OrthogenRx Looks to Stay Nimble with Patient Payment Programs

By Carolyn LaWell

OrthogenRx Looks to Stay Nimble with Patient Payment Programs

Michael Daley’s experience as an orthopedic patient includes injections of hyaluronic acid and knee replacements. That understanding, along with his background as a scientist with a Ph.D. and a biopharmaceutical and medical device leader, provided him a unique perspective on the hyaluronic acid product landscape, injection techniques, manufacturing operations and patient costs. It ultimately drove him, at the age of 61, to found OrthogenRx in 2013.

“The availability of products worldwide brought itself to this opportunity where an entrepreneur of a company could bring in products that could compete with the existing market. When I started the company, there were only five products. There are now 16. I thought there was an opportunity that if you did it efficiently, you did it with dedicated people with a real focus, you can do the right thing,” Dr. Daley said. “You can provide a quality product and quality treatment for patients at a fair price. We could compete with much larger companies because we’re small, we’re nimble, we’re able to make decisions quickly. I just didn’t understand how important that concept of pivoting was going to come into play as things evolved.”

OrthogenRx markets GenVisc 850 and TriVisc and employs 23 people. OrthogenRx executes at a level of efficiency, Dr. Daley said, allowing the company to invest in pricing programs. The ability to perform flexibility has been crucial for the small company to respond to market forces and the COVID pandemic.

As a young company, OrthogenRx, along with its competitors in the viscosupplement market, faced surgeon, regulatory and payor scrutiny, despite its safety profile and data that back its treatment of knee osteoarthritis, Dr. Daley said. While the number of hyaluronic acid injections increases each year, the reimbursement price continues to decrease. Additionally, larger and well-established companies have exclusive agreements with payors, making it more difficult for new companies to enter the market.

Then, of course, came COVID.

Like most orthopedic companies, OrthogenRx’s January and February 2020 sales were on target. Then elective surgeries paused. OrthogenRx sales dropped in April. Even so, they committed to not laying off employees.

The team reflected on the thought that more patients would be without insurance. They regrouped around the company’s core values of ethics and compassion. Ultimately, they launched programs targeted at patients struggling to pay for orthopedic care and needing pain relief as they postponed their knee replacement.

In May 2020, OrthogenRx announced a direct purchase program and patient assistance program for its TriVisc.

“We’re trying to build greater transparency partnering across the healthcare field in terms of products, access to products, access to information along the way,” said Ken Long, OrthogenRx’s Vice President – Market Access & Key Accounts. “We haven’t forgotten that’s a part of our core as an organization.”

The Direct Purchase Program is aimed at patients who don’t have insurance coverage. The program allows patients to purchase TriVisc directly through an exclusive network of pharmacy partners, at what OrthogenRx calls a fair and consistent price. The Patient Assistance Program offers access to TriVisc at no cost for patients without the financial resources to pay for the treatment.

“With the pandemic, there are so many patients that either lost coverage or are losing coverage, have very high deductible plans, are in a place where basically there’s a lot of out-of-pocket that’s involved,” Mr. Long said. “We wanted to try to give those patients a break, which is the reason why we’ve launched this program. …This program is novel and a way for patients to be able to do that.”

Dr. Daley noted that the company balances four pillars when considering pricing, the patient, the healthcare professional, private and public payors, and their stockholders. The trick is to find that balance where you optimize all four pillars. The new strategic pricing models opens the company to reach new patients and physicians, fill a gap left by insurance and drives new revenue channels.

OrthogenRx’s sales rebounded in June and remained on an “upward swing” through 2020.

Though challenging market forces and the pandemic remain, OrthogenRx is looking forward to expanding its product pipeline and its service offerings. TriVisc is a three injection hyaluronic product. GenVisc 850 is a five-injection regimen. The company is developing a one-injection product and a disposable positioned at the end of the syringe that tells physicians when they’ve reached the intra-articular space.

OrthogenRx is considering licensing partners and, in five years, seeks to target $200 million in revenue.

In the short term, the response to their pricing programs and their customer service has the company considering new programs that bring them closer to the customer, including a direct online portal.

The hyaluronic acid market has been around since the 1990s. It’s not a new market. The TriVisc formulation, alone, is approved in 63 countries outside the U.S. and, as of May, had 35 million doses had been administered worldwide.

“We need to be different. We need to be better,” Mr. Long said. “To do that, you need to think in untraditional ways and not look at success parameters the same way that everybody else does. That’s paid off for us.

“New challenges will arise, and we just need to be ready.”

Carolyn LaWell is ORTHOWORLD’s Chief Content Officer.

Product Labels: Bone Graft Materials/DBM