Elizabeth Masson Hurlburt; Executive Vice President, Head of Clinical and Medical Affairs; CorMedix Inc
Good day and welcome to the CorMedix Inc third quarter, 2024 financial results conference call (Operator Instructions). I would now like to turn the conference over to Dan Ferry of lifestyle advisers. Please go ahead.
Thanks operator. Good morning and welcome to the CorMedix third quarter, 2024 earnings conference call leading the call today is Joe Tedisco, Chief Executive Officer of for CorMedix and he is joined by Dr Matt David, Executive Vice President and CFO Beth Zelma Kaufman VP and Chief Legal Officer, Liz Hurlbert, EVP and Chief Clinical Strategy and Operations Officer and Erin M EVP and Chief Commercial Officer.
Before we begin, I would like to remind everyone that during the call management may make what are known as forward-looking statements within the meeting set forth in the private Securities Litigation Reform Act of 1995.
These statements are statements other than statements of historical fact regarding management’s expectations, beliefs, goals and plans about the company’s prospects and future financial position action results may differ materially from the estimates and projections on which these statements are based due to a variety of important factors including the risks and uncertainties describing in greater detail in CORS filings with the SEC which are available free of charge at the SECs website or upon request from CORS Cosmetics may not actually achieve the goals or plans describing in these forward-looking statements and investors should not place undue reliance on these statements.
Cosmetics does not intend to update these forward-looking statements except as required by law at this time. It is now my pleasure to turn the call over to Joe Disco, Chief Executive Officer of CorMedix. Joe. Please go ahead.
Thanks Jim, good morning everyone and thank you for joining the call as we approach the end of our first calendar year of commercial launch of DefenCath.
I’m incredibly proud of the team’s efforts and pleased with the commercial results. Thus far, the third quarter marks the first full quarter of product shipment for FCAS as well as the first quarter of outpatient product utilization.
Our net revenue for the third quarter of $11.5 million exceeded street consensus and was largely driven by our initial anchor customer, Us Renal, which has done an exceptional job with the FCAS implementation within its clinics.
We recently announced new agreements with two midsized dialysis operators and one large scale operator which combined with our existing customers will provide patients access to FCAS and roughly 60% of dialysis clinics in the US.
We are currently working diligently with our new partners to operationalize those agreements and currently expect purchases to commence for all three before the end of the fourth quarter.
While we have not issued revenue guidance for the fourth quarter, based upon our current forecast, we do expect to be positive for the fourth quarter.
With respect to guidance, there was a wide potential variability for fourth quarter revenue driven by the timing and scale of purchases by our LDO customer as well as the scale of purchases by our newly announced midsize customers. DefenCath for the most part is being protocolized by the outpatient customers that adopt the product, meaning they are establishing criteria for patients in their system for which DefenCath is appropriate and then implementing protocols based on those criteria.
This requires a significant pre implementation effort with each customer to establish protocols, order sets and conduct training on an enterprise level. And in the case of our LDO, customer requires implementation on a much larger scale to allow a rollout at over 2000 clinics.
The upside of having our drug protocolized in this manner is that once a customer goes live, we expect the patient conversion ramp to move fairly quickly.
The downside is that set up can take anywhere from several weeks to a few months.
Currently, we are expecting our LDO customer to begin ordering in December but a couple of weeks’ movement in either direction from a customer of this scale would obviously have a material impact on our fourth quarter revenue for our new (inaudible) customers. We expect orders to begin in November with respect to our inpatient launch activities. We have made significant progress in terms of building DefenCath champions within hospitals and health systems and scheduling meetings with those institutions.
A large number of P&T meetings occurred in the third quarter and we are in the process of fielding questions and providing additional information required for a formal decision.
The P&T committee discussions require both a comprehensive review and collaboration across multiple stakeholders including political and financial within the health system.
