Slide 1: Corporate presentation
As of December 31, 2021 nasdaq: axgn Corporate presentation
Slide 2: Forward-looking statements
2 This presentation contains “forward-looking” statements as defined in the Private Securities Litigation Reform Act of 1995. These statements are based on management's current expectations or predictions of future conditions, events, or results based on various assumptions and management’s estimate
Slide 3: The Axogen platform for nerve repair
3 The Axogen platform for nerve repair revolutionizing the science of nerve repair™
Slide 4: The function of nerves
4 The function of nerves Nerves are like wires • Transfer signals across a network • If cut, data cannot be transferred • If crushed, short circuits and data corruption may occur The peripheral nervous system is a vast network from every organ to and from the brain • Sensory • Motor • Autonomic Nerv
Slide 5: A comprehensive platform for addressing nerve injuries
Connection Protection Termination 5 A comprehensive platform for addressing nerve injuries revolutionizing the science of nerve repair™
Slide 6: Axogen is the preeminent nerve repair company
Axogen is the preeminent nerve repair company with a foundation for long-term sustainable growth 6 • Exclusively focused on peripheral nerve repair with a differentiated platform • 10+ years of demonstrated clinical outcome consistency • Featured in 181 peer-reviewed clinical publications • Over 50,
Slide 7: Current targeted nerve markets (U.S.)
Current targeted nerve markets (U.S.) 7 Trauma $1.9B Breast $250M OMF $300M Carpal & Cubital Tunnel $270M U.S. potential procedural estimates >900,000** • Trauma: > 700,000 • Carpal Tunnel Revisions & Cubital Tunnel: 130,000 • Oral Maxillofacial (OMF): 56,000 • Breast Neurotization Procedures: 15,00
Slide 8: Delivering strong, consistent revenue growth & gross margins
8 Delivering strong, consistent revenue growth & gross margins Operational Highlights • Q4 growth was approximately flat, excluding the impact of Avive® Soft Tissue Membrane • 2021 revenue growth, excluding the impact of Avive, was approximately 15%** • Revenue was negatively impacted by lower proce
Slide 9: Guidance update February 2022
Guidance update 9 February 2022 2022 Annual Financial Guidance • Full-year 2022 revenue is expected to be between $135 million and $142 million. – Represents approximately 10% to 15% growth over 2021 revenue excluding the impact of $4.1 million of Avive revenue in 2021. • Full-year 2022 gross margin
Slide 10: Traditional transection repair options are suboptimal
Traditional TRANSECTION repair options are suboptimal 10 SUTURE Direct suture repair of no-gap injuries • Common repair method • May result in tension to the repair leading to ischemia • Concentrates sutures at the coaptation site AUTOGRAFT Traditional method despite several disadvantages • Secondar
Slide 11: Processed human nerve allograft for bridging nerve gaps
11 25 µm Processed human nerve allograft for bridging nerve gaps Clinically studied off-the-shelf alternative • A biologically active nerve therapy with more than ten years of comprehensive clinical evidence • 82-84% meaningful recovery in sensory, mixed and motor nerve gaps in multi-center study22
Slide 12: Traditional compression repair options are suboptimal
Traditional COMPRESSION repair options are suboptimal 12 VEIN WRAPPING Autologous vein • Barrier to attachment to surrounding tissue • Requires extra time and skill to perform spiral wrapping technique • Second surgery site HYPOTHENAR FAT PAD Autologous vascularization flap • Barrier to attachment t
Slide 13: Axogen solution for compression repair
13 Axogen solution for COMPRESSION repair Minimally processed porcine extracellular matrix for wrapping and protecting injured peripheral nerve Protects repair site from surrounding tissue • Processing results in an implant that works with the body’s natural healing process33 • Minimizes soft tissue
Slide 14: Traditional stump neuroma options are suboptimal
Traditional STUMP NEUROMA options are suboptimal 14 TRACTION NEURECTOMY Nerve placed in traction and cut to allow for retraction • Simply resecting the nerve results in subsequent neuroma formation and risk of secondary surgery • Causes traction injury • High risk of recurrence36 BURYING IN MUSCLE/B
Slide 15: Axogen solution for stump neuroma
