PCRX - Earnings call transcript Q4 2019 | Pacira BioSciences, Inc.

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Operator

Good morning, ladies and gentlemen and welcome to the Q4 2019 Pacira BioSciences Inc. Earnings Conference Call. At this time, all participants are in a listen-only mode. Later, we will conduct the question-and answer session, and instructions will follow at that time. [Operator Instructions] As a reminder, this conference call is being recorded.

to conference like host, to now Ms. would hand over the your I of Relations. Mesco, Investor Susan Head Please go ahead.

Susan Mesco

quarter XXXX Tiffany, Welcome call fourth to you, today's full Thank and conference to good discuss results. financial morning everyone. and year our

Stack, Joining Executive and Financial Officer; are Chief Chief Reinhart, Chairman me Charlie call on Officer. today's Dave and

uncertainties. let judgment you based and that begin, expectations. Such as current involve on today statements call may will we Before our today's me remind represent of and statements include forward-looking risks

information that with please SEC, the For factors refer to website. which from company, risk affect the our concerning could available on our the SEC filings or are

With that, call to I Dave the over Stack. now will turn

Dave Stack

and Thank for us. for Pacira. joining measure, outstanding you, morning By year Susan. everyone thanks XXXX Good every was an

to EXPAREL delivered for delighted are and greater XX% revenues record consecutive six year-over-year report now than growth. of quarters have We

anesthesia to for field as take broaden hold within continues surgical Demand as of the and blocks EXPAREL-based blocks variety procedures. protocol nerve institutional community, a

the relationship of procedures. J&J Our with painful role has protocols of for opioid-sparing the orthopedic cornerstone as EXPAREL solidified

management addition, pain leadership relief. delivers and pain enhanced the acquisition novel our device in immediate long-term non-opioid iovera°, that we cryoanalgesia of In a with

mission advance pain in steadfast Looking forward, in continue management to remains our we our and as regenerative XXXX solutions. non-opioid leadership health

discuss To opportunities. executing global growth cash providing growth our significant flow, mission, will we expect to drive and leverage in all robust our the future across Charlie later As call, of we to financial in operating top pillars. line three substantial growth achieve invest are flexibility

iovera° management. for by growth expanding pain revenue use the EXPAREL robust delivering and of First, opioid-sparing

the pain third, a acquisition regenerative solutions. management targets pipeline to of in neuro pathway. pain And non-opioid innovative advancing Second, and health customer-focused improve patients' pursuing journey

demand and in sales strong I'll the over result all year-over-year of top care. XXXX. XX% we line procedures growth achieved of sites in This a product a across and begin with was start where EXPAREL with

to revenue with in long-term as achieve $X rates than and we teens the clear least efficacy excellent years remain mark approach given for the annual to treated high six at adoption on path for total remains positioned growth in expected market XXXX billion a five is Broad safety accelerating five-year EXPAREL $X.X revenue next With profile. goal established since leadership billion. launch, million well and its more a EXPAREL patients of the

continue to active of the customer in year-over-year and with XX% strong growth a accounts. steady our We see base, increase in size ordering

to customers customers new two-thirds epidurals. segments, orthopedics, such from XX surgical health and every catheters pumps, grow across with new and these cardiothoracic non-hospital of averaging are utilization as abdominal Inpatient thoracic We come replacing roughly and important continues month settings. pain EXPAREL women's

procedures to see in procedures both center the abdominal environment. continue migration also We of EXPAREL-based the to robust orthopedic surgery outpatient and enabling stay and protocols, XX-hour with uptick hospital a ambulatory

XX% of procedures, XX-hour taking spine are fact, no of with are or painful setting, as in In EXPAREL large procedures opioid stay EXPAREL clinicians in place providing management for roughly outside pain arthroplasty environment. inpatient the the knee such hospital low

as blocks and paving the using side same-day multimodal expensive by Here long-acting nerve cornerstone and peripheral strategies a admissions. discharge hospital enable that anesthesiologists effects are unplanned way opioid-related of EXPAREL opioid-sparing avoid

of number to momentum the painful increasing surgeries this expect an transferred are setting. of complex as for We continue out inpatient

change. continue cost drive the to this savings In substantial to addition stay affords to care, and to enhanced evolve patient environment policies patients XX-hour their

surgery payer listing the arthroplasty final these procedures. procedures setting. its hospital CMS procedures effective to driving ASC hip or example, center January arthroplasty are policies for setting. total rule knee in ASC-covered The the from of also to and total spine For and now XXXX removed Private outpatient procedures list X CMS inpatient-only its also six ambulatory are covering added

the ASC setting. there present These commonly in policy a EXPAREL ASC implemented medical is for are hospital authorization another of prior mandating that musculoskeletal setting, opportunity. UnitedHealthcare use surgeries necessity growth outpatient November, unless In are XX and performed the procedures

of Our a as States. further for across that partnership with to with in platform ambulatory our access partnerships, recovery by and enhanced Through we transition network payers, such across health protocols setting EXPAREL. the as and use enabling also surgery critically experience players Aetna have this EXPAREL systems of growing the key are important to United supporting strong are the ensuring care

Services on we through a regional January, to care. high-quality collaboration ultrasound-guided on approaches announce to the of were In country. Physician anesthesiologists pain The series innovation a with with particularly focuses EXPAREL program held patient-centered across pleased Envision train workshops

the is neonatology, training sessions health interscalene allow hospital obstetrics, trauma transverse than Services skills of field abdominis their will clinicians plane as plexus pain enhance as interactive surgery anesthesia, or in with to Physician blocks blocks These ultrasound-guided Envision blocks, brachial various nation XX,XXX management, as such pectoralis more and blocks. well care. urgent medicine, and radiology, across comprised specializing medicine, care providers emergency TAP

include techniques use will EXPAREL and a including the curriculum pain immediate broad of procedures. range relief, for with and volume safe and pain the larger so can across bupivacaine patients management large regional for small saline with individualized for The expansion admixing of procedures be

safety debulking were dose Overall, surgery our partnership for per cancer America programs from other completion the milligrams with at PLAY of adult PLAY years. kilogram. We pharmacokinetic study. growth for EXPAREL We X four successful expect this study identified programs to and recently and our tandem such findings the with safety pediatric for profiles with of coming EXPAREL. key the Phase Cancer a important the consistent clinical reported efforts, our no concerns with patients and of MEDNAX as are Treatment procedures cesarean In in be partnerships, drivers we for Centers advancing

urgent payers all to of importance need New postsurgical XX we a receive are pain and six non-opioid key submit severe for From a anticipated We our designated with review. a in expect this should date indication we action this for supplementary managing review critical stakeholders Application post-submission soon to options strategic for an children, Drug months label on parents, if and doctors months priority pediatrics vulnerable population. standard is perspective, there having post-submission is for PDUFA as

With all management, access very approved children. limit pain the will difficult in the believe to local we opioids for for approved use be only it analgesic for to a long-acting postsurgical pharmacist currently

are Beyond expand working also to label pediatrics, the EXPAREL nerve we to extremity blocks. with lower -- include

are extremity as million procedures year. foot Our report from before significant expect study at the evaluate line adult where undergoing than each STRIDE least would is STRIDE ankle X top Phase in the this is as We underway as extremity bupivacaine EXPAREL versus market, more to to To results X remind year. nerve patients lower surgeries. block end extremity and we of lower a there believe opportunity that you, upper a

we are and anesthesia-driven approaches, of key gynecologic field regional take Another opioid procedures. sparing mastectomy, protocols health, women's breast focus area oncology blocks reconstruction, using section, seeing cesarean where as hold abdominoplasty EXPAREL-based is for institutional

will EXPAREL for a in believe we of standard Here be transforming care the component key women's health.

