Amarin Corp Plc (AMRN)

[sts66]

It is true - only Empag||f|oz|n had a lower normalized start to sales, and we're barely above that line, and just below the Br|||que line - Entresto and Effient uptake lines were 3X higher at the 3 month mark.

What's more concerning to me is what I just read in the JPM call transcript - Germany requires an ~ 10% discount to the $240 USD price, not bad, much bigger net sales than AMRN gets in the US (~$143), but in a question about price negotiations with other EU countries KM said that the discounts must go up in some percentage to the number of patients expected to be prescribed the drug - the more you sell the less money you make per sale.

He also made this statement:

What price are you going to get for which patient population?.....The negotiation is usually you get a government that says, well, listen, if you're willing to discount X percent, I'll give you full access. And if you say, yes, you'll probably have very fast access but listen, no matter what you're never going to reach all of this population, even if you try very hard, right? So where is the balance? Which is the most important patient population?

What's he talking about here, these different patient populations - are EU countries going to set up two criteria, like secondary prevention vs. primary prevention? The US insurance industry is mixed on covering V for those two uses - some require you to already have CVD in order to qualify for coverage (pre-auths), while some cover for prevention, or rather don't require a reason for you to get your V scrip covered, if it's prescribed by your doc you get it, period. Sounds to me like AMRN might go after secondary prevention - those patients are more likely to stay on V, although the primary prevention group may be larger (at risk but haven't had a MACE yet).

That's a very tough nut to crack, deciding on how wide the coverage you want - of course patients would best be served to qualify for either reason, but that means many more patients and higher discounts, while you don't know if the trend of which group stays on V longer will match what happens in the US. And they also don't know how many docs will prescribe for primary prevention.