Check out CADX for instance.. Dificid will require formularies to accept the new drug and make it widely available to order... Once this happens it will be used.. However, formulary acceptance is anywhere from 1 month to 6 months depending on the timing of the PT and Med exec meetings and support from physicians.
Launch is in 6 weeks; listen and watch out for formulary win numbers, CADX sent out a press release early this year that announced 200 formulary wins and the stock popped $1 still 1.5$ from its high pre approval; then during the May CC they announced 600 formulary wins with unrestricted access; sales lagging behind a bit, to be expected with a hospital drug.. The price then dropped immediately to 7.50 and has since recovered within a month ...
They have a good team in place with CBST and I'm sure they already have meetings lined up to get a review for Dificid in ASAP...
It helps to have a comparison like CADX to understand what to expect. The difference is Offirmev is necessary drug post op and many surgeons wanted badly.. Remains to be seen with dificid as Flagyl and Vanco will remain 1 and 2 in line before Dificid..
Just my two cents for those long OPTR
Those are may main stocks.. CADX has been something I have been in and out of and made on the swings, but now looking for a permanent price to hold longterm.. I see a dip there one more time before it takes off.. that is where I get my experience regarding OPTR is a stock like CADX so I am just trying to give my point of view for all sides.. I love dificid as product but there are hurdles to jump.. awesome potential..
Love MNTA, OPTR
Also have HGSI, AVNR (very speculative but great growth potential), CYTK (Trade), and a few non biotech.. enough to make my head spin though..
hmm.i must be tired. let me try that again
if hospitals provide the outcomes and are successful the incentive is that medicare won't penalize the hospital by deducting 3% or something like that, not sure on the exact number.
you are right the hospitals are incentivized by reducing stay and re admittance. problem is i don't see fida being used for first line; recurrent CDAD (non hospital acquired) yes. hospital acquired new cases, no.. Flagyl and Vanco first and second for new diagnosis.. Many hospitals are still getting up to speed with anticoagulant, antibiotic SCIP and CMS core meaures.. it sounds like you are in a good hospital system; possibly HCA?
Bottom line is many hospitals, mostly pharmacy, continue to work in a silo mentality and I believe there will be restricted access to Dificid for treatment of CDAD relegated to recurrence.. It is going to take sometime for the CBST reps to get everyone on board to include Fida in the protocol for treatment.
Lets look at this realistically, a "slam dunk" is a very strong statement.. Unfractionated heparin is still widely used for both DVT treatment and VTE prophylaxis.. Talk about a slam dunk with enoxaparin yet hospitals are still about half and half; if majority enoxaparin used, where indicated, it would also reduce stay and readmits.. but the reality is UFH is cheaper... Not unlike vanco in the near future..
Cubist have good reps; but do you think pharmacy is going to be happy that cubist reps ANOTHER extremely expensive antibiotic that now needs to be on formulary? I constantly hear pharmacies complaining about Cubicin and the toll it takes on their budget. As a hospital administrator you have to be somewhat concerned about the price of this medication and to say you are not is simply unjust.
Also take a look at the label under the clinical trial section.. Table 5 talks about fida being superior to vanco, however in table 6 it looks at strains using a basline REA and what it found essentially is that fida is not superior in hyper-virulent strains.. Dificid is not the magic solution to CDAD, just another expensive option.
disclosure, hospital rep
Tom, as far as the clinical effectiveness of the drug, I'll leave that to physicians on the board. However, bottom line is that if Dificid can reduce the length of stay by at least 2 days, it will have paid for itself for a patient under a DRG case rate reimbursement, such as that used by Medicare. For a patient staying in the hospital over 10 days this seems realistic. For Commercial insurance, many hospitals will/can receive additional reimbursement to cover high cost drugs, so Commercial insurance presents less of an issue. Use of the drug may vary by hospital based on physician support/advocates of the drug, however if it reduces recurrence and provides better outcomes than alternatives, it will win the support it needs.
cannot concur with your assessment that Flagyl and vanco will be 1 & 2 "before Deficid"...where do you get that? have you talked to ANYONE in ID? sure, physicians are going to continue prescribing remedies with little affect on recurrence when there's potential to cut the recurrence probabilities...right...
you don't concur with my thought on when Dificid and when it will be used, that's fine.. I have spoken with GI's and ID's alike in my area and they will continue to use Flagyl and Vanc as 1st and 2nd line. GI's don't spend much time in the hospital aside from surgery so you will be hard pressed to see many GI's go to bat for a rep in that area..
Acceptance onto formularies will be the main issue especially when you consider shrinking pharmacy budgets.. It may be put on with restrictions, i.e. Flagyl and or Vanco to be used first line especially the $2800 dollar price tag compared to vanc.. It most definitely won't be "unrestricted"..
It will be the reps job to educate the hospital physicians, C-suite and quality department to realize the cost savings using Dificid first line to reduce hospital stay and re-admittance (all this affects the bottom line more so than the price of Dificid.. that is in OPTR's CBST favor). It will be a long selling cycle to have it used first line in a hospital setting; you have to get champions, go through formulary, re write protocols and pull through the use of the drug. That's the reality..