Item 1A. Risk Factors
Investing in our common stock involves a high degree of risk. You should carefully consider the risks described below, together with all of the other
information included in this Quarterly Report, before deciding whether to invest in shares of our common stock. Additional risks and uncertainties not presently known to us or that we currently deem immaterial also may impair our business
operations. The occurrence of any of the following risks could harm our business, financial condition or results of operations. In such case, the trading price of our common stock could decline, and you may lose all or part of your investment.
Risks Relating to Our Business
Our near-term prospects are dependent on ADASUVE. If we or our collaborators are unable to successfully commercialize ADASUVE for
the acute treatment of agitation in adults with schizophrenia or bipolar disease, our ability to generate significant revenue or achieve profitability will be adversely affected.
ADASUVE is our only product approved for marketing in the United States or the EU, and our ability to generate revenue in the near term is
entirely dependent upon sales of ADASUVE. We do not have any product approved for marketing outside of the United States or the EU. We or our collaborators may not be able to successfully commercialize ADASUVE for a number of reasons,
including:
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we or our collaborators may not be able to establish or demonstrate in the medical community the safety and efficacy of ADASUVE and any potential advantages over existing therapeutics and products currently in clinical
development;
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doctors may be hesitant to prescribe ADASUVE until results from our post-approval studies are available or other long term data regarding efficacy and safety become available;
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results from our post-approval studies may fail to verify the clinical benefit of ADASUVE for the treatment of agitation in patients with bipolar disorder and schizophrenia or may reveal unforeseen safety issues;
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our limited experience in marketing, selling and distributing ADASUVE;
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reimbursement and coverage policies of government and private payers such as Medicare, Medicaid, insurance companies, health maintenance organizations and other plan administrators;
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the relative price of ADASUVE as compared to alternative treatment options;
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the reliability of our estimates, including the frequency of agitation in many patients with bipolar disorder and schizophrenia;
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we or our collaborators may not have adequate financial or other resources to successfully commercialize ADASUVE;
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we may be unable to secure an adequate replacement manufacturer for sufficient quantities of the chemical heat packages in ADASUVE by October 2016 or the costs for such manufacturer to produce the chemical heat packages
may be higher than the cost from Autoliv; and
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we may not be able to manufacture ADASUVE in commercial quantities or at acceptable costs.
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we or our collaborators are unable to successfully commercialize ADASUVE for the treatment of agitation in adults with schizophrenia or bipolar disorder, our ability to generate revenue from royalties and product sales and achieve profitability will
be adversely affected and our stock price would likely decline.
We have a history of net losses. We expect to continue to incur
substantial and increasing net losses for the foreseeable future, and we may never achieve or maintain profitability.
We are not
profitable and have incurred significant net losses in each year since our inception, including net losses of $16.7 million, $39.6 million, $28.0 million, and $40.5 million for the six months ended June 30, 2014 and the years ended
December 31, 2013, 2012, and 2011, respectively. As of June 30, 2014, we had an accumulated deficit of $390.9 million and a stockholders deficit of $36.4 million. We expect to continue to incur substantial net losses and negative
operating cash flow through at least 2016. These losses and negative operating cash flows have had, and will continue to have, an adverse effect on our stockholders equity and working capital.
Because of the numerous risks and uncertainties associated with the commercialization of ADASUVE by Teva and Ferrer, our ability to
manufacture commercial quantities of ADASUVE and conduct pharmaceutical product development, we are unable to predict accurately the timing or amount of future revenues or expenses, or when, or if, we will be able to
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achieve or maintain profitability. To date we have not generated any significant product or royalty revenue. We have financed our operations primarily through the sale of equity securities,
equipment financing, debt financing, collaboration and licensing agreements, and government grants. The size of our future net losses will depend, in part, on the rate of growth or contraction of our expenses and the level and rate of growth, if
any, of our revenues. Revenues from strategic collaborations are uncertain because we may not enter into any additional strategic collaborations. If we or our collaborators are unable to successfully commercialize ADASUVE or one or more of our
product candidates or if sales revenue from ADASUVE or any product candidate that receives marketing approval is insufficient, we will not achieve profitability. Even if we do achieve profitability, we may not be able to sustain or increase
profitability.
Our operating results are unpredictable and may fluctuate. If our operating results are below the expectations of
securities analysts or investors, the trading price of our stock could decline.
Our operating results are difficult to predict and
will likely fluctuate from quarter to quarter and year to year. Due to the recent approval of ADASUVE for the treatment of agitation associated with schizophrenia or bipolar disorder in adults in the United States and the EU and the lack of
historical sales data, ADASUVE sales will be difficult to predict from period to period. We believe that our quarterly and annual results of operations may be negatively affected by a variety of factors, including:
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a failure to achieve a sufficient level of demand by patients and healthcare providers for ADASUVE;
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the timing and level of investment in our or our collaborators sales and marketing efforts to support ADASUVE sales;
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the timing and level of investment in our or our collaborators research and development activities involving ADASUVE; and
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expenditures we may incur to acquire or develop additional products.
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In addition, we measure
compensation cost for stock-based awards made to employees at the grant date of the award, based on the fair value of the award, and recognize the cost as an expense over the employees requisite service period. As the variables that we use as
a basis for valuing these awards change over time, including our underlying stock price, the magnitude of the expense that we must recognize may vary significantly. Any such variance from one period to the next could cause a significant fluctuation
in our operating results.
For these reasons, it is difficult for us to accurately forecast future profits or losses. As a result, it is
possible that in some quarters our operating results could be below the expectations of securities analysts or investors, which could cause the trading price of our common stock to decline, perhaps substantially.
We will need substantial additional capital in the future. If additional capital is not available, we will have to delay, reduce or
cease operations.
We will need to raise additional capital to fund our operations, to develop our product candidates and to
develop and expand our commercial manufacturing capabilities. Our future capital requirements will be substantial and will depend on many factors including:
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Tevas success in commercializing ADASUVE in the United States;
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Tevas executing the ADASUVE REMS program to the satisfaction of the FDA;
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Ferrers success in commercializing ADASUVE in the Ferrer Territories;
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the terms and success of any future licensing arrangement that we may enter into for the commercial rights for ADASUVE outside the United States and the Ferrer Territories;
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the development costs for our other product candidates;
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the cost and timing of complying with our post-approval commitments;
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the cost and timing of complying with the process for renewal of marketing authorization in the EU;
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the scope, rate of progress, results and costs of our preclinical studies, clinical trials and other research and development activities;
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the scope, rate of progress, results and costs of our commercial manufacturing development and commercial manufacturing activities;
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payments received under our collaborations with Ferrer and Teva and any future strategic collaborations;
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the continuation of the Ferrer and Teva collaborations under their agreed terms;
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the filing, prosecution and enforcement of patent claims; and
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the costs associated with commercializing our other product candidates, if they receive regulatory approval.
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We believe that, based on our cash, cash equivalents, marketable securities and restricted cash
balances at June 30, 2014, estimated product revenues and milestone payments associated with the sale of ADASUVE, and our current expected cash usage, we have sufficient capital resources to meet our anticipated cash needs for at least the next
twelve months. Changing circumstances may cause us to consume capital significantly faster or slower than we currently anticipate, or to alter our operations. We have based these estimates on assumptions that may prove to be wrong, and we could
exhaust our available financial resources sooner than we currently expect. The key assumptions underlying these estimates include:
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continuation of our Teva and Ferrer collaborations;
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no unexpected costs related to the development of our commercial manufacturing capability; and
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no unbudgeted growth in the number of our employees during this period.
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We may never be able
to generate a sufficient amount of product or royalty revenue to cover our expenses. We did not generate any product revenues until the second quarter of 2013 and did not generate any royalty revenues until the second quarter of 2014. In addition,
any royalty and milestone payments payable under the Teva Agreement will first be applied to repaying principal and interest on the $45.0 million of non-recourse notes that our wholly-owned subsidiary issued in our March 2014 royalty securitization
financing before we receive as income any royalty or milestone payments under the Teva Agreement. Until we generate sufficient revenues to cover expenses, we expect to finance our future cash needs through public or private equity offerings, debt
financings, strategic collaborations or licensing arrangements. Any financing transaction may contain unfavorable terms. For example, the terms of certain warrants we have issued in previous financings could require us to pay warrant holders a
significant portion of the proceeds in a change of control transaction, potentially materially reducing the proceeds available to holders of our common stock. If we raise additional funds by issuing equity securities our stockholders equity
will be diluted and debt financing, if available, may involve restrictive covenants. If we raise additional funds through strategic collaborations, we may be required to relinquish rights to ADASUVE, our product candidates or our technologies, or to
grant licenses on terms that are not favorable to us. Complying with the terms of the foregoing rights and restrictions may make it more difficult to complete certain types of transactions and result in delays to our fundraising efforts.
We do not have sales and marketing capabilities, and consequently must rely on commercial collaborations to sell our products, and we
and our collaborators may be unable to generate significant product revenue.
In December 2012, the FDA granted marketing approval
for ADASUVE in the United States for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults. The approval of ADASUVE is our first regulatory approval. We do not have a sales and marketing organization and as a
company, we do not have significant experience in the sales and distribution of pharmaceutical products.
We have exclusively licensed the
ADASUVE U.S. commercialization rights to Teva, which we believe will have a significant impact on the ultimate success of ADASUVE in the United States. Teva announced the U.S. launch of ADASUVE in March 2014. If Teva is unable to commercialize
ADASUVE successfully in the United States or Teva is unable to fulfill the post-marketing obligations that were required by the FDA as part of the ADASUVE NDA approval, our revenue will suffer and our stock price may decline. Tevas
commercialization efforts could also have an effect on investors perception of potential sales of ADASUVE outside the United States, which could also cause a decline in our stock price and may make it more difficult for us to enter into
additional strategic collaborations.
There are risks involved with utilizing Teva to sell our product. By licensing the U.S.
commercialization rights to Teva, we may generate fewer revenues from the royalties and milestone payments under the Teva Agreement than if we commercialized ADASUVE on our own. Additionally, Teva may not fulfill its obligations or carry out selling
and marketing activities as diligently as we would like. We could also become involved in disputes with Teva, which could lead to delays in or termination of commercialization programs and time-consuming and expensive litigation or arbitration. If
Teva terminates or breaches its agreement, or otherwise fails to complete its obligations in a timely manner, the chances of successfully selling or marketing ADASUVE would be materially and adversely affected. Teva has the right to terminate the
Teva Agreement with or without cause, upon 120 days notice. If Teva exercises this right, our business and operations and stock price may be negatively affected.
In February 2013, the EC granted a marketing authorization for ADASUVE, as ADASUVE (
Staccato
loxapine) 4.5 mg or 9.1 mg, inhalation
powder, pre-dispensed. In October 2011, we entered into a commercial collaboration with Ferrer pursuant to the Ferrer Agreement, to commercialize ADASUVE in the Ferrer Territories. In July 2013, Ferrer launched ADASUVE in the EU, with the first
commercial sale in Germany, and currently sells ADASUVE in Germany, Austria, Spain, Romania and the Nordic Countries (Sweden, Norway, Denmark and Finland). We expect Ferrer to launch ADASUVE in additional countries in the Ferrer Territories in 2014
and 2015. If Ferrer is unable to commercialize ADASUVE successfully in the various Ferrer Territories or we are unable to fulfill the post-marketing authorization commitments that were required as part of the marketing authorization granted for
ADASUVE in the EU, our revenue will suffer and our stock price may decline.
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We also intend to seek international distribution collaborators in addition to Ferrer for ADASUVE
and our product candidates. If we are unable to enter into an international distribution collaboration, we will be unable to generate revenues from countries outside the United States and the Ferrer Territories.
If we enter into additional strategic collaborations, we may be required to relinquish important rights to and control over the
development of ADASUVE or our product candidates or otherwise be subject to terms unfavorable to us.
Our relationships with Teva
and Ferrer are, and any other strategic collaborations with pharmaceutical or biotechnology companies we may establish will be, subject to a number of risks including:
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business combinations or significant changes in a strategic collaborators business strategy may adversely affect a strategic collaborators willingness or ability to complete its obligations under any
arrangement;
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we may not be able to control the amount or timing of resources that our strategic collaborators devote to the development or commercialization of ADASUVE or our product candidates;
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strategic collaborators may delay clinical trials, provide insufficient funding, terminate a clinical trial or abandon a product candidate, repeat or conduct new clinical trials or require a new version of a product
candidate for clinical testing;
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strategic collaborators may not pursue further development and commercialization of products resulting from the strategic collaboration arrangement or may elect to discontinue research and development programs;
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strategic collaborators may not commit adequate resources to the marketing and distribution of any future products, limiting our potential revenues from these products;
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disputes may arise between us and our strategic collaborators that result in the delay or termination of the research, development or commercialization of ADASUVE or our product candidates or that result in costly
litigation or arbitration that diverts managements attention and consumes resources;
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strategic collaborators may experience financial difficulties;
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strategic collaborators may not properly maintain or defend our intellectual property rights or may use our proprietary information in a manner that could jeopardize or invalidate our proprietary information or expose
us to potential litigation;
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strategic collaborators could independently move forward with a competing product candidate developed either independently or in collaboration with others, including our competitors; and
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strategic collaborators, including Teva or Ferrer, could terminate the arrangement or allow it to expire, which would delay and may increase the cost of developing our product candidates or commercializing ADASUVE.
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The REMS program for ADASUVE imposes, and any REMS on any other approved products may impose, regulatory burdens on
the distribution and sales of ADASUVE or any other approved products and also on healthcare providers that may make the products commercially unattractive or impractical.
