BOT - Anything but charting, page-11090

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Grainofsand

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09/10/24

14:45

Post #: 76046211
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Originally posted by SEPA: ↑

Nothing of note to add, other than to focus on the presentations, with reference to “Expected Sofdra Coverage” charts below. Apologies in advance for any errors / how this appears as it is copied from a word doc.

Left Chart shows 90% Commercial lives are covered (167 mil)
Right Chart shows 94% Commercial lives are covered (266 mil) 100mil government added -vastmajority of these are covered without any type of restriction.
Left Chart 36%PAH sufferers are covered (no restrictions) i.e. no “step edit” requirement.
19% arecovered subject to review – The pharmacy / dr must contact the payer and provide evidence of the diagnosis (PAH) and what the patient has tried out before (“step edit”) eg. Qbrexza
35% are also covered with either prior authorisation (prove PAH diagnosis) or requirement to try OTC medication first. Vast majority more than likely Tier 3, but a small amount may be Tier 4. The Tier 3 PAH sufferers might have a co-pay of $40-60 as per normal. The Tier 4 group may have some % price sharing, however the most extreme cost 50% sharing still works out to around $50 per week. BOT may also have a plan to pay this portion down too (like Qbrexza does).

So looking at 267mil commercial lives, the 10% “not covered” group wont contribute much to sales revenue.
The 36% “no restrictions” group – approx. US $400 per mth (less restrictions - higher payer rebate).
The “subject to review” and “prior auth / step edit” groups group (19% + 35% = 54%) >US $500 (more restrictions by the payer the lower the rebate paid to the payer).
So across all groups there is US $400 - $500 per mth which is what @BuffetsCleaner stated. This takes into consideration the “not covered” and paying down patient co-pays and what they have to pay the payers in rebates as well as other costs.

This appears to be a usual and achievable scenario that occurs across the dermatology and broader pharma industry in the US. Other gels and creams are hideously more expensive than Sofdra eg. Opzelura list price over $2k pmth (US $400mil sales revenue p.a.) currently reimbursed by payers, and sufferers have coupon access to buy down co-pay to zero. https://www.opzelura.com/atopic-dermatitis/cost

The US health care system to be complex and difficult to navigate. I’ve found that sometimes drugs are “not covered” by a payer which means it’s not on any tier, and unless it’s specifically “not covered” – it’s covered, but the question is what are the patient hurdles, co-pay etc. However, this isn’t the same across each plan a payer sells to an employer. It’s not uncommon for payers to have 10’s and sometimes 100’s of plans and depending upon the plan, the very same medication can be on different tiers with different co-pays. I’ve tried to go through the insurance companies and decipher everything but it’s far too complex to produce reliable / consistent data, and their data bases are behind particularly as contracts are currently being signed / in play. Looking at my notes, from what I can see I can’t add much more to this. I’ve said previously BOT are a gun / experienced team and I am happy with what they are all currently doing. I am very excited with what they bring next year - it’s just going to take time! I am looking forward to the next AGM in 3 weeks which will hopefully reveal more about what has transpired re PEP, IHhS Patients (~18,000), any sales update etc. AIMHOO DYOR GLTAH

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Excellent feedback. Thanks @SEPA

BOT Price at posting: 37.0¢ Sentiment: Buy Disclosure: Held
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