Shaun Thaxter
Management
Okay. Good morning, everybody, and welcome to our first-half results presentation at Indivior, where I am pleased to share with you the progress we are making and our next steps as we continue to strengthen our global leadership position in the treatment of addictions. I will assume that you’ve all read the forward-looking statements. Today, I am going to give an overview of our performance and talk about SUBLOCADE, where we’re at with the launch, understanding some of the dynamics in the market and a look at what comes next. And Javier will give us a legal update. Obviously, we’ve been very busy with the litigation matters in the last few weeks. So we will get a clear update from Javier. Then Mark will take us through the financial review, before I summarize at the end. So let’s first look at the first-half and our position on guidance for the year. Well, clearly, we have a tremendously intense number of competitor pressures bearing on our base business at the moment. And this is reflected in our net revenue, which is 5% down over prior year. The market growth in the U.S. continues, and this is happening at a very healthy rate. But the shape and the mix of this growth is predominately coming from the Medicaid channel. And this channel is of course the lower margin channel for our business that carries the highest number of rebates. So the growth that we’re seeing is in the lower margin business. And we’ve also seen a loss of some film share. So while we’re very pleased that the film share is very resilient, there is inevitability about some of these competitor pressures, and further enhanced by the fact that the generic tablet pricing has now reached the top-end of the commodity price floor. And I think we’ve always said that when generic tablet pricing gets to the commodity price floor, then we will start to see increased pressure on our market share. So not necessarily a surprise in term of some of the risks that we’ve known for a while, but certainly the timing is here and now and we’re starting to see a bigger impact. So the SUBLOCADE, the initial revenue to date in the first half of $2 million is clearly below all of our forecasts, including ours. So we are going to acknowledge the reality of that and seek to understand underneath that, what’s going well and what are some of the challenges, how are we making progress in overcoming those challenges as we move forward. The big story, of course, with respect to SUBLOCADE is that we still believe in the $1-billion-plus peak revenue forecast. The more immediate story for today is, well, how are we doing at the moment and what does the build towards that peak look like, so we can get a better understanding of that. Clearly, we’re very pleased with the legal progress that we’re making, that Javier will talk more about. We won the preliminary injunction against Dr. Reddy’s. We were very pleased with that, of course. We’ve always said that we believe in the strength of our intellectual property. We were pleased with the quality of the ruling that the judge issued on that. So, we will understand from Javier, okay, so far so good. But what are the milestones moving forward? We know that Dr. Reddy’s has filed to appeal. We’ve already filed our motion to oppose all of that. And we need to understand the timeframe moving forwards and the process. So Javier will take us through that a little bit more later. We’ve also continued to advance our discussions with the DOJ. And if you look at the language in our release, there’s more information about that there. So let’s get into SUBLOCADE then. So strategically, the fundamentals, some of the fundamentals that we are looking at with SUBLOCADE are strong. Now, it’s early days and some of the numbers are low. But nevertheless, we are seeing positive signs within the performance of the product that are indicative of long-term success. We’re also seeing – experiencing some challenges however. And I’m sure that many of you have heard some of the things that physicians and patients are saying in the market. And we’re going to explore some of those and tie them back to the challenges that we have seen and look at the progress we’re making and the plans that we’ve put in place to address these challenges moving forwards. So let’s focus, first of all, on what are some of those strengths that give us continued belief in SUBLOCADE. Well, first of all, the anecdotal feedback that we’re picking up from patients, so this is things that doctors have said to us. These are the things that patients are saying to each other in chat rooms that we can observe, is that the patients are having good experiences when they are actually taking SUBLOCADE. The sorts of things that they’re talking about are the sorts of things that we would expect them to say based on the scientific advancement of SUBLOCADE. With so, SUBLOCADE is a pioneering new treatment. It’s highly innovative, and it transforms treatment. What does that look like to a patient? So some of the things patients are saying at the moment is: I was worried about going on SUBLOCADE, because when I wake up in the morning and I didn’t feel very good, I need to reach out and take my daily medication; and I won’t have a daily medication, and therefore, I’m worried about that. Patients who are actually on SUBLOCADE are saying: yeah, I was worried about that too, but I’ve been on SUBLOCADE a couple of weeks now, and I feel good; I don’t wake up in the morning with those withdrawal symptoms; I don’t wake up with those feelings. If you think about the science of SUBLOCADE, where we said the huge innovation here is that steady-state plasma concentration of 2 nanograms per mil and that translate to 70% receptor occupancy, which means you don’t get the highs and the lows that are associated with daily oral administration, then that’s exactly how you would hope the patient would wake up feeling in the morning. So as you tie all these things together, you’re seeing a good consistency. We are very pleased with not only the quantity, but the quality of payor coverage. Often in a launch or sort of you’re trying to get patients requesting the product. And then you’re in at the payor, and that the demand from the patients influences the payor. But nevertheless, the fact that it’s not on formulary can have a restraining force on the advancement of your product. We’re seeing those forces at play here, but we are winning on that front. 