Bristol-Myers Squibb Company (NYSE:BMY) Citi’s 17th Annual BioPharma Conference September 8, 2022 8:50 AM ET
Company Participants
Adam Lenkowsky – Head of U.S. Commercialization
Roland Chen – Head of Cardiovascular Development
Tim Powers – Head of Investor Relations
Conference Call Participants
Andrew Baum – Citi
Andrew Baum
Start the Bristol-Myers Squibb session. So delighted to introduce our guests from Bristol-Myers Squibb today. We have Adam Lenkowsky, who’s Head of U.S. Commercialization. We’ve got Roland Chen, who is Head of Cardiovascular Development at Bristol-Myers. We’ve also got Tim Powers in the audience who’s Head of IR.
So thank you all for joining us today.
Adam Lenkowsky
Thanks for having us.
Andrew Baum
My pleasure. So maybe to start with milvexian segue to deucravacitinib and then we’ll ramp up the rest of it in the second half of the conversation. If anyone in the room has a question, then please let be shy, raise a hand, and we’re happy to take your question.
Question-and-Answer Session
Q – Andrew Baum
Okay. So let’s just start with milvexian. The share price had a significant negative impact following your presentation of the data at ESC, where I was at. We obviously have been very active and visible in expressing the size of the market potential as being way above what consensus is anticipating. We felt that the data fell within our expectations. It was pretty clear that the treatment effect was going to be driven by symptomatic stroke rather than MRI detected stroke. That clearly was a cause for concern. I’ll let you address that or not. That’s not my key point.
I guess, the two key points I want to identify; number one, the higher stroke rate in the very highest dose of that trial, which was a 200-milligram dose. And then secondly, I want to talk to the impact of IRA on your Inflation Reduction Act on the shape of your development program?
So on the first one, one hypothesis that we were talking about earlier is given the 200-milligram cohort, the highest dose was only initiated about a year plus after all the other doses and this little thing called COVID happened in the middle of it. Is it possible that the highest stroke rate in that patient group is a function of a hypercoagulable state post-COVID, and then we’ll come back and talk about IRA? Over to you.
Adam Lenkowsky
So thanks, Andrew, for the question. As you mentioned, the 200-milligram dose did start after the whole trial initiated. So we started enrolling the SSP study in the first quarter of 2019 COVID intervened. But when we had a sufficient number of patients, we enrolled the 200 BID group in the mid part of 2021 as there was enough safety accrued at the lower doses. We looked Andrew, at various analyses related to COVID with the data that we have, looking for imbalances within treatment groups and such.
And quite frankly, we have not seen that coded provides an explanation for the observation seen in the 200-milligram BID dose. In fact, if you step back, we’ve looked at a number of different things. We considered mechanistic hypotheses. We really haven’t identified anything that would help explain the observation. We looked at execution of the study nothing there. And we’ve done a number of analyses as well looking at patient demographics, characteristics, groups and such. Nothing that would explain the higher rate in the 200 group, which we consider anomalous.
I would say that in Phase 2 studies often in cardiovascular Phase 2 studies in particular, these studies aren’t sized to provide a high degree of confidence in any single treatment group just because of the size. And so these kinds of results have been seen in other Phase 2 cardiovascular studies. With that said, we’ll continue to keep looking for cats. We just got the data in June. We will continue to look for any potential cause and look at potential hypotheses here.
I think the key takeaway message, though, is that when we look at the data, and as you mentioned, with clinical ischemic stroke, we saw a relative risk reduction of about 30% across three doses. There was a consistency there. And we saw at the 25 BID to 100 BID doses. In fact, we saw a risk reduction in the 25 QD dose as well. That was about 17%. And so, we don’t have to go near the 200-milligram BID dose for Phase 3. It’s just not a dose that we’ll be taking forward. And the data here and the efficacy that we saw at those other doses give us confidence moving into Phase 3.
