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s, why the worry? KM, the expert on all things EU, is still our CEO. Our star quarterback, KM, is still here with a new experienced Superbowl (Sarissa) coaching staff.
POW was fired on 2/28/23 via the proxy vote.
n, what do you want him to say?
Kiwi, BA has the side effect of a 50% increase in gout and cholelithiasis, i.e., gallstones. Do you think that's better than muscle ache problems?
Q1 tank is due to JT and the previous CFO, Michael Kalb, buying up inventory to lock up supply. KM and the current CFO should get all the credit for their timely unwinding of previous supply agreements to stop the bleeding just in time. Otherwise, Amarin would have less than $200M in cash by now. JT and Michael Kalb were the ones to blame, not KM.
Tat, can you elaborate on how to get a V script without needing a doctor using Skynet? TIA.
Lisa DeFrancesco
Thank you, Holly. Good morning, everyone, and thank you for joining us. Please be aware that this conference call will contain forward-looking statements that are intended to be covered under the Safe Harbor provided by the Private Securities Litigation Reform Act. We may not achieve our goals, carryout our plans or intentions or meet the expectations disclosed in our forward-looking statements.
Actual results or events could differ materially, so you should not place undue reliance on these statements. We assume no obligation to update these statements as circumstances change. Our forward-looking statements do not reflect the potential impact of significant transactions we may enter into, such as mergers, acquisitions, dispositions, joint ventures or any material agreements that we may enter into, amend or terminate.
For additional information concerning the risk factors that could cause actual results to differ materially, please see the Risk Factors section of our annual report on Form 10-K for the year ended December 31, 2022, which have been filed with the SEC and are now available through the Investor Relations section of our website at www.amarincorp.com. We encourage everyone to read these documents.
This call is intended for investors in Amarin and is not intended to promote the use of VASCEPA/VAZKEPA. An archive of this call will be posted on Amarin's website in the Investor Relations section.
Karim Mikhail, Amarin's President and Chief Executive Officer, will lead our discussion, and Tom Reilly, Amarin's new Chief Financial Officer, will provide a more detailed review of our fourth quarter 2022 financial results. After prepared remarks, we will open the call to your questions.
I will now turn the call over to Karim Mikhail, President and Chief Executive Officer of Amarin. Karim?
Karim Mikhail
Thank you, Lisa. Good morning. And thank you all for joining us today. While 2022 was a challenging year for Amarin, it was also a year filled with significant accomplishments that we believe have created the foundation for our future and gives us confidence that 2023 will be a year of tremendous evolution for the company.
We are only beginning to see the results of the actions we took in 2022, and already in 2023. Throughout the remainder of this year, as each piece falls into place, we will be able to see more clearly a successful turnaround and the growing business that we have been building International.
Amarin is in a unique position as we are building value for a product outside of the U.S. while facing increasing genetic competition in the U.S. market. Our company is made up of people who come to work every day because they believe in our bold vision to stop cardiovascular disease from being a leading cause of death. This vision is what drives us.
I'm proud of this team and what we have been able to accomplish together, and I'm excited for what we are able of accomplishing in the future as we continue to execute on our strategy. Today, I will briefly summarize the actions that we took in 2022 in the spirit of operational excellence to create value over the long term and bring the VASCEPA, VAZKEPA to as many eligible patients as possible across the globe.
I will also provide an update on our launch in the UK and where we stand with our plans for global expansion. I will provide an update on our results in the U.S. where the team's efforts to stabilize this business is providing the support for our global commercialization efforts. I will then briefly discuss Amarin's presence at the upcoming ACC meeting. Tom, will then discuss our financial results for the fourth quarter and our guidance for 2023, and I will conclude with a look ahead at the remainder of 2023.
In 2022, we focused on three main areas, global commercialization, preserving our cash and ensuring that we have the right talent to execute on our new global strategy. We began the year 2022 negotiating pricing in one market in Europe and ended the year with our product available in five European markets. Since the beginning of 2023, we have added a sixth country with Switzerland where we have received individual reimbursement in February.
We also have an additional five European markets in advanced stages of pricing and reimbursement negotiations. Our objective is to conclude the vast majority by the end of 2023 as we focus on building a diverse and sustainable revenue stream in Europe.
In Spain, we remain active in the reimbursement process and are confident in our ability to secure pricing in this market, we have gone through two rounds of review and made solid progress. We anticipate a potential third round of review imminently.
In the Netherlands and Italy, we are in advanced changes of our price negotiations and are optimistic a decision could come around mid-year for these markets. We're also making good progress in France, which typically can take slightly longer than the other markets based on historical benchmarks. Other markets such as Norway, Portugal, Israel, and others are also progressing with potential decisions expected this year. We focused on preserving our cash.
In the first quarter of 2022, we saw almost a $100 million in cash burn with new members on our management team. We took Swift action to renegotiate supply purchase arrangements. We also implemented a comprehensive cost saving plan in June, and today, we are excited to announce that we are on track to exceed our $100 million cost saving target.
Thanks to our continued fiscal discipline and cost cutting efforts, which Tom will discuss in more details later in the call. These actions resulted in a cash flow positive fourth quarter in a year end cash balance of more than $300 million.
And lastly, we also built a strong European commercial organization with expertise in medical affairs, product launches, and with extensive cardiovascular product knowledge. Many of our team members come from companies where they successfully commercialized blockbuster drugs and have significant contacts, expertise, and knowledge of their respective markets.
These professionals came to Amarin because of our leading product, our unmatched data, and our entrepreneurial culture, and they are utilizing their background and leveraging their experience to build the Amarin business and brand in Europe. This European team also benefited from the valuable experience that our US colleagues had building the brand successfully over several years in the US market.
I'd like now to focus on providing an update on the UK. First, I think it's useful to provide a reminder of the key highlights. We completed our NICE application in July of 2021, spend the year focusing on securing final NICE approval, which came in July of 2022. 90 days later, in October of 2022, the NHS funding was made available to begin adding VASCEPA to formularies, and in November of 2022, the national guidelines were published and they included VASCEPA place in therapy for UK patients.
All of these steps and achievements were critical to help us establish a strong position for launch in this market. When we look at the pricing of VASCEPA compared to other oral analogs in the UK, we are extremely well positioned. Thanks, and large art to the effort of our local team.
Given the volume of data available for VASCEPA and the efforts of our local team in conveying the value this product brings to patients are pricing from a daily treatment price perspective, far exceeds oral analogs across the Cardiometabolic spectrum of products in the UK.