To that extent, we expect the inpatient uptake process to be longer and the ramp to be more consistent with traditional inpatient launches. In comparison to the more rapid uptake we have seen on the outpatient side, we have started to see some utilization in a handful of hospitals that have completed P&T review early and added the FCAS to formulary and we’re optimistic to build on that progress in 2025 as we continue our field efforts with the FCA Advocates focusing now on our clinical developments. We announced in the second quarter that we received supportive feedback from FDA related to our proposed clinical pathway for adult total parental nutrition or TPM.
Since then, we have received FDA feedback and conducted extensive market research and clinical feasibility studies. And accordingly, we are refining the clinical protocol and anticipate, submitting it to FDA by mid-November to align with our plans to operationalize the study in the first half of 2025.
The company’s goal for TPN is to obtain FDA approval for an expanded use of our tool and heparin lock solution in the late 2027 to 2028 time frame. And we estimate annual peak sales potential in this syndication to be in the range of $150 million to $200 million.
We will provide investors with updates on progress as we move forward from a clinical budget standpoint, we anticipate the study to cost between 10 and $12 million with the majority of expense spanning the 2025 and 2026 calendar years.
During our previous earnings call, we also announced three additional clinical initiatives all expected to commence in the 2024 or early 2025 time frame.
The most meaningful of the three from a data value standpoint is our real world evidence study that we will run in cooperation with our study partner, us renal care.
Our hope with this study in which we expect to evaluate outcomes of roughly 2000 patients over 24 months at a cost of less than $1 million a year would be to generate real world evidence around the impact of DefenCath c utilization on cost of patient care, infection rates, hospitalization, mortality, and multiple other metrics such as lost chair time and antibiotic use.
Ultimately, we would intend to utilize this data in our post adaptive period to negotiate future sustainable reimbursement for Medicare Advantage plans and other value based care contracting entities.
Data collection for this study has already commenced simultaneously with our adult TPN and real world evidence studies. We will also be commencing a study in paediatric haemodialysis.
This will be a relatively small study spread over several years as we expect patient enrolment to be a challenge given an extremely small patient population and the need for very personalized protocols for these ultra vulnerable patients.
This paediatric study is a post marketing requirement under the paediatric Research Equity Act by the FDA and we have FDAS concurrence on the final study protocol.
We have plans to begin patient enrolment in early 2025 and we expect the study to cost between four and $6 million spread over five years.
Lastly. In addition to our other clinical initiatives, we plan to commence an expanded access program for high risk populations including but not limited to paediatric TPM, peritoneal dialysis patients with refractory peritonitis and neutropenic oncology patients utilizing a CDC.
These high risk patients are those that have exhausted other infection prevention methods and unfortunately remain at significant risk for comorbidities and mortality.
The cost for the expanded access program is expected to be less than $750,000 a year primarily in the form of free product and distribution costs and we expect to generate data that supports further label expansion and complements our adult TPM program.
Now I turn the call over to Matt to discuss the company’s third quarter financial results and financial position that.
Matthew David
Thanks Joe and good morning everyone. I am pleased to be here today to provide an overview of our third quarter, 2024 financial results. As well as an update on cosmetics’ cash positions.
The company has filed its quarterly report on form 10 Q for the quarter ended September 30, 2024. I urge you to read the information contained in the report for a more complete discussion of our financial results with result with respect to our third quarter of 2024 financial results. Our net revenue for the third quarter of 2024 amounted to $11.5 million as Joe indicated. This marks the first full quarter since DefenCath became commercially available. This past spring, our net loss was approximately $2.8 million or 5¢ per share compared with a loss of $9.7 million or 17¢ per share in the third quarter of 2023.
The smaller net loss recognized in 2024 compared with 2023 was driven by the gross profits associated with the net sales of the FCA operating expenses. In the third quarter of 2024 increased approximately 33% to $14.1 million compared with $10.5 million. In the third quarter of 2023.
The increase was driven by higher selling and marketing and G and a expenses offset by a decrease in R&D prometric is now reporting selling and marketing expense and general and administrative expense as separate line items on an apples to apples basis, selling and marketing expense increased 66% to 6.7 million in the third quarter of 2024. Compared with $4.1 million in the third quarter of 2023 G&A expense increased 76% to $6.6 million in the third quarter of 2024 versus $3.7 million in the third quarter of 2023.
