10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C.  20549

FORM 10-Q

(Mark one)

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended June 30, 2020

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from ___________ to ______________.

Commission file number: 001-38241

 

OPTINOSE, INC.

(Exact name of registrant as specified in its charter)

Delaware	42-1771610
(State of other jurisdiction of incorporation or organization)	(I.R.S. Employer Identification Number)

1020 Stony Hill Road, Suite 300

Yardley, Pennsylvania 19067

(Address of principal executive offices, including zip code)

(267) 364-3500

(Registrant’s telephone number including area code)

Securities registered pursuant to Section 12(b) of the Act:

Title of each class	Trading symbol(s)	Name of each exchange on which registered
Common stock, par value $0.001 per share	OPTN	Nasdaq Global Select Market

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No  ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes  ☒  No  ☐

        Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer ☐	Accelerated filer	☒
Non-accelerated filer ☐	Smaller reporting company	☒
	Emerging growth company	☒

 If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☒

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).Yes ☐   No ☒

The number of shares of the registrant's common stock outstanding at July 31, 2020 was 45,992,273 shares.

	NOTE REGARDING FORWARD-LOOKING STATEMENTS	1
	PART I — FINANCIAL INFORMATION
Item 1.		4
	Consolidated Balance Sheets as of June 30, 2020 and December 31, 2019	4
	Consolidated Statements of Operations for the three and six months ended June 30, 2020 and 2019	5
	Consolidated Statements of Comprehensive Loss for the three and six months ended June 30, 2020 and 2019	6
	Consolidated Statements of Changes in Stockholders' Equity for the six months ended June 30, 2020 and 2019	7
	Consolidated Statements of Cash Flows for the six months ended June 30, 2020 and 2019	8
	Notes to Unaudited Interim Consolidated Financial Statements	9
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	19
Item 3.	Qualitative and Quantitative Disclosure About Market Risk	31
Item 4.	Controls and Procedures	31
	PART II — OTHER INFORMATION	33
Item 1A.	Risk Factors	33
Item 6.	Exhibits	34
	Signatures	35

_________________________

Unless the context otherwise requires, all references in this Form 10-Q to "Optinose," "Company," "we," "us," and "our" refer to OptiNose, Inc. and its subsidiaries.

_________________________

Trademark Notice

OPTINOSE^® and XHANCE^® are trademarks of ours in the United States. All other trademarks, trade names and service marks appearing in this Form 10-Q are the property of their respective owners. We do not intend our use or display of other companies' trademarks, trade names or service marks to imply a relationship with, or endorsement or sponsorship of us by, any other companies.

NOTE REGARDING FORWARD-LOOKING STATEMENTS

This Form 10-Q contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. These statements include, among others, statements relating to:

▪the impact of, our plans regarding and the uncertainties caused by, the COVID-19 pandemic;

▪the potential uses for and advantages of XHANCE^®, our product candidates and Exhalation Delivery System (EDS) devices and technologies;

▪planned product development activities, studies and clinical trials, and related increase in expenses, in pursuit of a follow-on indication for XHANCE for the treatment of chronic sinusitis;

▪future XHANCE prescription and net revenue growth and potential drivers of such growth;

▪planned operating expense reductions;

▪commercial initiatives and objectives related to XHANCE;

▪development plans and objectives for OPN-019, the potential benefits of OPN-019 and our intention to fund initial development of OPN-019 within our current operating expense plan and to seek grants, partnerships and/or other sources of capital to fund future development;

▪the potential for the co-promote agreement with kaléo to increase promotional reach and frequency starting by the fourth quarter of 2020;

▪potential for direct to consumer (DTC) advertising to be a future driver of XHANCE prescription growth;

▪the potential benefits of our patient affordability programs and their potential effect on XHANCE demand and financial results;

▪the potential for XHANCE prescriptions to be affected by the seasonality impact observed in the intranasal steroid (INS) market;

▪the potential for XHANCE prescriptions and average net revenue per prescription to be adversely impacted by the annual resetting of patient healthcare insurance plan deductibles and changes in individual patients' healthcare insurance coverage, both of which often occur in January;

▪the potential for XHANCE to be the first drug therapy approved by the U.S. Food and Drug Administration (FDA) for the treatment of chronic sinusitis;

▪the potential for XHANCE to be the standard of care for the treatment of chronic rhinosinusitis with and without nasal polyps;

▪our intent to evaluate providing guidance for XHANCE net revenues if the effects of the COVID-19 pandemic on XHANCE net revenues become more certain;

▪our expectation that top line results from both of our ongoing chronic sinusitis trials will be available in the second half of 2021;

▪our expectation that our GAAP operating expenses in 2020 will be between $131.0 million and $136.0 million and that our non-cash stock-based compensation expense will be approximately $11.0 million;

▪the potential to be eligible for additional cash under the Pharmakon Note Purchase Agreement;

▪our expectation that our existing cash, plus potential additional cash that may become available to us under the Pharmakon Note Purchase Agreement, could fund operations until we have top line data from at least one of the chronic sinusitis trials, expected in the second half of 2021;

▪our expectation that the average net revenue per prescription will improve for the remainder of 2020;

1

▪our ability to maintain sufficient inventory of XHANCE and for our manufacturers to timely supply XHANCE; and

▪the accuracy of our estimates regarding expenses, future revenue, capital requirements and need for additional financing;

as well as other statements relating to our future operations, financial performance and financial condition, prospects, strategies, objectives or other future events. Forward-looking statements appear primarily in the sections of this Form 10-Q entitled “Item 1. Financial Statements,” and “Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations.” In some cases, you can identify forward-looking statements by words such as “may,” “will,” “could,” “would,” “should,” “expect,” “confident,” “intend,” “plan,” “anticipate,” “believe,” “estimate,” “predict,” “project,” “potential,” “continue,” “ongoing,” “scheduled” and similar expressions, although not all forward-looking statements contain these identifying words.

Forward-looking statements are based upon our current expectations and assumptions and are subject to a number of known and unknown risks, uncertainties and other factors that could cause actual results to differ materially and adversely from those expressed or implied by such statements. Factors that could cause or contribute to such differences include, but are not limited to, those discussed in this Form 10-Q and in our annual report on Form 10-K for the year ended December 31, 2019, filed with the Securities and Exchange Commission (SEC), and in particular, the risks and uncertainties discussed therein and in this Form 10-Q under the caption “Risk Factors”. Moreover, we operate in a very competitive and rapidly changing environment. New risks emerge from time to time. It is not possible for our management to predict all risks, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements we may make. As a result, you should not place undue reliance on forward-looking statements.

Additionally, the forward-looking statements contained in this Form 10-Q represent our views only as of the date of this Form 10-Q (or any earlier date indicated in such statement). While we may update certain forward-looking statements from time to time, we specifically disclaim any obligation to do so, even if new information becomes available in the future. However, you are advised to consult any further disclosures we make on related subjects in the reports that we file with the SEC.

The foregoing cautionary statements are intended to qualify all forward-looking statements wherever they may appear in this Form 10-Q. For all forward-looking statements, we claim the protection of the safe harbor for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995.

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MARKET, INDUSTRY AND OTHER DATA

This Form 10-Q contains estimates, projections, market research and other data generated by independent third parties, by third parties on our behalf and by us concerning markets for XHANCE, XHANCE market access, the INS market and prescription data. Information that is based on estimates, projections, market research or similar methodologies is inherently subject to uncertainties and actual results, events or circumstances may differ materially from results, events and circumstances reflected in this information. As a result, you are cautioned not to give undue weight to such information.

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PART I

ITEM 1. FINANCIAL STATEMENTS

OptiNose, Inc.

Consolidated Balance Sheets

(in thousands, except share and per share data)

	June 30, 2020		December 31, 2019
	(unaudited)
Assets
Current assets:
Cash and cash equivalents	$	125,266	$	147,144
Accounts receivable, net	14,096		13,643
Inventory	6,125		3,484
Prepaid expenses and other current assets	3,418		3,789
Total current assets	148,905		168,060
Property and equipment, net	2,790		3,052
Other assets	1,353		1,538
Total assets	$	153,048	$	172,650
Liabilities and stockholders' equity
Current liabilities:
Accounts payable	$	3,505	$	3,625
Accrued expenses and other current liabilities	31,393		32,514
Total current liabilities	34,898		36,139
Long-term debt, net	104,947		74,531
Other liabilities	594		397
Total liabilities	140,439		111,067
Stockholders' equity:
Common stock, $0.001 par value; 200,000,000 shares authorized at June 30, 2020 and December 31, 2019; 45,992,273 and 45,906,162 shares issued and outstanding at June 30, 2020 and December 31, 2019, respectively	46		46
Additional paid-in capital	495,329		489,565
Accumulated deficit	(482,688)		(427,980)
Accumulated other comprehensive loss	(78)		(48)
Total stockholders' equity	12,609		61,583
Total liabilities and stockholders' equity	$	153,048	$	172,650

See accompanying notes to unaudited interim consolidated financial statements

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OptiNose, Inc.

Consolidated Statements of Operations

For the Three and Six Months Ended June 30, 2020 and 2019

(in thousands, except share and per share data)

(Unaudited) 

	Three Months Ended June 30,				Six Months Ended June 30,
	2020		2019		2020		2019
Revenues:
Net product revenues	$	10,272	$	6,677	$	17,334	$	10,653
Licensing revenues	—		—		—		500
Total revenues	10,272		6,677		17,334		11,153
Costs and expenses:
Cost of product sales	1,700		1,089		3,056		1,827
Research and development	5,474		5,295		10,406		9,857
Selling, general and administrative	25,697		26,000		52,757		52,340
Total operating expenses	32,871		32,384		66,219		64,024
Loss from operations	(22,599)		(25,707)		(48,885)		(52,871)
Other (income) expense:
Interest income	(33)		(716)		(365)		(1,400)
Interest expense	3,293		2,389		6,156		4,777
Foreign currency (gains) losses	(7)		(3)		32		3
Net loss	$	(25,852)	$	(27,377)	$	(54,708)	$	(56,251)
Net loss per share of common stock, basic and diluted	$	(0.56)	$	(0.66)	$	(1.19)	$	(1.36)
Weighted average common shares outstanding, basic and diluted	45,908,104		41,310,608		45,907,133		41,283,478

See accompanying notes to unaudited interim consolidated financial statements

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OptiNose, Inc.

Consolidated Statements of Comprehensive Loss

For the Three and Six Months Ended June 30, 2020 and 2019

(in thousands)

(Unaudited) 

	Three Months Ended June 30,				Six Months Ended June 30,
	2020		2019		2020		2019
Net loss	$	(25,852)	$	(27,377)	$	(54,708)	$	(56,251)
Other comprehensive loss:
Foreign currency translation adjustment	(5)		(13)		(30)		(10)
Comprehensive loss	$	(25,857)	$	(27,390)	$	(54,738)	$	(56,261)

See accompanying notes to unaudited interim consolidated financial statements

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OptiNose, Inc.

Consolidated Statements of Changes in Stockholders' Equity

(in thousands, except share data)

Six Months Ended June 30, 2020
	Stockholders' Equity
	Common Stock			Additional Paid-in Capital		Accumulated Deficit		Accumulated Other Comprehensive Loss		Total Stockholders' Equity
	Shares	Amount
Balance at December 31, 2019	45,906,162	$	46	$	489,565	$	(427,980)	$	(48)	$	61,583
Stock compensation expense	—	—		2,429		—		—		2,429
Foreign currency translation adjustment	—	—		—		—		(25)		(25)
Net loss	—	—		—		(28,856)		—		(28,856)
Balance at March 31, 2020	45,906,162	$	46	$	491,994	$	(456,836)	$	(73)	$	35,131
Stock compensation expense	—	—		2,748		—		—		2,748
Exercise of common stock options	15,806	—		71		—		—		71
Issuance of common stock under employee stock purchase plan	70,305	—		516		—		—		516
Foreign currency translation adjustment	—	—		—		—		(5)		(5)
Net loss	—	—		—		(25,852)		—		(25,852)
Balance at June 30, 2020	45,992,273	$	46	$	495,329	$	(482,688)	$	(78)	$	12,609

Six Months Ended June 30, 2019
	Stockholders' Equity
	Common Stock			Additional Paid-in Capital		Accumulated Deficit		Accumulated Other Comprehensive Loss		Total Stockholders' Equity
	Shares	Amount
Balance at December 31, 2018	41,227,530	$	41	$	436,554	$	(317,927)	$	(57)	$	118,611
Stock compensation expense	—	—		2,425		—		—		2,425
Exercise of common stock options	5,000	—		15		—		—		15
Issuance of common stock under employee stock purchase plan	31,892	—		173		—		—		173
Foreign currency translation adjustment	—	—		—		—		3		3
Net loss	—	—		—		(28,874)		—		(28,874)
Balance at March 31, 2019	41,264,422	$	41	$	439,167	$	(346,801)	$	(54)	$	92,353
Stock compensation expense	—	—		2,716		—		—		2,716
Exercise of common stock options	88,587	—		354		—		—		354
Issuance of common stock under employee stock purchase plan	77,909	—		439		—		—		439
Foreign currency translation adjustment	—	—		—		—		(13)		(13)
Net loss	—	—		—		(27,377)		—		(27,377)
Balance at June 30, 2019	41,430,918	$	41	$	442,676	$	(374,178)	$	(67)	$	68,472

See accompanying notes to unaudited interim consolidated financial statements

7

OptiNose, Inc.

Consolidated Statements of Cash Flows

For the Six Months Ended June 30, 2020 and 2019

(in thousands)

(Unaudited) 

	Six Months Ended June 30,
	2020		2019
Operating activities:
Net loss	$	(54,708)	$	(56,251)
Adjustments to reconcile net loss to cash used in operating activities:
Depreciation and amortization	563		592
Stock-based compensation	5,232		5,117
Amortization of debt discount and issuance costs	570		234
Changes in operating assets and liabilities:
Accounts receivable	(453)		(7,001)
Grants and other receivables	—		(48)
Prepaid expenses and other assets	1,244		1,096
Inventory	(2,620)		2,803
Accounts payable	253		(4,253)
Accrued expenses and other liabilities	(1,599)		129
Cash used in operating activities	(51,518)		(57,582)
Investing activities:
Purchases of property and equipment	(309)		(423)
Cash used in investing activities	(309)		(423)
Financing activities:
Proceeds from long-term debt	34,447		—
Repayment of long-term debt	(4,447)		—
Cash paid for financing costs	(637)		—
Proceeds from issuance of common stock under employee stock purchase plan	516		612
Proceeds from the exercise of stock options	71		369
Cash provided by financing activities	29,950		981
Effects of exchange rate changes on cash and cash equivalents	(9)		(9)
Net decrease in cash, cash equivalents and restricted cash	(21,886)		(57,033)
Cash, cash equivalents and restricted cash at beginning of period	147,165		201,011
Cash, cash equivalents and restricted cash at end of period	$	125,279	$	143,978
Supplemental disclosure of noncash activities:
Fixed asset purchases within accounts payable and accrued expenses	$	82	$	35
Recognition of right-of-use assets	$	742	$	3,724
Recognition of lease liabilities	$	742	$	4,201

See accompanying notes to unaudited interim consolidated financial statements

8

OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements

(in thousands, except share and per share data)

1. Organization and Description of Business

OptiNose, Inc. (the Company) was incorporated in Delaware in May 2010 (inception) and has facilities in Yardley, Pennsylvania, Ewing, New Jersey, and Oslo, Norway. The Company's predecessor entity, OptiNose AS, was formed under the laws of Norway in September 2000. In 2010, OptiNose AS became a wholly-owned subsidiary of the Company as part of an internal reorganization.

The Company is a specialty pharmaceutical company focused on the development and commercialization of products for patients treated by ear, nose and throat (ENT) and allergy specialists. The Company's first commercial product, XHANCE^® (fluticasone propionate) nasal spray, 93 mcg, is a therapeutic utilizing its proprietary Exhalation Delivery System (EDS) device that delivers a topically-acting corticosteroid for the treatment of chronic rhinosinusitis with nasal polyps and, if approved, chronic rhinosinusitis without nasal polyps (also referred to as chronic sinusitis). XHANCE was approved by the United States (US) Food and Drug Administration (FDA) in September 2017 for the treatment of nasal polyps in patients 18 years of age or older. XHANCE was made widely available through commercial channels in April 2018.

2. Liquidity

Since inception, the Company's operations have focused on organization and staffing, business planning, raising capital, establishing an intellectual property portfolio, conducting preclinical studies and clinical trials, pursuing regulatory approvals and most recently, commercializing XHANCE in the US. As of June 30, 2020, the Company had cash and cash equivalents of $125,266.

The Company will likely require additional capital in the future secured through equity or debt financings, partnerships, collaborations, or other sources in order to meet its debt service obligations, including repayment, under the Company's outstanding senior secured notes, and to carry out the Company's planned development and commercial activities. The terms of the outstanding senior secured notes, including applicable covenants, are described in Note 8. If additional capital is not secured when required, the Company may need to delay or curtail its operations until additional funding is received.

The Company is subject to a number of risks similar to other life sciences companies, including, but not limited to, successful discovery, development and commercialization of its products and product candidates, raising additional capital, the development by its competitors of new technological innovations, protection of proprietary technology and market acceptance of the Company's products.

3. Basis of Presentation and Summary of Significant Accounting Policies

The accompanying unaudited interim consolidated financial statements have been prepared in conformity with US generally accepted accounting principles (GAAP). Any reference in these notes to applicable guidance is meant to refer to GAAP as found in the Accounting Standards Codification (ASC) and Accounting Standards Updates (ASU) of the Financial Accounting Standards Board (FASB).

In the opinion of management, the accompanying unaudited interim financial statements include all normal and recurring adjustments (which consist primarily of accruals and estimates that impact the financial statements) considered necessary to present fairly the Company's financial position as of June 30, 2020 and its results of operations for the three and six months ended June 30, 2020 and 2019 and cash flows for the six months ended June 30, 2020 and 2019. Operating results for the three and six months ended June 30, 2020 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020. The unaudited interim financial statements, presented herein, do not contain the required disclosures under GAAP for annual financial statements. The accompanying unaudited interim financial statements should be read in conjunction with the annual audited financial statements and related notes as of and for the year ended December 31, 2019 contained in the Company’s annual report on Form 10-K for the year ended December 31, 2019, filed with the SEC on March 5, 2020.

9

OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements (Continued)

(in thousands, except share and per share data)

Use of estimates

The preparation of the unaudited interim consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited interim consolidated financial statements and reported amounts of expenses during the reporting period. Due to the uncertainty of factors surrounding the estimates or judgments used in the preparation of the unaudited interim consolidated financial statements, actual results may materially vary from these estimates. Estimates and assumptions are periodically reviewed and the effects of revisions are reflected in the unaudited interim consolidated financial statements in the period they are determined to be necessary.

Concentration of credit risk

Financial instruments that potentially subject the Company to concentrations of credit risk are primarily cash and accounts receivable. The Company generally invests its cash in deposits with high credit quality financial institutions. Additionally, the Company performs periodic evaluations of the relative credit standing of these financial institutions.

