Bad news for exparel

[Noyac]

Money is purely subjective but if being rich means owning a yacht and/or private airplane, waterfront homes and a few high end cars (over $100K each) I doubt anyone on this board qualifies....yet.

This most definitely is not what being rich is to me.

---

Members don't see this ad.

 

[sevoflurane]

Sold the rest of my PCRX. Warning letter from the FDA.

http://www.rttnews.com/2389116/paci...warning-letter-regarding-exparel.aspx?type=bn

"Further, the FDA noted that a journal ad by Pacira Pharma claimed Exparel as being able to provide pain-relief for up to 72 hours, while the drug is only approved for pain-relief up to 24 hours. The agency said these claims overstate Exparel's efficacy and are misleading."

This supports what I've seen in my patient population that gets exparel.

 

[Planktonmd]

Sold the rest of my PCRX. Warning letter from the FDA.

http://www.rttnews.com/2389116/paci...warning-letter-regarding-exparel.aspx?type=bn

"Further, the FDA noted that a journal ad by Pacira Pharma claimed Exparel as being able to provide pain-relief for up to 72 hours, while the drug is only approved for pain-relief up to 24 hours. The agency said these claims overstate Exparel's efficacy and are misleading."

This supports what I've seen in my patient population that gets exparel.

This is what I have seen as well

 

[caligas]

Down 10% today. Possible entry point.

 

[sevoflurane]

up 5% in pre-market... but at this point, I think this train has taken me as far as I want to ride it. Gilead on the other hand... is still smoking hot.

 

[sevoflurane]

This is what I have seen as well

👍

"The regulatory agency has asked Pacira to submit a written response to its warning letter by October 6, 2014. Noting that the violations are serious, the agency asked Pacira Pharma to include a comprehensive plan of action to "disseminate truthful, non-misleading and complete corrective messages" about the issues."

 

[epidural man]

Sold the rest of my PCRX. Warning letter from the FDA.

http://www.rttnews.com/2389116/paci...warning-letter-regarding-exparel.aspx?type=bn

"Further, the FDA noted that a journal ad by Pacira Pharma claimed Exparel as being able to provide pain-relief for up to 72 hours, while the drug is only approved for pain-relief up to 24 hours. The agency said these claims overstate Exparel's efficacy and are misleading."

This supports what I've seen in my patient population that gets exparel.

I did a saphenous nerve block with exparel the other day on a patient with anterior knee pain. She came back so I could do a pulsed RF treatment on the nerve. I didn't do it because she was still numb (4 days later).

I don't think they will have any problem showing that it lasts 3 days.

I did thoracic trigger points on someone with exparel - they came back and told me the side of their face was numb for 4 days. Apparently, it can spread. 🙂

The studies show relief for much greater than 24 hrs. It is unclear why the FDA is going after this, other than the obvious - the FDA is crooked as crooked gets.

It might be a good exit point. But it is certainly a great entry point to get in. Just before this FDA letter, the stock took a big jump because sales data is so strong. It will continue to be strong.

 

[sevoflurane]

I did a saphenous nerve block with exparel the other day on a patient with anterior knee pain. She came back so I could do a pulsed RF treatment on the nerve. I didn't do it because she was still numb (4 days later).

I don't think they will have any problem showing that it lasts 3 days.

I did thoracic trigger points on someone with exparel - they came back and told me the side of their face was numb for 4 days. Apparently, it can spread. 🙂

The studies show relief for much greater than 24 hrs. It is unclear why the FDA is going after this, other than the obvious - the FDA is crooked as crooked gets.

It might be a good exit point. But it is certainly a great entry point to get in. Just before this FDA letter, the stock took a big jump because sales data is so strong. It will continue to be strong.

Dude... you need to stop before the endoneurium... that's why you have such long blocks.

I'm totally just kidding bro. 🙂 Always glad to have your input on this board.

I do find that benefits of exparel for peri-infiltration for total joints to be minimal when compared to standard cocktail + blocks... and we've been administering it appropriately. I'm just not convinced it works as well as they say it does... and it certainly does not increase speed of D/C in our patient population. I'm up over 200% with this stock. It is time for me to get out for many reasons.

