Alpha Cognition (NASDAQ:ACOG) executives told investors the company is seeing continued sales growth and what it described as accelerating, durable adoption following the commercial launch of ZUNVEYL, an oral treatment approved for mild to moderate Alzheimer’s disease. Management emphasized early demand indicators in the long-term care channel, progress on payer access through additional pharmacy benefit manager (PBM) contracting, and a slate of real-world studies planned for 2026 to support positioning with providers and payers.
Commercial launch metrics and long-term care focus
Chief Executive Officer Michael McFadden said the fourth quarter represented the company’s “third full quarter” after the commercial launch of ZUNVEYL and reiterated the company’s belief that the product has a meaningful opportunity in long-term care, where symptom management, tolerability, and behavioral management can drive treatment decisions.
Management highlighted several launch and adoption indicators during the quarter:
- 4,941 bottles of ZUNVEYL dispensed in Q4, including 1,859 bottles in December, which executives said was the strongest month since launch.
- The field team reached almost 2,000 nursing homes during the quarter, bringing the launch-to-date total to nearly 4,000 unique facilities (Lauren D’Angelo later specified 3,856 unique homes reached).
- Prescribing doctors increased 50% versus Q3, and cumulative homes with prescriptions increased 69% in Q4, according to McFadden.
Chief Operating Officer Lauren D’Angelo framed Q4 as an “inflection point” for the long-term care launch and said demand, measured as bottles dispensed, grew 62% quarter over quarter. She also stressed repeat behavior as a key adoption signal: 729 homes placed orders in Q4, and 82% of those homes were repeat ordering homes. On the prescriber side, Alpha Cognition recorded 3,681 total healthcare provider calls in Q4, including nearly 2,000 prescriber calls. D’Angelo said approximately 865 prescribers wrote orders during the quarter and that about 69% were repeat writers.
D’Angelo said the company’s commercial messaging has increasingly leaned into behavioral outcomes alongside tolerability. She said the feedback the company has heard from customers regarding the product’s impact on behaviors “was just overwhelming,” and that this helped expand attention to psychiatry prescribers in long-term care settings who treat behavioral symptoms. Executives repeatedly described gastrointestinal adverse events as limited, citing low single-digit reported GI events and only two spontaneous GI adverse event reports by the end of the quarter.
Payer access: second national PBM contract and downstream pull-through
Executives repeatedly described payer access as both a friction point and a major opportunity. McFadden announced that Alpha Cognition executed a second national PBM contract during the quarter, bringing the company to agreements with two of the four major PBMs relevant to its long-term care business. D’Angelo said the company had previously stated it expected to sign the second contract by year-end 2025 and confirmed it met that milestone.
Management said the next step is “downstream pull-through” so contracted status translates to practical plan-level access with fewer restrictions and a smoother prior authorization process. D’Angelo said the company expects to begin seeing early traction in Q2 2026 with broader implementation in Q3 2026.
In the Q&A, the company added detail on payer conversion timing. Management said one PBM currently represents about 16% “open business” and the company is working to pull through regional plans, while the second PBM was signed at the end of 2025 and is moving through downstream account work. Executives said they expect acceleration beginning in Q2 with more significant implementation in Q3.
Asked about expansion beyond long-term care into neurology, management said the plan has been to consider expanding into the neurologist/specialty prescriber base as the company gets closer to profitability in 2027.
Clinical and real-world studies planned for 2026
Alpha Cognition announced three real-world studies that are or will be initiated in 2026, with two in long-term care and one in the outpatient setting:
- BEACON (long-term care): Initiated in February 2026; management said it will focus on tolerability as well as cognitive and behavioral efficacy. Top-line data is expected in Q4 2026.
- CONVERGE (long-term care): Expected to initiate in April 2026, with top-line data expected in Q3 2026.
- RESOLVE (outpatient): Expected to initiate in Q2 2026; management said the data could be promotional for the commercial team and “could be label-enabling.”
