アーデリックス（ARDX）2026年第3四半期決算説明会：売上高19%増、ガイダンスを維持

要点

• アーデリックス（ARDX）が発表した2026年第3四半期の製品総売上高は、前年同期の1億550万ドルから19%増の1億2,550万ドルとなりました。
• IBSRELAの売上高は処方医師数、処方箋数、および需要の拡大に支えられ、前年同期比23%増の9,630万ドルに増加しました。
• XPHOZAHの売上高は前年同期比7%増の2,920万ドルとなりました。有償処方箋数は22%増加したものの、顧客の購入パターンにより前四半期比で約9%の減収となりました。
• 純損失は前年同期の100万ドルから70万ドルに縮小しました。アーデリックスの当四半期末時点における現金、現金同等物および短期投資の残高は2億8,530万ドルでした。
• 経営陣は両製品の2026年通期売上高見通しを据え置き、営業費用については5億ドル未満にとどまると予想しています。
• 慢性特発性便秘症（CIC）を対象としたテナパノールの第III相ACCEL試験における被験者登録が予定より早く完了しました。経営陣は2027年後半にトップライン結果が得られると見込んでいます。

主要財務データ

経営陣は、売上総利益率95%以上を維持しており、売上の拡大と費用管理に伴い営業レバレッジが改善するとの見通しを示しました。

事業および業績の動向

IBSRELA

IBSRELAは引き続きアーデリックスの主な成長ドライバーとなっています。経営陣は過去最高の需要を記録し、総処方医師数、処方箋数、市場シェアが拡大し続けていると述べています。

同社は保険支払者や事前承認に関する障壁の低減に注力しています。現地償還支援チームを2倍に増員するとともに、「IBSRELA薬局ネットワーク」の活用促進を図っており、経営陣によれば、同ネットワークにより処方履行率の向上、調剤時間の短縮、および患者1人あたり年間少なくとも1回の追加リフィル処方が実現しているとのことです。

アーデリックスは当期中にも営業担当者を増員しました。経営陣はIBSRELAの売上がプロモーション活動に影響されやすいと説明しており、担当エリアの拡大は対象となる医療従事者とのエンゲージメント強化を目的としています。

9月1日には、Netflix、Hulu、Prime Video、Disneyなどのプラットフォームを通じてターゲティングしたDTCキャンペーンを開始しました。経営陣は消費者向けウェブサイトのアクセス数が増加したと報告したものの、これが追加の処方箋増加につながるかを判断するにはまだ時期尚早だとしています。

XPHOZAH

XPHOZAHの有償処方箋数は前年同期比で22%増加しました。売上高の伸びは7%にとどまり、顧客の購入パターンが前四半期比での比較に影響を及ぼしました。

経営陣は、人工透析における償還環境が引き続き複雑であることを強調しました。アーデリックスは、リン吸着薬に対するTDAPA期間終了後の見通しが明確になるのを待つ間、XPHOZAHをプラスの業績貢献製品として維持するため、慎重なアプローチを取る方針です。

開発パイプライン

慢性特発性便秘症（CIC）を対象にテナパノールを評価する第III相ACCEL試験の被験者登録が予定より早く完了しました。本研究は、IBS-Cの評価に用いられる疼痛要素を含めず、持続的な便秘改善効果を中心に検証しています。

経営陣は、CICの市場機会には市販薬や既存の処方薬で十分な効果が得られない患者が含まれると考えています。ただし、保険支払者の要件を考慮すると、IBSRELAがCICの一次治療薬になるとは予想していません。

経営陣の見通し（ガイダンス）

経営陣によると、IBSRELAのレンジの中央値は年率30%以上の成長を意味します。また、アーデリックスは売上高の拡大、厳格な費用管理、および手元流動性に支えられ、2027年の黒字化見通しを維持しています。

リスクおよび注視事項

• 保険支払者による制限や事前承認要求が、IBSRELAの処方需要と実際の調剤完了との間で引き続き障害となっています。
• 経営陣は、承認率や履行率が急速に改善するとは見込んでいません。運用、デジタル、契約、および償還に関する段階的な取り組みを通じて進展が得られると期待されています。
• 保険支払者との契約拡大はGross-to-Netの圧力を高める可能性があります。経営陣は、十分なアクセス向上効果が得られる場合に限って追加の譲歩を行うと述べています。
• XPHOZAHは、人工透析の償還環境およびTDAPA期間終了に伴う移行による不確実性に直面しています。
• IBSRELA薬局ネットワークを経由する取引量が増加するにつれ、処方データを直接観察することが困難になり、外部機関による処方予測の完全性が低下する可能性があります。
• ACCELは引き続き臨床段階のプログラムであり、トップライン結果の発表は2027年後半まで見込まれていません。