an women studies XX% opioids Opioid shown women newly are to become likely following surgery. alarming that rate and is addiction more in at persistent have growing users of

five-year this role trajectory. Given in that, our growth expect field play an to important we

while superior XX a line that Phase to an top positive demonstrates opioids maintaining for reported IV was EXPAREL pain and which study, reducing recently block TAP morphine-based opioid-free our score CHOICE spinal hours. anesthesia for results We

a submit journal peer-reviewed expect to We publication later full this for a in study year. results

Anesthesia Perinatology TAP of accelerate awareness related year's EXPAREL around this growth and within anesthesia blocks. presentations. OB efficacy, and the of Society for are drivers we of would expect as we meeting EXPAREL demand our opioid or a to one Obstetric expect that top amounts sections safety a through the of sparing the opioid Cesarean and benefits to have To end, series presence at SOAP and community

of change care providing efforts undergoing This study with million an FUSION J&J a segment an standard our look active Spine is orthopedic progressing is enrollment United an surgeries. in control comparing important our to year On patients in relationship multimodal procedures spine an per Phase EXPAREL the and of with care, can where non-opioid here. front, growth real-world forward management another standard IV is in data the of yet to pain regimen multi-center our estimated further the in example States. X.X addressable we in the market study

Turning to ex-U.S.

the market to the this approval in process expect in our advancing and We of year. application for the continue are review half second authorization EU

regulatory track. has in on underway. Canada now is process validated review also the and Canada Health Our officially remain submission our activities new drug

In China, we Kong and we in Hong study preparing are regulators completed soon a have with Nuance partner next pharmacokinetic with steps. Biotech meet to define to our

for confident highly block infiltration local Looking currently EXPAREL ahead, only positioned and market the team that dose long-acting is non-opioid leadership well field block. FDA-approved for single is analgesic as long-term that plexus Pacira brachial is the

need allows formulation procedures as around evidence bupivacaine, pain utilize range growing for include The as broad next tailored of label across is procedures, and two expand so that flexible for to well saline EXPAREL a can blocks. with to patient's small track we lower regional a within clinical as on ultrasound-guided approaches expansion the years. be There EXPAREL management larger EXPAREL as as nerve are body admixture pediatrics well the that to blocks extremity the large with of

manufacturing product. only complex validation EXPAREL the are specification multivesicular-based for required marketed process sterile and is FDA proprietary of a and Pacira product assays to a requires the Pacira. liposome manufacturer and fill

iovera. now to Turning

in the planning to we it highly expect to be our five-year confident opportunity and behind $XXX horizon. significant million the within in iovera Consequently, net net million sales -- $XXX sales innovative technology continue approach system the We this represents. commercial mark

on our initial two broad As categories. is we focus discussed, patient

for would first surgery with be a combination during surgery setting, The as this EXPAREL opioid-free EXPAREL arthroplasty of administered multimodal knee months plus iovera patients of provide to In procedural procedures. solution before control. pain several iovera a and is total

of EXPAREL multiple integrated seasoned which networks, begun We delivery initiatives training have all are users. at

We these workflow. networks define and protocols are to use planning to

principal and we nationally. out proof As replicate of will roll these data, we generate them programs

drug-free is pain seeking for market osteoarthritis target second patients management several last Our to months. surgery-free opioid-free

an simply the control like family we those of over the or golf, targeting iovera as such as those seeking We for or walking surgery delay surgery. and active hiking to weddings. lifestyle grandchildren, are with surgeons timing well provide choosing With events vacations as can tennis, patients patients

outlined we the for reflect price year, to value are per $XXX increasing last treatment better we this to customers, delivers. $XXX price base As of best technology a with the list our

volume-based great discounts Pacira We customers. offering businesses, other are to this progress device front. many is making with Consistent medical on

are a health We this sticky the build of with business nature robust business we continue new and pipeline by of encouraged systems. large to

of we've manufacturing capacity have to Smart front, the end made of iovera, the and an year. considerable progress expect annual at least this XXX,XXX On by Tips

be during opioid will surgery. after sparing data to pain the as and position clinical opportunity solution before, EXPAREL addition, multimodal In leading maximize and developing and we iovera for this management

development with be clinical focus initial will TKA Our iovera.

There's or year. repair, the We which we for of great PREPARE [ph] using expect calling interest pain areas as of for are a launch this in around this non-opioid need, shoulder, osteoarthritis iovera such the and high of the ankle plantar long-term spasticity management of fasciitis. also fracture to ACL rib across study, number middle unmet marketplace

Acquisitions to as such products strategy mission, allow our our now our pursuing iovera, remain they our component Turning growth innovative that further established as of or infrastructure growth with align leverage us key second P&L. pillar, to technologies. a and

complementary our of opportunities also also focused significant pursuing interest patient we a differentiated are number the improving on today. business neural -- from pathway anesthesia offerings, see portfolio development consider thoughtfully to to non-opioid of team. along are and our have a to that build opportunities surgical are calling opportunity to but a on and robust audiences journeys existing We the We

focus. Sports of regenerative medicine. the area patients as conditions. sports-related injuries with, Sports offers continuous products, already the of rapidly in opportunity growing physician specialist earlier ambulatory centers This of of new are advance strategic journey medicine and field medicine increasing a an also group driven and engaging a also market prospect of by pain of is their incidence is that a with are surgery one the influx This is typical younger site we in well-defined degenerative care. engaged significant

third of non-opioid our chronic global acute discuss pillar, pipeline for and the let's pain. opportunities advancing Finally,

and platform. programs flexibility that of Last for focused new Our DepoFoam leveraging clinical safety were year customizability is we two in-house our the selected team announced development. on DepoFoam proven

chronic next First delivery to subarachnoid and for pain. met we and acute the with the are study. of FDA defining other anesthetic intrathecal this DepoFoam-based We our a program local than steps a discuss recently or clinical bupivacaine for

these using the forward formulations for mimics year currently a dexmedetomidine appraised will we healthy study future pilot product are look you volunteers later of optimizing we release of begin DepoFoam-based DepoDexmedetomidine of to this progress Next, both simulated important programs. keeping and our profile. in a with We that

over to the call like turn who a With Charlie? to Charlie for of will that, review I'd the review -- financials.

Charlie Reinhart

financial through this to Dave, description I'll we results our you, our reconciliation for and by To along be release walk I XXXX. with discussing metrics summarizing XXXX these you, Thank found outlook morning. our be news will morning remind issued then non-GAAP A measures start GAAP in everyone. can good financial morning. and the this of

outstanding bullish so of trends of non-GAAP These another operating investments year-end resulting for in why more revenue million. with modest which supported increase operating business, increases year was future cash in of on also is XXXX accelerating exactly $XXX growth flows by for income. These in track accelerating in support are an our net the we significant expenses results yielding cash XX% growth on XXXX illustrate than profitability. and Pacira

health leadership were net non-opioid for was year. to fourth the million. to regenerative million at positioned solidify solutions. for This million management pain our $XXX.X $XXX.X guided of the XXXX financial EXPAREL million This us well strength quarter range sales the $XXX high-end $XXX and our of product leaves in and

For range and iovera, for line low-end $X.X guided million we with our $XX $X sales million roughly of recorded fourth to $X.X of year. was million. net the million This in the quarter for product of the