The increase in selling and marketing expense was attributable primarily to increased marketing efforts and new personnel inclusive of our field sales organization and support for the commercial launch of the FCA.
The increase in G&A expense was primarily due to increases in personnel costs in preparation for support activities related to the commercial launch as well as certain expenses previously expensed as a component of R&D. Prior to FDA approval, R&D expense decreased by approximately 73% to $0.7 million. Driven by the approval of DefenCath as a result of the post FDA approval, commercial operations costs related to medical affairs and certain personnel expenses that supported R&D efforts. Prior to the FDA approval of defines CF have been recognized in selling and marketing or G & a expense.
In addition, a portion of the costs related to the manufacturing of the FCA previously recognized in R&D are now capitalized as a result of the FDA approval with respect to our nine month year-to-date 2024 financial results total net revenue during the nine month year-to-date of 2024 amounted to $12.3 million total operating expenses during nine month. Year-to-date of 2024 amounted to $45.5 million compared with $33.3 million in the first nine months of 2023 an increase of 37% R&D expense decreased 80% to $2.2 million. Driven primarily by the approval of the FCA selling and marketing expense increased approximately 106% to $20.5 million compared with the first nine months of 2023 and G&A expense increased approximately 83% to $22.9 million compared with the comparable period in 2023.
The increases in selling and marketing and G&A were driven primarily by new personnel and costs to support the commercial launch of the FCA.
We recorded net cash used in operations during the nine month year-to-date of 2024 of $45 million compared with net cash used in operations of $27.7 million in the same period in 2023.
The increase is primarily driven by an increase in trade receivables and inventories offset by a smaller net increase of accrued expenses and accounts payable.
The company has cash and cash equivalents of $46 million as of September 30th 2024.
While we expect to begin to see cash collection from our accounts receivable. In Q4, our cash position was supplemented in Quarter three with approximately $12.4 million in net proceeds from ATM issuant.
We believe our cash equivalents short term investments and projected future operating cash flow gives the company the ability to fund operations for at least 12 months.
Assuming we maintain our current trajectory of sales from existing outpatient accounts and the initial shipments to new accounts during Quarter four, we believe we can achieve positive EBITDA in the fourth quarter. I will now turn the call back to Joe for closing remarks.
Joseph Todisco
Thanks, Matt CorMedix is executing well on our launch of DefenCath and focused on growing the business with existing customers as well as expanding utilization of new ones.
We’re also actively working to expand the label for DefenCath beyond haemodialysis and beginning to scout for commercial stage business development opportunities to expand our product portfolio beyond DefenCath.
I appreciate everyone’s continued support CorMedix and I’m happy to take questions.
Operator
We will now begin the question and answer session to ask a question. (Operator Instructions).
Our first question comes from Jason Butler with Samson J MP. Please go ahead.
Hi Thanks for Taking the questions and congrats on the quarter. I guess just a couple for me. Can you speak to, you know, the use that you’re seeing today to what extent is being driven by, you know, individual doctors or centres decision to use the product versus the, the overall institution already implementing sops.
Second question, you, you’ve laid out reimbursement dynamics before for the outpatient setting and including the split between Medicare fee for service and Medicare advantage. How do those broader population dynamics compare to what you are actually seeing during the launch?
And then just lastly for me, can you speak to what you think about the, the trend for expenses operating expenses in Quarter four? Thanks.
Joseph Todisco
Okay. All right, thanks, Jason. I appreciate the question. So, what, what I think we have seen most or entirely with the initial rollout has been a protocolization of the product, meaning it is more of a top-down driven approach in the outpatient setting. I do not, we do not see as much of this being driven on a patient by patient or doctor specific basis, right. So, the centres are putting protocols in place. They’re setting, they’re establishing criteria within their systems for whom DefenCath is appropriate and then they are implementing based on that criteria and as I mentioned in the script specifically with respect to, you know, our, LDO customer, which we expect to follow the same pattern, right? The downside is that set up takes a couple of extra weeks leading in. But the upside is we expect patient conversion to move fairly quickly, right?