Andrew Baum
And so on the impact of the Inflation Reduction Act, which allows for the government to negotiate pricing after nine years on the market. So one might imagine that a way to expedite the launch of this drug was to select a very high-risk proof of patients, such as those patients with atrial fibrillation who were eligible for NOACs or DOACs, which is a very, very large group and you could run a short trial as one of your competitors Anthos is doing in order to expedite how quickly you could bring this drug to market, start building physician familiarity and generate revenues.
Given the IRA and the fact the clock starts ticking from when you launch, I’m assuming that, that is now off the agenda, and that’s informing your decision to do this broad head-to-head versus the standard of care. Is that a correct way of reading at least the arterial thrombosis development plan?
Roland Chen
Well, as it relates to IRAs, there are really three components, right? There’s number one, is inflation caps that comes into effect next year. Number two is around Medicare Part D redesign, and third, as you said, is Medicare negotiation or price setting. As we have shared, we’re going to move forward with three indications: SSP, ACS and atrial fibrillation.
IRA, as we think about developing drugs, we will continue to make sure that we’re developing drugs consistent with what we’ve done in the past is to develop products that are either first-in-class, best-in-class and need significant unmet need. And that’s what we believe milvexian will do and the data that we presented just a few weeks ago, I think, strengthens our conviction in that data.
Of course, with IRA, it does make us take a step back from a commercialization standpoint at an R&D standpoint just to ensure that we’re maximizing ROI, and we’ll continue to make sure that we’re allocating our capital to be disciplined with our capital. But we’re going to continue to develop products like milvexian for areas of significant unmet need, which we’re doing in those three areas.
Andrew Baum
And just on the venous side, you had some very nice data in TKR that you presented previously. Venous indications have not been significant because, of course, the treatment duration is finite and limited, because of the risk of bleeding associated with existing therapeutics. Given the premise of milvexian is to materially lower the bleeding that you see with the current therapies why would you stop therapy?
And therefore, if that’s so, then couldn’t these venous indications where chronic therapy may well be optical be a significant opportunity. So I’m thinking not just post-PE, but in the high-risk patients, such as patients with malignancies and thromboprophylaxis, where patients could be on it post first DVT forever until they’re demised potentially because of the hypercoagulstate. So, is that an area that we should expect still to pursue? Do you see the commercial opportunity in a similar way as without wanted to put words in your mouth? A similar way as I’m doing.
Adam Lenkowsky
So maybe I could go ahead and take that, Andrew. We’ve talked about our core Phase 3 indications. That is an ACS, AF and SSP. And as Adam mentioned, these have really been guided by both the mechanism, the promise of the mechanism of milvexian as well as the unmet need. We are looking at other potential indications. I think we’re looking at them.
You’ll hear more about them as our thinking continues to mature there. I think you’ve touched on something that is important with the promise mechanism with — that could provide a lower bleeding rate. I think that’s important with the potential as well to provide comparable efficacy because it allows one to at least entertain the potential positive benefit as one gets longer into therapies where bleeding may have been a prohibitive factor in certain indications before.
And so while our Phase 2 studies were shorter in nature, as Phase 2 studies typically are — it certainly doesn’t portend that there are certain restrictions as we understand the profile and the potential of this mechanism.
Andrew Baum
I was going to segue to what seems to be the main event, which is the pending approval and label and deucravacitinib. So ,I think you’re expecting the label to be issued tomorrow. Could you talk to how you’re — and I’m assuming that you’ve got very high visibility on what the likely label looks at. And so, I understand why you may not want to share that with the content of this room.
But perhaps you could talk to your where you’ve ended up and how that fits with the expectations that you put into the market about peak sales? And if you could remind us of that and just eliminate the potential lupus contribution, which has only become more apparent recently with the Phase 2 data?
Adam Lenkowsky
Yes. So, we are 48 hours away from our PDUFA, which is on Saturday, September 10, and we’re hopeful to receive approval tomorrow. But the true PDUFA date is on Saturday the 10. All of the scenario planning that we talked about over the last 10 months to 12 months is complete. Our teams are launch-ready. We’ve got a very experienced team in the field in medical, commercial access and in the home office. We have hired a team that has extensive dermatology experience, and they’re very excited to launch.
