No major deficiencies related to the drug product, ingredients, proposed labeling, Chemistry, Manufacturing and Controls, or other drug-related review matters. No new clinical, safety, efficacy, or drug-related data are required for ANDA approval. Following receipt of the FDA comments, the Company held a clarification meeting with FDA on August 6, 2026 to confirm the remaining information required to support approval. The meeting was attended by leadership of the FDA Center for Drug Evaluation and Research (CDER) and the Office of Generic Drugs.

FDA identified a remaining question related to evidence that the luer lock tip of the medication vial would perform properly when connected to a syringe by a licensed health professional. Because the question related to the product’s container closure system, it was classified by FDA as a Major Deficiency. Importantly, this remaining item is packaging-related and does not relate to the ketamine drug product itself, its ingredients, proposed labeling, CMC, or other drug-related review matters.

The luer lock medication vial is used in three currently-approved ANDA products that collectively shipped 11.9 million doses of medication in the US over the past 12 months, without complaints, returns, recalls, or adverse events. NRx included testing data in its ANDA on more than 3,500 vials from seven manufactured lots of its ketamine product, with no observed failures in operation of the luer lock tip. At the August 6 meeting, FDA requested that NRx provide a manufacturer attestation confirming that the product is manufactured on the same manufacturing lines with the same methods as the currently approved products, together with an attestation of the above complaint-free history. The company is providing this attestation to FDA for immediate review and FDA committed to reviewing the requested certification in the shortest possible review cycle, while providing a clear path to resolution.

Current industry statistics suggest only 14% to 18% of ANDA products are approved during first cycle review. NRx believes that completion of this first review cycle with no drug-related major deficiencies and only a packaging-related certification remaining represents a meaningful regulatory milestone and substantially de-risks the path to commercialization.

The Company believes prompt review of the remaining certification would be consistent with ongoing public health efforts to address the current ketamine shortage, strengthen U.S.-based supply of strategic medicines, and support the objectives of the April 20, 2026 Presidential Executive Order aimed at advancing breakthrough mental health treatments for veterans and other patients in need. Currently, the Company believes the vast majority of ketamine for sale in the United States is manufactured outside the U.S. at a time when demand for ketamine continues to increase. Additionally, all other forms of IV ketamine contain a preservative that is no longer permitted by FDA in new drugs, hand cleansers or topical antiseptics.