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Wiki Wiki Summary
Operation Mincemeat Operation Mincemeat was a successful British deception operation of the Second World War to disguise the 1943 Allied invasion of Sicily. Two members of British intelligence obtained the body of Glyndwr Michael, a tramp who died from eating rat poison, dressed him as an officer of the Royal Marines and placed personal items on him identifying him as the fictitious Captain (Acting Major) William Martin.
Special Activities Center The Special Activities Center (SAC) is a division of the Central Intelligence Agency responsible for covert operations and paramilitary operations. The unit was named Special Activities Division (SAD) prior to 2015.
Operations management Operations management is an area of management concerned with designing and controlling the process of production and redesigning business operations in the production of goods or services. It involves the responsibility of ensuring that business operations are efficient in terms of using as few resources as needed and effective in meeting customer requirements.
Emergency operations center An emergency operations center (EOC) is a central command and control facility responsible for carrying out the principles of emergency preparedness and emergency management, or disaster management functions at a strategic level during an emergency, and ensuring the continuity of operation of a company, political subdivision or other organization.\nAn EOC is responsible for strategic direction and operational decisions and does not normally directly control field assets, instead leaving tactical decisions to lower commands.
Operations research Operations research (British English: operational research), often shortened to the initialism OR, is a discipline that deals with the development and application of advanced analytical methods to improve decision-making. It is sometimes considered to be a subfield of mathematical sciences.
Operation (mathematics) In mathematics, an operation is a function which takes zero or more input values (called operands) to a well-defined output value. The number of operands (also known as arguments) is the arity of the operation.
Bitwise operation In computer programming, a bitwise operation operates on a bit string, a bit array or a binary numeral (considered as a bit string) at the level of its individual bits. It is a fast and simple action, basic to the higher-level arithmetic operations and directly supported by the processor.
Product life-cycle management (marketing) Product life-cycle management (PLM) is the succession of strategies by business management as a product goes through its life-cycle. The conditions in which a product is sold (advertising, saturation) changes over time and must be managed as it moves through its succession of stages.
Sales letter A sales letter is a piece of direct mail which is designed to persuade the reader to purchase a particular product or service in the absence of a salesman. It has been defined as "A form of direct mail in which an advertiser sends a letter to a potential customer." It is distinct from other direct mail techniques, such as the distribution of leaflets and catalogues, as the sales letter typically sells a single product or product line, and further tends to be mainly textual as opposed to graphics-based, although video sales letters have become increasingly popular.
Product management Project management is the process of leading the work of a team to achieve all project goals within the given constraints. This information is usually described in project documentation, created at the beginning of the development process.
Sales presentation In selling technique, a sales presentation or sales pitch is a line of talk that attempts to persuade someone or something, with a planned sales presentation strategy of a product or service designed to initiate and close a sale of the product or service.\nA sales pitch is essentially designed to be either an introduction of a product or service to an audience who knows nothing about it, or a descriptive expansion of a product or service that an audience has already expressed interest in.
Sales order The sales order, sometimes abbreviated as SO, is an order issued by a business or sole trader to a customer. A sales order may be for products and/or services.
Executive (government) The executive (short for executive branch or executive power) is the part of government that enforces law, and has responsibility for the governance of a state.\nIn political systems based on the principle of separation of powers, authority is distributed among several branches (executive, legislative, judicial)—an attempt to prevent the concentration of power in the hands of a single group of people.
Borne government The Borne government is the forty-third and current government of the French Fifth Republic, formed on 16 May 2022 and headed by Élisabeth Borne as Prime Minister under the presidency of Emmanuel Macron.\n\n\n== Context ==\n\n\n=== Formation ===\nOn 16 May 2022, Jean Castex tendered the resignation of his government to the President of the Republic.
Military government A military government is generally any government that is administered by military forces, whether or not this government is legal under the laws of the jurisdiction at issue, and whether this government is formed by natives or by an occupying power. It is usually carried out by military workers.
