Dave Stack: It is, Glen. Yes.
Glen Santangelo: Okay, perfect. So then if we go to your guidance for 2023, you’re sort of forecasting 7% growth at the midpoint, which would that imply sort of low double-digit, sort of volume growth, with a similar type of pricing impact? And I’m not sure embedded within those assumptions, what you’re expecting for the overall surgical market based on that assumption.
Dave Stack: Close, Glen. The difference between what you just outlined in our guidance is the price increase. Remember in early January, we raised the price of the 10 ml by 8% and the 20 ml by 3%. And so, what you said is absolutely correct. If you understand that there is a roughly 3% net benefit to us as the price increase, then that comes back down into the 7% — 7% to 8% range, which is what we were trying to do is guide to what actually happened in ’22 thinking that the only thing that it would be conservative guidance, of course, based on the 2022 data. And if our assumption is that the primary reason that the market is — the macro environment is negatively impacted by inflation. And if that changes, then this would be a conservative guide, which is what we were trying to accomplish.
Glen Santangelo: Perfect, okay. And maybe just my last question regards — it relates to the competitive landscape. And you sort of touched on bupivacaine and maybe some of the fact that some of the opioids are free to some of these surgery centers. And could you sort of comment on the pricing difference between EXPAREL? And if you think that’s having any sort of impact on overall utilization, do you feel like it’s a pricing issue? Or do you think it’s just sort of a macroeconomic issue and just overall surgical volume issue?
Dave Stack: Thank you, Glen. That’s a three-credit course. So in the hospital, we’re in the DRG environment, and that’s not going to change. I mean, when I raised that issue in our Washington D.C. discussions that is the third rail of the Democrats as it relates to health care. And they won’t even discuss providing anything for one-off reimbursement inside the surgical bundles. That’s for inpatients. For outpatients where we had the ASC, as I commented with David, the benefit of that is largely muted by the fact that the insurance carriers saving 30% to 35% on the cost of a procedure are utilizing the vast majority of the ASC capacity with these high-margin procedures like joints and spine and things like that. In the middle there is the soft tissue procedures that are difficult to do given the reimbursement in the inpatient market and are more appropriately done in the outpatient market, given the improved cost structure of a hospital outpatient department.
But there are many, many hospitals across the United States, especially in indigent areas and low economic areas, where they can’t afford to use anything but the cheapest things that they can buy and there is no reimbursement. So — and I talked to many of these folks myself. And so, the importance of 340B, Glen, is to start those folks down the — to have an opportunity at a reduced price to be able to use EXPAREL in that environment to achieve our mission of providing an opioid alternative to as many patients as possible. There are still places, many of them here in rural Florida, where they still can’t afford EXPAREL even at the 340 price. So, it is absolutely driven by price in this environment. And that’s why the NOPAIN Act is so important.
So, the NOPAIN Act will force CMS, and there is a convergence there of these poor patients being largely under some form of social services, so this is the right patient population. But when CMS is forced to reimburse for non-opioid pain medicines in these — for these patients in these rural settings, we expect that you will see a very important inflection for EXPAREL. Because in that soft tissue rural market, it is absolutely cost that is a ceiling, basically, on surgeons’ use of the product.
