{ "docId": "019dd923-622c-750b-8b9a-21918ac10c17", "docSlug": "f3db2294dcf9", "documentTitle": "Harmony Biosciences (HRMY)", "authorId": "58_Scorpion_Capital", "authorName": "Scorpion Capital", "documentKindSlug": "research-note", "documentKindLabel": "Research note", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2023-03-28 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 350, "pageCount": 366, "prevPage": 349, "nextPage": 351, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "dense", "nDataPoints": 0, "notes": "The slide uses highlighted text to emphasize key admissions of fraudulent behavior.", "elementsJson": [ "paragraph", "quote_block" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-21918ac10c17/350", "deckHref": "/decks/019dd923-622c-750b-8b9a-21918ac10c17", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-21918ac10c17.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-21918ac10c17#slide-350", "components": [ { "bbox": null, "kind": "callout", "text": "In my opinion, that was kind of a strategy that the company might have had from the very, very beginning.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-64d1-73a9-abc0-6287934ca745", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "paragraph", "text": "Q: “All the off-label stuff - wouldn't that get shut down by the insurers? How is it getting through? Where's the weak link in the chain?”\nA: “Going back to the criteria, this is something that [redacted] would push, and [redacted] would want to know, so there are 10 referrals from this doctor. Why are only 5 of these being filled? Well, we had access to that data; they did not. So, they would push me. Well, [redacted], why are only half of these--? Well, because they were off-label? Well, what indications did they put down? Honestly, that's really none of your business what indication. But [redacted] would push for it. I think [redacted] would take that feedback from us, and take that to the rep and then the rep would go in and say, Hey, you remember those 10 referrals you said you put through? Well, only 5 of these were on-label. How can we creatively take a look at those 5 that were off-label, and could they possibly be narcolepsy instead of excessive daytime sleepiness? Could we possibly say that it's this by taking the patient information in such a way--? In my opinion, that was kind of a strategy that the company might have had from the very, very beginning.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "115d827a-a238-4bb8-980a-758a953965ad", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.23 }, "kind": "paragraph", "text": "Regional managers and reps badgered reimbursement staff for rejection information to magically convert off-label scripts to \"on-label\" though \"creative\" diagnosing and coaching physicians and support staff; allegedly a company \"strategy\"", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "342b95a5-563b-40df-b999-a70c3899b692", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.56 }, "kind": "paragraph", "text": "Q: “And so, who is having that conversation about, hey, can we be creative with the diagnosis? Is that the rep having that conversation with the doctor? Who's having that conversation?”\nA: “It could be management. It could be the rep. But that question was always asked, and that was unusual. I mean, the question was always asked, well, why only half? Well, because it's off-label. Oh, well, what were they saying it was? But that's ammunition that [redacted] or the rep themselves could actually go in and say, I mean, [redacted] would say that they just go in and say, well, why is that? Are you sure it's only excessive sleepiness?”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "4ae6193a-8242-43d0-aaae-22e806fadd10", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.23, "w": 0.86, "x": 0.07, "y": 0.71 }, "kind": "paragraph", "text": "Q: “So, they obviously are successful in getting these through these specialty pharmacies and not getting a rejection. Would you see a bunch of scripts rejected by a prescriber, and then all of a sudden, they're not rejected because they successfully said the right thing? Did you observe that?”\nA: “I could say, yeah. There was always an improvement...honestly, if someone could coach the individuals completing these referral forms on how to be successful with it and how to be creative with it, that would have an immediate impact if it was getting through the payors. The payors would tell you, no, we're not going to approve it because of this piece of criteria that we require is not there. Well, I didn't mention this, then. Oh, I didn't tell you this. Or, I've revised office notes. To answer your question, yes, I've seen offices be progressively more successful in getting Wakix prescribed...you could coach the doctors to say, well, it's not just the doctor. The doctor is not filling out the referral forms normally. You have support staff that does that. The doctor normally does not. So, the doctor should be educated on what those indications are, not how to be creative with the signs and symptoms so it would meet narcolepsy or it would meet cataplexy. But I see that happen. I mean, there were certain reps, and [redacted] was very good at that.”", "attrs": null, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "662e9163-cf59-414f-ac96-cfb0c5ede550", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“In my opinion, that was kind of a strategy that the company might have had from the very, very beginning.” — Ex-field reimbursement manager working with Harmony", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-64d1-73a9-abc0-662bb74ee114", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "3e580834-98eb-43a2-9fa0-4526db3a5c5d", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "He opined that the off-label scheme was “a strategy that the company might have had from the very, very beginning” – “to be creative with the signs and symptoms so it would meet” narcolepsy or cataplexy. He explained in detail how reps pressured reimbursement staff to help them facilitate the fraud.", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "4257448d-95fe-4b8f-a5fb-cbf8b33f3866", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }