Annual Report 2017 Annual Report Many journeys, one destination
Annual Report 2017 Indivior is a global specialty pharmaceutical company and a world leader in addiction treatment
Contents Strategic report 1 2017 Highlights 2 Chairman’s statement 4 At a glance – the global burden of disease 6 A patient’s journey: Nathan 10 Business model 12 Chief Executive Officer’s statement 18 A patient’s journey: Miguel 22 Stakeholder engagement 28 Research & development 34 Managing our business responsibly 42 Financial review 46 Litigation update 48 Risk management Nathan’s story page 6 57 Viability statement Governance 58 Chairman’s introduction to Corporate Governance 60 Our Board of Directors 62 Our Executive Committee 64 Corporate governance report 83 Directors’ remuneration report 107 Directors’ report 111 Statement of Directors’ Responsibilities Financial 113 Independent Auditor’s Report 121 Financial Statements 152 Information for shareholders Miguel’s story page 18 155 References and sources
Our Purpose is to pioneer Our name is iconic life-transforming treatment. Our Vision is that all patients Our name is iconic of the individual around the world have access to evidence-based treatment for patient’s journey to reclaim life from the chronic conditions and the disease of addiction and our co-occurring disorders of addiction. endeavor to address patients’ Our Mission is to be the global unmet needs. leader who is a pioneer in developing innovative Our logo radiates our patient focused, prescription treatments for holistic approach to expanding access addicted patients. to evidence-based treatment for addiction worldwide. 2017 Highlights
2017 was a year of significant Strategic Report accomplishment for Indivior. By executing strongly across the business, we continued to build Governance our leadership position in treating addiction and its co-occurring disorders. Statements Financial
$1,093m 57% 874,481 Net revenue US average market share US unique patients received (+3% vs 2016: $1,058m) (vs 2016: 61%) SUBOXONETM Film (vs. 2016: 842,176) $193m $58m 8c Operating profit Net income Earnings per share (+30% vs. 2016: $149m) (+66% vs. 2016: $35m) (+60% vs. 2016: 5c) $403m $270m 37c Adjusted operating profit* Adjusted net income* Adjusted earnings per share* (+4% vs 2016: $387m) (+6% vs 2016: $254m) (cents per share) (+6% vs 2016: 35c) *excluding exceptional items (further details on page 45.)
Key pipeline highlights
$89m One Six Twelve R&D investment US FDA Peer-reviewed Published (-25% vs. approval publications conference 2016: $119m) abstracts
Indivior Annual Report 2017 1 Chairman’s statement
Building the business and strengthening core assets to best serve the needs of patients
“In 2017, the Board worked in close partnership with Indivior’s Executive Committee to ensure that the Group is best positioned to generate long- term value for all of its stakeholders. We did so by strengthening Indivior’s core assets – our people, culture, relationships, intellectual property and capital base – all the while making great strides toward our vision that all patients will have access to evidenced-based treatment for the chronic conditions and co-occurring disorders of addiction.”
Howard Pien Chairman
The Board’s mission is excellence 2017 was also a year in which we the Group continued to invest in in governance, while collaborating continued to enhance Indivior’s Compliance, as well as in improving with Indivior’s Executive Committee platform for growth. With the Board’s Indivior’s already-strong capabilities to build a lasting foundation support, the Executive Committee is across all corporate functional for growth. I am proud that our investing in launching SUBLOCADE areas, including R&D, Medical, collective efforts have resulted in with excellence and is creating a new Legal and Finance. a company that is well-positioned business unit to house and launch to produce future benefits for all RBP-7000 (monthly risperidone Management and the Board stakeholders, especially for patients long-acting injectable), if approved. To maintain the balance of skills, around the world. We are also working closely with knowledge and experience of our the Executive Committee to identify Board members, we appointed a new Key achievements in 2017 assets with the potential to broaden Executive Director, Mark Crossley, The Group (Indivior PLC and its the Group’s opportunity set within and a new Non-Executive Director, subsidiaries) has an exceptionally addiction and its co-occurring Tatjana May. Both Mark and Tatjana able and experienced Executive disorders. The work we did to bring a wealth of financial and legal Committee who, working side-by-side, establish a strategic collaboration experience to the Group, respectively. lead a group of employees that are with Addex Therapeutics is a good During the year, Cary Claiborne committed to the improvement example of this. Also, in concert stepped down from the Board, and of patient lives. Toward that end, with the Executive Committee, we we would like to thank him for his the year’s major milestone was are proactively identifying business valuable contributions. Those Board US Food and Drug Administration risks and implementing strategies members appointed on demerger (FDA) approval of SUBLOCADE™ to manage them. We are prudently from Reckitt Benckiser in 2014 were (buprenorphine extended-release) investing in the right areas – reappointed for a further three-year injection for subcutaneous use people, processes and technology term, thereby ensuring stability and (CIII), which is now available in the – to mitigate identified internal and continuity at the Board level. US. You can read more about this external risks to Indivior. significant treatment innovation It goes without saying that integrity in our Chief Executive Officer’s is at the core of all our activities. This statement on page 12. is an area, we, as a Board, together with the Executive Committee, take seriously and are committed to strengthening. As part of this effort,
2 www.indivior.com During the year, the Board also guarantee in terms of when these Outlook Strategic Report reviewed the composition of the matters may be settled and what the We look to the future with Board Committees. As a result, ultimate impact to Indivior will be. We confidence. In 2018, we will continue Lizabeth Zlatkus has joined the continue to cooperate fully with the to build on our strong foundation Science & Policy Committee and various parties and are hopeful for and develop our business with a Daniel Tassé has re-joined the resolution in a timely manner. focus on creating sustainable value Remuneration Committee. for our shareholders and wider Governance stakeholders. We will also seek to
Risks, challenges and In 2017, we also commissioned an drive commercial success through Governance uncertainties external Board evaluation to assess pioneering new technologies to A significant risk presented in 2017 our corporate governance framework. meet unmet patient needs. Addiction was the potential negative financial We conducted a full review of our remains one of the largest public impact of the Court ruling in the Dr. remuneration policy and continued to health crises of our time and we Reddy’s patent infringement lawsuit. engage with and proactively keep our will continue to work tirelessly to Although the US District Court for the shareholders apprised of the strategy advance global treatment options District of Delaware ruled that our and execution of both our near and to help meet this challenge. patents were valid, it also ruled that long-term goals. Statements Financial I look forward to meeting many of Dr. Reddy’s did not infringe them. We you in the year ahead. are appealing this decision; however, Share price performance the Group is at risk of potential and dividend significant loss of market share for We outperformed the indices by Howard Pien SUBOXONE® (buprenorphine and which we measure ourselves. Our Chairman naloxone) Sublingual Film (CIII) in total shareholder return in 2017 was the US if Dr. Reddy’s (or another 37%. This compares to 18% for the generic manufacturer) receives FDA FTSE 250 Index of which Indivior is approval for their generic version of a member, representing almost 20 SUBOXONE Film, and decides to enter percentage points of outperformance. the market ‘at-risk.’ Given our ongoing investments in The Group has sought to address this pipeline and market development, and risk by obtaining intellectual property the need to preserve our capital in the protection for its products and by event of launch of a generic competitor developing robust contingency plans to SUBOXONE Film in the US in 2018, including focusing on a successful we made no dividend payments launch of SUBLOCADE™ in the US during 2017. This situation is unlikely and pipeline development. This to change in the year ahead. We do, enterprise-level approach, led by however, recognize the importance our strong Executive Committee, is of returning value directly to our intended to help counterbalance investors and will continue to any potential future uncertainty evaluate as this year progresses. or financial loss were we to fail to obtain, maintain and protect patents and other proprietary rights, including potential invalidity or non- infringement findings in the current US Federal Court or US Patent and Trademark Office proceedings. In relation to the various litigation and investigational matters, summarized on pages 46 to 47, the Board agreed with the Executive Committee that it was prudent to increase the provision related to these matters to $438 million to reflect collectively their current status. Since these matters are ongoing we cannot provide any
Indivior Annual Report 2017 3 At a glance – the global burden of disease
We are in a unique position to address this global epidemic
Our patient-focused A human crisis ࢀࢀ In the United States alone, opioid Addiction is a chronic condition use disorder is an epidemic and is platform – people, reaching epidemic proportions – accelerating. culture, collaboration and a global human crisis we are The US Centers for Disease Control and evidence-based committed to helping address. and Prevention (CDC) in December innovation – uniquely According to the 2017 World Drug 2017 reported a 21% increase in the Report, published by the United Nations age-adjusted rate of drug overdose position us to help Office on Drugs and Crime (UNODC): deaths from 63,632 lives lost in 2016 address patients’ unmet vs. 52,404 lives lost in 2015. In fact, ࢀࢀ An estimated 1 in 20 adults (5%) the rate of increase in deaths from needs for the chronic – more than 250 million people synthetic opioids, like fentanyl, conditions and co- worldwide – used an illicit drug* doubled from 2015 to 2016. in 2015. occurring disorders ࢀࢀ Opioids, including heroin, remain But the global addiction crisis is not of addiction. the most harmful drug type. restricted to drug use disorders and drug dependence. ࢀࢀ Opioid use disorders account for the heaviest burden of disease The World Health Organization attributable to drug use disorders: (WHO)’s Global Status Report on in 2015, approximately 70% of Alcohol and Health (2014) reports: the global burden of disease ࢀࢀ In 2012, approximately 3.3 million attributable to drug use disorders deaths, or 5.9% of all global deaths, were attributable to opioids. were attributable to alcohol *Defined as opioids, opiates, cocaine, cannabis, consumption. amphetamines, psychoactive substances.