Government gazette A government gazette (also known as an official gazette, official journal, official newspaper, official monitor or official bulletin) is a periodical publication that has been authorised to publish public or legal notices. It is usually established by statute or official action, and publication of notices within it, whether by the government or a private party, is usually considered sufficient to comply with legal requirements for public notice.Gazettes are published either in print, electronically or both.
The Managed Heart The Managed Heart: Commercialization of Human Feeling, by Arlie Russell Hochschild, was first published in 1983. A 20th Anniversary edition with a new afterword added by the author was published in 2003.
Renewable energy commercialization Renewable energy commercialization involves the deployment of three generations of renewable energy technologies dating back more than 100 years. First-generation technologies, which are already mature and economically competitive, include biomass, hydroelectricity, geothermal power and heat.
Commercial software Commercial software, or seldom payware, is a computer software that is produced for sale or that serves commercial purposes. Commercial software can be proprietary software or free and open-source software.
Table of Contents (Enochs) Table of Contents is a sculpture designed by the American artist Dale Enochs. The sculpture is made from limestone and was commissioned by Joseph F. Miller.
Marc Ecko's Getting Up: Contents Under Pressure Marc Ecko's Getting Up: Contents Under Pressure is a video game released in February 2006 for PlayStation 2, Xbox, and Windows. It was developed by The Collective and published by Atari, Inc.
Victory Contents Victory Contents (Korean: 빅토리콘텐츠; RR: bigtoli kontencheu) is a Korean drama production company based in Seoul.\n\n\n== History ==\nsource: \n\nApril 4, 2003 - Music Encyclopedia was established.
Contents of the Book of Leinster The following table of contents for the Book of Leinster is based on the diplomatic edition by R.I. Best and M.A. O'Brien. The contents are listed according to the folio number of the manuscript and the page and volume number of the edition.
Bioprospecting Bioprospecting (also known as biodiversity prospecting) is the exploration of natural sources for small molecules, macromolecules and biochemical and genetic information that could be developed into commercially valuable products for the agricultural, aquaculture, bioremediation, cosmetics, nanotechnology, or pharmaceutical industries. In the pharmaceutical industry, for example, almost one third of all small-molecule drugs approved by the U.S. Food and Drug Administration (FDA) between 1981 and 2014 were either natural products or compounds derived from natural products.Terrestrial plants, fungi and actinobacteria have been the focus of many past bioprospecting programs, but interest is growing in less explored ecosystems (e.g.
Manufacturing Manufacturing is the creation or production of goods with the help of equipment, labor, machines, tools, and chemical or biological processing or formulation. It is the essence of secondary sector of the economy.
Grasshopper Manufacture Grasshopper Manufacture Inc. (株式会社グラスホッパー・マニファクチュア, Kabushiki Gaisha Gurasuhoppā Manifakuchua) is a Japanese video game developer founded on March 30, 1998 by Goichi Suda.
Manufacture d'horlogerie Manufacture d'horlogerie (meaning "watchmaking manufacturer") is a French language term of horology that has also been adopted in the English language as a loanword. In horology, the term is usually encountered in its abbreviated form manufacture.
Design for manufacturability Design for manufacturability (also sometimes known as design for manufacturing or DFM) is the general engineering practice of designing products in such a way that they are easy to manufacture. The concept exists in almost all engineering disciplines, but the implementation differs widely depending on the manufacturing technology.
Computer-aided manufacturing Computer-aided manufacturing (CAM) also known as computer-aided modeling or computer-aided machining is the use of software to control machine tools in the manufacturing of work pieces. This is not the only definition for CAM, but it is the most common; CAM may also refer to the use of a computer to assist in all operations of a manufacturing plant, including planning, management, transportation and storage.
Health reimbursement account A Health Reimbursement Account, formally a Health Reimbursement Arrangement (HRA), is a type of US employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses and, in limited cases, to pay for health insurance plan premiums.An HRA is not truly an account, since it does not place funds under a separate legal title. Instead, it is an agreement under which the employee can submit qualified health expenses to the employer for reimbursement.Following implementation of the Affordable Care Act, HRAs must be integrated with a qualified employer-sponsored group health insurance plan to avoid excise tax penalties.