When we look at the market access picture of VASCEPA in the UK, initial market access is trending ahead of other recent comparable launches in the market. Our team has unlocked 19 out of the first 20 priority accounts, which collectively represents 50% of the eligible patient population for VAZKEPA in the UK.
As a reminder, the UK is a market that as a historically slower growing initially in terms of revenue. Based on these trends and the price achieved, we believe there is a viable strong and long-term business opportunity for VAZKEPA in the UK.
Moving now to our progress on global expansion outside of Europe. As a reminder, we set out to achieve more than 20 regulatory approvals between 2022, 2024 in international markets. We achieved our 2022 objective of getting approvals in six markets, and already in 2023, we received an additional regulatory approval in New Zealand. And yesterday, following this important approval, we announced an exclusive license and distribution agreement with CSL Seqirus in Australia and New Zealand.
We are excited to announce this agreement with CSL Seqirus, a world class pharmaceutical licensing and distribution partner. CSL Seqirus brings highly experienced market access and commercialization teams in Australia and New Zealand that are well positioned to support pricing and reimbursement efforts for VAZKEPA, particularly with their strong record in successfully supporting pharmaceutical benefits listings, and eventual marketing and promotion to help us to deliver this important medicine to patients in these countries.
Importantly, both Australia and New Zealand contributed significant number of patients to reduce it, so it is gratifying to know that we are moving in the direction of giving patients and physicians access to the product there. We expect the next wave of approvals to include China through our partner Eddingpharm.
Regarding China, our partner Eddingpharm is in charge of the regulatory review process. In their latest update, Edding indicated they expect an approval by mid-year as a result of delays related to the shutdown of the regulatory process in China for a period of time due to COVID-19 restrictions. We are working very closely with Edding to ensure we have the latest update from our partner. As of today, we have not received any indication that there are any open questions or concerns regarding the regulatory filing for our product.
In Canada, HLS Therapeutics has a pain reimbursement from all major private and public payers, gaining access to a majority of eligible patients in Canada. HLS continues to be in the launch phase in the public sector and they are seeing stronger growth with the product in provinces, where public access was secured.
We are also actively negotiating potential agreements in the Asia Pacific and Central Eastern European regions, which would enable us to get this important product into the hands of clinicians and patients, and ensure we can extract value from these important markets.
I'm pleased with the progress we have made our advancing international expansion plans. We remain focused on our core future objective, which is global growth and expansion for VASCEPA/VAZKEPA in Europe and internationally, as we believe expansion is the key to creating value for shareholders. We remain confident in the multi-billion-dollar market community for VASCEPA/VAZKEPA in Europe and international.
Moving to our U.S. business and our plans for ECC 2023, in the fourth quarter of 2022, we recorded $90.2 million in total net revenue including $88 million in U.S. product sales. Inline with last quarter despite the continued pressure from generic competition. This is the fourth quarter of four consecutive quarters of revenue stabilization in the U.S. in 2022.
This unique achievement was only possible through the relentless dedication and efforts of our highly experienced U.S. team on the field and with the managed care organizations. We are continuing to maintain our share in the IPE market. Our trends in January and February support continued stabilization of the business.
In the first quarter, we're experiencing typical pharma seasonal trends that branded products like VASCEPA can expect in the U.S. from fourth quarter to first quarter, driven by co-pays and deductibles resetting for patients and their healthcare plans with a new calendar year.
We also expect to see some continued price erosion this year, as we continue to experience generic competition. Tom will talk in more details about what we can expect shortly. One compelling fact is that, our U.S. team has generated more than $1 billion in sales, since generic launched in 2020.
And we continue to have multiple levers we can consider to maintain our profitability. As I mentioned earlier, our cost savings are ahead of plan and we have the ability to launch either a brand generic or an authorized generic as needed and at the right time. While we are planning carefully for all potential scenarios, it is clear today that, the strong and nimble infrastructure we retained in the U.S. provides us with the right team to continue to support business stabilization in the near term.
Lastly, we continue to benefit from the strong data that we have generated with reduce four abstracts were accepted and will be presented at the American College of Cardiology, meeting taking place later this week in New Orleans. We are excited to share new findings from the reducer trial that add to the wealth of data that has consistently validated the utility of VASCEPA and treating patients’ populations at high risk of cardiovascular disease.
This important information coupled with the analyses comparing the antioxidant effects of EPA, DHA, mineral oil, and corn oil should help advance the medical community's understanding of the role and value of VASCEPA and EPA to reduce cardiovascular events in an at-risk patients globally.
We remain committed to investing in our data and our medical presence with a global focus to support the medical education efforts for the launches of VASCEPA, VAZKEPA around the world.
With that, I'll turn it over to Tom to talk more about our progress and strong results this quarter. Tom?
Tom Reilly
Thank you, Karim. Good morning, everyone. I'm pleased to report additional details on our financial performance for the fourth quarter and full year 2022 following our pre-announcement in January. Let me begin by discussing our revenue performance, for the fourth quarter of 2022. We reported total net revenue of $90.2 million, including net product revenue of $89.5 million, a decrease of 38% compared to the fourth quarter of 2021.
U.S. product revenue was $88 million in line with a third quarter of 2022, reflecting relatively stable trend in volume. We remain pleased the stable trends in spite of multiple competing generics on the market. The U.S. business continues to generate a positive contribution margin and provides necessary financial support for expansion in Europe and other geographies around the world. The results included international product revenue of $1.5 million, which includes European product revenue of $0.3 million, beginning to reflect very early revenues from the UK.
Cost of goods sold for the three months ended December 31st, 2022 was $26.6 million compared to $30.6 million in the corresponding period of 2021. Gross margin was 70.3% for the three months ended December 31st, 2022, compared to 78.7% in Q4 2021, as a result of lower U.S. net selling price.
Now moving on to operating expenses. During the fourth quarter of 2022, we reported the expenses of $73.2 million compared to $97.7 million in the fourth quarter of 2021. It decreased at $24.5 million or 25%. The decrease compared to last year includes the impact of the cost saving initiative announced in June of 2022. These savings were partially offset by our investments in growth and expansion in Europe.
Under U.S. GAAP Amarin reported net income of $0.9 million for the fourth quarter 2022 for basic and diluted loss per share of zero. As of December 31st, 2022. Amarin reported aggregate cash and investments of $310.6 million in demonstrating the cash positive for quarter of 2022. We continue to experience relatively stable trends in our US business. Currently, we are not seeing any significant impact from Teva's listing on a one-gram generic version of the CFA.
We do expect our US revenues for the first quarter 2023 to reflect the impact of typical brand branded seasonality resulting in first quarter revenues slightly lower than the fourth quarter. We do expect the year to reflect continued pressure on both prescriptions and also price as we work the retain key customers to the brand.
