OptiNose (OPTN) 10-Q 15 Nov 21 2021 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2021	Oct. 31, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2021
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	Non-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		53,449,567
Entity Central Index Key	0001494650
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Amendment Flag	false

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 84,226	$ 144,156
Accounts receivable, net	24,088	23,394
Inventory	13,161	9,042
Prepaid expenses and other current assets	3,967	4,060
Total current assets	125,442	180,652
Property and equipment, net	1,515	2,028
Other assets	4,960	6,133
Total assets	131,917	188,813
Current liabilities:
Accounts payable	6,502	5,489
Accrued expenses and other current liabilities	47,125	46,683
Total current liabilities	53,627	52,172
Long-term debt, net	126,542	125,202
Other liabilities	3,217	4,651
Total liabilities	183,386	182,025
Stockholders' equity (deficit):
Common stock, $0.001 par value; 200,000,000 shares authorized at September 30, 2021 and December 31, 2020; 53,449,567 and 52,945,865 shares issued and outstanding at September 30, 2021 and December 31, 2020, respectively	53	53
Additional paid-in capital	542,996	534,585
Accumulated deficit	(594,437)	(527,765)
Accumulated other comprehensive loss	(81)	(85)
Total stockholders' equity (deficit)	(51,469)	6,788
Total liabilities and stockholders' equity (deficit)	$ 131,917	$ 188,813
Shares outstanding (in shares)	53,449,567	52,945,865
Shares issued (in shares)	53,449,567	52,945,865

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2021	Dec. 31, 2020
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)	53,449,567	52,945,865
Shares outstanding (in shares)	53,449,567	52,945,865

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Total revenues	$ 21,826	$ 15,436	$ 52,143	$ 32,770
Costs and expenses:
Cost of product sales	2,411	2,221	6,576	5,276
Research and development	6,654	6,524	20,058	16,930
Selling, general and administrative	25,801	24,575	80,293	77,332
Total operating expenses	34,866	33,320	106,927	99,538
Loss from operations	(13,040)	(17,884)	(54,784)	(66,768)
Other (income) expense:
Interest income	(9)	(31)	(42)	(396)
Interest expense	4,072	3,350	11,959	9,506
Foreign currency (gains) losses	14	11	38	44
Gain on sale of property and equipment	0	0	(67)	0
Net loss	$ (17,117)	$ (21,214)	$ (66,672)	$ (75,922)
Net loss per share of common stock, basic (in USD per share)	$ (0.32)	$ (0.43)	$ (1.25)	$ (1.62)
Net loss per share of common stock, diluted (in USD per share)	$ (0.32)	$ (0.43)	$ (1.25)	$ (1.62)
Weighted average common shares outstanding, basic (in shares)	53,334,669	48,907,514	53,151,730	46,914,561
Weighted average common shares outstanding, diluted (in shares)	53,334,669	48,907,514	53,151,730	46,914,561
Net product revenues
Total revenues	$ 21,826	$ 15,436	$ 51,143	$ 32,770
Licensing revenues
Total revenues	$ 0	$ 0	$ 1,000	$ 0

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Statement of Comprehensive Income [Abstract]
Net loss	$ (17,117)	$ (21,214)	$ (66,672)	$ (75,922)
Other comprehensive loss:
Foreign currency translation adjustment	2	13	4	(17)
Comprehensive loss	$ (17,115)	$ (21,201)	$ (66,668)	$ (75,939)

Consolidated Statements of Chan

Consolidated Statements of Changes in Stockholders' Equity (Deficit) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss
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 (in shares) at Mar. 31, 2020		45,906,162
Ending balance at Mar. 31, 2020	35,131	$ 46	491,994	(456,836)	(73)
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	(75,922)
Ending balance (in shares) at Sep. 30, 2020		52,080,552
Ending balance at Sep. 30, 2020	27,683	$ 52	531,598	(503,902)	(65)
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 (in shares) at Jun. 30, 2020		45,992,273
Ending balance at Jun. 30, 2020	12,609	$ 46	495,329	(482,688)	(78)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,615		2,615
Sale of common stock, net of issuance costs (in shares)		6,000,000
Sale of common stock, net of issuance costs	33,405	$ 6	33,399
Exercise of common stock options (in shares)		43,636
Exercise of common stock options	5		5
Issuance of common stock with Pharmakon Amendment (in shares)		44,643
Issuance of common stock with Pharmakon Amendment	250		250
Foreign currency translation adjustment	13				13
Net loss	(21,214)			(21,214)
Ending balance (in shares) at Sep. 30, 2020		52,080,552
Ending balance at Sep. 30, 2020	27,683	$ 52	531,598	(503,902)	(65)
Beginning balance (in shares) at Dec. 31, 2020		52,945,865
Beginning balance at Dec. 31, 2020	6,788	$ 53	534,585	(527,765)	(85)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,596		2,596
Vesting of restricted stock units (in shares)		166,709
Foreign currency translation adjustment	2				2
Net loss	(26,053)			(26,053)
Ending balance (in shares) at Mar. 31, 2021		53,112,574
Ending balance at Mar. 31, 2021	(16,667)	$ 53	537,181	(553,818)	(83)
Beginning balance (in shares) at Dec. 31, 2020		52,945,865
Beginning balance at Dec. 31, 2020	6,788	$ 53	534,585	(527,765)	(85)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(66,672)
Ending balance (in shares) at Sep. 30, 2021		53,449,567
Ending balance at Sep. 30, 2021	(51,469)	$ 53	542,996	(594,437)	(81)
Beginning balance (in shares) at Mar. 31, 2021		53,112,574
Beginning balance at Mar. 31, 2021	(16,667)	$ 53	537,181	(553,818)	(83)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,729		2,729
Vesting of restricted stock units (in shares)		37,034
Issuance of common stock under employee stock purchase plan (in shares)		135,525
Issuance of common stock under employee stock purchase plan	367		367
Foreign currency translation adjustment	0				0
Net loss	(23,502)			(23,502)
Ending balance (in shares) at Jun. 30, 2021		53,285,133
Ending balance at Jun. 30, 2021	(37,073)	$ 53	540,277	(577,320)	(83)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock compensation expense	2,680		2,680
Vesting of restricted stock units (in shares)		140,555
Exercise of common stock options (in shares)		23,879
Exercise of common stock options	39		39
Foreign currency translation adjustment	2				2
Net loss	(17,117)			(17,117)
Ending balance (in shares) at Sep. 30, 2021		53,449,567
Ending balance at Sep. 30, 2021	$ (51,469)	$ 53	$ 542,996	$ (594,437)	$ (81)