Business mileage reimbursement rate The business mileage reimbursement rate is an optional standard mileage rate used in the United States for purposes of computing the allowable business deduction, for Federal income tax purposes under the Internal Revenue Code, at 26 U.S.C. § 162, for the business use of a vehicle. Under the law, the taxpayer for each year is generally entitled to deduct either the actual expense amount, or an amount computed using the standard mileage rate, whichever is greater.
ERISA reimbursement In the United States, ERISA reimbursement refers to the efforts of an ERISA Plan administrator (an insurer) to obtain repayment from an insured person who had previously received payments for personal injury medical bills.When an insurer pays a injury claim to someone, the insurer can seize cash settlements from whoever caused the injury. This “right of reimbursement” is essentially a subrogation claim.
Capitation (healthcare) Capitation is a payment arrangement for health care service providers. It pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.
Fee Reimbursement Scheme (Andhra Pradesh) The Fee Reimbursement Scheme (also known as the Post-matric Scholarship Scheme) is a student education sponsorship programme of the Government of Andhra Pradesh. It supports students from lower economic strata in the state.
Diagnosis-related group Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group (coded as 470 through v24, 999 thereafter) being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health.
Risk Factors
GILEAD SCIENCES INC ITEM 1A RISK FACTORS In evaluating our business, you should carefully consider the following risks in addition to the other information in this Annual Report on Form 10-K Any of the following risks could materially and adversely affect our business, results of operations and financial condition
We note these factors for investors as permitted by the Private Securities Litigation Reform Act of 1995
It is not possible to predict or identify all such factors and, therefore, you should not consider any of the above risks to be a complete statement of all the potential risks or uncertainties that we face
Substantially all of our revenues are derived from sales of a limited number of products
If we are unable to maintain or continue increasing sales of our HIV products, our results of operations may be adversely affected
We are currently dependent on sales of our HIV products, especially Viread and Truvada, to support our existing operations
Our HIV products are exclusively of the nucleoside class of antiviral therapeutics
Were the treatment paradigm for HIV to change, causing nucleoside-based therapeutics to fall out of favor, or if we are unable to continue increasing our HIV product sales, our results of operations would likely suffer and we would likely need to scale back our operations, including our spending on research and development efforts
HIV product sales for the year ended December 31, 2005 were dlra1dtta39 billion, or 69prca of our total revenues, and sales of Viread and Truvada comprised 56prca and 41prca, respectively, of total HIV product sales in 2005
We may not be able to continue the growth rate of sales of our HIV products for the reasons stated in this risk factor section and, in particular, for the following reasons: • As our HIV products are used over a longer period of time in many patients and in combination with other products, and additional studies are conducted, new issues with respect to safety, resistance and interactions with other drugs may arise, which could cause us to provide additional warnings on our labels, narrow our approved indications or halt sales of a product, each of which could reduce our revenues
• As a product matures, private insurers and government reimbursers often reduce the amount they will reimburse patients for these products, which increases pressure on us to reduce prices
• A large part of the market for our HIV products consists of patients who are already taking other HIV drugs
If we are not successful in encouraging physicians to change patients’ regimens to include our HIV products, the sales of our HIV products will be limited
• As generic HIV products are introduced into major markets, our ability to maintain pricing may be affected
If we fail to commercialize new products or expand the indications for existing products, our prospects for future revenues and our stock price may be adversely affected
If we do not introduce new products or increase revenues from our existing products, we will not be able to increase our total revenues
If we fail to increase our sales of our HIV products, we may not be able to increase revenues and expand our research and development efforts
We may face difficulties in our collaboration efforts with BMS to commercialize a once-a-day single pill combination of Truvada and Sustiva
For example, regulatory approval for the NDA that we expect to file with the FDA in the second quarter of 2006 may not be granted on a timely basis, or at all
We face significant competition
We face significant competition from businesses that have substantially greater resources than we do
In addition, our competitors have more products and have operated in the fields in which we compete for longer than we have
Our HIV products compete primarily with products from GSK, which markets fixed-dose combination products that compete with Truvada
For AmBisome, we are encountering significant competition from new products produced by Merck and Pfizer