In response to investor questions, the company described CONVERGE as a long-term care data analysis intended to evaluate polypharmacy, including use related to sleep disturbance, GI disturbance, and behavior control. Management said it anticipates ZUNVEYL utilization may be associated with reduced polypharmacy, though it emphasized the study will determine what the data show. Executives also said CONVERGE will evaluate adherence, tolerability, dosing, and consistency versus other agents in the class.
For BEACON, management said the goal is to generate a long-term care dataset in approximately 200 nursing home patients that could be used with providers, nursing homes, and payers, noting that few studies have been completed in long-term care.
R&D update: sublingual formulation and regulatory path
McFadden said the company continues to make progress on a sublingual formulation and plans to initiate a comparative pharmacokinetic (PK) study versus its tablet and intranasal formulations in Q2 2026. Management said it believes a local toxicity study and equivalent PK dataset would be sufficient to advance the product to the clinic.
In the Q&A, management said the sublingual formulation is being pursued in part to address dysphagia or aphasia in long-term care, noting an estimate that up to 20% of patients may have difficulty swallowing tablets or capsules. The company described plans for a Type C meeting with the FDA in late summer 2026 and said that, following a positive meeting, it would likely advance the sublingual formulation to the clinic in the “very first part of 2027.” Executives said they currently expect a modified 505(b)(2) pathway and anticipate a 505(b)(2) study followed by a tolerability study that could be label-enabling, depending on FDA feedback. The company also said it plans to use the sublingual formulation in a program for cognitive impairment with mild traumatic brain injury and that combination-therapy work would follow those priorities.
When asked about commercialization synergy, management said it expects to be able to leverage its existing sales and marketing infrastructure if the sublingual formulation reaches the market.
Financial results, cash position, and 2026 expense outlook
Interim CFO Henry Du said Q4 2025 total operating expenses were $10.7 million, including $258,000 in cost of goods sold and cost of revenues and $10.4 million in SG&A and R&D expenses, compared with $2.7 million in Q4 2024. For full-year 2025, total operating expenses were $32.9 million, including $1.9 million in cost of goods sold and cost of revenues, compared with $12.0 million in 2024. Du attributed the year-over-year increase primarily to higher SG&A associated with building out commercialization, including personnel costs.
The company reported an operating loss of $7.9 million for Q4 2025 versus $2.7 million in Q4 2024, and an operating loss of $22.7 million for full-year 2025 versus $12.0 million in 2024. Net loss for Q4 2025 was $6.9 million, or $0.30 per share, compared with a net loss of $5.8 million, or $0.52 per share, in Q4 2024. For full-year 2025, net loss was $20.7 million, or $1.17 per share, compared with $14.8 million, or $2.04 per share, in 2024. Du noted the results included gains from changes in the fair value of warrant liabilities of $441,000 for Q4 and $88,000 for the full year.
As of Dec. 31, 2025, Alpha Cognition reported approximately $66 million in unrestricted cash and cash equivalents and said it remains debt-free. Du said the balance includes roughly $38 million in net proceeds raised in October 2025 through an equity offering and overallotment exercise. Based on the company’s operating plan, management said it believes this capital provides runway “well into 2027.”
For 2026, the company said it is not providing formal revenue guidance, but expects continued sequential growth in ZUNVEYL sales through 2026 as physician awareness increases and payer access expands. Du added that full-year 2026 operating expenses are currently expected to be in the range of $54 million to $58 million, driven by planned clinical studies and continued investment in sales and marketing.
In closing remarks, management reiterated its 2026 priorities: sales execution, improving payer coverage, completing studies on time and with high quality, advancing the R&D pipeline, and managing expenses as it targets operating profitability in 2027.
About Alpha Cognition (NASDAQ:ACOG)
Alpha Cognition, Inc is a clinical stage biopharmaceutical company that develops treatments for underserved neurodegenerative diseases such as Alzheimer’s Dementia and Amyotrophic Lateral Sclerosis. The company was founded in 2000 and is headquartered in Vancouver, Canada.