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Operating activities:
Net loss	$ (66,672)	$ (75,922)
Adjustments to reconcile net loss to cash used in operating activities:
Depreciation and amortization	478	1,036
Stock-based compensation	8,027	7,857
Amortization of debt discount and issuance costs	1,364	899
Gain on sale of property and equipment	(67)	0
Changes in operating assets and liabilities:
Accounts receivable	(695)	(3,881)
Prepaid expenses and other assets	1,416	2,804
Inventory	(4,049)	(5,773)
Accounts payable	1,188	2,821
Accrued expenses and other liabilities	(1,209)	3,109
Cash used in operating activities	(60,219)	(67,050)
Investing activities:
Purchases of property and equipment	(143)	(460)
Proceeds from sale of property and equipment	105	0
Cash used in investing activities	(38)	(460)
Financing activities:
Proceeds from long-term debt	0	34,447
Repayment of long-term debt	0	(4,447)
Cash paid for financing costs	(95)	(690)
Proceeds from issuance of common stock under employee stock purchase plan	367	516
Proceeds from sale of common stock	0	33,600
Proceeds from the exercise of stock options	39	76
Cash provided by financing activities	311	63,502
Effects of exchange rate changes on cash and cash equivalents	2	(11)
Net decrease in cash, cash equivalents and restricted cash	(59,944)	(4,019)
Cash, cash equivalents and restricted cash at beginning of period	144,179	147,165
Cash, cash equivalents and restricted cash at end of period	84,235	143,146
Supplemental disclosure of noncash activities:
Fixed asset purchases within accounts payable and accrued expenses	8	55
Recognition of right-of-use assets	157	6,174
Recognition of lease liabilities	$ 157	$ 6,174

Organization and Description of

Organization and Description of Business	9 Months Ended
	Sep. 30, 2021
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.

Liquidity

Liquidity	9 Months Ended
	Sep. 30, 2021
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 September 30, 2021, the Company had cash and cash equivalents of $84,226. For the nine months ended September 30, 2021, the Company had a net loss of $66,672 and negative cash from operations of $60,219. As of September 30, 2021, the Company had an accumulated deficit of $594,437. 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. The Company's continuation as a going concern is dependent on its ability to continue to maintain compliance with its covenants under that certain Note Purchase Agreement, dated as of September 12, 2019, as amended pursuant to that certain letter agreement dated as of August 13, 2020 and as further amended by that certain first amendment to the Note Purchase Agreement dated as of March 2, 2021 (the Note Purchase Agreement) that the Company entered into with funds managed by Pharmakon Advisors, LP (Pharmakon), the investment manager of the BioPharma Credit Funds (BioPharma), including the minimum trailing twelve-month consolidated XHANCE net sales and royalties the Company is required to achieve each quarter and its ability to generate sufficient cash flows from operations to meet its obligations and/or obtain additional financing from its stockholders or other sources, as may be required. The Note Purchase Agreement includes events of default, in certain cases subject to customary periods to cure, following which Pharmakon may accelerate all amounts outstanding under the senior secured notes issued pursuant to the Note Purchase Agreement (Pharmakon Senior Secured Notes). The accompanying consolidated financial statements have been prepared on a going concern basis, which contemplates the realization of assets and the settlement of liabilities and commitments in the normal course of business. As of the filing of this quarterly report on Form 10-Q, the Company expects consolidated XHANCE net sales and royalties for the trailing twelve-month period ending December 31, 2021 to be between $71,000 and $75,000. If the Company is unable to achieve $80,000 of consolidated XHANCE net sales and royalties for the trailing twelve-month period ending December 31, 2021 and the Company is unable to obtain a waiver or modification to this financial covenant, the Company will be in breach of a financial covenant under the Note Purchase Agreement, which will constitute an event of default under the terms of the Note Purchase Agreement. If the holders of the Pharmakon Senior Secured Notes elect to accelerate the repayment of all unpaid principal and accrued interest under such holders’ Pharmakon Senior Secured Notes, the Company may need to delay or curtail its operations. These factors raise substantial doubt about the Company's ability to continue as a going concern. 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 under the Pharmakon Senior Secured Notes, including repayment, and to carry out the Company's planned development and commercial activities. Financial capital, secured through equity 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 the Company's debt service obligations, including repayment, or enable the Company to continue to implement its long-term business strategy. If additional capital is not secured, the Company may need to delay or curtail its operations until such funding is received. The terms of the Note Purchase Agreement, including applicable covenants, are described in Note 8.