15 Axogen solution for STUMP NEUROMA Proprietary small intestine submucosa (SIS) matrix designed to separate the nerve end from the surrounding environment to protect it from mechanical stimulation and reduce painful neuroma formation. Protects and isolates • Reduces the development of symptomatic o
Slide 16: Avance IP and regulatory barriers to competitive entry
16 Avance IP and regulatory barriers to competitive entry Avance nerve graft is processed and distributed in accordance with US FDA requirements for Human Cellular and Tissue-based Products (HCT/P) Avance nerve graft Issued U.S. Patents 6,696,575 9,597,429 6,972,168 9,690,975 7,402,319 9,996,729 7,7
Slide 17: Unique Avance technology creates barriers to competitive entry
Unique Avance technology creates barriers to competitive entry 17 Progress toward Biologics License Application (BLA) for Avance Nerve Graft Obtaining reference product designation will provide 12 years of data exclusivity protection from biosimilars Received RMAT Designation from FDA in 2018
Slide 18: Market development strategy
18 Market development strategy B ui ld M ar ke t Aw ar en es s Ed uc at e Su rg eo ns , D ev el op A dv oc at es G ro w B od y of C lin ic al E vi de nc e Ex ec ut e Sa le s Pl an Ex pa nd P ro du ct P ip el in e + Ap pl ic at io ns revolutionizing the science of nerve repair™
Slide 19: Focus on building awareness among clinicians and patients
19 Focus on building awareness among clinicians and patients • Increasing omnichannel engagement with clinicians and patients • Continuing clinical conference participation both virtually and in-person as appropriate • Ongoing patient ambassador program • Garnering positive media attention • Growing
Slide 20: Emphasis on education
20 P IL L A R 2 Emphasis on education • Returned to in-person national education programs in September 2021 • Providing customized multimodal learning programs to specific surgeon cohorts for advanced learning • Ongoing interactive webinar series covering the principles of nerve repair • Train more
Slide 21: Strong commitment to developing clinical evidence
Outcomes from RANGER® Registry 48,49 21 P IL L A R 3 Strong commitment to developing clinical evidence RANGER® Registry Study: Enrollment Ongoing • The largest multi-center clinical study in peripheral nerve repair with >2,600 Avance nerve repairs enrolled to date • Overall meaningful recovery rates
Slide 22: Focused sales execution, increasing market penetration
22 P IL L A R 4 Focused sales execution, increasing market penetration P IL L A R 3 Ex ec ut e Sa le s Pl an Sales execution focused on driving results • Continue driving penetration in Active and Core Accounts • 5,100 potential U.S. accounts perform nerve repair • 951 Active Accounts as of December
Slide 23: Expand the opportunity in nerve repair
23 P IL L A R 5 Expand the opportunity in nerve repair P IL L A R 4 P IL L A R 3 Ex pa nd P ro du ct Pi pe lin e & A pp lic at io ns Breast Neurotization Loss of breast sensation affects QOL Urology Prostatectomy OMF Iatrogenic nerve injuries, mandible tumor resections affects eating, speaking, inti
Slide 24: Balance sheet and capital structure
24 Balance Sheet Highlights December 31, 2021 Cash, Cash Equivalents, and Investments $90.3 million Total Long-term Debt $50.0 million* Capital Structure (shares) December 31, 2021 Common Stock 41,736,950 Common Stock Options, RSUs, PSUs 4,825,413 Common Stock and Common Stock Equivalents 46,662,363
Slide 25: Executive team
Executive team 25 Erick DeVinney VP, Peripheral Nerve Science and Clinical Innovation Angiotech, PRA Intl Mike Donovan VP, Operations Zimmer Ivica Ducic, M.D., Ph.D. Medical Director Washington Nerve Institute Angelo Scopelianos, Ph.D. Chief Research & Development Officer J&J Peter J. Mariani Execut
Slide 26: Axogen is the preeminent nerve repair company
Axogen is the preeminent nerve repair company with a foundation for long-term sustainable growth 26 • Exclusively focused on peripheral nerve repair with a differentiated platform • 10+ years of demonstrated clinical outcome consistency • Featured in 181 peer-reviewed clinical publications • Over 50
Slide 27: Appendix
Appendix • Key Clinical Data • Historical Core and Active Accounts • CMS outpatient and ASC reimbursement rates • Total Addressable Market • Axogen product portfolio and indications for use 27revolutionizing the science of nerve repair™
Slide 28: Avance Nerve Graft repairs significantly better than conduit repairs