4 www.indivior.com Canada United Europe and South China Australia States Middle East Africa Strategic Report 0.2m 2.1m 1.3m 0.1m 7.3m 0.2m Opioid Opioid use High risk opioid Opioid Opioid Opioid dependent disorder users (Europe dependent dependent dependent (opioid only) painkillers only)
1.4m 15.1m 14.2m 1.2m 27m 0.3m Governance Alcohol Alcohol use Alcohol Alcohol Alcohol Alcohol dependent disorder dependent dependent dependent dependent 28m 17m 70% healthy years of life lost healthy years of life lost as a of the global burden of disease Statements Financial as a result of drug use result of drug use disorders attributable to drug use disorders were attributable to opioids
ࢀࢀ The same report concludes that In Europe, in 2015, there were Sublingual Tablet, and SUBUTEX® the harmful use of alcohol ranks potentially 1.3 million high-risk opioid (buprenorphine) Sublingual Tablet. among the top five risk factors users, the majority of whom were In these countries, we work closely for disease, disability and death heroin users. Of these 1.3 million with medical professionals, advocating throughout the world. high-risk opioid users, five countries on patients’ behalf and educating the in the European Union (Germany, public about opioid use disorder. Addiction differs in prevalence Spain, France, Italy, United Kingdom) and severity accounted for the majority (76%) of Addiction differs in substance use high-risk use. And, as in the US, the disorder, prevalence and severity in emergence of highly potent synthetic Fewer than one in six different parts of the world. opioids, like fentanyl, are causing persons with drug use much concern. The 2016 European According to the US 2016 National Survey Drug Report notes an overall increase disorder are provided on Drug Use and Health (NSDUH): in opioid-related overdose deaths. treatment each year. ࢀࢀ In 2016, approximately 20.1 million In 2014, Australia ranked as the people had a substance use third highest country worldwide for Our aim is to expand disorder (SUD) related to alcohol or prescription painkiller misuse per access to evidence- illicit drug use in the past year. year. China has an estimated 7.3 based treatments for ࢀࢀ Of the 20.1 million people with a million people dependent on opioids SUD, there were 15.1 million people and 27.3 million people dependent on patients. with an alcohol use disorder alcohol (2014). ࢀࢀ An estimated 2.1 million people suffered from an opioid use Rising to the challenge – our disorder, which includes 1.8 global presence million people with a prescription Indivior has a global presence in pain reliever use disorder and over 40 countries. Our core products approximately 626,000 people with are SUBLOCADE™ (buprenorphine a heroin use disorder. extended-release) injection for ࢀࢀ In Canada, in 2012, as many as subcutaneous use (CIII), SUBOXONE® 200,000 people were estimated (buprenorphine and naloxone) to be addicted to prescription Sublingual Film, SUBOXONE® painkillers. (buprenorphine and naloxone)
Indivior Annual Report 2017 5 A patient’s journey Nathan Patient, US
Nathan’s journey “I had reached rock bottom, but through determination and humility I worked my way back up. I attended meetings. I found a job where I started cleaning toilets and where I am now Head Supervisor. Gradually, with the help of the treatment program, I got my life back on track.”
Nathan started college Can you describe your struggle at 18, only to get drawn with addiction? At college I got into opiates, speed into drug and alcohol and alcohol. I quickly fell in love with use. Dropping out of his the feeling of getting high and not having to deal with reality. These studies, he began a feelings took control of my mind, 20-year struggle with my body and my life, and I gave into addiction. Now, aged 38, it every time. It became a constant cycle of insanity. Nathan is in recovery For a while I managed to hide my after enrolling in an problems from my family and friends. innovative treatment Only when I tried to commit suicide, around the age of 21, did they become study. After more than aware of my struggle with addiction. two years in recovery, From that point on I was in and out he is starting to rebuild of rehab, but I never truly committed to recovery. I was always doing it for his life. other people, to please my family. Never for myself. And as soon as I was out of treatment I would relapse back into my addiction.
6 www.indivior.com Indivior Annual Report 2017 7 “When Nathan came to us, he was really struggling with the symptoms of opioid use disorder. But he showed a real motivation to participate in the program and follow our treatment protocols. In addition to medication, our program included psychosocial support and counseling. We’ve built up a strong relationship based on honesty and trust, and over time Nathan has achieved excellent disease control.” Amit Vijapura MD Medical Director, Vijapura Behavioral Health LLC.
8 www.indivior.com Inevitably, addiction also damaged my relationships with people. I became a master manipulator and liar, and would tell my lies over and over until they became truths. It destroyed my ability to communicate honestly with those around me, and it eroded their trust in me.
What was the turning point for you? It wasn’t until I reached rock bottom that I finally reached out properly for help. I was homeless and knew I couldn’t go on living the way I was. One of my old friends got me into a halfway house. From there, I was referred to Dr Vijapura. He put me on a treatment program that included medication and counseling and I began my journey to recovery and stability which I have maintained for close to two years now. It’s been a real test of willpower and commitment, and I’ve had to be honest and transparent with Dr Vijapura at all times, otherwise it just doesn’t work.
How does it feel to be in recovery? It feels fantastic. The treatment program has brought clarity to my mind and helped me live a normal life. I’m able to make the right decisions and I have a new lease on life. And through the process of recovery, I have rebuilt my relationships with my family. I’m close with my sisters, and I often visit my father and stepmother in the country, where I help them on their farm. They trust me again. Alongside the treatment program, I’ve been attending meetings and Bible class, and working at a local store, where I am now the Head Supervisor. I’m proud of not having given up, of not having given in. And now I have a future to look forward to. I’d like to finish my studies, and maybe use my story to help others. Because if I can do it, anyone can.
Indivior Annual Report 2017 9 Business model
Our Purpose is to Our Vision is that all Our Mission the global pioneer life-transforming patients around the leader who is a pioneer is treatment. world have access to developing innovative evidence-based prescription treatments treatment for the chronic for addicted patients. conditions and co- occurring disorders of addiction.
E nt p re hi p s re r n e e n u w r O s h ip
Focus on patient Seek the wisdom of needs to drive the team decisions
Indivior Guiding Principles and
Demonstrate honesty Core Values Believe that people’s and integrity at actions are well all times intended
P a r t t See it, own it, n Care enough to coach n e make it happen e r m sh e ip ev hi Ac
10 www.indivior.com Strategic Report Indivior’s What Indivior Indivior’s assets does investment case
Highly skilled and Manufacturing Growing global marketplace knowledgeable people Indivior discovered buprenorphine for the Group’s existing Indivior possesses an exceptionally in Hull, UK, and developed it as a product portfolio able and experienced workforce that treatment for opioid dependence. The global addiction crisis has is committed to the improvement Indivior continues to manufacture provided an opportunity for the Group Governance of patient lives and achieving long- this key active ingredient for its to significantly expand the market for term success. opioid addiction treatments at buprenorphine medication-assisted its Fine Chemical Plant in Hull, treatments, acknowledged as an Culture UK. Indivior has continuously evidence-based treatment for opioid Based on a clearly-defined set of manufactured buprenorphine at this use disorder, to help patients in their principles and behaviors, Indivior’s facility for over 50 years and believes treatment journey. culture is a key competitive it produces the highest quality advantage enabling Indivior to create buprenorphine in the world. Unique focus on and Statements Financial not only a business that will prosper understanding of patient needs and grow, but an organization that Responsible sales and Indivior is committed to addressing will create lasting social value. marketing the global addiction crisis by Indivior is committed to conducting expanding the availability of its Stakeholder relationships all of its sales and marketing activities patient-focused treatments, including Indivior has strong and enduring responsibly and in compliance increasing treatment access, relationships with its key with the relevant regulations and while also leveraging its unrivaled stakeholders, including policy- guidelines. Although the Group’s knowledge in addiction science to makers, regulatory agencies, corporate compliance department develop novel treatments. healthcare professionals, patient partners with the business to advocacy organizations and the oversee certain activities and Innovative R&D pipeline investment community. These provide guidance, there is a clear Indivior has consistently built relationships provide Indivior with understanding among the sales and on its leadership position in the critical insights to develop and marketing teams that they each share treatment of opioid use disorder improve upon its patient-focused responsibility for compliance. globally to develop new patient- business approach. focused treatments that in turn Conducting advocacy and have enabled the Group to invest Intellectual property raising awareness of the opioid in its R&D pipeline. This skill set Indivior has a unique portfolio of addiction crisis also has enabled the Group to licenses and patents which enable A key aspect of Indivior’s activities consider expanding the scope of the it to manufacture and market its is raising awareness of the opioid treatments it provides to help address treatments. addiction crisis in all the markets it co-occurring disorders of addiction. serves through regular stakeholder Capital base dialogue and patient advocacy Strong profitability and cash flow Indivior’s cash generative business activities. These activities have Indivior is highly profitable and cash activities, combined with the Group’s contributed to expanded treatment generative, providing the resources access to the international capital access in the Group’s largest market, required to fund day-to-day operations markets, provide a stable base of the US, over the last five years to and reinvest in future growth liquidity that supports the Group’s record levels today. opportunities, including new geographies principle day-to-day activities and developing new treatment options while providing it further resources Research and development for addiction and its co-occurrences. for reinvestment in potential new Indivior conducts world leading and treatments targeting addiction innovative research and clinical Talented and experienced and its co-occurring disorders development activities for the management team and for extending its overall treatment of addiction and other co- Indivior possesses a talented, committed competitive position. occurring disorders. These efforts are and experienced management team led by staff in Fort Collins (Colorado, widely recognized by the industry as US), Richmond (Virginia, US), and Hull leading in the development of patient- and Slough (UK). focused treatments for addiction.
Indivior Annual Report 2017 11 Chief Executive Officer’s statement
Many journeys, one destination
"I firmly believe we are The year in review Committee that it was prudent to In 2017, Indivior delivered against its increase the provision related to the company – working strategic priorities. Our execution these matters to $438 million to in partnership with drove progress toward our vision reflect collectively their current other experts – best that all patients will have access to status. Since these matters are evidence-based treatment for the ongoing we cannot provide any positioned to tackle chronic conditions and co-occurring guarantee in terms of when these the growing global disorders of addiction. We created matters may be settled and what the addiction crisis. Our greater certainty for Indivior, most ultimate impact to Indivior will be. We significantly by extending our continue to cooperate fully with the vision, patient focus, leadership position in developing various parties and are hopeful for guiding principles, and and advancing global addiction resolution in a timely manner. pursuit of innovation treatment with the US FDA approval Below are the strategic priorities the of monthly SUBLOCADE for moderate Board and management team set will continue to drive to severe opioid use disorder (OUD). for the Group, understanding that Indivior’s success in At the same time we grew Indivior’s these have the greatest impact on our capabilities and resources to enable business, and that building upon them delivering value for us to invest in developing promising best positions Indivior to generate shareholders and future treatments focused on unmet long-term shareholder value. patient needs in addiction and its meeting the unmet co-occurring disorders. 1. Building the resilience of our needs of patients.” franchise by continuing to Our strong execution in 2017 translated expand access to treatment and into improved top- and bottom-line Shaun Thaxter maintaining a leadership position; results for Indivior. Sales grew by 3% to Chief Executive Officer 2. Developing our innovative pipeline $1,093 and net income grew by 6% to to help improve patient outcomes; $270m, on an adjusted basis. 3. Expanding global treatment by Our results are even more notable capitalizing on international growth considering the multiple forces we opportunities; and faced during the year: an intensifying 4. Preparing for our future by creating competitive landscape for our a robust growth infrastructure and market-leading SUBOXONE Film effectively managing business risks. treatment in the US, continued I’ll now expand on each of the healthcare austerity in Europe strategic priorities, looking at the and the investments required progress made against each in 2017, to successfully develop and and our plan for leveraging our commercialize our key pipeline achievements moving forward. assets in the US in 2018: SUBLOCADE and, if approved by FDA, RBP-7000 (monthly risperidone injection). 1. Building the resilience of our franchise by continuing to In relation to the various litigation expand access to addiction and investigational matters, the treatment and maintaining a Board agreed with the Executive leadership position According to new data released by the US Centers for Disease Control and Prevention (CDC), there were more than 63,600 total drug overdose deaths in 2016, or 174 drug overdose
12 www.indivior.com deaths per day. This number is up 2017 Sales by geography As a result, total market growth Strategic Report 21% in just one year – from 144 a accelerated to low double- day in 2015. Furthermore, the US digit levels in 2017, from high single- healthcare system is struggling to digit levels the previous year. keep pace with the addiction crisis, Against this backdrop in the US, and many patients are unable to our SUBOXONE Film franchise access the evidence-based treatment maintained its leading position in and care they require. In fact, despite its largest market, with an average extensive evidence of the personal Governance share of 57% of the buprenorphine and societal benefits of medication- medication-assisted treatment assisted treatment (MAT), only a small $1.1 Bil (BMAT) market in 2017. The minority of OUD patients receive it, resilience of our franchise is a and OUD diagnoses are currently testament to our patient-focused outpacing MAT prescriptions at an platform. We are well-positioned to alarming rate of nearly eight to one. support the launch of SUBLOCADE, In 2017, Indivior continued efforts which we believe may become a new to support patient access to care. standard of care for the treatment of Statements Financial United States 80% Treatment capacity expanded to Rest of World 20% moderate to severe OUD. a record number of physicians and other qualified treatment 2. Developing our innovative providers in the US, ending the year “I am pleased to report pipeline to help improve at about 48,480 providers, a 25% that SUBLOCADE is now patient outcomes increase over 2016. The increase TM in the patient treatment cap from available to US patients SUBLOCADE 100 patients to 275 patients, and and their treatment For patients and shareholders, the the ability of nurse practitioner’s providers.” story of the year was undoubtedly (NPs) and Physician Assistants (PAs) the FDA approval of our new product, to prescribe added to treatment SUBLOCADE, which is the first once- capacity and market growth. monthly injectable buprenorphine
US SUBOXONE® Film share has been resilient
80
70
60 55 8% 50
40
30
20 19 8% 19 7%
10 4 3% 0 0 5% Jul 17 Jul 13 Jul 15 Jul 14 Jul 16 Jan 17 Jan 13 Jan 15 Jan 14 Jan 16 Dec 17 Mar 17 Mar 13 Mar 15 Nov 13 Nov Nov 15 Nov Mar 14 Mar 16 May 17 May Nov 14 Nov Nov 16 Nov May 13 May May 15 May May 14 May May 16 May Sept 17 Sept 13 Sept 15 Sept 14 Sept 16 Suboxone® Suboxone® Generic Generic ubsolv® Bunavail® Film Tablet buprenorphine buprenorphine /naloxone ubsolv® is a licensed trademark of Orexo US, Inc. Bunavail® is a registered trademark of BioDelivery Sciences International, Inc.