Basis of Presentation and Summa

Basis of Presentation and Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2021
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 September 30, 2021 and its results of operations for the three and nine months ended September 30, 2021 and 2020 and cash flows for the nine months ended September 30, 2021 and 2020. Operating results for the three and nine months ended September 30, 2021 are not necessarily indicative of the results that may be expected for the year ending December 31, 2021. 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, 2020 contained in the Company’s annual report on Form 10-K for the year ended December 31, 2020 , filed with the SEC on March 3, 2021. 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 represented approximately 39% of the Company's accounts receivable at September 30, 2021 and five customers represented approximately 33% and 32% of the Company's net product sales for the three and nine months ended September 30, 2021, respectively. The Company currently purchases XHANCE and its components from several third-party suppliers and manufacturing partners, certain of which are available through a single source. The Company has initiated the process of qualifying alternate third-party suppliers for select components of XHANCE. Alternate third party suppliers of XHANCE components are subject to qualification and approval from the FDA. Fair value of financial instruments At September 30, 2021 and December 31, 2020, 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, the Company believes that at September 30, 2021, the carrying value of long-term debt approximated fair value as the interest rates are reflective of the rate the Company could obtain on debt with similar terms and conditions. At September 30, 2021 and December 31, 2020, there were no financial assets or liabilities measured at fair value on a recurring basis. Restricted cash As of September 30, 2021 and December 31, 2020, the restricted cash balance included in prepaid expenses and other assets was $9 and $23, respectively. Net product revenues The Company accounts for revenue in accordance with ASC Topic 606, Revenue from Contracts with Customers (ASC 606), which the Company 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. The Company recognized $1,000 as licensing revenue from Currax during the nine months ended September 30, 2021 and is not eligible to receive any further payments under the Currax license agreement other than reimbursement for certain expenses. 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 nine months ended September 30, 2021 and 2020, 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: September 30, 2021 2020 Stock options 7,928,817 8,157,752 Restricted stock units 2,013,934 1,499,456 Common stock warrants 810,357 2,677,188 Employee stock purchase plan 123,754 62,699 Total 10,876,862 12,397,095 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 nine months ended September 30, 2021 and 2020, the Company recorded no tax expense or benefit due to the expected current year loss and its historical losses. As of September 30, 2021 and December 31, 2020, the Company concluded that a full valuation allowance would be 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 July 2021, the FASB issued ASU No. 2021-05, Leases (Topic 842): Lessors—Certain leases with variable payments. ASU No. 2021-05 is intended to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing transactions. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2021, 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 May 2021, the FASB issued ASU No. 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options. ASU No. 2021-04 requires that issuers clarify and reduce diversity in accounting for modifications or exchanges of freestanding equity-classified written call options that remain equity classified after the modification or exchange. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2021, 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 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 Company has adopted ASU 2019-12 in the first quarter of 2021, and there was no significant impact. 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 has adopted ASU 2016-13 and there was no significant impact.

Inventory

Inventory	9 Months Ended
	Sep. 30, 2021
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consisted of the following: September 30, 2021 December 31, 2020 Raw materials $ 3,330 $ 2,669 Work-in-process 4,456 2,676 Finished goods 5,375 3,697 Total inventory $ 13,161 $ 9,042

Property and Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment, net, consisted of the following: September 30, 2021 December 31, 2020 Computer equipment and software $ 1,157 $ 1,128 Furniture and fixtures 366 366 Machinery and equipment 3,266 3,440 Leasehold improvements 609 609 Construction in process 216 271 5,614 5,814 Less: accumulated depreciation (4,099) (3,786) $ 1,515 $ 2,028 Depreciation expense was $153 and $473 for the three months ended September 30, 2021 and 2020, respectively. Depreciation expense was $476 and $1,035 for the nine months ended September 30, 2021 and 2020, respectively. In addition, depreciation expense of $551 and $13 was charged to inventory and prepaid expenses and other assets, respectively, as of September 30, 2021, which represents depreciation expense related to equipment involved in the manufacturing process.