Our and XX%. full fourth development for full non-GAAP $XX.X line fourth was $XX year of to XX% and million the expenses Non-GAAP were and in for quarter margin XX% research gross for our for the year. quarter with XX% million guidance year the the

at to call, IV Phase million. range our III increased levels opioid-free As C-section study. pediatric The year discussed R&D spend drivers this on $XX of guided main million in our Phase high-end were spine $XX this last of prior from our of our came our Phase the study IV and study,

costs, To addition U.K. fourth and capacity to $X.X product significant the product line in and included costs. expansion remind of the includes million scale including clinical XXXX, of in manufacturing expenses, and In capacity manufacturing of also $X.X million costs clinical R&D development R&D you, quarter traditional of and up regulatory costs total the development expansion our

included of capacity R&D development year, million manufacturing product clinical full of expansion the $XX.X and costs. For million $XX.X costs and

promotion on million just general $XXX.X related and directly million. $XX.X selling, guided fourth for quarter and for and administrative for non-GAAP the was $XXX year. to our $XXX The million Our were range below the drivers million activities over as expenses the of are This were additional XXXX EXPAREL growth well levels agreement markets spend selling increased SG&A and linked J&J to that commissions our outpatient in focused to ASC as sales. main

diluted quarter net or income $X.XX per non-GAAP the share million $XX.X for Our was diluted year. million the full fourth and $X.XX for $XX.X or share per

our now XXXX. Turning financial to expectations for

guiding midpoint revenues, year-over-year growth total to $XXX of of range rate million we million For a are representing a $XXX XX%. to

signs growth. off a another For year with point rates. in to as already of top robust all to just EXPAREL, great Dave year-over-year line the growth significant outlined, XXXX highly is start market successful And

$XXX view to of of product net a represents EXPAREL which year-over-year conservative rate as a sales. This point. We midpoint starting range XX%, $XXX million guidance are beginning growth we with for year a the million

early the with for that would I anesthesia-driven is growth The undefined, the more trajectory migration of key updates directly are procedure and days It and accounts. of progresses enabling sales growth of drivers will market's these are EXPAREL-based the provide as seasonality shift so the a protocols to by also as and visibility. number year the we of you somewhat to have regional XX-hour techniques stay we drivers driven remind timing environment. still such EXPAREL

due the quarter, procedures. the and of first elective to quarter timing orthopedic the typically largely the the fourth With lightest strongest,

seasonality in As to to to demand grow moderate. would expect begin this space, tissue we soft the continues

net component a are royalties liposomal $XX million third-party iovera, of via and For health sales. The million in million animal $X guiding to approximately XXXX range in $XX we product is to attributable agreement. remaining of our for the bupivacaine revenue to market license sales product

XX% Swindon. and second from suite the a to margins gross as be in our be to benefit will milestone comes will and key excuse our The capacity. at double XX% XXXX current next XX-liter increasing online, begin volumes XXX-liter me when we non-GAAP which expect between We XX% -- unit suite

XX-plus commercial start thereafter. expect begin to suite margins We gross in with in this percent to making improve XXXX product in and XXXX

and expect remaining R&D related in regulatory $XX science R&D million. to XXXX with is be This and XX% consistent includes we For medical costs. expense range million non-GAAP manufacturing XX% expense, approximately of $XX development The activities. expansion to the product for to and for capacity is and clinical

$XXX range. SG&A, non-GAAP are consistent XXXX $XXX also For with which to we is a of guidance to guiding range million our million

we of and business are bottom growing line, a a have remainder our and the steadily in excited top invest our outlook. we financial while XXXX the top to expenses, very appropriately With and margins beyond, ramping operating rapidly ahead simultaneously improving tremendous to Looking about opportunity managed lines.

prepared to call the our the concludes remarks. That to turn begin Q&A session. I'd now Operator? our over like to operator

Operator

Instructions] from Randall Markets. line RBC of Stanicky Capital with first the question [Operator Your comes

Randall Stanicky

Dave, that guys. you you're how the that you the through drivers lead follow-up that come as one, some revisit two thinking would talk to just And can EXPAREL has which about guidance trends. learned the you early about for provided? XXXX the Thanks upside Great. again. then I in And confirm night of talk also And that throughout seen no year competition delayed in last slowdown growth been you've Charlie. have we a could

Dave Stack

today. the that of -- a XX% XX-year in XXXX. procedures Randall. know or the States Sure. XX% we really only Thanks of in And approach as United to as growth are out anesthesia gate on a what is the you -- It's XX% come regional done is

use MEDNAX Treatment -- understand America make to teaching sure anesthesia the and is these the to how key excitement they and regional Cancer approaches EXPAREL. that and Centers around of community real and how Envision these so And real the

So, keep -- were an because local why plexus hospital they happens blocks, brachial move available painful them then block, them opioids, have is the it that valuable excitement the they door to that a up require for thoracic very before really long-acting that to kept They and able thinking to that have here field pain EXPAREL patients the not provides a do in community large to they these a opportunities we're in we or in don't that those anesthetic. what much used procedures generally opens a that in the anesthesia really to move it's not environment. something them had they use see to or reason to being epidural had stay to Things a the outside. XX-hour them environment they pump had ambulatory from patients

site basis it's XX%. of the business, programs opioids that times patients a twofold profile the really, of different they anesthesia care allows our reduced regional -- payers the where to impair improved XX% So, and we've several said drive say an of Randall, between profile care as is driving to the and

fellowship reason only those training XX% opportunity all it's with programs on the I use a an appropriate now, not being The XX% not the of but XXXX, that's to on ultrasound for the folks that matter the procedures but with of involved of of the use is medical with answer EXPAREL, programs. and first only

fundamental that And plan. piece of five-year the as a we so see

very trends the If being of the site another look these able comes at still then move to we're early the what care, and to you of in patients patients. from payers migration

to right? the bus basis, the the to On is an driving annual the then the as ambulatory to is more migration move here, they procedures environment CMS and and moving pathway plan that environment more them HOPD are almost. see You

and of of an to we've knee to make a had hernias critical day from for low-margin right, real to like procedures painful it surgeries a perspective where profitable in and centers. very the same and moving do spine And ASC, large are now actually highly hysterectomies financial moved goal these that, surgeries that lot things procedures from a is a they for issue

of hospital care the the environment acceleration least setting. patients not out for growing so hospital at driving the of is And but a the equal reasons, quality payers is where the cost a to only ambulatory

there, to payers And want so docs to want to patients there; the the there. go the them want go practice

a really it's So, perfect storm.

XXXX So, those beyond. sustain then us only not two going things for are and to

we're expect of -- our now. the that of first mean waiting we C-section out the short-term happen I the that from that outside to -- in for opportunity you see A&A things you expect any day spike paper well to an know come would and first all, to

C-section Those of units -- we've use EXPAREL. on trained over XXX hospital and the neonatology

journal going as those comes will mode. activities that As soon into that out, execution trigger

very a driver. that's short-term So,

outlined the script attend desire labs that The these is we innovation in to intense.

see to how training so And reaction. We use the hospital program you these immediate to response very and an labs, you innovation see can learn can run these is guys short-term. that

those go as we the you'll these So, perform continue see labs. around country to and

we're improve place Tampa. effectively I call can and the ways half patient out airport a having them building get because will to different education train we're say give hospital. it regional and we would in about and folks where We're of training in us Tampa of also center the anesthesia this a very here care from to on use another all mile these

that what on and I'll stop far. So, that of hope that about we're talking covers both I Randall so point

question had You Charlie? a for

Randall Stanicky

to that the change in we EXPAREL? say Charlie, it seen fair with to before near-term no No, you've is move Yes. trend growth

Dave Stack

and around it's make Yes. my right? room sure. Guidance funny the stuff lawyers So, here all relative. looking to is a thing, I'm at

So, up to I'll beat going I'm later. say yes and get

Charlie Reinhart

to pleasing happy. early We're us. been XXXX results Randall have

Randall Stanicky

directional And operating operating helpful. over that to And story three go margins specific years? is the maybe the about containing of margin Where a that's that? or hasn't it OpEx Charlie, big looks or can next gotten like leverage give Can of part lot you're us color. a you Okay, opportunity. then talk spend. And the attention

Charlie Reinhart

of we're keep we mid-XXs up not so as From get have high going into a going OpEx and obviously, to margins the XX% range, perspective, as an operating increases. revenues is think that -- lot or don't margin that

we'll reallocate perspective, spending start and the grow and we're down do as R&D an we marketing to that wind sales we wind was going ioveraº, from a things. on probably we Dave describing what spending those to perspective pipeline up EXPAREL, from think on I but DepoFoam

But we see that total don't changing much. that budget

we in story planning point XX%-plus the margin is a huge could think out as that over really the range So, exciting five-year that process. -- into the you operating there and hugely be

Randall Stanicky

great. Okay, guys. that's Thanks

Dave Stack

Thanks Randall.