As a condition of FDA approval, Teva is required to have a REMS program for ADASUVE, and we may be required to implement a REMS program for any
other product candidates we may develop. A REMS may include various elements, such as distribution of a medication guide or a patient package insert; implementation of a communication plan to educate healthcare providers of the drugs risks;
imposition of limitations on who may prescribe or dispense the drug, including training and certification requirements; or other measures that the FDA deems necessary to assure the safe use of the drug. The FDA has a wide degree of discretion in
deciding which elements are necessary for the safe use of a product, and it may impose elements that significantly burden our ability to commercialize the product, or that burden healthcare providers to the extent that use of the product is severely
curtailed.
For ADASUVE, the REMS program contains measures to ensure that the product is administered only in healthcare facilities
enrolled in the ADASUVE REMS program that have immediate on-site access to equipment and personnel trained to manage acute bronchospasm, including advanced airway management (intubation and mechanical ventilation). The REMS program may not allow
commercialization and use of ADASUVE in a commercially feasible manner. In the future, the FDA could impose additional REMS elements, such as if the REMS proves inadequate in managing the risk of bronchospasm associated with ADASUVE or if new safety
risks emerge, and such additional elements could substantially burden or even eliminate our ability to commercialize ADASUVE in a feasible manner.
If we or our collaborators are unable to successfully complete the ADASUVE post-marketing studies required by the FDA and EC, or if data
generated from the post-marketing studies indicate safety concerns, our sales could be diminished and our ability to generate a profit could be negatively affected.
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As a condition of U.S. ADASUVE approval, there are several required post-marketing studies,
including a 10,000 patient observational clinical trial that is designed to gather patient safety data based on the real-world use of ADASUVE in the hospital setting and a clinical program designed to evaluate the safety and efficacy of
ADASUVE in agitated adolescent patients. The data derived from any post-approval study or trial could result in additional restrictions on the commercialization of ADASUVE through changes to the approved ADASUVE label, additional goals or elements
in the REMS program, the imposition of additional post-approval studies or trials, or even the withdrawal of the approval of ADASUVE. Our business, operations and stock price may be negatively affected if any of these or similar events occur.
As a condition of the ADASUVE marketing authorization in the EU, we are responsible for the conduct and funding of post-authorization studies,
including (i) a benzodiazepine interaction study, which has been completed, (ii) a controlled study to determine ADASUVEs effect on cardiac rhythms, or a thorough QTc study, with two doses of ADASUVE, which has been completed,
(iii) a clinical program designed to evaluate the safety and efficacy of ADASUVE in agitated adolescent patients, (iv) an observational clinical trial, and (v) a drug utilization clinical trial. Results of the benzodiazepine
interaction study and the thorough QTc study have been submitted to the EMA.
If we or our collaborators are unable to fulfill the FDA or
EC post-approval obligations, or do not fulfill these obligations within an appropriate time, or if the EMA determines from the results of our completed benzodiazepine interaction study or our completed thorough QTc study that ADASUVE poses or may
pose actual or possible safety risks to some patients, the NDA could be suspended, withdrawn, or limited, and the current marketing authorization in the EU could be varied, suspended or withdrawn and our business, operations and stock price may be
negatively affected.
If we do not produce our commercial devices cost effectively, we will never be profitable.
ADASUVE and our
Staccato
system-based product candidates contain electronic and other components in addition to the active
pharmaceutical ingredient, or API. The cost to produce ADASUVE and our product candidates, and any additional approved products, will likely be higher per dose than the cost to produce intravenous or oral tablet products. This higher cost of goods
may prevent us or our collaborators from ever selling any products at a profit. The development and production of our technology entail a number of technical challenges, including achieving adequate dependability in our production, that may be
expensive or time consuming to solve. Any delay in or failure to develop and manufacture any future products in a cost effective way could prevent us from generating any meaningful revenues and prevent us from becoming profitable.
In October 2011, we committed to sell ADASUVE to Ferrer for a fixed transfer price, which is below our current production costs, and in May
2013, we committed to supply ADASUVE to Teva at a price based on costs of commercial production, which transfer price will convert to a fixed price upon achievement of costs equal to a specified per-unit price. Our future manufacturing costs per
unit will be dependent on future demand of ADASUVE. If we and our collaborators do not generate sufficient demand, our manufacturing costs will exceed the fixed transfer price and will result in losses. In October 2013, Autoliv notified us that they
were terminating, effective October 2016, the Manufacture Agreement. Prior to October 2016, Autoliv and we remain fully obligated to perform pursuant to the terms of both the Manufacture Agreement and the New Note. However, Autoliv may not continue
to perform its obligations in the same manner during the termination period. If we are unable to secure an adequate replacement manufacturer for sufficient quantities of the chemical heat packages in ADASUVE by October 2016 or if the costs for such
manufacturer to produce the chemical heat packages are higher than the cost from Autoliv, it will significantly impact our ability to produce our commercial devices or to produce them at quantities or at a cost to allow us to become profitable.
The availability and amount of reimbursement for ADASUVE and our product candidates and the manner in which government and private
payors may reimburse for our potential products is uncertain.
Many of the patients in the United States who seek treatment with
ADASUVE or any other of our products that are approved for marketing will be eligible for Medicare benefits. Other patients may be covered by private health plans. The Medicare program is administered by CMS, and coverage and reimbursement for
products and services under Medicare are determined pursuant to statute, regulations promulgated by CMS, and CMSs subregulatory coverage and reimbursement determinations. CMSs regulations and interpretive determinations are subject to
change, as are the procedures and criteria by which CMS makes coverage and reimbursement determinations and the reimbursement amounts established by statute, particularly because of budgetary pressures facing the Medicare program. For example, we
anticipate that ADASUVE will be used only in the hospital inpatient and hospital outpatient settings. In the hospital inpatient setting, Medicare does not provide separate reimbursement for drugs but pays for them as part of the payment for the
hospital stay. In the hospital outpatient setting, the statute establishes the payment rate for new drugs and biologicals administered incident to a physicians service that are granted pass-through status at the rate applicable in
physicians offices (i.e., ASP plus six percent) for two to three years after FDA approval. For drugs and biologicals that do not have pass-through status, CMS establishes the payment rates by regulation. For 2014, these drugs are reimbursed at
ASP plus six percent if they have an average cost per day exceeding $90; drugs with an average cost per day of less than $90 are not separately reimbursed. In
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future years, CMS could change both the payment rate and the average cost threshold, and these changes could adversely affect payment for ADASUVE. In addition, the President has proposed and
Congress has considered amending the statute to reduce Medicares payment rates for drugs and biologicals, and if such legislation is enacted, it could adversely affect payment for ADASUVE. Moreover, ADASUVE is different from many drugs covered
by Medicare Part B because it is administered by a healthcare professional through a disposable inhaler.
Effective April 1, 2013,
Medicare payments for all items and services, including drugs and biologicals, were reduced by up to 2% under the sequestration (i.e., automatic spending reductions) required by the Budget Control Act of 2011, Pub. L. No. 112-25, or BCA, as
amended by the American Taxpayer Relief Act of 2012, Pub. L. 112-240, or ATRA. The BCA requires sequestration for most federal programs, excluding Medicaid, Social Security, and certain other programs, because Congress failed to enact legislation by
January 15, 2012, to reduce federal deficits by $1.2 trillion over ten years. The BCA caps the cuts to Medicare payments or items and services at 2%, and requires the cuts to be implemented on the first day of the first month following the
issuance of a sequestration order. The ATRA delayed implementation of sequestration from January 2, 2013, to March 1, 2013, and as a result, the Medicare cuts took effect April 1, 2013, and will remain in effect unless Congress enacts
legislation to cancel the cuts. The cuts were originally scheduled to occur through 2021, but under the Bipartisan Budget Act of 2013, these cuts were extended through 2023. These cuts could adversely impact payment for ADASUVE and related
procedures.
In March 2014, Teva announced the U.S. launch of ADASUVE. We expect ADASUVE to experience pricing pressures in the United
States due to the trend toward managed healthcare, the increasing influence of health maintenance organizations and additional legislative proposals. We cannot be sure that reimbursement amounts, or the lack of reimbursement, will not reduce the
demand for, or the price of, ADASUVE or any future products. If reimbursement is not available or is available only to limited levels, we or any collaborator may not be able to effectively commercialize ADASUVE or any future products, In addition,
if we or any collaborator fail to successfully secure and maintain reimbursement coverage for ADASUVE or any future products or are significantly delayed in doing so, we or any collaborator will have difficulty achieving market acceptance of our
products and our business will be harmed.
Payors also are increasingly considering new metrics as the basis for reimbursement rates, such
as ASP, AMP and Actual Acquisition Cost. The existing data for reimbursement based on these metrics is relatively limited, although certain states have begun to survey acquisition cost data for the purpose of setting Medicaid reimbursement rates.
CMS has made draft National Average Drug Acquisition Cost, or NADAC, and draft National Average Retail Price, or NARP, data publicly available on at least a monthly basis. In July 2013, CMS suspended the publication of draft NARP data, pending
funding decisions. In November 2013, CMS moved to publishing final rather than draft NADAC data and has since made updated NADAC data publicly available on a weekly basis. Therefore, it may be difficult to project the impact of these evolving
reimbursement mechanics on the willingness of payors to cover ADASUVE or any future products. As discussed below, once we or any collaborator begin to participate in government pricing programs, recent legislative changes to the 340B drug pricing
program, and the Medicaid Drug Rebate program also could impact our revenues. We anticipate that a significant portion of our revenue from sales of ADASUVE will be obtained through government payors, including Medicaid, and any failure to qualify
for reimbursement for ADASUVE under those programs would have a material negative effect on revenues from sales of ADASUVE.
The EU Member
States are free to restrict the range of medicinal products for which their national health insurance systems provide reimbursement and to control the prices and/or reimbursement levels of medicinal products for human use. An EU Member State may
approve a specific price or level of reimbursement for the medicinal product, or alternatively adopt a system of direct or indirect controls on the profitability of the company responsible for placing the medicinal product on the market, including
volume-based arrangements and reference pricing mechanisms. We anticipate that pricing and reimbursement decisions concerning ADASUVE in the EU will have a significant impact on the sales of the product in the EU. Failure to obtain pricing and
reimbursement for ADASUVE at an appropriate level in any of the EU Member States would, in part due to EU parallel trade rules, have a material adverse effect on revenues from sales of ADASUVE.
Healthcare law and policy changes, including those based on recently enacted legislation, may impact our business in ways that we cannot
currently predict and these changes could have a material adverse effect on our business and financial condition.
Healthcare costs
have risen significantly over the past decade. In March 2010, the Healthcare Reform Act, or PPACA, was adopted in the United States. The Healthcare Reform Act substantially changes the way health care is financed by both governmental and private
insurers, and significantly impacts the pharmaceutical industry. The Healthcare Reform Act contains a number of provisions that are expected to impact our business and operations, in some cases in ways we cannot currently predict. Changes that may
affect our business include those governing enrollment in federal and private healthcare programs, new Medicare reimbursement methods and rates, increased rebates and taxes on pharmaceutical products, expansion of the 340B program, and revised fraud
and abuse and enforcement requirements. These changes will impact existing government healthcare programs and will result in the development of new programs, including Medicare payment for performance initiatives and improvements to the physician
quality reporting system and feedback program.
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We anticipate that with Tevas commercialization of ADASUVE in the United States or with
other potential product candidates, some of our revenue and the revenue from our collaborators may be derived from U.S. government healthcare programs, including Medicare. We expect that the Healthcare Reform Act and other healthcare reform measures
that may be adopted in the future could have an adverse effect on our industry generally and the ability to successfully commercialize ADASUVE or our product candidates or could limit or eliminate our spending on development projects.
The Healthcare Reform Act made significant changes to the Medicaid Drug Rebate program, in which we expect to participate. Effective
March 23, 2010, rebate liability expanded from fee-for-service Medicaid utilization to include the utilization of Medicaid managed care organizations as well. With regard to the amount of the rebates owed, the Healthcare Reform Act increased
the minimum Medicaid rebate from 15.1% to 23.1% of the average manufacturer price for most innovator products and from 11% to 13% for non-innovator products; changed the calculation of the rebate for certain innovator products that qualify as line
extensions of existing drugs; and capped the total rebate amount for innovator drugs at 100% of the average manufacturer price. We expect that the increased minimum rebate of 23.1% will apply to ADASUVE. In addition, the Healthcare Reform Act and
subsequent legislation changed the definition of average manufacturer price. In 2012, the Centers for Medicare and Medicare Services, or CMS, the federal agency that administers the Medicare and Medicaid Drug Rebate program, issued proposed
regulations to implement the changes to the Medicaid Drug Rebate program under the Healthcare Reform Act but has not yet issued final regulations. CMS is currently expected to release the final regulations in 2014. Finally, the Healthcare Reform Act
requires pharmaceutical manufacturers of branded prescription drugs to pay a branded prescription drug fee to the federal government beginning in 2011. Each individual pharmaceutical manufacturer pays a prorated share of the branded prescription
drug fee of $3.0 billion in 2014 (and set to increase in ensuing years), based on the dollar value of its branded prescription drug sales to certain federal programs identified in the law. Additional provisions of the Healthcare Reform Act, some of
which became effective in 2011, may negatively affect our future revenues.
The Healthcare Reform Act also expanded the Public Health
Services 340B drug pricing discount program, which we expect to participate in. The 340B pricing program requires participating manufacturers to agree to charge statutorily-defined covered entities no more than the 340B ceiling
price for the manufacturers covered outpatient drugs. The Healthcare Reform Act expanded the 340B program to include additional types of covered entities: certain free-standing cancer hospitals, critical access hospitals, rural referral
centers and sole community hospitals, each as defined by the Healthcare Reform Act. The Healthcare Reform Act exempts orphan drugs those designated under section 526 of the FDCA from the ceiling price requirements for these
newly-eligible entities. We believe our product candidate in active development, AZ-002 (
Staccato
alprazolam), could qualify for orphan drug status. The Health Resources and Services Administration, or HRSA, which administers the 340B
program, issued a final regulation to implement the orphan drug exception in July 2013. The final regulation interprets the orphan drug exception narrowly. It exempts orphan drugs from the ceiling price requirements for the newly-eligible entities
only when the orphan drug is used for its orphan indication. The newly-eligible entities are entitled to purchase orphan drugs at the ceiling price when the orphan drug is not used for its orphan indication. The final regulation, which became
effective October 1, 2013, is subject to a pending lawsuit that seeks to block its implementation. The narrow scope of the orphan drug exception in HRSAs final regulation will increase the complexity of compliance, will make compliance
more time-consuming, and could negatively impact our results of operations if we successfully commercialize AZ-002 (
Staccato
alprazolam) and AZ-002 qualifies for orphan drug status. We have applied for orphan drug status for
AZ-002,
and expect to apply for orphan drug status in the EU. There can be no assurance that
AZ-002
will receive such designation.