Source: Symphony Health Retail & Non-Retail TRx MG (IDV) ending Dec 2017
Indivior Annual Report 2017 13 Chief Executive Officer’s statement continued
formulation approved to treat moderate the treatment of schizophrenia. In We are particularly excited about to severe OUD. A significant scientific December 2017, the FDA accepted the potential of the lead compound, innovation, SUBLOCADE represents a our New Drug Application (NDA) ADX71441. The US National Institute on new treatment option to help patients for RBP-7000, which is a significant Drug Abuse (NIDA) recently awarded attain more illicit opioid-free weeks milestone for Indivior as we expand a $5 million grant to support the during their treatment program. our treatment portfolio. development of ADX71441 in CUD. In 2018, we will be working with Addex SUBLOCADE is the first therapy RBP-7000 leverages much of to define the key activities that will that, at steady state, delivers the science and capabilities we support the development of ADX71441 buprenorphine at a sustained rate of established with the ATRIGEL as well as the research program that at least 2 ng/mL over a one-month technology platform. In much the will be dedicated to the identification period. These sustained plasma levels same way that SUBLOCADE delivers of new GABA PAMs. of buprenorphine translate into high on unmet patient needs with B mu-opioid receptor occupancy in the buprenorphine, we believe RBP-7000, 3. Expanding global treatment brain, which blocks the drug-liking if approved, will meet key patient effects of opioids. needs with risperidone: principally a by capitalizing on international rapid onset of action with consistent growth opportunities In addition, SUBLOCADE is disseminated plasma levels of risperidone In 2017, we continued to make good through a restricted distribution system, over the entire monthly dosing progress with our SUBOXONE Film which is intended to prevent direct interval. We have spent time with and Tablet franchise outside the US. distribution to the patient, thereby prescribing psychiatrists and, while minimizing the risk of serious harm In Australia, SUBOXONE Film they like risperidone’s established or death through intravenous self- continues to gain share against efficacy profile – it is still the most administration. This approach is also legacy treatment approaches as the prescribed anti-psychotic – they intended to help reduce the risk of treatment community grows more don’t yet have a monthly risperidone diversion, misuse and abuse. familiar with Indivior. In Canada, option that they would consider a where per capita addiction (or SUBLOCADE represents an evidence- ‘breakthrough’ treatment. overdose) rates are greater than the based, paradigm shift from how we To ensure RBP-7000’s anticipated US, SUBOXONE Film was added to approach treatment of moderate to success, we have established a new the List of Drugs for an Urgent Public severe opioid use disorder today. Behavioural Health Business Unit, Health Need in British Columbia. Its development is testament which has required an investment in In Canada, overall, our SUBOXONE to Indivior’s depth of expertise new sales and marketing capabilities. Tablet share position continues in receptor pharmacology and This includes recruiting new talent to grow. Our early successes in pharmacokinetic understanding. It with expertise in this disease space to Australia and Canada demonstrate also demonstrates our focus and enable the successful launch of RBP- our ability to identify opportunities ability to listen and partner with our 7000 and to leverage our significant to address the unmet needs of stakeholders, including the US FDA, R&D capabilities to develop life-cycle patients and differentiate from the treatment community and patient management opportunities. other buprenorphine options and advocates, to find and develop quickly flex our organization to gain another evidence-based option that RBP-7000’s PDUFA date is July 28, meaningful market entry. meets patients’ needs. 2018 and, assuming a favorable approval decision from the FDA, we Our European business, which I am pleased to report that anticipate a Q4 launch and project constitutes our largest market outside SUBLOCADE is now available to US delivering peak annual net revenues the US, also continued to grow despite patients and our confidence in its of $200 to $300 million. the focus on funding austerity in potential is reinforced by our peak key European markets. We have annual net revenue expectations of at Addex continued to provide buprenorphine least $1,000 million. To further build upon our leadership medication-assisted treatment (BMAT) for OUD in Europe and have expanded RBP-7000 position in addiction, we entered into a strategic collaboration with Addex our portfolio in the region. In July 2017, Our patient focus and desire to Therapeutics to license and accelerate the French regulatory agency, l’Agence deliver on unmet patient needs the development of GABA positive Nationale de Sécurité du Médicament extends to the co-occurring B allosteric modulators (PAMs), which et des produits de santé (ANSM), disorders of addiction. In 2017, have demonstrated preclinical activity approved a Marketing Authorisation we made excellent progress with and tolerability in animal models (MA) in France for Indivior’s NALSCUE® RBP-7000, an investigational once- for alcohol use disorder (AUD) and (naloxone hydrochloride) nasal spray monthly injectable risperidone in cocaine use disorder (CUD). for the emergency treatment of the ATRIGEL® delivery system for suspected opioid overdose.
14 www.indivior.com Delivering on our strategy
Our strategic Progress priorities in 2017 Strategic Report Building the ࢀࢀ Maintained SUBOXONE Film’s leading share position at an average of 57% (2016: 61%) in our largest market, the US, despite competition from lower priced resilience of generic options our franchise ࢀࢀ SUBOXONE Film’s resilience demonstrates the strength of Indivior’s brand and our focus on patient needs ࢀࢀ Treatment capacity expanded to a record number of physicians and other qualified treatment providers in the US, ending the year at about 48,480 providers, a 25% increase over 2016 Governance
Developing ࢀࢀ SUBLOCADE – FDA approved on November 30th the first and only once-monthly treatment for moderate to severe OUD; SUBLOCADE now available to patients our innovative nationwide in the US pipeline ࢀࢀ
RBP-7000 (monthly risperidone injection) – FDA accepted submission of the NDA Statements Financial and established a PDUFA date of July 28, 2018; Q4 2018 launch expected, if approved ࢀࢀ Arbaclofen Placarbil – Phase 1 Bioavailability Clinical Study Protocol (INDV-AP-102) completed; planning to meet with FDA to share our plans and agree on next development stages
ࢀࢀ Addex Therapeutics Strategic Collaboration – Exploring the potential of GABAB PAMs in addiction treatment; US NIDA recently awarded a $5.3 million grant to Addex to support the development of ADX71441 for cocaine use disorder (CUD)
Expanding ࢀࢀ Maintained leading share of BMAT market in Europe, Indivior’s largest market our global outside the US ࢀࢀ Preparing regulatory submission for SUBLOCADE approval in key Western European treatment markets in 2018 ࢀࢀ NALSCUE for the emergency treatment of characterized or suspected opioid overdose received regulatory approval in France ࢀࢀ Australia and Canada continued to generate share with strong sales growth; SUBLOCADE regulatory submissions being prepared for both Australia and Canada
Developing ࢀࢀ Completed extension of Indivior R&D facilities in Fort Collins (CO, USA) (18,500 sq ft) the business and new R&D Center of Excellence in Hull (UK) (54,000 sq ft) ࢀࢀ Initiated the appeals process against Dr. Reddy’s after the Court validated Indivior’s patents, but found non-infringement; appeal is progressing in the Federal Circuit Court of Appeals ࢀࢀ Entered a settlement agreement with Mylan resolving patent litigation related to SUBOXONE Film, including termination of their inter partes review (IPR) action ࢀࢀ Continued to assert Intellectual Property, including SUBOXONE Film Orange Book listed patents ࢀࢀ Entered a settlement agreement with Amneal related to antitrust litigation ࢀࢀ Replaced US and Euro denominated term loans with new facilities that carry more favorable durations and terms, thereby significantly improving Indivior’s overall financial flexibility
Indivior Annual Report 2017 15 Chief Executive Officer’s statement continued
NALSCUE has been provided in France over the course of 2018 we will be R&D, future medicines development under a Temporary Authorisation working with key European agencies and finance. In 2017, our compliance for Use (Autorisation Temporaires to seek approval for use. In the near group doubled in size which reinforces d’Utilisation or ATU) since July 2016. term, the environment is expected to our commitment to operating a remain challenging, but we continue compliance-focused culture. Our solid growth in Australia to eye Europe as a future growth and Canada, along with steady Our R&D investments are aimed market for SUBLOCADE. performance in Europe, drove overall at solidifying our commitment to Rest of World sales to $216 million in focus on life-cycle management 4. Prepare for our future by 2017, a 7% increase. of SUBLOCADE. After launch, we creating a robust growth will monitor patient outcomes, the We continue to work with European infrastructure and effectively efficacy and safety of this important treatment leaders to destigmatize managing business risks medicine and monitor patient addiction and to raise awareness In 2017, we continued to build our experiences to learn how we can among policy makers about drug- capabilities and financial strength to further enhance treatment options. related deaths and the ways to help ensure Indivior is optimally positioned reduce them with buprenorphine- to endure both seen and unforeseen based OUD treatments. We believe challenges. We have expanded our the potential for SUBLOCADE is talent base across the organization, substantial in Western Europe, and including investments in compliance,
Indivior’s global presence
Austria Germany Luxembourg Bosnia Poland Switzerland Belgium Iceland Malta & Herzegovina Romania Croatia Ireland Norway Cyprus Slovakia Czech Republic Israel Portugal Estonia Slovenia Denmark Italy United Kingdom Greece Spain Finland Latvia Hungary Sweden France Lithuania The Netherlands Turkey
Canada
United States Taiwan
SUBOXONE Malaysia Hong Kong Film
SUBOXONE Indonesia Tablet
SUBUTEX Australia Tablet
SUBLOCADE Injection* South Africa New Zealand
Indivior has a global presence in over 40 countries. Our core products are SUBLOCADE™ (buprenorphine extended-release) Injection for subcutaneous use (CIII), SUBOXONE® (buprenorphine and naloxone) Sublingual Film, SUBOXONE® (buprenorphine and naloxone) Sublingual Tablet, and SUBUTEX® (buprenorphine) Sublingual Tablet. Indivior’s largest geographic market (based on sales origination) is the US, which in 2017 accounted for 80% of net revenues and where SUBOXONE® Film is the buprenorphine market leader. In other parts of the world, our SUBOXONE® Sublingual Tablet, SUBOXONE® Sublingual Film and SUBUTEX® Tablet are also market leaders based on market share. *SUBLOCADE™ received US FDA approval in November 2017, but had no net revenue impact in the year.
