For our next group setting here, we have Pacira BioSciences, and it's our pleasure to have Shawn Cross, the Chief Financial Officer, joining us today. Thank you for attending. Yeah, you bet. I wanted to start off, no surprise, with a number of questions on EXPAREL, the franchise, what's going on in the market. Maybe I could first start off with when you look at Q1 2026, we had volume growth of around 7%, revenue growth was around 5%, and I know we're just about to lap that third GPO, you know. Yeah, I think you've indicated sometime this summer. Can you talk about that volume to revenue gap and how that may change as we enter the second half of the year and the implications for the company?
Sure. Absolutely. As you would imagine, it's a question we get f requently.
Yes.
Just a reminder and a step back over the past 18 months or so, to really take advantage of the spark of the NOPAIN Act, we have entered into three GPO contracts. The third one took a little bit longer than expected. We're tough negotiators. They're tough negotiators.
Sure
It's turned out to be a great partnership. That was implemented or signed mid-2025, as you mentioned, and which did create a little bit of a gap between volume growth and revenue growth that we anticipate will sort of wane over time. I can talk about when we anticipate seeing that.
Okay.
If you look at the second half of last year, we saw sort of similar volume growth, and then there was that couple percent, low single-digit percent delta between volume and revenue. That was attributable to two factors: one, the GPO discounting, as you mentioned, and secondly, we have seen, as just as a reminder, we sell two vial sizes of EXPAREL, a 20 ml and a 10 ml, and we've seen incrementally faster growth in the 10 mls versus the 20 ml. That based upon the way the discounting works and the pricing, it does provide a little bit of a volume to dollar headwind just from a shift in vial mix.
What we articulated was in that roughly 2%-3% delta, it's half roughly attributable to the accelerating growth in the 10 mls, just the math there, and then also the GPO discounting. Long-winded way of saying and to answer your question directly is mid this year, we anticipate the discounting headwinds will ameliorate. We should see that narrow over time. Then you can sort of imagine, annual price increases and a continued narrowing of that volume to dollar gap where you'll start to see, you know, more growth on the revenue side as opposed, you know, consistent with the volume growth.
Do you still expect the 10 ml to accelerate in terms of its usage, or is it gonna flatten out shortly?
You know, we'll see over time where. It's sort of difficult for me to predict too far in the future.
Yeah.
Where if you think about sort of the segments, of that, you know, have benefit from the NOPAIN Act in expanding commercial coverage, it's of course the outpatient setting started with CMS, HOPD, and ASC, now that we have more commercial lives on board. And you think about the very basic segments, you know, the large IDNs, the community hospitals. The Ambulatory Surgery Centers. In reverse order, they can make decisions more quickly. ASCs...
Sure
community hospitals, and the large IDNs. We're seeing, very substantial same store sales growth in the ASC setting, and they tend to use a little bit more of the 10 mLs versus the 20s.
Got it.
It's just a function of who's adopting the NOPAIN Act more quickly. I'm hopeful, as we really turn the battleships around at the large IDNs.
Sure
We'll see the 20 ml, sort of catch up from a velocity perspective.
Okay. Perfect. You did mention this, but I know Brendan, your Chief Commercial Officer, has mentioned a couple times about the 110 million lives that you have covered outside the bundle now. Can we talk about what we'd expect to see by the end of the year in terms of coverage and maybe the pacing of that through the year?
Sure. Yeah. Can't give you a specific number.
Yeah.
Again, just as a reminder, we started 2025 with 30 million CMS lives under coverage. I'm very proud of Brendan team. The market access team has done a great job of bringing on board and expanding coverage into the commercial setting. As you mentioned, we ended Q1 with around 100 million lives total covered. With regard to the pace, you know, these can be sort of chunky-
Sure. Yeah.
You know, chunky opportunities and would hate to, you know, put a stake in the ground for Q2 and then have it
Have it.
implemented the day after Q2 is over.
Got it.
We stub our toe. Needless to say, it is a critical and , you know, sort of tier 1 goal for the market access team to bring on more commercial lives. We'll provide quarterly updates, I anticipate we'll end the year, you know, significantly above where we currently are.
Okay. That's fantastic. One of the other things you did late last year in November or so was conduct that survey, NOPAIN Act survey. One of the things that you noted as part of that was that 48% of the facilities had not yet taken any action in that regard. Now there's a number of reasons for that. They're simply unaware, et cetera, et cetera. When you think about the various reasons why it hasn't been implemented yet, what are you going to be focusing on to maximize the growth in the next little while?