アナリスト質疑応答の主なポイント

• IBSRELAのアクセス：経営陣は薬局ネットワーク経由の処方割合の数値化を控えましたが、ネットワークの利用が履行率と服薬アドヒアランスを改善することを改めて強調しました。
• 償還改善の時期：アーデリックスは短期的な劇的改善を予想していません。経営陣は現地償還支援、保険支払者との協議、デジタルツール、およびAI活用の可能性を通じて段階的な進展を期待しています。
• XPHOZAHの長期見通し：同社は、新たな長期売上フレームワークの検討に入る前に、TDAPA移行後の見通しがより明確になるのを待つ方針です。
• CICの市場ポジショニング：承認された場合、経営陣はIBSRELAが市販薬や既存の処方薬で十分な効果が得られなかったCIC患者に最も適していると考えています。
• 処方動向：経営陣は足元の表面的な処方の伸び悩みを、薬局ネットワーク分の予測データ不備が一因であるとし、裏にある基調的な動向は再確認されたガイダンスを裏付けるのに十分堅調であると述べました。
• 2027年の契約交渉：アーデリックスは2027年のアクセスやGross-to-Netの予測を示しませんでした。経営陣は、契約交渉は緩やかに進められ、譲歩によって測定可能な価値が生まれる場合にのみ実施すると述べました。

決算説明会 文字起こし全文

決算説明会の完全なトランスクリプト

経営陣による説明

Operator

[Presentation]

Welcome to the Ardelyx Third Quarter 2026 Earnings Call. [Operation Instructions] I would now like to turn the conference over to Lisa Caperelli, SVP, Investor Relations and Corporate Communications. Lisa, you may begin.

Lisa Caperelli

Thank you, [ Paul ]. Good afternoon, and welcome to our third quarter 2026 financial results and business update call. Earlier today, we issued our earnings release, which can be found on the Investors Section of our website at ardelyx.com. Slides that accompany today's call can also be found on our website.

On today's call, I am joined by Mike Raab, President and CEO of Ardelyx; and Sue Hohenleitner, our Chief Financial Officer. Before we begin, I'd like to remind you that some of the statements made during the call today are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements involve a number of risks and uncertainties that may cause our actual results to differ materially from those expressed or implied, including those described in our annual report on Form 10-K, our quarterly report on Form 10-Q, which was filed today, and from time to time in our other documents filed with the SEC. These forward-looking statements speak only as of today's date. And while we may elect to update these forward-looking statements in the future, we specifically disclaim any obligation to do so even if our views change. I will now pass the call over to Mike. Mike?

Michael Raab

Thank you, Lisa. Good afternoon, everyone, and thank you for joining us today. Ardelyx is a company focused on developing and commercializing innovative medicines. And today, with IBSRELA and XPHOZAH, we have 2 first-in-class medicines that in the third quarter generated over $125 million in revenue, up 19% from a year ago. With a strengthened financial position and a robust patent portfolio, our products are well-positioned for significant long-term growth. Our focus is now to leverage that foundation and to build a pipeline to create long-term value.

Our third quarter's performance bolsters our confidence as we focus on executing on our priorities, accelerating the growth of IBSRELA, maintaining XPHOZAH's momentum, building and expanding our pipeline and delivering strong financial results.

Starting with IBSRELA. In Q3, IBSRELA generated revenue of $96.3 million, representing 23% year-over-year growth. HCP confidence in IBSRELA remains high with demand reaching all-time highs as the number of total writers, total prescriptions and market share continues to grow. This growth supports our full year guidance and reinforces our long-term view of achieving $1 billion in annual revenue. Critical to that is our ongoing work to thoughtfully eliminate the payer friction HCPs and patients experience when first starting IBSRELA. In our efforts to alleviate some of this friction in the third quarter, we began to see progress that gave us confidence that these initiatives are beginning to take hold. As we've noticed in the past, IBSRELA is a promotionally sensitive brand, and mid-year, we expanded our sales force to increase reach and frequency to our target HCPs and continue to build the top of the funnel demand.

