Amarin Corp Plc (AMRN)

[ORBAPU]

I disagree that Vascepa is having a slow uptake because the US cardiology world is not convinced the risk reduction is real or any other single-minded simplistic explanation. I mean, really great logic should you stop to think about it. Cardiologists don’t prescribe Vascepa because they don’t think the risk reduction is real, yet they prescribe Lovaza, a drug with no known CVD benefit and dangerous side effects. Yeah, right!

Here is a list, not comprehensive, of possible reasons for slow Vascepa uptake.
1) Cardiologists may be unaware of Vascepa.
2) Institutional inertia.
3) Belief that historically used, current treatment protocols are sufficient.
4) Already having difficulty with patient compliance so adding another drug doesn’t make much sense.
5) Insurance complexity.
6) Institutional financial goals.

I wonder if #6 isn’t fairly significant. Cardiologists, generally, I believe work as employees for hospital systems. Cardiology Institute, Heart and Vascular Center, Cardiology Associates, Cardiology Consultants, Cardiovascular Associates, etc.

These businesses will have multiple revenue streams and faceless nomes who keep track of the financials and produce metrics for management. The rules are simple. Expenses must go down and revenues must increase, year over year. Each department is given goals. Individual doctors likely tracked.

How does Vascepa help a business that’s based on intervention? I can quite imagine how the reviews and performance evaluations will go. “Why is Dr. Issacs’ production down by 30%?” “I’m not sure but I’ll talk to him and let you know.” Later: “What did you find out from Dr Issacs, is he ok?” “I talked to him and it turns out he’s been prescribing Vascepa. Fewer of his patients are needing stents, bypasses, and redo’s.” “Well, just tell him to knock it off or he’s fired.” “I’m getting tired of his Lone Ranger antics.”

Somehow I rather doubt cardiologists stray too far from their institution’s established treatment protocols.