Accrued Expenses and Other Curr

Accrued Expenses and Other Current Liabilities	9 Months Ended
	Sep. 30, 2021
Payables and Accruals [Abstract]
Accrued Expenses and Other Current Liabilities	Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities consisted of: September 30, 2021 December 31, 2020 Accrued expenses: Selling, general and administrative expenses $ 6,997 $ 7,385 Research and development expenses 6,208 5,202 Payroll expenses 7,119 9,063 Product revenue allowances 21,833 20,917 Other 2,859 2,008 Total accrued expenses 45,016 44,575 Other current liabilities: Lease liability 2,109 2,108 Total other current liabilities 2,109 2,108 Total accrued expenses and other current liabilities $ 47,125 $ 46,683

Licensing Revenue

Licensing Revenue	9 Months Ended
	Sep. 30, 2021
Research and Development [Abstract]
Licensing Revenue	Licensing Revenue Currax License Agreement On September 25, 2019, OptiNose AS entered into a license agreement (the Currax License Agreement) with Currax pursuant to which the Company granted Currax a license to certain intellectual property for the commercialization of Onzetra Xsail ® in the US, Canada and Mexico. Under the terms of the Currax License Agreement, Currax paid the Company an upfront payment of $3,730, which was recognized as license revenue during the year ended December 31, 2019. On December 29, 2020, the Company received an additional $750 upon the expiration of the escrow that was established for a limited period to cover potential indemnification obligations. In addition, in January 2021 the Company received a $1,000 milestone payment in connection with the achievement of a specified regulatory milestone. The Company does not expect to receive any further payments from Currax under the terms of the Currax License Agreement other than reimbursement for certain expenses.

Long-term Debt

Long-term Debt	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Long-term Debt	Long-term Debt On September 12, 2019 (the Closing Date), the Company entered into the Note Purchase Agreement with funds managed by Pharmakon, the investment manager of BioPharma. The Note Purchase Agreement provided the Company with $130,000 in debt financing, of which $80,000 was issued on the Closing Date, $30,000 was issued on February 13, 2020 (the First Delayed Draw Notes) after achieving the $9,000 consolidated XHANCE net sales and royalties threshold for the quarter ended December 31, 2019 and $20,000 was issued on December 1, 2020 after achieving the $14,500 consolidated XHANCE net sales and royalties threshold for the quarter ended September 30, 2020. On August 13, 2020, the Company entered into a letter agreement (the Pharmakon Letter Agreement) to the Note Purchase Agreement. The Pharmakon Letter Agreement provided the Company with the option to issue additional Pharmakon Senior Secured Notes, subject to the Company achieving specified consolidated XHANCE net sales and royalties for the quarter ended June 30, 2021 and certain other conditions. As consideration for the Pharmakon Letter Agreement, the Company issued 44,643 shares of Common Stock to Pharmakon. The aggregate fair value of $250 was recorded as debt issuance costs and is being amortized to interest expense over the five On March 2, 2021, the Company entered into the first amendment (the First Amendment) to the Note Purchase Agreement. The amendment revised certain minimum trailing twelve-month consolidated XHANCE net sales and royalties the Company is required to achieve. As consideration for the amendment, the Company will pay an amendment fee of $1,300 upon the earlier of the prepayment of the Pharmakon Senior Secured Notes and the Maturity Date (defined below). The amendment fee was recorded as debt issuance costs and is being amortized to interest expense over the term of the Pharmakon Senior Secured Notes. 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 minimum 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 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. The Company is also required to pay a "make-whole" amount in respect of any principal prepayments (whether mandatory or voluntary) made prior to the 30-month anniversary of the issuance of the applicable Pharmakon Senior Secured 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 prepayment. The Pharmakon Senior Secured Notes are secured by a pledge of substantially all of the Company's assets and the Note Purchase Agreement 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 Note Purchase Agreement contains 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 September 30, 2021, 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 Pharmakon Senior Secured Notes. The Company recorded interest expense of $4,072 and $3,350 during the three months ended September 30, 2021 and 2020, respectively, and $11,959 and $9,506 during the nine months ended September 30, 2021 and 2020, respectively. Interest expense included total coupon interest and the amortization of debt issuance costs. The long-term debt balance is comprised of the following: September 30, 2021 December 31, 2020 Face amount $ 130,000 $ 130,000 Front end fees (701) (855) Debt issuance costs (4,057) (3,943) Back end fees 1,300 — Long-term debt, net $ 126,542 $ 125,202

Employee Benefit Plans

Employee Benefit Plans	9 Months Ended
	Sep. 30, 2021
Retirement Benefits [Abstract]
Employee Benefit Plans	Employee Benefit Plans For US employees, the Company maintains a defined contribution 401(k) retirement plan. As of September 30, 2021, $151 was recorded in accrued liabilities related to the Company match. The Company's contributions are made in cash. For foreign 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 $1 and $5 for the three months ended September 30, 2021 and 2020, respectively, and $5 and $15 for the nine months ended September 30, 2021 and 2020, respectively.