We've continued to make progress against our cost reduction program announced in June of 2022, and we are on track to exceed the $100 million cost savings target we announced in mid-2022. For the full year of 2023, we now expect the operating expenses to be between $290 million to $305 million compared with approximately the $350 million originally anticipated at the time of our June 2022 cost savings announcement.
The lower than anticipating expenses are result of additional initiatives taken across the organization to reduce costs, along with the timing of our European investments, where we committed to invest carefully in Europe ahead of reimbursement decisions. Since the cost savings announcements in June, we have taken significant steps this year to strengthen and streamline the company operationally.
In addition, we have made significant progress amending our supply agreements and those negotiations are still ongoing. With these initiatives and relatively stable trends in the US, we believe our current available cash and resources, including US profitability are adequate to support continued operations, including European launch activities.
Now, with that, I will turn the call back to Karim for closing remarks. Karim?
Karim Mikhail
Thank you, Tom, for that financial overview and our results during the fourth quarter. We exited 2022 with a strong foundation to support our future growth plans as we focus on becoming global diversified cardiometabolic layer, and we are off to a strong start in 2023. We have a very clear set of priorities. Our first and main objective is to conclude reimbursement discussion successfully in the remaining European markets and launch.
We will do this while remaining laser focused on our cash preservation efforts. We're just beginning to see the results of our efforts over the last 18 months. Gaining pricing and reimbursement in Europe remains critical for a strong sustainable future and shareholder value creation. We would also like to take a moment to address Amarin’s General Meeting that was held yesterday, the results of which were disclosed after market closed.
On behalf of the Amarin board and management team, we would like to thank all of our shareholders for their engagement and feedback throughout this process. Continuing to enhance our shareholder engagement program across our broad investor base remains a key priority as we move through this year and beyond.
2023 is a critical year for Amarin as we continue pricing and reimbursement negotiations. We are in the process of transitioning to F15 member board, including the onboarding of all new members to ensure that the company remains focused on progressing against our strategic objectives to deliver enhanced value for shareholders.
I would like to take this opportunity to thank [indiscernible] for his leadership, dedication, and counsel during his role as Chairman of the Emirates Board. The board expects to appoint a new Chairman in due course. I would also like to commend our employees across the organization for their steadfast hard work, focus and commitment to Amarin. Finally, I hope we provided our shareholders with clear details of our fourth quarter and full year earnings results.
And with that, operator, we are ready to take questions.
Question-And-Answer Session
Operator
Certainly. [Operator Instructions]. Your first question for today is coming from Michael Yee at Jefferies.
Unidentified Analyst
Hi. Good morning. This is Jocelyn on the line for Mike Yee. Thanks for taking my question. I guess I have two. First, on your UK launch, the access data you shared looks very promising. So how do you see the access you have in the UK could translate to your product sales? And do you plan to break out European sales in your future reporting? And secondly, on Germany, I think you have mentioned that, you plan to submit another dossier to Germany. Maybe remind us what the process looks like and how we should think about the timeline? Thank you.
Karim Mikhail
Thank you for the question. I'll start with the UK launch. So, as you have seen, it is difficult that any company by the way shares very specific metrics of a country launch. We decided to do that since UK is one of our first big market launches and we believe that there is value for shareholders to stay very close to these metrics.
What we have presented today is showing the formulary listing, which is really the most important step to opening the door for physicians to prescribe for the product. It demonstrates that, the product availability is real for a very large majority of patients. Now in terms of future results, we will try as much as possible to share more metrics hopefully also from a revenue perspective at the right moment.
Having said that, a breakout of reporting between countries in Europe is not a very customary thing, and I think would not help us honestly in terms of negotiating prices and maintaining proper working relationship with the reimbursement agencies. But our intent is to share as much as possible, especially on the UK as the first country launch.
For Germany resubmission, yes, this is the plan to go back to Germany, because we believe that the German patients deserve to use VASCEPA. But we believe, the timing for this would have better chances of success after other large markets approving the product.
So, once we have Spain, Italy, France, it will probably be a better time to submit the file. And at that point in time, we will have a stronger associate to submit. But thank you for the question. We are not giving up on Germany. We will keep trying.
Unidentified Analyst
Thank you. That's very helpful. Thank you so much.
Operator
Your next question is coming from Roanna Ruiz at SVB Securities.
Roanna Ruiz
Hi. Good morning everyone. So, wanted to check-in about the U.S. a little bit. So, what's your level of confidence in your inclusive contracts holding up this year, and do you expect revenue stabilization to continue through most of 2023?
Karim Mikhail
Thank you, Roanna. So, on the U.S. if you remember, the exclusive journey started really in July of 2021. So, this is not something that the team started working on this last quarter. Over the last 18 months, we were able to sustain our volume from the exclusive stable over six quarters.
So, there's definitely a very solid foundation, but we are in an open market where there is competition. Now we have a fourth entrance which listed, but is not yet available on the market. So, we feel confident that the foundation that we have established is stable. We already communicated in our comments that we're going to see some erosion on the price. We're going to see a typical erosion on volume that we've seen quarter-over-quarter. And we're ready for multiple scenarios.
If we have from the beginning -- assume that this market is going to act like a typical generic market and we're going to lose 90% of the business by now, we would not have sold the $1 billion that we sold. So, we continue to keep four fingers on the pulse. We stay very close, for the moment the situation is stable. We have not lost any of these exclusive, we are in a stable position. But if there are threats, we have a plan and we will act swiftly on this plan if need be to maintain U.S. profitability.
Roanna Ruiz
Got it. Thanks for clarifying. So, I wanted to also ask about Europe a little. So, I think on the call you mentioned Italy might have a reimbursement decision mid-year and France and Spain may possibly come online to, so I was curious, will you be ready to immediately launch in these regions after getting decisions or just curious what the rollout might look like for VAZKEPA there.
Karim Mikhail
Yes. So first of all, let me clarify. I mean, you mentioned three countries. Those three countries are very different processes and very different timelines. So, in Spain, we try to be as clear as possible that we've had two rounds of negotiation. We are starting a third round of negotiations.
So, this is imminent as we described it, at least based on where we are in terms of negotiation. Italy, the process is less structured and the way it's progressing current estimation is maybe by mid-year, France usually takes longer time, right? In terms of arriving to an agreed upon price.
But in those three markets, the minute we're going to have reimbursement, we will be ready for launch. And those markets differ in Spain, you have a lot of sort of regional market access, which by the way, we have also made progress with just to ensure we are ready to launch when we have a Spanish price.