Operator

next question David the line Your comes from with Amsellem of Piper Jaffrey.

David Amsellem

Thanks.

have questions. couple a Just of

Dave, of coming the First, given relationship thoughts That's in I get the remarks your growth where that structure alluded the future wanted EXPAREL and specifically on of number to early is your relationship the you economic relationship J&J latest and to of how from you're feeling about primarily? one. that

that then ultimately around number of us metrics EXPAREL you give can the And as is some two versus a in for portion volumes that talk if to block used terms the can? of infiltration? being you mix are Just

on that any ioveraº, opportunities? that million And Thanks. target, then $XXX lastly include does of osteoarthritis the

Dave Stack

an as Yes. And the a driving provides our on a focus our for really Thank the to us. of I community your business. are on for J&J to it very mean and block have question. point, just the answer the in all things that important get high you, remains opportunity I'll partner strategic increased that folks David. anesthesia

out of my indication one about thank you spine the still which importance we outpatient J&J sports for is head. script Susan. during went The right scoliosis, of the the of -- just still pediatric the own owns J&J the procedures. procedure owns strategic medicine that. growing fastest spine, and They and pediatric talked

Sorry guys.

marketplace. the scoliosis owns J&J

medicine on in with through as ASC of by working orthopedic keeping assuming that orthopedic folks addition relationship the to have the that through end and so spine other with every we sports way procedures the TKAs And will and of moving and at intention are the environment, they in place well the outpatient folks conclusion or XXXX. the we

that next We're never. preparing an right the on how like annual that. to own growth both on all after that's basis going just say We'll our seeing here. of to the couple Never this contributing now But David evolves are materially see -- parties years. be you're we're over

So it still our favor. in works

vast is The blocks David, thing annual versus think blocks. that growth say probably majority the our infiltration I the easiest is an on of basis to

and probably I fairly will infiltration that there always was still think is it apparent. be business there. The

for that of pediatric of example, the For the are there's most simply just and product indications infiltration. that block procedures because are can't There would without studied way the just having use can of you that pain the to you to about. a control the nerve and about to blockade clinicians motor some other get that worry appropriate provide things have no worry

ped. So the itself which example nerve probably pediatric what is best going discussions on having peds block figure we're figure you out to you can't have but FDA I block, -- a one mean difficult you're the want with to a do, very out it's to we in where right nerve

or the are apparent All an a of of for ulnar we maybe femur things we what I other study. than bunions children. open the to exactly just not with Very compound fracture out don't in a normal that do situation would the have we're mean, to in an ped adult in hemorrhoids. from much figure peripheral the we're so we one trying and nerve going either perspective were

would an and driving I of infiltration. practice that then medicine in a block many to folks And both the cases is say lastly use

when so And run double start the out too you risk of you to specifically right? counting this parse

both adductor and if use see them periarticular a block block was nerve nerve Reed, then block off-label. And a one injection what for Walter do infiltration. went vial nerve would for of example, So, EXPAREL left, an you with you but an to a use would they

going difficult year be So block. is it makes would to very associated say of XX/XX. that tell growth with it anticipated I you it's to this that the nerve a XX% plus

one move point of here use make the other way got do -- is knowledge when -- only under you ultrasound block of but not that training up. just when all they and can as I'll confidence an over And effective to The guidance, David, we've I goes an anesthesiologist ioveraº. that procedure you point their our neuroanatomy, before that

done relevant mine surgery to by in so So this going very an tomorrow I'm is a and knee do ambulatory you're me. have to center to if the way, going

pain You going done going And nerve that have to know whatever be them block control to again. patient that see going of for you've for a to be hours. you're the there to couple is is because effective not

can't And in night. they all rise so pain,

that when an a QA substantially ultrasound without guided And so about. of things does is ultrasound know our that and better infiltration when the procedure is doing all anesthesiologist guidance on surgeon nerve the than block, of other the an anesthesiologists an

ASC. outpatient from So it's nerve to hard driving Those things growth. block disconnect two are both

to defining tell the still actually than big We've put you more cases. market is. a I that over a for muffler and place had are the hope exactly from around about all so customers being positive keep osteoarthritis control the the is actually we because several would to we're from marketplace the without early surgical pain how sales to their some intervention. little able force excited doctors ioveraº, the opioids -- in response running are For months them would without

hospitals And piece expect likely growth next three ioveraº will materially we starting and next and or from last soft with years. The the relative that the you we our of coming see of this ramp the year osteoarthritis year's so two few up of are launch that meeting national that years. out substantially will revenue over a is over majority

David Amsellem

Thanks. Okay.

Dave Stack

Thanks, David.

Operator

next David question of line the Your comes Jefferies. with from Steinberg

David Steinberg

approved rollout a EXPAREL wondering on Yeah. was for I us the C-sections already for if you know is Thanks. color using give indication. could nerve some C-sections. I block that more as

you the it are sort generated are C-section? will revenues you IV this it the usage? de that going it's the of key drive going drive have timing actually paper Is if in key And Phase of, what, are such to be factors indicated completion that minimis, studies? to what factors and As

hospitals to situations might And delaying to competitive of off some where then point? a a you've purchase or the a companies want as against that any two there get are secondly, play seen other price EXPAREL each lower and wait groups purchasing be for product they

say groups so if do that launch know they they but lines, effect And Heron making the is EXPAREL. to lower-priced the than approved approved, they and if come point get And there's of, in do something when formulary, product the same purchasing product. then a price I or along their going they're lower a is you're they news on some at some when to get

You to lower What point. your would Thanks. with with us a play coming ball price response? need be

Dave Stack

David. Thanks,

anesthesia that trained is two to we that analgesia. the C-sections on of day been already regional relationship anesthesia gated order C-section the has relationship from are on providers referred pieces the any the MEDNAX for where and we've the of paper health expect approaches. first care X,XXX First, by to Again -- that and we out OB of in come rollout something

So there's for sessions are forward training because and been product blocks. using who some they've the because always thinkers to plane it's approved

And so indication. on-label it's an

the in a of expect will come in opioids showed patients directed majority in expect in future would to that paper very response the and one benefits the that and that growth the reduction -- that's of XX% opioids took a we majority to stage that one the We days weeks. shows of opioids. that as These be term the the vast to and reduced first vast of or fewer near so sort

CHOICE as data. will piece second be the The

in time pain patients at very least a where of can for effects is a dose side the plus arm control was indeed compared any the a and in CHOICE stay a EXPAREL The to we time. it EXPAREL spinal opportunity or C-section third of of showed improve stay an initiative. equal have the low opioids. that shorter without opioids can and that opioid-free or do an for shorter program period TAP With a hospital the opioid-free of the hospital to you So have morphine-based where period of you

SOAP meeting in is The May.