Customer and supplier concentration

XHANCE is sold to wholesale pharmaceutical distributors and Preferred Pharmacy Network (PPN) partners, who, in turn, sell XHANCE to pharmacies, hospitals and other customers. Five customers represent approximately 51% of the Company's accounts receivable at June 30, 2020 and five customers represent approximately 48% and 49% of the Company's net product sales for the three and six months ended June 30, 2020, respectively.

The Company purchases XHANCE and its components from several third-party suppliers and manufacturing partners, certain of which are available through a single source. Although the Company could obtain each of these components from alternative third-party suppliers, it would need to qualify and obtain FDA approval for another supplier as a source for each such component.

Fair value of financial instruments

At June 30, 2020 and December 31, 2019, the Company's financial instruments included cash and cash equivalents, accounts receivable, grants receivable, accounts payable and accrued expenses. The carrying amounts reported in the Company's financial statements for these instruments approximate their respective fair values because of the short-term nature of these instruments. In addition, at June 30, 2020, the Company believes the carrying value of long-term debt approximates fair value as the interest rates are reflective of the rate the Company could obtain on debt with similar terms and conditions. At June 30, 2020 and December 31, 2019, there were no financial assets or liabilities measured at fair value on a recurring basis.

Restricted cash

As of June 30, 2020 and December 31, 2019, the restricted cash balance included in prepaid expenses and other assets was $13 and $21, respectively.

Net product revenues

The Company accounts for revenue in accordance with ASC Topic 606, Revenue from Contracts with Customers (ASC 606), which was adopted on January 1, 2018. The Company recognizes revenue from XHANCE sales at the point customers obtain control of the product, which generally occurs upon delivery. The transaction price that is recognized as revenue for products includes an estimate of variable consideration. The Company’s estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of its anticipated performance and all information (historical, current and forecasted) that is reasonably available. The components of the Company’s variable consideration include the following:

Provider Chargebacks and Discounts. Chargebacks for fees and discounts to providers represent the estimated obligations resulting from contractual commitments to sell products to qualified healthcare providers at prices lower

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OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements (Continued)

(in thousands, except share and per share data)

than the list prices charged to customers who directly purchase the product from the Company. Customers charge the Company for the difference between what they pay for the product and the ultimate selling price to the qualified healthcare providers. These components of variable consideration are established in the same period that the related revenue is recognized, resulting in a reduction of product revenue and accounts receivable.

Trade Discounts and Allowances. The Company generally provides customers with discounts that include incentive fees which are explicitly stated in the Company’s contracts. These discounts are recorded as a reduction of revenue and accounts receivable in the period in which the related product revenue is recognized.

Product Returns. Consistent with industry practice, the Company has a product returns policy that provides customers a right of return for product purchased within a specified period prior to and subsequent to the product’s expiration date. The Company estimates the amount of its product that may be returned and presents this amount as a reduction of revenue in the period the related product revenue is recognized, in addition to establishing a liability. The Company considers several factors in the estimation process, including expiration dates of product shipped to customers, inventory levels within the distribution channel, product shelf life, prescription trends and other relevant factors.

Government Rebates. The Company is subject to discount obligations under state Medicaid programs and Medicare. Reserves related to these discount obligations are recorded in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a current liability. The Company’s liability for these rebates consists of estimates of claims for the current quarter and estimated future claims that will be made for product that has been recognized as revenue but remains in the distribution channel inventories at the end of the reporting period.

Payor Rebates. The Company contracts with certain third-party payors, primarily health insurance companies and pharmacy benefit managers, for the payment of rebates with respect to utilization of its products. These rebates are based on contractual percentages applied to the amount of product prescribed to patients who are covered by the plan or the organization with which it contracts. The Company estimates these rebates and records such estimates in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a current liability.

Patient Assistance. Other programs that the Company offers include voluntary co-pay patient assistance programs intended to provide financial assistance to eligible patients with prescription drug co-payments required by payors and coupon programs for cash payors. The calculation of the current liability for this assistance is based on an estimate of claims and the cost per claim that the Company expects to receive associated with product that has been recognized as revenue but remains in the distribution channel inventories at the end of each reporting period.

Licensing revenues

The Company has license agreements with Inexia Limited (Inexia) and Currax Pharmaceuticals LLC (Currax). These license agreements provide for exclusive licensed rights to certain intellectual property, a non-refundable up-front payment, potential milestone payment(s) and potential royalty payment(s). The Company analyzed the performance obligations under the license agreements, the consideration received to date and the consideration the Company could receive in the future as part of its analysis related to ASC 606. No licensing revenues were recognized during the three and six months ended June 30, 2020 (Note 7).

Net income (loss) per common share

Basic net income (loss) per common share is determined by dividing net income (loss) applicable to Company common stock (Common Stock) holders by the weighted average common shares outstanding during the period. For the three and six months ended June 30, 2020 and 2019, the outstanding Common Stock options, Common Stock warrants and shares to be issued under the Company's 2017 Employee Stock Purchase Plan have been excluded from the calculation of diluted net loss per share because their effect would be anti-dilutive. Therefore, the weighted average shares used to calculate both basic and diluted net loss per share are the same.

11

OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements (Continued)

(in thousands, except share and per share data)

Diluted net loss per common share for the periods presented do not reflect the following potential common shares, as the effect would be antidilutive:

	June 30,
	2020	2019
Stock options	8,385,831	7,983,370
Restricted stock units	1,274,354	—
Common stock warrants	2,677,188	1,866,831
Total	12,337,373	9,850,201

Income taxes

In accordance with ASC 270, Interim Reporting, and ASC 740, Income Taxes, the Company is required at the end of each interim period to determine the best estimate of its annual effective tax rate and then apply that rate in providing for income taxes on a current year-to-date (interim period) basis. For the three and six months ended June 30, 2020 and 2019, the Company recorded no tax expense or benefit due to the expected current year loss and its historical losses. As of June 30, 2020 and December 31, 2019, the Company has concluded that a full valuation allowance is necessary for all of its net deferred tax assets. The Company had no amounts recorded for uncertain tax positions, interest or penalties in the accompanying consolidated financial statements.

Recent accounting pronouncements

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. ASU 2019-12 eliminated certain exceptions and changed guidance on other matters. The exceptions relate to the allocation of income taxes in separate company financial statements, tax accounting for equity method investments and accounting for income taxes when the interim period year-to-date loss exceeds the anticipated full year loss. Changes relate to the accounting for franchise taxes that are income-based and non-income-based, determining if a step up in tax basis is part of a business combination or if it is a separate transaction, when enacted tax law changes should be included in the annual effective tax rate computation, and the allocation of taxes in separate company financial statements to a legal entity that is not subject to income tax. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, with early adoption permitted. The Company is currently evaluating the potential impact of the adoption of this standard on its results of operations, financial position and cash flows and related disclosures.

In August 2018, the FASB issued ASU No. 2018-15, Customer's Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract.  ASU 2018-15 requires that certain implementation costs incurred in a cloud computing arrangement be deferred and recognized over the term of the arrangement. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019, and early adoption is permitted. The Company adopted ASU 2016-02 on January 1, 2020 using the prospective transition method, which did not have a material impact on the Company’s results of operations, financial position, cash flows and related disclosures.

In August 2018, the FASB issued ASU No. 2018-13, Disclosure Framework - Changes to the Disclosure Requirements for Fair Value Measurement.  ASU 2018-13 resulted in certain modifications to fair value measurement disclosures, primarily related to level 3 fair value measurements. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019, and early adoption is permitted. The Company adopted ASU 2018-13 on January 1, 2020, which did not have a material impact on the Company’s disclosures.

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. ASU 2016-03, in conjunction with ASU No. 2019-04, Codification Improvements to Topic 326, Financial Instruments - Credit Losses, Topic 815, Derivatives and Hedging, and Topic 825, Financial Instruments, introduces an approach, based on expected losses, to estimate credit losses on certain types of financial instruments and modifies the impairment model for available-for-sale debt securities. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15,

12

OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements (Continued)

(in thousands, except share and per share data)

2022 for companies deemed to be smaller reporting companies as of November 15, 2019, with early adoption permitted. The Company is currently evaluating the potential impact of the adoption of this standard on its results of operations, financial position and cash flows and related disclosures.

4. Inventory

Inventory consisted of the following:

	June 30, 2020		December 31, 2019
Raw materials	$	1,796	$	1,227
Work-in-process	1,745		676
Finished goods	2,584		1,581
Total inventory	$	6,125	$	3,484

Inventories are stated at the lower of cost or net realizable value, as determined on a first-in, first-out, basis.

5. Property and Equipment

Property and equipment, net, consisted of the following:

	June 30, 2020		December 31, 2019
Computer equipment and software	$	1,102	$	1,112
Furniture and fixtures	366		366
Machinery and equipment	3,122		3,142
Leasehold improvements	609		609
Construction in process	357		70
	5,556		5,299
Less: accumulated depreciation	(2,766)		(2,247)
	$	2,790	$	3,052

Depreciation expense was $254 and $322 for the three months ended June 30, 2020 and 2019, respectively. Depreciation expense was $562 and $591 for the six months ended June 30, 2020 and 2019, respectively. In addition, depreciation expense of $259 and $10 was charged to inventory and prepaid expenses and other assets, respectively, as of June 30, 2020, which represents depreciation expense related to equipment involved in the manufacturing process.

13

OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements

(in thousands, except share and per share data)

6. Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of:

	June 30, 2020		December 31, 2019
Accrued expenses:
Selling, general and administrative expenses	$	5,469	$	5,544
Research and development expenses	4,468		3,379
Payroll expenses	5,309		7,810
Product revenue allowances	13,386		12,858
Other	1,505		1,788
Total accrued expenses	30,137		31,379
Other current liabilities:
Lease liability	1,256		1,135
Total other current liabilities	1,256		1,135
Total accrued expenses and other current liabilities	$	31,393	$	32,514

7. Licensing Revenue

Inexia License Agreement

On January 31, 2019, OptiNose AS entered into a license agreement (the Inexia License Agreement) with Inexia Limited (Inexia) pursuant to which the Company granted Inexia an exclusive worldwide license to certain intellectual property for the development and commercialization of products containing orexin receptor agonist and/or orexin receptor positive modulator molecules for the treatment, diagnosis or prevention of human diseases or conditions associated primarily with orexin receptor agonism and orexin receptor positive modulation.

Under the terms of the Inexia License Agreement, Inexia paid the Company a $500 upfront payment, which was recognized as license revenue in the first quarter of 2019. For each product developed under the Inexia License Agreement, the Company is eligible to receive up to $8,000 of development milestone payments and up to $37,000 of sales milestone payments. In addition, the Company is eligible to receive tiered, low-to-mid single digit royalties based on net sales of any products successfully developed and commercialized under the Inexia License Agreement. Other than the upfront payment, the Company does not anticipate the receipt of any milestone or royalty payments from Inexia in the near term.

8. Long-term Debt

On September 12, 2019 (the Closing Date), the Company entered into a Note Purchase Agreement (the Pharmakon Senior Secured Notes) with funds managed by Pharmakon Advisors, LP (Pharmakon), the investment manager of the BioPharma Credit funds (BioPharma). The Pharmakon Senior Secured Notes provide the Company with up to $150,000 in debt financing, of which $80,000 was issued on the Closing Date. On February 13, 2020, the Company received an additional $30,000 (the First Delayed Draw Notes) after achieving the $9,000 XHANCE net sales and royalties threshold for the quarter ended December 31, 2019.

At the Company's option, $20,000 of Pharmakon Senior Secured Notes may be issued between August 15, 2020 and February 15, 2021 (the Third Delayed Draw Notes, and together with the First Delayed Draw Notes and Second Delayed Draw Notes, collectively, the Delayed Draw Notes) subject to the Company achieving either (x) XHANCE net sales and royalties for the quarter ended September 30, 2020 of at least $14,500 or (y) XHANCE net sales and royalties for the six months ended December 31, 2020 of at least $31,000.

The issuance of the Third Delayed Draw Notes is not conditioned upon the issuance of the Second Delayed Draw Notes. Additionally, upon the closing date of the Third Delayed Draw Notes (subject to the Company’s satisfaction of the net sales and royalties thresholds applicable to the Third Delayed Draw Notes), the Company may request and BioPharma may issue, in its sole discretion, up to an additional $20,000 of Pharmakon Senior Secured Notes

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OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements

(in thousands, except share and per share data)

(representing the Second Delayed Draw Notes for which the Company did not satisfy the net sales and royalty thresholds for the quarter ended March 31, 2020 or the six months ended June 30,2020).

The Pharmakon Senior Secured Notes bear interest at a fixed per annum rate of 10.75% and are scheduled to mature on September 12, 2024 (the Maturity Date). The Company is required to make quarterly interest payments until the Maturity Date. The Company is also required to make principal payments, which are payable in eight equal quarterly installments beginning on December 15, 2022 and continuing until the Maturity Date; provided that the Company may, at its election, postpone any such principal payment until the Maturity Date if, as of the applicable payment date, certain trailing four-quarter consolidated XHANCE net sales and royalties thresholds have been achieved.

In conjunction with the Pharmakon Senior Secured Notes, the Company paid an upfront fee of $1,125 on the Closing Date and issued warrants to purchase an aggregate of 810,357 shares of Common Stock at an exercise price equal to $6.72 per share, which expire on September 12, 2022. The upfront fees were recorded as debt discount at issuance and are being amortized to interest expense over the five year term of the loan. The Company also incurred $4,991 in debt issuance costs, including $2,404 related to the fair value of the warrants and $150 associated with the First Delayed Draw Notes, which are also being amortized to interest expense over the term of the Pharmakon Senior Secured Notes. The Company will incur additional debt issuance costs of 0.5% of the principal amount of the remaining Delayed Draw Notes, if issued.

The Company is required to repay the Pharmakon Senior Secured Notes in full upon the occurrence of a change of control (as defined in the Note Purchase Agreement). In addition, the Company may make voluntary prepayments in whole or in part. All mandatory and voluntary prepayments are subject to the payment of prepayment premiums as follows: (i) if prepayment occurs prior to the third anniversary of the Closing Date, an amount equal to 2% of the principal prepaid, (ii) if prepayment occurs on or after the third anniversary of the Closing Date but prior to the fourth anniversary of the Closing Date, an amount equal to 1% of the principal prepaid, and (iii) if prepayment occurs on or after the fourth anniversary of the Closing Date, no prepayment premium is required. Additionally, the Company is also required to pay a "make-whole" amount in respect of any principal payments (whether mandatory or voluntary) made prior to the 30-month anniversary of the issuance of the applicable note, in an amount equal to the interest that would have accrued through the 30-month anniversary in respect of such note but for such principal payment.

The Pharmakon Senior Secured Notes are secured by a pledge of substantially all of the Company's assets and contains affirmative and negative covenants customary for financings of this type, including limitations on the Company’s and its subsidiaries’ ability, among other things, to incur additional debt, grant or permit additional liens, make investments and acquisitions, merge or consolidate with others, dispose of assets, pay dividends and distributions, repay junior indebtedness and enter into affiliate transactions, in each case, subject to certain exceptions. In addition, the Pharmakon Senior Secured Notes contain financial covenants requiring the Company to maintain at all times certain minimum trailing twelve-month consolidated XHANCE net sales and royalties, tested on a quarterly basis, and at least $30,000 of cash and cash equivalents. As of June 30, 2020, the Company was in compliance with the covenants.

The Note Purchase Agreement also includes events of default customary for financings of this type, in certain cases subject to customary periods to cure, following which BioPharma may accelerate all amounts outstanding under the notes.

On September 12, 2019, in conjunction with the entry into the Pharmakon Senior Secured Notes, the Company terminated the Athyrium senior secured notes and all outstanding amounts under such notes were repaid in full, and all security interests and other liens granted to or held by Athyrium were terminated and released.

The Company recorded interest expense of $3,293 and $2,389 during the three months ended June 30, 2020 and 2019, respectively, and $6,156 and $4,777 during the six months ended June 30, 2020 and 2019, respectively, in conjunction with both Pharmakon Senior Secured Notes and the Athyrium senior secured notes. Interest expense included total coupon interest, exit fees, front end fees and the amortization of debt issuance costs.

The long-term debt balance is comprised of the following:

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OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements

(in thousands, except share and per share data)

	June 30, 2020		December 31, 2019
Face amount	$	110,000	$	80,000
Front end fees	(956)		(1,030)
Debt issuance costs	(4,097)		(4,439)
Long-term debt, net	$	104,947	$	74,531

9. Employee Benefit Plans

For US employees, the Company maintains a defined contribution 401(k) retirement plan. As of June 30, 2020, approximately $97 is recorded in accrued liabilities related to the Company match. The Company's contributions are made in cash.

For Norway and UK employees, the Company maintains defined contribution pension plans which meet the statutory requirements of those jurisdictions. The Company incurred costs related to the pension plans of $5 for the three months ended June 30, 2020 and 2019, and $10 and $11 for the six months ended June 30, 2020 and 2019, respectively.

10. Stockholders' Equity

As of June 30, 2020, the Company had the following warrants outstanding to purchase shares of Common Stock:

Number of Shares	Exercise Price Per Share		Expiration Date
1,866,831	$	8.16	November 1, 2020
810,357	$	6.72	September 12, 2022

11. Stock-based Compensation

The Company recorded stock-based compensation expense related to stock options and shares issued under the Company's 2017 Employee Stock Purchase Plan (2017 Plan) in the following expense categories of its accompanying consolidated statements of operations for the three and six months ended June 30, 2020 and 2019:

	Three Months Ended June 30,				Six Months Ended June 30,
	2020		2019		2020		2019
Cost of product sales	$	34	$	26	$	88	$	45
Research and development	331		284		588		527
General and administrative	2,407		2,387		4,556		4,545
	$	2,772	$	2,697	$	5,232	$	5,117

In addition, stock-based compensation expense of $52 and $1 was charged to inventory and prepaid expenses and other assets, respectively, during the six months ended June 30, 2020, which represents the total stock-based compensation expense incurred related to employees involved in the manufacturing process of finished goods and samples during the period.

16

OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements

(in thousands, except share and per share data)

Stock Options

The Company issues stock-based awards pursuant to its 2010 Stock Incentive Plan. Effective as of October 12, 2017, the Company's 2010 Stock Incentive Plan was amended and restated (A&R Plan).The Company has issued service-based and performance-based stock options that generally have a contractual life of up to 10 years and may be exercisable in cash or as otherwise determined by the Company's board of directors or committee thereof. Vesting generally occurs over a period of not greater than four years. Performance-based options may vest upon the achievement of certain milestones in connection with the Company's development programs. Additionally, the Company has issued stock options in excess of the fair market value of Common Stock on the issuance date that were only exercisable upon a change in control or upon or after an initial public offering. As of June 30, 2020, all of the performance conditions related to performance-based stock options issued by the Company have been achieved.

