Pharmatrader

RESET-PSVT NEWS IS EXTREMELY BULLISH $MIST officially announced the launch of a Phase 4 Clinical Registry named RESET-PSVT. To understand what this is, you have to look at the timeline of drug development: Phase 1, 2, and 3 Trials: These happen before FDA approval. They are highly controlled, rigid experiments designed to prove to the government that the drug is safe and effective. Phase 4 (A Registry): This happens after the drug is already approved and on the market. It is an "observational" study. Researchers simply watch what happens when regular doctors prescribe the drug to regular patients in the real world. The Key Details of the Announcement: What they are tracking: They will follow 450 adult patients who are prescribed CARDAMYST. They are tracking how often they use it, their quality of life, and most importantly, their "healthcare utilization" (how often they end up in the ER or use an ambulance). Who is running it: It is being spearheaded by the Duke Clinical Research Institute (DCRI), one of the most prestigious academic medical centers in the world. Timeline: They expect to start enrolling patients by the end of 2026 across 20 cardiology centers. The Importance (Why It Matters to Investors) While Phase 3 trials are designed to convince the FDA, Phase 4 registries are designed to convince Insurance Companies (PBMs) and Doctors. This news is a massive strategic move to secure the company's long-term commercial dominance. Here are the three reasons this registry is fundamentally important: 1. The Ultimate Weapon for PBM Negotiations (Economic Value)Right now, Milestone has secured Express Scripts, but they still need to conquer CVS Caremark and OptumRx. Those holdout PBMs do not care about Phase 3 safety data anymore; they care about money. They want to know: "If we pay $1,600 for this nasal spray, does it actually save us money overall?" By tracking "healthcare utilization" in this registry, Milestone is gathering the exact math needed to prove that paying $1,600 for CARDAMYST prevents a $5,000 Emergency Room visit and a $1,500 ambulance ride. Once they have that real-world economic data in hand, CVS and OptumRx lose their ability to deny coverage. The registry proves the drug is an economic net-positive for the insurance system. 2. The "Duke" Stamp of Approval Having the Duke Clinical Research Institute (DCRI) attach its name to this registry is a massive credibility anchor. Institutional investors know that DCRI does not risk its reputation on failing, niche products. When the broader cardiology community sees that Duke is leading the post-market analysis of Cardamyst, it signals that this nasal spray is not just a novelty, but the new standard of care for PSVT. 3. Ammunition for the Sales Force (Real-World Evidence) Phase 3 clinical trial data is often viewed with a grain of salt by everyday doctors because trial patients are carefully selected and monitored. Doctors always ask sales reps, "That's great in a lab, but how does it work for my actual patients in the real world?" This registry generates Real-World Evidence (RWE). Once data from the registry shows that real patients are experiencing better quality of life and fewer panic-inducing hospital trips, the 60 sales reps can use those actual patient outcomes to break down hesitant doctors. Real-World Evidence is the number one driver of long-term prescription volume. The Bottom Line: Management is using their cash runway to buy the prestigious, undeniable real-world data that forces insurance companies to pay up and forces doctors to write scripts. #ShortSqueeze investors.milestonepharma.com/news-releases/…

I EXPECT GAMMA SQUEEZE IN $MIST The April 17 expiration date is critical. This is due to a greek metric called Gamma, which measures how fast an option's Delta changes. 30 Days to Expiry: If an option crosses the strike price, the Delta changes slowly. Market makers have plenty of time to buy shares to hedge. 7 Days to Expiry: Gamma becomes highly concentrated. The moment the stock crosses the $2.00 strike, the Delta violently snaps from roughly 0.30 to 0.80 almost instantly. The Forced Buying: Because Delta represents the hedge ratio, a Delta of 0.80 means the market maker must physically buy 80 shares of $MIST for every single contract sold. If retail traders buy 5,000 contracts of the $2.00 strike this week, market makers are algorithmically forced to market-buy 400,000 shares of stock in a matter of hours to cover their risk. This is the exact mechanism of a Gamma Squeeze. A gamma squeeze only happens if the Open Interest increases, meaning new contracts are being held overnight, permanently trapping the market maker and forcing them to hold the underlying shares. Last time I checked it, the open interest was around 5000 contracts. I believe the gamma squeeze will try to push the stock toward $2.50 levels NOT AN INVESTMENT ADVICE

$MIST price action explained: 📈 $1.78 ➡️ $2.15: Algorithmic short-covering squeeze + front-running next week's Needham conference. 📉 $2.15 ➡️ $1.95: Retail profit-takers and the institutional warrant-hedgers dumping their shares onto the open market simultaneously One look at today's options flow and it's clear: #gammasqueeze is pulling up!

