Shaun Thaxter
Management
Okay. Good morning everybody. And welcome to the Full Year Results for 2018 for Indivior. My name is Shaun Thaxter, I'm the Chief Executive Officer. And I'm looking forward today with my colleagues Mark Crossley, Chief Financial Officer; Javier Rodriguez, Chief Legal Officer; and Christian Heidbreder; Chief Scientific Officer to sharing with you the results from last year. Our plans for this year as we continue to pursue our journey towards our vision to ensure that patients all around the world have unrestricted access to evidence based treatments for the chronic relapsing conditions and the co-occurring disorders of addiction. I will assume that you've read the forward-looking statements and our agenda today is I will give an overview then Mark will give a financial report. We'll have a legal update and then we'll look at some new exciting scientific data and progress that's been made in our R&D and medical function last year. Well, clearly, 2018 was a challenging year with net revenues dropping from the prior year. This is reflecting two key drivers. First of all, the intensity of pressure on our SUBOXONE Film franchise in the U.S. from both the tablet sector which had a very downward effect on pricing and rebasing and from the film sector where we had a pulse of entry of generic product from Dr. Reddy's in the middle of last year. The second impact was obviously the SUBLOCADE got off to a slower than expected start, and I look forward to sharing with you the progress and the momentum that we're building on the SUBLOCADE. It is a tragedy that so many people continue to die from opioid overdose. The opioid epidemic continues to rage in America, but the silver lining for the cloud is that the environment, society's attitude, government legislation, regulation, the whole atmospherics and the environment are starting to shift towards being more supportive of treatment. Treatment is now seen as an important part of addressing the opioid crisis. This means that we saw across last year double-digit growth in the volume of buprenorphine medication-assisted treatment, and we believe that this growth will continue. This is a long-term problem. It is going to require a long-term solution and it means that there's a very important role for Indivior to play in the years ahead. Across last year, we were very disciplined and very prudent with our cash. We managed to pay off almost half of our outstanding debt and we continue to put the other cash into investment behind our growth drivers and into -- onto the balance sheet, ending the year with $924 million of cash. We made great progress in our pipeline line, not only did we start last year with the approval of SUBLOCADE we also had to service approved, we have SUBOXONE tablets in China are approved and that we managed to start to implement new studies that would pioneer the disease space, as R&D shifted its focus from Phase III implementation of regulatory approval into post-marketing studies, life cycle studies that will start to drive forwards our understanding of this disease states and create new science that will pave the way for further market development and further expansion of the number of patients that will be able to treat with SUBLOCADE. And Christian has some exciting data to share with you later in the presentation. We have divested our rights to SUBOXONE tables in China to help us focus on our core growth markets in the U.S. And I also have to share with you that two of our early phase assets in the pipeline were just continued. Early phase assets are always very high risk, low probability of success. It's always very important to know when to quit on those assets and when to look at other assets. And Christian will share more about that later. So where does this leave us for 2019 moving forward? Well, clearly, we have a lot of uncertainty about what will the true impact of generic film be on our business. We are still fighting. We're still asserting our intellectual property rights. We're going to the Supreme Court this week to see if we can continue to push on the potential generic entry, next week. Beyond that, we will continue to fight and assert our intellectual property no matter what happens on Monday. If there is generic entry on Monday, it's very hard for us to actually predict what the erosion curves will look like. We've given you the building blocks and some analogs to help guide you and to how you should think about your model and Mark will talk a little bit more about that later. So, we're not able to provide full your guidance for this year. We are, however, very pleased to share that we are issuing guidance of 50 to 70 million on SUBLOCADE, and that we have done a lot of work on our cost space to make sure that it fit for purpose as we enter a potential phase of generic entry with an OpEx of 440 million to 460 million. So there's two real key themes from 2018, we have to get ready for potential generic entry, we have to make sure that we have the right cost base, the right shape of investments, we had to make some choices, and we have to give priority to those things that will drive the greatest value. So from a growth point of view, we conserved our cash, we put it behind SUBLOCADE, we put it behind PERSERIS in