67% of all lives in the U.S. are now covered for SUBLOCADE. So if you think that the comparator price at the moment, there’s generic level tablet pricing, and we’re going in with a price of $1,580. That’s quite a delta for the payor. And they’re so compelled by the argument, the data and the health economics value created by this product that they are rushing to put it on formulary. So 67% formulary coverage, that’s today’s number. That’s not the number at the end of the H1, so that was 56%. Now, it’s 67% as of today. So I think that that’s very positive strategically moving forward. We’ve also actually seen a high number of doctors who’ve tried to start their patients on this medication. Now, unfortunately, we’ve had well over 6,000 doctors tried – 6,000 patient attempts. But a very small number of those have actually made it through the system and been successful. So there’s quite an erosion there. And I’m going to dive into the detail and show you a little bit more about that. But the physicians’ desire to treat the patient is evident in those numbers, so we are encouraged by that. Now clearly, there is a lot of frustration, and it is taking time to get that first prescription delivered. But what is positive, this is not an ongoing phenomenon that affects the patient for the rest of their time on SUBLOCADE. This is very much a onetime experience. Once you’ve had your first injection, when you need the second injection, that process all happens very quickly. So we are seeing that. We’re also seeing that patients are staying in treatment and that they are coming back for their second injection, and they are coming back for their third injection. So I think that’s a very important indicator. We’ll look at specific numbers there a bit later. Of the safety data that we have seen, and of course, the numbers are relatively small. But we’re also encouraged that we are seeing what we would have expected to see. We’re seeing an adverse events profile similar to transmucosal buprenorphine, and the additional things about injection site pain are consistent with what we observed in the Phase III study. We’re also pleased that the FDA has now completed its review of all our promotional materials. So this is sort of a positive now, but it has been a drag factor year-to-date because we’ve been talking to doctors about the product labeling. We haven’t had resources to be able to give to patients, so that has been a restraining force. But that is now behind us and we can feel good moving forward. So those are the things that we believe are going well. Let’s think about some of the challenges. The first and most obvious challenge is the duration of the prescription journey. And I’m going to talk a little bit more about the prescription journey in a minute. But basically, this is the time it takes from the time that doctor decides to treat the patient to the time it takes to actually get the injection into their practice to administer into the patient, all right. So this is taking a lot longer than it needs to and that we want it to, and we expected it to. And we are working very hard to get that done. Also, the number of patients who are successful is low as we mentioned earlier. We would also like to see more healthcare professionals actually trialing this, and I think that that will – this is naturally restrained by the first two challenges. So as those challenges start to become addressed then I think so this will pick up. This, obviously, knocks on to the absolute number of patients in the system. And we think that patients themselves will benefit from all the education and support that we will be able to give them from now moving forwards that we weren’t able to before. So we have labeled the term the Prescription Journey. So what do we actually mean by that? Well, I think it’s very important, just to the take a step back and understand the processes that go on for all prescriptions. In the U.S., when the doctor triggers the desire to have the patient put on a medication, there is a four-step process. The first is that a benefits investigation takes place as to whether that’s covered on the formulary. Secondly, are the prior authorization requirements met on the formulary? Then the pharmacy that’s responsible for dispensing the medication has to verify with the payor that they will actually give the medication for this treatment, and then you have to dispense the medication. Now, in the retail pharmacy channel, this is all done by computers, and systems, and algorithms, and artificial intelligence. It happens instantly. So with SUBOXONE Film, when the doctor decides to give the medicine to the patient, they press the button on their computer. And within seconds, it’s at the pharmacy, and the pharmacy systems automate it and presto, it comes up on the screen, ready to dispense. And all the patient has to do is walk to the pharmacy, get the medication and you’re on your way. What we are asking doctors to do is something radically different with our specialty pharmacy distribution. And why it’s radically different is the doctor and the patient have to sit together, and they have to fill out some forms. Those forms then get sent to an administrative center, where the forms are processed manually by hand. The process that take place is verification with the payor, verification for coverage, verification for prior authorizations. And when all that is complete, the papers then go to the specialty pharmacy. The specialty pharmacy then have to go through a verification process. And then, the specialty pharmacy has to organize the delivery of the product back to the patient. Now, the reason I’m sort of