16 www.indivior.com I am particularly proud of the of Delaware ruling that while our education, new scientific understanding Strategic Report world-class manufacturing and R&D patents were valid, Dr. Reddy’s and knowledge to the treatment capabilities we have established did not infringe on them. We have community. Indeed, a rigorous and in Hull (UK) and Fort Collins (US). since filed an appeal against the unwavering focus on patient needs These investments will help us lead Dr. Reddy’s decision and intend informs everything we do. the science of addiction and its to continue vigorously defending co-occurring disorders and develop our intellectual property, including Based on a clearly-defined set of new treatment options for patients asserting two important new Orange principles and behaviors, our culture is a key competitive advantage. All of around the world. Book listed patents (’454 and ’221). Governance Unfortunately, the Court’s timing our guiding principles, but particularly Late in the year, we further secured and ultimate decisions are out of our capacity to demonstrate honesty our future by favorably amending our control. I can, however, say for and integrity at all times, support a and extending credit terms with certain that Indivior’s position is culture that strives to adhere to the lenders. As a result, we gained much improved with the availability highest ethical principles at all times. the financial flexibility to allow us of SUBLOCADE in the US, our strong In 2017, this culture continued to to invest in Indivior’s key growth cash position and improved overall drive our performance, enabling us initiatives and consider business to create not only a business that will financial flexibility. Statements Financial development opportunities. prosper and grow, but an organization We have also continued to assert The Indivior culture that will create lasting social value by helping to address one of the most and defend appropriately the At the heart of Indivior is a shared urgent epidemics of our time. intellectual property surrounding passion and commitment to help SUBOXONE Film. In September 2017, support the patient journey to Looking ahead, our priority is to we experienced a setback in our treatment and recovery, remove the increase Indivior’s value by enhancing infringement lawsuit against Dr. barrier of stigma, enable access to our leadership in the treatment Reddy’s, with the US District Court evidence-based treatment, and provide of addiction and its co-occurring disorders, maintaining our focus on the patient and engaging and Gary Mendell, Chairman and CEO Shatterproof, learning from our stakeholders. As a joins Indivior for lunch company, we will continue to educate, after the Washington enable and convene with the aim of D.C. 5K walk/run. progressing our understanding of the broader addiction disease space and delivering better treatment solutions. I firmly believe we are the company – working in partnership with other experts – best positioned to tackle the growing global addiction crisis, and its co-occurring disorders. And, while change occurs at pace in the world around us, our vision, patient focus, guiding principles and pursuit of innovation remain Indivior employees resolutely unchanged. These are the listen to remarks. key ingredients that we believe will continue to drive Indivior’s success and long-term value for shareholders. We therefore face the future with great confidence, knowing that our bedrock foundation is strong.
Shaun Thaxter Chief Executive Officer
Indivior Annual Report 2017 17 18 www.indivior.com A patient’s journey Miguel Patient, France
Miguel’s journey “My involvement with Auto-Support des Usagers de Drogues has enabled me to overcome feelings of stigma, and I’m able to use my experience to help others.”
Miguel’s journey with Can you describe the early years of your addiction, and what your addiction began at the age life was like at that time? of 15, when he started I was influenced by 1970s culture taking cannabis and LSD, and wanted to open my mind. During the 1980s, I was living in Paris and turning then to cocaine then Madrid. It was a time of cultural and heroin. After school change, particularly in Spain, and lots he went to university, then of people were experimenting with drugs. I was a successful professional began working as a – perhaps not the expected profile Spanish teacher. He got of a drug user – so I had money, and drugs were easy to find. I began married and started a sniffing and smoking heroin every family, but his drug use day, occasionally shooting. My wife continued, getting steadily was also using, so I didn’t have to hide what I was doing. worse over time. Only now at the age of 61, after When did you realize you had three years of treatment, a problem that needed to be addressed? does he feel he finally has The turning point came when my a normal life and, wife committed suicide. It was very shocking and upsetting for me. I was following deep personal left with two children and had to tragedy, has rediscovered carry on working so I could support love and hope. and provide for them. I wanted to stop taking drugs, but I didn’t want to enroll in a treatment program because I was worried about the stigma, about the reaction of the social services.
Indivior Annual Report 2017 19 It was post-2000, when my sons had finished their education, that my struggle with heroin got really bad. I quit my job and spent the next few years injecting and living as a drug addict on the street. I would steal tools from construction sites and sell them to earn money. It was a very chaotic period and things really went downhill for me. Then one day, I was so ill I couldn’t even get on a bus. Some friends of mine found me and saw the state I was in. The very next day, they took me to a treatment center and I enrolled in a medication-assisted treatment program.
20 www.indivior.com “I have my family back. I am living life again.”
How did you respond to a drug user, and I can help speak the treatment? for people whose situations I I took my medication daily and I understand. Not only that, we as was analyzed every two weeks. It an organization fight against the was hard, but I kept going because stigmatization of drug users as I knew this was a way to stay safe criminals as this goes against the from harm, and my life began to progress of rehabilitation. I know normalize. During this period, I also that medication-assisted treatment met someone and rediscovered love, must be as widely available as and this further motivated me to possible, and that we must have stop taking drugs. It’s fair to say the different products to meet different medication-assisted treatment made people’s needs. Through advocacy a positive difference to my life. and insight, I want to help make a difference, and I’m pleased to be Along the way, I found ASUD (Auto- able to put my past experiences to Support des Usagers de Drogues), good use helping others. where I now work. My involvement with ASUD has enabled me to overcome feelings of stigma, and I’m able to use my experience to help others. I provide insight into patient needs and treatment efficacy from the perspective of
Indivior Annual Report 2017 21 Stakeholder engagement
For more than 20 years, Indivior has worked together with policymakers, medical societies, patient advocacy groups, healthcare providers, payers and other stakeholders to educate on the disease of addiction and advocate for patient access to evidence- based treatment.
In 2017, Indivior’s In supporting leading global advocacy advocacy efforts focused organizations, Indivior focused on: ࢀࢀ Expanding access to evidence- on shaping an external based treatment and information. environment to help ࢀࢀ Promoting education, advocacy and meet the unmet needs engagement. ࢀࢀ Advocating for access to substance of patients and to use and mental health benefits for destigmatize the US patients. disease of addiction. ࢀࢀ Breaking the intergenerational cycles of addiction. ࢀࢀ Accelerating innovation through science, education and leadership conversations. ࢀࢀ Awareness-building initiatives to help drive solutions. We are pleased to highlight the work of several of the organizations working tirelessly to advance change for patients and families suffering from addiction. We are proud to support their efforts.
22 www.indivior.com Indivior Annual Report 2017 23 Stakeholder engagement continued
“This support is so valuable – it helps to generate resources that simply didn’t exist before; resources designed to identify and help the most at-risk families and individuals.”
Jessica Hulsey Nickel President & CEO, APF
Addiction Policy Forum, US In the US, Indivior supports the Addiction Policy Forum (APF), a national organization working to elevate awareness around addiction and improve national policy through prevention, treatment, recovery and criminal justice reform. During 2017, Indivior provided financial support for APF’s Emergency Medicine Initiative, an area of strategic focus for the organization. Through this initiative, APF is developing open-source materials to educate emergency responders to help ensure that non-fatal overdoses do not become fatal through reoccurrence, and to develop treatment protocols to help meet that goal. “These post-overdose protocols are so important,” says Jessica Hulsey Nickel, founder and President & CEO, APF. “That’s where this support is so valuable – it helps to generate resources that simply didn’t exist before; resources designed to identify and help the most at-risk families and individuals.” Jessica, whose parents died as a result of long-term opioid use disorder, has been advocating for a better response to addiction since she was 15 years old.
24 www.indivior.com “It is by supporting collaboration and innovation that we can help make a difference for patients.”