We expect to see a similar type of ramp to what we saw with our initial rollout with (inaudible). So overall we view that as a as a positive. Now, your question on reimbursement, I just want to make sure I understand you were asking about what we are actually seeing in claims. Is that.
Exactly are you seeing that, that that roughly similar balance between fee for service and the Met advantage?
Joseph Todisco
Yeah. Well, the claims data lags. So, what we have seen with our initial customer roll out, I think is patients or, the facilities rather and fee for service patients first, right? And then expanding use into other payers. So, we are seeing claims that are being filed with Medicare Advantage with commercial with Medicaid. So, we are seeing I would say a broad dispersion of claims. I would say overall though, in terms of you just look at the aggregate number of patients that are, that are getting DefenCath. It is, it is, I believe it is starting in the fee for service patients first and then expanding outward.
And your third question, Jason, I apologize was just, how should we think about expenses? (multiple speakers)
Look for, the fourth quarter, I think, you know, we have guided to the year that 15 to 18 by quarter, we have been on the low end of that range. We are below the range for this quarter. You know, I think we will be somewhere in the 15 to 17 range for the fourth quarter is what I would expect.
Matt is that I just want to verify that with Matt. That’s.
Matthew David
Yeah, I think that is probably a fair job. We said that people were going to be, you know, begin to see things start up tick related to R&D, but it’s, really the 2025, 2026.
Joseph Todisco
Yeah, that’s a Quarter one.
Operator
The next question comes from Gregory Renza with RBC capital. Please go ahead.
Gregory Renza
Thanks. Good morning, Joe, and team. Congratulations on the progress and thanks for taking my questions. Yes, great, great to see the setup for the long-term Joe. And of course, as there is always interest in the fourth quarter and nearer term, we certainly appreciate all the uncertainties and the drivers, but just on the pushes and polls. Can you just remind us of just a few items when it comes to the stocking of DefenCath facilities, the holding time, and the order frequency, just how to think about that. And maybe on another topic related just when we think about the fourth quarter, how would we anticipate maybe some of the climate, the hurricanes or given? You are certainly southeast based focus for sure, with facilities, just any drivers on sort of the macro as it affects, getting gas to facilities to patients.
Joseph Todisco
No, thanks Greg. That is a good question. So, you know, for the, for the initial customer, that we have rolled out, we have been shipping direct to clinic and, to that extent, we are not seeing a lot of stocking. I think the estimates we are getting, maybe they are holding about 10 days on hand. You know, as we onboard our LDO customer, we do think there will be some stocking that they may hold 15 days to 30 days of inventory on hand. So, it will be a little bit more of a call, maybe a traditional turnover of inventory. You know, for the fourth quarter, we, did see a little bit of impact our initial customers. And one of the new MDO customers that, are deployed through the Southeast have a lot of clinics down there. So, we saw a little bit of disruption over the first, you know, week of the month but largely back, the trend we are seeing is largely back to, what we had when we exited Quarter three. So we’re focused now on onboarding new customers and trying to build, you know, build out as well.
Gregory Renza
That’s helpful and maybe just on the manufacturing and API can just remind us of what you’re doing just to ensure you’ve got, you know, the, the sufficient quantities for future demand. Thanks again and congrats.
Joseph Todisco
Well, first, I, I’d say that we have a, we have more than sufficient finished dose inventory on hand today to take us through a decent part of next year. So, from finished dosage in inventory standpoint, I think we are, we are in a really good position. We have also stockpiled a large amount of, of both of our, our key active ingredients and we are, we are I intend to purchase more in 2025 kind of to shore that up. We have two finished dosage manufacturers as well. We have, we have Rovi in Spain, and we have six regions, Germany.
Operator
The next question comes from Brandon folks with Rodman Renshaw. Please go ahead, friends and your line may be muted.
Hello. Can you hear me?