going out of my way to explain all of this because it’s fundamental to understanding why the launch and that things are where they are at the moment. So if we accept that that’s the process, there are two things related to that. First of all, I’ve said the time it takes to get through the process. So let’s just pause momentarily and let’s dig a little bit deeper into the time that it’s taking. If you look at this bar chart, you will see that the numbers are coming down quite dramatically. Well, on this occasion, that’s a good thing, because on the left, the average time it was taking in March was to get for the doctor deciding, I want to treat this patient to actually having the injection in their hands ready to inject into the patient that was taking between 43 and 62 days. So if you imagine you’re a doctor and you’ve started this process and only two months later, two whole months, right, you finally get the medication. Clearly, that’s an unacceptable length of time. So some of these things are directly within our control and some are within our influence, but not absolutely under our control. As you would expect, the things that are on our control are already dealt with. And we have taken what was sort of taking from 18 to 20 odd days, and we get our – the stuff we control done in one or two days at the moment. So we have optimized what’s within our control. Some of the things that have enabled with that is that, obviously, we said that we have made an investment of a field reimbursement specialist to go to doctor’s office and help them with this and educate them on how to get this right. So if you look at the end of the day, at the first month, it says that the intake took three to five days. But if you don’t fill the form in and you send it off, guess what, it’s going to come back and you’re going to have to redo it. So by spending our teams in to educate the doctor’s office, it has enabled them to get the forms right the first time, and therefore, we have addressed that issue. Getting the forms accurate is important. Having the number of people, administrative people within the hub, who actually do all this processing. At launch, we had far more investigations than we had the capacity for. We fixed that immediately, and now capacity is no longer an issue. As payor coverage continues to build, that’s helped speed up the process as well. So what are the things that are less controllable? The less controllable is how the specialty pharmacy operates. And this is also very new for specialty pharmacy. The specialty pharmacy was designed really for low-volume, really high-value products, products that cost $10,000, $15,000 a go, low-volume. So to have a mainstream volume technology that is also a scheduled drug that is also cold chain, it’s brought a new level of complexity to the specialty pharmacy as well. So they are currently learning that with this patient population, the coordination with the doctor’s office actually requires a little bit of effort. So they’re upgrading the quality of their processes to make sure that they are able to provide the type and quantity of service level that’s required to be successful in this disease space. So we expect that the 15 to 20 and the 10 to 12 days in June will start to come down, maybe not quite at the same rate as we’ve got things down to date. But the going state here, we would say that this thing is optimized when the total duration for this is between 15 and 18 days. So there is a certain minimum amount of time that these things take. We have studied other specialty pharmacy models, and we see that sort of 15 to 18 days is best-in-class. And that’s exactly the standard that we have set ourselves, and certainly I expect that we will get to over time. So of all the patients that got set on an – benefit investigation, which is the start of that prescription journey, only 13% of patients made it through. So if you imagine the wastage here from the top of the funnel, for every 100 that go in the top of the funnel you’re only getting 13 out at the bottom. And we did have a lot in the top of the funnel in the first half. There’s over 6,400 patients were set off on that journey. Only 1,000 made it through. And you can see that in April, 13% made it through; in May, 31%; and in June, 36%. So a third – over a third of all, the cases closed out in June, the patient actually received the medication. So again, you can see that a lot of work is going on to improve these things. We expect that when we reach a going state, if you get 65% to 70% of patients who are successful, then that is a good benchmark. Even in the retail pharmacy, you only get 85% to 90% yield of all patient attempts. In this specialty pharmacy the benchmarks are sort of in the 60% to 70%, so we would certainly expect set ourselves targets at the upper end of the range of that. So again, we wish it were the case that we didn’t have to make these improvements. But the reality is that you don’t always really know how these things are going to go until you actually dive in and you start doing. We have dived in. We are doing. And as you can see that we are being very analytical, and we are being very agile with the speed and purposefulness with which we are addressing the issues that we identify. Coincidently, by the way, this is exactly what happened 15 years ago. When we started this business, we had very similar issues. We thought this is so compelling there’s so many patients out there who need treatment, they haven’t got access to any treatment at the moment. Surely, when you launch your product, it will accelerate away. And we found that the time it takes doctors to understand and embrace a wholesale shift in how they do their work every day takes a little bit longer than you think. So the two charts I’ve shown you at the moment, we would all hope – you will say, yeah, but you will show us those charts in the next couple of quarters, Shaun. Surely, those charts will get to the going state, and then that will be it. So I certainly hope that that’s the case. I can’t