Item 2. |
Management’s Discussion and
Analysis of Financial Condition and Results of Operations.
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The following
discussion of our financial condition and results of operations,
which refers to our historical results, should be read in
conjunction with the other sections of this Quarterly Report on
Form 10-Q, including “Risk Factors” and our unaudited consolidated
financial statements and the notes thereto appearing elsewhere
herein, and in conjunction with the Management’s Discussion and
Analysis of Financial Condition and Results of Operations set forth
in our Annual Report on Form 10-K for the year ended December 31,
2021, filed on March 24, 2022 (the “2021 10-K”). The various
sections of this discussion contain a number of forward-looking
statements, all of which are based on our current expectations and
could be affected by the uncertainties and risk factors described
throughout or referenced within this Quarterly Report on Form 10-Q.
See “Special Note Regarding Forward-Looking Statements.” Our
actual results may differ materially from our current
expectations.
OVERVIEW
Our Business
ADMA Biologics, Inc. (the
“Company,” “ADMA,” “we,” “us” or “our”) is an end-to-end commercial
biopharmaceutical company dedicated to manufacturing, marketing and
developing specialty plasma-derived biologics for the treatment of
immunodeficient patients at risk for infection and others at risk
for certain infectious diseases. Our targeted patient populations
include immune-compromised individuals who suffer from an
underlying immune deficiency disorder or who may be
immune-suppressed for medical reasons.
We currently have three products
with U.S. Food and Drug Administration (the “FDA”) approval, all of
which are currently marketed and commercially available: (i)
BIVIGAM (Immune Globulin Intravenous, Human), an Intravenous Immune
Globulin (“IVIG”) product indicated for the treatment of Primary
Humoral Immunodeficiency (“PI”), also known as Primary
Immunodeficiency Disease (“PIDD”), and for which we received FDA
approval on May 9, 2019 and commenced commercial sales in August
2019; (ii) ASCENIV (Immune Globulin Intravenous, Human – slra 10%
Liquid), an IVIG product indicated for the treatment of PI, for
which we received FDA approval on April 1, 2019 and commenced first
commercial sales in October 2019; and (iii) Nabi-HB (Hepatitis B
Immune Globulin, Human), which is indicated for the treatment of
acute exposure to blood containing HBsAg and other listed exposures
to Hepatitis B.
We may also seek to develop a
pipeline of plasma-derived therapeutics, including but not limited
to, a product based on our most recently approved patent
application under U.S. Patent No. 10,259,865 related to methods of
treatment and prevention of S. pneumonia infection for an
immunoglobulin manufactured to contain standardized antibodies to
numerous serotypes of S. pneumoniae. In May 2022, the United States
Patent and Trademark Office issued U.S. Pat. No. 11,339,206 (the
“‘206 Patent”). The ‘206 Patent relates to methods of treating
respiratory infections and expands ADMA’s estate of patents
encompassing its proprietary immunotherapeutic compositions. In
particular, the ‘206 Patent encompasses use of standardized,
hyperimmune globulin for treating respiratory infections including
those caused by respiratory syncytial virus (“RSV”), coronavirus,
influenza virus, parainfluenza virus, and metapneumovirus. Our
products and product candidates are intended to be used by
physician specialists focused on caring for immune-compromised
patients with or at risk for certain infectious diseases.
We manufacture these products at
our FDA-licensed, plasma fractionation and purification facility
located in Boca Raton, Florida with a peak annual source plasma
processing capability of up to 600,000 liters (the “Boca
Facility”). Based on current production yields, our completed and
ongoing supply chain enhancements and capacity expansion
initiatives, we believe this facility has the potential to produce
quantities of our immune globulin (“IG”) products to generate
approximately $250 million or more in annual revenue beginning in
2024 and approximately $300 million or more thereafter, as well as
achieving profitability during the first quarter of 2024, as we
ramp-up production over the next several years. Based on our
current 2022 revenue growth year-to-date, we have increased our
total annual revenue target to approximately $145 million for
fiscal year 2022.
