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Vertex Pharmaceuticals Incorporated (VRTX)

Q2 2015 Earnings Call· Thu, Jul 30, 2015

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Transcript

Michael Partridge - Vice President-Investor Relations

Management

Good evening, everyone. This is Michael Partridge, Head of Investor Relations for Vertex Pharmaceuticals. Welcome to our Second Quarter 2015 Financial Results Conference Call. At this time, all participants are in a listen-only mode. Later, we will open the line for questions. As a reminder, this conference call is being recorded and a replay will be available following the conclusion of tonight's call on our website. Earlier in July, we announced the approval of ORKAMBI and many of you joined for that call. Tonight, we will be focused on second quarter performance and our execution against our corporate strategy. Joining me on tonight's call are Dr. Jeff Leiden, Chairman and CEO; Stuart Arbuckle, Chief Commercial Officer; and Ian Smith, Chief Financial Officer. Jeff Chodakewitz, our Chief Medical Officer is travelling and is not with us tonight. Our agenda tonight is as follows. Jeff will begin by discussing key priorities for our business. Stuart will review the second quarter performance of KALYDECO and make a few comments on the ORKAMBI launch. And to close, Ian will review the second quarter 2015 financial results and update our 2015 guidance. You can access the webcast slides by going to the Events section of the Investor Relations page on our website. I will remind you that we will make forward-looking statements on this conference call. These statements are subject to the risks and uncertainties discussed in detail in today's press release and our 10-K, which has been (1:32) without limitation, those regarding the ongoing development and potential commercialization of ORKAMBI, those about Vertex's other cystic fibrosis programs, and Vertex's future financial performance are based on management's current assumptions. Actual outcomes and events could differ materially. Information regarding our use of GAAP and non-GAAP financial measures and a reconciliation of GAAP to non-GAAP is available…

Operator

Operator

Our first question is from Michael Yee with RBC Capital Markets. Your line is open.

Michael J. Yee - RBC Capital Markets LLC

Analyst · RBC Capital Markets. Your line is open

Hey, great. Thank you. Congrats on the progress. A question for Stuart and then a question for Ian. I guess, Stuart, appreciate the comments on the launch. Maybe if you could just comment more specifically on reimbursement and the process for reimbursement that you're seeing. Are payers quickly getting people on drug? Maybe walk us through that process, and how long it takes to get people on drug, what you're seeing out there? And then for Ian, I know you maintained the guidance for expenses, it's fantastic. I know people are thinking bigger picture as you transform into a very profitable company. Maybe you can comment about how R&D expenses – how you're thinking about that, given you now have an ENaC inhibitor, all these Phase 3s, how you're thinking about controlling some of that, or making sure you're going to be very profitable? Thanks. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Hi, Mike. It's Stuart. Thanks for the question. So in terms of the process for reimbursement, essentially payers fall into a couple of different camps. Some come to making formal decisions very quickly, and we've seen some of those. Most have a process where they're going to have kind of the equivalent of a P&T Committee and review the product. And those will often then put in sort of interim policies, as it were, where they'll evaluate, on a case-by-case basis, whether a patient can be initiated on ORKAMBI. And so as a result of those interim policies and some initial policy decisions, that's why we have already seen patients start on ORKAMBI in the first few weeks following launch, and then over the next few months, more and more payers will come to their final determinations on their coverage policies for ORKAMBI. As…

Michael J. Yee - RBC Capital Markets LLC

Analyst · RBC Capital Markets. Your line is open

Perfect. Thank you very much.

Operator

Operator

Thank you. And our next question is from Geoff Meacham with Barclays. Your line is open.

Geoffrey Meacham - Barclays Capital, Inc.