We do believe, as we have shared previously, that deucravacitinib really has the potential to be the standard of care in PSO and best-in-class world with the opportunity to push back the biologics. So, we’re excited to launch that. As it relates to the peak sales, we think that this is a significant opportunity in peak sales, potentially greater than $4 billion NRA as we’ve shared, PSO will be a significant percentage of that.
But we’re also excited about the Phase 2 results that we presented several months ago in lupus in SLE because that’s an area of high unmet need. We’re very pleased with what we saw out of that data. We’re hoping to replicate that in the Phase 3 study, and we could be the first oral product on the market in lupus, which could significantly contribute to that $4 billion.
Andrew Baum
So assuming approval comes through tomorrow, you will then be seeking formal access, but I understand that you’ve missed the window from formulary negotiations, which means that you’re going to have to go straight to Bridge. How quickly do you think you’re going to be able during the course of next year, what percentage of patients do you think you’re going to be able to get off Bridge before you enter contract negotiations for the 2024 formulary?
Roland Chen
So, we’re going to be focused really on three areas: as it relates to the launch. Number one is like you would in any launch is increasing awareness immediately of the product and the value that the product delivers, that superiority versus Otezla. Now the good news is that there already is a high level of awareness and anticipation for the product, but we still need to make sure, particularly in the community that there is awareness unaided of the product.
Number two is our ability to drive demand, and that’s going to be by important like any launch and sourcing business from Otezla. And as you mentioned, number three is securing access. And the access timing is likely to be in January of ’24 because the access decisions for 2023 are really being made prior to the approval.
So getting ready to publish the access or the 2023 formularies as we speak. And so because of that, the majority of patients will be put into our patient support program and into our Bridge Program. And so as we take patients into our Bridge Program, we will be working, of course, to move patients out of Bridge. We’ll be working to remove the new-to-market blocks that will exist with the payers at launch.
And then, of course, we will start immediately with negotiations with payers to secure an open access position come January ’24.
Andrew Baum
In terms of pricing, anything you can say about how you’re considering list pricing relative to the landscape and also with a nod towards the potential development in lupus, where I think the dose is double. How much freedom that gives you in terms of where you put the list price?
Roland Chen
Unfortunately, I’m not going to be able to comment on pricing, but the price will be available and public shortly after the approval.
Andrew Baum
And then just staying with the managed market aspect of deucravacitinib, one observation that we hear frequently from your competitors is, it’s becoming much, much more difficult to get patients off Bridge Programs. So how are you thinking about the timing for that? So we say you’re going to be able to contract negotiations and you’re going to get significant coverage, but then there’s the additional impact of prior authorization step edits that may come with that.
So realistically, how many patients do you think you’re going to be able to get off in 12 months from now once you’ve gone through contract negotiations? And what can we learn from a Zeposia and what percent of your patients currently on Zeposia are still on the Bridge, which is probably what, 1.5 years post launch, maybe a bit more?
Roland Chen
Yes, we launched Zeposia in UC in June of 2021, so a little over a year there. So as it relates to the Bridge Program, a majority of patients for deucravacitinib will be placed on the Bridge. They’ll be placed one through our patient support program and then into our hub and then move into Bridge. We will move patients out as commercially allowable, but the majority of patients will be carried through to — on the Bridge Program.
We’ll be collecting making sure that we’re carrying those patients They’ll be on free drug until we secure access, as I mentioned, likely in 2024. And what we’ve seen with Zeposia is the same. I think we’ve been able to put in UC many patients onto our Bridge. We do have access at CVS for Zeposia. So those patients are able to move into commercial products for those patients who are not CVS don’t have CVS coverage carried on our Bridge.
