Interesting that Caremark axed Zubsolv and restored Film for 2016, after booting film in 2015.
I can speak pretty confidently to your questions as both a Doc and a guy who is married to a Pharma rep. Reps seldom make appointments unless is it for a scheduled lunch where they bring food...though this is becoming less common with the sunshine act. I actually do schedule appointments with them, but they have to be set up thru my office manager. The only reps who have had my cell, are the one's who I have become friends with, or have acted as a Key Opinion Leader for their company.
Most of the Reps present with some data, glossy, handouts, etc...none of which can be done via phone. Shoot...Reps get paid a ridiculous amount of $$ as evidence must show that face to face works much better than phone calls.
The hotline is merely to help patients find the nearest pharmacy that has Bun...but if Docs are unaware of its benefits, and don't write it, the hotline serves little value
Help me understand what you mean that existing client orders can be collected via phone? I've never had a rep successfully get in touch with me via phone. It just doesn't work that way, especially for new products.
Also,while most hires have prior experience, they still need to go thru a few weeks of at home or in-building training to get up to speed on the product they will sell. That is time completely out of the field. I understand the SGA bump with new hires, it is just frustrating that there has been such turnover in my territory, which means the hiring process and expense has to be repeated.
FWIW...I do think is getting cheap and did restart a position again today in the 7.50s. But it is much smaller than my last one, as I still fear there may be some additional downside
3. I practice in what is perhaps the 5th or 6th largest metro area in the country and yet we are currently without a BSDI rep. Instead, the RM from another state has responsibility to "cover" the territory while managing his remaining ones. It's going to take a few weeks to hire, and then train a new rep...so it's nearly impossible to grow sales in this very large market.
4. I presume all of the Salix hires will bring long term benefit, but they will add to the near term SGA and further skew the revenue to expense ratio.
With that said, I gotta figure BDSI is nearing a bottom again and any small positive catalyst should have longs happy once again.
Abuse Deterrent Formulations are not a Bup product killer. ADFs are needed, and will help minimize the misuse/diversion of RX opiates, however:
1. History has shown us that as when ADFs arrive, misuse of that drug drops, while use of heroin rises. This has the long term effect of driving more into Bup programs, as no one can delude themselves/family into thinking they are using H to manage their pain.
2. ADFs do not solve the issue of tolerance that requires the use of higher and higher opiate dose to achieve pain management. BUP, however, does not yield that same level of tolerance and is a better long term choice for those in need of chronic treatment.
Actually, the BDSI rep who stopped by was not my "original" rep, but rather a regional manager from another state who oversees the territory. Both my "original" rep and the "original" regional manager have left the company. They are looking to hire a new rep to replace the one who left. It is a large Metro territory, so one would think the hiring process will be a significant priority.
Investguy...your Kung #$%$ is strong. BDSI Rep stopped by today. Excuse was valid, but I will spare the details to protect anonymity. Also was given an 800 number for patients to call that purports to call patients back within an hour to find the pharmacy nearest them that has Bunavail in stock. That is not an issue for me, as my local Pharms stock it per my request, but it may help others.
1. Bunavail seems to be quite polarizing with patients, as they either love or hate it with very little in between. This who are loving it cite the convenience of taking it and not worrying about an incoming phone call or trying not to swallow for 10+ minutes. Those who hate it either consistently feel "under-dosed" compared to the other versions they have tried, or complain that it is difficult to "deploy" Bunavail without it sticking to their fingers (thus I encourage patients to deploy the med using tweezers if that is a concern).
2. I've been using Bunavail more and more, and this ran out of the coupon cards and patient information brochures. I phoned/messaged my BDSI rep early last week, and still have not received a response...not good.