Analyst · Barclays. Your line is open

Hey, guys. Thanks for taking the question, and good quarter. Couple more clinical questions, I'm hoping somebody there can answer it, but I noticed in the press release today, one of the endpoints for the younger population in Europe, the six-year-old to 11-year-old, was absolute change in lung clearance, and I wasn't sure if you guys were sort of rethinking some of the endpoints overall for development, beyond FEV1? Or is this just a special case, just given the age of the population? I have a couple other pipeline questions as follow-up. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Hey, Geoff. This is Jeff Leiden. Jeff Chodakewitz is travelling today, so he's not here, so I'm going to take the R&D questions. And thanks for asking that question. We've been talking for some time, both with Wall Street and with regulators, about the notion that we are eager to explore additional endpoints to FEV1, particularly for younger populations where it's more difficult to consistently blow a good FEV1 if you're two-years-old or three-years-old. And as part of that, we've explored three or four different endpoints, including lung clearance index. And this was a very nice opportunity, in talking with European regulators about this younger population, to begin to use lung clearance index, which is much less effort-dependent and much more consistent, particularly in young patients, as an efficacy endpoint. So it'll be interesting to see the result on this study which we think will be highly predictive using this endpoint. And we also plan to use those kinds of results to begin to discuss with other regulators, whether these other endpoints might be useful, particularly in the very young patients.

Geoffrey Meacham - Barclays Capital, Inc.

Analyst · Barclays. Your line is open

Okay. That's helpful, Jeff. And another question just on the ENaC inhibitor, does this change the priorities for you guys for your next-gen corrector? Or is this – would you view this as kind of complementary to what you already have? And then are we still on track to identify the third corrector, I guess, by year-end or early part of next year? Thanks. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Let me – maybe I'll take those in a reverse order, Geoff. So yes, we're absolutely on track to identify the third corrector. And just remind you, I know you know this that our strategy here has been to bring multiple next-gen correctors into the clinic. And our goal is the first one by the end of this year with a several others following directly behind it, and that's progressing nicely and we are on track. With respect to the ENaC inhibitors, yeah, we do view them very much as complimentary. And they could be complimentary in a couple of ways, right, because they fall outside of the classic CFTR correction. They may have activity as monotherapy, particularly in populations like het-mins that don't have anything and frankly in other lung diseases as well. But we're particularly eager to study them on top of our current regimens like ORKAMBI because they may amplify the signal that we're seeing here. So I wouldn't view them as one or the other, I would definitely view them as complimentary. And I guess, your question is sort of getting at do they in anyway slowdown or deprioritize our next-gen correctors? And the answer is, no, we're full speed ahead on next-gen correctors.

Geoffrey Meacham - Barclays Capital, Inc.

Analyst · Barclays. Your line is open

Okay, great. Really helpful. Thanks.

Operator

Operator

Our next question is from Matt Roden with UBS. Your line is open.

Matthew M. Roden - UBS Securities LLC

Analyst · UBS. Your line is open

Great. Thanks very much for taking the question. First, Stuart, I wonder if you could elaborate on some launch metrics that you're seeing. I know it's early days here, but is there any sense for the sort of numbers of centers prescribing or any other early indicators from maybe a time from prescription to fill, any other metrics that you can share so we can get a sense of what's happening out there? And then, I think this might be for Ian, if you could help us square the sales and the increase in guidance against your prior comments regarding the impact of enrollment of VX-661 trials on KALYDECO use. Do you have a same-store sales metric that enables you to see that that impact is happening but that the geographic expansion and label expansion is compensating for that, or is it just that it's actually not happening to the extent that you previously got, that is the impact of VX-661 trials? Thanks very much. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Matt, hi. It's Stuart here. Just in terms of launch metrics, I mean, we're less than four weeks in since the approval. So I'm really not going to comment on specific launch metrics and how predictive those are, the kind of the trajectory that we're seeing overall. As we said before, because of the interest in the product, the unmet need and the fact that it treats the underlying cause, we're certainly expecting the overall penetration of ORKAMBI in the eligible patient population to be high. And we've said it all along that we do think though it will take longer for ORKAMBI to reach peak penetration compared to KALYDECO for a number of factors that we've gone into previously like the volume of…

Matthew M. Roden - UBS Securities LLC

Analyst · UBS. Your line is open

Okay, great. Thanks for taking the question.