The Healthcare Reform Act also obligates the Secretary of the HHS to create regulations and processes to improve the integrity of the 340B
program and to update the agreement that manufacturers must sign to participate in the 340B program to obligate a manufacturer to offer the 340B price to covered entities if the manufacturer makes the drug available to any other purchaser at any
price and to report to the government the ceiling prices for its drugs. HRSA is expected to issue a comprehensive proposed regulation in 2014 that will address many aspects of the 340B program. When that regulation is finalized, it could affect our
obligations under the 340B program in ways we cannot anticipate. In addition, legislation may be introduced that, if passed, would further expand the 340B program to additional covered entities or would require participating manufacturers to agree
to provide 340B discounted pricing on drugs used in the inpatient setting.
Many of the Healthcare Reform Acts most significant
reforms take effect in 2014 and thereafter, and the details will be shaped significantly as the various provisions become active, especially given the political nature of the law. In 2012, the Supreme Court of the United States heard challenges to
the constitutionality of the individual mandate and the viability of certain provisions of the Healthcare Reform Act. The Supreme Courts decision upheld most of the Healthcare Reform Act and determined that requiring individuals to maintain
minimum essential health insurance coverage or pay a penalty to the Internal Revenue Service was within Congresss constitutional taxing authority. However, the Supreme Court struck down a provision in the Healthcare Reform Act that
penalized states that choose not to expand their Medicaid programs through an increase in the Medicaid eligibility income limit from a states current eligibility levels to 133% of the federal poverty limit. As a result of the Supreme
Courts ruling, it is unclear whether states will expand their Medicaid programs by raising the income limit to 133% of the federal poverty level and whether there will be more uninsured patients in 2014 than anticipated when Congress passed
the Healthcare Reform Act. For each state that does not choose to expand its Medicaid program, there will be fewer insured patients overall. The reduction in the number of insured patients could impact the sales, business and financial condition.
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While the constitutionality of key provisions of the Healthcare Reform Act was upheld by the
Supreme Court, legislative changes to it remain possible. We expect that the Healthcare Reform Act, as currently enacted or as it may be amended in the future, and other healthcare reform measures that may be adopted in the future could have a
material adverse effect on our industry generally and on our ability to successfully commercialize our product candidates or could limit or eliminate our future spending on development projects.
In addition to the Healthcare Reform Act, there will continue to be proposals by legislators at both the federal and state levels, regulators
and third-party payors to keep these costs down while expanding individual healthcare benefits. Certain of these changes could impose limitations on the prices we will be able to charge for ADASUVE or any other product candidates that are approved
or the amounts of reimbursement available for these products from governmental agencies or third-party payors, or may increase the tax obligations on life sciences companies such as ours. While it is too early to predict specifically what effect the
Health Reform Act and its implementation or any future legislation or policies will have on our business, we believe that healthcare reform may have an adverse effect on our business and financial condition.
If we or any collaborator fail to comply with reporting and payment obligations under the Medicaid Drug Rebate program or other
governmental pricing programs, including programs developed by countries outside the United States, after we or any collaborator begin to participate in such programs, we or any collaborator could be subject to additional reimbursement requirements,
penalties, sanctions and fines which could have a material adverse effect on our business, financial condition, results of operations and growth prospects.
We expect to participate, or any collaborator to participate, in the Medicaid Drug Rebate program, established by the Omnibus Budget
Reconciliation Act of 1990 and amended by the Veterans Health Care Act of 1992 as well as subsequent legislation. We also expect to participate, or any collaborator to participate, in and have certain price reporting obligations to several state
Medicaid supplemental rebate programs, and we anticipate that we will have obligations to report average sales price, or ASP, for the Medicare program for future product candidates. Under the Medicaid Drug Rebate program, we will be required to pay
a rebate to each state Medicaid program for our covered outpatient drugs that are dispensed to Medicaid beneficiaries and paid for by a state Medicaid program as a condition of having federal funds being made available to the states for our drugs
under Medicaid and Medicare Part B. Those rebates will be based on pricing data that we will report on a monthly and quarterly basis to CMS, the federal agency that administers the Medicaid Drug Rebate program. These data will include the average
manufacturer price, or AMP, and, in the case of innovator products, the best price, or BP, for each drug. The rebate liability resulting from this reporting will negatively impact our financial results.
The PPACA made significant changes to the Medicaid Drug Rebate program. Effective March 23, 2010, rebate liability expanded from
fee-for-service Medicaid utilization to include the utilization of Medicaid managed care organizations as well. With regard to the amount of the rebates owed, the PPACA increased the minimum Medicaid rebate from 15.1% to 23.1% of the average
manufacturer price for most innovator products and from 11% to 13% for non-innovator products; changed the calculation of the rebate for certain innovator products that qualify as line extensions of existing drugs; and capped the total rebate amount
for innovator drugs at 100% of the average manufacturer price. We expect that the increased minimum rebate of 23.1% will apply to ADASUVE. In addition, the PPACA and subsequent legislation changed the definition of AMP. Finally, the PPACA requires
pharmaceutical manufacturers of branded prescription drugs to pay a new branded prescription drug fee to the federal government beginning in 2011. Each individual pharmaceutical manufacturer will pay a prorated share of the branded prescription drug
fee of $3.0 billion in 2014 (and set to increase in ensuing years) based on the dollar value of its branded prescription drug sales to certain federal programs identified in the law. Additional provisions of the Healthcare Reform Act, some of which
became effective in 2011, may negatively affect our future revenues.
On July 15, 2013, CMS issued its Final Rule addressing
prescription drug coverage for the Medicaid expansion population under the PPACA. The Final Rule dramatically restricts mandatory coverage of prescription drugs for the expansion Medicaid enrollees by essentially eliminating the requirement that
states must cover each covered outpatient drug subject to a national rebate agreement. Although drugs provided to the new Medicaid expansion population still are subject to manufacturer rebates, state Medicaid programs are no longer required to
cover all drugs subject to the national rebate agreement. Instead, states are required to cover a minimum of drugs consistent with the applicable benchmark plan in the state coverage for the Medicaid expansion population.
In the future, Congress could enact legislation that further increases Medicaid drug rebates or other costs and charges associated with
participating in the Medicaid Drug Rebate program. The issuance of regulations and coverage expansion by various governmental agencies relating to the Medicaid Drug Rebate program will increase our costs and the complexity of compliance, will be
time-consuming, and could have a material adverse effect on our results of operations.
Federal law requires that any company that
participates in the Medicaid Drug Rebate Program also participate in the Public Health Services 340B drug pricing discount program in order for federal funds to be available for the manufacturers drugs under Medicaid and Medicare Part B.
The 340B pricing program requires participating manufacturers to agree to charge statutorily-defined
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covered entities no more than the 340B ceiling price for the manufacturers covered outpatient drugs. These 340B covered entities include a variety of community health clinics
and other entities that receive health services grants from the Public Health Service, as well as hospitals that serve a disproportionate share of low-income patients. The 340B ceiling price is calculated using a statutory formula, which is based on
the average manufacturer price and rebate amount for the covered outpatient drug as calculated under the Medicaid rebate program. Changes to the definition of average manufacturer price and the Medicaid rebate amount under PPACA and CMSs
issuance of final regulations implementing those changes also could affect our 340B ceiling price calculations and negatively impact our results of operations once we or any collaborator begin to participate in the 340B program.
Compliance with the regulations associated with the 340B program will increase our costs and the complexity of compliance, will be
time-consuming, and could have a material adverse effect on our results of operations once we or any collaborator begin to participate in the 340B program.
As described above, the Healthcare Reform Act expanded the 340B program to include additional types of covered entities but exempts
orphan drugs those designated under section 526 of the FDCA from the ceiling price requirements for these newly-eligible entities. We believe our product candidate in active development, AZ-002 (
Staccato
alprazolam),
could qualify for orphan drug status. HRSA issued a final regulation to implement the orphan drug exception in July 2013. The final regulation interprets the orphan drug exception narrowly. It exempts orphan drugs from the ceiling price requirements
for the newly-eligible entities only when the orphan drug is used for its orphan indication. The newly-eligible entities are entitled to purchase orphan drugs at the ceiling price when the orphan drug is not used for its orphan indication. The final
regulation, which became effective October 1, 2013, is subject to a pending lawsuit that seeks to block its implementation. The narrow scope of the orphan drug exception in HRSAs final regulation will increase the complexity of
compliance, will make compliance more time-consuming, and could negatively impact our results of operations if we successfully commercialize AZ-002 (
Staccato
alprazolam) and AZ-002 qualifies for orphan drug status.
The Healthcare Reform Act also obligates the Secretary of the HHS to create regulations and processes to improve the integrity of the 340B
program and to update the agreement that manufacturers must sign to participate in the 340B program to obligate a manufacturer to offer the 340B price to covered entities if the manufacturer makes the drug available to any other purchaser at any
price and to report to the government the ceiling prices for its drugs. HRSA is expected to issue a comprehensive proposed regulation in 2014 that will address many aspects of the 340B program. When that regulation is finalized, it could affect our
obligations under the 340B program in ways we cannot anticipate. In addition, legislation may be introduced that, if passed, would further expand the 340B program to additional covered entities or would require participating manufacturers to agree
to provide 340B discounted pricing on drugs used in the inpatient setting.
Federal law also requires that a company that participates in
the Medicaid Drug Rebate Program report average sales price, or ASP, information to CMS for certain categories of drugs that are paid under Part B of the Medicare program. We anticipate that ADASUVE will fall into that category. Manufacturers
calculate ASP based on a statutorily defined formula and interpretations of the statute by CMS as to what should or should not be considered in computing ASP. An ASP for each National Drug Code for a product that is subject to the ASP reporting
requirement must be submitted to CMS no later than 30 days after the end of each calendar quarter. CMS uses these submissions to determine payment rates for drugs under Medicare Part B. Once we or any collaborator begin to participate in the
Medicare program, changes affecting the calculation of ASP could affect the ASP calculations for our products and the resulting Medicare payment rate, and could negatively impact our results of operations once we begin to participate in the Medicare
program.
Pricing and rebate calculations vary among products and programs. The calculations are complex and are often subject to
interpretation by governmental or regulatory agencies and the courts. Once we or any collaborator begin to participate in the Medicaid program, the Medicaid rebate amount will be computed each quarter based on our submission to the CMS of our
current AMP and BP for the quarter. If we become aware that our reporting for prior quarters was incorrect, or has changed as a result of recalculation of the pricing data, we or any collaborator will be obligated to resubmit the corrected data for
a period not to exceed 12 quarters from the quarter in which the data originally were due. Such restatements and recalculations would serve to increase our costs for complying with the laws and regulations governing the Medicaid rebate program. Once
we begin to participate in the Medicaid program, any corrections to our rebate calculations could result in an overage or underage in our rebate liability for past quarters, depending on the nature of the correction. Price recalculations also may
affect the price that we or any collaborator will be required to charge certain safety-net providers under the Public Health Service 340B drug discount program.
Once we or any collaborator begin to participate in government pricing programs, we or any collaborator will be liable for errors associated
with our submission of pricing data. In addition to retroactive rebates and the potential for 340B program refunds, if we or any collaborator are found to have knowingly submitted false average manufacturer price, average sales price, or best price
information to the government, we or any collaborator may be liable for civil monetary penalties in the amount of $100,000 per item of false information. If a manufacturer is found to have made a misrepresentation in the reporting of ASP, the
statute provides for civil monetary penalties of up to $10,000 for each misrepresentation for each day in which the misrepresentation was applied. Failure to submit monthly/quarterly average manufacturer price, average sales price, and best price
data on a timely basis could result in a civil monetary penalty of $10,000 per day
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for each day the information is late beyond the due date. In the event that CMS were to terminate our rebate agreement after we or any collaborator begin to participate in the Medicaid program,
no federal payments would be available under Medicaid or Medicare Part B for our covered outpatient drugs.
In September 2010, CMS and the
Office of the Inspector General indicated that they intend to pursue more aggressively companies who fail to report these data to the government in a timely manner. Governmental agencies may also make changes in program interpretations, requirements
or conditions of participation, some of which may have implications for amounts previously estimated or paid. We cannot assure you that our or any collaborators submissions, once we or any collaborator begin to submit pricing data to CMS, will
not be found by CMS to be incomplete or incorrect.
Federal law requires that for a company to be eligible to have its products paid for
with federal funds under the Medicaid and Medicare Part B programs, as well as to be purchased by certain federal agencies and grantees, it also must participate in the Department of Veterans Affairs (VA) Federal Supply Schedule, or FSS, pricing
program. To participate, we or any collaborator will be required to enter into an FSS contract with the VA, under which we must make our innovator covered drugs, such as ADASUVE or other product candidates, available to the Big
Four federal agencies the VA, the Department of Defense, or DoD, the Public Health Service, and the Coast Guard at pricing that is capped pursuant to a statutory federal ceiling price, or FCP, formula set forth in
Section 603 of the Veterans Health Care Act of 1992, or VHCA. The FCP is based on a weighted average wholesaler price known as the non-federal average manufacturer price, or Non-FAMP, which manufacturers are required to report on a
quarterly and annual basis to the VA. If a company misstates Non-FAMPs or FCPs it must restate these figures. Pursuant to the VHCA, knowing provision of false information in connection with a Non-FAMP filing can subject a manufacturer to penalties
of $100,000 for each item of false information.
