Please provide an overview of Medicure’s current portfolio, including trends you observed in demand for your products?

The main product Medicure has been marketing is Aggrastat, an injectable antiplatelet used for patients undergoing percutaneous transluminal coronary angioplasty, which was originally developed by Merck. When we acquired Aggrastat, it held approximately 2% of the market in its class— we grew this to 65%.

As Aggrastat becomes a mature product, we have been adding drugs to our portfolio. In 2019, the company acquired another cardiovascular drug, Zypitamag, a statin with a unique formulation containing magnesium which acts as an HMG-CoA reductase inhibitor indicated for adult patients with primary hyperlipidemia or mixed dyslipidemia as an adjunctive therapy to their diet. This product is a late-stage entry into the statin market, but is unique in the sense that it is metabolized differently than most other statins, resulting in less drug-drug and drug-food interactions. Because Zypitamag is metabolized by a different chromosome, it is very beneficial for people that are on other drugs, such as HIV patients.

How is Medicure able to offer FDA-approved statins at an extremely low price?

When we were introducing Zypitamag to the market, we found it challenging to attain insurance coverage given the low pricing of generics. There are intermediaries known as pharmacy benefit managers (PBM) that facilitate the coverage of pharmaceutical insurance to manufacturers. Medicure approached a PBM and wanted to introduce Zypitamag to the market at US$90 per month. They refused to provide coverage unless we increased the price to US$300 per month, as PBMs earn their profits by taking a percentage of the price, hence they’re wanting higher prices to earn more profit. Not wanting to increase the price, we decided instead to sell directly to those who are uninsured and underinsured, which represents a significant market; in Texas, for example, 18% of the population is uninsured.

After our decision to market directly through pharmacies, we came across a company called Marley Drug, which was a pharmacy based in North Carolina and licensed in all 50 states. We formed a partnership with them to sell and deliver Zypitamag to homes across the US. Through our partnership with Marley Drug, we sell Zypitamag for just US$1/day and are generating more revenue than if we had insured the product through a PBM. In truth, most pharmaceuticals are inexpensive to make, and it is the insurance that significantly drives up costs.

What role does Marley Drug play in the company’s overall operations?

We decided that more than just home delivery, we would set up an e-commerce platform for Marley Drug, where people can purchase pharmaceuticals from the company online and get home delivery at a low cost. This portion of our business currently accounts for 40% of the company’s overall revenue, and we believe this will grow significantly over the next few years as e-commerce platforms expand into the pharmaceutical space.

Can you elaborate on Medicure’s MC-1 drug which is currently in its Phase 3 clinical study?

MC-1 is an investigational drug that contains pyridoxal 5'-phosphate monohydrate (PLP). By the time we filed for Phase 3, we had already invested US$140 million into the compound and decided to switch our focus to marketing Aggrastat. That said, we continued to review the data and literature related to MC-1 and recently discovered that there are patients with a genetic Pyridox(am)Ine 5'-Phosphate Oxidase (PNPO) deficiency, which prevents their ability to metabolize pyridoxal 5'-phosphate, resulting in epilepsy. This gave us renewed interest in developing MC-1, and Medicure is currently in the process of evaluating the safety and efficacy of this drug to treat patients with epilepsy. The population of people with this metabolic deficiency is less than 100 worldwide. We will continue to pursue this market as we have already invested significant time and funds. The FDA has a Rare Pediatric Disease Priority Review Vouchers program, and Medicure has qualified that when MC-1 is approved for the PNPO indication, the FDA will issue us a voucher to accelerate the approval process. These vouchers sell for between US$100 million and US$200 million, meaning that once we finish our Phase 3 trial and obtain approval, we will receive a voucher worth in excess of US$100 million that will provide us with further non-dilutive capital.

What does Medicure’s pipeline look like?  

Medicure currently has one generic in development, intended for launch in 2023. We are also in the process of developing a biosimilar in the cardiovascular space, which should be launched in 2025. Additionally, there is another indication for our MC-1 product, tardive dyskinesia, which we will explore and develop further in the years to come. Additionally, Medicure continues to seek opportunities to expand its portfolio through acquisition. In particular, we see opportunity in a few cardiovascular drugs developed by companies that lack the ability to produce or market the product.

What are Medicure’s goals for 2022 and beyond?

One of Medicure’s main focuses is getting the Phase 3 trail for MC-1 completed by 2023. In addition, our recently launched e-commerce site for Marley Drug has huge potential and will be our most significant driver of growth and major source of our profits moving forward.