Through our ADMA BioCenters
subsidiary, we currently operate seven FDA-licensed source plasma
collection facilities in the U.S., with two additional collection
facilities in operation and collecting plasma presently under FDA
licensing preparation and review and another facility under
construction. This business unit, which we refer to as our Plasma
Collection Centers business segment, provides us with a portion of
our blood plasma for the manufacture of our products, and also
allows us to sell certain quantities of source and hyperimmune
plasma to third-party customers for further manufacturing. As a
part of our planned supply chain robustness initiative, we have
opened four new plasma collection centers during the past 12
months, and we now have ten plasma collection centers in various
stages of approval and development, including nine that are
operational and collecting plasma. In addition, three of our
FDA-approved plasma collection centers also have approvals from the
Korean Ministry of Food and Drug Safety (“MFDS”), as well as FDA
approval to operate a Hepatitis B immunization program. After
giving effect to the progress we made in 2021 and thus far in 2022
with our plasma collection network expansion, we believe we remain
on track to achieve our goal of having ten plasma collection
centers licensed by the FDA by the end of 2023. A typical plasma
collection center, such as those operated by ADMA BioCenters, can
collect approximately 30,000 to 50,000 liters of source plasma
annually, which may be sold for different prices depending upon the
type of plasma, quantity of purchase and market conditions at the
time of sale. Plasma collected from ADMA BioCenters’ facilities
that is not used to manufacture our products or product candidates
is sold to third-party customers in the U.S. and in other locations
outside the U.S. where we are approved under supply agreements or
in the open “spot” market.
We sell plasma-derived intermediate
fractions to certain customers, which are generated as part of our
FDA-approved manufacturing process for IG and IVIG products. In
January 2020, we announced our entry into a five-year manufacturing
and supply agreement to produce and sell these intermediate
by-products, which are used as the starting raw material to produce
other plasma-derived biologics. In addition, from time to time we
provide contract manufacturing and testing services for certain
third-party clients. We also provide laboratory contracting
services to certain customers and anticipate providing contract
filling, labeling and packaging services in light of the FDA
approval of our in-house fill-finish capabilities.
On June 6, 2017, we completed the
acquisition of certain assets (the “Biotest Assets”) of the Therapy
Business Unit (“BTBU”) of Biotest Pharmaceuticals Corporation
(“BPC” and, together with Biotest AG, “Biotest”), which included
two FDA-licensed products, Nabi-HB and BIVIGAM, and the Boca
Facility (the “Biotest Transaction”).
Our Products
BIVIGAM
BIVIGAM is a plasma-derived IVIG that contains a
broad range of antibodies similar to those found in normal human
plasma. These antibodies are directed against bacteria and viruses,
and help to protect PI patients against serious infections. BIVIGAM
is a purified, sterile, ready-to-use preparation of concentrated
human Immunoglobulin G antibodies indicated for the treatment of
PI, a group of genetic disorders. This includes, but is not limited
to, the humoral immune defect in common variable immunodeficiency,
X-linked agammaglobulinemia, congenital agammaglobulinemia,
Wiskott-Aldrich syndrome and severe combined immunodeficiency.
These PIs are a group of genetic
disorders. Based on
recent estimates, these disorders are no longer considered to be
very rare, with as many as one in every 1,200 people in the United
States having some form of PI.
On May 9, 2019, the
FDA approved the Prior Approval Supplement (the “PAS”) for the use
of our IVIG manufacturing process, thereby enabling us to re-launch
and commercialize this product in the United States. We resumed
production of BIVIGAM during the fourth quarter of 2017 and
commercial production is ongoing, using our FDA-approved IVIG
manufacturing process under U.S. Department of Health and Human
Services (“HHS”) License No. 2019. The commercial re-launch and
first commercial sales for this product commenced in August of
2019.
On April 28, 2021, we announced
that the FDA granted approval for our expanded plasma pool
production scale process, allowing for a 4,400-liter plasma pool
for the manufacture of our BIVIGAM IVIG product. This increased
IVIG plasma pool scale allows us to produce BIVIGAM at an expanded
capacity, utilizing the same equipment, release testing assays and
labor force, and has had a favorable impact on our gross margins
and operating results.