FSS contracts are federal procurement contracts that include standard government terms
and conditions, separate pricing for each product, and extensive disclosure and certification requirements. All items on FSS contracts are subject to a standard FSS contract clause that requires FSS contract price reductions under certain
circumstances where pricing is reduced to an agreed tracking customer. Further, in addition to the Big Four agencies, all other federal agencies and some non-federal entities are authorized to access FSS contracts. FSS
contractors are permitted to charge FSS purchasers other than the Big Four agencies negotiated pricing for covered drugs that is not capped by the FCP; instead, such pricing is negotiated based on a mandatory disclosure of the
contractors commercial most favored customer pricing. We cannot anticipate the pricing structure we will enter into with respect to our products. The FSS contract price may have a material adverse effect on future revenues from
sales of ADASUVE.
Once we or any collaborator enter into an FSS contract, if we or any collaborator overcharge the government in
connection with the FSS contract, whether due to a misstated FCP or otherwise, we or any collaborator will be required to refund the difference to the government. Failure to make necessary disclosures and/or to identify contract overcharges could
result in allegations under the Federal False Claims Act and other laws and regulations. Unexpected refunds to the government, and responding to a government investigation or enforcement action, would be expensive and time-consuming, and could have
a material adverse effect on our business, financial condition, results of operations and growth prospects.
If we or any
collaborators fail to gain market acceptance among physicians, patients, third-party payors and the medical community, we will not become profitable.
The
Staccato
system is a fundamentally new method of drug delivery. ADASUVE or any future product based on our
Staccato
system
may not gain market acceptance among physicians, patients, third-party payors and the medical community. If these products do not achieve an adequate level of acceptance, we will not meet our revenue guidance nor will we generate sufficient product
or royalty revenues to become profitable. The degree of market acceptance of ADASUVE or any of our product candidates, if approved for commercial sale, will depend on a number of factors, including:
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the ability of our collaborators sales forces to convince potential purchasers of ADASUVEs advantages over other treatments;
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demonstration of acceptable quality, safety and efficacy in clinical trials and meeting applicable regulatory standards for approval;
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the existence, prevalence and severity of any side effects;
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potential or perceived advantages or disadvantages compared to alternative treatments;
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therapeutic or other improvements of ADASUVE over existing or future drugs used to treat the same or similar conditions;
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perceptions about the relationship or similarity between ADASUVE or our product candidates and the parent drug compound upon which ADASUVE or our product candidate is based;
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the timing of market entry relative to competitive treatments;
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the ability to produce ADASUVE or any future products in commercial quantities at an acceptable cost, or at all;
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the ability to offer ADASUVE or any future products for sale at competitive prices;
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relative convenience, product dependability and ease of administration;
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the restrictions imposed on ADASUVE by the REMS program and labeling requirements;
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the strength of marketing and distribution support;
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acceptance by patients, the medical community or third-party payors;
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the sufficiency of coverage and reimbursement of ADASUVE or our product candidates by governmental and other third-party payors; and
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the product labeling, including the package insert, and the marketing restrictions required by the FDA or regulatory authorities in other countries.
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We are subject to significant ongoing regulatory obligations and oversight, which may result in significant additional expense and limit
our and our collaborators ability to commercialize our products.
We and our collaborators are subject to significant ongoing
regulatory obligations, such as safety reporting requirements, periodic and annual reporting requirements, and regulatory oversight of the promotion and marketing of our products. In addition, the manufacture, labeling, packaging, distribution,
import, export, adverse event reporting, storage, advertising, promotion and recordkeeping for ADASUVE and any of our product candidates that may be approved by the FDA or foreign regulatory authorities will be subject to extensive and ongoing
regulatory requirements. Teva has agreed to take responsibility at its expense to complete several post-marketing requirements that were a condition to FDA approval of ADASUVE, including the responsibility for conducting a 10,000 patient
observational clinical trial designed to gather patient safety data based on the real-world use of ADASUVE, as well as a clinical program addressing the safety and efficacy of ADASUVE in agitated adolescent patients. As a condition of grant of EU
marketing authorization for ADASUVE by the EC, we are responsible for the conduct and funding of post-authorization studies, including (i) a benzodiazepine interaction study, which has been completed, (ii) a controlled study to determine
ADASUVEs effect on cardiac rhythms, or a thorough QTc study, with two doses of ADASUVE, which has been completed, (iii) a clinical program designed to evaluate the safety and efficacy of ADASUVE in agitated adolescent patients,
(iv) an observational clinical trial, and (v) a drug utilization clinical trial.
The FDA and foreign regulatory authorities may
also impose significant restrictions on the indicated uses or marketing of our future products, or impose requirements for burdensome post-approval study commitments. For example, ADASUVEs U.S. labeling contains a boxed warning
regarding the risks of bronchospasm caused by the product and the increased risk of death for elderly patients with dementia-related psychosis. Boxed warnings are used to highlight warning information that is especially important to the prescriber.
Products with boxed warnings are subject to more restrictive advertising and promotion regulations than products without such warnings. The terms of any product approval, including labeling, may be more restrictive than we desire and could affect
the commercial potential of the product. If we become aware of previously unknown problems with any of our products in the United States or overseas or at our contract manufacturers facilities, a regulatory agency may impose labeling changes
or restrictions on our products, our collaborators, our manufacturers or on us. In such an instance, we could experience a significant drop in the sales of the affected products, our product revenues and reputation in the marketplace may suffer, and
we could become the target of lawsuits.
The FDA and other governmental authorities, including foreign regulatory authorities, also
actively enforce regulations prohibiting off-label promotion, and governments have levied large civil and criminal fines against companies for alleged improper promotion. Governments have also required companies to enter into corporate integrity
agreements and/or non-prosecution agreements that impose significant reporting and other burdens on the affected companies.
We and our
commercial collaborators are also subject to regulation by regional, national, state and local agencies, including the Drug Enforcement Administration, or DEA, the Department of Justice, the Federal Trade Commission, the Office of Inspector General
of the U.S. Department of Health and Human Services and other regulatory bodies, as well as governmental authorities in those foreign countries in which we may in the future commercialize our products. The FDCA, the Public Health Service Act, the
Social Security Act, and other federal and state statutes and regulations govern to varying degrees the research, development, manufacturing and commercial activities relating to prescription pharmaceutical products, including preclinical testing,
approval, production, labeling, sale, distribution, import, export, post-market surveillance, advertising, dissemination of information, promotion, marketing, and pricing to government purchasers and government healthcare programs. Any
manufacturing, licensing, or commercialization collaborators we have or may in the future have, including Teva and Ferrer, will be subject to many of the same requirements.
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The Federal Anti-Kickback Statute prohibits, among other things, knowingly and willfully
offering, paying, soliciting, or receiving remuneration to induce or in return for purchasing, leasing, ordering or arranging for the purchase, lease or order of any healthcare item or service reimbursable under Medicare, Medicaid or other federally
financed healthcare programs. This statute has been interpreted to apply to arrangements between pharmaceutical companies on one hand and prescribers, purchasers and formulary managers on the other. Further, the Healthcare Reform Act, among other
things, amends the intent requirement of the Federal Anti-Kickback Statute. A person or entity no longer needs to have actual knowledge of this statute or specific intent to violate it. In addition, the Healthcare Reform Act provides that the
government may assert that a claim including items or services resulting from a violation of the Federal Anti-Kickback Statute constitutes a false or fraudulent claim for purposes of the false claims statutes. Although there are a number of
statutory exemptions and regulatory safe harbors protecting certain common manufacturer business arrangements and activities from prosecution, the exemptions and safe harbors are drawn narrowly, and practices that involve remuneration may be subject
to scrutiny if they do not qualify for an exemption or safe harbor. We intend to comply with the exemptions and safe harbors whenever possible, but our practices or those of our commercial collaborators may not in all cases meet all of the criteria
for safe harbor protection from anti-kickback liability and may be subject to scrutiny.
The Federal False Claims Act prohibits any person
from knowingly presenting, or causing to be presented, a false claim for payment to the federal government, or knowingly making, or causing to be made, a false statement to get a false claim paid. Many pharmaceutical and other healthcare companies
have been investigated and have reached substantial financial settlements with the federal government under these laws for a variety of alleged marketing activities, including providing free product to customers with the expectation that the
customers would bill federal programs for the product; providing consulting fees, grants, free travel, and other benefits to physicians to induce them to prescribe the companys products; and inflating prices reported to private price
publication services, which are used to set drug payment rates under government healthcare programs. Companies have been prosecuted for causing false claims to be submitted because of the marketing of their products for unapproved uses.
Pharmaceutical and other healthcare companies have also been prosecuted on other legal theories of Medicare and Medicaid fraud.
The
majority of U.S. states also have statutes or regulations similar to the Federal Anti-Kickback Statute and Federal False Claims Act, which apply to items and services reimbursed under Medicaid and other state programs, or, in several states, apply
regardless of the payor. Several states now require pharmaceutical companies to report expenses relating to the marketing and promotion of pharmaceutical products in those states and to report gifts and payments to individual health care providers
in those states. Some of these states also prohibit certain marketing related activities including the provision of gifts, meals, or other items to certain health care providers. In addition, California, Connecticut, Nevada and Massachusetts require
pharmaceutical companies to implement compliance programs or marketing codes.
Compliance with various federal and state laws is difficult
and time consuming, and companies that violate them may face substantial penalties. The potential sanctions include civil monetary penalties, exclusion of a companys products from reimbursement under government programs, criminal fines and
imprisonment. Because of the breadth of these laws and the lack of extensive legal guidance in the form of regulations or court decisions, it is possible that some of our business activities or those of our commercial collaborators could be subject
to challenge under one or more of these laws. Such a challenge could have a material adverse effect on our business and financial condition and growth prospects.
We or our commercial collaborators could become subject to government investigations and related subpoenas. Such subpoenas are often
associated with previously filed qui tam actions, or lawsuits filed under seal under the Federal False Claims Act. Qui tam actions are brought by private plaintiffs suing on behalf of the federal government for alleged Federal False Claims Act
violations. The time and expense associated with responding to such subpoenas, and any related qui tam or other actions, may be extensive, and we cannot predict the results of our review of the responsive documents and underlying facts or the
results of such actions. Responding to government investigations, defending any claims raised, and any resulting fines, restitution, damages and penalties, settlement payments or administrative actions, as well as any related actions brought by
stockholders or other third parties, could have a material impact on our reputation, business and financial condition and divert the attention of our management from operating our business.
The number and complexity of both federal and state laws continues to increase, and additional governmental resources are being added to
enforce these laws and to prosecute companies and individuals who are believed to be violating them. In particular, the Healthcare Reform Act includes a number of provisions aimed at strengthening the governments ability to pursue
anti-kickback and false claims cases against pharmaceutical manufacturers and other healthcare entities, including substantially increased funding for healthcare fraud enforcement activities, enhanced investigative powers, amendments to the False
Claims Act that make it easier for the government and whistleblowers to pursue cases for alleged kickback and false claim violations and, beginning in March 2014 for payments made on or after August 1, 2013, public reporting of payments by
pharmaceutical manufacturers to physicians and teaching hospitals nationwide. While it is too early to predict what effect these changes will have on our business, we anticipate that government scrutiny of pharmaceutical sales and marketing
practices will continue for the foreseeable future and subject us and our commercial collaborators to the risk of government investigations and enforcement actions. Responding to a government investigation or enforcement action would be expensive
and time-consuming, and could have a material adverse effect on our business and financial condition and growth prospects.
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Similar restrictions are imposed on the promotion and marketing of medicinal products in the EU
and other countries. The applicable laws at EU level and in the individual EU Member States require promotional materials and advertising concerning medicinal products to comply with the products Summary of Product Characteristics, or SmPC, as
approved by the competent authorities. The SmPC is the document that provides information to physicians concerning the safe and effective use of a medicinal product. Promotion of a medicinal product which does not comply with the SmPC is considered
to constitute off-label promotion. The off-label promotion of medicinal products is prohibited in the EU. The applicable laws at both EU level and in the individual EU Member States also prohibit the direct-to-consumer advertising of
prescription-only medicinal products. Violations of the rules governing the promotion of medicinal products in the EU could be penalized by administrative measures, fines and imprisonment.
Interactions between pharmaceutical companies and physicians are also governed by strict laws, regulations, industry self-regulation codes of
conduct and physicians codes of professional conduct in the individual EU Member States. The provision of any inducement to physicians to prescribe, recommend, endorse, order, purchase, supply, use or administer a medicinal product is
prohibited. A number of EU Member States have introduced additional rules requiring pharmaceutical companies to publically disclose their interactions with physicians and to obtain approval from employers, professional organizations and/or competent
authorities before entering into agreements with physicians. Violations of these rules could lead to the imposition of fines or imprisonment.
Laws, including those governing promotion, marketing and anti-kickback provisions, industry regulations and professional codes of conduct are
often strictly enforced. Increasing regulatory scrutiny of the promotional activities of pharmaceutical companies has been observed in a number of EU Member States. The Bribery Act in the United Kingdom entered into force on 1 July 2011. This
Act applies to any company incorporated in or carrying on business in the UK, irrespective of where in the world the alleged bribery activity occurs. Even though we strive for complete and continuous adherence to all laws and rules
during our promotion and marketing activities, this Act could have implications for our interactions or those of Ferrer with physicians both in and outside the UK.