In addition, we doubled our field reimbursement team to help HCPs navigate the prior authorization landscape. We're also continuing our efforts to transition writers to utilize the IBSRELA pharmacy network as we know that when the IPN is utilized, patients experience 2 to 3 higher fulfillment rates, faster fill times, and at least one additional refill per patient on an annual basis. We will continue to assess all tools at our disposal to streamline the prior authorization process such as how best to leverage digital and AI tools. Our teams are executing at a high level, translating into notable results with total prescriptions growing.

On September 1, we embarked on a highly targeted effort to raise awareness of IBSRELA with IBS-C patients and launched our first direct-to-consumer ad. This highly targeted ad has a clear call to action and is intended to reach more than 10 million people through outlets such as Netflix, Hulu, Prime Video and Disney. In the testing phase of the ad with IBS-C patients, 91% of them said that they would ask their doctor if IBSRELA was right for them. And in a short time, we've seen that the campaign has delivered meaningful impressions and is driving an increase in traffic to our consumer-focused website. These are early positive indicators, and we continue to monitor how this increased awareness translate into new patient starts.

As you know, the IBS-C market is very large. Over 7 million prescriptions are written for IBS-C-approved medications per year and more than 70% of patients continue to experience persistent symptoms, with IBSRELA being an important alternative for millions of dissatisfied IBS-C patients. In addition to providing benefits to IBS-C patients, our real-world data demonstrated that there is also the potential of generating significant savings in health care services for IBS-C patients when they are treated with IBSRELA. A few weeks ago at the American College of Gastroenterology Annual Scientific Meeting, we presented real-world data showing that when IBSRELA -- when on IBSRELA, GI-related health care resource utilization drops, primarily driven by fewer doctor visits and labs.

Taken together, IBSRELA not only provides symptom relief for IBS-C patients, but may also reduce broader health care resource burden associated with the disease. The fundamentals of the IBSRELA business remain very strong. And by staying focused on execution and improving patient access, we are positioned to drive continued adoption and create meaningful benefits for patients.

Now moving on to XPHOZAH. Revenue in Q3 was $29.2 million, representing 7% year-over-year growth, and we continue to see growth in paid prescriptions of 22% compared to the same quarter in 2025. The need for XPHOZAH remains high. In the United States, there are more than 550,000 adults with CKD on dialysis with more than 80% of them requiring treatment for hyperphosphatemia and yet nearly 70% of those patients struggle to reach and maintain target phosphorus levels. A few weeks ago at the American Society of Nephrology Kidney Week, we presented real-world evidence supporting XPHOZAH's ability to consistently reduce serum phosphate. We also presented data highlighting the difficulty of managing hyperphosphatemia and the serious mortality morbidity associated with cumulative phosphate burden.

Together, these findings continue to reinforce the need for XPHOZAH, a differentiated treatment that can help dialysis patients reach and maintain target phosphorus levels. As we've discussed before, the dialysis reimbursement environment is complex, and we are taking thoughtful and measured approach to help ensure that XPHOZAH continues to be a positive contributor.

Now pivoting to our pipeline. Tenapanor is our foundation and will enable us to grow our pipeline. Our most advanced program with IBSRELA is our ACCEL Phase III clinical trial in patients with chronic idiopathic constipation or CIC. Today, we announced that we have fully enrolled the trial ahead of schedule. The interest and pace of enrollment in the trial underscores the enthusiasm on the part of treating physicians for a new option for their patients experiencing the significant burden of CIC. Our confidence in the success with IBSRELA in CIC patients is, in large part, based on data from our IBS-C clinical development program. Patients with CIC and IBS-C have overlapping symptoms. We believe that expanding the use of IBSRELA to CIC will provide an additional option for patients currently underserved by their CIC treatments.

In October, we convened a Medical Advisory Board of HCPs to solicit their feedback on the CIC treatment landscape and our Phase III trial design. Three things stood out from that discussion that I'd like to share with you. First, the need is real as CIC patients cycle through multiple over-the-counter products for seeking care and, like IBS-C patients, often [awry] treatment experience. Second, there is a solid clinical rationale. CIC and IBS-C overlap substantially, and we believe that the clinical efficacy observed with IBSRELA on IBS-C could translate to patients with CIC. Third, the trial has been well received as evidenced by the faster-than-projected enrollment in the ACCEL trial.