Shaun Thaxter Strategic Report Chief Executive Officer
Indivior also provides financial than $300,000 to help communities support for APF’s CARA Family advocate for evidence-based solutions Day, named after the landmark and policy change. Dr. Ponni Subbiah, Comprehensive Addiction and Chief Medical Officer, Indivior, Recovery Act (CARA). Passed in the US highlighted Indivior’s commitment to Governance in 2016, this legislation has advanced patients in remarks at the opening evidence-based prevention, program in Washington, D.C. treatment and recovery services for substance use disorders. APF’s Harm Reduction Australia, annual event brings together families New South Wales directly affected by addiction from In 2017, Indivior provided support all over the US to advocate on behalf to Harm Reduction Australia, a of addiction resources and to raise Statements Financial national organization for individuals awareness to help end the stigma ScriptWise, Australia committed to reducing the health, surrounding this disease. ScriptWise is a national non-profit organization, based in Australia, social and economic harms dedicated to reducing prescription potentially associated with drug use. Parity at 10 Compliance To encourage a thorough rethink Campaign, US medication misuse and overdose fatalities. In 2017, Indivior provided of existing policies and support the Indivior supports the Parity at financial support for a range of much-needed reform of the Opioid 10 Compliance Campaign, a new activities including: Treatment Program (OTP) system, partnership of leading national Indivior provided funds to Harm organizations working for effective ࢀࢀ ScriptWise’s efforts to raise Reduction Australia to deliver a enforcement of the Parity Act in ten awareness of the importance of a series of information and discussion US states over the next three years. Real Time Prescription Monitoring forums with OTP stakeholders One of the major recommendations system for Australian States throughout late 2017. outlined in the final report of the US and Territories, and to provide President’s Commission on Combating information about over-the-counter The Hill, Washington D.C. Drug Addiction and the Opioid Crisis codeine rescheduling in Australia. To help accelerate innovative is the need for greater enforcement ࢀࢀ A stakeholder treatment advocacy solutions to the opioid crisis, in 2017 of the Federal Parity Act. Next year and awareness initiative which Indivior sponsored a leadership will mark the 10th anniversary of involved facilitating the start of conversation in Washington, D.C. with the landmark legislation, which Working Groups in Victoria and WA. The Hill newspaper. ‘America’s Opioid mandates that health insurance plans’ ࢀࢀ International Overdose Awareness Epidemic, the Search for Solutions’ standards for substance use and Day activities. featured US federal and state mental health benefits be comparable government policy-makers, patient to, and be no more restrictive than, Shatterproof, US advocates, medical societies and the standards for other medical/ In support of Shatterproof, a non- healthcare advocates in thoughtful surgical benefits. Parity at 10 has profit organization with a mission to discussion about solutions to combat launched in five states – Illinois, end the devastation that addiction the opioid crisis. Maryland, New Jersey, New York and causes families, Indivior sponsored 5k Closing the event, Indivior CEO Ohio. The campaign’s work in each walk/run events in Washington, D.C., Shaun Thaxter said: “We are facing a state includes researching the current Boston and Atlanta. The Shatterproof tremendous crisis of people suffering treatment and policy landscape, ‘Rise Up Against Addiction’ 5k walk/ from chronic addiction and we conducting extensive public and run events brought together people must continue to increase access to provider education about the Parity affected by addiction and united in care, invest in psychosocial support Act, and, in partnership with local their passion to end the stigma of infrastructure and offer evidence- stakeholders and advocates, working addiction by honoring loved ones lost based treatment choices.” with legislators and regulatory bodies to the disease and celebrating the to develop more effective compliance hope of recovery. At the Washington, and enforcement frameworks. D.C. event, Indivior employees, family members and friends were among 800 people who participated to raise more
Indivior Annual Report 2017 25 Stakeholder engagement continued
Ms. Burton-Phillips, from DrugFAM, help cut the ribbon to open Indivior’s R&D Centre of Excellence in Hull, UK.
DrugFAM, UK materials will provide additional The Moyer Foundation, US tools and potential for education DrugFAM is a UK-based global Founded in 2000 by American and engagement. organization dedicated to providing baseball player Jamie Moyer and safe, caring and professional support child advocate Karen Phelps Moyer, to families, friends and partners who USA Today National The Moyer Foundation supports are struggling to cope with a loved Opioid Addiction thousands of children and families one’s addiction. Awareness Campaign each year with free-of-charge programs and services. Indivior has supported DrugFAM for Recognizing that one of the greatest several years in its efforts to give barriers to the patient journey to Indivior provides ongoing financial families the strength to break free treatment and recovery is the stigma, support to Camp Mariposa, The Moyer from the cycle of addiction and prejudice and misconceptions Foundation’s addiction prevention rebuild their lives. In the words of around addiction and treatment, and mentoring program. Camp DrugFAM founder Elizabeth Burton- Indivior was a sponsor of the Mariposa serves youth impacted by Phillips, the two organizations national Opioid Addiction Awareness the substance use disorder of family “are united about the need to Campaign feature in USA Today, members, with the aim of breaking the destigmatize addiction and support in 6 major cities across the United intergenerational cycle of addiction. those whose lives have been derailed States. By helping provide a platform Indivior’s three-year grant (beginning by drug or alcohol misuse.” for voices of the Addiction Policy Forum, Shatterproof and Faces and September 2016) supports the Indivior’s support will help with the Voices of Recovery (FAVOR), Indivior strengthening, growth and expansion of development of workshop materials helped give voice to how imperative the Foundation’s prevention resources, to accompany a DrugFAM play ‘breaking down the barriers of sites and services. The newest Camp adapted from Elizabeth Burton- stigma’ is to empowering treatment Mariposa location, serving Princeton, Phillips’s book, Mum Can You Lend access for patients and removing the West Virginia, US, was launched in June Me Twenty Quid? To date, the barriers of guilt and shame. 2017, with two additional locations play, which depicts the effects of opening in 2018. Indivior’s support also addiction on family life, has been enabled infrastructure improvements performed 125 times in schools and for mentoring and addiction communities, and the new workshop prevention, and partnership forming to help tackle stigma. 26 www.indivior.com Strategic Report Governance Statements Financial
The Moyer Foundation, US.
Community Anti-Drug “CADCA supports the Helping to reduce OUD Coalitions of America whole continuum of (CADCA), US mortality in France care from education to In France, Indivior supported a For over five years, Indivior has partnership across several clinical provided educational grant support prevention to treatment and medico-social associations to the Community Anti-Drug and recovery. We believe in support of the early access Coalitions of America (CADCA) whose program for NALSCUE nasal spray mission is to strengthen the capacity leaders of all levels need for the emergency treatment of communities to create and to focus on initiatives of characterized or suspected maintain safe, healthy and drug-free that increase awareness, opioid overdose. communities globally. reduce stigma, and focus During 2017, over 400 centers In 2017, CADCA implemented (addiction centers, hospitals, programs in those communities in on initiatives to maintain prisons and harm reduction greatest need of access to evidence- safe, healthy and drug- centers), and 800 doctors, 200 based care for opioid use disorder free communities.” pharmacists and hundreds to help reduce the stigma associated of nurses, social workers and with the disease of addiction, General Arthur T. Dean educators received training educate communities on medication- Chairman and CEO, CADCA on overdose symptoms, risks, assisted treatment options and mortality and the use and increase the number of health-care benefits of NALSCUE. providers waivered to treat opioid use disorder. Indivior also supported the patient advocacy group ASUD (Auto- Support des Usagers de Drogues) development of public information materials on harm reduction and treatment approaches.
Indivior Annual Report 2017 27 Research & development
Driving innovation, strengthening our leadership profile
“Indivior’s R&D Indivior’s R&D mission is dedicated We entered into a multi-partner to the development of innovative funding collaboration with Virginia program is dedicated therapeutics that move the Commonwealth University, Inova to the development international community one step Fairfax Hospital and Virginia Tech of innovative closer to new treatment options that Carilion Research Institute to study help patients with substance use the effects of SUBLOCADE in the therapeutics that disorders (SUDs) worldwide improve emergency room environment to move the international their quality of life and well-being. possibly prevent repeat opioid overdoses and potentially change the community one One of our core guiding principles standard of care for those who are – focus on patient needs to drive step closer to new recovering from opioid overdose. decisions – incentivizes R&D to treatment options advance treatment innovations We also showcased Indivior’s that help patients in the face of the growing global scientific expertise and know-how addiction crisis. in six peer-reviewed publications with substance use and no less than 12 published In 2017, we continued to invest in R&D disorders (SUDs) conference abstracts with a focus to pioneer significant new treatment on the science in support of worldwide improve options for those suffering from SUBLOCADE and RBP-7000. their quality of life and SUDs, and in partnerships worldwide to realize our vision that all patients SUBLOCADE™: Expanding well-being.ˮ will have access to evidence-based treatment for addiction and other co- access to treatment for opioid Christian Heidbreder occurring disorders. use disorder Chief Scientific Officer Our major R&D success of 2017 was During the year, we delivered two the US FDA approval of SUBLOCADE. NDA submissions to the US FDA, As the first and only once-monthly completed two new state-of-the-art injectable buprenorphine formulation R&D Centers of Excellence, achieved to treat moderate to severe opioid FDA approval for our new product, use disorder (OUD), SUBLOCADE SUBLOCADE, and formed new represents an evidence-based strategic research partnerships. paradigm shift from how we approach treatment of OUD today. During the development of SUBLOCADE, we worked closely with the FDA through Type C meetings and an End-of-Phase 2 meeting. SUBLOCADE was granted US Fast Track Designation in May 2016. A pre-NDA meeting was successfully conducted in December 2016, which was followed by NDA submission in May 2017, and official NDA filing and PDUFA Priority Review designation in July 2017. Strategic Report The science behind SUBLOCADE™
SUBLOCADE™ (buprenorphine ATRIGEL Delivery System extended-release) is the first Injected Polymer liquid solidification and only therapy that, at Solvent at surface Solvent steady state, delivers out out Governance Water Water in in buprenorphine at a sustained Drug Drug rate of at least 2 ng/mL over a out out SUBLOCADE™ sustained-release formulation of buprenorphine. SUBLOCADE™ one-month period. uses the ATRIGEL delivery system, a solution consisting of a biodegradable poly-(DL-lactide-co-glycolide) co-polymer dissolved in N-methyl pyrrolidone (NMP), a water-miscible biocompatible solvent. After subcutaneous injection, A unique delivery system NMP interacts with body fluids that replace the NMP in the matrix, triggering polymerization. Buprenorphine trapped inside the polymer formed in situ is SUBLOCADE™ (buprenorphine extended- Statements Financial gradually released over a one-month period as the polymer biodegrades release) uses the ATRIGEL® delivery system, which consists of a polymeric solution of a biodegradable poly-(DL-lactide-co- How SUBLOCADE™ works glycolide) co-polymer dissolved in N-methyl pyrrolidone (NMP), a water-miscible A ore o ervation R predi tion A ore predi tion R predi tion biocompatible solvent. 100 100 After subcutaneous injection, NMP interacts with body fluids that replace the NMP 0 0 as it diffuses out of the polymer matrix, 70 70 R triggering polymerization. This traps the 0 0 buprenorphine inside and forms a solid deposit in place. The depot releases 0 0 buprenorphine over a one-month period by 20 20 diffusion as the polymer biodegrades. ean A ore ru i in ore ean A 0 0 SUBLOCADE™ Lifecycle Evidence 0 1 2 Generation & Optimization (LEGO) ean uprenorp ine on entration n During 2017, various studies were planned SUBLOCADE™ (300mg) administration leads to buprenorphine plasma and designed and we will continue to concentrations of 2-3 ng/mL, mu-opioid brain receptor occupancy of ≥70% producing significant reductions in drug-liking. generate and optimize evidence to support This graph is for illustrative purposes only. SUBLOCADE’s efficacy and strengthen Indivior’s leadership in the treatment of OUD. These included: The outcome: Abstinence rate ࢀࢀ Emergency Room Study – to assess % week abstinence (% opioid free weeks) the efficacy and safety of initiating 45% SUBLOCADE in ER settings to potentially 40% prevent repeat overdose events in 35% 30% OUD patients. 25% ࢀࢀ VAS Craving Project – to explore how 20% 15% craving could be used as potential clinical 10% endpoint in clinical trials in OUD patients. 5% 0% ࢀࢀ Buprenorphine Abuse, Misuse, Diversion 300mg/100mg 300mg/300mg Placebo (AMD) Epidemiology – to investigate the root causes of abuse and misuse in The primary efficacy endpoint (% abstinence from Week 5 through Week 24) diverted buprenorphine. was statistically significantly superior (P<0.0001) for both the 300 mg/100 mg and 300 mg/300 mg groups compared with the placebo group, with mean percentages as shown in the figure above.