publication later of that and year. the have come out in presentations abstracts expect there. series will then sometime to And a We

as acceleration see with all an too. those we doing So, I we're is everything out Envision point points. of part relationship of integral the would C-section also that

a also training them. So that component Envision with or OB an going C-section in through very interested anesthesia is to programs the having we're

be we as that's the in able XX,XXX healthcare it providers also So, go but to extend are to accelerators wouldn't train there year, of number We through is going something beyond XXXX. a all XXXX. critical

that's C-section So, data. sort the of

profile will you product a to when such a than of the all for I product, experience is very programs, -- marketplace, experience. all believe train that's more product on the piece, hospital stock the also be and I On safety ERAS that of the the the and the clear a these huge got of the the anesthesiologists the one in label safety have competitive all the product with protocols opportunity years for of it different differentiation difficult vastly a all of think don't drug

folks almost there's the hoping tension pricing marketplace we have we that pharmacists? that in do. they're do us tell some Of course, always So,

going going a Our have frankly has safety have is, it's box. black why answer you're to that's some to that issues, product a that to

considerations We any have equal of a of don't anywhere EXPAREL. product a the is we of near pricing that result no think having as intentions

So, ongoing from all I basis, on for all. EXPAREL got any implications David. a I perspective expect an That’s pricing at don't

David Steinberg

you. Thank Okay.

Dave Stack

Thanks.

Operator

Greg next Your Fraser comes with the from SunTrust. question of line

Greg Fraser

Thanks folks. question. for morning taking the Good

to of of can that use, now market terms the EXPAREL providers then, they number EXPAREL you. risk you number is you C-section at And In that or terms care EXPAREL. in on mentioned others? of more the you used account eat the proportion use think context competition the procedures XXX or put C-sections in settings Thank on of to of trained Can of a you've that than are extent the they the could where for? what U.S. into be represent health that

Dave Stack

around in data groups trained I'll you many There well, all people how source do. tells that the is comes C-sections a -- been moment the country When anesthesia different no many you time they're exactly -- It's when maybe broad in way. for. to each start the of it how very have one Yes. answer question

from of extrapolate data some and hospitals, but them using extrapolating it's into can median different a You sets it sort.

So, it gets little a bit sloppy.

pretty We're than in the we've States. already XX% the who trained do would of that United more comfortable C-sections anesthesiologists OB

the in we the roughly that CRNAs of as of roughly expect of XXX,XXX those anesthesia If you have there's we a of would folks the at providers end would group, largest of look and be folks who those XX% XXXX, anesthesia all the folks. treated United would By States.

we together have only have. a would data treated the be million would XXX,XXX the have of raw makes as sense? in number just expect were million would if in Does or you you use we then C-sections the C-sections and that to on the X.X piece there United It's X.X or So, then but them we've we sort approach, trained involved that opportunity that said regional you half we approaches, that States that of exit XXXX. it's

Greg Fraser

makes sense. that Yes

Dave Stack

about yes neurotoxicity that you've a product to dilute, And then can't have that issues I number a I I issues different mean, -- address. and got pre-bupivacaine. and some mean to think they're you small of significant volume NSAIDs and you -- add can't going they

I think -- far it's bunions. it actually as for that's as concerned. we're good I end don't drug quite of think about I a the

Greg Fraser

Okay. Thanks color. the for

Dave Stack

Thanks, Greg.

Operator

question of comes with Your next the Wedbush Liana Securities. from line Moussatos

Liana Moussatos

Charlie, Congratulations great this manufacturing year. sales veterinary an and on costs us you for any pediatrics for then be guidance a think for quarter, on what you give year? applications? great Can idea peak expansion of could And

Dave Stack

question. Let me sure I make got the

peds vet, about and asking You're Liana?

Liana Moussatos

Yes. Yes.

Dave Stack

Okay.

a let background least. at of well, So, so you little give bit me

it's it's because to it peds. marketplace taking opioids the FDA in mad long. there's I've -- get approval me had so understand get first other the an enthusiasm what's The they so So, I for something. frankly for at can't people mean long ever time than nothing takes approved just

we cardiac procedures. ourselves, that work the something we've in look surgery. we X.X business When and have done Remember, at million the scoliosis like

they the a milligram lower to picked of peak of might And because and at but EXPAREL vial opioids we of roughly of it, share top difficulty the over So per the and each where and the -- crass than off dosing. market of get project we those pain would full value and but we've kilogram not over about a patients XX% patients be use very less again.

And that at and we a million peak. patient get you so through at put $XXX $XXX roughly

for fact, million roughly In of $XXX all these peak. in get you procedures,

we consistent vet side, than Liana. to anything see manufacturing the do On growth, but you with it don't other have

get purchased be you other it -- outside that but know or it organization try it in some fact in Elanco. quantify the hands than by We they for would now U.S. we around The a bigger much be It was royalty. it sold me named any that, growth NOCITA modest thinking that's to is to I a to but the company NOCITA. tell the way -- about etcetera. inappropriate of that Aratana relatively Elanco would called it's specific we been has an that's So, product very NOCITA. EXPAREL thoughts

Liana Moussatos

For a pediatrics about vial in future? volume are thinking the smaller you

Dave Stack

XX lower in ml emblematic surgery why. ml XX you start is not. One Probably and volume. learned tell we've here. the the usually from the I'll be thing, would people Oral/maxillofacial And with spades that

take out they So XX batch they short would a ml a start for of dose, X, in doses their so patients X with vial but ml time very a cost ml reasons. would that would they XX

this difference And of there's X in so vial. XX business of a the that or ml cost very aspect little manufacturing ml is a the

price materially different. to And it's never half. hard the very make so be It's going to approaching

be for four within small okay they would that's is and purchase in in to package almost the of marketplace immediately facility, go our that, insert larger so the somebody the the volume a anticipation might it SKU it And and divide expensive first but hours. less

the go and So likely in they as they're them all through morning day. batch then much pull the to doses the patients more the and use

the years it's takes of a just end So line $X -- $X million to worth to cost it Liana is it new not It's and million of validate at years it. the day. X the X

doubt that I form. dosage a smaller So we'll have

it syringe. now right syringe prefilled some we Diego pipeline out very or in for our syringe looking could need San a are But of at ml easily product. building a X not X a we the prefilled a stuff. for we it, If prefilled go line that out that's turns new another out facility anticipated. We're to Now in

Liana Moussatos

it. expansion year? costs And this any Got then on guidance manufacturing for Charlie

Charlie Reinhart

down a from you and a that fluctuate anticipating. can the under but the But imagine up in at bit what bit actual little total, and point. XXXX, is little that's a as it's numbers numbers Yes we're those And on year-to-year $XX what development those thinking we're can go I'll this of acknowledge as research projects. million based

Liana Moussatos

Thank much. you very

Dave Stack

Liana. Thanks

Operator

Schott with Your line from the JPMorgan. next question Chris comes of

Chris Schott

Great, thanks very much.

