Neurocrine Biosciences (NASDAQ:NBIX) executives said the company is entering 2026 with what Chief Executive Officer Kyle Gano described as the strongest foundation in its more than 30-year history, pointing to continued momentum from INGREZZA and an “exceptionally strong” first full commercial year for CRENESSITY, alongside an expanding late-stage pipeline.
2025 sales growth led by INGREZZA and first full year of CRENESSITY
Chief Financial Officer Matt Abernethy said total product sales grew to more than $2.8 billion in 2025, representing 22% year-over-year growth. INGREZZA generated “just over” $2.5 billion in revenue, up 9% year-over-year, driven by double-digit volume growth that was partially offset by pricing concessions tied to formulary access investments.
2026 outlook: INGREZZA guidance; CRENESSITY investments without specific sales guidance
Neurocrine guided to 2026 INGREZZA sales of $2.7 billion to $2.8 billion, which Abernethy said implies roughly 10% growth. The outlook assumes continued double-digit volume growth, including contributions from an expanded sales force in the second half of 2026, partly offset by price declines associated with formulary access improvements implemented in 2025. Management said net pricing in 2026 is expected to be relatively consistent with levels exiting 2025, and that contracting changes seen in 2025 should not repeat as mid-year additions in 2026.
For CRENESSITY, the company again declined to provide 2026 sales guidance, noting the market is still being characterized. On the call, Gano said Neurocrine anticipates “meaningful, steady new patient additions every single quarter,” and executives repeatedly stressed confidence in continued growth even without an annual forecast. Abernethy also flagged a first-quarter gross-to-net impact of about 5% tied to a commercial copay reset.
Chief Commercial Officer Eric Benevich said prescriptions for CRENESSITY have trended toward a majority of pediatric patients and female patients, and he highlighted persistency, stating that once patients initiate therapy, they “tend to stay” on CRENESSITY—consistent with open-label extension experience. Benevich said more than 1,000 prescribers have written a prescription, but roughly two-thirds have treated only one patient so far, which he characterized as both progress and opportunity.
To support growth in 2026, Benevich outlined commercial priorities including expanding the CRENESSITY rare disease sales force, with new representatives expected to be in the field in April. He said the additional capacity is intended to go deeper within the existing endocrinology prescriber base and broaden reach to potential prescribers outside endocrinology, such as primary care providers and OB/GYNs. He also said Neurocrine is using technology tools and datasets to help identify practices likely to be caring for classic CAH patients, while noting the challenge that there is no specific diagnosis code for classic CAH.
Pipeline and clinical updates: next-gen VMAT2, CRF programs, and phase 3 neuropsychiatry studies
Gano reiterated the company’s three strategic R&D pillars discussed at its December R&D Day:
- VMAT2 leadership, including next-generation candidates NBI-890 (now in phase 2 in tardive dyskinesia) and NBI-675, both with potential long-acting injectable formulations.
- CRF expansion, including next-generation CRF1 antagonists such as NBI-1435 for CAH and CRF2 agonists beginning with NBI-2118, including exploration in metabolic diseases such as obesity.
- Late-stage neuropsychiatry, including two phase 3 programs: osavampator in major depressive disorder and direlotide in schizophrenia.
Chief Medical Officer Sanjay Keswani said Neurocrine’s late-stage phase 3 studies for osavampator and direlotide are enrolling well, with top-line data expected in 2027 for osavampator studies and the first of two direlotide studies. Keswani also noted initiation of a phase 2 study of NBI-890 in tardive dyskinesia.
On questions about psychiatric trial execution, Keswani said the company is applying site selection and monitoring strategies aimed at mitigating placebo response and limiting “professional patients,” including relatively small site footprints (he cited 20 sites per phase 3 study for direlotide) and hands-on monitoring.
New data highlights: INGREZZA occupancy study; CRENESSITY two-year OLE results
Keswani said Neurocrine presented head-to-head PET imaging data comparing INGREZZA and Austedo XR at the American College of Neuropharmacology meeting. He said the results showed INGREZZA with “nearly twofold higher” VMAT2 target occupancy versus therapeutic doses of Austedo XR, which management said supports Neurocrine’s view that higher occupancy may correlate with greater efficacy in tardive dyskinesia and informs dose selection for follow-on VMAT2 programs.
For CRENESSITY, Keswani discussed open-label extension findings through two years of treatment in adult and pediatric classic CAH patients. He said the study showed sustained reductions in excess ACTH and androgens, and reported low adrenal insufficiency rates (zero in the pediatric double-blind study and 1.6% in adults, described as identical between active and placebo patients). Keswani also cited findings including:
- In a prepubertal subset, slowing of bone age advancement translating to a predicted adult height increase of over two inches.
- In adults, about 70% of patients brought into the physiologic steroid range while maintaining androgen control.
- Among overweight or obese adults, about 40% achieving at least 5% weight loss over two years.
Management said safety and tolerability remained strong, citing approximately 80% retention at two years, no new safety signals, and more than 35,000 patient-weeks of exposure.
Expenses, cash position, and capital allocation priorities
Abernethy said Neurocrine ended 2025 with $2.5 billion in cash, up about $700 million from $1.8 billion at the end of 2024. The company reported approximately a 30% non-GAAP operating margin for 2025, or roughly $850 million of non-GAAP operating income, which included $83 million of R&D milestones and IP R&D expense.
Looking to 2026, Abernethy said Neurocrine expects another strong year of non-GAAP operating income, with increased product sales partially offset by higher SG&A and R&D investment. He said SG&A growth reflects sales force expansion, which the company expects to complete by the end of the first quarter, and that GAAP SG&A at the midpoint of guidance is expected to be in the low-40% of sales range for 2026. He also said GAAP R&D expense (excluding about $25 million in milestones) is expected to be in the mid-30% of sales range, driven by ongoing phase 3 investment as well as multiple phase 2 and phase 1 initiations, including obesity.
In closing remarks, Gano said the company’s focus for 2026 remains “disciplined execution,” centered on driving revenue growth and diversification from INGREZZA and CRENESSITY while advancing what he described as a “data-rich” 2027 and a pipeline positioned to deliver a “constant flow of data” beginning in 2027.
About Neurocrine Biosciences (NASDAQ:NBIX)
Neurocrine Biosciences (NASDAQ: NBIX) is a biopharmaceutical company based in San Diego, California, focused on developing treatments for neurological, endocrine and neuropsychiatric disorders. Since its founding in 1992, the company has pursued a research?driven strategy aimed at addressing unmet medical needs in movement disorders, reproductive health and central nervous system conditions. Neurocrine’s operations encompass drug discovery, clinical development and commercialization activities.
The company’s lead marketed product, Ingrezza™ (valbenazine), is indicated for the treatment of tardive dyskinesia, a movement disorder associated with long-term antipsychotic use.