promise you exactly when they will reach the going state, but I can reassure you that we will give it our best efforts. As we move forwards, I think data that will be very helpful is on this slide here. We’ve got 75% prompted awareness, and this is amongst all the physicians who are waivered and qualified to treat opioid dependence. So whilst we could sort of have an intellectual argument about 79%, why not 100%. Nevertheless, clearly, we have made a big impact on this disease space and physicians do know about this technology. We also know that over 1,300 physicians have tried to get at least one patient onto SUBLOCADE, but only 384 have actually succeeded. Again, so we see the desire the issues we’ve talked about of the preceding two slides mean that despite 1,300 doctors trying to get patients on it, only 384 have, so 384 health professionals have experience of administering SUBLOCADE. Of those, only 30 have administered to more than five patients. So we know from all the time that we’ve been doing this that when doctors are trying something new in this disease space, by the time they get to five to six patients, they’re usually over the brow of the hill. And you think, okay, we’re through the initiation phase now. Let’s look to see how those doctors have embraced and adopt the product moving forwards. If we look to the chart on the right, remember, I said we were pleased with the treatment adherence. Well, this is the numbers that stand behind that. And we are looking at our monthly cohorts and following them through. So this is the patients who were injected in March. And you say, well, what about the patients you injected in May and June, so we haven’t had enough time yet to see what happens to their sort of second and third prescription. But we do for March, so we’re sharing with you the March data. 77% of all the patients injected in March came back for their second injection. So this is clearly indicative of satisfaction with the patient. You have to assume that the doctor is pleased as well. Otherwise, he wouldn’t go ahead and administer the second injection. And we are encouraged that these are really good numbers for a chronic relapsing disease. If you then go to the third injection, which are still very positive, you’ll see that 59% of patients injected in March are retained in treatment in months three and come back for their third injection. Of course, we’re going to look at the fourth injection, the fifth injection and see how all this goes. So I think these are not encouraging in terms of the number of doctors and patients who made it through the system, slightly more encouraging of the doctors who’ve actually tried to get patients through the system, but this needs to obviously increase. But we are pleased with the patients and their desire to come back and have another treatment. Hang on. I’m going the wrong way. So let’s just reflect, what are patients and doctors saying? Well, you probably know as well as we do, because I’m sure that you’ve been to conferences and you’ve heard from doctors and you’re looking in the chat rooms, the same as we are. So what are some of the things that patients are saying? Well, first of all, they’re anxious, because we’re asking them to do something different. That is very characteristic of this patient population. They don’t like change. That’s one of the reasons why the film share has been resilient. It’s a very good product, and they don’t want the change. They’re happy with what they’ve got. So SUBLOCADE is a change. It’s something different. They don’t have that daily thing. That doesn’t mean they don’t want SUBLOCADE, but it does mean, I want it, but I’m a little anxious about what’s going to happen with it. So you might pick that up. Clearly, if you ask for something and you don’t get it for two months, you’re going to express your frustration. So I don’t think anyone is surprised to see that. And patients who have had the injection, some of them have said, yeah, the injection was painful. Some say, it went away quickly. Some say, it lasted a little bit longer. We haven’t picked up any evidence that this is a deterrent to people getting the treatment, and it’s certainly what we’re seeing is consistent with what we observed in our Phase 3 studies. But for those who have started treatment, again, it’s only anecdotal, but we are seeing that people are pleased, and they are getting the satisfaction. If we look to healthcare professionals, again, those that have treated appear to be big believers. They’re reporting positive experiences the safety profile, as we spoke before. But again, doctors – some things doctors are saying, well, I’ve got a lot of patients I want to try on this. I’ve already put five or 10 patients into the system, and I haven’t got all those patients back out yet. I’m not going to make more work for myself and go and put another 10 in until I’ve got the first 10 out. So I think it’s understandable that they would say some of those things. Different doctors are embracing the new storage requirements and processes at different rates, and I think all of this is expected when you know. So in terms of next steps, I mean we remain very positive about SUBLOCADE overall. Clearly, there is a huge opioid crisis. Clearly, there is a desire to improve the standards of care from patients and physicians and payors. That’s clearly demonstrated by payors. And at the end of the day they are the ones who have to pay for it. So that’s very positive. We will continue our relentless pursuit to reduce the duration and the efficiency of that prescription journey. And then all of our efforts will be focused on driving those new healthcare professionals and helping support them to get increasing numbers of patients treated on SUBLOCADE. So we remain very confident in the long-term potential for this, and we’ll keep you updated, of course, as we move on our journey. So that’s it for now on SUBLOCADE. I’m very happy to take your questions afterwards, of course. But now, I’ll invite Javier to update us on our legal progress.