Just couple of ones here. quick a

range we you the over about the look thinking think be dev company about saw to in expecting the of transactions? should you cash in acquisitions you're iovera? few when what generation with years Firstly size larger the flow of allow we does next biz deals Or at

quickly up a think pretty you I cash that's going about thinking And guess that to time? deals, smaller if simply do deploying about so build we're over to how that follow-up more flow

Dave Stack

all Yes. it's here. Thanks Chris. I'm yesterday the laughing day conversation of because topic

-- I think there's that. two we to So aspects

would we on to are do time the for as deals. goes I the at anything we the opportunity and levobupivacaine. think larger don't size think be approached what opportunity that have still deals and subarachnoid considered we looking given the larger We of EXPAREL is opportunity transformative

at than for larger would But years sure. opportunities looking are two ago we have we

now of at think profile, we into view to a of a cash ago deal because that just transactions. couple I not of the other aspect have is do it a because opportunity have looked as could have absolutely we come risk the years well

really play from would be opportunity our might a that benefit now. development in years been and commercial have that a open-minded that might of that more expertise about might some out development of couple big are things bounds actually clinical in We ago be

we're things. those looking of So all at

a your the and BD are the appropriate in to got We've combination team Ron answer your and are and question look got in of them most like to here lot Maybe medicine question question space of is, over the both keenly of pain way Randall's space. active. time? cash regenerative me opportunities. his we've very aware of a the We starts what for

other X-year got too start money. of get our we to in let much not have going to we've to we are consider the terms side what high enough is cash pile so to plan in that because that plan pressure And from do the

Charlie Reinhart

to point has that been our due current And from that. that $XXX that's Chris we cash choose principal have to April convert have at that recall at perspective least we to this pay will off and position amounting if do in we XXXX a a of million

Dave Stack

We'll for I We hope think transactions Chris, least. you're going this to year see sure. a transactions. of couple see a of at couple

Chris Schott

just quick one last And helpful. me. very Okay for a

right think about business overall? outpatient. I think of we a ASCs comes about if sorry in of lot terms I of mix from missed business this, now business you But your what percent the As talked EXPAREL but the

Dave Stack

we The way really Yes. is good only in there data get and out.

an you So treated inpatient as treated was was an tell we and can who as who outpatient.

As our XX%. we have is this about call, inpatient business

office their includes Our bit and messy. in little a ASC and oral/maxillofacial gets that and and HOPD plastic so outpatient business surgeons their again surgeons in office, it

is I need lot certificate where there had opportunities. modest a ambulatory The still where of places mean a looking share home market a states in basically. a is full of for part single for in The ASC in HOPD aren't digits. is lot of big reasons of extension ambulatory haven't we that to care

insurance carriers we we in driver is another So ambulatory the forward that are call. go insisting who care referenced on growth as this

continue by an expect be that XXXX, procedures the in we done of so we -- ASC setting. will in still XX% America And

that a X And that fall our year within will afford patients TAM. about million

we company So trend expect and outpatient-levered it's Chris, to we question, answer but continue a not to are a perfect already an lot. that your

where has anesthesiologists not touch possible tools definition, And like to in lay because number a final on would that it's days doing a folks belly their to the two setting that's epidural is ambulatory especially obvious just to an for the use of in put just that, thoracic by environment. the on not patient always an inpatient

the we that migration So the transition opportunity patients see enhanced. that we greatly moving not are but or enable EXPAREL see have to out only

a it's going why forward. our of program part that's So big such

Chris Schott

much. Thanks so

Dave Stack

Thanks Chris.

Operator

Your Serge Needham with & question the next comes Belanger Company. of from line

Serge Belanger

good Hi morning.

prior on follow-up to Just the question.

driver? number I as that you what past do growth EXPAREL would guess hospital. of to XXXX? outside you setting outpatient use about I think to Where in was then in unbundling And the the mean that XX% the a hospital is in a follow-up said expect be

Dave Stack

the payment of setting. CMS I ASC we setting Well, of unbundled mean outside the is are today. a payment there for hospital EXPAREL -- outside a the hospital and

Most are XX% milligram. to the And XX% paying payers to a that. is than of $X.XX have we CMS more that. commercial paying So answer the

For talking assume. I we're -- about EXPAREL

see question. so go well back -- your to And to first let continue me you

in we whether So only care. in the the and stick call the If depending probably it XX% to on country we range, access by grow going to now outside again. a said year on it's that's as in they of setting our X%, traditionally have X%, postsurgical the hospital. actually hospital are part And XX% to ambulatory have would you're pain treated of which that the continue XX% to been patients

high it's in very the ASCs. can that that hospital on neighborhood of combination different and five X% hospital that you parts And of But the by years next grows So remember in add outpatient basis. something the certain an over a annual And a in of parts the high have ASC country of you very the environment. of outpatient an you country a in percentage will have department. will percentage of in that

treated the here big the real this interest and especially, to of environment. is payers, payers And the I of cost the in ambulatory care acceptance the patients an think be because are driving transition that of

the or you So things. asking number that data give it it's can a to in again perfect of you provide you're different doesn't But for -- way together just XX%. exist a a that just reference. piecing I today not It's it's a

be over planning period think XX%. going this to I it's

or States that more the have Campbell the that was would the would There where one be can they surgeries United And patients would reference. with expected you environment. either referenced XXXX Clinic medically that inpatient I five paper And XX% in or we be way. mean by a of And they they in by I those done by the give an agree written indigent comorbidities.

picture you the So pretty as here. get world from going where a to is clear that

Serge Belanger

the then ex-U.S. And Okay. on strategy. just

With just about there? the later you just the dynamics? year commercial -- your plans maybe talk And how this can market European expectations approval of a plan you

Dave Stack

Sure.

activities of ground find We're regional of now. kinds there the education got -- it well and does companies like people to do to anybody training don't companies a on and that in the device you what things They're We've just other don't places more go the we're with and largely we do So Europe. we of ourselves the staff of going that right? for all EXPAREL. training need or those small less team because We're drug train ourselves physical can't day-to-day terms the education and the home EXPAREL. do And in in nursing in OR.

so be that group that I is in alongside Europe you the to our ioveraº would we expect a start. place have regulatory going making we tell in we're and today to approved markets. key And process engaged sure

intend launch Pan-European We have -- we a don't on to basis.

will launch and we a appropriate an United been of that's we that with pricing for opioid-sparing established there's that's countries six the or the States. alternative get can five for a have need strata pricing profile a We definition where in

with -- the KOLs of And countries people. working plan current most lot we would United we those or and six a by these of reps hire dozen couple in about and liaisons. five focus will a and a would the are learned It States. to coming on EXPAREL of We there hire mix science the we already KOLs be medical have

Europe. well we're downstream being in work so and And do of to clinical ready in launch some terms

example, At but Canada we've got with exposure a similar community. the folks of Canada, at ASA interaction we In situation, the to even meetings, EXPAREL. more from a have very anesthesia for from the anesthesia lot

that place we than we would did in expect there And can a different launch here. so you

procedures. best up all for different hundreds a We issues won't kinds of of go the practice through of with with to trying technique different associated surgical come

using than with will process the approval spectrum the the the and anesthesia high We the that's that on work Hopefully work. will doing And go. blocks. we'll guidance be more likely end and way dossiers way of that's ultrasound the nerve

be. program specific the Anything meeting the to waiting look a -- hold do has clear step back very Serge? The to a on China coronavirus what their the going Chinese And to is trial can data and us good. that place else -- all issues with for regulators next Hong we the up on with done. go a have PK to looks the so of been in sent Kong. That We're

Serge Belanger

No. Thank you.