Joseph Todisco
Can you hear me?
Let me start again, apologies about that. Well, congrats on the quarter, first and foremost and thanks for taking my questions. Just two questions from me. Firstly, just in terms of patient types that the different providers have, the midsized operators identified the patient types that were initially used in CF with how much consistency are you seeing across the providers in terms of where they’re expecting to use DefenCath?
And perhaps the other side of that, if you are seeing any variability, does that provide an opportunity to perhaps sort of cross so educate providers on where other providers are using DefenCath?
Joseph Todisco
Thanks Brandon. So, look, I think, you know, we have talked about this over the last couple of quarters that some customers are triaging their patients based on the benefits verification. Others are looking at it on a on a high-risk basis kind of first. And, and I think that that is, you know, certainly how they are doing it in the, in their respective institutions. So, I do not know that there’s consistency across all customers uniformly, but I think your question about opportunity is that yes, it is absolutely an opportunity for growth, right? Beyond whichever initial kind of triage criteria, the customers have used. And we are certainly already in discussions with some of our customers that have identified patients that are high risk as to what is the next cohort? And, and how much more broadly can we implement beyond high risk?
Great, thanks. And then secondly, from me, gross margin in the quarter looked extremely strong. How should we think about gross margin going forward given this was your first full quarter of DefenCath in the market. And then especially with, as you bring on these sort of larger contracts, just, you know, even if it’s just directionally, how do we think about gross margin from here?
Joseph Todisco
Look, I think gross margins are going to remain high. I mean, the initial gross margins, you are seeing a lot of that inventory was, was expensive R&D. These batches were manufactured prior to some of them prior to getting approval. But that said the cost of goods sold currently relative to the to the net selling price. It is, a healthy gross margin that, that we would expect, you know, through 2025.
Great. Thanks for taking my questions and congrats on all the progress.
Joseph Todisco
Thank you.
Operator
The next question comes from Les Suski with Truest Securities. Please go ahead.
Good morning, guys. Thank you for taking my questions and congrats on the progress. Just to look at Quarter three, any sort of metrics you can provide whether it was a patient count or vial usage. And then second out of the 60% access to dialysis centres that you have provided. Do you have a sense of what percentage of that is utilized with the ted calf? And then how do you capture the rest of those patients within that pool? And then the second part to that question is, what is the strategy to capture the other 40% operators to get them on board and how concentrated is that share, and I have a follow up. Thank you.
Joseph Todisco
Okay, thanks. So, I mean, last, in terms, of third quarter metrics, I think we have put out currently what we are comfortable putting out. You know, we can certainly revisit that as we move forward and whether we want to put out any patient numbers or, potentially unit information. But right now, I think we are just comfortable putting out our you know, our sales data.
So in terms of 60% access, right, that is measured based on the number of the total number of clinics where DefenCath could potentially be available, right? Relative to the total number of clinics in the US. Now, as you know, first, you know, DefenCath is indicated for patients with CDCs which are about 20% of dialysis patients overall. And, and what we are seeing varies by customers. Some customers, as I said, that are already implementing more broadly, it is probably a much higher percentage of their, of their overall catheterized population. The initial LDO customer which we have talked about in the past, looking to roll out with 4,000 patients would be about 10% of their catheterized population. And certainly, we are working with them to grow beyond just that initial cohort. So, that’s there is, so there is a decent amount of I think upside opportunity potential as we move into 2025 across, all customers.
Now you asked about the, the remaining 40% obviously that most of that is concentrated with, one other LDO, we’ve been engaged with them over the past year and a half. They took a wait and see approach at the launch. We are in the process of re-engaging with them. Now, generating some additional data that they, we think that they will find compelling and, hopefully, we can make some progress with them in the fourth quarter or into early next year. If not, I think we are, very comfortable. We have got a really good trajectory with the four of the top five dialysis providers in the US.
Got it very helpful. Second portion to this, I guess is you can make, when can we expect some sort of a meaningful contribution from the inpatient side? And then you had a (inaudible) agreement is, is there is that has been triggered, I believe based on your 10 Q, what is the amount and when that will be paid out? Thank you.