Andrew Baum
So moving on to mavacamten and maybe bringing Roland back into the conversation, let’s start with the commercial. Could you talk to the rollout and particularly the REMS program and how satisfactory you’re being able to educate cardiologists and a dynamic that is rather new to them? And then separately, Camzyos identifying patient populations in a disease, which is poorly diagnosed?
Roland Chen
Sure. Thanks, Andrew. So we’re very pleased with what with Camzyos. We have talked about really four key areas of focus for Camzyos. Number one, because it is the first product ever to be approved to actually treat the disease, the oHCM. The importance of educating physicians on the benefit risk profile was absolutely essential. Number two was around operational readiness. We’ve talked about our focus in roughly 500 centers in the U.S. that treat oHCM patients. That’s where these patients — the majority of patients reside.
Number three, as I talked about with deucravacitinib or any launches is the importance of driving demand. And number four is around securing access. So I’ll unpack each one of these, if that’s okay.
Number one, around educating physicians on the profile, it’s going very well. The receptivity to Camzyos has been very, very positive. The product is truly living up to what we saw in both EXPLORER and VALOR, I think a great anecdote that we’ve heard just about every single week or, for example, a patient who was on four liters of oxygen for about 10 years.
After four weeks of Camzyos is completely off oxygen, the reliance on oxygen and now returning to activities of daily living. And similar story is that we’re hearing every week, which is really exciting that the product is living up to the expectation.
Number two, you talked about REMS and operational readiness. Now REMS is new for most cardiologists. And so because it’s highly concentrated, we have a very strong support team that supports physicians in these centers. And so, educating physicians, nurses, echo technicians in these centers has been a key area of focus.
And then it took some of the centers a few weeks to get up and running because it’s different for them. But at this point, we now have nearly 2,000 physicians who are REMS certified, and this has been a great indicator for intent to prescribe and prescribing, and as it relates to prescribing in demand, what we have seen is each week, an increase in number of patients and number of HCPs prescribing the product, which is in line with our expectations.
And finally, it’s around access and reimbursement. Going back to the conversation we were just having unlike to deucravacitinib, the timing we launched in early Q2. So, those reviews have been taking place. We have already seen our ability to secure access in a number of plans around the country, particularly the number of key Blue Cross Blue Shield plans around the country.
The formulary decisions have been made and they’re readying to publish those decisions across really the large three PBMs. What we have seen and what we expect is that Camzyos will be approved via prior authorization to label. And that’s what we are seeing now for patients who have been placed on Camzyos, access has not been a significant barrier for those who have been rejected, they generally approved via appeal, but it does takes some time until we have access and reimbursement approved.
And so these patients are also in our hub, in our patient support program. And so they’re going through benefits investigation. And once they’re through the benefits investigation, they then put on free drug. And that is around 35 days at minimum for most patients. And so that’s why you’ll see patients really start to move into commercial product in the back end of the year, as we have described. So sales will increase notably in Q4.
Andrew Baum
Just to pick up on something you said, so they can only get free drug you said after they’ve been through benefits investigation. Is that correct?
Adam Lenkowsky
Typically, it is because you need to understand what their benefits are if they are Medicare patients for example, and they don’t have — they’re not LIS. And they moved into free drug into our patient [assistance] foundation.
Andrew Baum
Fine. And then in terms of the — just thinking about the longer-term reimbursement, the split in coverage between commercial, Medicaid and Medicare?
Roland Chen
It’s really early, but what we have seen thus far patients are coming through our patient support program, and that’s the majority of patients. It seems like it’s skewing closer to 50-50, maybe a little more commercial, but I think that will normalize. And that’s what we have stated. So, 50% commercial, 50% Medicare.
Andrew Baum
Got it. Okay. And then just turning to Roland. Could you just remind us of the line extensions that are being developed for mavacamten. And then we can talk about extending your footprint in specialty cardiology with other targets?
Roland Chen
Yes. So thanks for the question, Andrew. I think as Adam mentioned, we’re very excited, of course, by the data that had come out in EXPLORER and VALOR in patients with the obstructive form of hypertrophic cardiomyopathy. We’re equally excited about studying mavacamten in Phase 3 in the non-obstructive form of HCM. This is a condition that shares many of the characteristics that you see with the obstructive form.