The following table summarizes the activity related to stock option grants to employees and nonemployees for the six months ended June 30, 2020:

	Shares	Weighted average exercise price per share		Weighted average remaining contractual life
Outstanding at December 31, 2019	7,399,217	$	9.81	6.37
Granted	1,259,331	5.64
Exercised	(15,806)	4.50
Expired	—	—
Forfeited	(256,911)	9.91
Outstanding at June 30, 2020	8,385,831	$	9.19	6.37
Exercisable at June 30, 2020	5,236,017	$	9.47	4.92
Vested and expected to vest at June 30, 2020	8,385,831	$	9.19	6.37

During the six months ended June 30, 2020, stock options to purchase 1,259,331 shares of Common Stock were granted to employees and generally vest over four years. The stock options had an estimated weighted average grant date fair value of $3.44. During the six months ended June 30, 2019, stock options to purchase 2,013,173 shares of Common Stock were granted to employees that generally vest over four years. The stock options had an estimated weighted average grant date fair value of $4.80.

Included in the table above are 90,000 of options granted outside the A&R Plan. The grants were made pursuant to the NASDAQ inducement grant exception in accordance with NASDAQ Listing Rule 5635(c)(4).

The grant date fair value of each stock option grant was estimated at the time of grant using the Black-Scholes option-pricing model using the following weighted average assumptions:

	Six Months Ended June 30,
	2020			2019
Risk free interest rate	0.72		%	2.51		%
Expected term (in years)	6.03			6.05
Expected volatility	68.64		%	67.02		%
Annual dividend yield	0.00		%	0.00		%
Fair value of common stock	$	5.64		$	7.73

At June 30, 2020, the unrecognized compensation cost related to unvested stock options expected to vest was $17,030. This unrecognized compensation will be recognized over an estimated weighted-average amortization period of 2.29 years.

17

OptiNose, Inc.

Notes to Unaudited Interim Consolidated Financial Statements

(in thousands, except share and per share data)

Restricted Stock Units

The Company has issued service-based and performance-based restricted stock units (RSUs). Vesting generally occurs over a period not greater than four years. Vesting of the performance-based RSUs is subject to the achievement of certain milestones in connection with the Company's development programs.

The following table summarizes the activity related to RSUs granted to employees for the six months ended June 30, 2020:

	Shares
Balance at December 31, 2019	—
Granted	1,290,203
Vested and settled	—
Expired/ forfeited/ canceled	(15,849)
Balance at June 30, 2020	1,274,354
Expected to vest at June 30, 2020	1,274,354

In March 2020, the Company granted 1,290,203 RSUs at a grant date fair value of $5.41, of which 718,150 were service-based RSUs and 572,053 were performance-based RSUs. As of June 30, 2020, the milestones associated with the performance based-RSUs are not probable of achievement, and accordingly, no stock based compensation expense has been recognized to date for these awards. At June 30, 2020, the unrecognized compensation cost related to unvested service-based RSUs expected to vest was $3,502, to be recognized over an estimated weighted-average amortization period of 3.71 years. The unrecognized compensation cost related to unvested performance-based RSUs was $3,095, which will be recognized commencing in the period in which the performance condition is deemed probable of achievement over the remaining service period.

Included in the table above are 60,000 of RSUs granted outside the A&R Plan. The grants were made pursuant to the NASDAQ inducement grant exception in accordance with NASDAQ Listing Rule 5635(c)(4).

2017 Employee Stock Purchase Plan

Under the 2017 Plan, shares of Common Stock may be purchased by eligible employees who elect to participate in the 2017 Plan at 85% of the lower of the fair market value of Common Stock on the first or last day of designated offering periods. The Company recognized stock-based compensation expense of $137 and $114 during the three months ended June 30, 2020 and 2019, respectively, and $287 and $228 during the six months ended June 30, 2020 and 2019, respectively, related to the 2017 Plan.

The Company calculated the fair value of each option grant and the shares issued under the 2017 Plan on the respective dates of grant using the following weighted average assumptions:

	Six Months Ended June 30,
	2020		2019
Risk free interest rate	1.57	%	2.51	%
Expected term (in years)	0.5		0.5
Expected volatility	79.59	%	82.20	%
Annual dividend yield	0.00	%	0.00	%

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ITEM 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

You should read this section in conjunction with our unaudited interim consolidated financial statements and related notes included in Part I. Item 1 of this Form 10-Q and our audited consolidated financial statements and related notes thereto and "Management’s Discussion and Analysis of Financial Condition and Results of Operations" included in our Annual Report on Form 10-K for the year ended December 31, 2019, filed with the Securities and Exchange Commission (SEC) on March 5, 2020. In addition to historical information, some of the information contained in this discussion and analysis includes forward-looking statements that involve risks and uncertainties. As a result of many factors, our actual results could differ materially from the results described in or implied by such forward-looking statements. Please refer to the "Note Regarding Forward-Looking Statements" section of this Form 10-Q for additional information.

Company Overview

We are a specialty pharmaceutical company focused on the development and commercialization of products for patients treated by ear, nose and throat (ENT) and allergy specialists. Our first commercial product, XHANCE^® (fluticasone propionate) nasal spray, 93 micrograms (mcg), is a therapeutic utilizing our proprietary Exhalation Delivery System (EDS) device that delivers a topically-acting corticosteroid for the treatment of chronic rhinosinusitis with nasal polyps and, if approved, chronic rhinosinusitis without nasal polyps (also referred to as chronic sinusitis). Chronic rhinosinusitis is a serious nasal inflammatory disease that is treated using therapies, such as intranasal steroids (INS), which have significant limitations. We believe XHANCE has a differentiated clinical profile with the potential to become part of the standard of care for this disease because it is able to deliver medication to the primary site of inflammation high and deep in the nasal passages in regions not adequately reached by conventional INS.

In September 2017, the U.S. Food and Drug Administration (FDA) approved XHANCE for the treatment of nasal polyps in patients 18 years of age or older. XHANCE was made widely available through commercial channels in April 2018.

Business Updates in Response to the COVID-19 Pandemic

The COVID-19 pandemic has caused business and economic disruption, and the duration and impact of that disruption is uncertain at this time.

•In mid-March 2020, we transitioned to a full-time, virtual work environment in which all employees, including sales representatives (whom we refer to as territory managers), were encouraged to work from their place of residence. Our decision was based on actions taken by federal, state and local governments to contain the spread of severe acute respiratory coronavirus 2 (SARS-CoV-2) and the related Coronavirus Disease 2019 (COVID-19), as well as the impact of “social distancing” efforts and various mitigation actions implemented by healthcare practices across the United States.

•Federal, state and local government requirements and guidances have impacted virtually all of the physicians' offices in which our territory managers detail XHANCE. These impacts include reduced patient visits, temporary halt of territory managers' visits, and temporary closings of physicians' offices. Shortly after our transition to a full-time, virtual work environment, our territory managers began virtual details of XHANCE to target audience physicians.

•We have been monitoring, and will continue to monitor, federal, state, and local government requirements and guidances. In certain instances, the various mitigation efforts have been updated to facilitate a return to a working environment with fewer restrictions. Where permitted by local requirements and the policies of physician offices, our territory managers began to return to in-person detailing of physicians in May and June. Given the localized nature of the restrictions that are in place and the potential for restrictions to return we have equipped our territory managers to operate in an environment that will include a mix of virtual and in-person physician detailing with dependencies on geography and time.

•Late in the first quarter we began to observe an adverse impact of the COVID-19 pandemic on XHANCE prescription growth. This adverse impact was most pronounced during the "shelter-in-place" mitigation efforts that were prevalent from late-March through May. Although XHANCE prescription growth (and in particular, new prescription growth) continues to be adversely impacted by the COVID-19 pandemic, the magnitude of the impact has slowly improved as federal, state and local government requirements and guidances have been updated to facilitate economic reopening. Based on third-party prescription data as

19

well as data from Preferred Pharmacy Network (PPN) partners, XHANCE prescriptions increased 11% from first quarter 2020 to second quarter 2020. Although XHANCE prescriptions have grown during this initial COVID-19 period, the rate of growth was below our pre-pandemic expectations. Due to the adverse effect of the COVID-19 pandemic on XHANCE prescription growth to date, as well as the unknown effect in the future, we withdrew our previous XHANCE revenue guidance for 2020. If the effects of the COVID-19 pandemic on XHANCE net revenues become more certain, we will evaluate providing guidance for XHANCE net revenues. Additionally, the duration and magnitude of the negative impact from the COVID-19 pandemic on XHANCE net revenue are uncertain and may affect the availability of additional capital under our Pharmakon Note Purchase Agreement and our ability to remain in compliance with our revenue covenants thereunder.

•Due to the impacts of the COVID-19 pandemic, one of our contract manufacturers implemented a reduced work schedule and additional precautions which resulted in delays relating to the manufacture of XHANCE in second quarter 2020 but did not result in an interruption to commercial or clinical supply. Currently, all of our manufacturers are manufacturing XHANCE finished goods on time. Additionally, we believe we are maintaining appropriate levels of finished product inventories in the event of future supply disruption, however, the duration and magnitude of a future negative impact from COVID-19 could constrain our supply of XHANCE.

•Previous guidance related to the expected timing of results from our ongoing chronic sinusitis trials indicated that results from both trials would be available in the second half of 2021. Pauses in patient enrollment due to factors related to COVID-19 have had, and may continue to have, varying effects in different geographies and over time but have not yet led to a change in our projected timeline for initial data availability. For those subjects currently participating in these studies, procedures to facilitate ongoing treatment and capture of data during periods of in-person care restrictions have been put in place.

•In light of the uncertainties created by the COVID-19 pandemic, in May 2020 we announced actions to reduce 2020 operating expenses while preserving our ability to drive XHANCE growth and complete our ongoing chronic sinusitis trials. These expense reductions include a reprioritization of project spending, a reduction in payroll costs, and lower near-term clinical trial expenses as the result of temporarily paused patient enrollment at research sites in response to the acute COVID-19 environment.

The full impact of the COVID-19 pandemic on our business is still unknown. It is likely to continue to have negative impacts on XHANCE prescription growth and net revenues as a result of fewer patients visiting physician offices, rising unemployment adversely affecting demand and payor mix, and the availability and cost of capital for us to fund our business operations and service our debt. We will continue to assess the evolving impact of the COVID-19 pandemic and will make adjustments to our operations as necessary.

Additional Business Updates

We track and report metrics that we believe are an important part of assessing our progress in key strategic areas including:

•XHANCE Prescriptions and Market Share. Based on third-party prescription data as well as data from PPN partners, the total estimated number of XHANCE prescriptions in the second quarter of 2020 was 62,500, which represents 84% growth for prescriptions when compared to estimated second quarter 2019 prescriptions of 33,900. The INS prescription market decreased approximately 12% from second quarter 2019 to second quarter 2020 based on third-party prescription data. In addition, the total estimated number of XHANCE prescriptions was 43,000 in the third quarter of 2019, 54,300 in the fourth quarter of 2019, and 56,100 in the first quarter of 2020.

A seasonal effect has historically been observed in the INS prescription market in which market volume generally peaks near the middle of the second quarter and declines into the early part of the third quarter of each calendar year. As the result of the COVID-19 pandemic we expect the market volume peak and subsequent declines to be different in 2020. Based on third-party prescription data, the INS market decreased 11% from the second quarter of 2019 to the third quarter of 2019, increased 9% from the third quarter of 2019 to the fourth quarter of 2019, increased 8% from the fourth quarter of 2019 to the first quarter of 2020, and decreased 16% from the first quarter of 2020 to the second quarter of 2020.

Although the underlying disease that we are treating is chronic and causes symptoms year-round, we believe the variation in patient flow through the offices of relevant specialists, and seasonality in disease flare-ups, has an impact on the number of patients that present themselves and who are therefore available

20

to receive a new prescription for XHANCE. Demand has historically been, and we expect will continue to be, impacted by the INS market seasonality and the seasonal variation in patient visits with their doctor resulting in reduced XHANCE prescription demand in the third quarter. Additionally, as we experienced in 2020, we expect that the first quarter prescription demand and average net revenue per prescription for XHANCE will be adversely impacted in future years by the annual resetting of patient healthcare insurance plan deductibles and changes in individual patients' healthcare insurance coverage, both of which often occur in January.

We track the market share of XHANCE within our current target audience. For this purpose, we calculate market share as the proportion of XHANCE prescriptions to the number of prescriptions written for other INS within our current target audience of over 10,000 physicians. We believe market share, in addition to XHANCE prescription volume, provides important information regarding XHANCE utilization because market share normalizes XHANCE prescriptions for market effects including the INS market seasonality, seasonal variation in patient visits with their doctor, annual deductible resets and annual changes in individual patient's healthcare insurance coverage referenced above. Based on third-party prescription data as well as data from PPN partners, we estimate XHANCE had a market share of 2.2% in the second quarter of 2019, 3.0% in the third quarter of 2019, 3.5% in the fourth quarter of 2019, 3.8% in the first quarter of 2020, and 5.6% in the second quarter of 2020. Note that most of the INS prescriptions written within our target physician audience are for chronic sinusitis, allergic rhinitis and other conditions outside of our nasal polyp indication. Our target physician audience is subject to revision each quarter to account for changes such as revised sales target prioritization, and physician retirements. Changes to the target physician audience can contribute some of the quarter over quarter change in market share.

•XHANCE New Prescriptions and Refill Prescriptions. The underlying disease that we are treating is chronic and, as a result, many patients may fill multiple prescriptions per year. We monitor new prescriptions as they create the potential for future refill prescriptions. Based on third-party prescription data as well as data from PPN partners, the total estimated number of XHANCE new prescriptions in the second quarter of 2020 was 18,700, which represents 20% growth for new prescriptions when compared to estimated second quarter 2019 new prescriptions of 15,600. In addition, the total estimated number of XHANCE new prescriptions was 17,800 in the third quarter of 2019, 21,200 in the fourth quarter of 2019 and 22,300 in the first quarter of 2020. Based on third-party prescription data, the INS market for New Prescriptions decreased 25% from the second quarter of 2019 to the second quarter of 2020 and decreased 30% from the first quarter of 2020 to the second quarter of 2020.

We track refill prescriptions and provide patient assistance to support refill programs that are administered by our PPN partners. Based on third-party prescription data as well as data from PPN partners, the total estimated number of XHANCE refill prescriptions in the second quarter of 2020 was 43,800, which represents 139% growth for refill prescriptions when compared to estimated second quarter 2019 refill prescriptions of 18,400. In addition, the total estimated number of XHANCE refill prescriptions was 25,200 in the third quarter of 2019, 33,000 in the fourth quarter of 2019, and 33,700 in the first quarter of 2020.

•Prescribing Breadth and Depth. We track the number of physicians who prescribe XHANCE in a time period to evaluate the breadth of prescribing. Based on third-party prescription data as well as data from PPN partners, the total estimated number of physicians who had at least one patient fill a prescription for XHANCE in the second quarter of 2020 was 6,209, which represents 40% growth when compared to the estimated 4,442 physicians who had at least one patient fill a prescription for XHANCE in the second quarter of 2019. In addition, the total estimated number of physicians who had at least one patient fill a prescription for XHANCE was 5,075 in the third quarter of 2019, 5,859 in the fourth quarter of 2019, and 6,345 in the first quarter of 2020.

We also track the number of prescriptions filled by a prescribing physician's patients in a time period to evaluate depth of prescribing. Based on third-party prescription data as well as data from PPN partners, the total estimated number of physicians who had more than 15 XHANCE prescriptions filled by their patients in the second quarter of 2020 was 1,028, which represents 97% growth when compared to the estimated 523 physicians who had more than 15 XHANCE prescriptions filled by their patients in the second quarter of 2019. In addition, the total estimated number of physicians who had more than 15 XHANCE prescriptions filled by their patients was 665 in the third quarter of 2019, 828 in the fourth quarter of 2019, and 895 in the first quarter of 2020.

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Sales, Marketing & Distribution

We have established a commercial infrastructure designed to drive adoption and sales of XHANCE with healthcare professionals who treat patients with nasal polyps. We believe that approximately 15,000 physicians treat an estimated 3.5 million chronic rhinosinusitis patients, an estimated 1.2 million of whom have chronic rhinosinusitis with nasal polyps.

Customer Model We have hired and deployed approximately 100 territory managers into unique, geographically-defined territories. These territory managers target over 10,000 ENTs, allergists and “specialty-like” primary care physicians, and we target additional physicians through digital and non-personal promotion in areas where we do and do not have territory managers. Our sales team is equipped with educational materials demonstrating the benefit and safety profile of XHANCE. In the future we may increase the number of geographic territories as well as hire additional territory managers in order to increase the number of called-on target physicians and frequency of calls. We believe that in the long term, direct to consumer (DTC) advertising could be an effective way to increase XHANCE prescription growth. In the second half of 2019 we conducted a single-season, multi-channel, pilot DTC advertising program in three markets. We extended the pilot in the same markets during the early part of 2020 in order to continue to evaluate the potential benefits of such a program.

Kaléo Co-Promotion In July the Company entered into an agreement with kaléo, a pharmaceutical company dedicated to building innovative solutions for serious and life-threatening medical conditions, to co-promote XHANCE. Under the terms of the agreement, kaléo will promote XHANCE to an agreed-upon audience of office-based healthcare professionals, which is expected to increase promotional reach and frequency starting by the fourth quarter of 2020. The audience includes nearly 6,000 prescribers about half of whom are outside of the current Optinose called-on universe of approximately 10,000 healthcare professionals.

XHANCE Co-Pay Savings Program We believe our co-pay savings program provides an affordability solution for patients that physicians will support. This program provides patient co-pay assistance including a first prescription at no out-of-pocket cost ($0 co-pay) to eligible commercially insured patients and low subsequent co-pays for refills ranging from $0 to $50 per XHANCE unit. In second quarter 2020, we introduced ASSIST, a short-term patient assistance program to support patients during the early stages of the COVID-19 pandemic. ASSIST offered $0 patient out-of-pocket for the first three prescriptions for new commercially insured patients. We closed the ASSIST program to new patients at the end of June and returned to our previously successful co-pay support programs.

Market Access Based on currently available third-party data and our internal analyses as of June 30, 2020, we believe that approximately 75% of commercially insured lives are currently in a plan in which we have contracted for XHANCE coverage. However, payors may change coverage levels for XHANCE, positively or negatively, at any time. Additionally, payors generally impose restrictions on access to or usage of XHANCE, such as by requiring prior authorizations or "step-edits." For example, insurers may require that a patient first use a generic INS prior to becoming eligible for coverage for XHANCE. Some healthcare providers may not complete the administrative process required to demonstrate or document that the patients for whom XHANCE has been prescribed meet the payors’ utilization management criteria (i.e., prior authorizations or step-edits) and, as a result, patients may not gain access to XHANCE treatment. In our contract negotiations with payors we seek to balance patient access and affordability, breadth of coverage, payor utilization management and rebate levels. We have also contracted with the Centers for Medicare and Medicaid Services for coverage of certain government insured lives and continue to expand XHANCE market access for other government-insured populations.