Payments made to physicians in certain EU Member States must be publically disclosed and this obligation will expand to other EU Member
States. Moreover, agreements with physicians must often be the subject of prior notification and approval by the physicians employer, his/her competent professional organization, and/or the competent authorities of the individual EU Member
States. These requirements are provided in the national laws, industry codes, or professional codes of conduct, applicable in the EU Member States. Failure to comply with these requirements could result in reputational risk, public reprimands,
administrative penalties, fines or imprisonment. Even in those countries where we are not directly responsible for the promotion and marketing of our products, inappropriate activity by our international distribution collaborators can have
implications for us.
If we or any collaborators fail to comply with applicable federal, state, local, or foreign regulatory requirements,
we or they could be subject to a range of regulatory actions that could affect our or any collaborators ability to commercialize our products and could harm or prevent sales of the affected products, or could substantially increase the costs
and expenses of commercializing and marketing our products. Any threatened or actual government enforcement action could also generate adverse publicity and require that we devote substantial resources that could otherwise be used in other aspects
of our business.
We could be adversely affected by violations of applicable anti-corruption laws such as the U.S. Foreign Corrupt
Practices Act and the U.K. Bribery Act of 2010.
Anti-corruption laws, such as the U.S. Foreign Corrupt Practices Act and the U.K.
Bribery Act of 2010, generally prohibit directly or indirectly giving, offering, or promising anything of value to improperly induce the recipient to act, or refrain from acting, in a manner that would confer a commercial advantage. The anti-bribery
provisions of the U.S. Foreign Corrupt Practices Act generally prohibit directly or indirectly giving, offering or promising an inducement to a public official (broadly interpreted) to corruptly influence the officials actions in order to
obtain a commercial advantage. The U.K. Bribery Act of 2010 prohibits both domestic and international bribery, as well as bribery in both the private and public sectors. In addition, an organization that fails to prevent
bribery by anyone associated with the organization may be charged under the U.K. Bribery Act unless the organization can establish the defense of having implemented adequate procedures to prevent bribery. In recent years, the
U.S. Government has brought enforcement actions that resulted in significant monetary penalties against several multinational healthcare companies for violations of the U.S. Foreign Corrupt Practices Act stemming from illegal payments made to
non-U.S. healthcare professionals. We plan to adopt and implement policies and procedures to ensure that those involved in the marketing, sale, and distribution of our products are both aware of these legal requirements and committed to complying
therewith. However, we cannot assure that these policies and procedures will protect us from potentially illegal acts committed by individual employees or agents. If we were found to be liable for anti-corruption law violations, we could be
subject to criminal or civil penalties or other consequences that could have a material adverse effect on our business and financial condition.
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If we do not establish additional strategic collaborations, we will have to undertake
additional development and future commercialization efforts on our own, which would be costly and delay our ability to commercialize any future products.
An element of our business strategy is our intent to selectively collaborate with pharmaceutical, biotechnology and other companies to obtain
assistance for the development and commercialization of ADASUVE and our product candidates. In October 2011, we entered into the Ferrer Agreement with Ferrer for the commercialization of ADASUVE in the Ferrer Territories. In May 2013, we entered
into a commercial collaboration with Teva, granting Teva an exclusive license to develop and commercialize ADASUVE in the United States. We may never enter into additional strategic collaborations with third parties to develop and commercialize
ADASUVE or our product candidates. Other than Teva and Ferrer, we do not currently have any strategic collaborations for ADASUVE or any of our product candidates.
We face significant competition in seeking appropriate strategic collaborators, and these strategic collaborations can be intricate and time
consuming to negotiate and document. We may not be able to negotiate additional strategic collaborations on acceptable terms, or at all. We are unable to predict when, if ever, we will enter into any additional strategic collaborations because of
the numerous risks and uncertainties associated with establishing strategic collaborations. We are currently seeking collaborations to commercialize ADASUVE outside of the United States and the Ferrer Territories. If we are unable to negotiate
additional strategic collaborations for ADASUVE outside of the United States and the Ferrer Territories, we may be unable to maximize ADASUVEs commercial potential.
If we are unable to negotiate additional collaborations for ADASUVE or our product candidates we may be forced to curtail the development of a
particular candidate, reduce or delay its development program, or one or more of our other development programs, delay its commercialization, or undertake development or commercialization activities at our own expense. In addition, we will bear all
the risk related to the development of a product candidate. If we elect to increase our expenditures to fund development or commercialization activities on our own, we will need to obtain additional capital, which may not be available to us on
acceptable terms, or at all. If we do not have sufficient funds, we will not be able to bring ADASUVE or our product candidates to market successfully and generate revenue or profit.
ADASUVE and any of our product candidates approved for marketing remain subject to ongoing regulatory review in the United States, the
EU or in other countries. If we or any collaborators fail to comply with the regulations, we could lose these approvals, and the sale of any future products could be suspended. If approval is denied or limited in a country, or if a country imposes
post-marketing requirements, that decision could negatively affect our ability to market our product in such countries.
Even with
regulatory approval to market a particular product candidate, the FDA, the EC or another foreign regulatory authority could condition approval on conducting additional costly post-approval studies or trials or could limit the scope of our approved
labeling or could impose burdensome post-approval obligations, such as those required in the United States and in the post-marketing obligations required as part of a marketing authorization in the EU. Moreover, the product may later cause adverse
effects that limit or prevent its widespread use, force us to withdraw it from the market, cause the FDA, the EC or another foreign regulatory authority to impose additional obligations or restriction on marketing, or impede or delay our ability to
obtain regulatory approvals in additional countries. In addition, we will continue to be subject to FDA, EMA, EC and other foreign regulatory authority regulations, as well as periodic inspections to ensure adherence to applicable regulations. After
receiving marketing approval, the FDA, the EC and other foreign regulatory authorities could impose extensive regulatory requirements on the manufacturing, labeling, packaging, adverse event reporting, storage, advertising, promotion, distribution,
and record keeping related to the product. The approval of the ADASUVE NDA requires Teva to implement, administer and assess at regular intervals a REMS program that, among other things, limits the use of ADASUVE to healthcare facilities enrolled in
the ADASUVE REMS program.
As a condition to FDA approval of ADASUVE, Teva also has several post-approval commitments and requirements,
including a 10,000 patient observational clinical trial designed to gather patient safety data based on the real-world use of ADASUVE, as well as a clinical program addressing the safety and efficacy of ADASUVE in agitated adolescent patients.
As a condition to marketing authorization for ADASUVE granted by the EC in the EU, we are responsible for the conduct and funding of
post-marketing studies, including (i) a benzodiazepine interaction study, which has been completed, (ii) a controlled study to determine ADASUVEs effect on cardiac rhythms, or a thorough QTc study, with two doses of ADASUVE, which
has been completed, (iii) a clinical program designed to evaluate the safety and efficacy of ADASUVE in agitated adolescent patients, (iv) an observational clinical study, and (v) a drug utilization study. Results of the
benzodiazepine interaction study and the thorough QTc study have been submitted to the EMA.
The costs associated with development and
approval of study protocols and the completion of studies and clinical trials are significant. There are risks involved with relying on our own capabilities to perform the tasks required by the post-market studies for ADASUVE, as well as with
entering into arrangements with third parties to perform these services. If Teva enters into an arrangement with a third party or parties to perform the tasks required for the ADASUVE post-market studies and trials, the expense of such
outsourcing could be significant, decreasing the profitability of ADASUVE. Additionally, any third party with whom we may
45
collaborate may not fulfill its obligations or carry out activities sufficiently to satisfy FDA, EC, EMA or other U.S. or foreign regulatory authority standards, which could result in increased
expenses needed to remediate any deficiencies or could even result in an FDA, EC, EMA or other U.S. or foreign regulatory authority enforcement action, including the imposition of civil money penalties and the withdrawal of approval of the product
in the U.S. Finally, the data derived from any post-market study or trial could result in additional restrictions on the commercialization of ADASUVE through changes to the approved ADASUVE label, a more burdensome REMS program, the imposition of
additional post-market studies or trials, or could even lead to the withdrawal of the approval of the product.
If we or any collaborators
fail to comply with the regulatory requirements of the FDA, the EMA, the EC or other applicable U.S. and foreign regulatory authorities, or previously unknown problems with any future products, suppliers or manufacturing processes are discovered, we
or our collaborators could be subject to administrative or judicially imposed sanctions, including:
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restrictions on the products, suppliers or manufacturing processes;
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warning letters or untitled letters;
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injunctions, consent decrees, or the imposition of civil or criminal penalties;
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product seizures, detentions or import or export bans;
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voluntary or mandatory product recalls and publicity requirements;
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variation, suspension or withdrawal of regulatory approvals;
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required variations of the clinical trial protocol
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suspension or termination of any clinical trials of the products;
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total or partial suspension of production;
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refusal to approve pending applications for marketing approval of new drugs or supplements to approved applications; and
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denial of permission to file an application or supplement in a jurisdiction.
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If we or our
collaborators were subject to administrative or judicially-imposed sanctions arising out of enforcement of the FDA, EMA, EC or other applicable U.S. and foreign laws, it could impair our ability to manufacture and the ability of our collaborators to
successfully market ADASUVE, even if such an enforcement action does not relate specifically to ADASUVE. Such enforcement could have a significant impact on our financial condition and results.
Problems with the third parties that manufacture the API in ADASUVE or our product candidates may delay our clinical trials or subject
us to liability.
We do not currently own or operate manufacturing facilities for clinical or commercial production of the API used
in ADASUVE or any of our product candidates. We have no experience in API manufacturing, and we lack the resources and the capability to manufacture any of the APIs used in ADASUVE and our product candidates, on either a clinical or commercial
scale. As a result, we rely on third parties to supply the API used in ADASUVE and each of our product candidates. We expect to continue to depend on third parties to supply the API for ADASUVE and our current and future product candidates and to
supply the API for ADASUVE in commercial quantities.
An API manufacturer must meet high precision and quality standards for that API to
meet regulatory specifications and comply with regulatory requirements. A contract manufacturer is subject to ongoing periodic unannounced inspection by the FDA and corresponding state and foreign authorities to ensure strict compliance with cGMP
and other applicable government regulations and corresponding foreign standards. Additionally, a contract manufacturer must pass a pre-approval inspection by the FDA and corresponding foreign authorities to ensure strict compliance with cGMP prior
to the FDAs or corresponding foreign authorities approval of any product candidate for marketing. A contract manufacturers failure to conform to cGMP could result in a refusal by the FDA or a corresponding foreign authority to
approve or a delay in their approval of a product candidate for marketing. We are ultimately responsible for confirming that the APIs used in ADASUVE and our product candidates are manufactured in accordance with applicable regulations.
Our third-party suppliers may not carry out their contractual obligations or meet our deadlines. In addition, the API they supply to us may
not meet our specifications and quality policies and procedures or they may not be able to supply the API in commercial quantities. If we need to find alternative suppliers of the API used in ADASUVE or any of our product candidates, we may not be
able to contract for such supplies on acceptable terms, if at all. Any such failure to supply or delay caused by such contract manufacturers would have an adverse effect on our ability to continue clinical development of our product candidates or
commercialize ADASUVE.
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If our third-party drug suppliers fail to achieve and maintain high manufacturing standards in
compliance with cGMP regulations, we could be subject to certain product liability claims in the event such failure to comply resulted in defective products that caused injury or harm.
Unless our preclinical studies demonstrate an acceptable safety profile of our product candidates, we will not be able to pursue
clinical development or commercialize our product candidates.
We must satisfy the FDA and other regulatory authorities abroad,
through extensive preclinical studies, that our product candidates have an acceptable safety profile. Our
Staccato
system creates a condensation aerosol from drug compounds, and there currently are no approved products that use a similar
method of drug delivery other than ADASUVE. Companies developing other inhalation products have not defined or successfully completed the types of preclinical studies we believe will be required for submission to regulatory authorities as we seek
approval to conduct our clinical trials. We may not have conducted or may not conduct in the future the types of preclinical testing ultimately required by regulatory authorities, or future preclinical tests may indicate that our product candidates
are not safe for use in humans. Preclinical testing is expensive, can take many years and has an uncertain outcome. In addition, success in initial preclinical testing does not ensure that later preclinical testing will be successful.
We may experience numerous unforeseen events during, or as a result of, the preclinical testing process, which could delay or prevent our
ability to develop or commercialize our product candidates, including:
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our preclinical testing may produce inconclusive or negative safety results, which may require us to conduct additional preclinical testing or to abandon product candidates that we believed to be promising;
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our product candidates may have unfavorable pharmacology, toxicology or carcinogenicity; and
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our product candidates may cause undesirable side effects.
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Any such events would increase our
costs and could delay or prevent our ability to conduct clinical testing and commercialize our product candidates, which could adversely impact our business, financial condition and results of operations.
Failure or delay in commencing or completing clinical trials for our product candidates could harm our business.
Other than for ADASUVE, we have not completed all the clinical trials necessary to support an application with the FDA or other regulatory
authorities abroad for approval to market any of our product candidates other than for ADASUVE in the United States and the European Union. Future clinical trials may be delayed or terminated as a result of many factors, including:
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insufficient financial resources to fund such trials;
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delays or failure in reaching agreement on acceptable clinical trial contracts or clinical trial protocols with prospective sites;
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regulators, Ethics Committees or institutional review boards may not authorize us to commence a clinical trial;
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regulators, Ethics Committees or institutional review boards may suspend or terminate clinical research for various reasons, including noncompliance with regulatory requirements or concerns about patient safety;
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we may suspend or terminate our clinical trials if we believe that they expose the participating patients to unacceptable health risks;
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we may experience slower than expected patient enrollment or lack of a sufficient number of patients who meet the enrollment criteria for our clinical trials;
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patients may not complete clinical trials due to safety issues, side effects, dissatisfaction with the product candidate, or other reasons;
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we may have difficulty in maintaining contact with patients after treatment, preventing us from collecting the data required by our study protocol;
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product candidates may demonstrate a lack of efficacy during clinical trials;
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we may experience governmental or regulatory delays, failure to obtain regulatory approval or changes in regulatory requirements, policy and guidelines; and
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we may experience delays in our ability to manufacture clinical trial materials in a timely manner as a result of ongoing process and design enhancements to our
Staccato
system.