In addition, we are aware of reports of at least three lipid 19 ______________________________________________________________________ [47]Table of Contents formulations that claim similarity to AmBisome becoming available outside of the United States, including the anticipated entry of one such formulation in Greece in 2006
For Hepsera, we have encountered increased competition with the launch of BMS’s Baraclude (entecavir) and there is the potential for future competition from telbivudine, developed by Novartis and Idenix, which is awaiting approval in the United States and Europe
These companies may significantly impede our ability to be successful with our antiviral products and AmBisome
If significant safety issues arise for our marketed products, our sales may decline, which would adversely affect our results of operations
The data that support the marketing approvals for our products and that form the basis for the safety warnings in our product labels were obtained in controlled clinical trials of limited duration and, in some cases, from limited post-approval use
Safety and efficacy studies of Viread and Emtriva, dosed as separate products, are ongoing and have been underway for a longer period of time than the safety and efficacy studies of Truvada (Viread and Emtriva together), which are also underway
Following approval, our products are used over longer periods of time by many patients taking numerous other medicines, many of whom have underlying health problems and would not be monitored for dosing compliance
As drugs are used over longer periods of time by more patients, we have found and expect to continue to find new issues such as safety, resistance or drug interaction issues, which may require us to provide additional warnings on our labels or narrow our approved indications, each of which could reduce the market acceptance of these products
If serious safety, resistance or interaction issues arise with our marketed products, sales of these products could be limited or halted by us or by regulatory authorities
Our operations depend on compliance with complex FDA and comparable international regulations
Failure to obtain broad approvals on a timely basis or to achieve continued compliance could delay or halt commercialization of our products
The products that we develop must be approved for marketing and sale by regulatory authorities and, once approved, are subject to extensive regulation by the FDA and comparable regulatory agencies in other countries
We are continuing clinical trials for Viread, Truvada, Emtriva, AmBisome and Hepsera for currently approved and additional uses
We anticipate that we will file for marketing approval in additional countries and for additional products over the next several years
These products may fail to receive marketing approval on a timely basis, or at all
In addition, our marketed products and how we manufacture and sell these products are subject to extensive continued regulation and review
Discovery of previously unknown problems with our marketed products or problems with our manufacturing or promotional activities may result in restrictions on our products, including withdrawal of the products from the market
If we fail to comply with applicable regulatory requirements, we could be subject to penalties including fines, suspensions of regulatory approvals, product recalls, seizure of products and criminal prosecution
We depend on contract research organizations and our results of clinical trials are uncertain and may not support continued development of a product pipeline, which would adversely affect our prospects for future revenue growth
Gilead extensively outsources its clinical trial activities and usually performs only a small portion of the start-up activities in-house
We rely on third party contract research organizations (CROs) to perform most of our clinical studies, including document preparation, site identification, screening and preparation, pre-study visits, training and program management
If there is any dispute or disruption in our relationship with our CROs, our clinical trials may be delayed
In addition, we are required to demonstrate the safety and effectiveness of products we develop in each intended use through extensive preclinical studies and clinical trials
The results from preclinical and early clinical studies do not always accurately predict results in later, large-scale clinical trials
Even successfully completed large-scale clinical trials may not result in marketable products
If any of our 20 ______________________________________________________________________ [48]Table of Contents products under development fails to achieve its primary endpoint in clinical trials or if safety issues arise, commercialization of that drug candidate could be delayed or halted
In addition, clinical trials involving our commercial products could raise new safety issues for our existing products, which could in turn reduce our revenues
Manufacturing problems could delay product shipments and regulatory approvals, which may adversely affect our results of operations
We depend on third parties to perform manufacturing activities effectively and on a timely basis
If these third parties fail to perform as required, this could impair our ability to deliver our products on a timely basis or cause delays in our clinical trials and applications for regulatory approval, and these events could harm our competitive position