Dave Stack

you. Okay. Thank

Operator

of question next Nachman Your from Markets. comes line with BMO Capital Gary the

Gary Nachman

sort training anesthesiologists with a program pull-through have? from in many Dave, could have terms just describe you impact more it Hi. that It's reach the you seen program what of Good yet? Envision early morning. and of little but how might any

$XXX about promotional guidance just you expand to to in with ioveraº efforts a $XX million. the additional long clinical near-term talk It's way to the plan $XX go then And million. million how to and the use data? The still

that? you have I So better start better to just you'll when sense with think want to a of get traction

Dave Stack

Yes.

the signed we So ago, two weeks Gary. deal Envision

So have tell that can't I to. you anything point we I that can

it does organization our how labs So a So very relationship we with And work? these a the we've group inside KOL. got does that innovation this. have strong

So why snapshot it. portion if about all multivesicular aspects they quick where so I give them liposomes talk the would to a there stay where we didactic be of they would you really of put a

few the America one that cadaver. access has of a in are We companies virtual to

artery's can we out see blood glasses in the look put drug look the and how on the funny muscle, the so strip the can can places. vessels, we at the the strip understand nerve can we on the out people can back close so to put they arteries all can we So put that how nervesm just different can we we can and to

and majority most these mini of by section the one are there by a run more be course or there's the that a CME. these way of of So less the vast KOLS would almost --

to stations then guidance, are. five of how by exactly they and live each they with KOL. ultrasound the go And would And would models. be different where there interest see, break-up nerves using And would the anesthesiologist typically, would out, manned an pick group again

different can much And were you do? what use? tell that's How you this freewheeling do about you me, so that's if guy pretty session that know to of – doing a I you on block considerations? the worried hitting of for What's safety hitting about would doing much volume? do this going block the am your a brachial Am an you're block All plexus those are worried What nerve? If hours. go about I phrenic those kinds Gary artery? and I things

scheduled minutes three of matter four them had hours. they've were for that gone a for we've go or to fact, and XX As

around the And has country already so in that we'll with those year. the agreed places Envision through run been

The I the folks up. one, and we x did you were first number that you tell than of of but more the prepared won't we specific two I first would times give for folks numbers showed and one number

interest, idea you give is how will learning this. much of that there So an in

through we to I said, as continue so we the that we'll is have. of go And do And innovation year, primary the team this them. this like then activity

– And In on center, what's are video. of are all each training to there dedicated been there ERAS of are and also they that sessions endeavor most terms have Envision is of this the protocols. the in done resources

if them to TAP can learn can can learn use actually blocks, more It's need a of you'd that they up for we for pec providers it or looking America truly year. the proctor one end health book, opportunity treat to to Is could need a of palavers, these to for. they one of is less big watch about excited that's we're anesthesia wing idea of of KOLs go hospital doing learn what an why C-sections, you pull okay to do our be blocks get have and of do if teach Envision? by the two It's different you right? how So do specific, blocks, need for so videos, or we open you they us. the how to think to I the will. we will how that one if protocols specific an center OB they're then you how in to care half into and or do that's for what be if It but and this might something It generally the in group their just

Gary Nachman

Yeah. Thanks. very helpful. That Yeah. was

Dave Stack

itself enough. And in is is compounds – enough. this this a – Fair as you more – not this fair This is And iovera then marketplace. linear progression, the these grow right? are a

comment and your your understand fully I So question.

on the out EXPAREL and people iovera there already of said a plus have as couple bunch on got IDNs are working got So signed up. on big we've who times front, of some hospital the we've a that we've

I $XX think of was said iovera. that out iovera many we of went $XX Charlie EXPAREL trying about of to majority the million think that's have the so through We applies to everything think issues But this pull conservative I in million probably terms in don't think XXXX that specifically. to I – year. the And didn't guidance a also provide that that we don't

and and a that have and OA, done talking have just that. out to of the Gary doctor's going very office other resources do In sitting side, didn't the and we have folks like we On little. than and for patients to other really just talking other people stuff that been in me MyoScience, couple to

we've XX So regions. got

Our commercial have is iovera regions. organization each dedicated now a up made regions. person XX XX of We in of those

EXPAREL – right? they of plus iovera and the piece counterpart EXPAREL we'll iovera work this, on with to the goal So their own

of also person. a person iovera we an out In regions, OA our who putting are is five

open that and are a So are around and with CRNA they spine of seven interest. groups non-opioid day a both piece XX day CRNA of only groups big a clinics hour And a of work EXPAREL and several country. medicine week as orthopedic the point to iovera groups just that. looking We've groups got will course

two different we're poster together the iovera of them I right? with out them nerve of treatment so just TKA, – the weeks works. how couple for use want Do ago sense with actually want want? you you a were room a say a a the And can I so I of of eventually. that posters, can And show And We your working you how want docs a of to do means. I poster book give folks. what freezing what

in an – Can And without big the any like the plenty go a case. surgery area the May, you five then I'd if all can season I'd get fact in New we because of actual that golf that to golf at me or like upstate will four for a this relief this York June is in take posters and around poster of as from put clubs drugs of get the get them locker you can do through without example. room matter it in any – you you

when So is hospital the opportunity implemented. opportunity, of it's more but bigger that may think it nascent fully actually be we a much than

starting And just so we're here.

resources. of get to then you for So about almost will the be during $XX us to basis year it on million to said believe the that to can see all break we've on can half the think with from pay game in But this as system, $XX and we new ante of still million and even and the pricing the races. there you back we a that off P&L will as

Gary Nachman

Okay. one follow-up. And then quick just

You of to opportunities your products it's develop starts addressed BD you a more been pipeline lot where fits the years. the terms in an do But questions been you internally? have over earlier. think and That's area

your over that pipeline? more something you we'll So that out of time see is Thank think coming you.

Dave Stack

subarachnoid the as pipeline anesthetic actual our Yeah, potential to the about big in no, local EXPAREL. the pipeline BD – being anesthetic including we've think as be – that has the own API is our levobupivacaine that or thanks Gary. We talked only thing

a we formal look those. resource over So two next going or look dexmedetomidine actually think assets. at the we're different do the want few of to Gary a outside is over opioids others we more X,XXX to We've to them. using an and we see, very And review months couple that's to where commit at we standard that to opioids resources of care do three just of examine really here are if exciting. have that the We've can that of one replace where and finished got

we going could larger, in look at – has and something the in that to have develop could a be versus merger that $XXX use We're got clinical everything looking for on much at or DepoFoam resources we acquisition where think you can those that product an candidate. we Ron alongside same a cases many million we be

I would that's of there's question. appropriate probably but see more So and if XX there small. I And that couple the evaluation to know middle your expect we're They're I an opportunities. answer would not, say fully more, other that don't you'd – now not a in are

Gary Nachman

you. Okay. Yeah. That’s Thank great.

Dave Stack

Gary. Thanks,

Operator

question line from Fadia last come Your SVB with will of Leerink. Ami the

Ami Fadia

for Thanks morning. Good Hi. squeezing me in.

good outpatient trend is us there trend it gave you is some EXPAREL -- the is A inpatient couple follow-ups to on a setting. HOPD You from that how in from that. ASC? to inpatient of Do color bigger on outpatient? think being kind versus of the used Or

of your follow-up. across then And the blocks, views and region infiltration -- I have it's then, talk other whether about let's sort if base blocks XXXX That What sort nerve be mix helpful. EXPAREL. say, blocks, all of And would basically, TAP a Thanks. current in of is then of you business, could is which just revenues blocks?

