State of play. WAC trajectories diverge sharply across the set — Wakix up ~180% since 2019 launch (steepest in the set); Sunosi sits at ~$925/month, below payer value-argument thresholds. Watch. IRA Medicaid rebate uncapping (2024) and Part D manufacturer-discount exposure (2025–2027) translate those trajectories into net-price reality. Why it matters. Pricing posture becomes a structural input to every 2026–2027 forecast — and every rebate-liability footnote in coming 10-Ks.

State of play. Every operator in the set is hiring into narcolepsy right now — Harmony running a >50% FRM expansion with three open senior MA roles; Axsome doubling field force 300→600 for AXS-12; Alkermes integrating Avadel’s sleep-specialist team; Jazz scaling Asia-Pacific regions. Watch. LinkedIn job-post velocity, territory-grain regional postings, and MA/MSL openings — these lead commercial launch timing by 6–9 months. Why it matters. Field-force expansion is the most direct signal of who believes they can convert the 2026–2027 window — and where.

State of play. Dispensing-layer friction and financial-support architecture split the set along different axes. Wakix carries the lowest structural friction (non-REMS, non-scheduled) but no bridge supply and no first-fill trial during the PA window. Jazz covers up to 120 days during PA delays; Sunosi runs a 30-tablet pharmacist-dispensed trial. Watch. Changes to bridge-supply programs and copay-card per-fill caps — they signal where each brand thinks the PA window is costing them. Why it matters. The multi-week PA window is the structural gap delayed prescribers cite most — any program change is a direct read on gross-to-net strategy.

State of play. Digital-footprint depth splits the set. Jazz runs the category’s deepest property stack (five sites plus the myWAV app, wired to oxybate migration); Harmony runs two sites plus embedded savings; Alkermes runs a sparse LUMRYZ surface under rebuild; Axsome runs a dormant Sunosi site. Patient-personalization tooling exists across the set but stays thin — subpage surveys, not engagement layers. Watch. AI + Nurse Navigator chat is already deployed on Auvelity via Ostro Health — Sunosi has the vendor, playbook, and corporate mandate but hasn’t pulled the trigger yet. Why it matters. Digital is the lowest-cost channel to flex during a category reshape — whoever moves first on AI-native patient surfaces gets a disproportionate share of category traffic.

State of play. Narcolepsy DTC is model-differentiated, not escalating. Unlike ADHD or MDD, nobody is in a spend race — every brand is playing a different operating model. Harmony runs the only real-patient testimonial campaign, backed by three unbranded advocacy partnerships. Jazz owns the only unbranded disease-awareness ecosystem (More Than Tired + NarcolepsyLink + AHA). Sunosi is dormant; LUMRYZ is a rebuild mystery-box under Alkermes. Watch. DTC-to-field-force reallocation patterns — every operator is deciding whether to spend at the patient layer or the prescriber layer ahead of orexin entry. Why it matters. Zero celebrity partners across the entire set means either rare-disease volume can’t support the ROI math, or there’s genuine first-mover whitespace — the first brand to test it discloses its answer to the category.

State of play. Two peers are mid-transition at the top — Pops → Jackson Aug 1, 2026 at Alkermes, Galá eight months post-Cozadd at Jazz. Harmony is stable under Dayno (3-year runway) with Anastasiou’s $2.7B CNS BD track record in the CBO seat. Axsome’s Maizel is doubling field force 300→600 for AXS-12. Watch. CEO earnings-call posture shifts, CCO/CBO appointments, and field-force escalation — these are the cleanest signals of where each operator is placing its 2026–2027 bets. Why it matters. Execution leadership concentration is diverging across the set — stable planning horizons and aggressive expansion are two different bets on the same 18-month clock.

State of play. Evidence posture splits the set sharply at SLEEP 2025. Jazz leads volume with 19 abstracts; Alkermes debuted Ph2 orexin (VIBRANCE NT1/NT2 positive); Axsome posted AXS-12 SYMPHONY Ph3 win (83% vs 66% cataplexy). Harmony ran 3 IH posters and its only offensive podium move sat outside sleep (EPX-100 ARGUS OLE at AES 2025 in Dravet). Watch. SLEEP 2026, World Sleep 2026, and AAN 2026 abstracts — session titles and accepted authors telegraph each operator’s narrative 6–12 months ahead of launch. Why it matters. The category’s evidence gravity is shifting toward orexin and once-nightly agents during the exact window competitive positioning gets set.