the U.S. markets. In the short term, those are the major growth driving opportunities. The Rest of World does have potential, we have progressed our SUBLOCADE filings in some target markets. But for now, the key strategic financial role of Rest of World is to continue to generate that cash flow and to support the rest of the business as we move forward. I've already said, we've voluntarily paid down our debt, we've reduced our operating expenses and we are ready to launch our authorized generic, if required. So that will be done through our partner Sandoz and we are ready and fully prepared for launch. So I'm very proud to be able to say that we’ve started the diversification of risk within our business. The fact that we have a lot of work to do on SUBLOCADE is not prevent us from also launching PERSERIS. Clearly, the main focus of our efforts and our investment and the weight of supporters that is disproportionately behind SUBLOCADE rather than PERSERIS, but we still have enough investment in PERSERIS to be able to drive the success of that product. So, we now have not only a clear vision and a strong presence in with our addiction sciences, we now also have a behavioral health sciences group. And what this means this is diversification, is additional revenue growth as well as a broader scope for our business development in the future. I'm not sure whether everyone is aware because sometimes you say, well, why -- what's the link between schizophrenia and substance abuse? Well, 50% not quite 50%, almost 50% of all schizophrenic patients are also diagnosed with a substance use disorder. So, if you look holistically at the patient, you actually see that there is a tremendous deal of overlap, not something we can leverage in the short term, but as we move forward and expand our understanding of these two patients and the relationships between those two diseases, an important growth opportunity. Geographically, we know that we are focused in our big priority growth market which is the U.S., but we haven't overlooked the opportunity to continue to expand our geographical global footprint, and as you know, we have sold the rights to our products in China. The idea is to shift the whole commercial enterprise and the risk to the Chinese company. It will take us probably till the end of the year, before that deal is fully executed. And I also want to make you aware that it is subject to a number of closing conditions. So, one of the big closing conditions is which what sort of legal classification will the drug be given. But nevertheless, a good step towards delivering on our vision of treating patients all around the world. So if you think about the near-term, we've got some very innovative technologies. These technologies have very good efficacy, they're clearly differentiated. There are a lot of unmet needs, some of them that are obvious today. So in our U.S. core market, clearly the focus of our efforts at the moment is to establish a growth momentum, obtain penetration, let doctors who are currently in the disease that understand what the new opportunity and the new clinical benefits that come from SUBLOCADE. As we broaden our minds and we start to think about the medium and the long-term however. There are many segments of the market that are not even recognized yet alone developed. Emergency rooms, you talk to any emergency room doctor and they just tired of seeing the same over those patients coming in, over time and time again until one time till a day comes and they don't see them anymore. Very often because they overdosed and died, they didn't make it the hospital this time. Emergency rooms are crying out for something they can give to patients to helping date them with treatment before they leave them from the emergency room. That's a potential opportunity for us in the medium to longer term. Prisoners on release. Prisoners come out of prison and they often go back to their old drug-using ways. They use the same amount of heroin or their drug of misuse as they did before they went into prison, but their tolerance has come down and they overdose and die, another important opportunity. Prisoners in prison, another important opportunity, not something that is possible to access with daily dosing because it's very difficult for the prisons to supervise that daily dosing and cope with the extra cost burden of all those extra staff and processes, they need to run that. But a once monthly injection, that could be a different story. Drug courts, there's a very big trend in the U.S. to start thinking about, do we really want to keep sending as many prison, people to prison? Is there an opportunity for a better way? Is there a technology that we could give, to patients as an alternative to going to prison? So these are not the focus of our efforts today because clearly we are getting on top of and making progress in generating momentum from the current subscriber base and patients in the current market. But as we think longer term, these are all future opportunities. But I think that as we move our mind and we think about the future state, there are a lot of opportunities both for SUBLOCADE and PERSERIS that mean that we have -- we will create a sustainable organization with tremendous growth potential and the