The "Zero Revenue" Fallacy (Gross Burn vs. Net Burn) It is claimed that the expected cash burn is $20M per quarter ($80M annualized). As a gross expense, that is actually a very accurate estimate for running a 60-person sales force and corporate operations. However, it is assumed that Net Burn = Gross Burn. That is only true if revenue is zero. Because $MIST has unlocked 100 million covered lives via Express Scripts, revenue is absolutely not zero. Let's use a highly conservative launch model: If $MIST only captures 1% of the 600,000 Express Scripts PSVT patients in the near term (6,000 patients), at 6 scripts a year and an $800 net price, that generates roughly $28.8 million in annual revenue. That $28.8 million instantly drops the annual cash burn from $80M down to ~$50M. As market share grows, the net burn shrinks to zero, and the company flips to profitability. The argument below is ignoring the entire right side of the income statement.

@MrStarkCapital any news on $MIST?

$ONDS - Large 2m call buyer from Friday is still open!

ABOUT WST TARGETS OF $8.00 When an analyst sets a 12-month target of $8.00, they have to project what the company's balance sheet will look like at $8.00. Because $8.00 is massively higher than the $1.50 and $1.87 warrant strike prices, the analysts assume a 100% probability that those warrants are exercised. To model this, they use the Treasury Stock Method: They add the ~63 million warrant shares to the denominator (bringing the total share count to roughly 185M – 200M, just as you said). Crucially: They also add the ~$100 million+ in cash proceeds from those warrants directly to the company's treasury. Let’s do the exact math the analysts did to prove that $8.00 on a 200 million share count is perfectly logical for Milestone: Fully Diluted Shares: ~200 Million Analyst Price Target: $8.00 Implied Market Capitalization: $1.6 Billion ($8.00 × 200M) The Cash Position: ~$300 Million (The current ~$200M pro forma cash + ~$100M from the exercised warrants). Implied Enterprise Value (EV): ~$1.3 Billion ($1.6B Market Cap minus $300M Cash). Does a $1.3 Billion EV make sense? Absolutely. Capturing just 5% of the 2 million PSVT patients with a 50% PBM rebate generates roughly $480 million in annual revenue. Commercial-stage biotech companies are routinely valued at 3x to 4x their peak sales. A 3x multiple on $480M is $1.44 Billion. The $8.00 Price Target for $MIST fits the fully diluted valuation model perfectly.

1- WARRANTS The biggest mistake the market makes is assuming that 60 million warrants simply dilutes the share price to zero. These warrants are not free shares; they have strict strike prices. If the 30M Series A warrants are exercised at $1.50, the warrant holders must physically wire Milestone $45 million in cash. If the 30M Series B warrants are exercised at $1.87, they must wire another $56.1 million in cash. Yes, the share count goes up, but Milestone’s treasury instantly grows by over $100 million. When you factor in the ~$200 million in pro forma cash they already hold, a fully-diluted $MIST would be sitting on a massive cash war chest. Because Enterprise Value (EV) subtracts cash, the actual underlying valuation of the commercial business remains incredibly cheap. 2- WOULD IT CAUSE IMMEDIATE SELL-OFF? an institution isn't exercising a warrant just to break even on the strike price. To generate a true, reportable yield for their fund, the underlying stock price must exceed: Warrant Strike Price + Initial Warrant Premium + Time Cost of Capital. 3- ATM Regarding the ~25M shares left on the ATM: an ATM is just an open line of credit, not a mandatory sell order. Management already executed their capital raise and built a $200 million runway to fund the Express Scripts launch. Oliveto has zero financial need to tap an ATM while the stock is heavily depressed at these levels. Management typically saves the ATM for when the stock violently re-rates on a major catalyst (like the upcoming DoD formulary vote or a CVS/OptumRx contract), allowing them to raise capital at $4.00 or $5.00 by selling very few shares.