I will say however, that 3 days is certainly site dependant. It failed to show any real benefit when compared to PLACEBO for intercostal blocks. My knees and hips... well all I can really say is meh... Def. not 3 days routinely.

If it costs $200 per vial, the patient is getting charged at least $1000. I can do the same with a little marcaine and decadron for a lot less $$$.

Just my opinion of course. Our ortho group is only 10 md's thick.

 

[BLADEMDA]

Exparel lasts about 48 hours (reliably) for nerve blocks if undiluted. For smaller nerves I could easily see getting 72 hours out of one bottle.

Exparel has a role in my practice for long acting analgesia:

1. Adductor Canal Block- I'm getting 48 hours
2. Interscalene/Supraclavicular block for total shoulders- 48 hours
3. TAP/Subcostal Tap- 40 hours
4. Fem/Sciatic (Popliteal) for Lower Ext Amputations- 48 hours

 

[Pooh & Annie]

It's not better than bupi. It is an absolute waste of money.

 

[epidural man]

It's not better than bupi. It is an absolute waste of money.

If that is true, you totally need to do a well designed study to prove it. It would absolutely get published in a high impact journal.

The most important part is "well designed."

I mean, statements in anonymous anesthesia forums are powerful and all, but I think you owe it to you community to teach them and show them this knowledge you have gained.

 

[BLADEMDA]

It's not better than bupi. It is an absolute waste of money.

I disagree. For example with Tap blocks When I use Exparel with decadron the patient gets over 40 hours of solid analgesia vs 20 hours with Bupivacaine and decadron.

Exparel won't replace Bup with decadron for every block but it has its place in our arsenal of local anesthetics.

 

[Psai]

It's not better than bupi. It is an absolute waste of money.

I was talking to an ENT who does a lot of thyroids and he says that it definitely lasts much longer than bupi (claims about three days) and that the number of nighttime calls to their residents about post op pain dropped significantly since they started using it.

 

[Mman]

I was talking to an ENT who does a lot of thyroids and he says that it definitely lasts much longer than bupi (claims about three days) and that the number of nighttime calls to their residents about post op pain dropped significantly since they started using it.

Thyroids don't hurt. How terrible are their postop orders if their residents are frequently getting called about pain postop?

 

[BLADEMDA]

Exparel works and works well. I've partnered with a "star" surgeon and we are doing big cases and sending them home in 48-72 hours. We have avoided ICU stays by employing Exparel.

The naysayers are behind the curve (as usual) and I expect dozens of articles PROVING the efficacy and cost effectiveness of Exparel in certain surgical populations.

If my family member presented for surgery would I want them to have Exparel? Unequivocally YES.

 

[Pooh & Annie]

I'm looking forward to reviving this thread in a couple years.

 

[Mman]

Exparel works and works well. I've partnered with a "star" surgeon and we are doing big cases and sending them home in 48-72 hours. We have avoided ICU stays by employing Exparel.

The naysayers are behind the curve (as usual) and I expect dozens of articles PROVING the efficacy and cost effectiveness of Exparel in certain surgical populations.

If my family member presented for surgery would I want them to have Exparel? Unequivocally YES.

"Big cases" "avoided ICU stays"

those things need some details to make that claim. The data on any regional providing major patient outcome benefits is quite spotty if you really look. Local infiltration with Exparel certainly isn't keeping anybody I've ever taken care with out of an ICU. I mean it literally can do nothing that a catheter can already do except prevent you from needing an infusion pump, but then again you can send people home with those now a days.

 

[epidural man]

"Big cases" "avoided ICU stays"

those things need some details to make that claim. The data on any regional providing major patient outcome benefits is quite spotty if you really look. Local infiltration with Exparel certainly isn't keeping anybody I've ever taken care with out of an ICU. I mean it literally can do nothing that a catheter can already do except prevent you from needing an infusion pump, but then again you can send people home with those now a days.

That is the point - it totally replaces a catheter. Catheters are a huge pain to take care off and manage. On-Q pumps are almost twice the cost of exparel. Placing catheters are tricky.