Yeah. The survey was over 700 healthcare professionals, key stakeholders. It's something that we're doing with regard to the NOPAIN Act in particular. CMS is looking for evidence of success with regard to reducing opioid prescribing, et cetera. In terms of adoption and awareness, You know, I'd sort of rank the areas of opportunity more near term to some that might take a little bit longer but should naturally progress over time. The first we're focusing on those facilities that were already pre-NOPAIN- utilizing non-opioid acute pain therapies. They were sort of early adopters in independent of NOPAIN Act moving towards...
Yes
society beneficial and patient beneficial, acute pain therapies. Those, that's really more of an education on, "Hey, you're already utilizing and on the cutting edge of opioid-sparing therapies. Here, we now have more favorable reimbursement. CMS has reduced the barriers- to broaden formulary use and deepen it within your facility." The team's focused on education, sort of number one for those early adopters and to expand utilization. The second would be those facilities that were completely unaware of.
Yeah
NOPAIN Act because what we've seen also, if you'd really triple click on the survey, those facilities that were very familiar with NOPAIN also saw more rapid uptake in formula expansion. Formulary expansion. To the extent that we can also educate and make facilities aware, and I think that's for some of the reasons why we're seeing more rapid uptake in the ASC setting because they sort of get it.
Yeah
They can make quick decisions. The third, there is a concern because, just as a reminder, NOPAIN Act is reimbursement, favorable reimbursement in the, in the outpatient setting.
Yeah.
They're worried about spillover and sort of formulary creep into the, into the inpatient setting. As products on the CMS Inpatient-Only list move to the 23-hour setting. Over time, we should naturally see a progression there because they will also be eligible for favorable reimbursement under the NOPAIN Act.
Okay. Perfect. Maybe we can just talk about the NOPAIN Act. You know, it's been implemented, but it is set to expire at the end of 2027.
Yes.
Is-
We're acutely aware of that.
Is there any commentary around extension or how should we be thinking about that?
Sure. Yes. We have a very important government affairs effort, as you would imagine.
Yeah.
You know, the company took seven years to get NOPAIN Act legislated in the first place. We're highly focused on perpetuating it. I think importantly, it doesn't necessarily require another act of Congress.
Right.
CMS can extend it through an administrative action. We are working with CMS providing important data as we articulated from some of these surveys to show and demonstrate that the NOPAIN Act outcomes are what was originally intended. Providing CMS that information. In parallel, we are, of course, working with the key stakeholders in Congress and other key opinion leaders, et cetera, in case we need to go down the legislative pathway.
Sure.
That's something that we're working on in parallel. You know, in fact, I got an update from the government affairs folks yesterday. They're spending two days this week in D.C. There's conversations with the Trump administration, et cetera, et cetera. It's really an ongoing effort to make sure that patients will benefit from the NOPAIN Act beyond the end of 2027.
Bottom line is you're on top of that.
We're on top of it.
Okay. Perfect. Now you've recently presented some data and discussed EXPAREL's compelling value proposition. Could you expand on that? Like, what in particular was presented, and why is it important?
Sure. Absolutely. Again, continuing to provide strong, not only clinical, but pharmacoeconomic evidence of the benefits of utilizing non-opioid acute pain therapies. Is important not only for patients, but also for us to continue to penetrate the market and accelerate growth. It's basically spreading the gospel. We have something internally called the IGOR registry. It has approximately 3,500 patients, where we've followed these patients, in sort of a clinically rigorous manner where, through this, through this registry. For example, from the time of a TKA to, you know, 30 days, 60 days, 90 days.
Three, four, five years even, to look at the patient journey and the pharmacoeconomics and also clinical benefits of certain modalities. In these three congresses that you just mentioned, they it's sort of three examples of the power of what we can, what we can glean from from this database and following the patient journey. For example, we presented at AAOS, which is an important orthopedic conference, looking at, I'll make it very simple. Two arms, those that received EXPAREL at the time of procedures and those that didn't, and we're talking 600, 700 patients per arm. The [N] is not small. What we saw was, I think as expected, statistically significant reductions in opioid utilization.
In the EXPAREL arms compared to the other. Also importantly, very compelling pharmacoeconomic benefits from utilizing EXPAREL versus others. In summary, it would be reduction in healthcare utilization. For the EXPAREL arms versus the non. What does that mean? Fewer inpatient admissions.
