Item 1A. Risk Factors
Item
1A. Risk Factors
In
addition to the other information contained in this Quarterly Report you should consider the risk factors and the other information in
our Annual Report on Form 10-K for the year ended December 31, 2025, including our audited financial statements and the related notes
and “Management’s Discussion and Analysis of Financial Condition and Results of Operations.” If any such risks actually
occur, 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 investment.
Additional risks and uncertainties not presently known to us or that we currently deem immaterial also may impair our business operations.
Below
we provide, in supplemental form, material changes to the risk factors previously disclosed in Part I, Item 1A of our Annual Report on
Form 10-K for the year ended December 31, 2025. Except as set forth below, there have been no material changes to the risk factors previously
disclosed in our Annual Report on Form 10-K, which are incorporated herein by reference.
The
following risk factor amends and restates in its entirety the risk factor titled “Our sales depend on coverage and reimbursement
from government and commercial third-party payors, and pricing and reimbursement pressures have affected, and are likely to continue
to affect, our profitability” included in our Annual Report on Form 10-K for the year ended December 31, 2025.
Our
sales depend on coverage and reimbursement from government and commercial third-party payors, and pricing and reimbursement pressures
have affected, and are likely to continue to affect, our profitability.
Sales
of our products depend on the availability and extent of coverage and reimbursement from third-party payors, including government healthcare
programs and private insurance plans. Payors continue to implement measures to manage utilization and contain costs, including step edits,
prior authorization, formulary restrictions, increased patient cost sharing, and reimbursement rate reductions. These actions may reduce
the number of patients for whom our products are reimbursed, delay or restrict patient access, and limit our ability to increase prices
or maintain pricing levels, any of which could adversely affect our revenues and profitability.
In
the United States, legislative and regulatory actions continue to focus on reducing drug costs, including measures affecting Medicare
reimbursement and manufacturer financial obligations. In addition, policymakers and CMS have advanced proposals that would reference
prices in other economically comparable countries in determining Medicare beneficiary cost-sharing and/or additional manufacturer rebate
obligations, sometimes described as “most-favored-nation” or international reference pricing policies. CMS has proposed mandatory
demonstration models, including GLOBE for Medicare Part B and GUARD for Medicare Part D, that would assess additional manufacturer rebates
based on international benchmarks for certain therapeutic categories that include ophthalmology or ophthalmic agents. Because certain
of our ophthalmic products are reimbursed under Medicare Part B, and we may develop or acquire additional products reimbursed by government
programs, these and similar initiatives could be particularly relevant to our business. Moreover, because we do not own global rights
to many of the products we market in the United States and generally do not control commercialization or pricing outside the United States
for those products, we may have limited or no ability to affect non-U.S. pricing that could be used as a benchmark under most-favored-nation
or international reference pricing initiatives, which could increase our exposure to such policies.
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Our
reported revenues also depend on significant estimates of variable consideration, including estimates for government rebates, commercial
rebates, chargebacks, wholesaler fees, distribution service fees, returns, administrative fees, patient assistance programs, and other
gross-to-net revenue deductions. These estimates require judgment and are based on available information regarding contractual terms,
channel inventory, product utilization, payor mix, wholesaler and distributor data, government program requirements, and historical and
expected claims activity. Actual deductions may differ from our estimates, and we may be required to adjust revenues in future periods
as new information becomes available or as claims are submitted, reconciled, disputed, validated, settled, or otherwise resolved.
From
time to time, we may receive rebate claims, chargebacks, fee-for-service deductions, invoices, or other claims from government agencies,
wholesalers, distributors, customers, former product owners, or other third parties that we believe are unsupported, overstated, duplicative,
attributable to another party or product, or otherwise inconsistent with applicable contracts, statutes, regulations, or program requirements.
The resolution of these matters may require significant management judgment, data reconciliation, legal analysis, and interaction with
third parties, and may involve uncertainty regarding matters such as product attribution, labeler codes, utilization data, 340B exclusions,
Medicaid and Medicare program rules, wholesaler deduction timing, and other assumptions. If our estimates are inaccurate, if disputed
amounts are ultimately resolved adversely to us, or if we are unable to obtain credits, offsets, refunds, recoupments, or other recoveries
for amounts we believe were improperly claimed or deducted, our revenues, gross margins, cash flows, financial condition, and results
of operations could be adversely affected.
We
cannot predict the scope, timing, or ultimate impact of these or other policy, payor, reimbursement, pricing, or gross-to-net developments.
If such developments decrease coverage or reimbursement, increase rebates or other price concessions, limit utilization, or result in
revenue adjustments that differ materially from our estimates, our business, financial condition, results of operations, and cash flows
could be materially adversely affected.
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