Operator

Operator

Thank you. Our next question is from Geoffrey Porges with Bernstein. Your line is open. Geoffrey Craig Porges - Sanford C. Bernstein & Co. LLC: Thanks very much and congratulations on the progress and the good numbers. A question first related to the extension study for the patients that were on ORKAMBI coming into the approval. Could you give us a sense of, first, how many of the patients who were eligible were actually enrolled and stayed on treatment and then what number of them have rolled over to commercial drug? And then, I just wanted a quick follow-up on VX-371. Jeff, perhaps you could address why do the study with ORKAMBI rather than with VX-661? Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: So Geoff, it's Stuart here. In terms of the number of patients who rolled over from TRAFFIC and TRANSPORT into the extension study, that number was very high, it was north of 90%. And Jeff Chodakewitz, if he were here, would have the exact numbers, but it was north of 90% of patients rolled over from TRAFFIC and TRANSPORT into the open-label extension. About half of those were in the United States and the process of informing those centers and those patients, the commercial product is now available and beginning to roll those patients over to commercial product is just beginning. But it's about 500 or so of the 1,000 who rolled over into the 105 study, were here in the United States. And on the VX-371, I'll pitch back to Jeff Leiden. Geoffrey Craig Porges - Sanford C. Bernstein & Co. LLC: Great. Thanks. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Yeah, Geoff. In terms of VX-371 and why we're going with ORKAMBI, it's really a matter of how do we get the medicine potentially to patients the fastest. So since ORKAMBI has already approved, simply adding one unapproved drug and getting the result will let us – assuming that we have success, will let us get that new drug, VX-371, to patients the quickest then. And our goal all along has been improving therapy as quickly as we could. Geoffrey Craig Porges - Sanford C. Bernstein & Co. LLC: Okay. Thanks very much.

Operator

Operator

Thank you. Our next question is from Terence Flynn with Goldman Sachs. Your line is open. Terence C. Flynn - Goldman Sachs & Co.: Hi. Thanks for taking the question. Maybe just two for me. Can you just remind us about the anticipated timing of the Medicaid coverage for ORKAMBI? And then, regarding the VX-661 KALYDECO trial on het-min, now that you started that trial, can you just maybe remind us of expectations for when that interim analysis might occur? Thank you. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Yeah. Terence, it's Stuart here. In terms of the Medicaid coverage, there really isn't one answer, there's really 50 answers because obviously Medicaid managed state-by-state. So I really can't give you one answer to the Medicaid question. What I can share is that we've already seen patients initiated on therapy in the first four weeks. And within that number of the patients, we have patients who have commercial insurance as their primary insurance, we also have patients who have government insurance in the number of the people who've already been initiated. But to give one specific number for Medicaid is just impractical because there's really 50 answers to that particular question. And for the second part of the second, I'll hand it over to Jeff. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Yeah. In terms of the het-min trial, just to remind you, Terence, we actually just announced that that trial is open for enrollment. So it's essentially starting now, if you want to think about it that way. And to remind you the design of that trial, it actually has two parts. We enrolled around a 150 patients plus or minus, we then have a DSMB that will do a futility analysis. We…