Indivior Annual Report 2017 29 Research & development continued
In October 2017, an Advisory Committee symptoms, reducing the subjective, pruritus, vomiting, increased hepatic of the Psychopharmacologic Drugs drug-liking effects of opioid agonists, enzymes, fatigue, and injection Advisory Committee and the Drug and ultimately leading to significantly site pain. Safety and Risk Management Advisory reduced illicit opioid use compared We believe that SUBLOCADE™ is Committee voted 18 to 1 in favor to placebo over a six-month period. an important treatment option for of SUBLOCADE™ approval for the Exposure-response analyses patients, families and communities treatment of moderate to severe OUD. established a correlation between battling the opioid epidemic. The FDA decision to approve buprenorphine plasma concentration, SUBLOCADE™ marks the end of whole-brain mu-opioid receptor an eight-year long effort to bring occupancy, opioid-free weeks, to market this innovative novel and withdrawal. The overall safety formulation of buprenorphine in the profile of SUBLOCADE™ in the ATRIGEL delivery system and expand clinical trials program was consistent access to treatment options for OUD. with the known safety profile of SUBLOCADE™ provides sustained transmucosal buprenorphine. The plasma levels of buprenorphine that most common adverse reactions translate into high and sustained associated with SUBLOCADE™ (in mu-opioid receptor occupancy in ≥5% of subjects) were constipation, the brain over a one-month period, headache, nausea, injection site thereby suppressing withdrawal
Innovation through the Developing innovative decades: Indivior’s treatments for OUD for decades R&D timeline Indivior has a long history of supporting the addiction treatment community. It has been involved in manufacturing and supplying buprenorphine for OUD patients for decades. SUBUTEX® SUBOXONE® SUBOXONE® SUBLOCADE™ Tablet Film
1995* 2002* 2010* 2017*
ࢀࢀ Approval in ࢀࢀ Approval of ࢀࢀ Combination ࢀࢀ ATRIGEL France SUBUTEX and form delivery ࢀࢀ Sublingual SUBOXONE in US ࢀࢀ Sublingual system Tablet ࢀࢀ Sublingual Film ࢀࢀ Once monthly (buprenorphine) Tablets subcutaneous ࢀࢀ Monodose form ࢀࢀ SUBOXONE Injection (buprenorphine and naloxone) ࢀࢀ Combination form
* Date of Approval
30 www.indivior.com Strategic Report Indivior’s R&D strategy Strategic driver: Infrastructure Our R&D strategy is to develop products that address the major State of the art research and development centers challenges in the treatment of During the year, we completed neurobiological underpinnings SUDs, which are: efficacy, safety, our new R&D Center of Excellence of SUDs and advance the SUD and delivery including adherence to in Hull (UK) (54,000 sq ft) and the treatment paradigm. treatment and reduction in misuse extension of our R&D facilities in and diversion. In the US, our $11 million Fort Collins (CO, USA) (18,500 sq ft). Governance investment in Fort Collins has A pre-requisite for addressing these The new Hull facility is a $30 increased the site’s footprint challenges is understanding SUDs million R&D center dedicated to from 23,000 sq ft to 42,000 sq ft. It as the result of long-term molecular pioneering novel treatments for establishes Fort Collins as a leader and cellular adaptations in key patients struggling with SUDs. The in parenteral product development neural networks. new center, which will house over from a chemistry, manufacturing R&D partnerships 50 employees, is equipped with and controls (CMC) perspective. cutting-edge technologies, including
In 2017 we continued to develop Altogether, the new UK and US Statements Financial a 400MHz Nuclear Magnetic partnerships and collaborations that facilities will allow us to significantly Resonance spectrometer, and is allow us to understand patients’ expand our capabilities through constructed to environmental and unmet needs and accelerate the pilot plant storage, formulation energy-saving standards, including development of new medications. laboratories, analytical laboratories, the installation of a 25kW solar chemistry laboratories, stability We developed plans to collaborate panel farm to increase use of chambers, office spaces, and with Virginia Commonwealth renewable energy. support spaces. Not only will these University (VCU), Inova Fairfax As Indivior’s largest capital facilities help us remain at the Hospital and Virginia Tech Carilion investment in R&D, it is hoped cutting edge of innovation and Research Institute to study the effects the new center will enable discovery, they will help keep our of SUBLOCADE™ in the emergency us to leverage science and employees safe, and support our room environment to possibly research to help understand the independence as an organization. prevent repeat opioid overdoses and potentially change standards of care. Hull: At a glance We also entered a new strategic collaboration with Addex Therapeutics to explore GABA-B positive allosteric modulators $30m (PAMs) as an attractive target to Cost of Hull facility potentially treat various SUDs. Our joint research efforts could help to open new medication pathways for alcohol and cocaine use disorders. We are also committed to further 50 consolidating our prospective patient Employees outcomes research, which is key to demonstrating the value of medical therapies to patients, physicians, and payers, and can drive new 400MHz meaningful treatment options for patients suffering from SUDs. Nuclear Magnetic Resonance spectrometer
Indivior Annual Report 2017 31 Research & development continued
R&D strategic drivers Processes ࢀࢀ Partnership with Medical from medical governance to Advisory In 2017, we made progress against Another area of focus was improving Boards to Lifecycle Evidence our four R&D strategic drivers: the quality of our processes and Generation and Optimization Infrastructure see page 31, People, interactions within R&D Functions (LEGO) design and implementation. Processes and Portfolio. and with ex-R&D Functions. Our key initiatives, designed to enhance Portfolio People how we work together and make the right decisions on behalf of During 2017, we made significant Throughout 2017, we focused patients, included: progress across of our portfolio on bringing new talent into our development. True to our vision and organization and establishing strong ࢀࢀ Implementation of a Continuous mission, we focused on developing leadership teams. We know that any Improvement Team. innovative treatment solutions for business is only ever as good as the ࢀࢀ Partnership between Medicine OUD and its co-occurring disorders, quality of the people and talent it can Development Leaders (MDLs) and such as schizophrenia. We also recruit. Our facilities enhancements Global Therapy Leaders (GTLs) and continued to address the challenge of in 2017 deepened the appeal of our implementation of a Manufacturing alcohol use disorder (AUD). organization as a place of scientific Process Continuity Team (MPCT). excellence where people can thrive ࢀࢀ Collaboration with Information and make a difference. Our hiring Technology Department to campaign also focused on lessening move R&D towards industry organizational layers, building standard, compliant and scalable cross-functional networks, rewarding platforms to support growth and successes, and promoting a ‘right submission activities and address decisions’ mindset based on sound any immediate compliance and scientific grounds. support risks.
Significant pipeline milestones for the year include:
Opioid use disorder Product Milestone SUBOXONE® ‹‹ Data from two pivotal pharmacokinetics (PK) studies used to support application for two Sublingual Tablet additional dosage strengths (SUBOXONE 12mg/3mg and 16mg/4mg Sublingual Tablets) in Canada. Final approval received from Health Canada (HC) with Notice of Compliance (NOC) in September 2017. ‹‹ Three clinical trials finalized and used to submit an NDA to the Chinese FDA in December 2016. NDA submission under review by CFDA. SUBOXONE® ‹‹ SUBOXONE Film added to List of Drugs for an Urgent Public Health Need in British Columbia, Sublingual Film Canada, in June 2017 and for use in the Correctional Service Facilities in December 2017.
SUBLOCADE™ injection for ‹‹ SUBLOCADE™ received US FDA approval in November 2017 as the first and only once-monthly subcutaneous use (CIII) injectable buprenorphine formulation to treat moderate to severe opioid use disorder.
32 www.indivior.com “The US filing of RBP-7000 represents a significant milestone for Strategic Report Indivior in addressing unmet patient needs in schizophrenia. It is a demonstration of our ongoing commitment to developing innovative treatment options and in helping to battle the challenges associated with this serious disease.”
Christian Heidbreder Governance Chief Scientific Officer
Schizophrenia Product Milestone
RBP-7000 ‹‹ NDA for RBP-7000, our once monthly risperidone formulation using the ATRIGEL delivery system, Statements Financial successfully submitted to US FDA in September 2017. ‹‹ Official NDA filing in December 2017, with PDUFA date set for July 2018. ‹‹ In the pivotal randomized, double-blind, placebo-controlled study (RB-US-09-0010), RBP-7000 demonstrated statistically significant clinical improvement compared to placebo based on changes in mean Positive and Negative Syndrome Scale (PANSS) total and Clinical Global Impression-Severity of Illness (CGI-S) scores at eight weeks. ‹‹ The efficacy of RBP-7000 on the reduction in PANSS total scores and CGI-S was statistically significant with the first efficacy assessment on Day 15 through the duration of the eight week study. The most common adverse reactions in clinical trials (reported in ≥ 5% and greater than placebo group) were weight increase, constipation, sedation/somnolence, pain in extremity, back pain, akathisia, anxiety and musculoskeletal pain. The most common injection site reactions (≥ 5%) were injection site pain, erythema and induration/nodule. ‹‹ Measures of clinical efficacy in the open-label long-term safety extension trial (RB-US-13-0005) demonstrated that patients remained stable or improved across study visits over 12 months, as evidenced by decreases in mean PANSS total and CGI-S scores. This is the first demonstration of safety and durability of effect for an investigational once-monthly injectable form of risperidone administered subcutaneously in a long-term clinical trial. Alcohol use disorder Product Milestone Arbaclofen ‹‹ Phase 1 Bioavailability Study. Placarbil ‹‹ Reformulation and clinical pharmacology assessment. ‹‹ Currently planning to meet with the FDA to agree on next development stages.
Rescue medications for opioid overdose Product Milestone NALSCUE® (naloxone ‹‹ Received Marketing Authorization (MA) from French Regulatory Agency ANSM for NALSCUE in July hydrochloride) Nasal Spray 2017; the MA approved intranasal naloxone product for the emergency treatment of characterized or suspected opioid overdose in France.