We are encouraged by the progress we've made and look forward to reporting top line results in the second half of 2027. Finally, we are in a strong financial position with our $285 million of cash with our revenue funding our operations and supporting our path to profitability in 2027. And with that, I will now turn the call over to Sue to discuss the quarter's financials in detail. Sue?

Sue Hohenleitner

Thank you, Mike. Three points stand out for me from our third quarter results. First, IBSRELA continues to drive our growth with revenue up 23% year-over-year. Second, we're turning that growth into financial progress. Our net loss narrowed to $700,000, and we ended the quarter with $285.3 million in cash. Third, based on the continued strength and performance, we are reaffirming our full year guidance for both products and for operating expenses. Now let me walk you through the numbers. In the third quarter, our total product revenue was $125.5 million compared to $105.5 million in the same period last year, representing 19% growth year-over-year.

IBSRELA Q3 revenue was $96.3 million, an increase of 23% compared to Q3 2025. IBSRELA revenue growth reflects growing demand and an increase in total writers and total prescriptions. XPHOZAH revenue for the quarter was $29.2 million, an increase of 7% compared to Q3 2025. While the demand in Q3 sequentially grew, it was offset by customer buying patterns in the quarter. As Mike mentioned, the dialysis reimbursement environment is complex, and we are doing all we can to help ensure it remains a positive contributor.

Now moving on to expenses. R&D expenses for the quarter were $25.2 million compared to $18.1 million for the same period in 2025. This increase primarily reflects the ongoing investment in the ACCEL Phase III clinical trial in CIC. SG&A expenses for the quarter were $93.9 million compared to $83.6 million for the same period in 2025. This increase reflects the deliberate investments we made earlier in the year, including expanding the FRM team, optimizing the sales force, and launching the DTC initiative. Our financial strategy remains focused on driving towards profitability, which we continue to believe will occur in 2027.

We are diligently focused on growing revenues while managing our operating expenses. Considering our greater than 95% gross profit margin and prudently managed OpEx, we anticipate our operating margin to grow as we move forward. That is the leverage of this business that I hope our shareholders appreciate. Net loss for the third quarter was $700,000 compared to a net loss of $1 million for the same period in 2025. The net loss for Q3 2026 included $15.1 million for non-cash expenses from share-based compensation compared to $12.7 million for the same period in 2025. We ended the third quarter with $285.3 million in cash, cash equivalents, and short-term investments. Our liquidity remains robust. We are using our cash and revenue base to fund our operations and our pipeline.

Now turning to guidance. For IBSRELA, we are reaffirming our full year 2026 guidance of $350 million to $370 million. This represents annual growth of more than 30% at the midpoint. For XPHOZAH, we're reaffirming our full year 2026 revenue guidance of $110 million to $120 million. For OpEx, we continue to expect our full year 2026 operating expenses to be below $500 million. As we build towards profitability in 2027, OpEx and prudent expense management are key priorities for us. As a company, we're focused on 3 things: executing commercially, investing with discipline, and delivering value for our patients and shareholders. Our financial position and disciplined capital allocation strategy gives us the flexibility to execute these priorities and build on our strong foundation. And with that, I will hand it back to Mike.

Michael Raab

Thank you, Sue. We're a company with 2 first-in-class medicines, a solid financial foundation, a developing pipeline anchored by tenapanor and a team that has demonstrated that it can execute. I'm confident in the team and its ability to build on that foundation, and we look forward to sharing more about what comes next. Thank you for your continued support. And with that, Paul, we can open the call for questions.

Operator

[Operator Instructions] And our first question comes from Yigal at Citi.

質疑応答

Unknown Analyst

This is [ Carla ] on for Yigal. You've highlighted the benefits of the IBSRELA pharmacy network in terms of fulfillment and adherence. Can you tell us what percentage of prescriptions are flowing through the network today? And how much opportunity remains to further increase penetration?

Michael Raab

Yes. Thanks for the question. I mean the IBSRELA pharmacy network is clearly key to our strategy going forward. It's probably premature for us to give you any specifics in terms of what is actually flowing through. It's something that we want to do thoughtfully and carefully to not cause additional disruption. So it's probably not time for us to give you that kind of specificity.