Trade and Distribution We sell XHANCE primarily to PPN partners with whom we contract to perform certain patient services such as patient insurance benefit verification. We established this channel to offer patients the option of filling prescriptions through a network of preferred pharmacies that may be able to better serve the needs of patients through services including delivery of XHANCE by mail and performing certain patient services such as patient insurance benefit verification. We also sell XHANCE to wholesale pharmaceutical distributors, who, in turn, sell XHANCE to pharmacies, hospitals and other customers. We have contracted with a third-party logistics provider for key services related to logistics, warehousing and inventory management, and distribution. Further, our third-party logistics provider provides customer order fulfillment services and accounts receivable management.

XHANCE Development

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In addition to XHANCE’s existing indication for the treatment of nasal polyps, in order to broaden our U.S. market opportunity, we initiated a clinical trial program in pursuit of a follow-on indication for the treatment of chronic sinusitis in the U.S. We believe XHANCE has the potential to be the first drug therapy approved by the FDA for the treatment of chronic sinusitis. We expect the program will be comprised of two phase 3b clinical trials, the first of which was initiated in the fourth quarter of 2018 and is estimated to enroll approximately 378 subjects and the second of which was initiated in the second quarter of 2019 and is estimated to enroll approximately 399 subjects. Estimated enrollment for both trials is subject to change for factors that may include an interim analysis intended to inform the statistical powering of both trials. We expect top-line results from both of our ongoing chronic sinusitis trials in the second half of 2021.

OPN-019

In June, we announced the initiation of development of a new product candidate, OPN-019. OPN-019 will combine our proprietary nasal Exhalation Delivery System (EDS) technology with an antiseptic that has been recently shown in third party in vitro studies to kill the virus that causes COVID-19. Because components of the drug-device combination product candidate, including both the active drug and delivery device, are currently commercially available in the U.S., we expect to be able to rapidly progress to a meeting with FDA to discuss an IND and then onward to clinical trials. We are focused on supporting the initial stages of development within our current operating expense plan and intend to seek grants, partnerships, and/or other sources of capital to fund future development.

Financial Operations Overview

The following discussion sets forth certain components of our consolidated statements of operations as well as factors that impact those items.

Net product revenues

Sales of XHANCE generated $10.3 million and $6.7 million in net product revenues for the three months ended June 30, 2020 and 2019, respectively, and $17.3 million and $10.7 million for the six months ended June 30, 2020 and 2019, respectively. In accordance with GAAP, we determine net product revenues for XHANCE, with specific assumptions for variable consideration components including but not limited to trade discounts and allowances, co-pay assistance programs and payor rebates.

Based on available XHANCE prescription data purchased from third parties and data from our PPN partners, who collectively dispensed more than 80% of our total prescriptions (TRxs) in the period, our average net product revenues per prescription for the second quarter of 2020 was approximately $164, an increase compared to average net product revenues per prescription of $126 in first quarter of 2020.

The increase in average net product revenues in the second quarter of 2020 from the first quarter of 2020 is largely a consequence of reduced copay support under our assistance programs as the result of patients' meeting their out of pocket expense thresholds, and an increase in the proportion of prescription refills of total prescriptions.

We calculate average net product revenues per prescription, one metric that we use to gauge the profitability of XHANCE, by dividing net product revenues for the quarter by the estimated number of XHANCE prescriptions dispensed during the quarter. As a result, average net product revenues per prescription is subject to variability. That variability is impacted by factors that do not necessarily reflect a change in the price that is paid for an individual unit of XHANCE, including but not limited to ordering patterns and inventory levels for our wholesale customers and PPN partners, patient utilization rates of affordability programs and the proportion of patients acquiring XHANCE through an insurance benefit. There is also the potential for variability that results from changes in estimation methodology by the third parties that we rely upon to provide prescription data which may lead to revisions of historical estimates of prescription volumes and our calculated average net product revenues per prescription.

For the remainder of 2020, we believe average net product revenues per prescription will improve. Factors supporting this expected growth include patients meeting their out-of-pocket expense thresholds, the closing of the ASSIST program, and continued strength in the proportion of prescription refills.

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Licensing revenues

In January 2019, OptiNose AS entered into the Inexia License Agreement with Inexia. Under the terms of the Inexia License Agreement, Inexia paid us a $0.5 million upfront payment. For each product developed under the Inexia License Agreement, we are eligible to receive up to $8.0 million of development milestone payments and up to $37.0 million of sales milestone payments. In addition, we are eligible to receive tiered, low-to-mid single digit royalties based on net sales of any products successfully developed and commercialized under the Inexia License Agreement. Other than the upfront payment, we do not anticipate the receipt of any milestone or royalty payments from Inexia in the near term.

Costs of product sales

Costs of product sales includes the cost of inventory sold, which includes direct and indirect manufacturing and supply chain costs.

Research and development expense

Research and development expense consists primarily of expenses incurred to prepare for, initiate and conduct our planned clinical trials, ongoing research efforts of new products and device improvements. We expense research and development costs as incurred. These expenses include:

▪personnel expenses, including salaries, benefits and stock-based compensation expense;

▪costs of funding clinical development performed by third parties, including pursuant to agreements with contract research organizations (CROs), as well as investigative sites and consultants that conduct or support our nonclinical studies and clinical trials;

▪expenses associated with the continued development of our EDS devices;

▪expenses incurred under agreements with contract manufacturing organizations (CMOs), including manufacturing scale-up expenses prior to regulatory approval of products for commercial sale and the cost of acquiring and manufacturing preclinical study and clinical trial materials;

▪consultant fees and expenses associated with outsourced professional scientific development services;

▪expenses for regulatory activities, including filing fees paid to regulatory agencies and costs incurred to compile and respond to filings with the FDA prior to regulatory approval of products for commercial sale;

▪costs incurred to maintain, expand and protect our patent portfolio as it relates to product candidates in development; and

▪allocated expenses for facility costs, including rent, utilities, depreciation and maintenance.

We typically use our employee, consultant and infrastructure resources across our research and development programs. Although we track certain outsourced development costs by product candidate, we do not allocate personnel costs or other internal costs to specific product candidates.

We plan to incur research and development expenses for the foreseeable future as we expect to continue the development of XHANCE for the treatment of chronic sinusitis and our other product candidates, including OPN-019. At this time, due to the inherently unpredictable nature of preclinical and clinical development and the regulatory approval process, compounded by the uncertainty introduced by the COVID-19 pandemic, the rate of subject enrollment, number of subjects required, and trial duration, we are unable to estimate with reasonable certainty the costs we will incur and the timelines we will require in our continued development efforts.

Selling, general and administrative expense

General and administrative expense consists primarily of personnel expenses, including salaries, benefits and stock-based compensation expense, for employees in executive, finance, accounting, business development, information technology, legal and human resource functions. General and administrative expense also includes corporate facility costs, including rent, utilities, depreciation and maintenance, not otherwise included in research and development expense, as well as regulatory fees and professional fees for legal, patent, accounting and other consulting services.

Sales and marketing expenses include our sales team and supporting promotional materials, digital promotion, peer-to-peer education, congresses / conventions, samples, and marketing activities such as direct-to-patient /

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direct-to-consumer initiatives. Additionally, sales and marketing-related expenses include fees paid to our PPN partners for services unrelated to traditional distribution functions, such as data fees and benefit claims adjudication.

Interest (income) expense

Interest (income) expense consists of interest earned on our cash and cash equivalents held with institutional banks and interest expense is primarily related to our note purchase agreement (Pharmakon Senior Secured Notes) with Pharmakon Advisors, LP (Pharmakon) and our former note purchase agreement (Athyrium Senior Secured Notes) with Athyrium Opportunities III Acquisition LP (Athyrium).

Other (income) expense

Other (income) expense consists primarily of foreign currency (income) losses due to exchange rate fluctuations on transactions denominated in a currency other than our functional currency.

Consolidated Results of Operations

Comparison of three months ended June 30, 2020 and 2019

The following table sets forth our selected consolidated statements of operations data for the periods indicated (in thousands):

	Three Months Ended June 30,
	2020		2019
Revenues:
Net product revenues	$	10,272	$	6,677
Licensing revenues	—		—
Total revenues	10,272		6,677
Costs and expenses:
Cost of product sales	1,700		1,089
Research and development	5,474		5,295
Selling, general and administrative	25,697		26,000
Total operating expenses	32,871		32,384
Loss from operations	(22,599)		(25,707)
Other (income) expense:
Interest (income) expense	3,260		1,673
Other (income) expense	(7)		(3)
Total other (income) expense	3,253		1,670
Net loss	$	(25,852)	$	(27,377)

Net product revenues

Net product revenues related to sales of XHANCE were $10.3 million and $6.7 million for the three months ended June 30, 2020 and 2019, respectively. Revenue growth is attributable primarily to an increase in units sold to customers, as a result of a greater number of XHANCE prescriptions dispensed during the three months ended June 30, 2020.

Cost of product sales

Cost of product sales related to XHANCE were $1.7 million and $1.1 million for the three months ended June 30, 2020 and 2019, respectively, with the increase primarily attributed to an increase in units sold to customers during the period.

Research and development expense

Research and development expense was $5.5 million and $5.3 million for the three months ended June 30, 2020 and 2019, respectively. The $0.2 million increase was attributable primarily to:

•a $0.3 million increase in personnel and severance costs; and

•a $0.2 million increase in development costs related to design improvements in XHANCE and the manufacturing of clinical trial supply .

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This increase was offset by:

• a $0.3 million decrease in clinical expenses related to the conduct of our clinical trials of XHANCE for the treatment of chronic sinusitis and FDA-mandated pediatric studies as a result of COVID-19 related delays.

Selling, general and administrative expense

Selling, general and administrative expense was $25.7 million and $26.0 million for the three months ended June 30, 2020 and 2019, respectively. The $0.3 million decrease was due primarily to:

▪a $2.9 million decrease related to delayed expenses and/or expenses not incurred as a result of the COVID-19 interruption. These expenses include:

•$1.7 million in advisory board, congresses, speaker programs and meeting expenses; and

•$1.2 million in travel expenses

This decrease was offset by:

▪a $1.3 million increase in service fees paid to our PPN partners, the result of a greater number of XHANCE prescriptions dispensed by our PPN partners during the period;

▪a $1.0 million increase in personnel expenses due to increases in headcount and the expansion of our sales team; and

▪ a $0.3 million increase in expenses related to the sale of XHANCE, including marketing expenses.

Interest (income) expense, net

Interest (income) expense, net, was $3.3 million and $1.7 million for the three months ended June 30, 2020 and 2019, respectively. Interest expense was $3.3 million and $2.4 million for the three months ended June 30, 2020 and 2019, respectively. The increase was primarily related to the increased principal balance of our long-term debt. Interest expense was offset by interest income of $0.03 million and $0.7 million for the three months ended June 30, 2020 and 2019, respectively. Interest income decreased by $0.7 million as compared to the three months ended June 30, 2019 as a result of lower cash balances and reduced interest rates.

Comparison of six months ended June 30, 2020 and 2019

The following table sets forth our selected consolidated statements of operations data for the periods indicated (in thousands):

	Six Months Ended June 30,
	2020		2019
Revenues:
Net product revenues	$	17,334	$	10,653
Licensing revenues	—		500
Total revenues	17,334		11,153
Costs and expenses:
Cost of product sales	3,056		1,827
Research and development	10,406		9,857
Selling, general and administrative	52,757		52,340
Total operating expenses	66,219		64,024
Loss from operations	(48,885)		(52,871)
Other (income) expense:
Interest (income) expense	5,791		3,377
Other (income) expense	32		3
Total other (income) expense	5,823		3,380
Net loss	$	(54,708)	$	(56,251)

Net product revenues

Net product revenues related to sales of XHANCE were $17.3 million and $10.7 million for the six months ended June 30, 2020 and 2019, respectively. Revenue growth is attributable primarily to an increase in units sold to

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customers, as a result of a greater number of XHANCE prescriptions dispensed during the six months ended June 30, 2020.

Licensing revenues

Licensing revenues were $0.5 million for the six months ended June 30, 2019 as a result of the upfront payment received under the terms of the Inexia License Agreement. No licensing revenue was recognized during the six months ended June 30, 2020.

Cost of product sales

Cost of product sales related to XHANCE were $3.1 million and $1.8 million for the six months ended June 30, 2020 and 2019, respectively, with the increase primarily attributed to an increase in units sold to customers during the period.

Research and development expense

Research and development expense was $10.4 million and $9.9 million for the six months ended June 30, 2020 and 2019, respectively. The $0.5 million increase was attributable primarily to:

• a $0.6 million increase in personnel expenses due to increases in headcount.

This increase was offset by:

▪a $0.1 million decrease in consulting expenses.

Selling, general and administrative expense

Selling, general and administrative expense was $52.8 million and $52.3 million for the six months ended June 30, 2020 and 2019, respectively. The $0.5 million increase was due primarily to:

▪a $2.6 million increase in service fees paid to our PPN partners, as a result of a greater number of XHANCE prescriptions dispensed by our PPN partners during the period;

▪an $0.7 million increase in personnel expenses due to increases in headcount and the expansion of our sales team;

▪a $0.7 million increase in insurance and infrastructure expenses; and

▪a $0.5 million increase in market access expenses.

This increase was offset by:

▪a $4.0 million decrease related to delayed expenses and/or expenses not incurred as a result of the COVID-19 interruption. These expenses include:

•$1.0 million in advisory board, congresses, speaker programs and meeting expenses;

•$1.3 million in travel expenses; and

•$1.7 million in marketing expenses.

Interest (income) expense, net

Interest (income) expense, net, was $5.8 million and $3.4 million for the six months ended June 30, 2020 and 2019, respectively. Interest expense was $6.2 million and $4.8 million for the six months ended June 30, 2020 and 2019, respectively. The increase was primarily related to the increased principal balance of our long-term debt. Interest expense was offset by interest income of $0.4 million and $1.4 million for the six months ended June 30, 2020 and 2019, respectively. Interest income decreased by $1.0 million as compared to the six months ended June 30, 2019 as a result of lower cash balances and reduced interest rates.

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Liquidity and Capital Resources

Since inception, we have incurred significant net losses and expect to continue to incur net losses for the foreseeable future. We incurred net losses of $54.7 million and $56.3 million for the six months ended June 30, 2020 and 2019, respectively. As of June 30, 2020, we had an accumulated deficit of $482.7 million. We have funded our operations primarily through the sale and issuance of stock and debt, as well as through licensing revenues. As of June 30, 2020, we had $125.3 million in cash and cash equivalents.

The following table shows a summary of our cash flows for the periods indicated (in thousands):

	Six Months Ended June 30,
	2020		2019
Net cash used in operating activities	$	(51,518)	$	(57,582)
Net cash used in investing activities	(309)		(423)
Net cash provided by financing activities	29,950		981
Effects of exchange rates on cash and cash equivalents	(9)		(9)
Net decrease in cash, cash equivalents and restricted cash	$	(21,886)	$	(57,033)

Operating activities

Cash used in operating activities decreased by $6.1 million, from $57.6 million for the six months ended June 30, 2019 to $51.5 million for the six months ended June 30, 2020. The decrease in cash used in operating activities was attributable primarily to an increase in revenue and the timing of payment of expenses.

Investing activities

Cash used in investing activities decreased $0.1 million from $0.4 million for the six months ended June 30, 2019 to $0.3 million for the six months ended June 30, 2020. The decrease in cash used in investing activities is related to purchases of manufacturing equipment during the six months ended June 30, 2019.

Financing activities

Cash provided by financing activities was $29.9 million for the six months ended June 30, 2020. Cash provided by financing activities was $1.0 million for the six months ended June 30, 2019. Cash provided by financing activities for the six months ended June 30, 2020 was primarily driven by the receipt of $30.0 million from the issuance of the First Delayed Draw Notes under the Pharmakon Senior Secured Notes offset by additional debt issuance costs of $0.2 million.

Senior Secured Note Purchase Agreement

On September 12, 2019 (the Closing Date), we entered into the Pharmakon Senior Secured Notes with funds managed by Pharmakon, the investment manager of the BioPharma Credit funds (BioPharma). The Pharmakon Senior Secured Notes provide us with up to $150.0 million in debt financing, of which $80.0 million was issued on the Closing Date and $30.0 million was issued on February 13, 2020 (the First Delayed Draw Notes).

At our option, $20.0 million of Pharmakon Senior Secured Notes may be issued between August 15, 2020 and February 15, 2021 (the Third Delayed Draw Notes, and together with the First Delayed Draw Notes and Second Delayed Draw Notes, collectively, the Delayed Draw Notes) subject to the achievement of either (x) XHANCE net sales and royalties for the quarter ended September 30, 2020 of at least $14.5 million or (y) XHANCE net sales and royalties for the six months ended December 31, 2020 of at least $31.0 million.

The issuance of the Third Delayed Draw Notes are not conditioned upon the issuance of the Second Delayed Draw Notes. Additionally, upon the closing date of the Third Delayed Draw Notes (subject to our satisfaction of the net sales and royalties thresholds applicable to the Third Delayed Draw Notes), we may request, and BioPharma may issue, in its sole discretion, up to an additional $20.0 million of Pharmakon Senior Secured Notes (representing the Second Delayed Draw Notes for which we did not satisfy the net sales and royalty thresholds for the quarter ended March 31, 2020 or the six months ended June 30, 2020).

The proceeds of the initial Pharmakon Senior Secured Notes issued on the Closing Date were used to repay all existing indebtedness under the note purchase agreement with Athyrium. The proceeds from the First Delayed Draw Notes are being used for general corporate purposes.

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The Pharmakon Senior Secured Notes bear interest at a fixed per annum rate of 10.75% and are scheduled to mature on September 12, 2024 (the Maturity Date). We are required to make quarterly interest payments until the Maturity Date. We are also required to make principal payments, which are payable in 8 equal quarterly installments beginning on December 15, 2022 and continuing until the Maturity Date; provided that we may, at our election, postpone any such principal payment until the Maturity Date if, as of the applicable payment date, certain trailing four-quarter consolidated XHANCE net sales and royalties thresholds have been achieved.

We are required to repay the Pharmakon Senior Secured Notes in full upon the occurrence of a change of control (as defined in the Note Purchase Agreement). In addition, we may make voluntary prepayments in whole or in part. All mandatory and voluntary prepayments are subject to the payment of prepayment premiums as follows: (i) if prepayment occurs prior to the third anniversary of the Closing Date, an amount equal to 2% of the principal prepaid, (ii) if prepayment occurs on or after the third anniversary of the Closing Date but prior to the fourth anniversary of the Closing Date, an amount equal to 1% of the principal prepaid, and (iii) if prepayment occurs on or after the fourth anniversary of the Closing Date, no prepayment premium is required. Additionally, we are also required to pay a "make-whole" amount in respect of any principal payments (whether mandatory or voluntary) made prior to the 30-month anniversary of the issuance of the applicable note, in an amount equal to the interest that would have accrued through the 30-month anniversary in respect of such note but for such principal payment.

The Pharmakon Senior Secured Notes are secured by a pledge of substantially all of our assets and contains affirmative and negative covenants customary for financings of this type, including limitations on our and our subsidiaries’ ability, among other things, to incur additional debt, grant or permit additional liens, make investments and acquisitions, merge or consolidate with others, dispose of assets, grant certain license rights to our products, technologies and other intellectual property rights; pay dividends and distributions, repay junior indebtedness and enter into affiliate transactions, in each case, subject to certain exceptions. In addition, the Pharmakon Senior Secured Notes contain financial covenants requiring us to maintain at all times certain minimum trailing twelve-month consolidated XHANCE net sales and royalties, tested on a quarterly basis, and at least $30.0 million of cash and cash equivalents.