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Any delay in commencing or completing clinical trials for our product candidates could delay commercialization of our product candidates and
harm our business, financial condition and results of operations. It is possible that none of our product candidates will successfully complete clinical trials or receive regulatory approval, which would severely harm our business, financial
condition and results of operations.
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If our product candidates do not meet safety and efficacy endpoints in clinical trials,
they will not receive regulatory approval, and we will be unable to market them.
The clinical development and regulatory approval
process is extremely expensive and takes many years. Prior clinical trial program designs and results are not necessarily predictive of future clinical trial designs or results. Initial results may not be confirmed upon full analysis of the detailed
results of a trial. Product candidates in later stage clinical trials may fail to show the desired safety and efficacy despite having progressed through initial clinical trials with acceptable endpoints. Whether an approval will be granted, and the
timing of such approval cannot be accurately predicted. If we fail to obtain regulatory approval for ADASUVE in markets outside of the United States and the Ferrer Territories or for our other product candidates in any markets where we seek
regulatory approval, we will be unable to market and sell them in those locations and therefore we may never be profitable.
As part of
the regulatory process, we must conduct clinical trials for each product candidate to demonstrate safety and efficacy to the satisfaction of the FDA, the EMA, the EC and other regulatory authorities abroad. The number and design of clinical trials
that will be required varies depending on the product candidate, the condition being evaluated, the trial results and regulations applicable to any particular product candidate. In June 2008, we announced that our Phase 2a proof-of-concept clinical
trial of AZ-002 (
Staccato
alprazolam) did not meet either of its two primary endpoints. In September 2009, we announced that our Phase 2b clinical trial of
AZ-104
(
Staccato
loxapine, low-dose)
for the treatment of migraine did not meet its primary endpoint.
If our product candidates fail to show a clinically significant
benefit compared to placebo, they will not be approved for marketing.
The design of our clinical trials is based on many
assumptions about the expected effect of our product candidates, and if those assumptions prove incorrect, the clinical trials may not produce statistically significant results. For example, in 2008 we released the preliminary results from our Phase
2a clinical trial with AZ-002 in patients with panic disorder, a separate indication from our current AZ-002 indication of ARS. The study did not meet its two primary endpoints, which were the effect of AZ-002 on the incidence of a doxapram-induced
panic attack and the effect of AZ-002 on the duration of a doxapram-induced panic attack, both as compared with placebo. Our
Staccato
system is not similar to other approved drug delivery methods, and there is no precedent for the application
of detailed regulatory requirements to our product candidates. We cannot assure you that the design of, or data collected from, the clinical trials of our product candidates will be sufficient to support the FDA, the EC and other foreign regulatory
approvals.
Regulatory authorities may not approve our product candidates even if they meet safety and efficacy endpoints in
clinical trials.
The FDA, the EC and other foreign regulatory agencies can delay, limit or deny marketing approval for many
reasons, including:
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a product candidate may not be considered to have a favorable risk-benefit ratio;
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the manufacturing processes or facilities we have selected may not meet the applicable requirements; and
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changes in their approval policies or adoption of new regulations may require additional work on our part.
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Part of the regulatory approval process includes compliance inspections of manufacturing facilities to ensure adherence to applicable
regulations and guidelines. The regulatory agency may delay, limit or deny marketing approval of our other product candidates as a result of such inspections. Any delay in, or failure to receive or maintain, approval for any of our product
candidates could prevent us from ever generating meaningful revenues or achieving profitability.
Our product candidates may not be
approved even if they achieve their endpoints in clinical trials. Regulatory agencies, including the FDA, the EMA, the EC or their advisors may disagree with our trial design and our interpretations of data from preclinical studies and clinical
trials. Regulatory agencies may change requirements for approval even after a clinical trial design has been approved. For example, ADASUVE and our other product candidates combine drug and device components in a manner that the FDA considers to
meet the definition of a combination product under FDA regulations. The FDA exercises significant discretion over the regulation of combination products, including the discretion to require separate marketing applications for the drug and device
components in a combination product. ADASUVE and our product candidates are being regulated as drug products under the NDA process administered by the FDA. The FDA could in the future require additional regulation of ADASUVE or our product
candidates under the medical device provisions of the FDCA. Our systems are designed to comply with the QSR, which sets forth the FDAs cGMP requirements for medical devices, and other applicable government regulations and corresponding foreign
standards. If we fail to comply with these regulations, it could have a material adverse effect on our business and financial condition.
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Regulatory agencies also may approve a product candidate for fewer or more limited indications
than requested or may grant approval subject to the performance of post-marketing studies, such as the FDAs requirement that we perform a Phase 4 observational study and a study in adolescent patients for ADASUVE. Similarly, as a condition to
EC approval of ADASUVE, we are responsible for the conduct and funding of post-authorization studies, including (i) a benzodiazepine interaction study, which has been completed, (ii) a controlled study to determine ADASUVEs effect on
cardiac rhythms, or a thorough QTc study, with two doses of ADASUVE, which has been completed, (iii) a clinical program designed to evaluate the safety and efficacy of ADASUVE in agitated adolescent patients, (iv) an observational clinical
study, and (v) a drug utilization study. In addition, regulatory agencies may not approve the labeling claims that are necessary or desirable for the successful commercialization of our product candidates.
We rely on third parties to conduct our preclinical studies and our clinical trials. If these third parties do not perform as
contractually required or expected, we may not be able to obtain regulatory approval for our product candidates, or we may be delayed in doing so.
We rely on third parties, such as contract research organizations, medical institutions, academic institutions, clinical investigators and
contract laboratories, to conduct our preclinical studies and clinical trials. We are responsible for confirming that our preclinical studies are conducted in accordance with applicable regulations and that each of our clinical trials is conducted
in accordance with its general investigational plan and protocol. The FDA requires us to comply with regulations and standards, commonly referred to as good laboratory practices, or GLP, for conducting and recording the results of our preclinical
studies and with good clinical practices, or GCP, for conducting, monitoring, recording and reporting the results of clinical trials, to assure that data and reported results are accurate and that the clinical trial participants are adequately
protected. Our reliance on third parties does not relieve us of these responsibilities. If the third parties conducting our clinical trials do not perform their contractual duties or obligations, do not meet expected deadlines, fail to comply with
the FDAs GLP or GCP regulations and standards, do not adhere to our clinical trial protocols or otherwise fail to generate reliable clinical data, we may need to enter into new arrangements with alternative third parties and our clinical
trials may be extended, delayed or terminated or may need to be repeated, and we may not be able to obtain regulatory approval for or commercialize the product candidate being tested in such trials.
If we experience problems with the manufacturers of components of ADASUVE or our product candidates, our ability to supply ADASUVE and
our other product candidates will be impaired, our sales may be lower than expected and our development programs may be delayed and we may be subject to liability.
We outsource the manufacturing of the components of our
Staccato
system, including the printed circuit boards, the plastic airways, and
the chemical heat packages to be used in our commercial single dose device. We have no experience in the manufacturing of components, other than our chemical heat packages, and we currently lack the resources and the capability to manufacture them,
on either a clinical or commercial scale. As a result, we rely on third parties to supply these components. We expect to continue to depend on third parties to supply these components for ADASUVE and our current product candidates and any devices
based on the
Staccato
system we develop in the foreseeable future.
The third-party suppliers of the components of our
Staccato
system must meet high precision and quality standards for our finished devices to comply with regulatory requirements. A contract manufacturer is subject to ongoing periodic unannounced inspection by the FDA and corresponding state and foreign
authorities to ensure that our finished devices remain in strict compliance with the QSR, and other applicable government regulations and corresponding foreign standards. We are ultimately responsible for confirming that the components used in the
Staccato
system are manufactured in accordance with specifications, standards and procedures necessary to ensure that our finished devices comply with the QSR or other applicable regulations.
Our third party suppliers may not comply with their contractual obligations or meet our deadlines, or the components they supply to us may not
meet our specifications and quality policies and procedures. If we need to find alternative suppliers of the components used in the
Staccato
system, we may not be able to contract for such components on acceptable terms, if at all. Any such
failure to supply or delay caused by such contract manufacturers would have an adverse effect on our ability to manufacture commercial quantities of ADASUVE and on our ability to continue clinical development of our product candidates or
commercialize ADASUVE. In April 2014, we contracted with Autoliv to build two additional manufacturing cells, but we or a third party may not be able to use the cells to manufacture heat packages of sufficient quality, in sufficient quantity or at
low enough cost to become profitable.
In addition, the heat packages used in the single dose version of our
Staccato
system are
manufactured using certain energetic, or highly combustible, materials that are used to generate the rapid heating necessary for vaporizing the drug compound while avoiding degradation. Manufacture of products containing energetic materials is
regulated by the U.S. government. We have entered into a manufacture agreement with Autoliv for the manufacture of the heat packages in the commercial design of our single dose version of our
Staccato
system. If Autoliv fails to manufacture
the heat packages to the necessary specifications, or does not carry out its contractual obligations to supply our heat packages to us, or if the FDA requires different manufacturing or quality standards than those set forth in our manufacture
agreement, our clinical trials or commercialization efforts may be delayed, suspended or terminated while we seek additional suitable manufacturers of
49
our heat packages, which may prevent us from commercializing ADASUVE or our product candidates that utilize the single dose version of the
Staccato
system. In October 2013, Autoliv
notified us of their intent to terminate, effective October 2016, the Manufacture Agreement. Prior to October 2016, Autoliv and we remain fully obligated to perform pursuant to the terms of both the Manufacture Agreement and the New Note. However,
Autoliv may not continue to perform its obligations in the same manner during the termination period. If we are unable to secure an adequate replacement manufacturer for sufficient quantities of the chemical heat packages in ADASUVE or if the costs
for such manufacturer to produce the chemical heat packages are higher than the cost from Autoliv, it will significantly impact our ability to produce our commercial devices or to produce them at quantities or at a cost to allow us to become
profitable.
Product candidates that we may develop may require expensive carcinogenicity tests.
We combine small molecule drugs with our
Staccato
system to create proprietary product candidates. Some of these drugs may not have
previously undergone carcinogenicity testing that is now generally required for marketing approval. We may be required to perform carcinogenicity testing with product candidates incorporating drugs that have not undergone carcinogenicity testing or
may be required to do additional carcinogenicity testing for drugs that have undergone such testing. Any carcinogenicity testing we are required to complete will increase the costs to develop a particular product candidate and may delay or halt the
development of such product candidate.
If some or all of our patents expire, are invalidated or are unenforceable, or if some or
all of our patent applications do not yield issued patents or yield patents with narrow claims, competitors may develop competing products using our or similar intellectual property and our business will suffer.
Our success will depend in part on our ability to obtain and maintain patent and trade secret protection for our technologies, ADASUVE and our
product candidates both in the United States and other countries. We do not know whether any patents will issue from any of our pending or future patent applications. In addition, a third party may successfully circumvent our patents. Our rights
under any issued patents may not provide us with sufficient protection against competitive products or otherwise cover commercially valuable products or processes.
The degree of protection for our proprietary technologies, ADASUVE and our product candidates is uncertain because legal means afford only
limited protection and may not adequately protect our rights or permit us to gain or keep our competitive advantage. For example:
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we might not have been the first to make the inventions covered by each of our pending patent applications and issued patents;
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we might not have been the first to file patent applications for these inventions;
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others may independently develop similar or alternative technologies or duplicate any of our technologies;
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the claims of our issued patents may be narrower than as filed and not sufficiently broad to prevent third parties from circumventing them;
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it is possible that none of our pending patent applications will result in issued patents;
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we may not develop additional proprietary technologies or drug candidates that are patentable;
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our patent applications or patents may be subject to interference, opposition or similar administrative proceedings;
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any patents issued to us or our potential strategic collaborators may not provide a basis for commercially viable products or may be challenged by third parties in the course of litigation or administrative proceedings
such as reexaminations or interferences; and
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the patents of others may have an adverse effect on our ability to do business.
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On
September 16, 2011, the Leahy-Smith America Invents Act, or the Leahy-Smith Act, was signed into law. The Leahy-Smith Act includes a number of significant changes to U.S. patent law. These include provisions that affect the way patent
applications will be prosecuted and may also affect patent litigation. The United States Patent and Trademark Office has developed regulations and procedures to govern administration of the Leahy-Smith Act, but many of the substantive changes
to patent law associated with the Leahy-Smith Act, particularly the first inventor to file provisions, only became effective 18 months after its enactment. Accordingly, it is not clear what, if any, impact the Leahy-Smith Act will have on the
operation of our business. However, the Leahy-Smith Act and its implementation could increase the uncertainties and costs surrounding the prosecution of our patent applications and the enforcement or defense of our issued patents, all of which could
have a material adverse effect on our business and financial condition.
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Even if valid and enforceable patents cover ADASUVE, our product candidates and our
technologies, the patents will provide protection only for a limited amount of time.
The Teva Agreement provides Teva with the
first right to enforce certain of the Alexza patents listed in the FDA Orange Book as well as product-specific patents related to ADASUVE that may be identified and prosecuted during the term of the Teva Agreement. While Teva may not settle any such
enforcement action without our consent, there can be no assurance that Teva would enforce the ADASUVE patents in the same manner or with the same strategy as we might if we maintained the sole right to control litigation against potential
third-party infringers. Our current patents or any future patents that may be issued regarding ADASUVE or our product candidates or methods of using them, can be challenged by our competitors who can argue that our patents are invalid and/or
unenforceable. Third parties may challenge our rights to, or the scope or validity of, our patents. Patents also may not protect ADASUVE or our product candidates if competitors devise ways of making these or similar product candidates without
legally infringing our patents. The FDCA and the FDA regulations and policies provide incentives to manufacturers to challenge patent validity or create modified, non-infringing versions of a drug or device in order to facilitate the approval of
generic substitutes. These same types of incentives encourage manufacturers to submit new drug applications that rely on literature and clinical data not prepared for or by the drug sponsor.
