Alpha Cognition Inc. Common Stock (ACOG) Earnings

Management highlights

- Commercial Launch of Zunvel * This was the third full quarter post-commercial launch of Zunvel, the first new oral Alzheimer's treatment approved in over 15 years, focused on the $2 billion U.S. long-term care market. * Q4 2025 demand: 4,941 bottles dispensed (62% quarter-over-quarter growth), with a December record of 1,859 bottles dispensed. Cumulatively, the sales force has reached nearly 4,000 unique nursing homes; 82% of Q4 orders were repeat orders from existing facilities, and 69% of prescribing clinicians were repeat prescribers, indicating durable adoption beyond initial trial use. * Prescriber count increased 50% quarter-over-quarter, and cumulative facilities with prescriptions increased 69% in Q4. Management confirmed strong tolerability, with only 2 spontaneous GI adverse event reports reported by the end of Q4, far lower than expected for this stage of launch. * Payer progress: The company signed a second contract with a top-4 national PBM, now covering 2 of the 4 major PBMs relevant to its long-term care business. Work is ongoing to drive downstream pull-through to regional plans and streamline prior authorization processes. * Marketing update: The company completed national speaker training for 48 key opinion leaders to launch peer-to-peer educational programs across the U.S., and expanded the sales force fully by January 2026 with additional reimbursement support staff. Marketing positioning was shifted to emphasize both behavioral symptom improvement (which resonates strongly with long-term care providers) and strong tolerability, after early market feedback highlighted stronger-than-expected behavioral benefits. - Clinical and R&D Progress * Three new real-world evidence studies will be initiated in 2026 to strengthen Zunvel's payer and provider positioning: Beacon (long-term care, initiated February 2026, top-line data expected Q4 2026, focused on tolerability, cognitive and behavioral efficacy), Converge (long-term care, initiating April 2026, top-line data expected Q3 2026, focused on polypharmacy use and outcomes), and Resolve (outpatient setting, initiating Q2 2026, potentially label-enabling). * 15 abstracts and posters were submitted/presented at medical conferences in 2025. 2026 R&D priorities include generating new Zunvel data on adverse events, behavioral response, and mechanism of action to differentiate the product from competitors. * Development of a sublingual Zunvel formulation is advancing: a comparative pharmacokinetics (PK) study versus the existing tablet and intranasal formulations will initiate in Q2 2026, with an FDA Type C meeting planned for late summer 2026, and potential clinical entry in early 2027 pending positive data and FDA feedback. - Business Development * Asia partner CMS Pharma is progressing through regional regulatory processes, with two product approvals expected in 2026. A milestone payment contingent on Chinese regulatory approval is expected to be received in 2026.

Guidance

- The company does not provide formal full year 2026 revenue guidance, but expects continued sequential growth in Zunvel sales throughout 2026, driven by increasing physician awareness and expanding payer access. - Full year 2026 operating expenses are guided to a range of $54 million to $58 million, with the increase from 2025 driven by planned clinical studies for Zunvel and continued investment in sales and marketing. - Management reaffirmed the target of reaching operational profitability in 2027, and confirmed that current cash reserves provide sufficient operational runway into 2027 to execute all planned commercial and R&D initiatives. - No change to the expected timing of 2026 study readouts: Converge top-line data in Q3 2026, Beacon top-line data in Q4 2026. Broad implementation of the new second PBM contract is expected in Q3 2026, with early traction expected in Q2 2026. - Expansion into the neurologist prescriber segment is planned to occur only after the company approaches profitability in 2027, with current focus remaining on long-term care facilities and psychiatry providers.