The Note Purchase Agreement also includes events of default customary for financings of this type, in certain cases subject to customary periods to cure, following which BioPharma may accelerate all amounts outstanding under the notes.

Projected 2020 operating expenses

We expect that our total GAAP operating expenses (consisting of selling, general & administrative expenses and research & development expenses) for 2020 will be between $131.0 million and $136.0 million of which approximately $11.0 million is expected to be stock-based compensation expense. Total GAAP operating expenses excluding stock-based compensation expense are expected to be between $120.0 million and $125.0 million. An increase in expenses from 2019 to 2020 is anticipated due to the annualization of the 2019 sales force expansion, an increase in fees paid to our PPN partners associated with higher projected XHANCE TRx volumes, and an increase in research and development expenses related to our clinical trial program in pursuit of a follow-on indication for XHANCE for the treatment of chronic sinusitis in the U.S.

Future funding requirements

We expect to continue to incur significant expenses in connection with our ongoing activities, particularly as we:

▪maintain and expand our sales force and the commercial infrastructure to support the sales and marketing for XHANCE;

▪continue advertising and other promotional activities, including the kaléo co-promotion, to support the commercialization of XHANCE;

▪continue to provide co-pay and other patient affordability programs;

▪continue clinical development activities for XHANCE, including FDA-mandated pediatric studies and clinical trials for a follow-on indication for the treatment of chronic sinusitis;

▪continue research and development activities for additional product candidates, including OPN-019;

▪continue to contract to manufacture XHANCE and our other product candidates;

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▪maintain, expand and protect our patent portfolio;

▪service our debt obligations under the Pharmakon Senior Secured Notes issued in September 2019 and February 2020;

▪maintain infrastructure necessary to operate as a publicly-traded, commercial-stage company; and

▪hire additional staff and add operational, financial and information systems to execute our business plan.

Our future funding requirements, both near and long-term, will depend on many factors, including, but not limited to:

▪duration and impact of COVID-19 restrictions on our business;

▪the success of our commercialization of XHANCE for the treatment of nasal polyps including, among other things, patient and physician acceptance of XHANCE and our ability to maintain adequate insurance coverage and reimbursement for XHANCE;

▪the cost of commercialization activities for XHANCE, including product manufacturing, distribution, marketing and sales;

▪net product revenues received from sales of XHANCE;

▪the costs and timing of expanding our sales force;

▪the level of co-pay assistance and other patient affordability programs offered for XHANCE;

▪our clinical development plans for XHANCE, including the outcome, timing and cost of FDA-mandated pediatric studies and clinical trials for the supplemental indication for the treatment of chronic sinusitis;

▪the outcome, timing and cost of the regulatory approval process of XHANCE for chronic sinusitis by the FDA, including the potential for the FDA to require that we perform more studies and clinical trials than those that we currently expect;

▪the costs involved in preparing, filing and prosecuting patent applications and annuity fees relating to issued patents;

▪the cost of maintaining and enforcing our intellectual property rights, as well as the cost of defending intellectual property disputes, including patent infringement actions brought by third parties against us;

▪the initiation, progress, timing, costs and results of clinical trials and other research and development related to additional product candidates, including OPN-019; and

▪the extent to which we in-license, acquire or otherwise partner in development or commercialization of other products, product candidates or technologies.

Although it is difficult to predict our future liquidity requirements, we will likely require additional capital in the future secured through equity or debt financings, partnerships, collaborations, or other sources in order to meet the debt service obligations under our outstanding Pharmakon Senior Secured Notes, including repayment, and to carry out our planned development and commercial activities. We believe that our existing cash, plus potential additional cash that may become available to us under the Pharmakon Note Purchase Agreement, could fund operations until we have top line data from at least one of the chronic sinusitis trials, expected in the second half of 2021. Additional capital, secured in the future through equity or debt financings, partnerships, collaborations, or other sources, may not be available on a timely basis, on favorable terms, or at all, and such capital, if raised, may not be sufficient to meet our debt service obligations, including repayment, or enable us to continue to implement our long-term business strategy. If additional capital is not secured when required, we may need to delay or curtail our operations until such funding is received. If we cannot expand our operations or otherwise capitalize on our business opportunities because we lack sufficient capital, our business, financial condition and results of operations could be materially adversely affected and we may need to delay or curtail our operations until such funding is received. Additionally, we may never become profitable, or if we do, we may not be able to sustain profitability on a recurring basis.

Off-balance sheet arrangements

We did not have during the periods presented, and we do not currently have, any off-balance sheet arrangements, as defined in the rules and regulations of the SEC.

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Contractual obligations and commitments

The following table summarizes our contractual obligations at June 30, 2020:

	Total		Less than 1 year		1-3 years		3-5 years		More than 5 years
	(in thousands)
Operating leases(1)	$	1,200	$	1,197	$	3	$	—	$	—
Long-term debt(2)	150,475		11,989		64,103		74,383		—
Total	$	151,675	$	13,186	$	64,106	$	74,383	$	—

⁽¹⁾ Reflects obligations pursuant to our office leases in Yardley, Pennsylvania, Ewing, New Jersey, Oslo, Norway and Swindon, England and leases of certain other equipment.

⁽²⁾ Reflects principal, interest obligations and exit fees pursuant to the Pharmakon Senior Secured Notes entered into on September 12, 2019 (the Closing Date). The Pharmakon Senior Secured Notes bear interest at 10.75% and are scheduled to mature on September 12, 2024 (the Maturity Date). We are required to make quarterly interest payments until the Maturity Date. Principal payments are payable in eight equal quarterly installments beginning on December 15, 2022 and continuing until the Maturity Date; provided that we may, at our election and upon achieving certain trailing four-quarter consolidated XHANCE net sales and royalties, postpone any such amortization payment until the Maturity Date. The Pharmakon Senior Secured Notes include events of default customary for financings of this type (including, among others, failure to comply with affirmative, negative and financial covenants), in certain cases subject to customary periods to cure, following which BioPharma may accelerate all amounts outstanding under the notes.

Critical accounting policies

The Critical Accounting Policies and Significant Judgments and Estimates included in our annual report on Form 10-K for the year ended December 31, 2019, as filed with the SEC on March 5, 2020, have not materially changed.

Recent accounting pronouncements

See Note 3 to our unaudited interim consolidated financial statements of this Form 10-Q for a description of recent accounting pronouncements applicable to our consolidated financial statements.

JOBS Act

The JOBS Act permits an “emerging growth company” such as us to take advantage of an extended transition period to comply with new or revised accounting standards applicable to public companies until those standards would otherwise apply to private companies. We have irrevocably elected to “opt out” of this provision and, as a result, we will comply with new or revised accounting standards when they are required to be adopted by public companies that are not emerging growth companies.

ITEM 3. QUALITATIVE AND QUANTITATIVE DISCLOSURES ABOUT MARKET RISK

We are a smaller reporting company as defined by Rule 12b-2 of the Securities Exchange Act of 1934 and are not required to provide the information under this item.

ITEM 4. CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

The term “disclosure controls and procedures,” as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended, (Exchange Act) refers to controls and procedures that are designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is accumulated and communicated to the company’s management, including its principal executive and principal financial officers, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure.

In designing and evaluating our disclosure controls and procedures, management recognizes that any controls and procedures, no matter how well conceived and operated, can provide only reasonable, not absolute, assurance that the objectives of the disclosure controls and procedures are met. Additionally, in designing disclosure controls and procedures, our management was required to apply its judgment in evaluating the cost-benefit relationship of possible disclosure controls and procedures. The design of any system of controls also is based in part upon certain

31

assumptions about the likelihood of future events, and there can be no assurance that any design will succeed in achieving its stated goals under all potential future conditions; over time, controls may become inadequate because of changes in conditions, or the degree of compliance with policies or procedures may deteriorate. Because of the inherent limitations in a control system, misstatements due to error or fraud may occur and not be detected.

Our Chief Executive Officer and our Chief Financial Officer evaluated the effectiveness of our disclosure controls and procedures, as defined in Rules 13a 15(e) and 15d 15(e) under the Exchange Act, as of the end of the period covered by this report. Based on this evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls and procedures were effective as of June 30, 2020.

Changes in Internal Control over Financial Reporting

There were no changes in our internal control over financial reporting that occurred during the three months ended June 30, 2020 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

32

PART II

ITEM 1A. RISK FACTORS

You should carefully consider the risk factors described under the caption "Risk Factors" in our annual report on Form 10-K for the year ended December 31, 2019, filed with the SEC on March 5, 2020. Except as set forth below, there have been no material changes to the risk factors disclosed in our Form 10-K.

The coronavirus (COVID-19) pandemic has and may continue to adversely affect our business, results of operations and financial condition.

On March 13, 2020, the President of the United States announced a national emergency relating to the coronavirus (COVID-19) pandemic. Government authorities in the U.S. have recommended or imposed various social distancing, quarantine, and isolation measures on large portions of the population, and similar measures have also been taken in many other countries around the world.

In March 2020, we modified our business practices and transitioned to a full-time, virtual work environment in which all employees were encouraged to work from their place of residence if their job functions allowed, and all work-related travel was temporarily discontinued. A significant portion of the physicians' offices in which our territory managers detail XHANCE either were closed, had reduced patient flow or temporarily stopped sales representatives’ visits, which has hindered our ability to detail XHANCE to physicians' offices. If our territory managers continue to have a limited ability to meet with physicians and if patients’ visits to doctors continue to be limited, XHANCE prescription growth and net revenues will continue to be adversely impacted. In addition, changes in insurance coverage or reimbursement levels by governmental authorities, private health insurers and other third-party payors, or in the type of such coverage held by patients, due to the impacts of the COVID-19 pandemic, including the related increase in unemployment in the U.S., may negatively impact XHANCE prescription growth and net revenues.

The duration and magnitude of the negative impact from the COVID-19 pandemic on XHANCE net revenues could also affect our ability to meet the net revenue threshold to draw additional capital under our Pharmakon Note Purchase Agreement and to remain in compliance with our revenue covenants. Furthermore, capital markets in the U.S. and around the world have also been negatively impacted by COVID-19, which may harm our business, including our ability to obtain future financing.

Our ability to enroll patients and retain principal investigators and site staff for our ongoing clinical trials have been, and could continue to be, impaired due to the COVID-19 outbreak in their geographic areas, the prioritization of medical resources toward the COVID-19 pandemic, or as a result of quarantines and other restrictions that interrupt healthcare services. Furthermore, patients, investigators, or site staff have been and may continue to be unwilling or unable to comply with clinical trial protocols due to COVID-19 illness, concerns about the pandemic, or quarantines or other restrictions that impede their movement. Any interruption in the supply of the study drug might also delay our ability to complete our ongoing clinical trials. Significant delays in the completion of our ongoing clinical trials are costly and could adversely affect our business and financial condition.

COVID-19 may also have an adverse impact on our contract manufacturers, suppliers, PPN partners, wholesalers, distributors and third party logistic provider as a result of employees or other key personnel becoming infected, preventive and precautionary measures that governments or such third parties are taking, such as social distancing, quarantines, and other restrictions, and shortages of supplies necessary for the manufacture of XHANCE. Any of these circumstances could adversely impact the ability of third parties on which we rely to manufacture and distribute adequate volumes of XHANCE. For example, in April, our contract manufacturer for the formulation and assembly of finished XHANCE drug product implementing a reduced work schedule in response to the pandemic which resulted in delays relating to the assembly of XHANCE finished goods. While we believe that we have sufficient inventory of XHANCE available to support expected demand, any further or other unexpected delays could constrain our supply of XHANCE.

The extent to which the coronavirus impacts our business and the third parties on whom we rely, such as our contract manufacturers, suppliers, PPN partners, wholesalers, distributors, third party logistics, contract research organizations, investigators for our clinical trials and other vendors, will depend on future developments, which are highly uncertain and cannot be predicted with confidence, including the duration of the outbreak and any resurgence, new information that may emerge concerning the severity of the coronavirus, the actions to contain the coronavirus or treat its impact, and the speed with which and the extent to which normal economic and operating conditions resume, among others.

33

ITEM 6. EXHIBITS

The following is a list of exhibits filed as part of this Quarterly Report on Form 10-Q. Where so indicated, exhibits that were previously filed are incorporated by reference. For exhibits incorporated by reference, the location of the exhibit in the previous filing is indicated.

INDEX TO EXHIBITS

Exhibit Number		Exhibit Description
3.1		Fourth Amended and Restated Certificate of Incorporation of OptiNose, Inc. (incorporated by reference to Exhibit 3.1 to the Company’s Current Report on Form 8-K (File No. 001-38241), as filed with the SEC on October 18, 2017).
3.2		Amended and Restated Bylaws of OptiNose, Inc. (incorporated by reference to Exhibit 3.2 to the Company’s Current Report on Form 8-K (File No. 001-38241), as filed with the SEC on October 18, 2017).
31.1	*	Certification of Chief Executive Officer pursuant to Rule 13a-14(a) or 15a-14(a) under the Exchange Act.
31.2	*	Certification of Chief Financial Officer pursuant to Rule 13a-14(a) or 15a-14(a) under the Exchange Act.
32.1	*	Certification Pursuant to 18 U.S.C. Section 1350 of principal executive officer.
32.2	*	Certification Pursuant to 18 U.S.C. Section 1350 of principal financial officer.
101.SCH	*	Inline XBRL Taxonomy Extension Schema Document.
101.CAL	*	Inline XBRL Taxonomy Extension Calculation Linkbase Document.
101.DEF	*	Inline XBRL Taxonomy Extension Definition Linkbase Document.
101.LAB	*	Inline XBRL Taxonomy Extension Label Linkbase Document.
101.PRE	*	Inline XBRL Taxonomy Extension Presentation Linkbase Document.
104	*	Cover Page Interactive Data File (formatted as inline XBRL and contained in Exhibit 101)

* Filed herewith.

34

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the Registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

		OPTINOSE, INC.
Date:	August 4, 2020	By:	/s/ KEITH A. GOLDAN
			Name:	Keith A. Goldan
			Title:	Chief Financial Officer
			(Principal Financial and Accounting Officer)

35

EX-31.1

CERTIFICATION UNDER SECTION 302 OF THE

SARBANES-OXLEY ACT OF 2002

I, Peter K. Miller, certify that:

1.     I have reviewed this Quarterly Report on Form 10-Q of OptiNose, Inc.;

2.     Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.     Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.     The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have:

a.     Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b.     Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

c.     Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and

5.     The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):

a.     All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and

b.     Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting.

Date: August 4, 2020 /s/ Peter K. Miller Peter K. Miller Chief Executive Officer (Principal Executive Officer)

EX-31.2

CERTIFICATION UNDER SECTION 302 OF THE

SARBANES-OXLEY ACT OF 2002

I, Keith A. Goldan, certify that:

1.     I have reviewed this Quarterly Report on Form 10-Q of OptiNose, Inc.;

2.     Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.     Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.     The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have:

a.     Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

b.     Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

c.     Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and

5.     The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):

a.     All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and

b.     Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting.

Date: August 4, 2020 /s/ Keith A. Goldan Chief Financial Officer (Principal Financial Officer and Principal Accounting Officer)

EX-32.1

CERTIFICATION UNDER SECTION 906 OF THE

SARBANES-OXLEY ACT OF 2002

I, Peter K. Miller, Chief Executive Officer of OptiNose, Inc. (the “Company”), do hereby certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that to the best of my knowledge:

1. the Quarterly Report on Form 10-Q of the Company for the period ending June 30, 2020 (the “Report”) fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

2. the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company for the periods presented therein.

Date: August 4, 2020 /s/ Peter K. Miller Peter K. Miller Chief Executive Officer (Principal Executive Officer)

EX-32.2

CERTIFICATION UNDER SECTION 906 OF THE

SARBANES-OXLEY ACT OF 2002

I, Keith A. Goldan, Chief Financial Officer of OptiNose, Inc. (the “Company”), do hereby certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that to the best of my knowledge

1. the Quarterly Report on Form 10-Q of the Company for the period ended June 30, 2020 (the “Report”) fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

2. the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company for the periods presented therein.

