Hero Finding
Prescribers project the entrant from third place to share leadership within three years, on delivery convenience and access rather than efficacy.
Across 50 prescribers, the mean constant-sum allocation moves the entrant from 29% of their own patients at the end of the launch year to 41% by 2028, overtaking both of the incumbent's delivery formats. The same prescribers rate the entrant's symptom control at parity, so the projected flip is carried by delivery convenience, dosing headroom, and access dynamics.
Mean constant-sum share of each prescriber's own patients · primary indication · 2028 horizon vs end of launch year · N=50
Key Findings
What the forecast surfaced.
Six signals fed the revenue model directly, each pairing a quantified parameter with the prescriber reasoning behind it.
Prescribers project the entrant from third place to share leadership in the primary indication within three years.
For the remainder of the launch year, prescribers allocated a 29% mean share of their patients to the entrant, against 41% for the incumbent's dry-powder format and 27% for its nebulized format. Asked to allocate the same patients three years out, they moved the entrant to 41% and pulled the incumbent down to 36% and 19% respectively. In the second indication the same exercise produced parity by 2028, 36% entrant and 36% dry-powder, with the nebulized format again the donor.
Clinical perception sits at parity, so convenience and access carry the projected shift.
Between 71% and 81% of prescribers with entrant experience rated its symptom control as about the same as the incumbent, with net-better readings of 17% and 11% by indication and worse readings of 5% or less. The shift rests on delivery convenience, dosing headroom, and access dynamics, which matters for durability: a share gain built on device preference is exposed to different competitive responses than one built on clinical outcomes.
The prescription funnel is parameterized end to end, and script counts overstate realized revenue.
Prescribers expected a mean 63% of written entrant scripts to be filled (median 70%), roughly half of new starts to begin on the free-start program (mean 48%), and a mean 67% of those free starts to convert to paid therapy (median 80%). Roughly a third of written entrant scripts are expected to go unfilled and a third of free starts to lapse without converting. On the incumbent side, prescribers reported 14% to 16% mean annual discontinuation due to tolerability, a recurring switching pool the entrant can draw from.
Access is the binding constraint on the near-term curve.
Prescribers rated patient access to the entrant at a mean 4.9 on a 10-point ease scale, with two thirds on the difficult side of the scale and no one choosing the easiest ratings. In the qualitative track, prescribers locate the friction in payer approval, formulary inclusion, and specialty pharmacy logistics rather than in clinical hesitancy.
Two thirds of prescribers are unaware of the free-start program, an adoption lever already in market.
Only 34% of prescribers were aware of the entrant's free-start access program. Among those aware, 59% said it increased their likelihood of prescribing and none said it decreased it. A launch lever that moves prescribing behavior in a favorable direction was invisible to two thirds of the prescriber base at fielding, which is adoption upside sitting outside the observed run rate.
The sample itself carries the sizing objective: 4,700+ patients under management.
The 50 physicians collectively manage more than 4,700 patients across the two indications, with means of 35 and 60 patients per physician by indication. One prescribing specialty carried significantly larger panels in the second indication, 74 versus 47 mean patients, significant under testing, a mix input for any prescriber-targeting model.
In many cases, the decision will be based on which formulary carries which option, and who has the better price contracted with the GPO. So, except for the cost, they are pretty much comparable.
Specialist Physician · Community Hospital
Study Design
N=50high-volume US prescribers
Two specialties across four practice settings
Constant-sum shares at two horizons
Nine-item compliance and MNPI screen
Every respondent actively manages patients in both target indications, prescribes the inhaled therapy class, and cleared minimum patient-volume thresholds in each indication. Banded screener volumes were cross-checked against exact counts given later in each interview, with contradictions flagged for human review before the base was locked. Field ran six days.