But again, a condition for which there are really great treatments available, really symptomatic therapy, and there’s an unmet need here in certain cases and in certain patients, the only option is cardiac transplant with progression. And so, we’re looking to start a Phase 3 study in the non-obstructive form with mavacamten by the end of the year.
I’d also say that we’re looking to understand the role and the potential of mavacamten in cardiac myosin inhibition in patients with heart failure with preserved ejection fraction. So, we’re conducting a Phase 2 study called the EMBARK study in patients with [indiscernible] [HFpEF] with mavacamten.
I would say stepping back to your other question or your follow-on question, Andrew, is we’re very excited about the portfolio that we have in the cardiovascular space. We’ve talked about milvexian and mavacamten our mid-stage portfolio as well as our discovery assets and programs. We’re looking broadly, I could say this across all of our therapeutic areas in terms of how we continue to think about innovation, how we can augment, how we can supplement what we have in-house.
And so the same is in the cardiovascular area, where we’re looking for medicines that ultimately fundamentally change the course of disease and address unmet needs in a fundamental way.
Andrew Baum
So just picking up on the preserved heart failure indication. I mean you can select a very high-risk group of patients, but even so these are trials that take three, four years to complete. And given mavacamten has been launched and given the IRA and given the patient population is predominantly Medicare. And the final caveat, I would add, is the treatment paradigm first BHR observed is rapidly changing, right?
So even if you demonstrated a positive signal in your Phase 2, what is your desire to then go ahead given all those factors I mentioned?
Roland Chen
So I think with heart failure with preserved ejection fraction, you touched on a number of important points. The field has changed over the last five years with some of the agents and some of the — even the recent data that has come out, for example, at ESC of this year in the past few years. I think there’s still an unmet need in heart failure with preserved ejection fraction.
There is still substantial morbidity and mortality here. I think our focus from the development side, Andrew, is we really want to understand. Can this mechanism provide benefit in this patient population? There’s an unmet need. And I think it’s important, and we think it’s important to try to study patients and try to understand, can we help patients with really what would be considered a complementary mechanism to what we’ve seen that has just recently been disclosed.
Can we help those patients even further? It’s been a historically very difficult area to develop in. And there are a number of reasons why cardiac myosin inhibition could help patients with heart failure with preserved ejection fraction. Might ask, Adam, if he has anything to add with respect to the latter part of your question?
Adam Lenkowsky
It goes back to what I shared earlier. I think the lifeblood of our company has been and will continue to be the ability to discover to develop and commercialize drugs in high areas of unmet need and helping patients with serious disease regardless of IRA. And that’s what we’re going to continue to do.
Andrew Baum
And then staying with the broader EV specialty portfolio, amyloid targeting would seem to be an area which fits very well with the mavacamten framework, the historic legacy with cardiology. How are you thinking about the opportunities from a BD perspective within that segment?
Adam Lenkowsky
I think as you’re alluding to with amyloid, there’s been exciting data that have come out and that continues to come out. But I would step back and say, we are looking at innovation at business development opportunities broadly across CV. I wouldn’t say or limit to any particular area, it really goes back to what Adam said. And with cardiovascular, we’ve had a long history of developing drugs across a number of different aspects within the cardiovascular space.
There’s a lot of innovation out there, different targets, different platforms and things that one have thought of being offering potential, say, 15 or 20 years ago. We’re looking broadly, and we’ll continue to look to see how we can complement what we have in-house in our own discovery efforts as well as our mid delayed portfolio.
Andrew Baum
So then ending up with oncology, I know it’s — we don’t have someone from the oncology division here, but we certainly have a management involve in selling them. So why don’t we start with Reblozyl, which would be hit during COVID because of the infusional nature of the administration. How are you seeing trends improving for that indication? And maybe you could talk about the additional data, which I think is expected next year?