Date: August 4, 2020 /s/ Keith A. Goldan Keith A. Goldan Chief Financial Officer (Principal Financial Officer and Principal Accounting Officer)

XML

Cover Page - shares	6 Months Ended
	Jun. 30, 2020	Jul. 31, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2020
Document Transition Report	false
Entity File Number	001-38241
Entity Registrant Name	OPTINOSE, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	42-1771610
Entity Address, Address Line One	1020 Stony Hill Road
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Yardley
Entity Address, State or Province	PA
Entity Address, Postal Zip Code	19067
City Area Code	267
Local Phone Number	364-3500
Title of 12(b) Security	Common stock, par value $0.001 per share
Trading Symbol	OPTN
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		45,992,273
Entity Central Index Key	0001494650
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q2
Amendment Flag	false

XML

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 125,266	$ 147,144
Accounts receivable, net	14,096	13,643
Inventory	6,125	3,484
Prepaid expenses and other current assets	3,418	3,789
Total current assets	148,905	168,060
Property and equipment, net	2,790	3,052
Other assets	1,353	1,538
Total assets	153,048	172,650
Current liabilities:
Accounts payable	3,505	3,625
Accrued expenses and other current liabilities	31,393	32,514
Total current liabilities	34,898	36,139
Long-term debt, net	104,947	74,531
Other liabilities	594	397
Total liabilities	140,439	111,067
Stockholders' equity:
Common stock, $0.001 par value; 200,000,000 shares authorized at June 30, 2020 and December 31, 2019; 45,992,273 and 45,906,162 shares issued and outstanding at June 30, 2020 and December 31, 2019, respectively	46	46
Additional paid-in capital	495,329	489,565
Accumulated deficit	(482,688)	(427,980)
Accumulated other comprehensive loss	(78)	(48)
Total stockholders' equity	12,609	61,583
Total liabilities and stockholders' equity	$ 153,048	$ 172,650
Shares issued (in shares)	45,992,273	45,906,162

XML

Consolidated Balance Sheets (Parenthetical) - $ / shares	Jun. 30, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Common stock, par value (usd per share)	$ 0.001	$ 0.001
Shares authorized (in shares)	200,000,000	200,000,000
Shares issued (in shares)	45,992,273	45,906,162
Shares outstanding (in shares)	45,992,273	45,906,162

XML

Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Total revenues	$ 10,272	$ 6,677	$ 17,334	$ 11,153
Costs and expenses:
Cost of product sales	1,700	1,089	3,056	1,827
Research and development	5,474	5,295	10,406	9,857
Selling, general and administrative	25,697	26,000	52,757	52,340
Total operating expenses	32,871	32,384	66,219	64,024
Loss from operations	(22,599)	(25,707)	(48,885)	(52,871)
Other (income) expense:
Interest income	(33)	(716)	(365)	(1,400)
Interest expense	3,293	2,389	6,156	4,777
Foreign currency (gains) losses	(7)	(3)	32	3
Net loss	$ (25,852)	$ (27,377)	$ (54,708)	$ (56,251)
Net loss per share of common stock, basic and diluted (in USD per share)	$ (0.56)	$ (0.66)	$ (1.19)	$ (1.36)
Weighted average common shares outstanding, basic and diluted (in shares)	45,908,104	41,310,608	45,907,133	41,283,478
Net product revenues
Total revenues	$ 10,272	$ 6,677	$ 17,334	$ 10,653
Licensing revenues
Total revenues	$ 0	$ 0	$ 0	$ 500

XML

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Statement of Comprehensive Income [Abstract]
Net loss	$ (25,852)	$ (27,377)	$ (54,708)	$ (56,251)
Other comprehensive loss:
Foreign currency translation adjustment	(5)	(13)	(30)	(10)
Comprehensive loss	$ (25,857)	$ (27,390)	$ (54,738)	$ (56,261)

XML

Consolidated Statements of Changes in Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss
Beginning balance (in shares) at Dec. 31, 2018		41,227,530
Beginning balance at Dec. 31, 2018	$ 118,611	$ 41	$ 436,554	$ (317,927)	$ (57)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,425		2,425
Exercise of common stock options (in shares)		5,000
Exercise of common stock options	15		15
Issuance of common stock under employee stock purchase plan (in shares)		31,892
Issuance of common stock under employee stock purchase plan	173		173
Foreign currency translation adjustment	3				3
Net loss	(28,874)			(28,874)
Ending balance at Mar. 31, 2019	92,353	$ 41	439,167	(346,801)	(54)
Ending balance (in shares) at Mar. 31, 2019		41,264,422
Beginning balance (in shares) at Dec. 31, 2018		41,227,530
Beginning balance at Dec. 31, 2018	118,611	$ 41	436,554	(317,927)	(57)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(56,251)
Ending balance at Jun. 30, 2019	68,472	$ 41	442,676	(374,178)	(67)
Ending balance (in shares) at Jun. 30, 2019		41,430,918
Beginning balance (in shares) at Mar. 31, 2019		41,264,422
Beginning balance at Mar. 31, 2019	92,353	$ 41	439,167	(346,801)	(54)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,716		2,716
Exercise of common stock options (in shares)		88,587
Exercise of common stock options	354		354
Issuance of common stock under employee stock purchase plan (in shares)		77,909
Issuance of common stock under employee stock purchase plan	439		439
Foreign currency translation adjustment	(13)				(13)
Net loss	(27,377)			(27,377)
Ending balance at Jun. 30, 2019	68,472	$ 41	442,676	(374,178)	(67)
Ending balance (in shares) at Jun. 30, 2019		41,430,918
Beginning balance (in shares) at Dec. 31, 2019		45,906,162
Beginning balance at Dec. 31, 2019	61,583	$ 46	489,565	(427,980)	(48)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,429		2,429
Foreign currency translation adjustment	(25)				(25)
Net loss	(28,856)			(28,856)
Ending balance at Mar. 31, 2020	35,131	$ 46	491,994	(456,836)	(73)
Ending balance (in shares) at Mar. 31, 2020		45,906,162
Beginning balance (in shares) at Dec. 31, 2019		45,906,162
Beginning balance at Dec. 31, 2019	61,583	$ 46	489,565	(427,980)	(48)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(54,708)
Ending balance at Jun. 30, 2020	12,609	$ 46	495,329	(482,688)	(78)
Ending balance (in shares) at Jun. 30, 2020		45,992,273
Beginning balance (in shares) at Mar. 31, 2020		45,906,162
Beginning balance at Mar. 31, 2020	35,131	$ 46	491,994	(456,836)	(73)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,748		2,748
Exercise of common stock options (in shares)		15,806
Exercise of common stock options	71		71
Issuance of common stock under employee stock purchase plan (in shares)		70,305
Issuance of common stock under employee stock purchase plan	516		516
Foreign currency translation adjustment	(5)				(5)
Net loss	(25,852)			(25,852)
Ending balance at Jun. 30, 2020	$ 12,609	$ 46	$ 495,329	$ (482,688)	$ (78)
Ending balance (in shares) at Jun. 30, 2020		45,992,273

XML

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Operating activities:
Net loss	$ (54,708)	$ (56,251)
Adjustments to reconcile net loss to cash used in operating activities:
Depreciation and amortization	563	592
Stock-based compensation	5,232	5,117
Amortization of debt discount and issuance costs	570	234
Changes in operating assets and liabilities:
Accounts receivable	(453)	(7,001)
Grants and other receivables	0	(48)
Prepaid expenses and other assets	1,244	1,096
Inventory	(2,620)	2,803
Accounts payable	253	(4,253)
Accrued expenses and other liabilities	(1,599)	129
Cash used in operating activities	(51,518)	(57,582)
Investing activities:
Purchases of property and equipment	(309)	(423)
Cash used in investing activities	(309)	(423)
Financing activities:
Proceeds from long-term debt	34,447	0
Repayment of long-term debt	(4,447)	0
Cash paid for financing costs	(637)	0
Proceeds from issuance of common stock under employee stock purchase plan	516	612
Proceeds from the exercise of stock options	71	369
Cash provided by financing activities	29,950	981
Effects of exchange rate changes on cash and cash equivalents	(9)	(9)
Net decrease in cash, cash equivalents and restricted cash	(21,886)	(57,033)
Cash, cash equivalents and restricted cash at beginning of period	147,165	201,011
Cash, cash equivalents and restricted cash at end of period	125,279	143,978
Supplemental disclosure of noncash activities:
Fixed asset purchases within accounts payable and accrued expenses	82	35
Recognition of right-of-use assets	742	3,724
Recognition of lease liabilities	$ 742	$ 4,201

XML

Organization and Description of Business

6 Months Ended

Jun. 30, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Organization and Description of Business

Organization and Description of Business

OptiNose, Inc. (the Company) was incorporated in Delaware in May 2010 (inception) and has facilities in Yardley, Pennsylvania, Ewing, New Jersey, and Oslo, Norway. The Company's predecessor entity, OptiNose AS, was formed under the laws of Norway in September 2000. In 2010, OptiNose AS became a wholly-owned subsidiary of the Company as part of an internal reorganization.

The Company is a specialty pharmaceutical company focused on the development and commercialization of products for patients treated by ear, nose and throat (ENT) and allergy specialists. The Company's first commercial product, XHANCE^® (fluticasone propionate) nasal spray, 93 mcg, is a therapeutic utilizing its proprietary Exhalation Delivery System (EDS) device that delivers a topically-acting corticosteroid for the treatment of chronic rhinosinusitis with nasal polyps and, if approved, chronic rhinosinusitis without nasal polyps (also referred to as chronic sinusitis). XHANCE was approved by the United States (US) Food and Drug Administration (FDA) in September 2017 for the treatment of nasal polyps in patients 18 years of age or older. XHANCE was made widely available through commercial channels in April 2018.

XML

Liquidity

6 Months Ended

Jun. 30, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Liquidity

Liquidity

Since inception, the Company's operations have focused on organization and staffing, business planning, raising capital, establishing an intellectual property portfolio, conducting preclinical studies and clinical trials, pursuing regulatory approvals and most recently, commercializing XHANCE in the US. As of June 30, 2020, the Company had cash and cash equivalents of $125,266.

The Company will likely require additional capital in the future secured through equity or debt financings, partnerships, collaborations, or other sources in order to meet its debt service obligations, including repayment, under the Company's outstanding senior secured notes, and to carry out the Company's planned development and commercial activities. The terms of the outstanding senior secured notes, including applicable covenants, are described in Note 8. If additional capital is not secured when required, the Company may need to delay or curtail its operations until additional funding is received.

The Company is subject to a number of risks similar to other life sciences companies, including, but not limited to, successful discovery, development and commercialization of its products and product candidates, raising additional capital, the development by its competitors of new technological innovations, protection of proprietary technology and market acceptance of the Company's products.

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Basis of Presentation and Summary of Significant Accounting Policies

6 Months Ended

Jun. 30, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Basis of Presentation and Summary of Significant Accounting Policies

Basis of Presentation and Summary of Significant Accounting Policies

The accompanying unaudited interim consolidated financial statements have been prepared in conformity with US generally accepted accounting principles (GAAP). Any reference in these notes to applicable guidance is meant to refer to GAAP as found in the Accounting Standards Codification (ASC) and Accounting Standards Updates (ASU) of the Financial Accounting Standards Board (FASB).

In the opinion of management, the accompanying unaudited interim financial statements include all normal and recurring adjustments (which consist primarily of accruals and estimates that impact the financial statements) considered necessary to present fairly the Company's financial position as of June 30, 2020 and its results of operations for the three and six months ended June 30, 2020 and 2019 and cash flows for the six months ended June 30, 2020 and 2019. Operating results for the three and six months ended June 30, 2020 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020. The unaudited interim financial statements, presented herein, do not contain the required disclosures under GAAP for annual financial statements. The accompanying unaudited interim financial statements should be read in conjunction with the annual audited financial statements and related notes as of and for the year ended December 31, 2019 contained in the Company’s annual report on Form 10-K for the year ended December 31, 2019, filed with the SEC on March 5, 2020.

Use of estimates

The preparation of the unaudited interim consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited interim consolidated financial statements and reported amounts of expenses during the reporting period. Due to the uncertainty of factors surrounding the estimates or judgments used in the preparation of the unaudited interim consolidated financial statements, actual results may materially vary from these estimates. Estimates and assumptions are periodically reviewed and the effects of revisions are reflected in the unaudited interim consolidated financial statements in the period they are determined to be necessary.

Concentration of credit risk

Financial instruments that potentially subject the Company to concentrations of credit risk are primarily cash and accounts receivable. The Company generally invests its cash in deposits with high credit quality financial institutions. Additionally, the Company performs periodic evaluations of the relative credit standing of these financial institutions.

Customer and supplier concentration

XHANCE is sold to wholesale pharmaceutical distributors and Preferred Pharmacy Network (PPN) partners, who, in turn, sell XHANCE to pharmacies, hospitals and other customers. Five customers represent approximately 51% of the Company's accounts receivable at June 30, 2020 and five customers represent approximately 48% and 49% of the Company's net product sales for the three and six months ended June 30, 2020, respectively.

The Company purchases XHANCE and its components from several third-party suppliers and manufacturing partners, certain of which are available through a single source. Although the Company could obtain each of these components from alternative third-party suppliers, it would need to qualify and obtain FDA approval for another supplier as a source for each such component.

Fair value of financial instruments

At June 30, 2020 and December 31, 2019, the Company's financial instruments included cash and cash equivalents, accounts receivable, grants receivable, accounts payable and accrued expenses. The carrying amounts reported in the Company's financial statements for these instruments approximate their respective fair values because of the short-term nature of these instruments. In addition, at June 30, 2020, the Company believes the carrying value of long-term debt approximates fair value as the interest rates are reflective of the rate the Company could obtain on debt with similar terms and conditions. At June 30, 2020 and December 31, 2019, there were no financial assets or liabilities measured at fair value on a recurring basis.

Restricted cash

As of June 30, 2020 and December 31, 2019, the restricted cash balance included in prepaid expenses and other assets was $13 and $21, respectively.

Net product revenues

The Company accounts for revenue in accordance with ASC Topic 606, Revenue from Contracts with Customers (ASC 606), which was adopted on January 1, 2018. The Company recognizes revenue from XHANCE sales at the point customers obtain control of the product, which generally occurs upon delivery. The transaction price that is recognized as revenue for products includes an estimate of variable consideration. The Company’s estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of its anticipated performance and all information (historical, current and forecasted) that is reasonably available. The components of the Company’s variable consideration include the following:

Provider Chargebacks and Discounts. Chargebacks for fees and discounts to providers represent the estimated obligations resulting from contractual commitments to sell products to qualified healthcare providers at prices lower

than the list prices charged to customers who directly purchase the product from the Company. Customers charge the Company for the difference between what they pay for the product and the ultimate selling price to the qualified healthcare providers. These components of variable consideration are established in the same period that the related revenue is recognized, resulting in a reduction of product revenue and accounts receivable.

Trade Discounts and Allowances. The Company generally provides customers with discounts that include incentive fees which are explicitly stated in the Company’s contracts. These discounts are recorded as a reduction of revenue and accounts receivable in the period in which the related product revenue is recognized.

Product Returns. Consistent with industry practice, the Company has a product returns policy that provides customers a right of return for product purchased within a specified period prior to and subsequent to the product’s expiration date. The Company estimates the amount of its product that may be returned and presents this amount as a reduction of revenue in the period the related product revenue is recognized, in addition to establishing a liability. The Company considers several factors in the estimation process, including expiration dates of product shipped to customers, inventory levels within the distribution channel, product shelf life, prescription trends and other relevant factors.

Government Rebates. The Company is subject to discount obligations under state Medicaid programs and Medicare. Reserves related to these discount obligations are recorded in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a current liability. The Company’s liability for these rebates consists of estimates of claims for the current quarter and estimated future claims that will be made for product that has been recognized as revenue but remains in the distribution channel inventories at the end of the reporting period.

Payor Rebates. The Company contracts with certain third-party payors, primarily health insurance companies and pharmacy benefit managers, for the payment of rebates with respect to utilization of its products. These rebates are based on contractual percentages applied to the amount of product prescribed to patients who are covered by the plan or the organization with which it contracts. The Company estimates these rebates and records such estimates in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a current liability.

Patient Assistance. Other programs that the Company offers include voluntary co-pay patient assistance programs intended to provide financial assistance to eligible patients with prescription drug co-payments required by payors and coupon programs for cash payors. The calculation of the current liability for this assistance is based on an estimate of claims and the cost per claim that the Company expects to receive associated with product that has been recognized as revenue but remains in the distribution channel inventories at the end of each reporting period.

Licensing revenues

The Company has license agreements with Inexia Limited (Inexia) and Currax Pharmaceuticals LLC (Currax). These license agreements provide for exclusive licensed rights to certain intellectual property, a non-refundable up-front payment, potential milestone payment(s) and potential royalty payment(s). The Company analyzed the performance obligations under the license agreements, the consideration received to date and the consideration the Company could receive in the future as part of its analysis related to ASC 606. No licensing revenues were recognized during the three and six months ended June 30, 2020 (Note 7).

Net income (loss) per common share

Basic net income (loss) per common share is determined by dividing net income (loss) applicable to Company common stock (Common Stock) holders by the weighted average common shares outstanding during the period. For the three and six months ended June 30, 2020 and 2019, the outstanding Common Stock options, Common Stock warrants and shares to be issued under the Company's 2017 Employee Stock Purchase Plan have been excluded from the calculation of diluted net loss per share because their effect would be anti-dilutive. Therefore, the weighted average shares used to calculate both basic and diluted net loss per share are the same.

Diluted net loss per common share for the periods presented do not reflect the following potential common shares, as the effect would be antidilutive:

	June 30,
	2020	2019
Stock options	8,385,831	7,983,370
Restricted stock units	1,274,354	—
Common stock warrants	2,677,188	1,866,831
Total	12,337,373	9,850,201

Income taxes

In accordance with ASC 270, Interim Reporting, and ASC 740, Income Taxes, the Company is required at the end of each interim period to determine the best estimate of its annual effective tax rate and then apply that rate in providing for income taxes on a current year-to-date (interim period) basis. For the three and six months ended June 30, 2020 and 2019, the Company recorded no tax expense or benefit due to the expected current year loss and its historical losses. As of June 30, 2020 and December 31, 2019, the Company has concluded that a full valuation allowance is necessary for all of its net deferred tax assets. The Company had no amounts recorded for uncertain tax positions, interest or penalties in the accompanying consolidated financial statements.

Recent accounting pronouncements

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. ASU 2019-12 eliminated certain exceptions and changed guidance on other matters. The exceptions relate to the allocation of income taxes in separate company financial statements, tax accounting for equity method investments and accounting for income taxes when the interim period year-to-date loss exceeds the anticipated full year loss. Changes relate to the accounting for franchise taxes that are income-based and non-income-based, determining if a step up in tax basis is part of a business combination or if it is a separate transaction, when enacted tax law changes should be included in the annual effective tax rate computation, and the allocation of taxes in separate company financial statements to a legal entity that is not subject to income tax. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, with early adoption permitted. The Company is currently evaluating the potential impact of the adoption of this standard on its results of operations, financial position and cash flows and related disclosures.

In August 2018, the FASB issued ASU No. 2018-15, Customer's Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract.  ASU 2018-15 requires that certain implementation costs incurred in a cloud computing arrangement be deferred and recognized over the term of the arrangement. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019, and early adoption is permitted. The Company adopted ASU 2016-02 on January 1, 2020 using the prospective transition method, which did not have a material impact on the Company’s results of operations, financial position, cash flows and related disclosures.

In August 2018, the FASB issued ASU No. 2018-13, Disclosure Framework - Changes to the Disclosure Requirements for Fair Value Measurement.  ASU 2018-13 resulted in certain modifications to fair value measurement disclosures, primarily related to level 3 fair value measurements. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019, and early adoption is permitted. The Company adopted ASU 2018-13 on January 1, 2020, which did not have a material impact on the Company’s disclosures.

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. ASU 2016-03, in conjunction with ASU No. 2019-04, Codification Improvements to Topic 326, Financial Instruments - Credit Losses, Topic 815, Derivatives and Hedging, and Topic 825, Financial Instruments, introduces an approach, based on expected losses, to estimate credit losses on certain types of financial instruments and modifies the impairment model for available-for-sale debt securities. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15,

2022 for companies deemed to be smaller reporting companies as of November 15, 2019, with early adoption permitted. The Company is currently evaluating the potential impact of the adoption of this standard on its results of operations, financial position and cash flows and related disclosures.

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Inventory

6 Months Ended

Jun. 30, 2020

Inventory Disclosure [Abstract]

Inventory

Inventory

Inventory consisted of the following:

	June 30, 2020		December 31, 2019
Raw materials	$	1,796	$	1,227
Work-in-process	1,745		676
Finished goods	2,584		1,581
Total inventory	$	6,125	$	3,484

Inventories are stated at the lower of cost or net realizable value, as determined on a first-in, first-out, basis.

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Property and Equipment

6 Months Ended

Jun. 30, 2020

Property, Plant and Equipment [Abstract]

Property and Equipment

Property and Equipment

Property and equipment, net, consisted of the following:

	June 30, 2020		December 31, 2019
Computer equipment and software	$	1,102	$	1,112
Furniture and fixtures	366		366
Machinery and equipment	3,122		3,142
Leasehold improvements	609		609
Construction in process	357		70
	5,556		5,299
Less: accumulated depreciation	(2,766)		(2,247)
	$	2,790	$	3,052

Depreciation expense was $254 and $322 for the three months ended June 30, 2020 and 2019, respectively. Depreciation expense was $562 and $591 for the six months ended June 30, 2020 and 2019, respectively. In addition, depreciation expense of $259 and $10 was charged to inventory and prepaid expenses and other assets, respectively, as of June 30, 2020, which represents depreciation expense related to equipment involved in the manufacturing process.