The manufacturing process for pharmaceutical products is highly regulated, and regulators may shut down manufacturing facilities that they believe do not comply with regulations
We and our manufacturers are subject to the FDA’s current Good Manufacturing Practices, which are extensive regulations governing manufacturing processes, stability testing, record-keeping and quality standards and similar regulations are in effect in other countries
In addition, our manufacturing operations are subject to routine inspections by regulatory agencies
We depend on third party manufacturers to manufacture Viread, Truvada, Emtriva, Hepsera and Vistide, including the Truvada and Viread made available to physicians and treatment programs at cost in developing countries under our Access Program
We rely on these third parties for the manufacture of both the active pharmaceutical ingredient and final drug product for clinical and commercial purposes
In addition, Roche, either by itself or through third parties, is responsible for manufacturing Tamiflu
These third-party manufacturers may develop problems over which we have no control and these problems may adversely affect our business
We manufacture AmBisome and Macugen at our facilities in San Dimas, California
These are our only formulation and manufacturing facilities in the United States
We own a manufacturing facility in Ireland that conducts quality control testing, labeling and packaging
In addition, we use third parties as alternate contract suppliers to fill and freeze dry certain batches of product
In the event of a natural disaster, including an earthquake, equipment failure, strike or other difficulty, we may be unable to replace this manufacturing capacity in a timely manner and would be unable to manufacture AmBisome and Macugen to meet market needs
We may not be able to obtain materials necessary to manufacture our products, which could limit our ability to generate revenues
Many of the materials that we utilize in our operations are made at only one facility
For example, we depend on single suppliers for high quality amphotericin B, distearoylphosphatidylcholine and high quality cholesterol, each of which is used in the manufacture of AmBisome
Because the suppliers of key components and materials must be named in the NDA filed with the FDA for a product, significant delays can occur if the qualification of a new supplier is required
If delivery of material from our suppliers were interrupted for any reason, we may be unable to ship Viread, AmBisome, Hepsera, Emtriva, Truvada or Vistide, or to supply any of our products in development for clinical trials
We depend on relationships with other companies for sales and marketing performance and revenues
Failure to maintain these relationships, poor performance by these companies or disputes with these other companies could negatively impact our business
We rely on a number of significant collaborative relationships with major pharmaceutical companies for our sales and marketing performance
These include collaborations with Astellas and Sumitomo for AmBisome, GSK for Hepsera, Roche for Tamiflu, Pfizer for Vistide, OSI and Pfizer for Macugen and Japan Tobacco for Viread, Truvada and Emtriva and our joint venture with BMS to develop and commercialize a fixed-dose regimen of Truvada and Sustiva
In many countries, we rely on international distributors for sales of Viread, 21 ______________________________________________________________________ [49]Table of Contents Truvada, Emtriva, AmBisome and Hepsera outside the United States
Some of these relationships also involve the clinical development of these products by our partners
Reliance on collaborative relationships poses a number of risks, including: • we are not able to control whether our corporate partners devote sufficient resources to our programs or products; • disputes may arise in the future with respect to the ownership of rights to technology developed with corporate partners; • disagreements with corporate partners could lead to delays in, or termination of, the research, development or commercialization of product candidates or result in litigation or arbitration; • contracts with our corporate partners may fail to provide significant protection or may fail to be effectively enforced if one of these partners fails to perform; • corporate partners have considerable discretion in electing whether to pursue the development of any additional products and may pursue alternative technologies or products either on their own or in collaboration with our competitors; • corporate partners with marketing rights may choose to devote fewer resources to the marketing of our products than they do to products of their own development; and • our distributors and corporate partners may be unable to pay us
Given these risks, there is a great deal of uncertainty regarding the success of our current and future collaborative efforts
If these efforts fail, our product development or commercialization of new products could be delayed or revenue from existing products could decline
Under our April 2002 licensing agreement with GSK, we gave GSK the right to control clinical and regulatory development and commercialization of Hepsera in territories in Asia, Africa and Latin America
These include major markets for Hepsera, such as China, Japan, Taiwan and The Republic of Korea
The success of Hepsera in these territories will depend almost entirely on the efforts of GSK In this regard, GSK promotes Epivir-HBV/Zeffix, a product that competes with Hepsera
