Bull case
Milestone Pharmaceuticals is supported by a differentiated CARDAMYST franchise that addresses an acute PSVT treatment gap with the first FDA-approved self-administered nasal spray, backed by compelling phase 3 efficacy and safety data, including a 17.2-minute median time to conversion versus 53.5 minutes for placebo and broader validation in the RAPID and JX02002 studies. Its China approval adds meaningful ex-U.S. optionality through Everest’s rights across Greater China, a $2M milestone payment, up to $98M of additional milestones, and tiered royalties of up to 18% on future sales, all without incremental commercial investment from Milestone. The core U.S. thesis remains improving coverage, now above 50%, which should reduce reimbursement friction, improve net economics from roughly $500-$1,000 per Rx for covered patients, and help prove a larger PSVT opportunity while AFib-RVR remains a sizable, largely unvalued second growth driver.