Indivior Annual Report 2017 33 Managing our business responsibly
Overall approach Indivior seeks to continuously The Fine Chemical Plant has OHSAS improve its standard operating 14001 certification and closely Guiding principles procedures, management systems monitors its emissions, ground water and core values and performance indicators. and effects on local biodiversity in Indivior’s Guiding Principles, Core conjunction with the UK Environment Values and Vision provide the Governance and oversight Agency. These include regular Group’s framework for decision- Adherence to responsible business testing of ground water samples and making and create a blueprint for performance is overseen by air quality to ensure that harmful business success. They also support the Executive Committee and contamination is not taking place the Group’s culture which unites and managed by comprehensive through leaks, spills or fugitive guides its employees. This genuine governance processes. emissions. It also conducts a program competitive differentiator enables of ongoing improvements to enhance and encourages a shared passion to Environment and the Group’s approach over time. At remove the stigma of substance use climate change all other sites, the Group conducts a disorders and shift its treatment into variety of energy saving, reuse and mainstream medical practice. Policies and approach recycling initiatives. The Group’s environmental Responsible business drivers policy commits it to operating in Indivior’s approach to responsible a responsible, environmentally business is driven by its focus on sound and sustainable manner at addressing the needs of the patient all times. It also recognizes that and reducing the burden of substance these responsibilities extend to the use disorders, its aim to achieve Group’s supply chain, processes and regulatory compliance at all times, products and that these aspects of its understanding of stakeholder the business have both direct and expectations concerning the Group’s indirect environmental impacts. behavior, its management of risk, and The Group has pledged to achieve the desire across the Group to do the continuous improvement in its right thing in the right way in all of its environmental performance and day-to-day business activities. compliance with the law as the minimum standard. Management of the approach Indivior’s framework addresses seven Management systems Case study key areas of its business: The Group’s management of its Hull Fine Chemical environmental and climate change ࢀࢀ Environment and climate change impacts has been developed at a Plant Cryo-Condenser ࢀࢀ Employee health and safety local level to address the varying In 2017, the Group’s program ࢀࢀ Patient safety and product quality impacts at its Fine Chemical Plant of continual improvements ࢀࢀ People in Hull, UK, the new R&D Center of included the acquisition and ࢀࢀ Business conduct Excellence (also located in Hull, UK), implementation of a state-of- ࢀࢀ Information technology its research and development facility the-art Cryo-Condenser at the ࢀࢀ Access to medicine, research and in Fort Collins, Colorado, US and Fine Chemical Plant in Hull. The education funding and advocacy across its various office facilities. Cryo-Condenser helps ensure initiatives that emissions relating to the use of solvents are minimized within limits agreed with the UK Environment Agency and to reduce energy use.
34 www.indivior.com Performance Reporting Standard (revised edition) Employee Health Strategic Report The Group has recorded no material using the location based Scope 2 and Safety environmental incidents (e.g. spills, calculation method, together with emissions to air) during 2017. the latest emission factors from Policies and approach recognized public sources, including Indivior is committed to maintaining Greenhouse gas emissions but not limited to, the Department the health, safety and welfare at This is the third year Indivior for Environment, Food & Rural work of its employees. The Group has comprehensively reported Affairs (DEFRA), the International strictly adheres to legal requirements greenhouse gas emissions as a Energy Agency, the US Energy and the continual improvement Governance stand-alone entity. The baseline Information Administration, the US of its health and safety control year for emissions reporting is 2015. Environmental Protection Agency arrangements and performance. The reporting period for emissions and the Intergovernmental Panel is consistent with Indivior’s financial on Climate Change. Management systems reporting period, being the calendar The Group’s occupational health year ended December 31, 2017. Emissions and safety management systems Type Tonnes of CO2e Indivior has reported on all the are tailored to local requirements Scope 1 593 Statements Financial emission sources required under to address specific areas of impact the UK Companies Act 2006 Scope 2 2345 and risk. Since the Group demerged from Reckitt Benckiser (RB) in 2014, (Strategic Report and Directors’ Scope 3 172 Report) Regulations 2013. These the Fine Chemical Plant in Hull has sources fall within the consolidated Total emissions 3110 conducted a continuous health and Financial Statements. safety improvement program at the Per full time employee 5.54 site which has OHSAS 18001 (45001) Indivior does not have responsibility Per tonne of production 647.9 certification. Product safety is an for any emission sources that are important aspect of the Group’s not included in the consolidated activities at the Fine Chemical Plant Financial Statements. Indivior and its procedures are regularly has also reported Scope 3 data, reviewed and enhanced to ensure where it was available, that relates that product integrity and quality are to transmission and distribution consistently maintained. losses (52 tonnes of CO2e) and water supply (6 tonnes of CO2e). The Group maintains health and This assessment has been carried safety policy and procedural out in accordance with the World information for each of its sites and Business Council for Sustainable this is available to all employees Development and World Resources on the Indivior intranet. It conducts Institute’s (WBCSD/WRI) Greenhouse regular site risk assessments and Gas Protocol; a Corporate provides training for all employees Accounting and Reporting Standard. tailored to individual roles and This protocol is considered current responsibilities. Procedures are best practice for corporate or in place to ensure that workplace organizational greenhouse gas incidents, should they occur, are (GHG) emissions reporting. GHG Case study – energy investigated and that any corrective or investigative action is taken promptly. emissions have been reported by saving initiatives at new the three WBCSD/WRI Scopes. Scope Hull R&D center 1 includes direct GHG emissions Performance The Group recorded no material from sources that are owned or The Group’s new R&D Center of employee health and safety controlled by Indivior, such as Excellence in Hull is constructed incidents in 2017. natural gas combustion and Indivior to environmental and energy- owned vehicles. Scope 2 accounts saving standards, including the for GHG emissions from the installation of a 25kW solar panel generation of purchased electricity, farm to increase use of renewable heat and steam generated off-site. energy. Other energy saving Scope 3 includes all other indirect initiatives include electric car emissions. The method used to charging points for employee and calculate emissions is the GHG Group vehicles. Protocol Corporate Accounting and
Indivior Annual Report 2017 35 Managing our business responsibly continued
Patient safety and A pharmacovigilance process has Connecting patients to help product quality been established to monitor the In 2017, over 9.1 million unique visitors safety of the Group’s marketed in the US accessed Indivior’s opioid Policies and approach and investigational products in a dependence websites, representing a The Group takes patient safety comprehensive and thorough manner. 3% increase over 2016 visits. very seriously. Patient safety is This includes a Risk Evaluation and Turn-to-Help.com is a patient and fundamental to the integrity of Mitigation Strategies (REMS) program its global brands and businesses. family resource for educational to mitigate the risks of accidental materials on the disease of OUD The Group actively promotes overdose, misuse and abuse for responsibility and concern for the and treatment options. The site also SUBOXONE Film and to mitigate the provides a search tool for patients safety of its patients, products, risk of serious harm or death that employees and the general public in to help them locate a waivered could result from intravenous self- healthcare provider in their area. all aspects of its business. administration for SUBLOCADE™ in the US. The Group measures the impact Suboxone.com is intended to support Management systems of the REMS program and reports the patients at each stage of their journey, Patient safety and product quality results to the US FDA as required. including providing tools to help are embedded in the Group’s culture patients find a waivered healthcare The Group also operates a Patient and patient-focused business model. provider as well as providing savings and Product Safety Group which cards for medication. includes pharmacovigilance medical teams to monitor the safety profile of In 2017, nearly 613,000 ‘Find A Doctor’ both its marketed and investigational searches were completed on these products, which are closely monitored two websites. on a continuous basis. In Australia, Indivior also makes Indivior believes that patient safety available for patients a website, and product quality are not just an TurntoHelp.com.au, to connect obligation but a responsibility. families and patients to resources.
Case study 2017 saw continued investment in health and safety improvements at the Fine Chemical Plant in Hull through the conduct of the Group’s Turn-to-Help.com capital expenditure program. One important initiative was the introduction of ‘glove-box’ isolation at the final stage of the production process to provide improved employee protection from active pharmaceutical ingredients and to maintain product quality. Suboxone.com
36 www.indivior.com Global quality People Management systems Strategic Report Our responsibility is to the patients The Group’s adherence, systems we serve. To this end, we are Policies and approach development, recruitment and committed to a culture of innovation The Group has a variety of employment management of employee and quality defined by the following policies that provide a framework to training and development occur four principles: ensure that it is an employer of choice in partnership with other business and that it provides a fair, equitable and areas, such as corporate compliance. ࢀࢀ Our patients are at the heart of conducive working environment free what we do and we continually seek Indivior’s employees consciously from discrimination and harassment. Governance to build and maintain their trust in live by the Guiding Principles, and us. This drives our passion for the Its policy documents and Code of management and employees embed continuous improvement of our Conduct also contain commitments and maintain the Group’s culture products and processes and is at to support the UN Declaration of through the following mechanisms: the heart of our guiding principles. Human Rights and the provisions of ࢀࢀ Annual global survey: Management ࢀࢀ Our people are empowered to the International Labour Organization Declaration (which embraces free and conducts an annual global survey continuously identify and evaluate to assess the Group’s culture risk and we are focused on collective bargaining and organized and identify opportunities for Statements Financial achieving ‘zero’ quality defects and worker representation and prohibits the use of forced or child labor). enhancement. These strong waste. Our people have confidence and improving results surpass in the products we manufacture Key policy documents include a external benchmarks. and distribute globally. diversity and inclusion policy, a ࢀࢀ Culture champions: Designated ࢀࢀ Our regulators are viewed as flexible working policy, harassment employees act as ambassadors and partners in helping us achieve and grievance policies. The Group create opportunities for employee standards of excellence. We seek has, in line with UK reporting engagement, as well as informally to ensure our quality systems and requirements, published a statement assessing where the culture is processes are globally harmonized, on its website outlining its approach working well and where attention and view feedback as continual to addressing slavery. The Group’s is needed. learning opportunities. employment policies also commit ࢀࢀ Performance reviews: Annual ࢀࢀ Our shareholders understand Indivior to supporting relevant performance reviews emphasize our culture of quality. We focus local initiatives such as the Living both what business results were on creating value by driving Wage Foundation in the UK (which achieved and how behaviors and continual improvement, seeking to calculates a minimum wage rate actions were aligned with Indivior’s achieve excellence in compliance based on the average cost of living). Guiding Principles. at all levels, standardizing and They also state that the Group seeks simplifying our processes to reduce to employ, wherever practicable, costs and flawlessly executing our people from local communities to pipeline and supply chain so that support those who may find it difficult our growth potential is exceeded. to find employment.
Indivior Annual Report 2017 37 Managing our business responsibly continued
ࢀࢀ Leadership development: Leadership Business conduct The compliance team’s development programs focus on responsibilities include oversight of specific competencies to cultivate Approach and policies pharmaceutical marketing, Medical’s coaching skills that foster growth The Group requires compliance scientific interactions with healthcare through the Guiding Principles. with laws, regulations and industry professionals, healthcare fraud ࢀࢀ New employee orientation: New practice at all times. Its comprehensive prevention and anti-bribery guidance employees must complete an on- compliance programs include a focused to all of the Group’s employees. compliance staff and policies across the line culture training within the first In 2017, the Group continued to full panoply of operations, including: two months and attend a full-day enhance its corporate compliance culture workshop. ࢀࢀ An anti-bribery policy department as part of its risk ࢀࢀ International Women in Leadership ࢀࢀ A data protection policy mitigation strategy. (IWIL): Program supporting diversity ࢀࢀ A commercial interactions with in leadership. The department’s healthcare professionals policy responsibilities include: ࢀࢀ A healthcare business ethics policy Workforce information ࢀࢀ Ensuring that the department has ࢀࢀ A share dealing policy and code At the end of 2017, the Group access to the Board and executive employed 1,023 people (559 female ࢀࢀ A field medical personnel policy team, which oversee the program. and 464 male). 673 employees were ࢀࢀ A records and information ࢀࢀ Establishing, maintaining and based in North America. Employee management policy communicating standards of headcount by job function is conduct for the business as a whole. supplied below: Management systems Regulatory and legal compliance is ࢀࢀ Ensuring appropriate internal Employee and external due diligence Function numbers a key aspect of the Group’s patient- systems are in place to avoid and Commercial 435 focused business model. The Group maintains a Corporate Compliance mitigate wrongful or potential R&D/Clinical/Regulatory 178 Department to guide compliance efforts criminal activity. through policies, training education ࢀࢀ Maintaining a confidential General management/ 209 and monitoring. These steps ensure reporting system and ensuring support adherence to industry codes, laws that its existence and purpose is Medical 105 and regulations in all the countries communicated effectively across in which the Group operates. The the organization. Supply 96 department also works to ensure ࢀࢀ Ensuring that effective and Total 1,023 that all of the Group’s operations are prompt response processes are conducted in line with all regulatory in place following the receipt of requirements and industry codes of reports submitted through the ethics, including those published by confidential system. US PhRMA; Association of the British ࢀࢀ Ensuring that robust monitoring Pharmaceutical Industry (ABPI); and and investigative processes are in by Medicines Australia, along with place to ensure that allegations the Pharmaceutical Manufacturer’s of wrongdoing are detected Compliance Program Guide published and corrective action is taken by the Office of Inspector General promptly; and of the US Department of Health and ࢀࢀ Designing and conducting Human Services. enforcement processes that include The Vice President, Corporate incentives and disincentives that Compliance has routine access to the are consistent with related levels of Board and Executive Committee. risk and opportunity.