Consequently, GSK’s marketing strategy for Hepsera may be influenced by its promotion of Epivir-HBV We receive royalties from GSK equal to a percentage of GSK’s net sales of Hepsera as well as net sales of GSK’s Epivir-HBV/Zeffix
If GSK fails to devote sufficient resources to, or does not succeed in developing or commercializing Hepsera in its territories, our potential revenues from sales of Hepsera may be substantially reduced
Expenses associated with clinical trials and sales fluctuations as a result of inventory levels held by wholesalers may cause our earnings to fluctuate, which could adversely affect our stock price
The clinical trials required for regulatory approval of our products, as well as clinical trials we are required to conduct after approval, are extremely expensive
It is difficult to accurately predict or control the amount or timing of these expenses from quarter to quarter
In addition, during the year ended December 31, 2005, approximately 89prca of our product sales in the United States were to three wholesalers, AmerisourceBergen Corp, Cardinal Health, Inc
and McKesson Corp
Inventory levels held by those wholesalers can cause our operating results to fluctuate unexpectedly if our sales to wholesalers do not match end user demand
The US wholesalers with whom we have entered into inventory management agreements may not be completely effective in matching inventory levels to end user demand, as they make estimates to determine end user demand
Approximately half of our product sales occurs outside the United States, and currency fluctuations may cause our earnings to fluctuate, which could adversely affect our stock price
A significant percentage of our product sales are denominated in foreign currencies, primarily the Euro
Increases in the value of the US dollar against foreign currencies in the past have reduced, and in the future may 22 ______________________________________________________________________ [50]Table of Contents reduce, our US dollar equivalent sales and negatively impact our financial condition and results of operations
We use foreign currency forward contracts to hedge a percentage of our forecasted international sales, primarily those denominated in the Euro currency
We also hedge a portion of our accounts receivable balances denominated in foreign currencies, which reduces but does not eliminate our exposure to currency fluctuations between the date a sale is recorded and the date that cash is collected
Our hedging program only hedges a portion of our total exposure and significant foreign exchange rate fluctuations within a short period of time could still adversely affect our results of operations
We face credit risks from our European customers that may adversely affect our results of operations
Our European product sales to government owned or supported customers in Greece, Italy, Portugal and Spain are subject to significant payment delays due to government funding and reimbursement practices
Our accounts receivable from government owned or supported customers in these countries totaled dlra221dtta9 million as of December 31, 2005
Historically, receivables tended to accumulate over a period of time and were settled as large lump sum payments as government funding became available
If significant changes were to occur in the reimbursement practices of European governments or if government funding becomes unavailable, we may not be able to collect on amounts due to us from these customers and our results of operations would be adversely affected
Our plan to supply Viread and Truvada to certain developing countries under our Access Program may expose us to unforeseen liabilities and risks
We have launched our Access Program pursuant to which we will supply Viread and Truvada at our cost to all 97 developing countries
The supply and distribution of drugs in a resource-poor environment is a complicated undertaking
As this program develops, we could face unforeseen challenges and risks, which could give rise to unforeseen liabilities
For example, patients in less developed countries using Viread and Truvada may not be as closely supervised by a doctor as they would be in more developed nations
Accordingly, there may be an increased likelihood of Viread- or Truvada-related complications going undetected or untreated, which could result in significant liability to Gilead
Our product revenues could be reduced by imports from countries where our products are available at lower prices
Prices for our products are based on local market economics and competition and sometimes differ from country to country
Our sales in countries with relatively higher prices may be reduced if products can be imported into those countries from lower price markets
There have been cases in which pharmaceutical products were sold at steeply discounted prices in the developing world and then re-exported to European countries where they could be re-sold at much higher prices
If this happens with our products, particularly Viread and Truvada, which we have agreed to provide at our cost under our Access Program, our revenues would be adversely affected
In addition, in the European Union, we are required to permit cross border sales
This allows buyers in countries where government-approved prices for our products are relatively high to purchase our products legally from countries where they must be sold at lower prices
