President and CEO Richard Paulson explained the lower revenue on the first-quarter earnings call by citing more competition; a greater utilization by patients of the company's Patient Assistance Program, including Medicare patients without sufficient funding; and a higher gross to net ratio from increased Medicare rebates and 340B discounts, year over year. The big problem for investors, though, was the revenue drop was combined with downgraded guidance. The company said it now expects annual revenue between $145 million and $160 million, compared to earlier guidance of between $160 million and $175 million.