Dave Stack

Okay.

community environment. that's a close will a are patient defines So, prospective admit, is see to payment HOPD backwards a the still and to from a covers and community, not a being what a be have an procedure primarily in have medical patient as and and hospital that who But, happened, you traditional to payer DRG a inpatients, that and be considers a is cover thought process inpatients HOPD the that they it anything generally treated but have So, right? ASCs right? XX-hour you they if where I'll patient inpatient of the

payers that, CMS. the are And TKA, define of will only thinking in see way I about you is the you it, terms for can mean how example,

So, hips HOPD then, to environment. very see you and And things CMS the knees were and frankly list inpatient-only until on move recently. spine an

successful there the do ASC? they enough be HOPD so couple And years that? progression given do that a from they to then they community do an an of is that? could Were define a how to Could

inpatient-only you different TKA saw the procedures you see that is fact the environment now that a in for the less for or example. can reimbursement patient for a in it right? thinking, see for an And an inpatient line HOPD an thousand And from price dollars to an of to is ASC. CMS move those than can And ASC environment knee, several expensive example, you in follow

trend. need I anesthesia instituted aggressively regional under who that not is more is really it mean a drug because much know you the -- to more time being that's are nerve line. working, trend is keeping and guidance strict So, has frankly world, right? already block are on that And can ultrasound provide -- a you You from what's happened. that it people a can't

the have slave have the after So, would throughput the you surgery, much rather give ambulatory the pain pain because anesthesiologist than moving surgeon in give to before are would you you control you are a environment. the surgery the control an --

an And actually so, that makes to five, have six you a if in do have ambulatory to one four, room day some confidence be you able center using knees that sense. in can

happening question on your what's now. in So,

block. you torturing the have provide nursing level going of the opioids, the pump to or days think will So, It's not nerve time do I you environment was a every it's in staff where pain that's a of infiltration patient cases days, in you in be an they vitals inpatient many an in control? because pain how hospital. they do have luxury hospital option in but hit completely anyway different if four an inpatient environment, you’re example, for and the using a large three because the doses for to of the

themselves can do a hours pump, do -- or dose You can them put epidural. thoracic few them you every can you a on pain and let a

also stay patient things would provide those moving to XX-hour They keep that from would All of control. pain you a environment.

a And form epidural Cleveland EXPAREL so data replace intriguing. with with if looked we and in is the art fairly to a wounds large here thoracic you'll that just quite did reading at Clinic ability abdominal be you study And the the will, we XXX-patient where soon TAP. an

is control there. The pain opportunity

where And in allows so, to management an a require doesn't stay TAP that to the that that an technique EXPAREL requires large move an area you environment you epidurals hospital. patient pain add to that

situation. So, the which or in Does nerve sense? TAP is more it's replacing EXPAREL regional that not with the make infiltration a other nerve modalities it's block block, really

Ami Fadia

gets irrespective how the infiltration Yeah. is mix EXPAREL TAP of -- That's the helpful. used? it of And whether today, what's across setting where being versus used

Dave Stack

to we -- how no we very and clear real give against than answer plan block that it. nerve It's that what infiltration there's that a -- that it's I block, Yeah. I mean would say It's the question. total. more I So I'll almost you growth nerve and there there's said XX% the blocks in include field pure is decreasing of of infiltration, and is right? as less percentage than in XX% if over you

going said market be blocks as percent XX-ish because in it's always then Now, of decreasing virtually by be growth field forward. not the it's blocks to pediatrics you growing by little nerve be growing all definition, to is a so going already And bit a going just and right? But that's careful, are have we've again. infiltration to

dynamic have cardiac something a pediatrics launching million you're surgery. almost and there's to a one to So, It's to block we're all to going very going that be from difficult patients block, into nothing are when be a four-month old right? to into year infiltrations now in going going because just

Ami Fadia

the about... was And follow-up then other Okay.

Dave Stack

black That's sure. and for a white world

Ami Fadia

No. yeah. Yeah,

was question the and actually seems how sort in accelerate products kind potential peak -- you use. other block of it's EXPAREL. the of the The seen of like the sort by or or about about it revenue recent of for plan more five-year nerve of driven growth think the regional use the We've block years, kind

that's as a opposed using a institutions sizing blocks be could greater us about seeing help these couple of for for hundred you would of That billion-dollar a sort product you sort of regional Are pay and how If bupivacaine there? dollars come you to these a think nerve from to opportunity? think helpful. blocks? how about up And with do that you open-mindedness the

Dave Stack

Sure.

scenario which when with actually So, eight, we bupivacaine they about somebody blocks depending getting best a free for they're bupivacaine, to case us do much use who's XX trying how regional volume talking they hours you're XX, any because on block example. find how for and that's if and much use

But when in move EXPAREL, hours few most a to from cases -- days. you switch most few and that cases, bupivacaine to a you from in

you give case can best the I example I'll give probably So, that you.

do to called used docs what blocks. rescue TAP The they

they block the do that long And would trying that is surgery that have did were block TAP extend to you could. then would And up after as as and patient duration and would in wake the TAP pain because they the so they they reason surgery. of the a

bupivacaine a XX X get And a to XX-hour whole things in would try going another That was up were XX wake do XX going range drug block would bunch patient to last afternoon. in do to to or last add trying the long thing enough. o'clock that again wanted to the TAP be was the morning in they hours X of pain in they X had and somebody dexamethasone, then at meant the o'clock because you the to generally, to to activity because to didn't do TAP to the at with which o'clock block add get meant they

you And a was procedure in relief. of XX to fact, and Ami, doing only train the places of actually stopped required to staff the lot when were blocks XX of do because TAP getting hours what

that actually several you're Juxtapose EXPAREL now procedure. before against do it you days, the where because getting

That's we to focusing brachial you of basis were are a list that's people the have. in going forward-thinking who these the and of if and were on all plexus whole institution that by growing So, approaches today you a way, MEDNAX. is regional block the get Envision partnerships

that machine. up and you're have you're block to give having I plexus go going an on EXPAREL. XX get fellow plexus say, We're ultrasound five -- they dose a anesthesiologist of because and give don't a a brachial would If going brachial The know you cc into of EXPAREL you were The block, would you old you rotator going would to you cuff. cc bupivacaine. are left how a room X.XX% would to you Ami, get

of Now, you control would pain board. days have four three or on

You haven't had an incision yet.

patients to environment that as cases those haven't -- and move being are why on reported can majority and today us Tylenol. You the had patient an anything. And discharged that's you are to of these ambulatory

pain management. basic practice we changes of the how And so it foundation

TAP blocks so very beauty that's blocks -- have days blocks allows around technology have time. that long TAP EXPAREL. exploded. is And the to for effective why No, of be a the say A been TAP for block several TAP people

partnership a I'm gets moving a And why charge compliment, regional environment paid who so just saying, a for a payer. an patient and actually not the paying I'm just can group a us fact, anesthesia for you expensive less right? these can that's with see approaches who actually have then to

we their If day a of can and you shorten big came were a a and by these we group, all from payer said, stay hey we and half, can take to length Ami you of or patients day and saying, do That's program are by happening. And train versus to block you us them as different on all inpatient. that's and these what's coming keeping a why an to to people regional these going things? how us can

Ami Fadia

it. Got

Dave Stack

Makes sense?

Ami Fadia

helpful. you. was That Thank Yes.

Dave Stack

$X your so And billion.

So, is. your then billion $X question

growth -- the done started the in out the XX% we scenario said anesthesia. five project that the being cases you only as now. of And of regional best next you can so on, are regional question, years out So case early over Randall's we with

growth the doses use you of can an et can growth can't huge talk of what cetera. going to all these center patient modalities about just the where so you have something you talked different where And ambulatory about doesn't the and expanding and we folks opioids, use out project then to you get of

talked we've million; And you you a extremity a we you $XXX think $XXX million. then that think already block, if peds, percentage about a world, think that's marry million; get two things those rest if together think growth of basis. on $XXX that's that's add that's And annual C-section, million; nerve to lower we we $XXX we

You could three telling I be or me me yelling now that was really four at conservative. from years

Ami Fadia

Okay, much. that you was Thank so helpful.

Dave Stack

Thanks.

Operator

over turn to turn I CEO like now Yes the Stack, over closing Chairman for the to Dave like sir, and call back now would to would remarks. I back -- conference

Dave Stack

your We future. your time Good. this to forward in look the for providing additional questions and for updates near Thanks morning.

is the forward us you soon. for to Meeting everybody. up Next Thanks Miami. Barclays seeing look in We

Operator

a and today's your Ladies you Thank day. have and gentlemen, conference. this wonderful concludes participation for

disconnect. now may You

Pacira BioSciences (PCRX) 20 Feb 202019 Q4 Earnings call transcript