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Accrued Expenses and Other Current Liabilities

6 Months Ended

Jun. 30, 2020

Payables and Accruals [Abstract]

Accrued Expenses and Other Current Liabilities

Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of:

	June 30, 2020		December 31, 2019
Accrued expenses:
Selling, general and administrative expenses	$	5,469	$	5,544
Research and development expenses	4,468		3,379
Payroll expenses	5,309		7,810
Product revenue allowances	13,386		12,858
Other	1,505		1,788
Total accrued expenses	30,137		31,379
Other current liabilities:
Lease liability	1,256		1,135
Total other current liabilities	1,256		1,135
Total accrued expenses and other current liabilities	$	31,393	$	32,514

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Licensing Revenue

6 Months Ended

Jun. 30, 2020

Research and Development [Abstract]

Licensing Revenue

Licensing Revenue

Inexia License Agreement

On January 31, 2019, OptiNose AS entered into a license agreement (the Inexia License Agreement) with Inexia Limited (Inexia) pursuant to which the Company granted Inexia an exclusive worldwide license to certain intellectual property for the development and commercialization of products containing orexin receptor agonist and/or orexin receptor positive modulator molecules for the treatment, diagnosis or prevention of human diseases or conditions associated primarily with orexin receptor agonism and orexin receptor positive modulation.

Under the terms of the Inexia License Agreement, Inexia paid the Company a $500 upfront payment, which was recognized as license revenue in the first quarter of 2019. For each product developed under the Inexia License Agreement, the Company is eligible to receive up to $8,000 of development milestone payments and up to $37,000 of sales milestone payments. In addition, the Company is eligible to receive tiered, low-to-mid single digit royalties based on net sales of any products successfully developed and commercialized under the Inexia License Agreement. Other than the upfront payment, the Company does not anticipate the receipt of any milestone or royalty payments from Inexia in the near term.

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Long-term Debt

6 Months Ended

Jun. 30, 2020

Debt Disclosure [Abstract]

Long-term Debt

Long-term Debt

On September 12, 2019 (the Closing Date), the Company entered into a Note Purchase Agreement (the Pharmakon Senior Secured Notes) with funds managed by Pharmakon Advisors, LP (Pharmakon), the investment manager of the BioPharma Credit funds (BioPharma). The Pharmakon Senior Secured Notes provide the Company with up to $150,000 in debt financing, of which $80,000 was issued on the Closing Date. On February 13, 2020, the Company received an additional $30,000 (the First Delayed Draw Notes) after achieving the $9,000 XHANCE net sales and royalties threshold for the quarter ended December 31, 2019.

At the Company's option, $20,000 of Pharmakon Senior Secured Notes may be issued between August 15, 2020 and February 15, 2021 (the Third Delayed Draw Notes, and together with the First Delayed Draw Notes and Second Delayed Draw Notes, collectively, the Delayed Draw Notes) subject to the Company achieving either (x) XHANCE net sales and royalties for the quarter ended September 30, 2020 of at least $14,500 or (y) XHANCE net sales and royalties for the six months ended December 31, 2020 of at least $31,000.

The issuance of the Third Delayed Draw Notes is not conditioned upon the issuance of the Second Delayed Draw Notes. Additionally, upon the closing date of the Third Delayed Draw Notes (subject to the Company’s satisfaction of the net sales and royalties thresholds applicable to the Third Delayed Draw Notes), the Company may request and BioPharma may issue, in its sole discretion, up to an additional $20,000 of Pharmakon Senior Secured Notes

(representing the Second Delayed Draw Notes for which the Company did not satisfy the net sales and royalty thresholds for the quarter ended March 31, 2020 or the six months ended June 30,2020).

The Pharmakon Senior Secured Notes bear interest at a fixed per annum rate of 10.75% and are scheduled to mature on September 12, 2024 (the Maturity Date). The Company is required to make quarterly interest payments until the Maturity Date. The Company is also required to make principal payments, which are payable in eight equal quarterly installments beginning on December 15, 2022 and continuing until the Maturity Date; provided that the Company may, at its election, postpone any such principal payment until the Maturity Date if, as of the applicable payment date, certain trailing four-quarter consolidated XHANCE net sales and royalties thresholds have been achieved.

In conjunction with the Pharmakon Senior Secured Notes, the Company paid an upfront fee of $1,125 on the Closing Date and issued warrants to purchase an aggregate of 810,357 shares of Common Stock at an exercise price equal to $6.72 per share, which expire on September 12, 2022. The upfront fees were recorded as debt discount at issuance and are being amortized to interest expense over the five year term of the loan. The Company also incurred $4,991 in debt issuance costs, including $2,404 related to the fair value of the warrants and $150 associated with the First Delayed Draw Notes, which are also being amortized to interest expense over the term of the Pharmakon Senior Secured Notes. The Company will incur additional debt issuance costs of 0.5% of the principal amount of the remaining Delayed Draw Notes, if issued.

The Company is required to repay the Pharmakon Senior Secured Notes in full upon the occurrence of a change of control (as defined in the Note Purchase Agreement). In addition, the Company may make voluntary prepayments in whole or in part. All mandatory and voluntary prepayments are subject to the payment of prepayment premiums as follows: (i) if prepayment occurs prior to the third anniversary of the Closing Date, an amount equal to 2% of the principal prepaid, (ii) if prepayment occurs on or after the third anniversary of the Closing Date but prior to the fourth anniversary of the Closing Date, an amount equal to 1% of the principal prepaid, and (iii) if prepayment occurs on or after the fourth anniversary of the Closing Date, no prepayment premium is required. Additionally, the Company is also required to pay a "make-whole" amount in respect of any principal payments (whether mandatory or voluntary) made prior to the 30-month anniversary of the issuance of the applicable note, in an amount equal to the interest that would have accrued through the 30-month anniversary in respect of such note but for such principal payment.

The Pharmakon Senior Secured Notes are secured by a pledge of substantially all of the Company's assets and contains affirmative and negative covenants customary for financings of this type, including limitations on the Company’s and its subsidiaries’ ability, among other things, to incur additional debt, grant or permit additional liens, make investments and acquisitions, merge or consolidate with others, dispose of assets, pay dividends and distributions, repay junior indebtedness and enter into affiliate transactions, in each case, subject to certain exceptions. In addition, the Pharmakon Senior Secured Notes contain financial covenants requiring the Company to maintain at all times certain minimum trailing twelve-month consolidated XHANCE net sales and royalties, tested on a quarterly basis, and at least $30,000 of cash and cash equivalents. As of June 30, 2020, the Company was in compliance with the covenants.

The Note Purchase Agreement also includes events of default customary for financings of this type, in certain cases subject to customary periods to cure, following which BioPharma may accelerate all amounts outstanding under the notes.

On September 12, 2019, in conjunction with the entry into the Pharmakon Senior Secured Notes, the Company terminated the Athyrium senior secured notes and all outstanding amounts under such notes were repaid in full, and all security interests and other liens granted to or held by Athyrium were terminated and released.

The Company recorded interest expense of $3,293 and $2,389 during the three months ended June 30, 2020 and 2019, respectively, and $6,156 and $4,777 during the six months ended June 30, 2020 and 2019, respectively, in conjunction with both Pharmakon Senior Secured Notes and the Athyrium senior secured notes. Interest expense included total coupon interest, exit fees, front end fees and the amortization of debt issuance costs.

The long-term debt balance is comprised of the following:

	June 30, 2020		December 31, 2019
Face amount	$	110,000	$	80,000
Front end fees	(956)		(1,030)
Debt issuance costs	(4,097)		(4,439)
Long-term debt, net	$	104,947	$	74,531

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Employee Benefit Plans

6 Months Ended

Jun. 30, 2020

Retirement Benefits [Abstract]

Employee Benefit Plans

Employee Benefit Plans

For US employees, the Company maintains a defined contribution 401(k) retirement plan. As of June 30, 2020, approximately $97 is recorded in accrued liabilities related to the Company match. The Company's contributions are made in cash.

For Norway and UK employees, the Company maintains defined contribution pension plans which meet the statutory requirements of those jurisdictions. The Company incurred costs related to the pension plans of $5 for the three months ended June 30, 2020 and 2019, and $10 and $11 for the six months ended June 30, 2020 and 2019, respectively.

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Stockholders' Equity

6 Months Ended

Jun. 30, 2020

Equity [Abstract]

Stockholders' Equity

Stockholders' Equity

As of June 30, 2020, the Company had the following warrants outstanding to purchase shares of Common Stock:

Number of Shares	Exercise Price Per Share		Expiration Date
1,866,831	$	8.16	November 1, 2020
810,357	$	6.72	September 12, 2022

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Stock-based Compensation

6 Months Ended

Jun. 30, 2020

Share-based Payment Arrangement [Abstract]

Stock-based Compensation

Stock-based Compensation

The Company recorded stock-based compensation expense related to stock options and shares issued under the Company's 2017 Employee Stock Purchase Plan (2017 Plan) in the following expense categories of its accompanying consolidated statements of operations for the three and six months ended June 30, 2020 and 2019:

	Three Months Ended June 30,				Six Months Ended June 30,
	2020		2019		2020		2019
Cost of product sales	$	34	$	26	$	88	$	45
Research and development	331		284		588		527
General and administrative	2,407		2,387		4,556		4,545
	$	2,772	$	2,697	$	5,232	$	5,117

In addition, stock-based compensation expense of $52 and $1 was charged to inventory and prepaid expenses and other assets, respectively, during the six months ended June 30, 2020, which represents the total stock-based compensation expense incurred related to employees involved in the manufacturing process of finished goods and samples during the period.

Stock Options

The Company issues stock-based awards pursuant to its 2010 Stock Incentive Plan. Effective as of October 12, 2017, the Company's 2010 Stock Incentive Plan was amended and restated (A&R Plan).The Company has issued service-based and performance-based stock options that generally have a contractual life of up to 10 years and may be exercisable in cash or as otherwise determined by the Company's board of directors or committee thereof. Vesting generally occurs over a period of not greater than four years. Performance-based options may vest upon the achievement of certain milestones in connection with the Company's development programs. Additionally, the Company has issued stock options in excess of the fair market value of Common Stock on the issuance date that were only exercisable upon a change in control or upon or after an initial public offering. As of June 30, 2020, all of the performance conditions related to performance-based stock options issued by the Company have been achieved.

The following table summarizes the activity related to stock option grants to employees and nonemployees for the six months ended June 30, 2020:

	Shares	Weighted average exercise price per share		Weighted average remaining contractual life
Outstanding at December 31, 2019	7,399,217	$	9.81	6.37
Granted	1,259,331	5.64
Exercised	(15,806)	4.50
Expired	—	—
Forfeited	(256,911)	9.91
Outstanding at June 30, 2020	8,385,831	$	9.19	6.37
Exercisable at June 30, 2020	5,236,017	$	9.47	4.92
Vested and expected to vest at June 30, 2020	8,385,831	$	9.19	6.37

During the six months ended June 30, 2020, stock options to purchase 1,259,331 shares of Common Stock were granted to employees and generally vest over four years. The stock options had an estimated weighted average grant date fair value of $3.44. During the six months ended June 30, 2019, stock options to purchase 2,013,173 shares of Common Stock were granted to employees that generally vest over four years. The stock options had an estimated weighted average grant date fair value of $4.80.

Included in the table above are 90,000 of options granted outside the A&R Plan. The grants were made pursuant to the NASDAQ inducement grant exception in accordance with NASDAQ Listing Rule 5635(c)(4).

The grant date fair value of each stock option grant was estimated at the time of grant using the Black-Scholes option-pricing model using the following weighted average assumptions:

	Six Months Ended June 30,
	2020			2019
Risk free interest rate	0.72		%	2.51		%
Expected term (in years)	6.03			6.05
Expected volatility	68.64		%	67.02		%
Annual dividend yield	0.00		%	0.00		%
Fair value of common stock	$	5.64		$	7.73

At June 30, 2020, the unrecognized compensation cost related to unvested stock options expected to vest was $17,030. This unrecognized compensation will be recognized over an estimated weighted-average amortization period of 2.29 years.

Restricted Stock Units

The Company has issued service-based and performance-based restricted stock units (RSUs). Vesting generally occurs over a period not greater than four years. Vesting of the performance-based RSUs is subject to the achievement of certain milestones in connection with the Company's development programs.

The following table summarizes the activity related to RSUs granted to employees for the six months ended June 30, 2020:

	Shares
Balance at December 31, 2019	—
Granted	1,290,203
Vested and settled	—
Expired/ forfeited/ canceled	(15,849)
Balance at June 30, 2020	1,274,354
Expected to vest at June 30, 2020	1,274,354

In March 2020, the Company granted 1,290,203 RSUs at a grant date fair value of $5.41, of which 718,150 were service-based RSUs and 572,053 were performance-based RSUs. As of June 30, 2020, the milestones associated with the performance based-RSUs are not probable of achievement, and accordingly, no stock based compensation expense has been recognized to date for these awards. At June 30, 2020, the unrecognized compensation cost related to unvested service-based RSUs expected to vest was $3,502, to be recognized over an estimated weighted-average amortization period of 3.71 years. The unrecognized compensation cost related to unvested performance-based RSUs was $3,095, which will be recognized commencing in the period in which the performance condition is deemed probable of achievement over the remaining service period.

Included in the table above are 60,000 of RSUs granted outside the A&R Plan. The grants were made pursuant to the NASDAQ inducement grant exception in accordance with NASDAQ Listing Rule 5635(c)(4).

2017 Employee Stock Purchase Plan

Under the 2017 Plan, shares of Common Stock may be purchased by eligible employees who elect to participate in the 2017 Plan at 85% of the lower of the fair market value of Common Stock on the first or last day of designated offering periods. The Company recognized stock-based compensation expense of $137 and $114 during the three months ended June 30, 2020 and 2019, respectively, and $287 and $228 during the six months ended June 30, 2020 and 2019, respectively, related to the 2017 Plan.

The Company calculated the fair value of each option grant and the shares issued under the 2017 Plan on the respective dates of grant using the following weighted average assumptions:

	Six Months Ended June 30,
	2020		2019
Risk free interest rate	1.57	%	2.51	%
Expected term (in years)	0.5		0.5
Expected volatility	79.59	%	82.20	%
Annual dividend yield	0.00	%	0.00	%

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Basis of Presentation and Summary of Significant Accounting Policies (Policies)

6 Months Ended

Jun. 30, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Use of estimates

Use of estimates

The preparation of the unaudited interim consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited interim consolidated financial statements and reported amounts of expenses during the reporting period. Due to the uncertainty of factors surrounding the estimates or judgments used in the preparation of the unaudited interim consolidated financial statements, actual results may materially vary from these estimates. Estimates and assumptions are periodically reviewed and the effects of revisions are reflected in the unaudited interim consolidated financial statements in the period they are determined to be necessary.

Concentration of credit risk and customer and supplier concentration

Concentration of credit risk

Financial instruments that potentially subject the Company to concentrations of credit risk are primarily cash and accounts receivable. The Company generally invests its cash in deposits with high credit quality financial institutions. Additionally, the Company performs periodic evaluations of the relative credit standing of these financial institutions.

Customer and supplier concentration

XHANCE is sold to wholesale pharmaceutical distributors and Preferred Pharmacy Network (PPN) partners, who, in turn, sell XHANCE to pharmacies, hospitals and other customers

Fair value of financial instruments

Fair value of financial instrumentsAt June 30, 2020 and December 31, 2019, the Company's financial instruments included cash and cash equivalents, accounts receivable, grants receivable, accounts payable and accrued expenses. The carrying amounts reported in the Company's financial statements for these instruments approximate their respective fair values because of the short-term nature of these instruments. In addition, at June 30, 2020, the Company believes the carrying value of long-term debt approximates fair value as the interest rates are reflective of the rate the Company could obtain on debt with similar terms and conditions.

Restricted cash

Restricted cashAs of June 30, 2020 and December 31, 2019, the restricted cash balance included in prepaid expenses and other assets was $13 and $21, respectively.

Net product revenues and licensing revenues

Net product revenues

The Company accounts for revenue in accordance with ASC Topic 606, Revenue from Contracts with Customers (ASC 606), which was adopted on January 1, 2018. The Company recognizes revenue from XHANCE sales at the point customers obtain control of the product, which generally occurs upon delivery. The transaction price that is recognized as revenue for products includes an estimate of variable consideration. The Company’s estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of its anticipated performance and all information (historical, current and forecasted) that is reasonably available. The components of the Company’s variable consideration include the following:

Provider Chargebacks and Discounts. Chargebacks for fees and discounts to providers represent the estimated obligations resulting from contractual commitments to sell products to qualified healthcare providers at prices lower

than the list prices charged to customers who directly purchase the product from the Company. Customers charge the Company for the difference between what they pay for the product and the ultimate selling price to the qualified healthcare providers. These components of variable consideration are established in the same period that the related revenue is recognized, resulting in a reduction of product revenue and accounts receivable.

Trade Discounts and Allowances. The Company generally provides customers with discounts that include incentive fees which are explicitly stated in the Company’s contracts. These discounts are recorded as a reduction of revenue and accounts receivable in the period in which the related product revenue is recognized.

Product Returns. Consistent with industry practice, the Company has a product returns policy that provides customers a right of return for product purchased within a specified period prior to and subsequent to the product’s expiration date. The Company estimates the amount of its product that may be returned and presents this amount as a reduction of revenue in the period the related product revenue is recognized, in addition to establishing a liability. The Company considers several factors in the estimation process, including expiration dates of product shipped to customers, inventory levels within the distribution channel, product shelf life, prescription trends and other relevant factors.

Government Rebates. The Company is subject to discount obligations under state Medicaid programs and Medicare. Reserves related to these discount obligations are recorded in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a current liability. The Company’s liability for these rebates consists of estimates of claims for the current quarter and estimated future claims that will be made for product that has been recognized as revenue but remains in the distribution channel inventories at the end of the reporting period.

Payor Rebates. The Company contracts with certain third-party payors, primarily health insurance companies and pharmacy benefit managers, for the payment of rebates with respect to utilization of its products. These rebates are based on contractual percentages applied to the amount of product prescribed to patients who are covered by the plan or the organization with which it contracts. The Company estimates these rebates and records such estimates in the same period the related revenue is recognized, resulting in a reduction of product revenue and the establishment of a current liability.

Patient Assistance. Other programs that the Company offers include voluntary co-pay patient assistance programs intended to provide financial assistance to eligible patients with prescription drug co-payments required by payors and coupon programs for cash payors. The calculation of the current liability for this assistance is based on an estimate of claims and the cost per claim that the Company expects to receive associated with product that has been recognized as revenue but remains in the distribution channel inventories at the end of each reporting period.

Licensing revenues

The Company has license agreements with Inexia Limited (Inexia) and Currax Pharmaceuticals LLC (Currax). These license agreements provide for exclusive licensed rights to certain intellectual property, a non-refundable up-front payment, potential milestone payment(s) and potential royalty payment(s). The Company analyzed the performance obligations under the license agreements, the consideration received to date and the consideration the Company could receive in the future as part of its analysis related to ASC 606. No licensing revenues were recognized during the three and six months ended June 30, 2020 (Note 7).