Segment performance

Alpha Cognition has one core commercial product segment, Zunvel (for mild to moderate Alzheimer's disease), plus a small licensing collaboration segment. For Q4 2025: Total revenue was $2.8 million, with Zunvel net product revenue of $2.5 million (89.3% of total revenue), and $259,000 in licensing revenue from the CMS Pharma collaboration (10.7% of total revenue). For full year 2025: Total revenue was $10.2 million, with Zunvel net product revenue of $6.8 million (66.7% of total revenue), and the remainder from licensing. Total Q4 2025 operating expenses were $10.7 million ($0.26 million cost of goods sold, $10.4 million SG&A/R&D), leading to an operating loss of $7.9 million and a net loss of $6.9 million (30 cents per share). Full year 2025 total operating expenses were $32.9 million ($1.9 million cost of goods sold), leading to an operating loss of $22.7 million and a net loss of $20.7 million ($1.17 per share). As of December 31 2025, the company held $66 million in unrestricted cash and cash equivalents and remained debt-free.

Risks & headwinds

- All financial results discussed on the call are preliminary and unaudited; final audited results may differ due to audit adjustments or other developments before the annual report is filed in March 2026. - Forward-looking statements regarding future performance, regulatory approvals, study results, and profitability are not guarantees, and actual results may differ materially due to inherent risks and uncertainties. - Payer access remains a major friction point for adoption, even with two PBM contracts signed, as downstream implementation and unrestricted coverage at the plan level is still in process. - Clinical study results may differ from management's current expectations, and regulatory approval of the sublingual formulation and international Zunvel approvals are not guaranteed, even if preclinical and clinical data meet internal expectations. - Early revenue in the launch phase can be influenced by the pace of payer coverage and prescribing ramp, and may not fully reflect Zunvel's long-term market potential.

Analyst Q&A

• Q: What is the timeline for converting remaining payers, and when will the company expand promotion to neurologists? /

  A: The company has signed two of the four major PBMs, and is now working to pull through coverage to downstream regional plans. Early adoption from these plans is expected in Q2 2026, with broad implementation and significant uptake expected in Q3 2026. Expansion into the neurologist prescriber base is planned only as the company approaches its 2027 profitability target, with current focus remaining on long-term care. (196 characters)

• Q: What are the expected key takeaways from the Converge study, and how will it inform commercial strategy? /

  A: Converge is a real-world analysis of Zunvel use in long-term care that will evaluate polypharmacy, a common issue for Alzheimer's patients: it will assess reductions in additional medications used for sleep disturbance, GI side effects, and behavioral symptoms that existing treatments do not control well. It will also evaluate adherence, tolerability, and dosing versus competitor products. The resulting data will help position Zunvel with providers and payers, supporting coverage adoption and prescribing. (287 characters)

• Q: What is the development timeline and market role for the sublingual Zunvel formulation, and would it require additional sales capacity? /

  A: The sublingual formulation is designed to address dysphagia (difficulty swallowing), which affects ~20% of long-term care Alzheimer's patients, providing an easier administration alternative to patches or crushed tablets. A comparative PK study will start in Q2 2026, with an FDA Type C meeting planned for late 2026, and clinical entry expected in early 2027 if data is positive. It will use a modified 505(b)(1) pathway, and can be fully commercialized via the existing sales infrastructure with no additional sales team needed. (358 characters)

• Q: Is the sales force expansion complete, and how has Zunvel marketing positioning changed post-launch? /

  A: The planned sales force expansion was fully completed by early 2026, with additional new reps focused on psychiatry providers in long-term care, and an expanded field reimbursement team to reduce payer access friction. Initial launch positioning focused heavily on Zunvel's strong tolerability and low GI adverse event rates, but shifted to emphasize both behavioral symptom improvement and tolerability after overwhelming early provider feedback highlighted strong, clinically meaningful behavioral benefits that drive adoption in long-term care. (321 characters)

• Q: What are the goals and expected impact of the Beacon study, compared to Converge? /

  A: Beacon is a prospective observational study of 200 patients in long-term care nursing homes that will evaluate Zunvel's tolerability, cognitive efficacy, and behavioral symptom efficacy. There is very little high-quality published data for Alzheimer's treatments specifically in the long-term care setting, so positive data from Beacon will support positioning with providers, nursing facilities, and payers, similar to Converge. Top-line data for Beacon is expected in Q4 2026, versus Q3 2026 for Converge. (273 characters)