ARS Pharmaceuticals (SPRY) Q1 2026: NEFI Prescription Volume Triples, Payer Access Set for July Inflection
NEFI’s prescription volume tripled as ARS Pharmaceuticals sharpened execution on access, affordability, and prescriber engagement. The company’s Q1 saw significant momentum with expanded Medicaid wins, a retail cash program rollout, and a pending CVS Caremark decision that could meaningfully broaden coverage by July. With refill cycles maturing and a larger sales force in place, SPRY is positioned for a pivotal back-to-school season and a shift toward recurring revenue in the second half of 2026.
Summary
- Payer Access Acceleration: CVS Caremark decision and Medicaid wins set up rapid coverage expansion.
- Affordability Initiatives: $199 retail cash program aims to reduce abandonment and prescribing friction.
- Refill Cycle Maturation: Growing installed base and label expansion drive durable, recurring demand into 2027.
Business Overview
ARS Pharmaceuticals develops and commercializes NEFI, a needle-free epinephrine nasal spray for treating severe allergic reactions, including anaphylaxis. The company earns revenue through U.S. product sales, international supply agreements, and milestone payments from partners. Its primary business is in the U.S. prescription epinephrine market, a mature, refill-driven category, with additional growth targeted through international launches and pediatric label expansion.
Performance Analysis
Q1 marked a major inflection in NEFI’s commercial trajectory, with U.S. net product revenue more than doubling and prescription volume tripling year over year. This growth is notable given Q1 is typically the weakest period for epinephrine due to insurance deductible resets, underscoring the underlying demand and effectiveness of recent access and affordability initiatives.
International revenue was supported by milestone payments from ALK following regulatory wins in Europe and Canada, though ongoing royalty streams remain nascent. Gross-to-net retention remained in the low to mid-50% range, in line with long-term targets, while SG&A spend rose to support expanded sales force and DTC marketing. The company ended the quarter with $201 million in cash, supporting continued investment in commercial execution and pipeline development.
- Prescription Volume Surge: NEFI scripts tripled YoY, outpacing the market in a seasonally weak quarter.
- Access and Affordability Levers: 90% commercial coverage achieved, with 57% free of prior authorization, and new $199 retail cash program launched.
- Refill Dynamics Emerging: Installed base growth and label expansion set up for refill-driven revenue lift in H2 2026 and 2027.
Key operational focus is now on converting access wins into refill adoption and broadening prescriber penetration beyond high-volume accounts. The company expects revenue and margin leverage to build as coverage expands and refill cycles mature.
Executive Commentary
"We are off to a strong start in 2026, following our first full year as a commercial company and building momentum across the business. During the quarter, we continue to focus on key drivers of growth, which are expanding access, making NEFI more affordable to patients and caregivers, increasing prescriber adoption, and strengthening consumer awareness."
Richard Lowenthal, Co-founder, President & CEO
"As access improves and pending the outcome of the CVS Caremark process, we would expect more consistent prescription capture and improved revenue through the second half of the year. The focus is shifting from infrastructure build to optimizing spend toward the highest return commercial activities."
Kathy Scott, Chief Financial Officer
Strategic Positioning
1. Access Expansion: Payer Coverage and Prior Authorization Removal
SPRY’s most immediate lever is payer access, with the CVS Caremark proposal in final approval stages. CVS, Aetna, and Anthem together represent nearly a quarter of the commercial epinephrine market. Removal of prior authorization would place NEFI’s access on par with entrenched autoinjectors, unlocking large patient pools and reducing prescribing friction. Medicaid momentum is also strong, with nine states now granting unrestricted coverage and more expected by early 2027.
2. Affordability and Conversion: $199 Retail Cash Program
The company’s new retail cash program caps out-of-pocket costs at $199 for rejected claims at the pharmacy, addressing a major abandonment driver and aligning NEFI’s pricing with competitors. This initiative is expected to cut abandonment rates and improve prescriber willingness, especially as more scripts are routed through retail channels. The program covers 90% of pharmacies and is operational as of May.