Avance Nerve Graft repairs found to be significantly better than conduit repairs 28 • Peer-reviewed publication from the MATCH cohort of the RANGER Registry • Includes outcomes from 110 subjects with 162 nerve injuries; 113 were repaired with Avance Nerve Graft and 49 were repaired with manufactured
Slide 29: Avance Nerve Graft recovery rates comparable to nerve autograft
Study finds Avance Nerve Graft (allograft) clinical outcomes recovery rates comparable to nerve autograft 29 “Safa et al., A Propensity Matched Cohort Study on Outcomes from Processed Nerve Allograft and Nerve Autograft in Upper Extremity Nerve Repairs”49 Presented at American Society for Surgery of
Slide 30: Avance performed comparably to autograft for outcomes and costs
Studies find Avance Nerve Graft performed comparably to nerve autograft for both clinical outcomes and facility procedure costs 30 “Styron et al., Nerve Repair Hospital Index Procedure Costs – Allograft vs. Autograft Repair Type” Presented at the American Society for Surgery of the Hand (ASSH), Octo
Slide 31: Breast neurotization outcomes with Avance Nerve Graft
First publication on breast neurotization outcomes with Avance Nerve Graft demonstrated greater return of protective sensation 31 • Early outcomes from a single center study, as part of the Sensation-NOW registry • 36 breast reconstructions that included: 22 breast reconstructions with Resensation®
Slide 32: REPOSE pilot study with Axoguard Nerve Cap
Axogen sponsored REPOSESM pilot study analysis demonstrates clinically significant improvement for subjects with chronic neuropathic pain when using Axoguard Nerve Cap® following neurectomy60 32 15-subject, single arm pilot phase evaluating reduction in pain from baseline following surgical excision
Slide 33: Historical Active and Core Accounts
Historical Active and Core Accounts Active Accounts typically contribute ≈85% of total revenue Top 10% of Active Accounts typically contribute ≈35% of total revenue Active Accounts 6 orders in the last 12 months Core Accounts typically contribute ≈60% of total revenue Core Accounts ≥$100,000 revenue
Slide 34: CMS outpatient and ASC reimbursement rates
CPT Code Descriptor C-APC Hospital Outpatient (HOPD) Ambulatory Surgery Center (ASC) 2019 2020 2021 2022 3Y % Change 2019 2020 2021 2022 3Y % Change 64912 Nerve allograft repair2 5432 $4,566 $5,508 $5,700 $5,824 27.6% $1,920 $3,422 $3,788 $3,868 101.5% 64910 Conduit or vein allograft repair2 5432 $4
Slide 35: 2022 CMS Physician Fee Schedule
2022 Center for Medicare and Medicaid Services (CMS): Physician Fee Schedule (PFS) 35 CPT Codes3 Descriptor Physician Fee Schedule (PFS) 2019 2020 2021 2022 3Y % Change 64912 Nerve allograft repair $804 $ 951 $904 $910 13.2% 64910 Conduit or vein allograft repair $825 $820 $803 $790 -4.2% 64885 to 6
Slide 36: Total Addressable Market
Annual Incidence(a) Weighted Average Procedure Value Total Addressable Market Trauma Transection injuries >5mm (b) Other trauma injuries (c) 700,000 100% 203,000 29% 497,000 71% $2,715 $5,515 $1,570 $1,900M 100% $1,120M 59% $780M 41% Carpal and Cubital Tunnel 130,000 $2,100 $270M Oral and Maxillo-Fa
Slide 37: Trauma total addressable market
37 Trauma total addressable market revolutionizing the science of nerve repair™
Slide 38: Trauma total addressable market (continued)
Trauma total addressable market (continued) 38revolutionizing the science of nerve repair™
Slide 39: Axogen comprehensive portfolio of products
Axogen comprehensive portfolio of products Avance® Nerve Graft • Regulatory Classification: Avance Nerve Graft is processed and distributed in accordance with U.S. Food and Drug Administration (FDA) requirements for Human Cellular and Tissue-based Products (HCT/P) under 21 CFR Part 1271 regulations,
Slide 40: nasdaq: axgn 40revolutionizing the science of nerve repair™
nasdaq: axgn 40revolutionizing the science of nerve repair™
Slide 41: Footnotes
41 Footnotes Trauma Market Data: 1. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables – Table 18. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf 2. Noble, et al.. Analysis of Upper and Lower Extremity Peripheral Nerve Injuries in a Pop
Slide 42: Footnotes
42 Footnotes 38. Galeano M, et al. A free vein graft cap influences neuroma formation after nerve transection. Microsurgery. 2009;29(7):568-572. 39. Stokvis A. Surgical management of painful neuromas. Rotterdam, The Netherlands: Optima Grafische Communicatie; 2010. 40. Lin E, et al. Local administra