“To-Do” List for Mr. Derkacz
Braeburn’s new CEO has a chance to hit the reset button on probuphine. There a some things he can do immediately to change things for the positive. These items would be at the top of my list.
1. Lower the cost of probuphine.
Price is always one of the objections raised to probuphine, and one of the main reasons for the resistance being met by insurers and state medicare and Medicaid formularies.
Per Braeburn’s S-1, four implants cost around $600 to manufacture. And yes, Braeburn has to pay Titan a royalty, pay a specialty pharma its cut and pay for its own expenses, but….$4,950 selling price for something it costs $600 to make? 725% gross profit?
Braeburn’s initial decision on pricing was based on Sheldon’s view that probuphine should be priced competitively with Vivitrol (which cost about $1,000 a month). The thing is, Vivitrol may be long-acting, but it has no buprenorphine in it…it’s for people who have completely de-toxed from opioids. Suboxone is probuphine’s competition, not Vivitrol, and it should be priced accordingly.
The cost of suboxone film is around $480 a month, $2,880 for six months. Braeburn should be charging somewhere in the mid-3000’s for the implants.
2. No More Smiley Faces
Braeburn has used a marketing strategy based on faith in the goodness of human nature and a belief that the merit of a good product will eventually be recognized. Braeburn’s competitors use back-room deals and slandering the competition. I mean, look at these guys. Indivior has been sued by 35 state attorney generals for monopoly practices. Alkermes actively lobbies conservative lawmakers with the “don’t fight drugs with another drug” lie. Meanwhile, thousands more die.
Braeburn doesn’t have to become scum of the earth, but they need to learn to play hardball. No more funding “Advocates for Opioid Recovery” which is essentially a pension plan for Patrick Kennedy and Newt Gingrich, who have done zilch for probuphine. No more funding “Female Opioid Research and Clinical Experts” who are just another voice getting lost in all the confusion.
Hire lobbyists. Contribute to political campaigns. Play the game.
Look at Vivitrol and medicare. $12,000 a year and it is a “covered-preferred” method of treatment in most states. Probuphine is not a preferred method in any state, and some states don’t even cover it. That doesn’t have anything to do with the merits of the drugs. Hardball.
3. Focus on Institutions
They have started this already, but training should not be provided to solo practioners, small practices or others who are unlikely to ever prescribe probuphine. If that means no coverage to rural areas, then too bad. What is the point in having doctors trained in rural areas if they never prescribe?
4. Fire People.
Number one on my list… a tie:
David Byram, VP of Government Affairs and Market Access. One federal government sale in the past 12 months. Market access is a disaster. Case closed.
Craig Brown, VP of Commercializaton and Program Management. His title tells you all you need to know.