Stockholders' Equity

Stockholders' Equity	9 Months Ended
	Sep. 30, 2021
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity As of September 30, 2021, the Company had the following warrants outstanding to purchase shares of Common Stock: Number of Shares Exercise Price Per Share Expiration Date 810,357 $ 6.72 September 12, 2022

Stock-based Compensation

Stock-based Compensation	9 Months Ended
	Sep. 30, 2021
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 nine months ended September 30, 2021 and 2020: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Cost of product sales $ 20 $ 25 $ 38 $ 113 Research and development 298 334 865 922 General and administrative 2,366 2,267 7,124 6,822 $ 2,684 $ 2,626 $ 8,027 $ 7,857 In addition, stock-based compensation expense of $87 and $1 was charged to inventory and prepaid expenses and other assets, respectively, during the nine months ended September 30, 2021, 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 The following table summarizes the activity related to stock option grants to employees and non-employees for the nine months ended September 30, 2021: Shares Weighted Weighted Outstanding at December 31, 2020 6,852,733 $ 10.34 6.84 Granted 1,615,696 3.48 Exercised (23,879) 1.63 Expired (307,892) 12.30 Forfeited (207,841) 6.46 Outstanding at September 30, 2021 7,928,817 $ 8.97 6.72 Exercisable at September 30, 2021 5,029,197 $ 11.19 5.54 Vested and expected to vest at September 30, 2021 7,928,817 $ 8.97 6.72 During the nine months ended September 30, 2021, stock options to purchase 1,615,696 shares of Common Stock were granted to employees and generally vest over four four Included in the table above are 200,000 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: Nine Months Ended September 30, 2021 2020 Risk free interest rate 1.00 % 0.71 % Expected term (in years) 6.08 6.03 Expected volatility 74.18 % 68.77 % Annual dividend yield 0.00 % 0.00 % Fair value of common stock $ 3.48 $ 5.64 At September 30, 2021, the unrecognized compensation cost related to unvested stock options expected to vest was $8,570. This unrecognized compensation will be recognized over an estimated weighted-average amortization period of 2.31 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 nine months ended September 30, 2021: Shares Balance at December 31, 2020 1,491,589 Granted 957,990 Vested and settled (344,298) Expired/forfeited/canceled (91,347) Balance at September 30, 2021 2,013,934 Expected to vest at September 30, 2021 2,013,934 In March 2021, the Company granted 957,990 RSUs at a grant date fair value of $3.51, all of which were service-based RSUs. No performance-based RSUs were granted in 2021. As of September 30, 2021, the milestones associated with previously granted performance based-RSUs were not probable of achievement, and accordingly, no stock based compensation expense has been recognized for these awards. At September 30, 2021, the unrecognized compensation cost related to unvested service-based RSUs expected to vest was $5,432, to be recognized over an estimated weighted-average amortization period of 2.81 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 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 $65 and $102 during the three months ended September 30, 2021 and 2020, respectively, and $264 and $389 during the nine months ended September 30, 2021 and 2020, 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: Nine Months Ended September 30, 2021 2020 Risk free interest rate 0.07 % 0.96 % Expected term (in years) 0.5 0.5 Expected volatility 65.43 % 84.55 % Annual dividend yield 0.00 % 0.00 %

Basis of Presentation and Sum_2

Basis of Presentation and Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2021
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
Fair value of financial instruments	Fair value of financial instrumentsAt September 30, 2021 and December 31, 2020, 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, the Company believes that at September 30, 2021, the carrying value of long-term debt approximated 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 September 30, 2021 and December 31, 2020, the restricted cash balance included in prepaid expenses and other assets was $9 and $23, 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 the Company 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. The Company recognized $1,000 as licensing revenue from Currax during the nine months ended September 30, 2021 and is not eligible to receive any further payments under the Currax license agreement other than reimbursement for certain expenses.
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 nine months ended September 30, 2021 and 2020, 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 nine months ended September 30, 2021 and 2020, the Company recorded no tax expense or benefit due to the expected current year loss and its historical losses. As of September 30, 2021 and December 31, 2020, the Company concluded that a full valuation allowance would be 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 July 2021, the FASB issued ASU No. 2021-05, Leases (Topic 842): Lessors—Certain leases with variable payments. ASU No. 2021-05 is intended to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing transactions. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2021, 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 May 2021, the FASB issued ASU No. 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options. ASU No. 2021-04 requires that issuers clarify and reduce diversity in accounting for modifications or exchanges of freestanding equity-classified written call options that remain equity classified after the modification or exchange. The new standard is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2021, 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 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 Company has adopted ASU 2019-12 in the first quarter of 2021, and there was no significant impact. 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 has adopted ASU 2016-13 and there was no significant impact.