ASCENIV
ASCENIV is a
plasma-derived IVIG that contains naturally occurring polyclonal
antibodies, which are proteins that are used by the body’s immune
system to neutralize microbes, such as bacteria and viruses, and
prevent against infection and disease. We manufacture ASCENIV under
HHS License No. 2019 using a process known as fractionation. The
Centers for Medicare and Medicaid Services (“CMS”) has issued a
permanent, product-specific-J-code for ASCENIV. Under the
Healthcare Common Procedure Coding System (“HCPCS”), the J-code
(J1554) became effective April 1, 2021. As part of our proprietary
manufacturing process for ASCENIV, we leverage our unique, patented
plasma donor screening methodology and tailored plasma pooling
design, which blends normal source plasma and plasma from donors
tested to have high levels of neutralizing antibody titers to
respiratory syncytial virus (“RSV”) using our proprietary
microneutralization testing assay. We are able to identify the high
titer or “hyperimmune” plasma that meets our internal and required
specifications for ASCENIV with our patented testing methods and
assay. This type of high titer plasma is typically found in less
than 10% of the total donor collection samples we test.
ASCENIV is approved
for the treatment of Primary Immune Deficiency Disorder (“PIDD”), a
class of inherited genetic disorders that causes a deficient or
absent immune system in adults and adolescents (12 to 17 years of
age). Our pivotal Phase 3 clinical trial in 59 PIDD patients met
the primary endpoint of no Serious Bacterial Infections reported
during 12 months of treatment. Secondary efficacy endpoints further
demonstrated the benefits of ASCENIV in the low incidence of
infection, therapeutic antibiotic use, days missed from
work/school/daycare and unscheduled medical visits and
hospitalizations. We believe this clinical data together with the
FDA approval for the treatment of PIDD better positions ADMA to
potentially further evaluate ASCENIV in immune-compromised patients
infected with or at-risk for RSV infection or potentially other
respiratory viral pathogens at an appropriate time. Due to the
COVID-19 pandemic, our plans have been delayed. In the future
however, we may work with the FDA and the immunology and infectious
disease community to design an appropriate clinical trial to
evaluate the use of ASCENIV in this patient population. Commercial
sales of ASCENIV commenced in October of 2019 and our commercial
and medical education efforts are focused on the labeled indication
of patients with PIDD.
Nabi-HB
Nabi-HB is a hyperimmune globulin
that is rich in antibodies to the Hepatitis B virus. Nabi-HB is a
purified human polyclonal antibody product collected from plasma
donors who have been previously vaccinated with a Hepatitis B
vaccine. Nabi-HB is indicated for the treatment of acute exposure
to blood containing HBsAg, prenatal exposure of infants born to
HBsAg-positive mothers, sexual exposure to HBsAg-positive persons
and household exposure to persons with acute Hepatitis B virus
infection in specific, listed settings. Hepatitis B is a
potentially life-threatening liver infection caused by the
Hepatitis B virus. It is a major global health problem. It can
cause chronic infection and puts people at high risk of death from
cirrhosis and liver cancer. Nabi-HB has a well-documented record of
long-term safety and effectiveness since its initial market
introduction. The FDA approved Nabi-HB on March 24, 1999.
Production of Nabi-HB at the Boca Facility has continued under our
leadership since the third quarter of 2017. In early 2018, we
received authorization from the FDA for the release of our first
commercial batch of Nabi-HB for commercial distribution in the U.S.
and we continue to manufacture Nabi-HB under HHS License No.
2019.
POTENTIAL IMPACT OF
COVID-19
We continue to monitor the ongoing
developments related to the COVID-19 pandemic, including the
emergence of the Delta, Omicron and BA.2 variants and other
resistant strains of the coronavirus, and its impacts to our
commercial and manufacturing operations and plasma collection
facilities, including collections of source plasma, procurement of
raw materials and packaging materials, a portion of which are
sourced internationally, and the testing of finished drug product
that is required prior to its availability for commercial sale. A
substantial portion of such testing has historically been performed
by contract laboratories outside the United States.
