"Difficult to understand how the insurance coverage works...."Too right it is. I've spent too many wasted hours researching the US health care system, watching tutorials, going through out-of-date unreliable inconsistent data bases, Sofdra / tiers, co-pays etc. By way of illustration regarding complexity, 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 appear on different tiers with different co-pays.
BOT is my largest position (above TLX) and I have great confidence in being a LTH of BOT. My focus is on the charts where Dr Howie (
responsible for previous multi billion acquisitions incl Pfizer etc.) explains
that most PAH sufferers are covered. The 10% "not covered" group wont contribute greatly to the sales revenue, but the 36% group and 54% group will produce average $400-$500 pmth discussed previously. 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.
From what I can gather the vast majority of PAH sufferers more than likely are 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 currently does). I'd say more will come out regarding these issues at the AGM / coming seminars.
As stated, this (Sofdra cost) 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/costBOT have a gun / experienced team and have 79mil in bank with no debt.
What are we paying management to do? To ensure the art of balancing pricing, payer rebates, and co-pay buy downs to get to a price that doesn't effect uptake and ensures profitability. I'm confident BOT will meet sales targets. It's just going to take time - early to mid next year. AIMHOO DYOR GLTAH
(20min delay)