Unknown Analyst

Okay. And if I may, in terms of the long-term XPHOZAH revenue target, what are the key variables you'd need to see to become comfortable with reestablishing that longer-term framework for the business?

Michael Raab

Sure. No, that's an important question. We're just coming to the end of the TDAPA period for the binders and the turmoil that we've been talking about for the better part of 1.5 years continues. So I think we all need to be patient until we exit this TDAPA period, see what next year looks like. And when we have confidence, we'll come back to you with those numbers.

Operator

Our next question comes from Roanna Ruiz of Leerink Partners.

Roanna Clarissa Ruiz

A couple for me. So first one, I was wondering if you could talk a bit more about the specific initiatives you've been doing to eliminate payer friction that came through in prior quarters? And are you able to talk about if you have any sense if this could happen again? Was it more a onetime thing or it could be a part of new seasonality for payer dynamics?

Michael Raab

Yes. I mean, I think, the most important thing, Roanna, is the growing demand and how strong that has been, right? The top of the funnel is sort of our true north that we all should continue to be paying attention -- we can't assume it's a one-and-done is something we in this industry always have to focus on, right? If a physician has identified that you need a certain medicine and then you can't get it as a patient, that's the friction that we speak of.

So we will be very thoughtful as we look at all approaches of doing this, I mentioned, whether it's AI, other digital efforts, the discussions we're having with payers, how we optimize that, and importantly, the FRMs that we have in the field that are working hand in glove with our ABDs and the offices to help people get familiar with the process of getting a prior authorization filled. So there isn't one answer to this. It is going to be a panoply of many things that we have to be prepared to do.

Sue Hohenleitner

Yes. And I would just add, the physicians are very strongly convicted in prescribing IBSRELA. I really think it's -- we've got to get them through that funnel and get more approvals through. So I think the great thing there is, Roanna, like the product is amazing. We hear that all the time from patients and from physicians.

Operator

Our next question comes from Matt Caulfield at H.C. Wainwright.

Unknown Analyst

Congrats for another great earnings, and this is Dora on Matt. Our question is, since you expanded the field reimbursement management team, how has the PA approval and the fill rates through the IPN network trended?

Michael Raab

Yes. I mean I think as we spoke, we definitely see higher fulfillment rates through the IPN. I'm not going to give you any specific numbers on it at this stage. But importantly, we see an additional script filled per annum at least, and it's just easier for the physicians when they have the help and their staff helping the prior authorization to be accomplished. So again, it is going to be all of these things happening at the same time not just one magic bullet, sadly. We have to be prepared to deploy FRMs as we have. They're doing phenomenal work in the field with the Area Business Directors. And my guess is that their calendars are chock-full of requests for support from the field as they continue to see other ways to help offices accomplish the goal.

Operator

Our next question comes from Laura Chico of Wedbush Securities.

Laura Chico

I've got a housekeeping one, Mike. How did inventory at wholesalers change during the third quarter? I might have missed that if you commented, sorry. And then in the past, you've indicated when you expand the field force, it takes a few quarters for that to be translating into greater sales. But I'm curious on the FRM side, by increasing that top of funnel layer, how should we think about the time for the reimbursement team expansion to impact fill times and shorten that?

Michael Raab

Yes. I mean there's -- I'll have Sue address the inventory question. Let me address the FRM question first, is there is plenty to do for the FRM team. And all I hear directly from the field is how grateful they are and helpful they are in getting things accomplished. So probably no direct metrics that I can give you right now. But it is clear once the engine gets running in an office, that an office gets accustomed to the process, similar to what they're doing for other drugs that they have in their armamentarium for other diseases in the GI practice, getting IBSRELA the same kind of attention as what our FRMs are doing. And it becomes a little bit like a muscle that is exercised as offices get more familiar with it, it becomes easier and the FRMs are doing phenomenal work in accomplishing that.

Sue Hohenleitner

Yes. And just -- Laura, just to address the buying dynamics, I really more comment that for XPHOZAH because what you see from a script growth perspective, sequentially, you see our scripts growing. But quarter-over-quarter, we did show a decline of about 9%, and that was really just the buying dynamics. So depending on what day of the week, the second quarter versus the third quarter end, we can have a little bit of like a little lower inventory, et cetera. So I wanted to comment to that because we did see that sequential decline. Nothing of note. It's really just, from time to time as the a little bit more, a little bit less...