Sure.
Fewer ER visits. I would encourage everybody to take a look at our website. You can double-click on the presentations, but there's very compelling downstream pharmacoeconomic benefits as it relates to EXPAREL versus the others. It varies in magnitude in different settings, but we can take this information, provide it to key opinion leaders, to the facilities showing the pharmacoeconomic benefits of utilizing opioid-sparing therapies, patient rehab, et cetera. Those are examples of what we've been presenting and will continue to present over the course of this year.
Okay, perfect. Switching to ZILRETTA, just a question here. We had you know, a year-over-year growth of 15% or so in Q1, but still the guide is for flat, I think year-over-year. How should we think about that?
Yeah, sure. Another frequent question we've received since Q1 earnings. It's the summary is that we're very encouraged by the progress that the new sales team has made in Q1. We're just looking for some additional data points before we get ahead of ourselves from a guidance perspective.
Sure.
Stay tuned for an update in Q2. But yeah, we are encouraged with the progress and just need to see a few more data points before we are confident in upping that guidance.
Okay, excellent. I want to switch to 5x 30 now. In sort of the first two points of that, number of patients and then the compound annual revenue growth. One thing that we've noted, and I imagine a lot of people have, is that FY 2026 calls for mid-single digit total revenue growth, but you're calling for double-digit revenue growth over the period of the 5 x 30. Can you square that and maybe bring in the patient populations as well?
Sure
Getting to $3 million?
Absolutely. We're very proud that last year we, there were 2.5 million patients domestically that benefited from Pacira products. The first pillar of the 5x 30 plan is to treat 3 million patients by 2030. My personal opinion is, it should be significantly more than 3 million patients, and that's what the goal is.
Okay.
I don't know what the CAGR for that is off the top of my head, but it's definitely less than 10%.
Sure.
I think that's. We should, we're aiming to overachieve there.
Okay.
With regard to the double-digit compound annual growth target, the other components of 5x30, in addition to the NOPAIN Act, sort of provide multiple building blocks in terms of how we could get there. Some will be more influential than others, but there is-- we believe there's a path to double-digit compound annual growth for a couple of reasons. One, we've talked about the NOPAIN Act. EXPAREL is an important component of that revenue trajectory. We saw 7% volume growth, as you mentioned.
Yeah.
As that delta converges over time, there's a component there. You could imagine annual price increases going forward.
If that volume and revenue delta is converged, we'll get more benefit for those annual price increases. Secondly, if you look at both EXPAREL and ZILRETTA, and the penetration into the total addressable market, we're just scratching the surface. For EXPAREL, mid-single digit percent. ZILRETTA's even lower than that. If we can increase the reach domestically, and accelerate that penetration on the back of NOPAIN Act, then with ZILRETTA, for example, partnerships is a key component of 5x30. We inked the J&J partnership-
Yeah
That effectively triples our reach. You know. Those reps are in place, they're trained, and we anticipate that will bear fruit over time. Then finally, you recall we don't sell product ex-U.S.
Right.
Again, one of the pillars of 5x30 is partnerships. That could include additional ex-U.S. partnerships. If you think about as we inked LG Chem earlier this year, we publicly disclosed that is likely to generate revenue for LG Chem and us in the second half of 2027. It's 2027, 2028, 2029, 2030 will be sort of the launch trajectory in those markets. To the extent that we can, we can sign up additional ex-U.S. partnerships, it will just sort of continue to stack that bar, so to speak, on the way to potential double-digit top-line growth.
Okay. Let's focus a little bit on that. If you were as a company to sign a couple more of these, would the way that they're structured mean that if this one, LG Chem, was H2 2027, would the others start at a later date into 2028, or could they even be sooner?
They could be sooner. The reason why second half of 2027, there's a few, what I would call, regulatory speed bumps
Yeah
that LG Chem needs to go through. There are other geographies where the speed bumps are lower, so we could see product in market sooner, but we'll provide updates as we ink those deals.
Okay. Another component that you briefly mentioned is the pipeline, and I know we've gotten a lot of readouts this year. Is there anything that you particularly would like to share with us?
Sure
About the important thing there?
Yeah. We're talking You know, we're sort of viewing this, as frankly says the year of Pacira. We have a data rich second half-
Yeah
which I am particularly excited about. Three top line readouts. Recall we have a phase II ongoing for a product called PCRX-201. That could be potentially transformative for the company. Recall it's a local injection of a gene therapy for knee osteoarthritis. We ran a 72 patient phase I trial that showed compelling data at one, two, three years. One dose improvements in WOMAC pain and stiffness for certain patients, you know, you have three, four years and we'll actually have five year. We've been following these patients for five years, and we'll be compiling that data la ter this year.