In France, it's a very nationally driven system. So, there are no regional access hurdles. So, the minute we're going to have a French price, we're going to be launching to really the major primary care population, and it's a significant market, but France takes longer time based on benchmarks that we have. So, we're working on the three of them.
Roanna Ruiz
Understood. Thanks a lot.
Operator
Your next question for today is coming from Louise Chen at Cantor.
Louise Chen
Hi. Thanks for taking my question. So, I wanted to ask you how committed you are to sustain cashflow breakeven, and how feasible is that given generics and also incremental burn with each new European approval?
Karim Mikhail
Thank you, Louise. So, 2022, we had a very clear vision to turn around the cash burn situation from the $100 million to the cash flow positive that you've seen. Now we're entering a different phase, right? Because we have a number of milestones that we are going to have in 2023, especially with European launches. With those European launches, there will be an necessity to invest. So, the situation will change quarter to quarter, but there are also other variables that impact our cash flow and let to maybe talk more about that.
Tom Reilly
Yeah. So overall, cash flow -- overall, our guidance is that we have enough cash, and cash equivalents to get to profitability to support the European launches. What we expect is for 2023, depending on the situation, what we expect is that we will have a decline in cash balance. There's going to be ebbs and flows between particular quarters, right? And so, it's -- so we will not be coming in cash positive every quarter, but more of an ebbs and flows. As should recall, we took specific initiatives last year on the supply chain. We still have negotiations taking place and the cost savings initiatives as well.
Karim Mikhail
And of course, you've heard us delivering above plan in terms of OpEx and the savings, which is significant number. And big part will also depend on the stabilization of the US. So, we are very clear on what are the key drivers of maintaining our cash position, whether it is the US business, our level of OpEx, which we are making far more additional efforts to try to save money.
But if we're going to spend a bit more, it'll be good news because it means we have more European markets that are joining the launch phase. It's important to note that a lot of our European expenses are already built in and bake within these numbers, right? So, you've seen on some of our slides, we talk about overall headcount in Europe today in the range of 200, which is basically saying we have recruited a significant number in all those markets where we're launching. We are well equipped. So hopefully that will answer your question Louise.
Louise Chen
Yes, thank you.
Operator
Your next question is coming from Cade Cruz at Goldman Sachs.
Cade Cruz
This is Cade Cruz on for Paul Choi. Our question is how are you thinking about potential shifts in strategy? And has the new board provided any comments or directional guidance on a new strategy? Thank you, so much.
Karim Mikhail
Thank you. So, first of all, I mean, the new board members, it's still very fresh. I mean, the meeting was yesterday. Today is day one. We're in very early stages of onboarding. But I mean, for the moment our strategy is very clear, right? Shareholder value creation is about expanding and launching and succeeding in Europe while maintaining the profitability in the US because that's necessary for us to make it there.
So, these are the key priorities for the moment. We have not had any shift in strategy, but as management, we have always been very open to reevaluate what's happening in the market and what we need to do, because if you look at what happened in the market over the last two to three years, things have developed and evolved significantly.
So, we stay very open to the market, to the situation and to adapt our plans and our strategies accordingly. But for the moment, I believe, we have a clear path to the future and moving ahead. Thank you. Thank you again for the question.
Operator
Your next question for today is coming from Naresh Chouhan at Intron Health.
Lisa DeFrancesco
We can't hear a question.
Operator
Just one moment. Naresh, your line is live.
Naresh Chouhan
Thank you. Can you hear me now?
Karim Mikhail
Yes.
Naresh Chouhan
Great. So, three questions, please. Firstly, on G&A. Can you help us understand what's in here? So, 25% to 30% of sales. Trying to get a sense of what's in there and where we should expect that to go overtime. And on COGS, they were quite a bit higher on our estimates, about 300 basis points higher than consensus expected in Q4.
Is there some underlying cost inflation here or is this more one-off and how should we view this for the rest of the year? And then in the UK, the price agreed with NICE was a good strong price, but obviously each customer then requires a further discount. So, given you have done such a good job now in terms of getting access to the local level. Just trying to get a sense of whether or not those secondary discounts are material and we should be considering those? Or if you are pretty close to the pricing, set by NICE? Thank you.
Karim Mikhail
Thank you, Naresh, for the questions. I'll let Tom handle the G&A sort of overview and the COGS. And I'm going to deal with sort of the price, net price and potential discounts and so on. Tom?
Tom Reilly
Sure. So, Naresh, thanks for the question. So, in general, in the G&A, what's in that line item, it's our corporate expenses to support the organization in there as well. We have legal based expenses. We have insurance charges are related to our overall programs from a program management, from a risk perspective.
So that's what's in our G&A. And your question related to cost of goods and the increase on margins of approximately 0.3. It really comes down to a sales mix. So, it comes down to U.S. product sales versus mix of some of our product revenue that we have with some of our collaborative partners. So overall, I think the root of your question was, were there any inflation impact, and short answer to that is no, there was not an inflation impact.
And on the positive side, from the working capital perspective, we bring down quite a bit of inventory, giving overall supply negotiations that we have taken and continues to onboard with.
Karim, would you like to answer the last question please?
Karim Mikhail
Yes. For the UK price, so you have seen from the slide that we put sort of the prices of the multiple consumer -- oral drugs in the UK on a list level. And we are very conscious that some of these list prices for other benchmarks is not really the net, meaning that, some of them are even discounting further to NHS to basically gain access. Where do we stand today? And based on our agreement, we are actually not discounting from this number that you see to NHS.
So, this is for us, a big part of the strategy of why we believe that the negotiation we've had was very successful, because we convinced nice of the value of the product and that there was -- it was not necessary for us to be discounting this. So, all the formulary listings that you've seen there do not actually involve additional discounts, right? So, the list is the net and we feel very proud of that performance.
And by the way, this is what's positioning us to strong negotiations in the other markets, because the Spanish governments and everybody else can see and visualize our price in the UK and they understand exactly what the British government is paying for Amarin for VASCEPA.
Operator
We have reached the end of the question-and-answer session, and I'll now turn a call over to Karim for closing remarks.
Karim Mikhail
Well, I just want to thank you all for your presence today and for the engagement throughout 2022, as we've said was a challenging year, but we've had a very significant turnaround and it's only the beginning of a two evolution of Amarin. We look forward to stay connected throughout the quarters and to very soon be sharing with you our results in the first quarter.
Thank you all for joining. Thank you.
newman, that's BS. Can you stop posting garbage on this board if it's not $16 in 3 months?
zip, I guarantee that BO, if any, will be in cash, not in acquiring company stock.
Capt, seems like their email gives more color of the deal than the press release.