I still think it is absolutely nuts that a pump company (On-Q, Stryker) hasn't bought Pacira.

 

[Mman]

That is the point - it totally replaces a catheter. Catheters are a huge pain to take care off and manage. On-Q pumps are almost twice the cost of exparel. Placing catheters are tricky.

I still think it is absolutely nuts that a pump company (On-Q, Stryker) hasn't bought Pacira.

Yes, that is the point. Which means it provides no benefit in terms of patient outcome. It can't. That's not how local anesthetic works. If you inject exparel instead of bupivicaine, there is no difference to the patient until maybe 12-18 hours later at best.

Now if you want to argue that it makes things more convenient, that's one thing. But that's not the same as saying it keeps patients out of the ICU or helps discharge them faster.

 

[Jay K]

Sold the rest of my PCRX. Warning letter from the FDA.

http://www.rttnews.com/2389116/paci...warning-letter-regarding-exparel.aspx?type=bn

"Further, the FDA noted that a journal ad by Pacira Pharma claimed Exparel as being able to provide pain-relief for up to 72 hours, while the drug is only approved for pain-relief up to 24 hours. The agency said these claims overstate Exparel's efficacy and are misleading."

This supports what I've seen in my patient population that gets exparel.

F-ckin vultures - So far, I count 7 law firms (on Yahoo Finance news) announce class actions against Pacira "on behalf of" investors who have seen their stock drop in value due to this warning letter from the FDA, or rather due to the alleged misrepresentations by Pacira re: Exparel.

You got out at the perfect time; I still can't believe the explosive growth of this stock's price over the past 2 years - missed this train. :-(

 

[urge]

Exparel works and works well. I've partnered with a "star" surgeon and we are doing big cases and sending them home in 48-72 hours. We have avoided ICU stays by employing Exparel.

The naysayers are behind the curve (as usual) and I expect dozens of articles PROVING the efficacy and cost effectiveness of Exparel in certain surgical populations.

If my family member presented for surgery would I want them to have Exparel? Unequivocally YES.

I have not been impressed with Exparel for infiltration. Putting 20ml of that thing on the skin after you have done a major whack inside doesn't sound that useful.

It might be different with blocks, but experimentation without IRB is not my thing. I would like to see nerve safety data before venturing there. Quick google search shows this: http://www.hindawi.com/journals/jdd/2012/962101/

The only EXPAREL-related effect seen was minimal to mild granulomatous inflammation of adipose tissue around nerve roots (8 of 24 rabbits and 7 of 24 dogs) in brachial plexus sites....

On Day 15, brachial plexus lesions included granulomatous inflammation and hemorrhage; females also had minimal fibrosis; males also had subacute inflammation and mineralization.

 

[BLADEMDA]

I have not been impressed with Exparel for infiltration. Putting 20ml of that thing on the skin after you have done a major whack inside doesn't sound that useful.

It might be different with blocks, but experimentation without IRB is not my thing. I would like to see nerve safety data before venturing there. Quick google search shows this: http://www.hindawi.com/journals/jdd/2012/962101/

I use Exparel for BD Tap blocks as described by Hebbard. These BD tap blocks have kept patients out of the ICU, lowered pain scores and shortened hospital admissions. We are getting $280 worth of value from Exparel. I never expected these kinds of results from BD Tap blocks; the results and patient satisfaction have exceeded my expectations.

Again, if a family member or one of you shows up for surgery (inguinal hernia, Laparoscopic surgery, ventral hernia, etc) remember to ask for a skilled anesthesiologist along with the correct TAP (specific surgeries require adaptation of the TAP) utilizing Exparel. My results have been outstanding and patient satisfaction scores are very high.

Anticoagulation dtugs, Plavix, Lovenox, etc are NON ISSUES when performing a tap. This means there are very FEW patients who can't benefit from a Tap block. Exparel expands those benefits to over 40 hours of solid analgesia.