Just a couple of random musings;
1. Not long ago, I mentioned that summer month had always been a period of slow-down for my and other Bup clinics. This summer started slow as well, but it is off-the-hook busy now...far busier than previous summers. The headlines today seem to echo why. In the past decade, Heroin deaths have quadrupled, heroin use has increased by 300,000 and use with females have doubled. As we Docs are being very actively messaged to use less opiates in general, and "abuse deterrent" opiates, when possible, the access to RX opiates is harder to find and far more expensive than heroin.
2. It has been at least 6-9 months since I've encountered a new patient who had not already tried Bup by purchasing it off the street. Like it or not, Bup is heavily diverted, with most addicts clamoring for either pure subutex or Suboxone Film. With "street Bup" becoming all too common, there is a growing false narrative that Bup/Suboxone is "evil." The fact is, Bup in all forms saves lives. Even on the streets, it is used mostly to stave off withdrawal, and far less often as a means to get high. But with this growing perception, a smart company would be wise to capitalize on the abuse resistant make-up of their unique delivery system.
Sure...as a Shrink, it is my duty to boost your mood. Here are a few things that could bring you good cheer
1. Bunavail does have the most convenient and "abuse proof" delivery system. For right or wrong, Suboxone Film has a unique "currency value" for diversion, compared to other Branded Bup and generic. There is also the recent false narrative that the racist shooter on Charleston became a racist and murder because of Suboxone Film...utter nonsense...but some Docs are moving away from Film just to get away from the name.
2. Don't necessarily pay attention to the weekly numbers that everyone hangs on. The message on Bunavail will take time to be heard. Also...at least with the Sub Docs I know (including me), business is down in the summer. Folks want to party and get high in the summer and focus on sobriety as Fall approaches.
3. The Treat Act. Currently, both the House and Senate, are looking at Bills to increase the 100 patient cap and allow NP/PAs to RX Bup. While I think this is a terrible idea, as clinicians with little training/experience will then RX a drug that already has high diversion rates...if it passes, Bup sales across all channels will increase.
4. Belbuca. I hate investing in Binary events...and Belbuca is about as binary as it gets. However, if approved (and it should be based on efficacy), then BDSI will do well. People were too frustrated with the Clonidine results. Disappointing for sure...but clonidine is already easily and cheaply compounded into transdermal creams. With Belbuca...that ain't happening.
5. Puppies...everybody smiles when they think of puppies.
I look back at my own investments and realize the ones that created the most profits were the ones where I patiently waited, and not tried to focus on the day to day fluctuations.
You may not like my answer. I think the cap is where it needs to be. This is a very challenging population and most Docs don't have the time or skillset to treat addiction properly. If the cap is lifted, you run an even greater risk of the "pill-mill" Docs stepping into the game, or well-meaning but poorly educated Docs RXing Bup in a fashion that leads to a widely publicized bad outcome.
But even if the Fed sees the benefits of lifting the cap or allowing NPs/PAs to RX, many states may no go along with the idea. Look at Ohio and the rather draconian restrictions they have recently placed on patients and Doctors. These are completely lacking in scientific foundation, but based more on unfounded fear that "street Bup" is a raging epidemic.
As to weekly numbers watch, I have not check year over year data trend, but I do know that within my practice and the practices of my peers, some folks "take a break from Bup" during the summer and we see our census drop as the summer party-time mentality trumps good health.
I would not be concerned about the terms of this debt structure. People see an 8-9% rate and freak as they compare biotech investing rates to their home mortgage. Nothing could be further from the truth. I am part of two med-device companies whose products are infinitely more innovative than the BDSI IP. Yet when we borrow $$ the rates are often 12-13%. Expensive cash for sure, but relatively non-recourse and no IP hijacking, so the high price is worth it if we/BDSI can grow revs at a much higher rate. Unless the market tanks, this is a non event.
I think one possible reason for the drop is that folks who thought BDSI might be bought out, bailed if they perceive that debt acquisition precludes a near term sale. I'm not sure BDSI is looking to sell, but taking on debt would not impede that sale if the $$ leveraged are accretive. Just my 2 cents