Does anybody receive an email from Lisa this morning titled "Amarin Announces License Agreement for VAZKEPA in Australia / New Zealand with CSL Seqirus"?
I am guaranteeing a Sarissa victory, Joe Nameth style, tomorrow!
duke, my insurance, Metroplus, also change V coverage from no coverage to Tier 1 starting 2/1/2023. GL and GV are not covered as well (see p.28):
https://metroplus.org/wp-content/uploads/2022/11/Medicare_Formulary_Document_Comprehensive_2_23.pdf
IMO that's all due to the HN settlement and explain the slight uptick in V script last week. KM is much smarter than JT who lost the US patents, not KM.
duke, thanks for checking. Your post prompted me to check my Metroplus formulary coverage, which did not list V on its formulary last month, hence I got my V via BlinkRx in Jan 2023. To my surprise, Metroplus lists V as tier 1 in its February formulary (see p.28):
https://metroplus.org/wp-content/uploads/2022/11/Medicare_Formulary_Document_Comprehensive_2_23.pdf
That explains the slight V uptake in Raf and capt's script report last week. As I said before, KM is much better than that low-IQ JT who is the person to blame for destroying shareholder value, not KM.
tke, when your only revenue source (US) is dwindling and a new revenue source (EU) is nowhere in sight while management and non-productive employees are draining the company coffer 24/7, $300M is not something shareholders should be comfortable with. AMRN only promises a cash runway for the next 12 months.
Capt, the blue proxy said the deadline is 2/21/23 11:59 pm EST.
50.1%, at least, that's what I hope.
A deal, if any, will be all cash. Do you think the acquiring company CEO wanted to piss off his shareholders by diluting the company stock?
study, can you name one drug that's doing greater than $1B/year of revenue in the EU, as promised by AMRN management, not marketed by a BP? TIA.
liz, GL & ISS's endorsements are going to take away some tute votes. Every BLUE votes count now. Let's go BLUE!
The keyword is "Mochida came up with", not Amarin came up with? Amarin's R&D department is trash. It never comes up with anything.
duke, thanks for the feedback. LTRO is just anti-IHUB for some reason but I am always looking forward to his posts and research. Denner's holding confusion is just his yearend tax loss selling maneuver and not a big deal since he maintains his net AMRN position.
TTE, I plan to vote as below:
1) Throw out Per Wold-Olsen as Chair of BoD (he's a dinosaur)
2) Vote for Patrice Bonfiglio (She will be Denner's coveted mouthpiece)
3) Vote for Dr. Paul Cohen (he's qualified; at least semi-independent)
4) Vote against Mark DiPaolo (he has shown his worthlessness on Innoviva board.)
5) Abstain on Keith Horn (don't need more yes-men)
6) Vote against Odysseas Kostas (worthless on Innoviva board)
7) Vote for Louis Sterling (smart; will ensure communities of color are a CV focus)
8) Vote for Diane Sullivan (fine background)
Essentially following LTRO's recommendation.
Before I pull the trigger, just wondering what's the downside compared with a straight "YES" vote across the board. TIA.
Ns, I respect your view. Can you name one drug that's doing greater than $1B/year in EU, as promised by AMRN management, not marketed by a BP? TIA.
Tat, how come Generic Lovaza, which raises LDL by 49%, is selling like hot cake?
Roanna Ruiz
Great. Welcome back, everyone. I'm Roanna Ruiz, Senior Biotech Analyst here at SVB Securities, and it's my pleasure to introduce members of the Amarin management team, specifically, Karim Mikhail, President and CEO and Tom Reilly, CFO. So welcome. Thanks for joining us. And I'll pass it to Karim now to kick off the presentation about the company.
Karim Mikhail
Hi, everyone. And thank you so much for joining us today. And thank you, Roanna and SVB Leerink for the invite. My presentation contains forward-looking statements, so for a full risk of -- list of risk factors, please do consult our SEC filing.
I want to start with 2022 and the achievements of 2022. This has been a challenging year for Amarin. We started the year with the introduction of a third generic to the market, where we've had an impact on revenue and impact on cash. But we have delivered this year on every objective that we've had in a consistent way. So successful execution of the global commercialization where we have achieved five country reimbursement where we launched in five of those markets. Internationally, we had six additional regulatory approvals and where we've made very good strides on building the team in Europe where largely in those five markets and regionally, we have really invested in the teams that we need for the launch and we're sort of getting ready for the next phase of country launches.
In terms of progress on cash preservation, which is top priority for 2022, but continues to be a top priority in 2023. We delivered an actual saving of $50 million in the second half of 2022 on track to achieve a $100 million, maybe above by mid-2023. Our renegotiation of supply agreements continue to make progress resulting in significant production of our inventory purchases. All of this has been achieved via a true energetic, new leadership team, but also, a truly refresh board where we've had, again, 70% of new board member in the year 2022.
Our strategy to recreate the value that was basically lost post US IP litigation is very clear. We are set out to create that value of us get by ex U.S. in Europe and international. So the number one priority is really geographic expansion. It’s Europe, international and you've seen that in 2022, we have had significant progress on pricing reimbursement in Europe, but also regulatory approvals in additional markets. We made a lot of effort and continued to advance on our operational evolution objectives, which is really how can we save costs from all our non-revenue generating expense, right? We are very conscious that some of our expense base are revenue generating expenses. So we do cut them, but we're very sensitive as to what we cut and when we cut them because it's important to maintain them to keep the revenue in the U.S. But also advancing on the portfolio diversification with the FDC pipeline will give a bit of update on where we are in terms of getting EMEA guidance on how it's proceeding there.
So let's first start with the U.S. where two years after generic launches, you would expect that we have lost by now more than 90%. Actually, you would expect that we would have lost 90% of the value maybe six weeks after the introduction. We still maintain 60% of market share with four generics on the market. And again, we have delivered that while we reduced cost of the U.S, field structures starting October of 2021 when we cut half of the field force in the U.S., then 75 of the remaining where we are today, only 10% of the field force that with their big, big testimony of the drive of these teams. I mean, they are doing a great job on the field. And with the managed care group, securing the exclusive, making sure we are where we are in terms of delivering performance on the U.S. level.
Having said that, it's been very dynamic, we've had a number of scenarios moving forward because this is a very dynamic space. So, where do we stand today and as we start thinking, look, there is a full generic, we will have to see what can happen. The first quarter of the year for a branded product tends to be soft in any way because of out of pocket deductibles versus generic. Having said that, our objective is to maximize profitability and we can still do that even with a Teva on the market unless there is significant erosion on the price. But if there are unforeseen events, we have a plan for further operating expense reduction, obviously. But we are also ready to enter into a branded generic mode, but also an authorized genetic mode and other strategic ideas that would still allow us to be profitable in the U.S. and to generate the cash that is needed for us to invest in Europe and complete the launches across.