Basis of Presentation and Sum_3

Basis of Presentation and Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2021
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: September 30, 2021 2020 Stock options 7,928,817 8,157,752 Restricted stock units 2,013,934 1,499,456 Common stock warrants 810,357 2,677,188 Employee stock purchase plan 123,754 62,699 Total 10,876,862 12,397,095

Inventory (Tables)

Inventory (Tables)	9 Months Ended
	Sep. 30, 2021
Inventory Disclosure [Abstract]
Schedule of Inventory	Inventory consisted of the following: September 30, 2021 December 31, 2020 Raw materials $ 3,330 $ 2,669 Work-in-process 4,456 2,676 Finished goods 5,375 3,697 Total inventory $ 13,161 $ 9,042

Property and Equipment (Tables)

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment, net, consisted of the following: September 30, 2021 December 31, 2020 Computer equipment and software $ 1,157 $ 1,128 Furniture and fixtures 366 366 Machinery and equipment 3,266 3,440 Leasehold improvements 609 609 Construction in process 216 271 5,614 5,814 Less: accumulated depreciation (4,099) (3,786) $ 1,515 $ 2,028

Accrued Expenses and Other Cu_2

Accrued Expenses and Other Current Liabilities (Tables)	9 Months Ended
	Sep. 30, 2021
Payables and Accruals [Abstract]
Schedule of Accrued Expenses and Other Current Liabilities	Accrued expenses and other current liabilities consisted of: September 30, 2021 December 31, 2020 Accrued expenses: Selling, general and administrative expenses $ 6,997 $ 7,385 Research and development expenses 6,208 5,202 Payroll expenses 7,119 9,063 Product revenue allowances 21,833 20,917 Other 2,859 2,008 Total accrued expenses 45,016 44,575 Other current liabilities: Lease liability 2,109 2,108 Total other current liabilities 2,109 2,108 Total accrued expenses and other current liabilities $ 47,125 $ 46,683

Long-term Debt (Tables)

Long-term Debt (Tables)	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	The long-term debt balance is comprised of the following: September 30, 2021 December 31, 2020 Face amount $ 130,000 $ 130,000 Front end fees (701) (855) Debt issuance costs (4,057) (3,943) Back end fees 1,300 — Long-term debt, net $ 126,542 $ 125,202

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 30, 2021
Equity [Abstract]
Schedule of Warrants Outstanding	As of September 30, 2021, the Company had the following warrants outstanding to purchase shares of Common Stock: Number of Shares Exercise Price Per Share Expiration Date 810,357 $ 6.72 September 12, 2022

Stock-based Compensation (Table

Stock-based Compensation (Tables)	9 Months Ended
	Sep. 30, 2021
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 nine months ended September 30, 2021 and 2020: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Cost of product sales $ 20 $ 25 $ 38 $ 113 Research and development 298 334 865 922 General and administrative 2,366 2,267 7,124 6,822 $ 2,684 $ 2,626 $ 8,027 $ 7,857
Schedule of Stock Option Activity	The following table summarizes the activity related to stock option grants to employees and non-employees for the nine months ended September 30, 2021: Shares Weighted Weighted Outstanding at December 31, 2020 6,852,733 $ 10.34 6.84 Granted 1,615,696 3.48 Exercised (23,879) 1.63 Expired (307,892) 12.30 Forfeited (207,841) 6.46 Outstanding at September 30, 2021 7,928,817 $ 8.97 6.72 Exercisable at September 30, 2021 5,029,197 $ 11.19 5.54 Vested and expected to vest at September 30, 2021 7,928,817 $ 8.97 6.72
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: Nine Months Ended September 30, 2021 2020 Risk free interest rate 1.00 % 0.71 % Expected term (in years) 6.08 6.03 Expected volatility 74.18 % 68.77 % Annual dividend yield 0.00 % 0.00 % Fair value of common stock $ 3.48 $ 5.64 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: Nine Months Ended September 30, 2021 2020 Risk free interest rate 0.07 % 0.96 % Expected term (in years) 0.5 0.5 Expected volatility 65.43 % 84.55 % 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 nine months ended September 30, 2021: Shares Balance at December 31, 2020 1,491,589 Granted 957,990 Vested and settled (344,298) Expired/forfeited/canceled (91,347) Balance at September 30, 2021 2,013,934 Expected to vest at September 30, 2021 2,013,934

Liquidity (Details)

Liquidity (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended		12 Months Ended
	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2021	Dec. 31, 2020
Revenue from External Customer [Line Items]
Cash and cash equivalents	$ 84,226						$ 84,226			$ 144,156
Net loss	17,117	$ 23,502	$ 26,053	$ 21,214	$ 25,852	$ 28,856	66,672	$ 75,922
Cash from operations							60,219	67,050
Accumulated deficit	594,437						594,437			$ 527,765
Net product revenues	$ 21,826			$ 15,436			$ 52,143	$ 32,770
Note Purchase Agreement | Forecast
Revenue from External Customer [Line Items]
Debt instrument, covenant, minimum net sales and royalties									$ 80,000
Minimum | XHANCE | Forecast
Revenue from External Customer [Line Items]
Net product revenues									71
Maximum | XHANCE | Forecast
Revenue from External Customer [Line Items]
Net product revenues									$ 75,000