Particularly excited about the top line data for part A of PCRX-201, which could be truly transformative for the company. 15 million knee OA patients, high unmet medical need, so very excited about the top line readout there. Then secondly, we have two registrational trials that could be, if approved, indication and label expansion for ZILRETTA, a part of the 5x30.
Yeah.
To the extent that we could accelerate in the shoulder osteoarthritis for ZILRETTA, that could be interesting for us. Also, although it's a smaller product, there's a very important trial going on in spasticity for iovera. These patients are typically treated with toxins, which is thousands of dollars a year, versus hundreds of dollars a tip. It could be a premium market for us, and we'll have data readout for that, which is a registrational trial to expand the label for iovera.
Okay. Perfect. That's great. Part B of the PCRX-201, that of the ASCEND study, one of the things that has to happen is you need to have a commercially viable manufacturing capability. Has that happened and you'll be able to go into that- Yeah?
Yes. Again, another got an update from the team yesterday.
Okay.
Make sure I was ready for this, but we have It's a particularly, and maybe just a quick fast-forward.
Yeah.
We'll talk more about the manufacturing process and the compelling COGS. Later this year.
Okay.
It is really, truly could be a step forward for gene therapy. Low, tiny local dosing, not systemic, low cost of goods. It could be truly transformative in magnitude and duration of therapy. Long-winded way of saying we have onshored the manufacturing to the, to the East Coast. We haven't disclosed where yet, but we'll do that in due course, a re in the final stages of having that commercial material ready for part B. W e anticipate the first patient will be dosed sometime this summer. This is also, y ou know, not only is it important, to begin that portion of the trial. It's also sort of tactically important as it relates to in gene therapy, the earlier you can start dosing patients with a commercially-
Right
viable product, it just helps with the regulatory filings going forward.
You got it.
There's some tactics behind there as well.
Okay, excellent. Last two questions. What's the priority between business development, share buybacks, or I should be really saying continued share buybacks as it stands right now?
Yeah. We, as you would imagine, frequently and regularly, go through a capital allocation exercise.
We, you know, we're, you know, of course, looking at peers, making sure we have an appropriate liquidity profile.
Yeah
Strong balance sheet. Wanna have enough liquidity on hand for a rainy day. God forbid there's another COVID and the, you know, hospital elective procedures are shut down again.
Sure
All in recent memory. With that liquidity benchmarking sort of as a backdrop, we have sort of 3 key areas of prioritization for capital allocation. The first is making sure that we're supporting the commercial infrastructure to drive that top line growth. That investment is in place, and we intend to leverage that infrastructure that we've built over the past 18 months. You'll see that is be relatively flat, you know, maybe growing at the most of inflation going forward, but possibly even less. Second is very thoughtfully investing in the future, and that could that's for advancing the pipeline as we evolve into an innovative biopharma company, but also looking at opportunistic BD.
We are prioritizing their online accretive assets, assuming they came with an appropriate price tag. We're not going to blow the bank or compromise strong operating margins when we think about business development. Also, as you mentioned, there is the share buyback component. We, last year, on the back of all this liquidity benchmarking, et cetera, the board increased the authorization to $300 million. Through the end of Q2, we're through $200 million of that, and we continually evaluate those sort of three buckets as we move forward in terms of capital allocation.
Okay. You've done a great job so far, so I'm gonna give you a financial question.
Okay
At the very end-
Thank you.
To reward you. When you think about the EPS for this company, $2.86, I think is consensus this year. If you were to strictly look at, and you went through the full buyback $300 million for next year, how much accretion would that alone equate?
Sure
To on the $2.86?
Yeah. It's stating the obvious. It depends on how many shares you're buying back.
Yeah.
The simple view from my perspective of accelerating EPS growth or maintaining strong earnings is leveraging that infrastructure, driving the top line, as you mentioned, we could also reduce the denominator.
Yeah
It's a component of both of those. What it actually equates to...
Yeah
I don't know, and it depends, but that's kinda how we think about it.
All right. Thanks so much. It was wonderful to have you here again.
Good. Thanks for having us.
Appreciate it.
Appreciate it. Thank you.
I'll wrap it up there.