Joseph Todisco
All right, thanks. So I’ll, I’ll start with the, with the inpatient and I’ll, I’ll kick the ND partners over to Matt.
Look.
So, so in patient, if you look at the size of the opportunity right now, outpatient is about 90% of our of our volume opportunity and certainly it’s got a much deeper ramp in terms of the ability to convert patients more quickly. So, that is certainly what is going to driving and we are going to drive you know, our material revenue. Certainly in the short term, well, when we think about inpatient contribution, we look at it much more as a long term potential revenue contributor, we see a lot of value in that segment as we’ve talked about over the last two years, we see potentially better price durability there, but, it’s going to take a longer time to build share and penetration there. It is just the nature of the inpatient market. So, I have a long-term view there. I think we are very happy with the trajectory we have seen for sale on the outpatient side and then we are going to continue to plug away on the inpatient side. You know, building relationships and making progress.
Matt. Do you want to comment on (inaudible)?
Matthew David
Yeah, sure, no problem. I will just mention real briefly, you know, earlier this year this year, the company determined it was probable that the net sales milestones related to this would be achieved. And so, as a result, we recorded a license intangible asset which is included in accrued expenses in the consolidated balance sheet. The milestones were met during the three-month period ended September 30th, 2024. So, this is something that you should probably see. We would expect over the coming year to be paid.
Got it. Thank you, guys.
Operator
The next question comes from serge the launcher with Needham and Co company. Please go ahead.
Hi, good morning and congrats on the quarter. A couple of questions around your anchor customer, US Renal Care. I guess the first one, just what percentage of Quarter three sales that they represent? And then secondly, it sounds like it has been a solid partnership so far. They’ve had, they’ve had a successful (inaudible) process, just curious if this customer operates differently and whether you can replicate this partnership with some of the other partners that you’ve enlisted over the third quarter.
Joseph Todisco
Thanks.
Alright, thanks, Serge. So, yes, I think, and we put there might be some numbers in the queue around concentration of receivables. But yes, the US Renal accounted for an incredibly large percentage of, of third quarter sales more than 90%.
And I think in terms of trying to, to replicate, you know, how well a job they have done with implementation. Yes, that is certainly something that we are you know, trying to duplicate with, other customers, you know, particularly you know, our LDO customers. So, you know, we’re, hopeful for that and you know, we’re just going to keep executing over the next couple of months.
Maybe one follows up to that currently reimbursed at, the (inaudible). I think it is going to transition to ASP sometime in the early part of 2025. Just curious what that transition will look like and whether it could impact ordering patterns.
Joseph Todisco
I do not think it is expected to impact ordering patterns. So, this is something that is anticipated, and we have structured our agreements around the transition from WACC to ASP and, and we don’t expect ASP to erode that drastically initially. Right. So, yes, this is, this is somewhat, of a known commodity. I think government will publish ASP at some point in late November or early December. I understand for, Quarter one and, I don’t think it’s going to be something that’s problematic.
Thanks for taking my questions.
Operator
This concludes the audio portion of the Q&A session. I will now turn it over to Dan Ferry for written questions from the audience.
Dan Ferry
Thank you operator. So, Joe, we have some written questions from the audience. The first one is why isn’t the company providing guidance? Do you have a sense when it may be possible to provide guidance for investors and analysts alike?
Joseph Todisco
Okay. Thanks then. So, look, I think I kind of touched on it in the script a little bit. You know, we have got so much variability around the timing of on boarding our, LDO customer and think about a customer of that scale and, if they, you know, begin purchasing December 1 versus December 15 versus November 15. There is a lot of variation there in what it could do for fourth quarter numbers. So, we did not feel comfortable putting out a range at this point in time as we move through the quarter. We can certainly, you know, reevaluate that decision and see and see what we are, you know, once we, have orders and see, you know, repetition, you know, what, what we are comfortable putting out there. But right now, I think, you know, we are, comfortable guiding that. We do expect to be positive, which is I think an incredible accomplishment in the first, you know, 6 to 9 months of a, product launch (inaudible).