If you look at the performance in Europe, we started the year 2022 with only one country where we are negotiating pricing and reimbursement and it was a tough year where governments are getting out of COVID and old public budget deficit that they were dealing with. And we finished the year with five countries where we have achieved pricing and reimbursement and where we are launching successfully. And the most important proxy of the success that is achieved in Europe and maybe it's the first time we share this type of data. So clearly, as now -- you can see now the difference in our daily treatment price that we have achieved in the UK compared to other cardiometabolic products that basically operate in the same therapy area, competing over a similar patient population where we have demonstrated to the UK government and NICE that EUR5 euro plus is the price that the UK government needs to pay for the value provided by the [indiscernible]. So, the UK would not allow -- would not be ready to pay EUR5, while they're paying EUR1.5 and EUR2.5 and EUR3.5 to other products unless they believed that what was presented to them as evidence for VASCEPA actually saves them budget. This is really what the team delivered in the UK is demonstrating to the authorities that this is a product that's coming with very serious evidence that it will save budget for NHS. And by demonstrating this budget saving, they could allow us to have this price, which is, by the way, compared to any others is not discounted. So unlike many other products, this is the tool visible list/net product in the UK, and we believe that that's the most important proxy for success in the UK and in other markets.
Having said that, I just want to summarize a little bit where we are in the UK, because it's really the -- the top five market where we're launching today. Believe it or not, the journey is not five years old. Right? We got approval in April 8, 2021. We completed the file and submitted the data for the UK, for NICE in July of 2021. And we got that approval basically 12 months, after four nights review. So from a timeline perspective and despite the fact that we had three rounds of negotiations, it's been quite relatively quick process where we have achieved very important price levels. You can see that we did not hire our key account manager team except one month before we got. The approval is exactly the same what we promised. We're not going to burn cash too early. We're going to wait until the last round when we see we're very close to getting a price that we do not burn cash unnecessarily. And we launched very early on in October and in November, VASCEPA was listed on the national lipid guidelines which included VASCEPA and triglyceride testing as a necessity now for patients in that space.
And if you look at -- and this is the first time we present this data. If you look at some of our early launch metrics, you can see on the left side, this is the formulary listing uptake in the key accounts of the UK. So once you have approval, you need to go and get listed on the formularies of all the key accounts at the UK. There are in total 142. And we have achieved up to now 83 listing. Now if you compare that to the latest two launches, Right? So Bempedoic acid by Daiichi Sankyo and Inclisiran by Novartis, which is originally the medicine company. We are ahead of both of them. Interestingly, also ahead of Inclisiran where there is a population health agreement. Right? Where theoretically, NHS is making a very big effort to make this product available for a very significant discount that Novartis is offering, which we are not offering, so they full are priced and we are at the same level as not higher our formulary listing in the UK.
Now if you look on to the right hand side of the slide, you'll see the availability index by account, which basically tells you who can prescribe. So it's the level of prescription freedom for specialist NGP's. And you can see, and this is ranked by order of importance of priority, 100 means that anybody can prescribe VASCEPA to their patients, whether it's a specialist GP, whether it's a new or a repeat prescription is basically full access and you can see that there is very significant progress there in terms of accessing the GP. So we're very early in the launch phase, but we feel very encouraged by the early metrics. If you add this to the positive price that we just shared, we believe that that's going to maximize shareholder value in the UK and in Europe.
If we move to the international regulatory approval, we already have the first wave complete of seven countries, up to now six of them achieved in 2022. Most importantly, in Australia, New Zealand, and -- we will have more countries obviously to add to the list in 2023, 2024, 15 of them, including China where the latest information we have from our partner, adding that the approval is expected in the first quarter. There has been a delay due to the zero tolerance policy of the Chinese FDA, and they had to close down for a month. But now there's sort of back to operation and we wait to hear from them where we stand in terms of approval. And we are actively negotiating in many of these international markets like Australia and New Zealand, like Asia, like Central Eastern Europe, which by the way if you remember, we have regulatory approval in Central Eastern Europe, and we said we are not going to go ourselves and build any infrastructure, we're going to partner. In these markets, we're making very good progress and all of these partnerships we are taking very much into account that flexibility in the future is priority number one in case there is change of control of the company, then that would not prohibit any [indiscernible]. So that's an important area where we're also making progress.
Now I want to remind people that the chapter that we are in now, which is the chapter of new Amarin. When we started in 2021 after losing the IP litigation in the US, where the objective -- my objective, and the objective of my team member when I became CEO in August of 2021 and my team, most of them, joined in 2022. Actually, the large majority joined in the second half of 2002. Our mission is to recreate that value for Amarin outside of the US. This was a company that was expected to deliver the $3 billion to $5 billion in the U.S. We believe there is potential in Europe, potential in international markets to deliver $1 billion plus in Europe and $1 billion in international. So recreate that value and that's a journey that takes time. The last time ever faced such a challenging 2012, 2013 after the anchor data it took many years to get the REDUCE-IT study and go back to the level of market cap that was expected for the company, but we haven't worked on this journey. And we have dealt with this with urgency from day one.
In the U.S. one might think that the easiest thing was just withdraw all efforts and just pull out all expenses. But if you face a 90% erosion of your revenue, there will not be any cash left to invest in Europe at that point in time. So we had to negotiate exclusive agreements very early on and before anything. We started this in July of 2021. We actually started this before I became officially CEO, and we started the reductions in different phases. All of them timed and sequenced. They're being learning with how their revenue is declining so that we don't walk faster. Well, we don't dance faster than the music. We have to the tune in sync while also renegotiating the supply agreements. So huge effort done there, Tom and the finance team did a lot of effort in renegotiating all expenses that were not revenue generating from the corporate headquarter, at least to many of the non-revenue generating expenses to ensure that we focus all our investments on revenue generating investments.
And as you can see, 2022, we already sort of pre announced that we're going to have a fourth quarter that's going to be in the range of $88 million to $90 million, which basically means that despite all of these challenges, we've had four quarter of consecutive stabilization of the revenue. Despite generic activity, despite very significant cost cutting measures but because they were done strategically and at the right pace, we were able to stabilize the business and refer it from prior slides, if we face additional challenges we are ready to take further actions to ensure that we maintain this level of profitability. And I think the best closing of 2022 is when we've had that very consistent turnaround of the cash burn from $100 million cash burn in first quarter of 2020 to $65 in 2020 -- in the second quarter 2020 and the third quarter and then ending with a cash flow positive in Q4. Now obviously, you know, we will have quarters where that number will evolve. We hope that we will be investing more in Europe because it means more reimbursement. But it means we're on the right track to create value outside of the U.S. and take the company back to where it needs to be. So overall, very solid performance and very successful turnaround in the year 2022.