Our potential strategic collaborators ability to obtain patents is uncertain because, to date, some legal principles remain unresolved,
there has not been a consistent policy regarding the breadth or interpretation of claims allowed in patents in the United States, and the specific content of patents and patent applications that are necessary to support and interpret patent claims
is highly uncertain due to the complex nature of the relevant legal, scientific and factual issues. Furthermore, the policies governing pharmaceutical and medical device patents outside the United States may be even more uncertain. Changes in either
patent laws or interpretations of patent laws in the United States and other countries may diminish the value of our intellectual property or narrow the scope of our patent protection.
We also rely on trade secrets to protect our technology, especially where we do not believe that patent protection is appropriate or
obtainable. However, trade secrets are difficult to protect. The employees, consultants, contractors, outside scientific collaborators and other advisors of our company and our strategic collaborators may unintentionally or willfully disclose our
confidential information to competitors. Enforcing a claim that a third party illegally obtained and is using our trade secrets is expensive and time consuming and the outcome is unpredictable. Failure to protect or maintain trade secret protection
could adversely affect our competitive business position.
Our research and development collaborators may have rights to publish data and
other information in which we have rights. In addition, we sometimes engage individuals or entities to conduct research that may be relevant to our business. The ability of these individuals or entities to publish or otherwise publicly disclose data
and other information generated during the course of their research is subject to certain contractual limitations. These contractual provisions may be insufficient or inadequate to protect our trade secrets and may impair our patent rights. If we do
not apply for patent protection prior to such publication or if we cannot otherwise maintain the confidentiality of our technology and other confidential information, then our ability to receive patent protection or protect our proprietary
information may be jeopardized.
Litigation or other proceedings or third-party claims of intellectual property infringement could
require us to spend time and money and could shut down some of our operations.
Our commercial success depends in part on not
infringing patents and proprietary rights of third parties. Others have filed, and in the future are likely to file, patent applications covering products that are similar to ADASUVE or our product candidates, as well as methods of making or using
similar or identical products. We are aware of certain pending U.S. patent applications related generally to a systemic respiratory delivery of loxapine. If these patent applications result in issued patents and we wish to use the claimed
technology, we would need to obtain a license from the third party. We may not be able to obtain these licenses at a reasonable cost, if at all.
In addition, administrative proceedings, such as interferences and reexaminations before the U.S. Patent and Trademark Office, could limit the
scope of our patent rights. We may incur substantial costs and diversion of management and technical personnel as a result of our involvement in such proceedings. In particular, our patents and patent applications may be subject to interferences in
which the priority of invention may be awarded to a third party. We do not know whether our patents and patent applications would be entitled to priority over patents or patent applications held by such a third party. Our issued patents may also be
subject to reexamination proceedings. We do not know whether our patents would survive reexamination in light of new questions of patentability that may be raised following their issuance.
Third parties may assert that we are employing their proprietary technology or their proprietary products without authorization. In addition,
third parties may already have or may obtain patents in the future and claim that use of our technologies or our products infringes these patents. We could incur substantial costs and diversion of management and technical personnel in defending
against any of these claims. Furthermore, parties making claims against us may be able to obtain injunctive or other equitable relief, which
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could effectively block our ability to further develop, commercialize and sell any future products and could result in the award of substantial damages against us. In the event of a successful
claim of infringement against us, we may be required to pay damages and obtain one or more licenses from third parties. We may not be able to obtain these licenses at a reasonable cost, if at all. In that event, we could encounter delays in product
introductions while we attempt to develop alternative methods or products. In the event we cannot develop alternative methods or products, we may be effectively blocked from developing, commercializing or selling any future products. Defense of any
lawsuit or failure to obtain any of these licenses would be expensive and could prevent us from commercializing any future products.
We
review from time to time publicly available information concerning the technological development efforts of other companies in our industry. If we determine that these efforts violate our intellectual property or other rights, we intend to take
appropriate action, which could include litigation. Any action we take could result in substantial costs and diversion of management and technical personnel in enforcing our patents or other intellectual property rights against others. Furthermore,
the outcome of any action we take to protect our rights may not be resolved in our favor.
Competition in the pharmaceutical
industry is intense. If our competitors are able to develop and market products that are more effective, safer or less costly than ADASUVE or any future products that we may develop, our commercial opportunity will be reduced or eliminated.
We face competition from established as well as emerging pharmaceutical and biotechnology companies, academic institutions,
government agencies and private and public research institutions. Our commercial opportunity will be reduced or eliminated if our competitors develop and commercialize products that are safer, more effective, have fewer side effects or are less
expensive than ADASUVE or any future products that we may develop and commercialize. In addition, significant delays in the development or commercialization of ADASUVE or our product candidates could allow our competitors to bring products to market
before us and impair our ability to commercialize ADASUVE or our product candidates.
We anticipate that ADASUVE will compete with various
injectable formulations of other antipsychotic and benzodiazepine drugs and oral, orally-disintegrating tablet and liquid formulations of other antipsychotic drugs and benzodiazepine drugs. Only the injectable antipsychotics are approved for the
treatment of agitation.
We anticipate that, if approved, AZ-002 would compete with the oral tablet forms of alprazolam and possibly IV,
oral and rectal forms of other benzodiazepines.
We anticipate that, if approved, AZ-008 would compete with the oral tablet forms of
dopamine agonists that are currently used to treat restless legs symptoms, including benzodiazepines, alpha-2 agonists, dopamine agonists and opioids, none of which are FDA-approved for this indication.
We anticipate that, if approved,
AZ-009
would compete with Apokyn, an apomorphine injection that is
FDA-approved to treat hypomobility, off episodes (end-of-dose wearing off and unpredictable on/off episodes) associated with advanced Parkinsons disease. Patients also use oral tablet forms of dopamine
agonists, including carbidopa/levodopa combinations, ropinirole, pramipexole, as treatment for hypomobility, although these products are not FDA-approved for this indication.
Many of our competitors have significantly greater financial resources and expertise in research and development, manufacturing, preclinical
testing, conducting clinical trials, obtaining regulatory approvals and marketing approved products than we do. Established pharmaceutical companies may invest heavily to discover quickly and develop novel compounds or drug delivery technology that
could make ADASUVE or our product candidates obsolete. Smaller or early stage companies may also prove to be significant competitors, particularly through strategic collaborations with large and established companies. In addition, these third
parties compete with us in recruiting and retaining qualified scientific, sales, marketing, and management personnel, establishing clinical trial sites and patient registration for clinical trials, as well as in acquiring technologies and technology
licenses complementary to our programs or advantageous to our business. Accordingly, our competitors may succeed in obtaining patent protection, receiving FDA approval or discovering, developing and commercializing products before we do. If we are
not able to compete effectively against our current and future competitors, our business will not grow and our financial condition will suffer.
If we lose our key personnel or are unable to attract and retain additional personnel, we may be unable to develop or commercialize
ADASUVE or our product candidates.
We are highly dependent on our President and Chief Executive Officer, Thomas B. King, the loss
of whose services might adversely impact the achievement of our objectives. In addition, recruiting and retaining qualified clinical, scientific and engineering personnel to manage clinical trials of our product candidates and to perform future
research and development work will be critical to our success. There is currently a shortage of skilled executives in our industry, which is likely to continue. As a result, competition for skilled personnel is intense and the turnover rate can be
high. Although we believe we will be successful in attracting and retaining
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qualified personnel, competition for experienced management and clinical, scientific and engineering personnel from numerous companies and academic and other research institutions may limit our
ability to do so on acceptable terms. In addition, we do not have employment agreements with any of our employees, and they could leave our employment at will. We have change of control agreements with our executive officers and vice presidents that
provide for certain benefits upon termination or a change in role or responsibility in connection with a change of control of our company. We do not maintain life insurance policies on any employees. Failure to attract and retain personnel would
prevent us from developing and commercializing ADASUVE and our product candidates.
If plaintiffs bring product liability claims or
lawsuits against us or our collaborators, we may incur substantial liabilities and may be required to limit commercialization of ADASUVE or product candidates that we may develop.
As the supplier of ADASUVE to Teva and Ferrer, we are obligated to deliver commercial supply from a qualified manufacturing facility in
accordance with certain specifications. In addition, we are obligated to supply ADASUVE free from product defects or manufacturing defects from our manufacture of ADASUVE. The development, manufacture, testing, marketing and sale of combination
pharmaceutical and medical device products, like ADASUVE, entail significant risk of product liability claims, lawsuits, safety alerts or recalls. We may be held liable if any product we develop or manufacture causes injury or is found
otherwise unsuitable or unsafe during product testing, manufacturing, marketing or sale, including, but not limited to quality issues, component failures, manufacturing flaws, unanticipated or improper uses of ADASUVE or any future products, design
defects, inadequate disclosure of product-related risks or product-related information, or for unlawful, unfair or fraudulent competition or business practices relating to such products. Side effects of, or design or manufacturing defects in,
the products tested or commercialized by us or any collaborator could result in exacerbation of a clinical trial participant or patients condition, serious injury or impairment or even death. This could result in product liability claims,
lawsuits, safety alerts and/or recalls for ADASUVE or any future products, including those in clinical testing, to be commercialized, or already commercialized. Product liability claims or lawsuits may be brought by individuals seeking relief
for themselves, by persons seeking to represent a class of claimants/plaintiffs, or by a large number of individual claimants in a coordinated or mass litigation. We cannot predict the frequency, outcome, or cost to defend or resolve product
liability claims or lawsuits.
While we have not had to defend against any product liability claims or lawsuits to date, we face greater
risk of product liability claims or lawsuits as we or any collaborator commercialize ADASUVE or other future products. As ADASUVE or any future product is more widely prescribed, we believe it is likely that product liability claims or lawsuits
will eventually be brought against us. Regardless of merit or eventual outcome, such claims or lawsuits may result in decreased demand for any products or product candidates that we may develop, injury to our reputation, withdrawal of clinical
trials, issuance of safety alerts, recall of products under investigation or already commercialized, costs and legal fees to defend and resolve litigation, injunctive relief, disgorgement of profits, or substantial monetary awards to clinical trial
participants or patients, loss of revenue, and the inability to commercialize any products we develop. Safety alerts or recalls could result in the FDA or similar government agencies in the United States, or abroad, investigating or bringing
enforcement actions regarding any products and/or practices, with resulting significant costs and negative publicity, all of which could materially adversely affect us.
Product liability insurance is expensive, can be difficult to obtain and may not be available in the future on acceptable terms, if at
all. We currently have product liability insurance that covers commercial product and clinical trials. Partly as a result of product liability lawsuits related to pharmaceutical and medical device products, product liability and other types of
insurance have become more difficult and costly for pharmaceutical and medical device companies to obtain. Insurance may be prohibitively expensive, or may not fully cover our potential liabilities. Inability to maintain sufficient insurance
coverage at an acceptable cost or otherwise to protect against potential product liability claims or lawsuits could impede or negatively affect the commercialization of ADASUVE or our product candidates. If we are sued for any injury caused by any
product, our liability could exceed our insurance coverage and total assets. In addition, there is no guarantee that insurers will pay for defense and indemnity of claims or lawsuits or that coverage will be adequate or otherwise available.
A successful claim or lawsuit brought against us in excess of available insurance coverage could subject us to significant liabilities and
could have a materially adverse effect on our business, financial condition, results of operations and growth prospects. Such claims could also harm our reputation and the reputation of ADASUVE or any future products, adversely affecting our ability
to develop and market any products successfully. In addition, defending a product liability claim or lawsuit is expensive and can divert the attention of key employees from operating our business.
Product recalls and safety alerts may be issued at our discretion or at the discretion of our suppliers, collaborators, government agencies,
and other entities that have regulatory authority for medical device and pharmaceutical sales. Any recall of ADASUVE could materially adversely affect our business by rendering us unable to sell ADASUVE for some time, causing us to incur
significant recall costs and by adversely affecting our reputation. A recall could also result in product liability claims.
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Our product candidate AZ-002 contains a drug substance that is regulated by the U.S. Drug
Enforcement Administration. Failure to comply with applicable regulations and requirements could harm our business.
The Controlled
Substances Act imposes various registration, recordkeeping and reporting requirements, procurement and manufacturing quotas, labeling and packaging requirements, security controls and a restriction on prescription refills on certain pharmaceutical
products. The DEA regulates drug substances as Schedule I, II, III, IV or V substances, with Schedule I substances considered to present the highest potential for abuse and Schedule V substances the lowest potential for abuse relative to the other
schedules in the CSA. Alprazolam, the API in AZ-002, is regulated as a Schedule IV substance.
AZ-002
is subject to DEA regulations relating to registration, security, record keeping and reporting, distribution
and, if approved, physician prescription procedures, and DEA regulations may impact the availability of the scheduled substance available for clinical trials and commercial distribution. The DEA periodically inspects facilities for compliance with
its rules and regulations. Failure to comply with current and future regulations of the DEA could lead to a variety of sanctions, including revocation, or denial of renewal, of DEA registrations, injunctions, or civil or criminal penalties and could
harm our business, financial condition and results of operations.
The single dose version of our Staccato system contains materials
that are regulated by the U.S. government, and failure to comply with applicable regulations could harm our business.