Due to a combination of previous
state and local “shelter-in-place” orders, as well as government
stimulus packages, persisting social distancing measures and
varying roll-outs of vaccinations by state, we were experiencing
lower than normal donor collections at our FDA approved plasma
collection centers. We are also subject to delays in shipments of
source plasma from our contracted third-party suppliers, as well as
delays in deliveries for personal protective equipment, reagents
and other non-plasma raw materials and supplies used in the
manufacture and distribution of our products. In addition, we are
subject to supply chain delays as a result of certain of our
suppliers diverting significant resources towards the rapid
development and distribution of COVID-19 vaccines and, as a result,
we have elected to carry more raw materials inventory than we have
in the past. The COVID-19 pandemic previously impacted, to a
certain degree, our customer engagement initiatives, whereby ADMA’s
sales and medical affairs field personnel faced difficulties
communicating directly with physicians and other healthcare
professionals, as well as the cancellation or postponement of a
number of key scientific and medical meetings, further limiting our
ability to communicate with potential customers.
The pandemic could also impact our
ability to interact with the FDA or other regulatory authorities
and may result in delays in the conduct of inspections or review of
pending applications or submissions. Although we received several
FDA approvals and two FDA inspections of the Boca Facility were
completed during the year ended December 31, 2021, no assurances
can be provided as to the timing for completion of any other
regulatory submissions or applications that may be impacted by
restrictions related to COVID-19.
During the nine months ended
September 30, 2022 and 2021, our revenue attributable to
international customers was approximately 7% and 13%, respectively,
of our total revenues. As we seek to grow this aspect of our
business, we may also be subject to the impacts of the COVID-19
pandemic in locations outside the United States.
Notwithstanding the foregoing, the
COVID-19 pandemic to date has not had a material impact on our
financial condition or results of operations, and we do not believe
that our production operations at the Boca Facility, our contract
fill/finishers or our plasma collection facilities have been
significantly impacted by the COVID-19 pandemic. As a result, we do
not anticipate and have not experienced any material impairments
with respect to any of our long-lived assets, including our
property and equipment, goodwill or intangible assets.
Although the COVID-19 pandemic has
not, to date, materially adversely impacted our capital and
financial resources, because we are unable to determine the
ultimate severity or duration of the pandemic or its long-term
effects on, among other things, the global, national or local
economies, the capital and credit markets or our workforce,
customers or suppliers, at this time we are unable to predict
whether COVID-19, or any known or future variant or government
order, will have a material adverse impact on our business,
financial condition, liquidity and results of operations. After the
COVID-19 global pandemic has settled, we may continue to experience
adverse impacts to our business as a result of evolving
macroeconomic factors, including general economic uncertainty,
unemployment rates, inflationary pressures and any actual economic
recession that has occurred or may occur in the future.
RESULTS OF OPERATIONS
Critical Accounting Policies and
Estimates
This Management’s Discussion and
Analysis of Financial Condition and Results of Operations is based
on our condensed consolidated financial statements, which have been
prepared in accordance with Accounting Principles Generally
Accepted in the United States of America (“U.S. GAAP”). The
preparation of these condensed consolidated financial statements
requires us to make estimates and assumptions that affect the
reported amounts of assets, liabilities, revenues and expenses. On
an ongoing basis, we evaluate these estimates and assumptions,
including those described below. We base our estimates on our
historical experience and on various other assumptions that we
believe to be reasonable under the circumstances. These estimates
and assumptions form the basis for making judgments about the
carrying values of assets and liabilities that are not readily
apparent from other sources. Actual results and experiences may
differ materially from these estimates. Significant estimates
include rebates and certain other deductions from gross revenues,
impairment of long-lived assets, assumptions used in projecting
future liquidity and capital requirements, assumptions used in the
fair value of awards granted under our equity incentive plans and
warrants issued in connection with the issuance of notes payable
and the valuation allowance for our deferred tax assets.
Some of the estimates and
assumptions we have to make under U.S. GAAP require difficult,
subjective and/or complex judgments about matters that are
inherently uncertain and, as a result, actual results could differ
from those estimates. Due to the estimation processes involved, the
following summary of accounting estimates and their application are
considered to be critical to understanding our business operations,
financial condition and results of operations. For a description of
our significant accounting policies, see Note 2 to the Consolidated
Financial Statements included in the 2021 10-K. Estimates and
assumptions used in projecting future liquidity and capital
requirements are described in Note 1 to the condensed consolidated
financial statements appearing elsewhere in this Quarterly Report
on Form 10-Q.