Roland Chen
Yes. So we’re very happy with what we’re seeing with Reblozyl in particular. We have seen an increase in demand for Reblozyl quarter-over-quarter. Outside of the U.S., we’re launching Reblozyl now and getting the imbursement across many of our markets. And so yes, we do expect to see a data readout of the COMMAND study at the back end of this year.
Andrew Baum
And on the cell therapy, which I think is that within your remit?
Roland Chen
It’s not, but happy to answer the question. If not, we have Tim here, who can answer it.
Andrew Baum
So just reprising a conversation we had earlier, part of the feedback for us is oncologists are uncomfortable, even though theoretically, you could administer Breyanzi as an outpatient therapy that they don’t have the necessary infrastructure deal with CRS, when it does occur, it will be at lower rates than some of the peers.
And therefore, they need to administer it in hospital because of the CRS, which begins very rapidly post onset, you haven’t got the 72 hours and therefore, you get readmitted and therefore, you can’t escape from the DRG, which therefore takes away the economic incentive for a hospital to use it compared to some of your peers. So how do you change that? And what’s the dynamic there in order to escape the DRG?
Adam Lenkowsky
Yes. Well, let me just start at a high level and say very pleased with what we’re seeing from a demand standpoint as it relates to CAR-T. And clearly, the demand is outpacing the supply, and that’s an area that we’re significantly focused on and we share supply position in the middle of the year, and we’re working with Breyanzi as you’ve asked to improve our supply position next year. We’ll continue to secure increased vector.
As it relates to Breyanzi in the outpatient, we have heard from a number of large oncology — community oncology groups some of these super practices, there’s a lot of enthusiasm for them to use Breyanzi because of the differentiated safety profile versus the competition. It’s just way to make sure that we’re able to supply have adequate supply for them to do that. So that is our key focus.
But ultimately, we do believe that this product will be used in the outpatient setting as well as in these large centers.
Andrew Baum
And in terms of prophylactic at temporary, you saw something like that — I mean, maybe that’s an unfair question to you. So I’ll let you definitely pass on that. And then on Abecma, J&J’s competitor has a warning on its label for neurologic manifestations of Parkinsonism or Parkinson-like symptoms. And there is on autopsy, there’s been evidence of substantial [indiscernible] impact. That doesn’t appear on your label.
To what extent — and maybe this isn’t a problem of there because there’s just some capacity there. So you take what you can get. But looking longer term, is this something that can be monetized particularly as you go upstream? Or do you believe that J&J will be able to address that through debulking and so on and so forth? How much does that figure in your competitive dynamics?
Adam Lenkowsky
Yes. So we’re very pleased with what we’ve seen with the demand for Abecma. I think what we have clearly seen just over the last year or so is that there’s room for multiple players in this marketplace. You’re right. Physicians are playing back to us concerns of neurotoxicity with J&J’s product. We know that J&J is having some manufacturing challenges. I think one of the obvious statements that we make is that CAR-T manufacturing is challenging. It’s complex. And when you look at all of the players in CAR-T, it’s taken time to build that supply and build that capability.
And that’s what we’re doing, and I’m certain J&J is doing that as well. But the profile that we hear, played back to us from physicians who have used the Abecma are very, very pleased with what they’re seeing. We have heard now earlier lines of treatment. And we’re very enthusiastic as we continue to build our supply for Abecma and for Breyanzi, that we have the opportunity to be leaders in the CAR-T space.
Andrew Baum
So maybe just to end up in the last pipeline, the conversation, given your role in the U.S. commercial, and I’m sure it includes a lot of managed markets, to assess some of the dynamics that you see changing and becoming more problematic. So we obviously be risk from our perspective, but you have greater insight. For example, the intense likely future competition for drugs that fall into catastrophic coverage where there are therapeutic alternatives because the PBMs are now on the hook for 60%. How are PBMs going to react to that in insurance companies when they can’t increase their premium? What does that mean for you? What does it mean for your business development strategy? But there may be other things that you see in terms of the various stakeholders that we may not see so anything you could share would be interesting and useful?
