I don't think that they have "burned" their commercial bridge, but I think that there has been significant damage. I have been a part of 4 launches. With these launches, we always knew that if the MD gives you a chance that you better hit a homerun. Now that chance could be one time in surgical or could be related to a number of patients. With BONTS we always asked for a subset of patients. We shot for 10 or so. As you know with the studies, there are a certain percentage of patients that get to longer duration so we needed a bit of a sample size. Then we helped the MD set their expectations related to the data. That was the most important part as if their expectations were out of line of the study then we were bound to fail. I think with RVNC that this was the big problem. Expectations may not have been set appropriately as they priced the drug at a premium level. With that premium pricing came premium expectations for them and their patients. Many private medical practices are word of mouth referrals so if the patients get pissed that their premium expectations were not met . MDs are not fans of patients that are not happy as they know that they will go elsewhere and dent their good reviews. Everyone gets online and reviews MDs now. So... long way of answering your question - I think that there has been significant damage to MD relationships and that will take time to heal. It will take time for MDs to give them another chance. Many reps have left so now a new rep has to try to form relationships with the gatekeeper and staff. Not easy.
I do feel that the price decrease will provide them with opportunity as MDS like Soma on this board that are incredibly skilled injectors will have great results with happy patients that spread the word. SOMA will also be happy as his ROI is better than the other BONTs. Word will get around which will compel other MDS to give it another shot. This will all take time as each injection cycle is around 3 to 6 months. Of course, a top notch leadership team would be proactive in marketing this new value proposition. I am not sure that this leadership team if the right one. They have only been reactive. Long story well...long. I could see this company doing quite well in a year, but investors will sit on the sidelines until they see results.
On the flip side, if handled correctly - the therapeutic could be a real boon for them. They need to get a very strong leader in place with ample experience on the therapeutic side. But heck, we won't see those results til 3rd quarter next year.
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