Michael Raab

And Laura, I think as we said in the past, much of this inventory is almost just in time. There isn't significant amount out [ there ].

Operator

Our next question comes from Allison Bratzel of Piper Sandler.

Unknown Analyst

This is [ Peter ] on for Ali. Just wondering how investors should frame the range of outcomes across the Phase III ACCEL doses? And what would you view as a clinically meaningful result? And if ACCEL is positive, which patients do you see as the most relevant candidates for IBSRELA in CIC? And how large could that opportunity be?

Michael Raab

Very thorough question, Peter. And some of those things we'll get into more specifics as we talk more about CIC and the program going forward as we see the data. But a win is a successful clinical trial, right? You're looking at the durable response, which is the endpoint for CIC patients. So it's basically the constipation endpoint you saw in IBS-C without pain. And that's really a differentiator between the 2 populations.

So the durable response that you need there is through the last 4 weeks of the period, you have to have a maintained effect of the drug and similar to what we saw with the IBSRELA trial in IBS-C. I think as we've spoken before, the epi of this constipation market is significantly greater than IBS-C. Now the vast majority of those patients are treated sufficiently with over-the-counter medications. Now, I think as you heard in my opening statements, what we do see is the journey that CIC patients who aren't responding to OTC or even current prescription drugs because they're well-experienced with a lot of different treatments, those are the ones that come to IBSRELA.

We shouldn't expect that we're going to get first-line treatment just given the nature of the payer environment for any of these indications. So it's not dissimilar to what we anticipate and see in the IBSRELA for IBS-C patient population.

Operator

Our next question comes from Julian Harrison of BTIG.

Julian Harrison

Let me add my congratulations on the quarter. First, regarding the ACCEL initiative progress that you mentioned gaining traction in the third quarter. Can you clarify whether the underlying payer requirements themselves have changed at all or whether that progress is mostly reflective of more efficient execution on prior authorizations? And then on the DTC campaign, I'm curious if you're already seeing any measurable step-up in patient engagement or prescription demand? And was the strategy around the September timing there considering the strong seasonality you typically see for IBSRELA in the fourth quarter?

Michael Raab

Yes. So I think your last part first, yes, I mean, we moved it up as quickly as we could, just given our enthusiasm and the testing for the ad that we saw, right? As I said in my opening comments, when we tested the ad with IBS-C patients, 91% of them said that they would ask for it going to their physician. And we know the grant rate from physicians is quite high when a patient asks for a certain medicine. So that all aligns appropriately for what we want.

As I said in my opening statement, we've seen a significant increase in our traffic to our consumer-based website as we launched in September. So whether or not that translates into more scripts, early days, and that's something we'll monitor and share with everyone as we get that. To the first part of your question, the answer is yes. I think it's everything together, similar to the other answers I've given, that we have to be pulling on all different threads to try to facilitate this challenge that all of -- all patients, irrespective of IBSRELA or any therapeutic area for a new medicine, prior authorization battles are what we all have to fight for in this industry. So deploying all tactics to try to facilitate that is what we're doing, whether it's the FRMs thoughtfully negotiating with payers.

We cannot give away the store. So we're going to be very mindful of getting something for what we give because I think as you've heard me over the years, we could give every penny of profit away, and we probably wouldn't have a substantively greater position than we have today. So it's really trying to understand at the bottom of the funnel, what are the investments that we make to facilitate that process.

Operator

Our next question comes from Chris Raymond of Raymond James.

Samuel Alexander Leach

This is Sam on for Chris. Just one follow-up on CIC. I know there's already a significant amount of off-label scripts for IBSRELA in this indication. Could you give us a ballpark estimate of how many IBSRELA patient scripts today are driven by CIC and then how you think a future label expansion would change that?

Michael Raab

Yes. I mean, off-label utilization is probably something I won't comment on. We are approved only for IBS-C. So that's what we anticipate folks are going to go to. Now as we all know, a physician in practice of medicine can fight for a different utilization, and that's their prerogative. We agree that there has been some organic utilization, both this and for that and for in first-line. That's ultimately, I think, indicative of the conviction that treaters have for what IBSRELA can do for their patient population.