 

[BLADEMDA]

Recently, I'm using as much as 2 bottles of Exparel:

1. Ortho Infiltrates knee- 1 bottle (266 mg)
2. Adductor Canal block- 1 bottle (266 mg)

Results are excellent with most getting over 48 hours of solid analgesia- no pain pumps or catheters required.

 

[BLADEMDA]

Bramlett et al22 compared the efficacy and safety of 150 mg bupivacaine HCl with 1:200,000 epinephrine versus EXPAREL® at doses of 133 mg, 266 mg, 399 mg, and 532 mg, following total knee arthroplasty. The double-blinded study found that the cumulative pain intensity scores through 4 days postsurgery were 20.7, 19.5, 18.8, and 19.1, for using EXPAREL® at doses of 133 mg, 266 mg, 399 mg, and 532 mg, respectively, compared to a cumulative pain intensity score of 20.4 when using bupivacaine HCl at a dose of 150 mg. Smoot et al23 conducted a randomized, double-blinded study on 136 patients who underwent submuscular augmentation mammoplasty and compared the pain and opioid usage after a single 600 mg dose of EXPAREL® and a single 200 mg dose of bupivacaine HCl. The mean cumulative pain scores (numerical rating scale with activity through 3 days) were 441.5 using EXPAREL® and 468.3 using bupivacaine HCl (P = 0.3999). EXPAREL® usage was associated with a significant decrease in opioids consumed during the first 24 hours (P = 0.0211) and 48 hours (P = 0.0459). Bergese et al24 analyzed a pool of 823 patients, from ten randomized, double-blinded studies, who were injected via local wound infiltration sites with EXPAREL® (doses varied from 66 mg to 532 mg).

 

[Mman]

These BD tap blocks have kept patients out of the ICU, lowered pain scores and shortened hospital admissions.

I'm calling bull****. I cannot even dream up a magical patient scenario where that would be true. Not one. Not a single imaginary scenario that exparel would have kept somebody out of an ICU that regular old bupivicaine wouldn't. A sales rep wouldn't even claim that. There is no difference between regular bupivicaine and exparel until many hours later.

I'm also calling bull**** on shortening hospital admissions. Can't be done by extending the duration of a local anesthetic.

 

[Mman]

Bramlett et al22 compared the efficacy and safety of 150 mg bupivacaine HCl with 1:200,000 epinephrine versus EXPAREL® at doses of 133 mg, 266 mg, 399 mg, and 532 mg, following total knee arthroplasty. The double-blinded study found that the cumulative pain intensity scores through 4 days postsurgery were 20.7, 19.5, 18.8, and 19.1, for using EXPAREL® at doses of 133 mg, 266 mg, 399 mg, and 532 mg, respectively, compared to a cumulative pain intensity score of 20.4 when using bupivacaine HCl at a dose of 150 mg. Smoot et al23 conducted a randomized, double-blinded study on 136 patients who underwent submuscular augmentation mammoplasty and compared the pain and opioid usage after a single 600 mg dose of EXPAREL® and a single 200 mg dose of bupivacaine HCl. The mean cumulative pain scores (numerical rating scale with activity through 3 days) were 441.5 using EXPAREL® and 468.3 using bupivacaine HCl (P = 0.3999). EXPAREL® usage was associated with a significant decrease in opioids consumed during the first 24 hours (P = 0.0211) and 48 hours (P = 0.0459). Bergese et al24 analyzed a pool of 823 patients, from ten randomized, double-blinded studies, who were injected via local wound infiltration sites with EXPAREL® (doses varied from 66 mg to 532 mg).

Did you really just quote a study that showed a "trend toward benefit" but was "underpowered to acheive statistical significance"? That's the words of "Smoot et al" in their own conclusion.

And then a meta-analysis that grouped a bunch of unrelated studies on different kinds of surgical patients and attempted to draw some sort of conclusion?

I mean really?


Let's just stick to facts. Exparel is long acting bupivicaine. That's about it. If your patient would benefit from being numb longer, it can provide some benefit, although most benefit from all forms of regional is strongest in the immediate postop period. It isn't curing cancer. It isn't keeping people off the vent. It isn't preventing deaths. It isn't getting people home quicker.

