Auxilium Pharmaceuticals, Inc. (AUXL)

Do any investors out there know anything about Dupuytren's contracture? It is not very common. Most patients who need intervention would be referred to an orthopedic surgeon. If Xiaflex were actually FDA approved, the surgeon could recommend either fixing the problem surgically or trying injections of a new agent that would require multiple visits and doesn't always work.

With regard to insurance company payment, with surgery, they pay a physician fee for the operation and a hospital fee for the procedure. With Xiaflex, they would pay Auxilium for the drug, the physician fee for the procedure (injection), and the hospital/clinic fee for the procedure. If the drug is priced too high or it requires multiple visits for repeat injections, the companies will not approve payment for xiaflex, and the patient will be left only with the option of surgery. If the drug is priced lower and insurance will pay for it, the surgeon will consider his physician fee for operation (high) or injection (low). Most surgeons are already biased toward performing surgery, and the financial disadvantage for choosing injection rather than operation will influence most surgeons to continue with the established standard of care which is surgery.