Roland Chen
Yes. I think there are a few areas that we’re seeing dynamics that are changing. Number one, think the access environment is getting more challenging, certainly beyond just the IRA, but just in general, securing access to becoming more and more challenging in the U.S. and certainly ex-U.S. as well with pricing and reimbursement is complex and dynamic.
Number two, I do think that the science is moving very, very quickly. If you think about what some of the assets that we’ve brought forward. These are first-in-class assets, even in the oncology space as well, bringing in new targeted therapies in the market adds complexity to physicians who just, frankly, don’t have time.
And number three, I think the area is around just access to customers. And post-COVID, we have seen that, and so, although access to customers have certainly improved significantly post-COVID in most therapeutic areas, not quite back to the pre-COVID levels. So the importance of leveraging digital capabilities to supplement the personal promotion is essential.
I will say though, I think as an organization, we’re very well positioned in all three of those areas because when — number one, when you think about the access environment, bringing best-in-class, first-in-class products to market, some of which we talked about today, many of which positions us well on the access and reimbursement front.
Just on the overall complexity, we’ve work very closely with whether it’s community positions, whether it’s hospital physicians to ensure that we’re trying to simplify as much as we can, the complex science. We’ve got rate medical teams, commercial teams and new roles in place that will help physicians navigate through potentially complex diseases.
And number three, around building digital capability. It’s something that we’ve been working on now for many, many years, even prior to COVID, that’s helped us. We think we have a nice leadership advantage leveraging digital capabilities for commercial, but also for R&D as well.
Andrew Baum
So two questions. So number one on digital. I think there was a hard tend to play with the death of a salesmen, maybe I’m mistaken the author. But is — does this — the combination of COVID, the transition — accelerated transition to digital Bristol, obviously, because of your portfolio, predominantly relies on a small number of sales force to a limited number of prescribers, but looking more broadly across your industry, do you expect significant aggressive downsizing of field forces as the transition to digital is now ready for prime time?
Roland Chen
Well, I don’t — as you mentioned, I think we are in terms of the size of the markets that we’re in right now, whether it’s in HCM or psoriasis. We have generally relatively small physician populations, for example, in oncology, looking at 10,000 physicians. So it doesn’t require a more significant.
Andrew Baum
Yes, I’m just picking your brains as to the — some of your peers.
Roland Chen
I don’t want to speculate as to some of our peers. Some of our peer companies have already announced large restructuring, as you’re aware. But as it relates to digital capabilities, I do think there’s kind of a race to digital leadership and commercialization, and that’s something that all of our peer companies are looking at as well as looking at how do we maximize efficiencies how do we make sure that we’re more effective in commercializing our products. And that’s what we’re doing as a company and all of our peer companies are doing the same thing.
Andrew Baum
And then again, and this is a broad industry question rather than Bristol part of IRA is the imposition of out-of-pocket caps and one could imagine that you’re going to get greater volumes greater compliance because of that. But still the patient has got to pay a sizable deductible. So realistically, how much do you expect that to impact? And there’s going to be some, but is there a risk, it’s not quite as great as we might anticipate because they’re still that $2,000. There’s still a significant deductible.
Roland Chen
Well, as a company and as an industry, we have been really focusing and we’re hopeful that any pricing reform would help to improve patient out-of-pocket cost patient affordability. As you’re mentioning, I think IRA as it relates to Part D reform has helped that. I don’t think it’s gone as far enough. But we do think that it does — it will improve patient out-of-pocket, particularly in some areas. So yes, as it relates to some therapeutic areas. For example, using Eliquis has a as an example to share, we do think that will help some patients be able to better afford their medication.
Andrew Baum
So I think we’ve reached time, but many thanks to Adam, Roland and audience.
Thank you again.
Roland Chen
Thanks, Andrew.
Adam Lenkowsky
Thanks for the questions.
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