There are a lot of doubts about how could Anjeso replace the generic IV NSAID (Toradol) that only lasts 6 hours but costs only $1 per dosage, interestingly below was the same doubt against Pacira's Exparel when it was launched in April 2012:
Exparel will cost more than regulaor bupivicaine, both of which are typically injected into a wound just before it's closed. Pacira says surgeons and hospitals will save money overall using Exparel for post-surgical care because patients will require fewer opioid painkillers following surgery. Use of opioids is not only expensive for hospitals but it also causes significant side effects for patients, Pacira says.
Pacira's challenge is to convince hospitals that adopting Exparel to replace standard (and cheaper) bupivicaine is good for patients and for their bottom line. To make that argument, the company has commissioned health care economic studies to demonstrate Exparel's value. Additional studies are also planned.
There are a lot of doubts Getting a new drug added to a hospital's so-called "formulary" can take time, and even if a new drug is added to the formulary doesn't necessarily guarantee that doctors will it.
Cadence Pharmaceuticals has found it relatively easy to convince hospitals to add its injectable acetaminophen Ofirmev to formularies but generating revenue has been much more difficult and the company's stock price has suffered for it.
While it goes through the hospital formulary process, Pacira hopes to jumpstart Exparel sales by marketing the painkiller to plastic surgeons for use after breast augmentations or tummy tucks. Since plastic surgery is an all-cash business and doesn't require insurance reimbursement, the company believes these doctors could be early adopters.