3. Prescriber and Patient Base Maturation
NEFI’s adoption is concentrated among high-volume prescribers, but the base is broadening as more than 28,000 HCPs have now written scripts, with about half demonstrating repeat use. The expanded sales force (now 148 reps) and targeted DTC marketing are expected to deepen penetration into lower decile accounts and drive durable, refill-based growth. Pediatric label expansion and school-based programs further support long-term uptake.
4. International and Pipeline Leverage
While U.S. commercialization is the current growth engine, international markets are opening up with approvals in Canada and the EU, setting the stage for future royalty and supply revenue. Pipeline investment is ongoing, with R&D focused on chronic urticaria and other allergic indications.
Key Considerations
SPRY’s Q1 execution demonstrates a clear pivot from infrastructure build to commercial optimization, with a focus on maximizing access, reducing friction, and scaling the patient base. The next two quarters will test the company’s ability to translate these strategic wins into accelerating market share and revenue leverage.
Key Considerations:
- CVS Caremark Decision as Catalyst: July 1 effective date could unlock a step-change in access and script volume.
- Back-to-School Seasonality: Q3 and Q4 are critical as refill cycles and pediatric demand peak.
- SG&A Optimization: Shift from infrastructure to targeted commercial spend may drive operating leverage if execution is disciplined.
- Prescriber Penetration Depth: Broadening adoption beyond high-decile accounts is essential to sustain growth into 2027.
- International Ramp Lag: Royalty and supply revenue from ex-U.S. markets remains low but could scale in 2027 and beyond.
Risks
Execution risk remains around the timing and breadth of payer wins, particularly with CVS Caremark and state Medicaid plans. Prescriber inertia, competitive response from entrenched autoinjector brands, and potential delays in refill cycle maturation could limit near-term revenue lift. International ramp is at an early stage, and SG&A discipline will be tested as the company shifts from build-out to optimization. Macroeconomic pressures on healthcare spending and regulatory changes in pharmacy benefit management also present ongoing uncertainty.
Forward Outlook
For Q2 2026, ARS Pharmaceuticals management guided to:
- Continued sequential revenue growth, with Q2 expected to outpace Q1 as coverage and refill cycles build.
- Operating expenses to remain elevated as sales force expansion and DTC campaigns continue through the back-to-school season.
For full-year 2026, management maintained guidance:
- Revenue ramp weighted to H2, with break-even targeted by mid-2027.
Management highlighted several factors that could accelerate or temper results:
- CVS Caremark formulary addition and Medicaid expansion are the most significant near-term catalysts.
- Refill adoption and prescriber base broadening are expected to drive durable, recurring revenue growth into 2027.
Takeaways
Investors should focus on payer access milestones, refill cycle maturation, and disciplined SG&A allocation as the key drivers of SPRY’s commercial inflection and path to profitability.
- Payer Access as Primary Lever: CVS Caremark and Medicaid wins will determine the magnitude and speed of NEFI’s script growth in H2 2026.
- Refill and Pediatric Adoption: Label expansion and maturing installed base are critical for recurring revenue and margin leverage.
- Execution Watchpoints: Conversion of access into prescriber action and refill behavior, alongside SG&A discipline, are essential for long-term value creation.
Conclusion
ARS Pharmaceuticals enters the summer with clear momentum in NEFI adoption and payer access, but the true test will come as refill cycles and broad-based coverage converge in the second half of 2026. Disciplined execution and capital allocation will be key as the company moves from launch to scale mode.
Industry Read-Through
SPRY’s Q1 underscores the critical role of payer access and affordability in driving adoption of new therapies in mature, refill-driven markets. The company’s approach to removing prior authorization barriers and simplifying patient out-of-pocket costs is a template for other specialty pharma entrants. Seasonality and refill dynamics are increasingly important for forecasting in the allergy and chronic medication landscape, while the interplay between PBMs, Medicaid, and direct-to-consumer strategies will shape competitive positioning across the sector. International ramp timelines remain long, but early regulatory wins can provide future optionality for specialty brands.