Item 1A. Risk Factors
Item
1A. Risk Factors
You
should carefully consider the following risk factors in addition to the other information contained in this Quarterly Report.
Our business, financial condition, results of operations and stock price could be materially adversely affected by any of these
risks. You should consider all of the factors described in this section as well as the risk factors and the other information
in our Quarterly Report on Form 10-Q for the three months ended March 31, 2020 and our Annual Report on Form 10-K including
our audited financial statements and the related notes and “Management’s Discussion and Analysis of Financial Condition
and Results of Operations” when evaluating our business. If any of the following risks actually occurs, our business, financial
condition, results of operations and future growth prospects would likely be materially and adversely affected. In these circumstances,
the market price of our common stock would likely decline and you may lose all or part of your investments. Additional
risks and uncertainties not presently known to us or that we currently deem immaterial also may impair our business operations.
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The
COVID-19 pandemic has had an adverse effect on our business and results of operations and is expected to continue to have further
adverse effects, which could be material, on our business, results of operations, financial condition, liquidity, and capital
investments.
On
March 11, 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. The COVID-19 pandemic has negatively
impacted the global economy, disrupted supply chains and created significant volatility in financial markets. We have implemented
business policies intended to protect our employees from the spread of COVID-19. Those policies include employees working from
home when possible and employees in our facilities increasing physical distancing.
On
March 18, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released guidance for U.S. healthcare providers
to limit all elective medical procedures in order to conserve personal protective equipment and limit exposure to COVID-19 during
the pendency of the pandemic. Many of our customers use our products in procedures impacted by the guidance. In addition to limiting
medical procedures, many hospitals and other healthcare providers have strictly limited access to their facilities during the
pandemic. We cannot predict the duration or scope of the pandemic, actions that may be taken by governments and businesses in
response to the pandemic, or the impacts of the pandemic on healthcare systems. The impacts of the pandemic may include, but are
not limited to:
●
Reduced
revenues from our customers, including our major customers, whose products are impacted by CMS guidance to limit elective
medical procedures;
●
Diminished
ability or willingness of third parties to market, distribute and sell our products, due to reduced demand from, or lack of
access to, healthcare facilities and providers;
●
Diminished
ability, or inability, to complete clinical trials and other activities required to achieve regulatory clearance of our products
under development due to lack of access to healthcare facilities, healthcare providers and patients;
●
Diminished
or lost access to third party service providers that we use in our research and development or marketing efforts;
●
Reduced
cash flow from our operations due to reductions in revenues or collections from our customers and increases in operating costs
related to actions we have taken in response to the pandemic;
●
Reduced
business productivity due to inefficiencies in employees working from home or increasing physical distancing and other pandemic
response protocols in our production facilities;
●
Increased
susceptibility to the risk of information technology security breaches and other disruptions due to increased volumes of remote
access to our information systems from our employees working at home;
●
Inability
to source sufficient components used in our products due to disruptions in supply chains;
●
Diminished
ability to identify, evaluate and acquire, or effectively integrate, complementary businesses, products, materials or technologies
due to travel restrictions, physical distancing protocols, and lack of access to third party service providers related to
our development activities;
●
Loss
of manufacturing capacity, which could lead to failures to meet product delivery commitments, or increased operating costs
if one of our facilities were to experience a COVID-19 outbreak;
●
Difficulties
in assessing and securing intellectual property rights due to lack of access to, or delayed responsiveness of, third party
service providers or governmental agencies;
●
Diminished
ability to retain personnel over concerns about workplace exposure to COVID-19, or to hire and effectively train new personnel,
due to physical distancing protocols; and
●
Impairment
of goodwill or other assets due to reductions in the fair value of our reporting units.
These
and other factors relating to, or arising from, the pandemic could have material adverse effects on our business, results of operations,
cash flows, financial condition, and capital investments. Actual or anticipated adverse effects on our cash flows or financial
condition may lead us to seek additional funding. Any future debt financing into which we enter may impose upon us covenants that
restrict our operations, including limitations on our ability to incur liens or additional debt, pay dividends, repurchase our
common stock, make certain investments and engage in certain merger, consolidation or asset sale transactions. We cannot be certain
that additional funding will be available on acceptable terms, if at all. If we do not have, or are not able to obtain, sufficient
funds, we may have to delay development or commercialization of our products or otherwise curtail our operations. Any of these
events could materially harm our business and operating results.
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Our
business is significantly impacted by state and federal statutes and regulations.
Our
proprietary formulations are comprised of active pharmaceutical ingredients that are components of drugs that have received marketing
approval from the FDA, although our proprietary compounded formulations have not themselves received FDA approval. FDA approval
is not required in order to market and sell our compounded formulations. In the future we may choose to pursue FDA approval to
market and sell certain potential drug candidates. The marketing and sale of compounded formulations is subject to and must comply
with extensive state and federal statutes and regulations governing compounding pharmacies. These statutes and regulations include,
among other things, restrictions on compounding for office use or in advance of receiving a patient-specific prescription or,
for outsourcing facilities, requirements regarding preparation, such as regular FDA inspections and cGMP requirements, prohibitions
on compounding drugs that are essentially copies of FDA-approved drugs, limitations on the volume of compounded formulations that
may be sold across state lines, and prohibitions on wholesaling or reselling. These and other restrictions on the activities of
compounding pharmacies and outsourcing facilities may significantly limit the market available for compounded formulations, compared
to the market available for FDA-approved drugs.