I think, as I said both in my opening comments and some of the questions that have happened already, is it's a sizable market. It will eliminate a friction where you as a physician have to determine whether I have constipation pain or not. And if I don't have constipation with pain, I probably will not get an IBSRELA script until you get the CIC indication. That's the friction we're trying to eliminate at the office level at the top of the funnel. We'll always have the battles at the bottom of the funnel, which is why we're investing in the FRMs and the other things that we're doing.

Operator

Our next question comes from Prakhar Agrawal of Cantor Fitzgerald.

Prakhar Agrawal

Congrats on the quarter as well. So maybe on IBSRELA in 2027, I guess if you can comment on how we should think about access and contracting given that's something that you had discussed before will be more prevalent for IBSRELA going forward? And maybe what does it mean for the evolution of gross to net? And maybe if you can clarify what was the gross to net for 3Q as well?

Michael Raab

Yes. I appreciate your effort trying to get us to give you some perspective on '27, but you know I won't. But we're going to mindfully do this, right? We're not going to just do deals for the deal's sake in contracting. So I think you'll see us meaningfully, slowly, and thoughtfully move into it, but we got to get something in return for it. That's the rule. Gross to net, obviously, we won't comment for '27, but for current gross to net...

Sue Hohenleitner

Yes. For current gross to net, Prakhar, for the 3 months, our blended rate was 31.7%, and that compares to this time last year was about 30.6%. So we continue to show a little bit more of erosion to GTN, really, just the normal mix of business as well as the inflation rebate penalties that we have to pay. So as I've said before, our GTN, although we combine it, we're like low- to mid-30s is kind of what to expect, and that's squarely where we are now for '26.

Operator

Our next question comes from Dennis Ding of Jefferies.

Yuchen Ding

So regarding IBSRELA, how are the -- we've noticed some script weakness over the last few weeks and also some simultaneous channel mix. We are reassured at the fact that you reiterated IBSRELA guidance, which means that the fundamentals are still fine. So is it that there's a reporting discrepancy with the scripts?

Michael Raab

I mean, I think, as we all have talked about over this year, as we move to IPN, those are projected, right? So that's not 100% capture. We're very confident in the guidance that we've given. So the fundamentals are absolutely strong as you articulated then. So that's why we reaffirm where we think we're going to end up this year. The business remains strong. The opportunity is significant. And as we move into IPN, there's probably going to be more projection and your patience, as we look at projected numbers versus 100% capture that we see from IQVIA for other brands, is just something we're going to have to navigate together.

Sue Hohenleitner

Yes. And I would just add to that, too, a blip here and there, we try to really just look at the trends because we know there's some data inaccuracy depending on what data source you use. So trends are looking strong and obviously continue to give us the confidence to reaffirm the guidance that we gave.

Operator

Our next question comes from Caroline Palomeque of Ladenburg Thalmann.

Caroline Palomeque

So are there any updates on the pediatric program for IBSRELA, either in the IBC -- I'm sorry, in the IBS-C indication or the FC indication?

Michael Raab

No. I mean what we [ did in this ] earnings was to give you an update on status changes, which is why we gave you the update on ACCEL. Nothing new to report on the pediatric program.

Sue Hohenleitner

Operator, is there any other question?

Operator

Yes. Our next question comes from Peyton Bohnsack of TD Cowen.

John Peyton Bohnsack

I guess with all the initiatives that you've got on board, could you give us kind of a general time line when you want to see kind of inflection in either fulfillment rates or less friction, just to give kind of investors a sense of what to look for? And then kind of secondly, what makes you feel that these are -- this is the right amount of initiatives to take in order to put a stop to any friction with your payers?

Michael Raab

Let me address the second part first. I never rest. So I'm not sure it's always enough initiatives. We should always be thinking of new things and trying new things as we look at the challenges that you face in any new drug like this. I think a dramatic inflection is probably not something anyone should anticipate. This is going to be something that we're going to take steps in improving over time. There isn't some magic bullet that you're suddenly going to see a dramatic change in PA rates. And certainly, what that would cost is not something I'm willing to even contemplate because you have no certainty.

So I think we all need to be prepared for meaningful steps that are going to take some time to eliminate the friction, both bottom of the funnel with things like FRMs and thoughtful contracting and rebating with payers. We need to be certain that what we're giving up, because it's a one-way street, that it is actually something that's going to yield a benefit to the patients who are going through this process.

Operator

And this concludes our question-and-answer session. There are no further questions at this time. And this concludes today's conference call. Thank you for joining.