Operator

Operator

Thank you. Our next question is from Cory Kasimov with JPMorgan Chase. Your line is open. Cory W. Kasimov - JPMorgan Chase & Co.: Hey, guys. Thanks for taking the questions. I guess, just to follow-up on that, just based on your early discussions with payers on ORKAMBI, is there any change to your expectations for gross-to-net? Or maybe in other way has reaction to the price been about what you expected when you announced it earlier this month? And then secondly on the new ENaC product you have, does the ongoing Phase 2 trial in patients with any CFTR mutation include heterozygous patients? Thanks. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: So Cory, on the reaction to the price, I would say, has been very balanced. Indeed, the focus of our discussions has really been less around the price and more around the clinical profile of ORKAMBI. And in terms of whether it changes our view on the gross-to-net, it really doesn't. The gross-to-net is almost exclusively driven by the payer mix. And as we explained previously, we are expecting the Medicaid payer mix to be a higher percentage for ORKAMBI than it was for KALYDECO. And it's likely to be in around that sort of 35% to 40% of eligible patients we predict will be covered by Medicaid. The vast majority of the rest will be covered by commercial insurance. But our view on that gross-to-net hasn't been changed by anything we've seen in the first four weeks. Cory W. Kasimov - JPMorgan Chase & Co.: Okay, great. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: And then in terms of the ENaC trial, just to remind you, there actually we're planning two trials, the first one's already underway. And that trial is basically monotherapy in any mutation. I assume, you're referring to het-mins and so the answer is, yes, het-mins would be there. Cory W. Kasimov - JPMorgan Chase & Co.: Yeah. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: With the obvious exception that KALYDECO-treated patients and, now going forward, ORKAMBI-treated patients, wouldn't be included in that study. The second study is going to be the ENaC inhibitor on top of ORKAMBI in patients who are treated with ORKAMBI. Cory W. Kasimov - JPMorgan Chase & Co.: Okay. Perfect. Thank you.

Operator

Operator

Our next question is from Ying Huang with Bank of America Merrill Lynch. Your line is open.

Ying Huang - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch. Your line is open

Thanks for taking my questions as well. First one maybe for Stu. It was reported that Harvard Pilgrim in Boston is actually discussing with you guys about pricing scheme based on pulmonary function in patients taking ORKAMBI. I was wondering if that's a single isolated case, or have you seen that among the other payers or not? And then secondly, on the R&D front, I noticed that in the press release you guys are adding one arm in the Phase 3 trial for VX-661 for patients who have one allele of F508 and the other allele with residual CFTR function. You're adding one monotherapy KALYDECO arm. Is that due to request from FDA or – and also, are you going add monotherapy arm in the other Phase 3 trials or not, in VX-661 trial? Thanks. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Yeah, Ying, so I'm really not comment on what discussions that we're having with individual payers and plans. I'll say what we've said all along. Our belief is that all eligible patients deserve to have access to ORKAMBI, and for it to be a decision for the physician and patient, whether they want to initiate those patients on ORKAMBI. And on the VX-661 program, I'll hand that off to Jeff. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Yeah, just to be clear, the design of the VX-661 program has not changed, we haven't added any new arms. The residual function arm always had in it, both the placebo and ivacaftor monotherapy compared with VX-661 plus ivacaftor. So nothing has changed there.

Ying Huang - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch. Your line is open

Okay. Thanks.

Operator

Operator

Our next question is from Matthew Harrison with Morgan Stanley. Your line is open. Matthew K. Harrison - Morgan Stanley & Co. LLC: Great. Thanks for taking the question. So I just wanted to go back to the ENaC, just for a second. I think you talked a little bit about the rationale, but maybe if you could expand upon the rationale for combining with ORKAMBI? And then secondly, what specifically might you hope to see? Should we be looking for increased lung function? Should we be looking for a lowering of the exacerbation rate? I mean, what would you be hoping to see with that combination? And then separately, just on KALYDECO, I just want to make sure I understood your comments correctly, are you saying that all of the growth came from increased penetration across the new gating mutations? Thanks. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: So maybe I'll take the R&D question first, the ENaC inhibitors. Ian described this in terms of the ocean and seaweed, but I can't be nearly that eloquent. So I'll take it from a more scientific standpoint, maybe. The way we think about ENaC, and the way the ENaC inhibitors work, as you know, is that ENaC is a separate channel; it's a sodium channel that is also involved in hydrating the secretions in the mucus in the lung. And so, you could think about it as – and is actually even an interaction with CFTR. So CFTR is a chloride channel that helps hydrate the mucus; ENaC the sodium channel, it helps hydrate the mucus. And so the rationale, based upon preclinical studies, is that if you combine an ENaC inhibitor with a potentiator, for example, or corrector potentiator, you'll get even better hydration of the mucus,…

Operator

Operator

Our next question is from Mark Schoenebaum with Evercore ISI. Your line open.

