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  "documentTitle": "Soleno Therapeutics (SLNO)",
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  "presentationDate": "2025-08-15 00:00:00",
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  "notes": "The slide highlights the gap between physician prescribing behavior (driven by patient pressure) and their actual clinical belief in the product.",
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      "text": "Of the 15 start forms submitted, only 3 have been approved with 6 outright denials and 4 with a soft denial, for a roughly 3:1 denial to approval ratio",
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      "text": "The hour-long interview note started on a bullish note for Soleno as he has submitted 15 start forms, and then quickly collapsed as he confessed that he thinks the drug has minimal benefit and the data is “marginal”; that this “a drug that could give them diabetes or edema or death”; that he only prescribed it because he can’t so no to desperate families that have been hyped up by Facebook groups and Jennifer Miller; that he feels “hypocritical” for caving in to pressure to prescribe given his reservations; and that of the 15 start forms he’s submitted, most have been denied with hardly any approvals – “the parents are burnt out and really looking for anything...and so, the hype around any new medicine coming out has been very high…”",
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      "text": "Of the 15 start forms submitted, only 3 have been approved with 6 outright denials and 4 with a soft denial, for a roughly 3:1 denial to approval ratio; and that he is in wait-and-see mode and hasn’t appealed the denials: “several have denied it...if I was to say 15, three approved it, I would probably say six denied it...and four have said premature to approve or deny...we’re waiting until we have a little more information about how to be successful with the appeals...or get a little more guidance about how to be successful from the manufacturer.”",
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      "text": "Despite submitting start forms, the endocrinologist harbors strong doubts about the drug and is just caving to families’ sense of desperation, and – shockingly – concurs with skeptical insurers - “from the insurance company’s perspective, I don’t disagree with their denials”: “I don’t think the benefit will be to the tune of the amount of money the drug costs…I’m trying to undersell the expectations…the unique thing about this patient population is just the desperation from the families to try something…and to have me say I’m not willing to try – that is not really acceptable….”",
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      "text": "denial to approval ratio: 3:1",
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      "text": "I’m very familiar with Vykat...I was monitoring all of the clinical trials and read all the publications...I feel like I know pretty much everything there is to know about Vykat. — Endocrinologist #6",
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      "text": "Source: Scorpion Capital consultation calls with experts",
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      "text": "Endocrinologist #6: Lead pediatric endocrinologist at a major academic center, one of the largest PWS clinics in the US with 30-40 patients and 11 endocrinologists – “I’m very familiar with Vykat…I was monitoring all of the clinical trials and read all the publications…I feel like I know pretty much everything there is to know about Vykat.”",
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