Dan Ferry
All right, thanks Joe. Another one here. Could you expand a bit on TPN? What is the FDA feedback been to date and what drove the company to make protocol amendments?
Joseph Todisco
Yeah, I am going to turn that over to Liz in a moment. But you know, we are, excited about the TPN opportunity. You know, we put our protocol into, FDA. They provided some comments, I think essentially around the, the statistics and the calculations, but nothing really that is going to change, you know, our timelines or cost of the study. So, Liz, you want to go ahead?
Elizabeth Masson Hurlburt
Sure, thanks Joe. So, e exactly, we received pretty minor feedback, wholly statistical in nature on the TPN protocol. And we have absorbed that and integrated it into a new protocol amendment that is forthcoming. There is always really a fine line in protocol development, right? The need to address the critical unmet need of the patient population with a study that is designed to provide rigor and high clinical value and one that can be translated post approval and integrated into clinical practice in a meaningful way. So, I think I am confident now we have a deeply experienced clinical regulatory and biostats team in place to meet those needs. And we will be resubmitting that protocol amendment in the next couple of weeks.
Dan Ferry
Okay, great.
Thanks. Another one here, Joe. Can you share any feedback from the nephrology community regarding product use and practice since launch?
And has there been anything in there that surprised you?
Joseph Todisco
I do not know if there’s anything that I’ve, I’ve found surprising. Obviously, I think some of the good things about that utilizing DefenCath, right? There is no change to the workflow. The clinical results are really, really easy to understand, but I think overall the feedback that we get is positive and continues to be overall positive. But I will, you know, Aaron and Liz are in the field on a day-to-day basis. So, I mean, if they want to add some comments.
Erin Mistry
Yeah, I can, add from there.
Yeah, thanks. Thanks Joe. I think for the, from an implementation standpoint, we have seen very positive feedback from nurses, physicians, and patient advocates. On the, on the inpatient side, the coordination and complexity involves are obviously complex and takes time. But we have seen a crucial role being played by infectious disease in the infection prevention as well as quality community and guiding those processes across the inpatient setting.
Liz. Do you have anything else you want to add to that?
Elizabeth Masson Hurlburt
No, I think you, really covered it. I mean, I think we are just continually surprised to learn that despite all of these infection prevention efforts that are out there from a number of groups and a number of initiatives that CRBSIS are continuing to happen. And there is still a great need to educate and raise awareness around them and prevention around them. So, I think we have a plan for that. The team is actively addressing it and I think we have really solid stewards in our clinician community and nursing communities that have adopted DefenCath and are really working with us to further that awareness within institutions.
Operator
Too.
Dan Ferry
Excellent. Yes. Thanks Liz. Thanks Aaron, Joe one final one here.
Can you give some thoughts on how CorMedix is thinking about financing going forward?
Joseph Todisco
Okay. Yes. And I, I think, you know, we didn’t touch on in the script, we’ve talked about it in past earnings calls, you know, over the last quarter, you know, with the, higher volume and the appreciation of the stock, it made sense to use the AP ma little bit and we did that and we may continue to do that in a, in a limited basis. But with the trajectory that we, see for the business, obviously, I do not think we need to do, you know any type of raise from an operational cash flow standpoint, right? To fund the business, you know, the reasons why we and we may want to consider something in the future where we, are getting a lot of inbound interest from, large institutional investors, right? Long, only investors, the type of people that we may want in the stock that they cannot currently find liquidity on the market. You know, we also may want, you know, start looking at, building up a little bit of dry powder for business development, but , we don’t have anything I say, you know, imminently planned, but those would be the, you know, the reasons why we might want to consider something, you know, down the road.
Dan Ferry
Okay, great.
Thanks Joe. Operator may now close the call.
Operator
This concludes our question-and-answer session and the conference is now concluded. Thank you for attending today’s presentation. You may now disconnect.