The single
dose version of our
Staccato
system uses energetic materials to generate the rapid heating necessary for vaporizing the drug, while avoiding degradation. Manufacture of products containing energetic materials is controlled by the Bureau of
Alcohol, Tobacco, Firearms and Explosives, or ATF. Technically, the energetic materials used in our
Staccato
system are classified as low explosives, and the ATF has granted us a license/permit for the manufacture of such low
explosives. Additionally, due to inclusion of the energetic materials in our
Staccato
system, the United States Department of Transportation, or DOT, might regulate shipments of the single dose version of our
Staccato
system. However,
the DOT has granted the single dose version of our
Staccato
system Not Regulated as an Explosive status. Failure to comply with the current and future regulations of the ATF or DOT could subject us to future liabilities and could
harm our business, financial condition and results of operations. Furthermore, these regulations could restrict our ability to expand our facilities or construct new facilities or could require us to incur other significant expenses in order to
maintain compliance.
We use hazardous chemicals and highly combustible materials in our business. Any claims relating to improper
handling, storage or disposal of these materials could be time consuming and costly.
Our research and development processes
involve the controlled use of hazardous materials, including chemicals. We also use energetic materials in the manufacture of the chemical heat packages that are used in our single dose devices. Our operations produce hazardous waste. We cannot
eliminate the risk of accidental contamination or discharge or injury from these materials. Federal, state and local laws and regulations govern the use, manufacture, storage, handling and disposal of these materials. We could be subject to civil
damages in the event of an improper or unauthorized release of, or exposure of individuals to, hazardous materials. In addition, claimants may sue us for injury or contamination that results from our use of these materials and our liability may
exceed our total assets. Compliance with environmental and other laws and regulations may be expensive, and current or future regulations may impair our research, development or production efforts.
Certain of our suppliers are working with these types of hazardous and energetic materials in connection with our component manufacturing
agreements. In the event of a lawsuit or investigation, we could be held responsible for any injury caused to persons or property by exposure to, or release of, these hazardous and energetic materials. Further, under certain circumstances, we have
agreed to indemnify our suppliers against damages and other liabilities arising out of development activities or products produced in connection with these agreements.
We identified a material weakness in our internal control over financial reporting as of December 31, 2013, and our business and
stock price may be adversely affected if we do not adequately address this weakness or if we have other material weaknesses or significant deficiencies in our internal control over financial reporting.
We did not adequately implement certain controls relating to our review and verification of internally prepared reports and analyses utilized
in the financial statement closing process. Therefore, we identified a material weakness in our internal control over financial reporting relating to the financial statement closing process as of December 31, 2013. The existence of this or one
or more other material weaknesses or significant deficiencies could result in errors in our financial statements, and substantial costs and resources may be required to rectify any internal control deficiencies. If we cannot produce reliable
financial reports, investors could lose confidence in our reported financial information, the market price of our stock could decline significantly, we may be unable to obtain additional financing to operate and expand our business, and our business
and financial condition could be harmed.
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We will need to implement additional systems, procedures and controls in the future as we
grow and to satisfy new reporting requirements as a commercial entity.
Numerous laws and regulations affect commercial companies,
including, but not limited to, the Federal Anti-Kickback, False Claims Act, the Federal Physician Payment Sunshine Act, the U.S. Foreign Corrupt Practices Act and the U.K. Bribery Act of 2010. The rules make it more difficult and costly for us to
obtain certain types of insurance, including director and officer liability insurance, and we may be forced to accept reduced policy limits and coverage or incur substantially higher costs to obtain the same or similar coverage as compared to the
policies generally available to public companies. The impact of these events could also make it more difficult for us to attract and retain qualified persons to serve on our board of directors or our board committees or as executive officers.
Compliance with the Federal Anti-Kickback, False Claims Act, the Federal Physician Payment Sunshine Act, the U.S. Foreign Corrupt Practices
Act and the U.K. Bribery Act of 2010 and other regulations will continue to increase our costs and require additional management resources. As we grow, we will need to continue to implement additional reporting systems, procedures and controls to
satisfy new reporting requirements. We currently do not have an internal audit group. In addition, we may need to hire additional legal and accounting staff with appropriate experience and technical knowledge, and we cannot assure you that if
additional staffing is necessary that we will be able to do so in a timely fashion.
Our business is subject to complex corporate
governance, public disclosure and accounting requirements that could adversely affect our business and financial results.
We are
subject to changing rules and regulations of federal and state governments, the SEC, and the NASDAQ Global Market. These entities have issued a significant number of new and increasingly complex requirements and regulations over the course of the
last several years and continue to develop additional regulations and requirements. On July 21, 2010, the Dodd-Frank Wall Street Reform and Protection Act, or the Dodd-Frank Act, was enacted. The Dodd-Frank Act contains significant corporate
governance and executive compensation-related provisions, some of which the SEC, has implemented by adopting additional rules and regulations in areas such as the compensation of executives, referred to as say-on-pay. We cannot assure
you that we are or will be in compliance with all potentially applicable regulations. If we fail to comply with the Sarbanes Oxley Act of 2002, the Dodd-Frank Act and associated SEC rules, or any other regulations or if our interpretations of these
rules and regulations differ from the regulating bodies, we could be subject to a range of consequences, including restrictions on our ability to sell equity securities or otherwise raise capital funds, the de-listing of our common stock from the
NASDAQ Global Market, suspension or termination of our clinical trials, restrictions on future products or our manufacturing processes, significant fines, or other sanctions or litigation. Any of such consequences could have a material adverse
effect on our business, results of operations and the price of our common stock. Our efforts to comply with these requirements have resulted in, and are likely to continue to result in, an increase in expenses and a diversion of managements
time from other business activities.
Our facility is located near known earthquake fault zones, and the occurrence of an earthquake
or other catastrophic disaster could damage our facility and equipment, which could cause us to curtail or cease operations.
Our
facility, which is the location where the final manufacturing of our product occurs, is located in the San Francisco Bay Area near known earthquake fault zones and, therefore, is vulnerable to damage from earthquakes. We are also vulnerable to
damage from other types of disasters, such as power loss, fire, floods and similar events. If any disaster were to occur, our ability to operate our business could be seriously impaired. We currently may not have adequate insurance to cover our
losses resulting from disasters or other similar significant business interruptions, and we do not plan to purchase additional insurance to cover such losses due to the cost of obtaining such coverage. Any significant losses that are not recoverable
under our insurance policies could seriously impair our business, financial condition and results of operations.
Significant
disruptions of information technology systems or breaches of data security could adversely affect our business.
We are
increasingly dependent on information technology systems and infrastructure, including mobile technologies, to operate our business. In the ordinary course of our business, we collect, store and transmit large amounts of confidential information,
including intellectual property, proprietary business information and personal information. It is critical that we do so in a secure manner to maintain the confidentiality and integrity of such confidential information. We have also outsourced
elements of our information technology infrastructure, and as a result we manage a number of third party vendors who may or could have access to our confidential information. The size and complexity of our information technology systems, and those
of third-party vendors with whom we contract, make such systems potentially vulnerable to breakdown, malicious intrusion, security breaches and other cyber attacks. In addition, the prevalent use of mobile devices that access confidential
information increases the risk of data security breaches, which could lead to the loss of confidential information, trade secrets or other intellectual property. While we have implemented security measures to protect our data security and
information technology systems, such measures may not prevent the adverse effect of such events. Significant disruptions of our information technology systems or breaches of data security could adversely affect our business.
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Regulations related to conflict minerals could adversely impact our business.
The Dodd-Frank Wall Street Reform and Consumer Protection Act contains provisions to improve transparency and accountability concerning the
supply of tin, tantalum, tungsten and gold, known as conflict minerals, originating from the Democratic Republic of Congo, or the DRC, and adjoining countries. As a result, in August 2012 the SEC adopted annual disclosure and reporting requirements
for public companies that use conflict minerals mined from the DRC and adjoining countries in their products. We have determined that we use at least one of these conflict minerals in the manufacture of ADASUVE and our other product candidates,
although we have not yet determined the source of the conflict minerals that we use. These new disclosure requirements require us to use diligent efforts to determine which conflict minerals we use and the source of those conflict minerals, and
disclose the results of our findings beginning in May 2014. There are and will be costs associated with complying with these disclosure requirements, including those costs incurred in conducting diligent efforts to determine which conflict minerals
we use and the sources of conflict minerals used in ADASUVE and our other product candidates. Further, the implementation of these rules could adversely affect the sourcing, supply and pricing of materials used in ADASUVE and our other product
candidates. As there may be only a limited number of suppliers offering conflict free conflict minerals, and we cannot be sure that we will be able to obtain necessary conflict free conflict minerals in sufficient quantities or at competitive
prices. In addition, we may face reputational challenges if we determine that ADASUVE and our other product candidates contain minerals not determined to be conflict free or if we are unable to sufficiently verify the origins for all conflict
minerals used in ADASUVE and our other product candidates through the procedures we may implement. If we determine to redesign ADASUVE and our other product candidates to not use conflict minerals, we would incur costs associated with doing so.
Risks Relating to Owning Our Common Stock
Our stock price has been and may continue to be extremely volatile.
Our common stock price has experienced large fluctuations. In addition, the trading prices of life science and biotechnology company stocks in
general have experienced extreme price fluctuations in recent years. The valuations of many life science companies without consistent product revenues and earnings are extraordinarily high based on conventional valuation standards, such as price to
revenue ratios. These trading prices and valuations may not be sustained. Any negative change in the publics perception of the prospects of life science or biotechnology companies could depress our stock price regardless of our results of
operations. Other broad market and industry factors may decrease the trading price of our common stock, regardless of our performance. Market fluctuations, as well as general political and economic conditions such as terrorism, military conflict,
recession or interest rate or currency rate fluctuations, also may decrease the trading price of our common stock. In addition, our stock price could be subject to wide fluctuations in response to various factors, including:
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the success of the commercial launches of ADASUVE in the United States and the Ferrer Territories;
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our and our collaborators ability to complete and implement our post-approval commitments for ADASUVE;
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the process and outcome of our post-approval commitments for ADASUVE;
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our ability to manufacture ADASUVE at a cost effective price;
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actual or anticipated regulatory approvals or non-approvals of our product candidates or competing products;
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actual or anticipated cash depletion of our financial resources;
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actual or anticipated results and timing of our clinical trials;
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changes in laws or regulations applicable to ADASUVE or our product candidates;
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changes in the expected or actual timing of our development programs such as for AZ-002, including delays or cancellations of clinical trials for our product candidates;
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period to period fluctuations in our operating results;
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announcements of new technological innovations or new products by us or our competitors;
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changes in financial estimates or recommendations by securities analysts;
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conditions or trends in the life science and biotechnology industries;
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changes in the market valuations of other life science or biotechnology companies;
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developments in domestic and international governmental policy or regulations;
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announcements by us or our competitors of significant acquisitions, strategic collaborations, joint ventures or capital commitments;
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additions or departures of key personnel;
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difficulty, or increased costs, associated with replacing Autoliv as the supplier of chemical heat packages for ADASUVE and other product candidates;
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disputes or other developments relating to proprietary rights, including patents, litigation matters and our ability to obtain patent protection for our technologies;
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sales of our common stock (or other securities) by us; and
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sales and distributions of our common stock by our stockholders.
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In the past, stockholders
have often instituted securities class action litigation after periods of volatility in the market price of a companys securities. If a stockholder files a securities class action suit against us, we would incur substantial legal fees, and our
managements attention and resources would be diverted from operating our business in order to respond to the litigation.
If
we sell shares of our common stock in future financings, existing common stockholders will experience immediate dilution and, as a result, our stock price may go down.
We will need to raise additional capital to fund our operations to develop our product candidates and to develop our manufacturing
capabilities. We may obtain such financing through the sale of our equity securities from time to time. As a result, our existing common stockholders will experience immediate dilution upon any such issuance. For example, in February 2012, we issued
4,400,000 shares of our common stock and warrants to purchase up to an additional 4,400,000 shares of our common stock in an underwritten public offering; in March 2012, we issued 241,936 shares of our common stock in a private placement to Ferrer;
in July 2012 we issued 80,429 shares of our common stock to Azimuth in consideration for its execution and delivery of the Purchase Agreement; in August and September 2012, we issued an aggregate of 3,489,860 shares of our common stock to Azimuth
under the Purchase Agreement; and in May 2013, we issued 1,437,481 shares of our common stock to Azimuth under the Purchase Agreement. If we enter into other financing transactions in which we issue equity securities in the future, our existing
common stockholders will experience immediate dilution upon any such issuance.
If we fail to maintain compliance with the listing
requirements of The NASDAQ Global Market, we may be delisted and the price of our common stock and our ability to access the capital markets could be negatively impacted.
Our common stock is currently listed on The NASDAQ Global Market. To maintain the listing of our common stock on The NASDAQ Global Market, we
are required to meet certain listing requirements, including, among others, either: (i) a minimum closing bid price of $1.00 per share, a market value of publicly held shares (excluding shares held by our executive officers, directors and 10%
or more stockholders) of at least $5 million and stockholders equity of at least $10 million; or (ii) a minimum closing bid price of $1.00 per share, a market value of publicly held shares (excluding shares held by our executive officers,
directors, affiliates and 10% or more stockholders) of at least $15 million and a total market value of listed securities of at least $50 million. On January 31, 2012, we received a notice from The NASDAQ Stock Market indicating that our common
stock had not met the $1.00 per share minimum closing bid price requirement for 30 consecutive business days and that, if we were unable to demonstrate compliance with this requirement during the applicable grace periods, our common stock would be
delisted after that time. We were notified that we had regained compliance with the minimum closing bid requirement on June 27, 2012 after our one-for-ten reverse stock split.
This reverse stock split may not prevent our common stock from dropping back down below The NASDAQ Global Market minimum closing bid price
requirement in the future. It is also possible that we would otherwise fail to satisfy another NASDAQ Global Market requirement for continued listing of our common stock. As of July 31, 2014, the total market value of our publicly held shares
of our common stock (excluding shares held by our executive officers, directors, affiliates and 10% or more stockholders) was $82.6 million, the total market value of our listed securities was $83.9 million and the closing bid price of our common
stock was $4.83 per share. As of June 30, 2014, we had a stockholders deficit of $36.4 million.
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PART II. OTHER INFORMATION