 

[Arch Guillotti]

I use Exparel for BD Tap blocks as described by Hebbard. These BD tap blocks have kept patients out of the ICU, lowered pain scores and shortened hospital admissions. We are getting $280 worth of value from Exparel. I never expected these kinds of results from BD Tap blocks; the results and patient satisfaction have exceeded my expectations.

Again, if a family member or one of you shows up for surgery (inguinal hernia, Laparoscopic surgery, ventral hernia, etc) remember to ask for a skilled anesthesiologist along with the correct TAP (specific surgeries require adaptation of the TAP) utilizing Exparel. My results have been outstanding and patient satisfaction scores are very high.

Anticoagulation dtugs, Plavix, Lovenox, etc are NON ISSUES when performing a tap. This means there are very FEW patients who can't benefit from a Tap block. Exparel expands those benefits to over 40 hours of solid analgesia.

Seems like mostly anecdote to me slim.

 

[sleepallday]

That is the point - it totally replaces a catheter. Catheters are a huge pain to take care off and manage. On-Q pumps are almost twice the cost of exparel. Placing catheters are tricky.

I still think it is absolutely nuts that a pump company (On-Q, Stryker) hasn't bought Pacira.

I can't see it replacing catheters. The nice thing about catheters is that you can always give a demand bolus for breakthrough pain.

And are that many of you really using exparel for peripheral nerve blocks already? I was under the impression that its use was limited to TAPs, intrarticular, and skin infiltration for now. And that phase 2 trials were currently underway for peripheral nerve blocks.

 

[BLADEMDA]

Seems like mostly anecdote to me slim.

Anecdote that works just like my use of Bupivacaine with Decadron. The fact is WE CAN MAKE A DIFFERENCE in hospital costs and length of stay with good anesthetic technique. Regardless of your personal stance on this issue there is NO REASON Not to give it a go and help patients do better postop. For an average hospital stay or even a SDS case the cost of Exparel is minimal and will POSITIVELY impact postop pain scores.

TAP blocks with Bup and Decadron may NOT last 24 hours and those performed with Ropivacaine will NOT last longer than 20 hours. Hence, obese patients with sleep apnea require MONITORING in a step down or ICU environment. The use of Exparel allows me to BYPASS the ICU and saves the overnight cost of that unit.

BD Tap blocks as described by Hebbard require about 60 mls of Local. This means the Bupivacaine must be diluted significantly or Ropivacaine must be utilized in order to avoid local anesthetic toxicity. Even with Epi added to the mixture to decrease peak blood levels the Local is DILUTED from 0.5% to 0.375% or even 0.25%. Patients report higher satisfaction scores with Exparel vs Ropivacaine.

 

[BLADEMDA]

Did you really just quote a study that showed a "trend toward benefit" but was "underpowered to acheive statistical significance"? That's the words of "Smoot et al" in their own conclusion.

And then a meta-analysis that grouped a bunch of unrelated studies on different kinds of surgical patients and attempted to draw some sort of conclusion?

I mean really?


Let's just stick to facts. Exparel is long acting bupivicaine. That's about it. If your patient would benefit from being numb longer, it can provide some benefit, although most benefit from all forms of regional is strongest in the immediate postop period. It isn't curing cancer. It isn't keeping people off the vent. It isn't preventing deaths. It isn't getting people home quicker.

You totally missed my point. I was showing SAFETY with using TWO BOTTLES of Exparel. FYI, Exparel HAS KEPT PATIENTS OFF THE VENT.

 

[BLADEMDA]

We conclude that paravertebral block is superior to intravenous analgesia in providing pain control and preserving postoperative pulmonary function while it is equal to thoracic epidural analgesia regarding this two issues. Paravertebral block has a better safety profile when compared to intravenous and thoracic epidural analgesia.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484628/

Exparel has kept patients off the vent! Several patients presented for Thoracotomy or VATS who had contraindications to Thoracic Epidural Placement. The use of Exparel with Paravertebral blocks preserved pulmonary function and provided 48 hours of solid analgesia. I was able to do a dual injection technique (two levels) which provided 100% analgesia postop; Paravertebral catheters can be dicey for complete coverage and may NOT work postop. Exparel is the DABOMB for Paravertebral blocks.