Odysseas D. Kostas - Evercore ISI Institutional Equities

Analyst · Evercore ISI. Your line open

Hello, hi. This is Odysseas sitting in for Mark. Congratulations, and thanks for taking my questions. But just a few questions, one around the het-min trial, wondering about potential disclosure, or lack of disclosure, at the interim if it doesn't hit and there – an expansion is required for an additional 150 patients? The second question had to do with this lung clearance index. I'm just wondering whether Vertex is previously used at endpoint any of these trials that have any data from of any these drugs? And if so or if not in terms of thinking about how Vertex thought about the powering and design of the study based on that? And then the last question in terms of the next-generation corrector and one coming by year-end, but as I understand, there'll be additional probably next-generation correctors – next-generation potentiators, but next-generation correctors that may follow. Just wondering if Vertex is perhaps eyeing or if Vertex could quantify how many of those they're maybe eyeing to bring to the clinic in 2016? Thank you. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Sure. This is Jeff. Let me take the last two questions and I'll turn it over to Ian on the disclosure question. Starting with the next-gen program, we've said previously that we have multiple next-gen correctors in lead optimization, which as you know is sort of the study of the drug-like properties and tox (34:20) data from those molecules. And as I said, we're on track to bring the first of those into the clinic this year, and our goal is to bring at least two or three additional behind that following completion of lead optimization for those additional molecules and to compare several different next-generation correctors. And then your question about lung clearance index, yeah, lung clearance index is actually a fairly widely used measure of the ability to empty the lungs or the air effectively. And there is data from a number of studies showing, for instance, that when G551D patients were treated with KALYDECO, there's a significant improvement in lung clearance index and we're happy to send you some of those studies. So it is an end point that's pharmacologically validated, if you want to think about it that way.

Odysseas D. Kostas - Evercore ISI Institutional Equities

Analyst · Evercore ISI. Your line open

Thanks. Ian F. Smith - Executive Vice President & Chief Financial Officer: And, Odysseas, thanks for the question. Just to refer to an earlier comment Jeff Leiden made, which was the initial thought – the initial cohort of patients that enters the het-min study with VX-661. And the idea of that is there is a futility assessment. That futility assessment, if an independent advisory board deems that it is worth progressing forward, we will just continue to recruit patients and the study will be ongoing. We will not be at a disclosure point to that point, we'll just continue to recruit into the study and wait for the complete and final results of that study. If the board deems that it is futile, effectively futile in dosing those patients, they will advise us so and we will curtail the study on stopping that study and working the patients off-drug. We will provide a disclosure to let you know that that study is no longer going forward. So I think the way to think about this is if there is no news, it is because the study will progress and they will continue to recruit het-min patients. And if there is an early closure of that study, we'll advise you at that point in time.

Odysseas D. Kostas - Evercore ISI Institutional Equities

Analyst · Evercore ISI. Your line open

Thanks. Just to clarify, so there won't be, let's say, an increase in the number of patients on ClinicalTrials.gov or anything of that sort? Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: No, there won't be any disclosures, no.

Odysseas D. Kostas - Evercore ISI Institutional Equities

Analyst · Evercore ISI. Your line open

Thank you very much for all the questions.

Operator

Operator

Our next question is from Robyn Karnauskas with Deutsche Bank. Your line is open.

Robyn Karnauskas - Deutsche Bank Securities, Inc.

Analyst · Deutsche Bank. Your line is open

Hello. Hi, guys. Thank you for taking my questions. Can you hear me okay because I'm kind of in a noisy area outside. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: We can hear you. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Very clearly, Robyn.

Robyn Karnauskas - Deutsche Bank Securities, Inc.