IMPORTANCE OF THE NEEDHAM PRESENTATION $MIST is at the Needham Healthcare Conference next week to pivot the narrative from "clinical cash-burn" to "commercial revenue engine." Institutions buy based on the 1-on-1s. Watch for major accumulation as the Express Scripts data gets shared behind closed doors. The stock may skyrocket further following the $MIST Needham presentation on April 13th🚀 investors.milestonepharma.com/news-releases/…

Why didn't the $MIST stock spike suddenly from $1 to $1.55, but rather climbed gradually around 10% every day? A sudden 50% jump in one hour is usually a retail pump that crashes the next day. A steady, daily staircase climb is the footprint of institutional "smart money." Here is what is actually happening with $MIST: 1️⃣ Algorithmic Short Covering: Trapped shorts are using volume-weighted algos (VWAP) to quietly buy back shares over several days without triggering a massive, uncontrollable squeeze. #shortsqueeze 2️⃣ Institutional Accumulation: Large funds are methodically building long positions based on the Express Scripts deal. They buy slowly to avoid ruining their own entry price. Gradual climbs build rock-solid floors. 📈

@engineer_yousf I bought $MIST after FDA approval. For drugs still in Phase 2 or 3, it's always a zero-sum game. That's Cardiff's problem right now. Everything hinges on trial outcomes.

@smallcapharma Thanks a lot for clarification, Can you explain as well as for $crdf Cardiff please? Again thanks a lot

Why didn't $MIST instantly snap back to $1.70 after the Express Scripts PR? People ask me why the share price didn't break $1.70, given that things are better now than before the earnings call. 1️⃣ Overhead supply from trapped retail sellers clearing out. 2️⃣ Institutional lag as risk models update the 100M+ covered lives. 3️⃣ Controlled short covering. The fundamental value is higher today than it was at $1.70. Next stop: $2.00.

$MIST just issued 123k options to poach 3 new hires for the commercial launch. The $MIST inducement PR is exactly what you want to see during a launch. They are expanding the commercial team without burning a dime of the $200M cash runway. The strike is $1.31 and vests over 4 years. Zero immediate dilution threat. The baseline is building. investors.milestonepharma.com/news-releases/…

Express Scripts manages pharmacy benefits for approximately 75 million people, which means they control roughly 25% of the U.S. commercial market. * Total PSVT Market: 2 million diagnosed #PSVT patients * Total ESI PSVT Patients: ~500,000 patients. $MIST is not going to capture all 500,000 patients immediately. We have to apply a realistic launch adoption curve (market penetration) for the next 12 to 18 months. Conservative Case (2% Capture): If the 60 sales reps only manage to convert 2% of the eligible Express Scripts patients in the first year, that equals 10,000 active patients. Base Case (5% Capture): If the removal of the Hub friction causes cardiologists to adopt Cardamyst as the standard frontline rescue therapy, a 5% capture rate equals 25,000 active patients. Unlike a one-time antibiotic, Cardamyst is a rescue medication that patients will refill throughout the year as they experience PSVT episodes. Based on the Centene coverage limits (up to 24 treatments a year), institutional models assume a conservative average of 6 scripts (refills) per patient, per year. Here is what the Express Scripts contract alone translates to in script volume: Conservative Volume (10,000 patients): 10k × 6 scripts = 60,000 scripts per year. Base Volume (25,000 patients): 25k × 6 scripts = 150,000 scripts per year. To tie this back to the financials, assuming a 50% rebate off the $1,600 WAC (netting $800 per script): 60,000 scripts = ~$48 Million in annual revenue. 150,000 scripts = ~$120 Million in annual revenue. Besides, as a side benefit, it will trigger CVS Caremark and OptumRX to accept frictionless contractual coverage.

$MIST End of 2026 Target Share Price: ~$8.00 per share. (According to WSt Analysts) Wall Street values commercial-stage biotech companies demonstrating aggressive quarter-over-quarter revenue growth at a multiple of 3.5x to 4x their forward annualized run-rate. • Enterprise Value (EV): $240 Million (Run-Rate) × 3.5x Multiple = $840 Million. • Total Market Capitalization: $840 Million (EV) + $140 Million (Year-End Cash) = $980 Million. Time to #shortsqueeze