38 www.indivior.com As part of its continuing mission to Information Technology In 2017, Indivior also established a Strategic Report identify and mitigate business risks, Global Business Services function The Group invests in Information Corporate Compliance implemented reporting to the Chief Information and Technology (IT) as a key competitive the following in 2017: Innovation Officer. Global Business enabler. To this end, Indivior has Services provides consolidated ࢀࢀ Added a compliance director in the implemented a scalable, cloud-based global processing for all financial EMEA region and two employees in technology platform to support transactions. This enables the Group the US: a manager responsible for future growth. policy development and education, to standardize, continuously improve and a director of compliance In 2017, the Group completed all and closely align to our Enterprise Governance program operations responsible for IT-focused separation activities Resource Planning (ERP) solutions project management initiatives. from Reckitt Benckiser (RB) across to gain further efficiencies and all entities and locations. As part of deliver cost savings. ࢀࢀ Revised and updated over 25 the transition, Indivior established IT corporate compliance policies, To support future scalability and services for R&D sites in Hull (UK) and provided comprehensive education reduce IT operational expenses, Fort Collins (US) as well as various on compliance standards of conduct Indivior also transitioned global offices. IT also supported a to employees and contractors all remaining data center variety of global audits undertaken Statements Financial globally, and delivered targeted operations to Amazon. education to clinical liaisons, sales in 2017 to provide assurance that the To protect Indivior data and assets, management team, field medical Group’s systems are ‘fit for purpose.’ Indivior invested in comprehensive team and field reimbursement Technology highlights for 2017 include cyber security measures supported specialists. Global policy update the following platform and system with global employee training. trainings were delivered by April enhancements: streamline and 2017 with a 100% completion rate. support cross-functional business IT is also partnering with R&D, ࢀࢀ Enhanced the due diligence processes; provide key business units Medical and Commercial functions to processes, both for employees and with data-driven insights; and enable help identify, assess, pilot and launch for third parties, and increased the SUBLOCADE™ approval and new digital technology-enabled monitoring and oversight to assure commercialization process, and the business capabilities. appropriate business practices, RBP-7000 NDA submission. These actions, investments and which will continue in 2018. strategic focus further support ࢀࢀ The Group also has a separate the Group’s approach to providing internal audit department that compliant, secure, streamlined, cost is responsible for designing and effective and scalable IT platforms to implementing its own work programs the business, globally. and reports to the Audit Committee.
Performance Indivior significantly expanded its compliance and related monitoring activities in 2017. These procedures did not discover any material instances of non-compliance with the Group’s business conduct policies and procedures during the year.
Indivior Annual Report 2017 39 Managing our business responsibly continued
Access to medicine, Investigator initiated studies ࢀࢀ Removing barriers to innovative research and education Indivior continues to support treatments: funding and advocacy Investigator initiated studies to Indivior believes new, evidence- expand upon the science in addiction. based buprenorphine long initiatives acting injectable medications are innovations in medication-assisted Indivior Patient Help Foundation Medical education grants Indivior also has a long-standing treatment for opioid use disorder In 2017, the Indivior Patient Help history of providing unrestricted and that any ambiguity in current Foundation provided SUBOXONE Film educational grants to support federal and state controlled product valued at $17 million through medical education. substance distribution laws should its patient assistance program in the be addressed to ensure patients US. Since 2010, the foundation has Stakeholder engagement and providers can realize the full provided access to an average of value of these innovations. 5,000 qualified patients per year to In 2017, Indivior engaged with a range ࢀࢀ Disease and treatment education: obtain medication. of stakeholders to help stimulate and accelerate change for patients. More Indivior advocates for accelerated Pricing information about these activities can public, healthcare provider and be found on pages 22 to 27. patient education on the disease of Indivior is committed to investing in OUD and evidence-based treatment new science and new technologies options, including all FDA approved to treat the chronic diseases Advocacy and public policy medication-assisted treatments and co-occurring disorders of Indivior advocates on public policy such as methadone, buprenorphine addiction. Revenues generated issues relevant to the Company and naltrexone. from the sales of our products by engaging responsibly with enable Indivior to continue to invest public officials, policymakers ࢀࢀ Supporting medical education: in studies, building on current and stakeholders at all levels Indivior supports education of technologies and developing new of government. addiction and evidence-based treatments in medical, physician treatment innovations. Indivior supports public policies that: assistant and nursing schools Indivior wants to help ensure ࢀࢀ Enable long-term OUD recovery for and as a core requirement our products are affordable patients. for continuing medical to appropriate patients. When ࢀࢀ Promote increased access to education programs within the determining the price of our evidence-based OUD treatments. healthcare system. products, multiple factors are ࢀࢀ Reduce and help prevent the ࢀࢀ Supporting the enforcement of considered, including the value the abuse; misuse and diversion of our the US Parity Act: new treatment innovation delivers products. Indivior supports robust education, to patients, significant new scientific ࢀࢀ Accelerate innovation; enforcement and awareness of US evidence generated as part of a federal and state parity laws and robust clinical development program ࢀࢀ Promote public health. advocates to strengthen where and the potential benefits to the In the US, Indivior’s public policy necessary, working together with healthcare system. approach is focused in the key external stakeholders. following key areas: ࢀࢀ Expanding access to medication- assisted treatment: Indivior believes that medication- assisted treatment (MAT), including treatment with buprenorphine (BMAT), is a critical part of the solution to the nation’s opioid crisis. MAT brings substantial value to both patients and society, but remains, for many reasons, severely underutilized.
40 www.indivior.com Abuse, misuse and Strategic Report diversion of our products “Indivior has long believed Ensuring best practices in treatment and managing the that education about risks of buprenorphine OUD treatments are critical to patients’ safety and their future ability to substance use disorders access treatment. Governance As the manufacturer of can and will improve SUBLOCADE and SUBOXONE Film, and the current US market leader in buprenorphine treatments, patient treatment Indivior works to address the potential risk of abuse, misuse and access.” and diversion of buprenorphine
treatments for OUD and supports Dr. Ponni Subbiah Statements Financial the efforts of other stakeholders Chief Medical Officer to do the same. Indivior continues to collaborate with medical associations, policy Case study makers, law enforcement and In September 2017, Indivior Chief She highlighted the need for: other key stakeholders to help Medical Officer, Dr. Ponni Subbiah, access to evidence-based advance solutions. represented Indivior at a meeting treatment; additional waivered of the US President’s Commission treatment providers; an increase on Combating Drug Addiction and in patient treatment limits to the Opioid Crisis. In alignment with increase the number of patients perspectives of public health and with access to treatment; and the patient advocates, Dr. Subbiah need to reduce and eliminate outlined barriers to treatment and structural barriers to effective recovery that must be overcome for disease management that exist in additional progress to be made. the US healthcare system.
Indivior Annual Report 2017 41 Financial review
Full year operating highlights ࢀࢀ Indivior entered into a strategic review (IPR), and is asserting its ࢀࢀ US market growth in financial year collaboration with Addex new Orange Book-listed patents 2017 improved to low double-digit Therapeutics on January 3, 2018 that covering SUBOXONE® Film, levels. Suboxone® Film average includes exclusive global license US Patent Nos. 9,687,454 (the market share was 59% (2016: 61%), rights to their GABAB positive ’454 patent) and 9,855,221 (the exiting the year at 56% (2016: 61%) allosteric modulator program. ’221 patent), against the other primarily due to ongoing generic ࢀࢀ Indivior initiated an appeals abbreviated new drug application tablet competition in the most process against Dr. Reddy’s after (ANDA) filers. price sensitive US payors (Managed the US District Court for the District ࢀࢀ The Group continues in active Medicaid). of Delaware found asserted claims discussions with the various ࢀࢀ SUBLOCADE™ became the first of Patent Nos. 8,017,150 (the ’150 governmental and other entities once-monthly buprenorphine long- patent), 8,603,514 (the ’514 patent) about possible resolutions to their acting injection delivery system and 8,900,497 (the ’497 patent) valid investigative and antitrust litigation approved by FDA for the treatment but not infringed by Dr. Reddy’s matters. Please see pages 6 to 9 for of moderate-to-severe opioid use proposed generic buprenorphine/ a comprehensive Litigation Update. disorder (OUD); launching in the US naloxone film. The appeal is in March 2018. progressing in the Federal Circuit Full year financial highlights ࢀࢀ FDA accepted NDA for RBP-7000, a Court of Appeals. ࢀࢀ Net revenue at $1,093m (2016: once-monthly risperidone long- ࢀࢀ Indivior took additional actions $1,058m) increased 3%. Net revenue acting injection for the treatment of to secure its intellectual property at constant FX was also +3%. schizophrenia; PDUFA date of July position by reaching a settlement ࢀࢀ Operating profit was $193m (2016: 28, 2018 established; setting up new with Mylan, including the $149m) including exceptional costs business unit. termination of their inter partes of $210m. Adjusted operating profit, excluding exceptional costs of Period to % ∆ % ∆ $210m (2016: $238m), grew 4% to December 31 2017 2016 actual constant (as reported) $m $m FX FX $403m (2016: $387m). Net revenue 1,093 1,058 3 3 ࢀࢀ Net income was $58m (2016: $35m) after net financing costs of $56m Operating profit 193 149 30 25 (2016: $51m) and tax expense Net income 58 35 66 57 of $79m (2016: $63m). Adjusted effective tax rate of 25% (2016: 25%). EPS (cents per share) 8 5 60 57 Adjusted net income, excluding exceptional items, was $270m (2016: m $254m), an increase of 6%. ࢀࢀ 2015 1,014 2015 246 Cash balance at year-end was $863m (2016: $692m). Net cash of $376m (2016: $131m). 2016 1,058 2016 254
2017 1,093 2017 270
US Dollars (m) US Dollars (m)