Our
pharmacy business is impacted by federal and state laws and regulations governing the following: the purchase, distribution, management,
compounding, dispensing, reimbursement, marketing and labeling of prescription drugs and related services including; FDA
and/or state regulation affecting the pharmacy and pharmaceutical industries, including state pharmacy licensure and registration
or permit standards; rules and regulations issued pursuant to HIPAA and other state and federal laws related to the use, disclosure
and transmission of health information; and state and federal controlled substance laws. Our failure to comply with any of these
laws and regulations could severely limit or curtail our pharmacy operations, which would materially harm our business and prospects.
Further, our business could be adversely affected by changes in these or any newly enacted laws and regulations, and federal and
state agency interpretations of the statutes and regulations. Statutory or regulatory changes could require us to make changes
to our business model and operations and/or could require us to incur significantly increased costs to comply with such regulations.
On
July 30, 2020, FDA issued a notice for comments related to certain bulk drug substances to be removed from the 503B Bulk’s
List (or Category 1 List). Included in this notice for comment were certain bulk drug substances which we currently use in some
of our compounded products. In the event one or more of these bulk substances are ultimately removed from the Category
1 List, we intend to utilize commercially available versions of these substances or similar active pharmaceutical ingredients
as replacements of the bulk powders contained in our sterile products. In addition, nothing in the FDA’s notice affects
the dispensing of bulk powder-containing products from our 503A pharmacy. Nonetheless, if all or some of the bulk drug substances
we use are removed from the 503B Bulk’s List, this may result in a disruption in our operations, revenues and cash flows.
Our
loan under the Paycheck Protection Program may not be forgiven or may subject us to challenges and investigations
regarding qualification for the loan.
In
April 2020, we received the PPP Loan, which was established under the CARES Act in the principal amount of $1,967,000. Pursuant
to Section 1106 of the CARES Act we may apply for and be granted forgiveness for all or a portion of the PPP Loan. Such forgiveness
will be determined, subject to limitations, based on the use of the loan proceeds for qualifying expenses, which include payroll
costs, rent, and utility costs over the allowable measurement period following receipt of the loan proceeds.
The SBA continues to develop and issue
new and updated guidance regarding the PPP Loan application and forgiveness process, including guidance regarding required borrower
certifications and requirements for forgiveness of loans made under the program. Given the evolving nature of the guidance and
depending upon our ability to use the loan proceeds for qualifying expenses, we cannot give any assurance that our PPP Loan will
be forgiven in whole or in part.
Additionally,
the PPP Loan application required us to certify that the current economic uncertainty made the PPP Loan request necessary to support
our ongoing operations. While we made this certification in good faith after analyzing, among other things, our financial situation
and access to alternative forms of capital, and believe that we satisfied all eligibility criteria for the PPP Loan and that our
receipt of the PPP Loan is consistent with the broad objectives of the Paycheck Protection Program of the CARES
Act, the certification described above does not contain any objective criteria and is subject to interpretation. In addition,
the SBA has stated that it is unlikely that a public company with substantial market value and access to capital markets will
be able to make the required certification in good faith. The lack of clarity regarding loan eligibility under the program has
resulted in significant media coverage and controversy with respect to public companies applying for and receiving loans. If,
despite our good faith belief that we satisfied all eligibility requirements for the PPP Loan, we are found to have been ineligible
to receive the PPP Loan or in violation of any of the laws or regulations that apply to us in connection with the PPP Loan, including
the False Claims Act, we may be subject to penalties, including significant civil, criminal and administrative penalties and would
be required to repay the PPP Loan. In the event that we seek forgiveness of all or a portion of the PPP Loan, we will also be
required to make certain certifications which will be subject to audit and review by governmental entities and could subject us
to significant penalties and liabilities if found to be inaccurate, including being required to repay the PPP Loan.
In addition, our receipt of the PPP Loan may result in adverse publicity and damage to our reputation, and a review or audit by
the SBA or other government entity or claims under the False Claims Act could consume significant financial and management
resources. Any of these events could materially harm our business, results of operations and financial condition.
Business
disruptions could seriously harm our future revenue and financial condition and increase our costs and expenses.
Our
operations, and those of contract research organizations (or CROs), contractors and consultants, could be subject to power shortages,
telecommunications failures, wildfires, water shortages, floods, earthquakes, hurricanes, typhoons, fires, extreme weather conditions,
medical epidemics, such as the COVID-19 pandemic, and other natural or man-made disasters or business interruptions for which
we are predominantly self-insured. The occurrence of any of these business disruptions could seriously harm our operations and
financial condition and increase our costs and expenses. Our ability to obtain clinical supplies of our product candidates could
be disrupted if the operations of our contract manufacturers or cell line storage facilities are affected by a man-made or natural
disaster or other business interruption.
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Unstable
market and economic conditions may have serious adverse consequences on our business, financial condition and stock price.
From
time to time, including recently as a result of the COVID-19 pandemic, global credit and financial markets have experienced extreme
volatility and disruptions, including severely diminished liquidity and credit availability, declines in consumer confidence,
declines in economic growth, increases in unemployment rates and uncertainty about economic stability. Our general business strategy
may be adversely affected by any such economic downturn, volatile business environment and continued unpredictable and unstable
market conditions. If the equity and credit markets deteriorate it may make any debt or equity financing more difficult to complete,
more costly, and more dilutive. In the event the Company or one of its subsidiaries needed to access additional capital, failure
to secure financing in a timely manner and on favorable terms could have a material adverse effect on our growth strategy, financial
performance and stock price and could require us to delay or abandon development plans. In addition, there is a risk that one
or more of our current service providers, manufacturers and other partners may not survive an economic downturn, which could directly
affect our ability to attain our operating goals on schedule and on budget.
Text extracted from the filing as submitted to EDGAR. Formatting, tables and exhibits are simplified for reading; the original document is authoritative for anything you rely on.