Analyst · Deutsche Bank. Your line is open

Great. All right. Excellent. There are two questions, one for Stuart and one for Ian. So you guys have talked a lot about in CF centers there could be a backlog with the processing within the CF centers and there may not be a lot to do about that. Can you just talk a little bit about what you're seeing or any design to (37:06) help that process as patients move through, and if it's better or in line with your expectations? And then for Ian a lot of your competitors or comps are diversifying and you still are really a CF company and what are your thoughts on importance of diversification over the next year? Thanks. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Robyn, hi, it's Stuart here. So yeah, I think, whilst its early days, I think our experience in the first four weeks is the sort of factors that we were anticipating, are really playing out as we anticipate if they would. And those factors, just to remind you is, the volume of patients is obviously much greater than it was, when KALYDECO was initially approved, just the G551D patients. So there's a volume of patient that centers need to get in. Then obviously, when a physician is making the decision to start a patient on a new drug, then obviously there's fair amount of discussion, education is going to want to go on there, explaining the product, the mechanism of action, how to take it, all those sorts of things. And then obviously, we move onto the sort of reimbursement approval process. And so all those factors that we anticipated prior to launch being involved in how the launch is going to go have certainly been playing out exactly as we thought…

Operator

Operator

Thank you. Our next question is from Phil Nadeau with Cowen & Co. Your line is open. Phil M. Nadeau - Cowen & Co. LLC: Good afternoon. Thanks for taking my questions. Just two, one scientific, or, I guess, actually both on clinical development. First on VX-661 Phase 3, have you ever disclosed what the futility analysis hurdle is or, if not, would you care to disclose it now? And then second, on the new – the second generation correctors. Can you give us some idea of what the clinical development path is likely for those, specifically how quickly could they get into combination therapy regimens within FEV1 endpoint? Thank you. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Yeah. Thanks for both questions. So we haven't disclosed the hurdle and we won't be disclosing it today. As Ian said, I think the first news that you would get on that is if we didn't meet the hurdle and the study was stopped, we would disclose at that point what's going on. With respect to the second generation correctors, we really see them following a fairly straightforward development path we've sort of pioneered the way here with our previous medicines. They go into a Phase 1 in normal single-ascending dose, multi-ascending dose. And following hopefully successful safety results from those studies, we would put them both as monotherapy and as combination therapy into patients. And I think we've figured out – we've learned a lot over the last few years about how to do those studies very quickly, very efficiently with small numbers of patients. And so I think we can get pretty definitive data using FEV1 as well as other endpoints on how they fare both by themselves and within combination. Phil M. Nadeau - Cowen & Co. LLC: Great. Thank you.

Operator

Operator

Thank you. And our next question is from Tony Butler with Guggenheim Partners. Your line is open.

Tony Butler - Guggenheim Securities LLC

Analyst · Guggenheim Partners. Your line is open

Thanks very much, Jeff. Two brief questions. One is eliminating the sodium channel compounds for the moment. Is there a rationale for a next-gen corrector to actually be QD or BID, such that it's more easily formulated with either ivacaftor and/or VX-661? And the second question is, is there any rationale from HBE experiments that actually suggest to you that there may be the need for three correctors in addition to a potentiator? Thanks. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Yeah. Thanks for both questions. So with respect to the formulation question, our goal always has been to make it as easy as possible for these patients to take their medicines, because they do take very large numbers of pills every day. And so we continue to push for co-formulated products, that's certainly our goal, into one pill or small number of pills, and either QD or BID, both of those seem pretty acceptable to patients. And that's certainly our target product profile with the next-gen correctors and combinations. Your other question was, could we need three correctors? The answer is, we don't yet fully know, but certainly our goal is to try to keep this to as few medicines as possible, simply from drug-drug interaction standpoint, from a co-formulation standpoint. So again, if you ask me what our target product profile was today, it would be a first-gen corrector, a second-gen corrector and a potentiator.

Tony Butler - Guggenheim Securities LLC

Analyst · Guggenheim Partners. Your line is open

Thank you. That's helpful. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Operator, we have time for two more questions.