Strategically speaking, we still conserved the budgets and the investments needed for a fixed dose combination. The process is underway to seek scientific advice from EMEA in Europe because we believe that these fixed dose combination can bring in enormous value in Europe. Simply because they allow you to continue your penetration rate growth consistently throughout the life cycle. And we have data from private launches, and I was involved myself in the [indiscernible] launches in Europe where you can demonstrate that by introducing additional fixed dose combination every two to three years. You just keep your penetration rates up and growing with no slowing down throughout the life cycle of the product. So that's definitely something that we're working very hard to deliver. I know we got questions on. So what are we doing for the US for a fixed dose combination, we will have the opportunity to also bring it to the U.S. I think it will all depend on where the price of VASCEPA monotherapy will be if the price is still at the appropriate level, we believe we can bring this product to the U.S. But for the moment, we believe there is just significant value in Europe.
And only with the value created in Europe, it is definitely worth the investments for fixed dose companies' standards. Our priorities in 2023 are very clear. Right? We continue to make progress on all reimbursements, moving well in Spain, in Italy and the Netherlands and France and other countries. We maintain a full focus on profitability in the U.S. it's all about generating net cash that is necessary for the launch in Europe. The only way of doing this is to focus on operational excellence and to continue all the regulatory approvals outside, get new partners for the international markets and advance the fixed dose combination, which will allow us to bring additional products to the market.
So, yes, it is it is actually in a number of bold ambitions for the company. A challenging turnaround, but where the team -- the executive team, but also the board have demonstrated that they have a clear strategy, a clear vision of where we want to go that we are executing on the strategy and demonstrating success both in the U.S. and in Europe and on the international level. And again, we look forward to sharing more progress in 2023. 2023 is going to be another critical year where we hope we're going to be able to communicate positive milestones that will enhance the company value and will get us closer to achieve -- achieving our objectives.
So with that, I want to thank you all, and Tom and I are open for questions.
Question-and-Answer Session
Q - Roanna Ruiz
Great. Thanks, Karim. So I'll start it off. There is a common investor question that I've been getting recently. So if you could talk a bit about the outlook for Q1? And what do you expect in terms of the U.S. revenues for VASCEPA?
Karim Mikhail
Yes. So you've seen that we've had stabilization of revenue throughout 2022. Big part of this was the effort that was done to stabilize the decline on the volume. So from a volume perspective, currently, we're basically in the 2% to 3% quarter over quarter. We don't anticipate that this will change dramatically. We'll have to see what Teva will do. Teva is not yet on the market. So we suspect that they're obviously going to be more maybe volume erosion when they come to the market, they will take volume from other genetics, but potentially also from us. And there is the price erosion that would be expected from year to year. The very good news that until today or mid-February, our exclusive position is still strong. We have a lot of inventory. We are ready to be as competitive as we need to be to ensure women. Having said that, Q1 is a soft quarter usually. So we expect to see a bit of softness in Q1. But for the moment, we continue to strive for positive profitability moving forward.
Tom, do you want to comment anything on expense maybe? Because it's also important on the same lines.
Tom Reilly
Yeah. Just two components. One on the revenue piece just to add one additional point. Historically, trade inventory patterns in Q1 related to the wholesalers also brings some softness. And that's not just our product, but overall, products of similarity as well. So just keep that in mind. And two, I think it was -- Karim mentioned it a few times during his presentation. Our operating expenses based off the announcement we did in Q2, we are ahead of those -- our expectation. So we're achieving above $50 million we reiterated that we were going to exceed. We were going to achieve a $100 million of savings. So our operating expenses are ahead of that. And when the upcoming earnings come forward, we'll be readdressing that as well.
Roanna Ruiz
Great. Super helpful. And I actually thought your chart of the initial market access performance in the UK was very interesting. So maybe could you elaborate a little bit on what are the drivers behind that growth? And when do you think you could reach more majority favorable access and coverage in the UK?
Karim Mikhail
So the main driver for that is really the effort of our key account manager team at the local level. So NHS provided, basically, open access. They're allowing us to go account by account and negotiate the listing. We have very strong evidence and because we took the time to build a patient level for macroeconomic dossier for the UK, we are able to demonstrate to all of the authorities what value can we bring to them. Which you can see basically resulted in a significant uptake on the listings. Our Medical Affairs team is doing an amazing job educating all the key stakeholders. We are now listed since November on the national guidance. That's a very important effort. So I would say from all aspects, there's just huge progress made at a local level. Everybody is working with one very clear goal is to make sure that this is a true success. And again, as I said, we hope we could also share more of the data, especially, in revenue. The challenges compared to many of these products where we showed the prices, they have a lot of confidential discounts. So the comparisons are not going to be fair because for us, we're giving no discounts. So what you see is what Amarin gets in their pocket at the end of the year, while for all of them, no exception, there is a significant discount made especially for the injectable biologics, like Inclisiran and others, discounts can go up to 80% or 90%.
Roanna Ruiz
Got it. And I got a question from the audience that tags onto this pretty well. So I'm curious if you have any updates on the NHS budget allocations? And is this starting to benefit VASCEPA over time?
Karim Mikhail
Now remember, we negotiated with NICE full open access to our patient population. And the Ministry of Health in the UK [indiscernible] the day of our approval and our reimbursement that almost half a million patients will benefit from this drug. As a reminder, I believe that other products that had a population based agreement with NHS had lower number of patients that was published. So, here's a case where, look, we -- it was more difficult, right? It took one more round of negotiation, but the team in the UK delivered and we believe that that's going to maximize the value of the product, not just as the UK for the UK. Because I can tell you now that Spain, Europe, France, Italy, and other markets see clearly the price in the UK. That sets where the negotiation starts, tight? The negotiations start from five point something euro, it doesn't start from an over level. That's why it was so critical in those early markets. That we go for the highest level possible, highest also without going too high so that it prohibits penetration, right? You don't want to give this perception that the product is too expensive. I don't want to use it, although it's covered by the government, but still. So I think we stroke this right balance between a premium price, but open access for everybody.
Roanna Ruiz
Yep. That's fair. And actually, that's a good segue. I did want to check-in with you. Any updates on where things stand with Italy, Spain, some of the other larger European markets?
