CMS proposal includes non-opioid pain treatments for Medicare

TAMPA, Fla. - Pacira BioSciences, Inc. (NASDAQ:PCRX) announced that the Centers for Medicare and Medicaid Services (CMS) has proposed to extend Medicare reimbursement for certain non-opioid pain management drugs in hospital outpatient and ambulatory surgical center settings.

The proposal, part of the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for 2025, includes EXPAREL, a drug developed by Pacira for postsurgical pain, among six non-opioids to be reimbursed separately.

This development follows the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which was signed into law on December 27, 2022, as part of the Consolidated Appropriations Act of 2023. The NOPAIN Act mandates separate CMS payment for qualifying non-opioid drugs and devices, aiming to reduce reliance on opioids by increasing access to alternative pain treatments.

Pacira's CEO, Frank D. Lee, expressed satisfaction with the inclusion of EXPAREL in the CMS proposed rule. The company believes that, if finalized, this policy will enhance clinicians' ability to offer non-opioid pain control and facilitate the transition to outpatient care. EXPAREL is approved for both local and regional analgesia in various surgical procedures and has been used in more than 14 million patients in the United States.

The proposed Medicare payment rates for the covered non-opioid products in the rule equate to the average sales price plus 6%. The proposal lists specific payment rates for each qualifying drug, including $1.41 per billing unit for EXPAREL.

EXPAREL is indicated for postsurgical local analgesia in patients aged 6 years and older and for regional analgesia in adults. Its safety and efficacy for other nerve blocks have not been established. The drug combines bupivacaine with multivesicular liposomes to provide extended pain relief.

The proposed rule is subject to change and is expected to be finalized later this year, with the policy potentially effective from January 1, 2025. This announcement is based on a press release statement from Pacira BioSciences.

In other recent news, Pacira Pharmaceuticals (NASDAQ:PCRX) has been the subject of significant attention from various analyst firms, following the Food and Drug Administration's (FDA) approval of eVenus' generic version of Exparel, Pacira's flagship product. Piper Sandler maintained its 'Overweight' rating on Pacira, citing ongoing patent litigation between Pacira and eVenus as a key factor.

Still, Barclays downgraded its stance on Pacira from 'Overweight' to 'Equalweight' due to the same approval. On the other hand, H.C. Wainwright maintained a 'Buy' rating, expressing confidence in Pacira's potential to either settle with the generic challenger or win the ongoing patent litigation.

In terms of financial performance, Pacira reported Q1 2024 revenue of $149 million, slightly below consensus estimates, with Exparel accounting for $118 million. Furthermore, the company launched a private placement of $250 million in convertible senior notes due in 2029, projected to yield net proceeds of approximately $242 million.

In addition to these developments, Pacira announced management changes, including the appointment of a new Chief Commercial Officer and Chief Business Officer, as well as the retirement of Dr. Gary Pace from the company's Board of Directors. These are among the recent developments for Pacira Pharmaceuticals.

InvestingPro Insights

As Pacira BioSciences, Inc. (NASDAQ:PCRX) garners attention with the CMS proposal to extend Medicare reimbursement for EXPAREL, investors are closely watching the company's financial health and market performance. According to InvestingPro real-time data, Pacira's market capitalization stands at a solid $942.56 million. Despite the recent market volatility, the company's P/E ratio remains attractive at 13.35, suggesting that investors may find the stock's valuation reasonable in relation to its earnings.

Analyzing the company's performance over the last twelve months as of Q1 2024, Pacira has demonstrated a gross profit margin of 61.8%, indicating a strong ability to translate sales into profit. Additionally, with a robust EBITDA growth of 20.92%, the company shows potential for further financial improvement and efficiency in operations. These metrics suggest that Pacira's financial fundamentals are sound as it navigates the evolving healthcare reimbursement landscape.

Turning to InvestingPro Tips, analysts predict that Pacira will be profitable this year, which aligns with the company's anticipated growth in net income. Moreover, the stock's current position in oversold territory, as indicated by the RSI, could signal an opportunity for investors considering an entry point.

For those interested in a deeper analysis, InvestingPro offers additional insights with 9 more tips available for Pacira, providing a comprehensive outlook on the stock's future prospects. Explore these insights and consider using the coupon code PRONEWS24 to get up to 10% off a yearly Pro and a yearly or biyearly Pro+ subscription at InvestingPro.

This article was generated with the support of AI and reviewed by an editor. For more information see our T&C.