Khoso Baluch
Analyst · H.C. Wainwright. Please state your question
Thanks, Phoebe and Jack for describing clearly important work for CorMedix as we continue to move forward in the next phase for Neutrolin. Now, let me cover some exciting insights. During the last several quarters, CorMedix updated its understanding of the market opportunity and the evolving reimbursement environment for Neutrolin in the U.S. CorMedix undertook several studies including extensive interviews with almost 180 nephrologists, oncologists, TPN, healthcare providers, and nurses in each of the segments, plus payers covering all the different sectors involved with reimbursement. The work that was previously done is several years old and we wanted to ensure that our understanding of the market includes current standard of care in the various indications and the impact of the current therapies on the need for catheter lock solutions. As a result, we believe we would be better prepared to meet the need of the patients and the caregivers, should the FDA approves Neutrolin in the U.S. Our work has reinforced our belief that the medical need is substantial. Nurses and physicians agree that a catheter-related infection is the most clinically concerning complication associated with central line use. Neutrolin’s profile, as we now know, based on our Phase 3 study is clearly a game-changer. And we are convinced that it has the potential to be a best-in-class product. We have reconfirmed the significant unmet medical need and that practitioners considered current solutions inadequate. Healthcare providers are seeking a better solution. Based on the research, Neutrolin received very-high acceptance ratings within all segments and by all healthcare providers. This clearly positions Neutrolin as a popular solution for preventing the catheter-related bloodstream infections that so many patients and healthcare providers dread. In fact, based on the current market research with nurses and physicians, the interest in Neutrolin product profile was very-high. The market research was conducted by a firm that has done similar research on over a 100 new products and the receptibility to Neutrolin was among top 10 percent of all products tested across many disease states and treatment modalities, including very-innovative product such as cell therapy. CorMedix also undertook a deep and detailed analysis of the three segments of the catheter lock solution. The segments that were studied were hemodialysis, oncology and TPN. The ICU segment required further work. The size of these catheter lock solution markets was assessed in detail. As it’s not easy to determine the number of catheter lock solutions used in each of these markets or in any of the segments within these markets, there is no available IMS data or omnibus reports that accurately capture this information in the U.S. CorMedix’s cross-functional team of medical affairs, regulatory supply chain finance and commercial participated. The outcome revealed some interesting findings. The market for catheter lock solutions in the hemodialysis segment was estimated to be around 40 million catheter lock solutions per year and growing. The oncology and TPN segments were estimated to be almost 150 million catheter lock solutions per year and also growing. This information separates catheter lock solutions from flushes, which sometimes are misunderstood and combined into as catheter lock solutions. We believe that based on today’s practice, saline would be used as a flash followed by the catheter lock solution. What is also interesting is that while primary access route for hemodialysis is a central venous catheter, in the oncology segment, catheters with port are most often used instead. Having gained further insight between the hemodialysis and oncology markets, we have learned how can address the needs of these different markets with variation in product presentation and packaging, in a way that allows us to tailor our product and our pricing to best address the value in these different market segments. A separate CorMedix work effort examined reimbursement and the burden of CRBSI in the hemodialysis patient population. The focus was on value pricing and the impact on different budget holders. Time was also spent understanding the legislation that was initially issued in the summer of 2018, called TDAPA that stands for Transitional Drug Add-on Payment Adjustment for end stage renal disease. What this would provide is for Neutrolin to be eligible for reimbursement outside of the ESRD bundle for at least the first two years. CMS last year expanded illegibility of the TDAPA to include all new drugs’ biologicals, including generic drugs. CMS just last month released a new proposal for 2020. CMS is proposing to narrow the eligibility criteria to exclude drugs and biologics approved under certain types of FDA approvals. In general, drugs with approvals as new molecule entities, new active ingredients and a new drug to drug combination, and new biologics would still remain eligible for TDAPA. Neutrolin falls within this criteria as a new molecule entity and should therefore be eligible for TDAPA. This TDAPA applies for the hemodialysis patients only. The oncology, TPN, which is total parenteral nutrition segments are quite different. In these segments, the large majority of patients are treated as outpatient. On a fee-for-service model, AFP Plus, while a smaller group are treated in hospital in which the reimbursement is generally via capitated payment system based on DRG codes. The reimbursement in the outpatient oncology TPN is generally more leveraged, in other words, higher price. For value due to the higher incidence of CRBSIs. There is still a lot more work to be done before we can finalize our pricing strategy. Work such as budget impact, health economics, value messaging and payout strategy were need to be completed in order to refine and optimize CorMedix strategy for Neutrolin in the U.S. Let me be clear, our goal is to maximize shareholders’ value. Because hemodialysis is a very concentrated payer provider market, we are continuing to prepare CorMedix to launch Neutrolin in the hemodialysis segment, while at the same time being open to potential partnerships. We are now beginning the process to recruit into CorMedix, the commercial market access and medical affairs leadership for the U.S. market. We also acknowledge particularly in the area of oncology, TPN, and critical care that these in a very broad and therefore would be more appropriate that a larger, more strategic care who already is in this space be best able to maximize shareholders’ value. Now, let me ask Bob to cover quarter two finance and CorMedix finances.