Karim Mikhail
Yeah. In Spain, we completed the round two, and I remember when we were completing round two in the UK and getting all the questions from investors because NICE publishes in English everything so you can’t really read all the minutes of our discussions with them. In Spain, we come completed round two, and we are initiating round three. We got the price in the UK from round three. I don't want to say that we're going to get it in Spain in the round three also. But we are making very good progress in the negotiation there. Those markets there are other variables that get hit to the negotiation. So it's not only your pharmacoeconomic evaluation. They have a larger patient population. So they care a lot about budget impact, what's going to be the total stand for them? How much can you save truly for them maybe for other product usage and other and other elements? So it's a more complex negotiation, but we believe we're making very good progress in Spain, but also in Italy. Italy, I thought that Italian agency has just announced a restructure a month ago. So far, the information we have that that's not going to have a significant impact on our priority on the list of the price negotiation. We already had a number of rounds, or price negotiations, all of them are confidential. So unlike Spain you do not know how many rounds there are. And the same progress is made with France and the Netherlands. These are the key countries where we're focusing on. Progress is made in others, but these are the top priorities where we stand today.
Roanna Ruiz
Yep. Understood. And I think maybe a bigger picture question just to give you a chance to update us a little bit. Maybe Tom, if you could talk a little bit about cash runway expectations. I know you alluded to some of the savings that you expect, but what are things going to look like in 2023? 2024, etcetera? As best you can explain.
Tom Reilly
Sure. Thanks Roanna for the question. So overall cash position, we announced earlier in January we have $310 million at the beginning of this year. Our expectation is that we have enough cash on hand to support our launch activities through Europe. So overall, enough cash to support the ongoing activities for the business.
Roanna Ruiz
Great. And in our final couple of minutes, I'll shift gears a little bit back to the US market as well. So maybe what's your level of confidence that your exclusive contracts will hold in terms of this year? And can you talk a little bit about -- are there any push pulls that you're considering?
Karim Mikhail
Yeah. Look, this is an open competition market. There is no -- we've been competing for the last one year and a half when we started the year in 2022, half of our business was coming from exclusive PBMs. Now a large majority of our business is coming from those plans. So we worked very hard to maintain them. But by the way, we also worked very hard to defend the nonexclusive because both are important. It’s not like we let go of the others, this is a marketplace and you need to be competitive in every segment. And that's why, by the way, we keep 75 reps. Because it allows us to also continue to fight in non-exclusion where we have also high profitability. So both matters for the moment. We are confident if something happens, we have the plan ready. We would press some of the button we need be. But for the moment, we continue to strive to deliver the performance first quarter may be a little soft, but we continue to push forward.
Roanna Ruiz
Okay. Great. Sounds good. So I think we're about at time. So just want to thank you, Karim and Tom for hopping on and walking us through the key points of Amarin. I appreciate the insights, and I hope everybody has a great rest of the conference.
Karim Mikhail
Thank you, Roanna.
Tom Reilly
Thanks, Roanna.
Ns, "I absolutely believe that GIA in Europe is the best way"? How many years will Amarin take to break even in its EU operation, excluding US operation? TIA.
J, following is the voting recommendation of lettruthringout (LTRO):
) Throw out Per Wold-Olsen as Chair of BoD (he's a dinosaur)
2) Vote for Patrice Bonfiglio (She will be Denner's coveted mouthpiece)
3) Vote for Dr. Paul Cohen (he's qualified; at least semi-independent)
4) Vote against Mark DiPaolo (he has shown his worthlessness on Innoviva board.)
5) Abstain on Keith Horn (don't need more yes-men)
6) Vote against Odysseas Kostas (worthless on Innoviva board)
7) Vote for Louis Sterling (smart; will ensure communities of color are a CV focus)
8) Vote for Diane Sullivan (fine background)
https://www.investorvillage.com/smbd.asp?mb=2294&mn=9160&pt=msg&mid=23900665
J, thanks! Your vote is the same as lettruthringout.
J, which of Denner's slates you won't vote for?
Are you saying NVS wouldn't have bought MDCO without Denner's involvement?
Stockboy, are you saying Amarin needs to be marketed to BPs who are not capable of seeking out acquisition targets themselves?
con, thanks for the suggestion. Following is the recommendation from poster lettruthringout:
1) Throw out Per Wold-Olsen as Chair of BoD (he's a dinosaur)
2) Vote for Patrice Bonfiglio (She will be Denner's coveted mouthpiece)
3) Vote for Dr. Paul Cohen (he's qualified; at least semi-independent)
4) Vote against Mark DiPaolo (he has shown his worthlessness on Innoviva board.)
5) Abstain on Keith Horn (don't need more yes-men)
6) Vote against Odysseas Kostas (worthless on Innoviva board)
7) Vote for Louis Sterling (smart; will ensure communities of color are a CV focus)
8) Vote for Diane Sullivan (fine background)
You and he disagree on Bonfiglio, DiPaolio, Kostas, and Sterling.
Is there a difference to the future prospect of Amarin if Sarissa gains only 5 board seats instead of 7 with PWO voted out? Will that increase the chance of KM keeping his CEO job? A new CEO at this juncture might further delay potential BO as it takes time to look for a qualified candidate; I also valued KM's EU expertise. Just try to find an angle to have the best of both worlds.
J, following is the voting recommendation of lettruthringout (LTRO):
) Throw out Per Wold-Olsen as Chair of BoD (he's a dinosaur)
2) Vote for Patrice Bonfiglio (She will be Denner's coveted mouthpiece)
3) Vote for Dr. Paul Cohen (he's qualified; at least semi-independent)
4) Vote against Mark DiPaolo (he has shown his worthlessness on Innoviva board.)
5) Abstain on Keith Horn (don't need more yes-men)
6) Vote against Odysseas Kostas (worthless on Innoviva board)
7) Vote for Louis Sterling (smart; will ensure communities of color are a CV focus)
8) Vote for Diane Sullivan (fine background)
https://www.investorvillage.com/smbd.asp?mb=2294&mn=9160&pt=msg&mid=23900665
Like you, I also prefer KM to stay as I think he did a good job considering the baggage low-IQ JT left for him and his EU expertise. Voting according to LTRO might ensure KM would stay. I am torn.
s, institutions such as passive funds would most likely listen to Glass Lewis. That's why it's very important to vote BLUE. For those who have voted WHITE, do what MrMain did, cancel the WHITE votes, and vote BLUE.
liz, I said "betting on a Denner loss", might be due to the Glass Lewis news last night.
The Glass Lewis news last night is putting pressure on AMRN stock price today despite a strong market.