Basis of Presentation and Sum_4

Basis of Presentation and Summary of Significant Accounting Policies - Concentration of Credit Risk (Details) - Customer Concentration Risk - Five Customers	3 Months Ended	9 Months Ended
	Sep. 30, 2021customer	Sep. 30, 2021customer
Accounts Receivable
Concentration Risk [Line Items]
Number of customers	5	5
Concentration risk (as a percent)		39.00%
Sales Revenue, Net
Concentration Risk [Line Items]
Number of customers	5	5
Concentration risk (as a percent)	33.00%	32.00%

Basis of Presentation and Sum_5

Basis of Presentation and Summary of Significant Accounting Policies - Restricted Cash (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Prepaid Expenses and Other Current Assets
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Restricted cash	$ 9	$ 23

Basis of Presentation and Sum_6

Basis of Presentation and Summary of Significant Accounting Policies - Net product revenues (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Research and Development Arrangement, Contract to Perform for Others [Line Items]
Total revenues	$ 21,826	$ 15,436	$ 52,143	$ 32,770
Licensing revenues
Research and Development Arrangement, Contract to Perform for Others [Line Items]
Total revenues	$ 0	$ 0	$ 1,000	$ 0

Basis of Presentation and Sum_7

Basis of Presentation and Summary of Significant Accounting Policies - Antidilutive Shares Excluded From Computation of Net Loss Per Share (Details) - shares	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securities excluded from computation of net loss per common share	10,876,862	12,397,095
Stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securities excluded from computation of net loss per common share	7,928,817	8,157,752
Restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securities excluded from computation of net loss per common share	2,013,934	1,499,456
Common stock warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securities excluded from computation of net loss per common share	810,357	2,677,188
Employee stock purchase plan
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Securities excluded from computation of net loss per common share	123,754	62,699

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 3,330	$ 2,669
Work-in-process	4,456	2,676
Finished goods	5,375	3,697
Total inventory	$ 13,161	$ 9,042

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 5,614	$ 5,814
Less: accumulated depreciation	(4,099)	(3,786)
Property and equipment, net	1,515	2,028
Computer equipment and software
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,157	1,128
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	3,266	3,440
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	$ 216	$ 271

Property and Equipment - Narrat

Property and Equipment - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Property, Plant and Equipment [Line Items]
Depreciation	$ 153	$ 473	$ 476	$ 1,035
Inventory
Property, Plant and Equipment [Line Items]
Depreciation			551
Prepaid expenses and other assets
Property, Plant and Equipment [Line Items]
Depreciation			$ 13

Accrued Expenses and Other Cu_3

Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Accrued expenses:
Selling, general and administrative expenses	$ 6,997	$ 7,385
Research and development expenses	6,208	5,202
Payroll expenses	7,119	9,063
Product revenue allowances	21,833	20,917
Other	2,859	2,008
Total accrued expenses	45,016	44,575
Other current liabilities:
Lease liability	2,109	2,108
Total other current liabilities	2,109	2,108
Total accrued expenses and other current liabilities	$ 47,125	$ 46,683

Licensing Revenue (Details)

Licensing Revenue (Details) - USD ($) $ in Thousands	Dec. 29, 2020	Jan. 31, 2021	Dec. 31, 2019
Currax License Agreement
Research and Development Arrangement, Contract to Perform for Others [Line Items]
Upfront payment received			$ 3,730
Additional revenue eligible and held in escrow	$ 750
Royalty Agreement Terms
Research and Development Arrangement, Contract to Perform for Others [Line Items]
Sales milestone payments eligible to be received (up to)		$ 1,000

Long-term Debt - Narrative (Det

Long-term Debt - Narrative (Details) $ / shares in Units, $ in Thousands	Aug. 13, 2020USD ($)shares	Sep. 12, 2019USD ($)installment$ / sharesshares	Sep. 30, 2021USD ($)$ / shares	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)$ / shares	Sep. 30, 2020USD ($)	Dec. 31, 2019USD ($)	Mar. 02, 2021USD ($)	Dec. 01, 2020USD ($)	Feb. 13, 2020USD ($)
Debt Instrument [Line Items]
Amendment fee								$ 1,300
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		$ 130,000
Debt face amount		80,000
Debt issuance costs		$ 6,514
Loans, term	5 years	5 years
Stated interest rate		10.75%
Debt principal payments, number of installments | installment		8
Debt upfront fee		$ 1,125
Fair value of warrants		$ 2,404
Prepayment fee, after second and before third anniversary		2.00%
Prepayment fee, after third and before fourth anniversary		1.00%
Debt instrument, make-whole provision, payment accrual period		30 months
Debt covenant, cash and cash equivalents		$ 30,000
Interest expense			$ 4,072	$ 3,350	$ 11,959	$ 9,506
Senior Notes | Note Purchase Agreement - First Delayed Draw Notes
Debt Instrument [Line Items]
Debt face amount										$ 30,000
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
Senior Notes | Note Purchase Agreement - Third Delayed Draw Notes
Debt Instrument [Line Items]
Debt face amount									$ 20,000
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
Senior Notes | Note Purchase Agreement Additional Delayed Draw Notes
Debt Instrument [Line Items]
Common stock issued (in shares) | shares	44,643
Debt issuance costs	$ 250