 

[BLADEMDA]

Exparel is superior to Bupivacaine and the BIGGest negative is the $280 cost. Once you realize these procedures cost $10K-$15K each the positive impact of a $280 bottle of local makes good fiscal sense. Many centers utilize "pumps" and fill them with Ropivacaine. This routinely costs in excess of TWO BOTTLES OF EXPAREL.

The likely outcome is EXPAREL will gain market share. Hospitals like mine are using more and more each day.

 

[Mman]

We conclude that paravertebral block is superior to intravenous analgesia in providing pain control and preserving postoperative pulmonary function while it is equal to thoracic epidural analgesia regarding this two issues. Paravertebral block has a better safety profile when compared to intravenous and thoracic epidural analgesia.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484628/

Exparel has kept patients off the vent! Several patients presented for Thoracotomy or VATS who had contraindications to Thoracic Epidural Placement. The use of Exparel with Paravertebral blocks preserved pulmonary function and provided 48 hours of solid analgesia. I was able to do a dual injection technique (two levels) which provided 100% analgesia postop; Paravertebral catheters can be dicey for complete coverage and may NOT work postop. Exparel is the DABOMB for Paravertebral blocks.

So if you did the PVB with bupivicaine you would've had some different effect that would've sent the patient to the ICU post op? I mean really?

 

[BLADEMDA]

So if you did the PVB with bupivicaine you would've had some different effect that would've sent the patient to the ICU post op? I mean really?

A single shot Paravertebral block doesn't last very long and I use ROPIVACAINE in this setting. Typically, a single shot Paravertebral block lasts 8-10 hours and thus, a catheter is required for postop analgesia overnight.

Some patients will get excellent relief from the catheter with a Ropivacaine infusion. Others will still have pain and dimished respiratory mechanics which could result in postop resp. failure. I send those patients to the ICU.

Exparel improves pain scores and because I utilize multiple injection sites results in higher efficacy. This means better postop pulmonary mechanics with less likelihood of requiring mechanical ventilatory support.

Exparel is cost effective if utilized for the right patients having the right procedure. Until you try Exparel and see the benefits you will remain a skeptic.

 

[BLADEMDA]

Exparel is a GAME CHANGER for those who understand the game.

 

[Mman]

This means better postop pulmonary mechanics with less likelihood of requiring mechanical ventilatory support.

And that's where I disagree. And there is and will be zero evidence to support that.

 

[Consigliere]

Recently, I'm using as much as 2 bottles of Exparel:

1. Ortho Infiltrates knee- 1 bottle (266 mg)
2. Adductor Canal block- 1 bottle (266 mg)

Results are excellent with most getting over 48 hours of solid analgesia- no pain pumps or catheters required.

I do the same and this has been my experience as well.

 

[sleepallday]

This can't be good for PCRX

http://finance.yahoo.com/news/pomerantz-law-firm-announces-filing-223513501.html

 

[BLADEMDA]

3,062 customers ordered Exparel since its launch. In the reported quarter, Pacira gained 247 new customers who ordered Exparel. The strong demand is being driven by new accounts and growth within existing accounts due to continued adoption in soft tissue procedures as well as rapid adoption in orthopedic procedures.

Meanwhile, Pacira is working on the label expansion of Exparel. The company is currently seeking FDA approval for Exparel in femoral nerve-block in total knee arthroplasty with a response due by Mar 5, 2015.

Research and development expenses decreased 25.8% to $4.4 million from the year-ago quarter. Selling, general and administrative expenses increased 84.2% year over year to $28.2 million.

we expect 2015 to be a catalyst rich year for Pacira as the company has an important regulatory event in Mar 2015. A potential label expansion of Exparel will boost sales.

Pacira currently carries a Zacks Rank #2 (Buy). Other well-placed stocks in the health care sector are Valeant Pharmaceuticals (VRX), Lannett Inc. (LCI) and Auxilium Pharmaceuticals (AUXL). All these stocks sport a Zacks Rank #1 (Strong Buy).

