail. What I can tell you now, it doesn't mean that it's not happening. I'm not speaking to the universe, but we have not had or heard of patients, especially within our data, that are coming off due to tolerability or lack of efficacy.
We've actually heard the very opposite. This drug works and this drug works really well. And I think the feedback has been overwhelmingly positive. Of course, the downside of long term care is these patients are very frail and so you will see death for patients. You'll also see patients who leave the long term care facility and they have a fall so they get put into the hospital. So you might have some break. We will recapture those patients when they come back into the home.
But the time that they, you know, it looks like a discontinue in the data when they're actually checking going into the hospital. So those are really probably the two biggest factors. And then of course, if there's a formulary change or the prior authorization wasn't completed, then our reimbursement team will follow up and ensure that that patient gets put back on drug. So those would be the main reasons why you would see a patient come off Zunvail.
To your question about opportunity and our base, from my perspective and the company's perspective, we have significant opportunity in long term care. If you look at just the highest volume Alzheimer patients across the country, split these out into homes. There's about 5,000 homes, right, that are your tier one targets that provide significant opportunity for Zunvail. And then of course there's about 3,000 top, top tier physicians. So right now, you know, we've got about 1,000 writing, you know, so not only do we need to increase the depth of those providers, but we also have significant more prescribers that we need to activate on Zunvail.
So from our perspective, tons of upside opportunity from a market opportunity.
UNKNOWN Analyst
Got it. And one last one, if I may, in terms of just the patients who are switching or are starting drug, do you find that you're getting more patients that are refractory to other drugs or more switchers that are actively looking for a drug? So sort of pulling from a non-drug user or a drug user? It's a minor.
Lauren D'Angelo (Chief Operating Officer)
Yeah. We're seeing about 50, 50. So if you look at the data, of course in long term care, you know, there's many, many patients who have already tried these drugs. You know, these drugs have been out for decades. There's nothing available to them. So they've been off drug for some time. So they look like a treatment naïve, but they've actually tried something previously likely. So we are actually, we're getting many, we'll call them treatment naïve, but patients who were not on drug.
But we're also seeing a significant amount of switches. So those patients who are either already still on it today, they're having tolerability issues, they're experiencing significant insomnia. Many of them already have behavioral issues. Those patients, that patient profile right there is probably our highest switch because that is obviously, you know, with Zunvail being core foundation and impacting all of those areas in a positive way, it's a pretty easy switch for a physician.
So I'd say about half of our business is coming from patients who have probably tried and failed. They're no longer on treatment right now, but, you know, the doctor is then adding Zunvail or they're being directly switched from a generic acetylcholinesterase inhibitor due to those issues that I described.
UNKNOWN Analyst
Got it. Very helpful. Thank you for taking our questions and congrats on the quarter.
OPERATOR (Operator)
There are no further questions at this time. I'd like to turn the floor back over to Michael McFadden for closing comments.
Michael McFadden, CEO
Thanks everybody for attending the call and those who are listening to the call. We're excited about the quarter. Feel like we had a strong quarter highlighted by our growth both in bottles, prescribers, adoption, our progress in payer and evidence generation, and the focus on high target opportunities for the company that we believe will continue the growth in quarters to come. Thank you for listening to the call. If you have interest in speaking with the company further, you can reach out to our IR on our website.
Thank you so much.
OPERATOR (Operator)
This concludes today's teleconference. You may disconnect your lines at this time. Please. Thank you for your participation.
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