Net income (loss) per common share

Net income (loss) per common shareBasic net income (loss) per common share is determined by dividing net income (loss) applicable to Company common stock (Common Stock) holders by the weighted average common shares outstanding during the period. For the three and six months ended June 30, 2020 and 2019, the outstanding Common Stock options, Common Stock warrants and shares to be issued under the Company's 2017 Employee Stock Purchase Plan have been excluded from the calculation of diluted net loss per share because their effect would be anti-dilutive. Therefore, the weighted average shares used to calculate both basic and diluted net loss per share are the same.

Income taxes

Income taxes

In accordance with ASC 270, Interim Reporting, and ASC 740, Income Taxes, the Company is required at the end of each interim period to determine the best estimate of its annual effective tax rate and then apply that rate in providing for income taxes on a current year-to-date (interim period) basis. For the three and six months ended June 30, 2020 and 2019, the Company recorded no tax expense or benefit due to the expected current year loss and its historical losses. As of June 30, 2020 and December 31, 2019, the Company has concluded that a full valuation allowance is necessary for all of its net deferred tax assets. The Company had no amounts recorded for uncertain tax positions, interest or penalties in the accompanying consolidated financial statements.

Recent accounting pronouncements

Recent accounting pronouncements

In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. ASU 2019-12 eliminated certain exceptions and changed guidance on other matters. The exceptions relate to the allocation of income taxes in separate company financial statements, tax accounting for equity method investments and accounting for income taxes when the interim period year-to-date loss exceeds the anticipated full year loss. Changes relate to the accounting for franchise taxes that are income-based and non-income-based, determining if a step up in tax basis is part of a business combination or if it is a separate transaction, when enacted tax law changes should be included in the annual effective tax rate computation, and the allocation of taxes in separate company financial statements to a legal entity that is not subject to income tax. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, with early adoption permitted. The Company is currently evaluating the potential impact of the adoption of this standard on its results of operations, financial position and cash flows and related disclosures.

In August 2018, the FASB issued ASU No. 2018-15, Customer's Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That Is a Service Contract.  ASU 2018-15 requires that certain implementation costs incurred in a cloud computing arrangement be deferred and recognized over the term of the arrangement. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019, and early adoption is permitted. The Company adopted ASU 2016-02 on January 1, 2020 using the prospective transition method, which did not have a material impact on the Company’s results of operations, financial position, cash flows and related disclosures.

In August 2018, the FASB issued ASU No. 2018-13, Disclosure Framework - Changes to the Disclosure Requirements for Fair Value Measurement.  ASU 2018-13 resulted in certain modifications to fair value measurement disclosures, primarily related to level 3 fair value measurements. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2019, and early adoption is permitted. The Company adopted ASU 2018-13 on January 1, 2020, which did not have a material impact on the Company’s disclosures.

In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. ASU 2016-03, in conjunction with ASU No. 2019-04, Codification Improvements to Topic 326, Financial Instruments - Credit Losses, Topic 815, Derivatives and Hedging, and Topic 825, Financial Instruments, introduces an approach, based on expected losses, to estimate credit losses on certain types of financial instruments and modifies the impairment model for available-for-sale debt securities. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15,

2022 for companies deemed to be smaller reporting companies as of November 15, 2019, with early adoption permitted. The Company is currently evaluating the potential impact of the adoption of this standard on its results of operations, financial position and cash flows and related disclosures.

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Basis of Presentation and Summary of Significant Accounting Policies (Tables)

6 Months Ended

Jun. 30, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Antidilutive Shares Excluded From Computation of Net Loss Per Share

Diluted net loss per common share for the periods presented do not reflect the following potential common shares, as the effect would be antidilutive:

	June 30,
	2020	2019
Stock options	8,385,831	7,983,370
Restricted stock units	1,274,354	—
Common stock warrants	2,677,188	1,866,831
Total	12,337,373	9,850,201

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Inventory (Tables)

6 Months Ended

Jun. 30, 2020

Inventory Disclosure [Abstract]

Schedule of Inventory

Inventory consisted of the following:

	June 30, 2020		December 31, 2019
Raw materials	$	1,796	$	1,227
Work-in-process	1,745		676
Finished goods	2,584		1,581
Total inventory	$	6,125	$	3,484

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Property and Equipment (Tables)

6 Months Ended

Jun. 30, 2020

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment, net, consisted of the following:

	June 30, 2020		December 31, 2019
Computer equipment and software	$	1,102	$	1,112
Furniture and fixtures	366		366
Machinery and equipment	3,122		3,142
Leasehold improvements	609		609
Construction in process	357		70
	5,556		5,299
Less: accumulated depreciation	(2,766)		(2,247)
	$	2,790	$	3,052

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Accrued Expenses and Other Current Liabilities (Tables)

6 Months Ended

Jun. 30, 2020

Payables and Accruals [Abstract]

Schedule of Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of:

	June 30, 2020		December 31, 2019
Accrued expenses:
Selling, general and administrative expenses	$	5,469	$	5,544
Research and development expenses	4,468		3,379
Payroll expenses	5,309		7,810
Product revenue allowances	13,386		12,858
Other	1,505		1,788
Total accrued expenses	30,137		31,379
Other current liabilities:
Lease liability	1,256		1,135
Total other current liabilities	1,256		1,135
Total accrued expenses and other current liabilities	$	31,393	$	32,514

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Long-term Debt (Tables)

6 Months Ended

Jun. 30, 2020

Debt Disclosure [Abstract]

Schedule of Long-term Debt Instruments

The long-term debt balance is comprised of the following:

	June 30, 2020		December 31, 2019
Face amount	$	110,000	$	80,000
Front end fees	(956)		(1,030)
Debt issuance costs	(4,097)		(4,439)
Long-term debt, net	$	104,947	$	74,531

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Stockholders' Equity (Tables)

6 Months Ended

Jun. 30, 2020

Equity [Abstract]

Schedule of Warrants Outstanding

As of June 30, 2020, the Company had the following warrants outstanding to purchase shares of Common Stock:

Number of Shares	Exercise Price Per Share		Expiration Date
1,866,831	$	8.16	November 1, 2020
810,357	$	6.72	September 12, 2022

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Stock-based Compensation (Tables)

6 Months Ended

Jun. 30, 2020

Share-based Payment Arrangement [Abstract]

Schedule of Allocated Stock-Based Compensation Expense

The Company recorded stock-based compensation expense related to stock options and shares issued under the Company's 2017 Employee Stock Purchase Plan (2017 Plan) in the following expense categories of its accompanying consolidated statements of operations for the three and six months ended June 30, 2020 and 2019:

	Three Months Ended June 30,				Six Months Ended June 30,
	2020		2019		2020		2019
Cost of product sales	$	34	$	26	$	88	$	45
Research and development	331		284		588		527
General and administrative	2,407		2,387		4,556		4,545
	$	2,772	$	2,697	$	5,232	$	5,117

Schedule of Stock Option Activity

The following table summarizes the activity related to stock option grants to employees and nonemployees for the six months ended June 30, 2020:

	Shares	Weighted average exercise price per share		Weighted average remaining contractual life
Outstanding at December 31, 2019	7,399,217	$	9.81	6.37
Granted	1,259,331	5.64
Exercised	(15,806)	4.50
Expired	—	—
Forfeited	(256,911)	9.91
Outstanding at June 30, 2020	8,385,831	$	9.19	6.37
Exercisable at June 30, 2020	5,236,017	$	9.47	4.92
Vested and expected to vest at June 30, 2020	8,385,831	$	9.19	6.37

Schedule of Fair Value Options using Black-Scholes Pricing Model

The grant date fair value of each stock option grant was estimated at the time of grant using the Black-Scholes option-pricing model using the following weighted average assumptions:

	Six Months Ended June 30,
	2020			2019
Risk free interest rate	0.72		%	2.51		%
Expected term (in years)	6.03			6.05
Expected volatility	68.64		%	67.02		%
Annual dividend yield	0.00		%	0.00		%
Fair value of common stock	$	5.64		$	7.73

The Company calculated the fair value of each option grant and the shares issued under the 2017 Plan on the respective dates of grant using the following weighted average assumptions:

	Six Months Ended June 30,
	2020		2019
Risk free interest rate	1.57	%	2.51	%
Expected term (in years)	0.5		0.5
Expected volatility	79.59	%	82.20	%
Annual dividend yield	0.00	%	0.00	%

Schedule of Nonvested Restricted Stock Units Activity

The following table summarizes the activity related to RSUs granted to employees for the six months ended June 30, 2020:

	Shares
Balance at December 31, 2019	—
Granted	1,290,203
Vested and settled	—
Expired/ forfeited/ canceled	(15,849)
Balance at June 30, 2020	1,274,354
Expected to vest at June 30, 2020	1,274,354

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Liquidity (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash and cash equivalents	$ 125,266	$ 147,144

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Basis of Presentation and Summary of Significant Accounting Policies - Concentration of Credit Risk (Details) - Customer Concentration Risk	3 Months Ended	6 Months Ended
	Jun. 30, 2020 customer	Jun. 30, 2020 customer
Accounts Receivable
Concentration Risk [Line Items]
Number of customers	5	5
Concentration risk (as a percent)		51.00%
Sales Revenue, Net
Concentration Risk [Line Items]
Number of customers	5	5
Concentration risk (as a percent)	48.00%	49.00%

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Basis of Presentation and Summary of Significant Accounting Policies - Restricted Cash (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Prepaid Expenses and Other Current Assets
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Restricted cash	$ 13	$ 21

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Basis of Presentation and Summary of Significant Accounting Policies - Antidilutive Shares Excluded From Computation of Net Loss Per Share (Details) - shares	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securites excluded from computation of net loss per common share	12,337,373	9,850,201
Stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securites excluded from computation of net loss per common share	8,385,831	7,983,370
Restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securites excluded from computation of net loss per common share	1,274,354	0
Common stock warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securites excluded from computation of net loss per common share	2,677,188	1,866,831

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Inventory (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw materials	$ 1,796	$ 1,227
Work-in-process	1,745	676
Finished goods	2,584	1,581
Total inventory	$ 6,125	$ 3,484

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Property and Equipment - Property and Equipment (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 5,556	$ 5,299
Less: accumulated depreciation	(2,766)	(2,247)
Property and equipment, net	2,790	3,052
Computer equipment and software
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,102	1,112
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment, gross	366	366
Machinery and equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	3,122	3,142
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	609	609
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 357	$ 70

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Property and Equipment - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Property, Plant and Equipment [Line Items]
Depreciation	$ 254	$ 322	$ 562	$ 591
Inventory
Property, Plant and Equipment [Line Items]
Depreciation			259
Prepaid expenses and other assets
Property, Plant and Equipment [Line Items]
Depreciation			$ 10

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Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Accrued expenses:
Selling, general and administrative expenses	$ 5,469	$ 5,544
Research and development expenses	4,468	3,379
Payroll expenses	5,309	7,810
Product revenue allowances	13,386	12,858
Other	1,505	1,788
Total accrued expenses	30,137	31,379
Other current liabilities:
Lease liability	1,256	1,135
Total other current liabilities	1,256	1,135
Total accrued expenses and other current liabilities	$ 31,393	$ 32,514

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Licensing Revenue (Details) - Inexia License Agreement $ in Thousands	Jan. 31, 2019 USD ($)
Research and Development Arrangement, Contract to Perform for Others [Line Items]
Upfront payment received	$ 500
Development milestone payments eligible to be received (up to)	8,000
Sales milestone payments eligible to be received (up to)	$ 37,000

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Long-term Debt - Narrative (Details)		3 Months Ended		6 Months Ended
	Sep. 12, 2019 USD ($) installment $ / shares shares	Jun. 30, 2020 USD ($) $ / shares	Jun. 30, 2019 USD ($)	Jun. 30, 2020 USD ($) $ / shares	Jun. 30, 2019 USD ($)	Feb. 13, 2020 USD ($)
Warrants Expiring September 12, 2022
Debt Instrument [Line Items]
Number of shares called by warrants | shares	810,357
Warrants exercise price (in USD per share) | $ / shares	$ 6.72	$ 6.72		$ 6.72
Senior Notes | Note Purchase Agreement
Debt Instrument [Line Items]
Debt maximum borrowing capacity	$ 150,000,000
Debt face amount	$ 80,000,000
Stated interest rate	10.75%
Debt principal payments, number of installments | installment	8
Debt upfront fee	$ 1,125,000
Loans, term	5 years
Debt issuance costs	$ 4,991,000
Fair value of warrants	$ 2,404,000
Debt issuance costs, additional as percentage of principal amount	0.50%
Prepayment fee, after second and before third anniversary	2.00%
Prepayment fee, after third and before fourth anniversary	1.00%
Prepayment premium amount	$ 0
Debt covenant, cash and cash equivalents	30,000,000
Interest expense		$ 3,293,000	$ 2,389,000	$ 6,156,000	$ 4,777,000
Senior Notes | Note Purchase Agreement - First Delayed Draw Notes
Debt Instrument [Line Items]
Debt face amount						$ 30,000,000
Fair value of warrants	150,000
Senior Notes | Note Purchase Agreement - First Delayed Draw Notes | Quarter Ended December 31, 2019
Debt Instrument [Line Items]
Debt issuance criteria term, net sales and royalties benchmark	9,000,000
Senior Notes | Note Purchase Agreement - Second Delayed Draw Notes
Debt Instrument [Line Items]
Debt face amount	20,000,000
Senior Notes | Note Purchase Agreement - Third Delayed Draw Notes
Debt Instrument [Line Items]
Debt face amount	20,000,000
Senior Notes | Note Purchase Agreement - Third Delayed Draw Notes | Quarter Ended September 30, 2020
Debt Instrument [Line Items]
Debt issuance criteria term, net sales and royalties benchmark	14,500,000
Senior Notes | Note Purchase Agreement - Third Delayed Draw Notes | Six Months Ended December 31, 2020
Debt Instrument [Line Items]
Debt issuance criteria term, net sales and royalties benchmark	$ 31,000,000

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Long-term Debt - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Short-term Debt [Line Items]
Long-term debt, net	$ 104,947	$ 74,531
Note Purchase Agreement | Senior Notes
Short-term Debt [Line Items]
Face amount	110,000	80,000
Front end fees	(956)	(1,030)
Debt issuance costs	(4,097)	(4,439)
Long-term debt, net	$ 104,947	$ 74,531

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Employee Benefit Plans (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2020	Jun. 30, 2019
Defined Contribution Plan Disclosure [Line Items]
Accrued liabilities related to the Company match	$ 97	$ 97
Norway and UK employee plans
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, cost	$ 5	$ 10	$ 11

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Stockholders' Equity - Schedule of Warrants Outstanding (Details) - $ / shares	Jun. 30, 2020	Sep. 12, 2019
Warrants Expiring November 1, 2020
Class of Stock [Line Items]
Warrants outstanding (in shares)	1,866,831
Warrants exercise price (in USD per share)	$ 8.16
Warrants Expiring September 12, 2022
Class of Stock [Line Items]
Warrants outstanding (in shares)	810,357
Warrants exercise price (in USD per share)	$ 6.72	$ 6.72

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Stock-based Compensation - Allocated Stock-Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 2,772	$ 2,697	$ 5,232	$ 5,117
Cost of product sales
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	34	26	88	45
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	331	284	588	527
General and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 2,407	$ 2,387	$ 4,556	$ 4,545

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Stock-based Compensation - Narrative (Details) - USD ($)	3 Months Ended			6 Months Ended
	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 2,772,000		$ 2,697,000	$ 5,232,000	$ 5,117,000
Plan options contractual life (up to)				10 years
Award vesting period				4 years
Service Based Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period				4 years	4 years
Stock options to purchase shares (in shares)				1,259,331	2,013,173
Weighted average grant date fair value (usd per share)				$ 3.44	$ 4.80
Unrecognized cost related to unvested RSUs expected to vest	17,030,000			$ 17,030,000
Estimated weighted-average amortization period				2 years 3 months 14 days
Restricted stock units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period				4 years
Granted (in shares)		1,290,203		1,290,203
Restricted shares fair value at grant date (usd per share)				$ 5.41
Restricted Stock Units, Service-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized cost related to unvested RSUs expected to vest	3,502,000			$ 3,502,000
Estimated weighted-average amortization period				3 years 8 months 15 days
Granted (in shares)				718,150
Restricted Stock Units, Performance-Based
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense				$ 0
Unrecognized cost related to unvested RSUs expected to vest	3,095,000			$ 3,095,000
Granted (in shares)				572,053
NASDAQ Inducement Grant Exception | Service Based Stock Options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options to purchase shares (in shares)				90,000
NASDAQ Inducement Grant Exception | Restricted stock units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Granted (in shares)				60,000
2017 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 137,000		$ 114,000	$ 287,000	$ 228,000
Inventory
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense				$ 52,000
Prepaid expenses and other assets
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense					$ 1,000

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Stock-based Compensation - Stock Option Activity (Details) - Service Based Stock Options - $ / shares	6 Months Ended		12 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Dec. 31, 2019
Shares
Beginning balance (in shares)	7,399,217
Granted (in shares)	1,259,331	2,013,173
Exercised (in shares)	(15,806)
Expired (in shares)	0
Forfeited (in shares)	(256,911)
Ending balance (in shares)	8,385,831		7,399,217
Exercisable (in shares)	5,236,017
Vested and expected to vest (in shares)	8,385,831
Weighted average exercise price per share
Beginning balance (usd per share)	$ 9.81
Granted (usd per share)	5.64
Exercised (usd per share)	4.50
Expired (usd per share)	0
Forfeited (usd per share)	9.91
Ending balance (usd per share)	9.19		$ 9.81
Exercisable (usd per share)	9.47
Vested and expected to vest (usd per share)	$ 9.19
Weighted average remaining contractual life
Options outstanding, weighted average remaining contractual life	6 years 4 months 13 days		6 years 4 months 13 days
Options exercisable, weighted average remaining contractual life	4 years 11 months 1 day
Vested and expected to vest, weighted average remaining contractual life	6 years 4 months 13 days

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Stock-based Compensation - Fair Value Options using Black-Scholed Pricing Model (Details) - $ / shares	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
2017 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	1.57%	2.51%
Expected term (in years)	6 months	6 months
Expected volatility	79.59%	82.20%
Annual dividend yield	0.00%	0.00%
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	0.72%	2.51%
Expected term (in years)	6 years 10 days	6 years 18 days
Expected volatility	68.64%	67.02%
Annual dividend yield	0.00%	0.00%
Fair value of common stock (usd per share)	$ 5.64	$ 7.73

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Stock-based Compensation - Restricted Stock Units Activity (Details) - Restricted stock units - shares	3 Months Ended	6 Months Ended
	Mar. 31, 2020	Jun. 30, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Balance at December 31, 2019 (in shares)	0	0
Granted (in shares)	1,290,203	1,290,203
Vested and settled (in shares)		0
Expired/ forfeited/ canceled (in shares)		(15,849)
Balance at June 30, 2020 (in shares)		1,274,354
Expected to vest at June 30, 2020 (in shares)		1,274,354