 

[sevoflurane]

PCRX continues to get hammered.

 

[BLADEMDA]

All our Ortho surgeons have now switched to Exparel for total knees and hips. Pharmacy is on board because opioid use is lower in those patients.

PCRX was expensive but it is a buy once it bottoms out.

 

[BLADEMDA]

While Pacira is yet to become profitable on an annual basis, its forward valuation looks compelling given the margin expansion potential and the likelihood of triple digit earnings growth in the next two years. Pacira currently trades at a forward 2015 P/E ratio of 35, which is low considering the expected earnings growth rates in the next three to five years. I believe that a forward P/E ratio of 50 or higher is justified given the expected growth rates. I am maintaining my $145 price target which was based on a 2015 P/S ratio of 15, which roughly coincides with a forward 2015 P/E of 50. If we take a longer term view, I believe that the upside potential is still in the triple digits.

 

[BLADEMDA]

PCRX around $70-$75 is a good entry point. That price point will likely result in 100 percent gains in 24-36 months.

 

[slunk]

Its a retrospective cohort study with 85 patients though. Is this really definitive proof?

 

[BLADEMDA]

Its a retrospective cohort study with 85 patients though. Is this really definitive proof?

Once Exparel gets FDA approval for nerve blocks PCRX will go up and up until it hits $140. I will likely double my usage once Exparel gets FDA approval.

If you don't think Exparel works as advertised then don't use it. But, the majority of Physicians utilizing Exparel on a regular basis like it and recommend it to their colleagues. Hence, PCRX will continue to gain market share in 2015 and 2016 with overseas use after 2017.

 

[Mman]

While Pacira is yet to become profitable on an annual basis, its forward valuation looks compelling given the margin expansion potential and the likelihood of triple digit earnings growth in the next two years. Pacira currently trades at a forward 2015 P/E ratio of 35, which is low considering the expected earnings growth rates in the next three to five years. I believe that a forward P/E ratio of 50 or higher is justified given the expected growth rates. I am maintaining my $145 price target which was based on a 2015 P/S ratio of 15, which roughly coincides with a forward 2015 P/E of 50. If we take a longer term view, I believe that the upside potential is still in the triple digits.

as a point of clarification, anybody using forward P/E ratios and expected sales growth rates for a company that lost more money in 2013 than it lost in 2012 than it lost in 2011 is speculating and not investing.

There is nothing wrong with speculation, but earnings estimates and forward P/E projections are no more likely to be correct than chance. I particularly like this graph of PCRX's annual financials. Sales keep skyrocketing and they keep losing even more money. It's like spending $10 to make a product to sell for $5. The more you sell, the more you lose.

 

[BuzzPhreed]

There is nothing wrong with speculation, but earnings estimates and forward P/E projections are no more likely to be correct than chance.

Yeah, but apparently some people possess a crystal ball that the rest of us don't have. 🙄

 

[Mman]

Yeah, but apparently some people possess a crystal ball that the rest of us don't have. 🙄

People can make predictions that are correct. I'm just not at a point in life where I need to rely on that to provide a comfortable retirement. I prefer to analyze a stock purchase as if I was buying a private business. If my neighbor was trying to sell me his hardware store and told me sales go higher every year but he's never turned a profit and in fact has been losing more money each year, I probably wouldn't want to buy his hardware store regardless of what he told me his projections for the next 5 years were.

As Benjamin Graham said, "An investment operation is one which, upon thorough analysis, promises safety of principal and an adequate return. Operations not meeting these requirements are speculative."

 

[urge]

All I can tell you is that the surgeon I work with stopped using it. The current indication of infiltration is like bringing a knife to a gun fight.

It might be different with blocks, but the inflammatory reaction caused by the liposomes makes me hesitant to think it will be approved.

What about Europe? How is exparel doing there? I haven't heard it is approved for blocks there and they tend to approve drugs years before the FDA does.

 

[dhb]

No Exparel in Europe to my knowledge i suppose once it get's full FDA approval they will start marketing it here.