intellectual property on these two technologies, is long range IP and we continue to work on strengthening it all the time. So fundamentally, all right, as we think okay, we've had a really intense last 6 to 9 months in our business where naturally you get operationally and you focus on what's in front of us. It's very important, why we do that to recognize that the reason we're doing it is so that we can progress towards the longer term opportunity. We are the leader in addiction treatment. The new science that we're generating has never been generated before. We are pioneering, we are leading, we are visioning and we are creating a future roadmap for the treatment of addiction medicine. I've already spoken to the environment and how supportive that is. And I'm also very proud to say, how well the employees within the organization have managed the last six months. It's been a very challenging environment. Of course, as you get all the news, we've downsized part of our organization and yet the vision and the purpose of the Company continues to inspire our employees to keep driving forward despite the atmospheric noise, but we're behind all that now. Our culture is very strong, the organization is very resilient and everyone is very excited about the future opportunity. So let's think about SUBLOCADE and PERSERIS now as two specific opportunities and to share with you some of the factual data as to why we are pleased with the progress that we are making. Well, I think if you talk to opinion leaders and the wise people who've been doing this most of their careers. They would say, well, look, this is really very simple. What we're trying to do in managing this patient population is, we're trying to help them get off their drug of misuse. We're trying to keep them off their drugs. And then we're trying to create a life for them that is full filled back again with meaning and purpose. When you're tracked in the cycle of addiction, all you think about is your drugs and you just live that every day the short-term reward from taking the drugs. But if we can have meaning and purpose in our lives, we don’t have a greater need for those drugs anymore, and SUBLOCADE provides a tremendous opportunity to help doctors as they leave patients on that journey. It's a once a month treatment. It's the only once a month treatment. It generates very sustained plasma concentrations, it blocks the subjective effects the opioids. So it is a technology, a unique technology, the only technology that offers all of these benefits that will enable the doctor to treat the patient with a product that gives that patient an opportunity to engage with the psychosocial support and the counseling, which is where the real power comes as they start to look for meaning and purpose in their life. The new data you're going to see from Christian starts to suggest that we're getting a clearer idea of how long patients ought to stay in treatment before they can hope to be successful in achieving abstinence. Let's turn our attention now to some of the KPIs, so that you can see the progress that's been made. While we continue to be very positive reports from patients, our access has inched up to 83% and the prescriptions journey timeline is being sustained a 15 to 22 days. So historically, we've shown you the graph of the patient journey line. We're not going to do that anymore, but we will continue to report that we are maintaining our journey timelines in that range. The dispensing yields continue to reflect the hard work that's going into working on the prior authorizations and getting doctors' offices more competent and we're seeing the institutionalization of the practices around the medical benefit. So, we're seeing the yield continue to improve, not yet at our target, but we're making good progress. The health care prescriber base with think good progress in adoption, we're seeing progress in trial, and one of our key focus areas moving forward will be to generate greater rates of physician trials. So just let's look at some of the specific numbers. By the end of the year, we have over 16,000 unique prescriptions initiated. This is a 50% improvement over the numbers we reported in quarter three and with a unique patient injected a 90% improvement. So, we're really starting to see some momentum. We're not seeing the inflection point that would give us a reason to believe that we're on an accelerated trajectory but we're starting to see things move and we're building the momentum. You can see the yield now is above 40%. And when we get to 50%, we will say, okay, we're in the range now of what everyone else is achieved after many years in the market. We're now about 50% threshold, but as I said before, that's our first milestone, we won't rest until we've really optimize the yield as best we can. And that work is through the work I've described to you before with the work on the prior authorizations, the opportunity to move from that medical benefits to pharmacy benefit and we're making encouraging systematic progress with that. We're seeing a 30% increase in the number of healthcare professionals who have initiated prescription journeys, a 60% increase in the number of healthcare professionals that have actually administer SUBLOCADE to patients, and