Revenues
Our gross product revenues are
subject to a variety of deductions, which are estimated and
recorded in the same period that the revenues are recognized. These
deductions primarily consist of rebates, distribution fees,
chargebacks and sales allowances. These deductions represent
estimates of the related obligations, some of which are contractual
in nature and do not require extensive judgment to be exercised by
management, while other estimates require complex or subjective
matters of knowledge and judgment when estimating the impact of
these revenue deductions on net revenues for a reporting
period.
Historically, adjustments to these
estimates to reflect actual results or updated expectations have
not been material to our overall business. However, two of our
primary immunoglobulin products, ASCENIV and BIVIGAM, were only
approved for commercial sale by the FDA in 2019, and as such our
historical experience with rebates with respect to these products
is limited. If any of our ratios, factors, assessments, experiences
or judgments are not indicative or accurate estimates of our future
experience, our results could be materially affected. Estimates
that are most at risk for material adjustment are those associated
with U.S. Medicaid rebates because of the extensive time delay
between the recording of the accrual and its ultimate settlement,
an interval that can generally take up to several years or more.
While our results of operations to date have not required any
material adjustment due to this risk, the lag time between when
this obligation is initially recorded and ultimately settled could
potentially materially impact our revenues and our results of
operations in the future.
Stock-Based
Compensation and Valuation of Warrants
All equity-based payments,
including grants of stock options and Restricted Stock Units
(“RSUs”) are recognized at their estimated fair value at the date
of grant, and compensation expense is recognized on a straight-line
basis over the grantee’s requisite vesting period. For the purpose
of valuing stock options granted to our employees, directors and
officers, we use the Black-Scholes option pricing model. The
Black-Scholes option valuation model was developed for use in
estimating the fair value of publicly traded options, which have no
vesting restrictions and are fully transferable. The Company’s
employee stock options have characteristics significantly different
from those of traded options, and changes in the underlying
Black-Scholes assumptions can materially affect the fair value
estimate. To determine the risk-free interest rate, we utilize the
U.S. Treasury yield curve in effect at the time of the grant with a
term consistent with the expected term of our awards. The expected
term of the options granted is in accordance with U.S. Securities
and Exchange Commission (“SEC”) Staff Accounting Bulletins 107 and
110 and is based on the average between vesting terms and
contractual terms. The expected dividend yield reflects our current
and expected future policy for dividends on our Common Stock. The
expected stock price volatility for our stock options was
calculated by examining the historical volatility of our Common
Stock since our Common Stock became publicly traded in the fourth
quarter of 2013. We will continue to analyze the expected stock
price volatility and expected term assumptions and will adjust our
Black-Scholes option pricing assumptions as appropriate. Any
changes in the foregoing Black-Scholes assumptions, or if we were
to elect to utilize an alternative method for valuing stock options
granted to employees, directors and officers, could potentially
impact our stock-based compensation expense and our results of
operations.
We also use the Black-Scholes
option valuation model for the purpose of estimating the fair value
of warrants we issue from time to time in connection with the
issuance of notes payable. Changes in our Black-Scholes
assumptions, or if we were to utilize an alternative method for
valuing warrants issued to our lenders, could impact our interest
expense and results of operations.
Impairment of
Long-Lived Assets
We assess the recoverability of our
long-lived assets, which include property and equipment and
definite-lived intangible assets, whenever significant events or
changes in circumstances indicate impairment may have occurred. If
indicators of impairment exist, projected future undiscounted cash
flows associated with the asset are compared to its carrying amount
to determine whether the asset’s carrying value is recoverable. Any
resulting impairment is recorded as a reduction in the carrying
value of the related asset in excess of fair value and a charge to
operating results. For the nine months ended September 30, 2022 and
2021, we determined that there was no impairment of our long-lived
assets. Examples of events or circumstances that may be indicative
of impairment that would require the use of significant judgment by
management include:
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A significant adverse change in legal factors or in the
business climate that could affect the value of the asset.
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Significant and continued cash flow losses.
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