Long-term Debt - Schedule of Lo

Long-term Debt - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Short-term Debt [Line Items]
Long-term debt, net	$ 126,542	$ 125,202
Note Purchase Agreement | Senior Notes
Short-term Debt [Line Items]
Face amount	130,000	130,000
Front end fees	(701)	(855)
Debt issuance costs	(4,057)	(3,943)
Back end fees	1,300	0
Long-term debt, net	$ 126,542	$ 125,202

Employee Benefit Plans (Details

Employee Benefit Plans (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Defined Contribution Plan Disclosure [Line Items]
Accrued liabilities related to the Company match	$ 151		$ 151
Norway and UK employee plans
Defined Contribution Plan Disclosure [Line Items]
Defined contribution plan, cost	$ 1	$ 5	$ 5	$ 15

Stockholders' Equity - Schedule

Stockholders' Equity - Schedule of Warrants Outstanding (Details) - Warrants Expiring September 12, 2022 - $ / shares	Sep. 30, 2021	Sep. 12, 2019
Class of Stock [Line Items]
Warrants outstanding (in shares)	810,357
Warrants exercise price (in USD per share)	$ 6.72	$ 6.72

Stock-based Compensation - Allo

Stock-based Compensation - Allocated Stock-Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 2,684	$ 2,626	$ 8,027	$ 7,857
Cost of product sales
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	20	25	38	113
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	298	334	865	922
General and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 2,366	$ 2,267	$ 7,124	$ 6,822

Stock-based Compensation - Narr

Stock-based Compensation - Narrative (Details) - USD ($)	1 Months Ended	3 Months Ended		9 Months Ended
	Mar. 31, 2021	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense		$ 2,684,000	$ 2,626,000	$ 8,027,000	$ 7,857,000
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)				1,615,696	1,303,210
Weighted average grant date fair value (usd per share)				$ 2.26	$ 3.44
Unrecognized cost related to unvested RSUs expected to vest		8,570,000		$ 8,570,000
Estimated weighted-average amortization period				2 years 3 months 21 days
Restricted stock units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period				4 years
Granted (in shares)	957,990			957,990
Restricted shares fair value at grant date (usd per share)	$ 3.51
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		5,432,000		$ 5,432,000
Estimated weighted-average amortization period				2 years 9 months 21 days
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
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)				200,000
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		$ 65,000	$ 102,000	$ 264,000	$ 389,000
2017 Plan | Employee Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
ESPP purchase price of common stock, percent of market price				85.00%
Inventory
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense				$ 87,000
Prepaid expenses and other assets
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense				$ 1,000

Stock-based Compensation - Stoc

Stock-based Compensation - Stock Option Activity (Details) - Service Based Stock Options - $ / shares	9 Months Ended		12 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Shares
Beginning balance (in shares)	6,852,733
Granted (in shares)	1,615,696	1,303,210
Exercised (in shares)	(23,879)
Expired (in shares)	(307,892)
Forfeited (in shares)	(207,841)
Ending balance (in shares)	7,928,817		6,852,733
Exercisable (in shares)	5,029,197
Vested and expected to vest (in shares)	7,928,817
Weighted average exercise price per share
Beginning balance (usd per share)	$ 10.34
Granted (usd per share)	3.48
Exercised (usd per share)	1.63
Expired (usd per share)	12.30
Forfeited (usd per share)	6.46
Ending balance (usd per share)	8.97		$ 10.34
Exercisable (usd per share)	11.19
Vested and expected to vest (usd per share)	$ 8.97
Weighted average remaining contractual life
Options outstanding, weighted average remaining contractual life	6 years 8 months 19 days		6 years 10 months 2 days
Options exercisable, weighted average remaining contractual life	5 years 6 months 14 days
Vested and expected to vest, weighted average remaining contractual life	6 years 8 months 19 days

Stock-based Compensation - Fair

Stock-based Compensation - Fair Value Options using Black-Scholes Pricing Model (Details) - $ / shares	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
2017 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	0.07%	0.96%
Expected term (in years)	6 months	6 months
Expected volatility	65.43%	84.55%
Annual dividend yield	0.00%	0.00%
Stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	1.00%	0.71%
Expected term (in years)	6 years 29 days	6 years 10 days
Expected volatility	74.18%	68.77%
Annual dividend yield	0.00%	0.00%
Fair value of common stock (usd per share)	$ 3.48	$ 5.64

Stock-based Compensation - Rest

Stock-based Compensation - Restricted Stock Units Activity (Details) - Restricted stock units - shares	1 Months Ended	9 Months Ended
	Mar. 31, 2021	Sep. 30, 2021
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Balance at December 31, 2020 (in shares)		1,491,589
Granted (in shares)	957,990	957,990
Vested and settled (in shares)		(344,298)
Expired/ forfeited/ canceled (in shares)		(91,347)
Balance at September 30, 2021 (in shares)		2,013,934
Expected to vest at September 30, 2021 (in shares)		2,013,934