Operator

Operator

All right. Our next question is going to be from Brian Skorney with Baird. Your line is open. Brian P. Skorney - Robert W. Baird & Co., Inc. (Broker): Hey. Good afternoon, guys. Thanks for taking the question. I guess I just wanted to kind of get your temperature on how we should be thinking about pricing of the VX-661 combination in the context of ORKAMBI and KALYDECO's price. They're obviously at different print points, but they're in different patient populations right now. Based on the VX-661 combo studies, there's probably going to wind up being significant overlap between KALYDECO and ORKAMBI patients. I guess about 80% of KALYDECO responders have probably shown improvement on VX-661 plus ivacaftor, based on the Phase 2 data. And it doesn't look like there'd be a meaningful amount of clinical efficacy above and beyond ORKAMBI for the combo. So I guess, is it more important to you guys to maintain price per patient for KALYDECO responders, or to try to get ORKAMBI patients to switch to the VX-661 combo, because it doesn't seem like you could really do both? Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Yeah. Brian, I think, the most important things to us overall are to increase the number of patients that we're able to bring a benefit to, and continue to increase the benefit we deliver for the patients that we are able to treat. That's our overall strategy. And KALYDECO combined with VX-661 is a part of that overall strategy. But to really be commenting on price right now is way too early. As you know, we've got this broad Phase 3 program studying it across multiple patient populations. And until we see the results, both safety and efficacy, across those different patient populations, it…

Operator

Operator

Thank you. And our last question is from Liisa Bayko with JMP Securities. Your line is open.

Liisa A. Bayko - JMP Securities LLC

Analyst · JMP Securities. Your line is open

Hi. I guess you saved the best for last. Thank you very much. Stuart A. Arbuckle - Chief Commercial Officer & Executive Vice President: Absolutely.

Liisa A. Bayko - JMP Securities LLC

Analyst · JMP Securities. Your line is open

Okay. First question, I just wanted to better understand the guidance. So if we extrapolate the results this quarter and just assume it's flat for the remainder of the year, we actually get to a number that's slightly above your guidance. So I'm just wondering if there was any stocking or if there's some FX kind of considerations or greater gross-to-net in the future, what – and help us better understand the guidance you provided for KALYDECO. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: So Liisa, thanks, and you certainly did save the best for last. So congratulations, your math is correct. If you take the first six months of this year and then take this quarter and multiply it by two, which is a way of just saying the last three quarters are the same as the second and the first quarter is already done, you do get to slightly above the $590 million, that's correct. I made comments earlier on the call, though, which is, we do anticipate patients that we expected to come onto KALYDECO treatment will now go towards the VX-661 Phase 3 studies. And clearly, we're trying to estimate that, but we have taken a conservative approach and we anticipate that will affect the growth of KALYDECO specifically in Europe. And therefore, we're not anticipating a significant growth in the second half of this year with KALYDECO.

Liisa A. Bayko - JMP Securities LLC

Analyst · JMP Securities. Your line is open

Okay. That makes sense. Thank you. I didn't totally put that together. Thanks. And then just a final question, again, I know a lot of people have asked, but on this lung clearance index. Can you maybe give us what kind of assumptions you made in this population or how you powered it, and kind of like what clinical difference you expect to see or make sense just because we're not as familiar with it and we haven't seen as much of the data? That would be very helpful. Thank you. Jeffrey M. Leiden - Chairman, President & Chief Executive Officer: Yeah. Thanks for the question. This is Jeff. We haven't disclosed the numbers there and probably won't until we get towards the end of the study. There is a fair amount of literature out there that we can send you on what kind of numbers one might see, as I said, the KALYDECO as an example. The study is 200 patients, so it's appropriately powered to see the kinds of the differences that we think would be important to see clinically and statistically.

Liisa A. Bayko - JMP Securities LLC

Analyst · JMP Securities. Your line is open

Okay. Thanks a lot.

Michael Partridge - Vice President-Investor Relations

Management

Okay. That's going to conclude the call. We appreciate everybody joining us tonight. The IR team is available in the office tonight if anyone has additional follow-up questions. I'll also mention that we will be presenting at a few investor conferences in the coming months. And in early October, we will plan to host analysts and investors at the North American CF Conference in Phoenix, so stay tuned for details on that. Thanks and have a good night.

Operator

Operator

Ladies and gentlemen, thank you for participating in today's conference. This does conclude the program and you may all disconnect. Everyone, have a great day.