Sample by segment
Mix
What the guide covered
- Constant-sum share allocation across four therapy options, at end of year and at 2028, for each indication
- Prescription-funnel estimates: script fill rate, free-start share, free-to-paid conversion, discontinuation
- Comparative symptom-control and safety ratings versus the incumbent's two formats
- Patient access ease on a 10-point scale, with probing on payer and formulary friction
- Free-start program awareness and its effect on prescribing likelihood
- Prescribing drivers, switching triggers, and dosing practice, probed with AI-moderated follow-ups
Who qualified
- US board-certified physicians in two prescribing specialties (24 and 26)
- Actively managing patients in both target indications
- Minimum patient-volume thresholds cleared in each indication
- Nine-item compliance and MNPI screen with hard terminations, for securities use
- Recruited through three expert networks (21 / 18 / 11)
Crosstab · Share Trajectory
Mean share allocation by therapy option and horizon.
Constant-sum allocation of each prescriber's own patients in the primary indication, at the end of the launch year and at the 2028 horizon. Each column sums to 100. Highlighted row = the entrant's trajectory, the steepest move in the table.
| End of launch year | 2028 horizon | |
|---|---|---|
| Newly launched inhaled therapy | 29% | 41% |
| Incumbent · dry-powder format | 41% | 36% |
| Incumbent · nebulized format | 27% | 19% |
| Other therapies | 3% | 4% |
N=50 · patient-weighted constant-sum allocation · Entrant gains 12 mean share points · Second indication reaches 36% / 36% entrant and dry-powder parity by 2028 · The nebulized format is the donor at both horizons
Voice of the Prescriber
What prescribing physicians actually said.
Verbatim excerpts from the interview sample, selected to span practice settings: adoption logistics, payer friction, and delivery-format preference in the prescribers' own words.
“Route of administration and device preference. Second would be tolerability and side effect profile. Third would be efficacy and clinical evidence. Fourth would be patient-specific factors, like manual dexterity or cognitive ability, comorbid respiratory diseases, and adherence potential. Fifth would be insurance coverage and cost. And sixth would be availability and logistics, like device training and support, as well as pharmacy distribution.”
“For example, if a nebulizer in a liquid form is hard for a patient to use and hinders effective penetration into the lungs, I might change it to a dry powder form.”
“When the insurance chooses one, you don't have much of a choice. You have to go with what the insurance selects.”
“A lot of paperwork, a lot of forms. A lot of waiting, a lot of questions.”
“I think once insurance approval becomes easier, prescribing will increase as well.”
Implications · what the evidence supports
Four readings from the research.
What the investment team took into its revenue model, grounded in the data.
The share curve is a convenience and access story.
With 71% to 81% of experienced prescribers rating symptom control about the same as the incumbent, the projected 12-point gain rests on delivery convenience, dosing headroom, and access dynamics. A gain built on device preference is exposed to different competitive responses than one built on clinical outcomes, so the thesis tracks delivery and access mechanics rather than unresolved clinical debate.
Script counts alone overstate near-term realized revenue.
Prescribers expect a mean 63% of written scripts to be filled, 48% of new starts to begin on the free-start program, and 67% of free starts to convert to paid therapy. Each parameter entered the client's monthly patient-flow build as a distribution rather than a point estimate, so the model runs at base and downside cases.
The awareness gap is adoption upside outside the observed run rate.
Only 34% of prescribers were aware of the free-start access program; among the aware, 59% said it increased their likelihood of prescribing and none said it decreased it. A launch lever that moves prescribing behavior favorably was invisible to two thirds of the prescriber base at fielding.
The loss concentrates in the incumbent's older delivery format.
At both horizons the share the entrant gains comes disproportionately from the nebulized format, which identifies where the competitive response will concentrate. The incumbent's 14% to 16% mean annual tolerability discontinuation is a recurring switching pool the entrant can draw from.
Signals the data flagged
- Entrant mean patient share tracking toward 41% in the primary indication by 2028
- Free-start program awareness rising off its 34% baseline as the launch matures
- Realized fill and conversion holding near the 63% and 67% prescriber means
- Patient-access ease improving from the 4.9 mean as payer coverage widens
Risks the data surfaced
| Access friction caps the near-term uptake curve | High |
| Convenience-led gains exposed to an incumbent device response | High |
| A third of free starts lapse without converting to paid therapy | Med |
| Projections are self-reported prescriber intent, not claims-validated actuals | Med |
| Single-country sample | Low |