we've more than doubled the number of healthcare professionals that are administered to more than five patients. So this is really encouraging because although we would like to see a faster rate of trial, what it's showing that when the doctors come in and they do trial then they adopt very quickly, which is further reinforcement for the positive anecdotal reports we're getting from patients. The repeat injection data sort of speaks for itself. Well, one of the things we're going to see in the data later is that it's starting to suggest that you get better treatment outcomes, if you stay in treatment for longer. So where as we've seeing in month for the four month, five and month six, we're saying that sort of retention and treatment rates are starting to trail away. When we have new science, there will be a basis to say that, look, an -- successful treatment doesn't mean that you stopped taking your medicine because caregivers and family, they're quite happy for their patients, their sons and daughters and partners to go into treatment. But all too often, they measure the success of treatment as to when you stop taking your medicine because you don't need it anymore. And so there's a whole educational opportunity to do here, but of course, you can only do it on the back of very robust times and we're starting to see that data. So what are our priorities for SUBLOCADE for this year? Clearly, we want to continue with the good work and the momentum we've built with payout access policy. We want to continue to make sure that that dispensing yield moves up towards our target into the 60 to 70 range. We want to improve our commercial effectiveness. As you go through a launch, you get learning that you can incorporate to improve the effectiveness of how you communicate your messaging. We've done that with the salesforce. We have a salesforce meeting next week and there's a refocus on how do we make the story more compelling and simpler to tell the doctors based on what we've learned. We'll continue to expand the health care professional subscriber base, we want more trial, you will probably not be aware that over the last two or three years there's been a huge explosion in individual physicians offices, joining networks, whether it's a hospital network or a community network or a network of other practices that are in their own specialty these because independent distribution networks and often once you sign up to a hospital group. If you want to prescribe a product like SUBLOCADE, you have to get the policy of the group change and to enable you to do this because you're now part of someone else's operating model and you're governed by their rules. There's about 100 of these and we are targeting them, we are making good progress in getting them interested and amending their policies to allow a SUBLOCADE treatment through their network. And this is another barrier that we will break down across the year. As we have a very robust and far reaching network, we will continue to build our investment in patient awareness. So, we know that if the patients go to the doctor and ask for information about SUBLOCADE, that's a very positive thing. You don't want to overdo it before the doctor network is in place, but we are working on this. So we will simplify the treatment journey and continue to attract new doctors. Once we're through this phase, we will then start turning our attention to some of the market development opportunities that we talked earlier looking at emergency rooms and elsewhere. So beyond the obvious there is future opportunity. So let's just have a little think about PERSERIS. We're very pleased with the label that we got on PERSERIS. I think one of the more interesting things about this is that label does not recommend supplemental dosing. So PERSERIS is going to be launch into a highly competitive market, it'll be a nice play a follow in many ways, but still we have unique differentiation that brings real value to the patient. Because if your schizophrenia patient, you don't like taking your medicines, so if you can take a once a month injection, and you don't have to take any supplemental dosing, that is a big deal. If you have schizophrenia patient, it doesn't sound like much to us, but it's really meaningful to them. We get the target dosing on the first day and the plasma levels are sustained throughout the whole month. So I think that this is something that is going to generate a lot of interest with physicians. Our launch is formally starts next week, but we've already had our payer teams out there, we've got access at 38% and we're targeting comparable access with our peers that from a managed care point of view. There's no blocks or reasons that artificially put in the way of PERSERIS, so that whole experience should be very different to the SUBLOCADE experience because, one is pioneering a new market, one is plugging into an already systems. We're going to the doctors who know how to do this, we're going to the doctors who already subscribe long acting technologies and we're focusing on our key attributes. So I think as you can tell we're quite enthusiastic about the year ahead and look forward to it with great enthusiasm. I will hand over now to Mark, who will take you through the financials.