Additionally, some US consumers have been able to purchase products, including HIV products, from Internet pharmacies in other countries at substantial discounts
Such cross border sales could adversely affect our revenues
In some countries, we may be required to grant compulsory licenses for our products or face generic competition for our products
In a number of developing countries, government officials and other groups have suggested that pharmaceutical companies should make drugs for HIV infection available at a low cost
Alternatively, governments in those countries could require that we grant compulsory licenses to allow competitors to 23 ______________________________________________________________________ [51]Table of Contents manufacture and sell their own versions of our products, thereby reducing our product sales
Certain offices of the government of Brazil have expressed concern over the affordability of our HIV products and declared that they are considering issuing compulsory licenses to permit the manufacture of otherwise patented products for HIV infection, including Viread
We are currently engaged in discussions with the Brazilian government regarding the affordability of our HIV products
In addition, concerns over the cost and availability of Tamiflu as fear grows about a potential avian flu pandemic have generated international discussions over potential compulsory licensing of our Tamiflu patents
Furthermore, Roche may issue voluntary licenses to permit third party manufacturing of Tamiflu
Should one or more compulsory licenses be issued permitting generic manufacturing to override Gilead’s Tamiflu patents, or should Roche issue additional voluntary licenses to permit third party manufacturing of Tamiflu, those developments could reduce royalties received from Roche’s sales of Tamiflu
Certain countries do not permit enforcement of our patents, and manufacturers are able to sell generic versions of our products in those countries
Compulsory licenses or sales of generic versions of our products could significantly reduce our sales and adversely affect our results of operations, particularly if generic versions of our products are imported into territories where we have existing commercial sales
Our existing products are subject to reimbursement from government agencies and other third parties
Pharmaceutical pricing and reimbursement pressures may reduce profitability
Successful commercialization of our products depends, in part, on the availability of governmental and third party payor reimbursement for the cost of such products and related treatments
Government health administration authorities, private health insurers and other organizations generally provide reimbursement
Government authorities and third-party payors increasingly are challenging the price of medical products and services, particularly for innovative new products and therapies
This has resulted in lower average sales prices
For example, a majority of our sales of AmBisome and Vistide, and a majority of our sales of Truvada, Viread and Hepsera, are subject to reimbursement by government agencies, resulting in significant discounts from list price and rebate obligations
Our business may be adversely affected by an increase in US or international pricing pressures
These pressures can arise from rules and practices of managed care groups, judicial decisions and governmental laws and regulations related to Medicare, Medicaid and health care reform, pharmaceutical reimbursement policies and pricing in general
In Europe, the success of Viread, Truvada, Emtriva, Hepsera, AmBisome and Tamiflu will also depend largely on obtaining and maintaining government reimbursement because in many European countries, including the United Kingdom and France, patients will not use prescription drugs that are not reimbursed by their governments
In addition, negotiating prices with governmental authorities can delay commercialization by twelve months or more
We also expect that the success of our products in development, particularly in Europe, will depend on the ability to obtain reimbursement
Even if reimbursement is available, reimbursement policies may adversely affect our ability to sell our products on a profitable basis
For example, in Europe as in many international markets, governments control the prices of prescription pharmaceuticals and expect prices of prescription pharmaceuticals to decline over the life of the product or as volumes increase
As new drugs come to market, we may face significant price decreases for our products across much of Europe
We believe that this will continue into the foreseeable future as governments struggle with escalating health care spending
As a result of these pricing practices, it may become difficult to maintain our historic levels of profitability or to achieve expected rates of growth
Our results of operations could be adversely affected by future health care reforms
In both the United States and some foreign jurisdictions, there have been a number of legislative and regulatory changes to the healthcare system that could impact the pricing of our products
In the United States, in December 2003, President Bush signed into law new Medicare prescription drug coverage legislation
Part of the legislation authorizes the Centers for Medicare & Medicaid Services, or CMS, the agency within the Department of Health and Human Services that administers Medicare, to implement a new Medicare Part D coverage benefit 24 ______________________________________________________________________ [52]Table of Contents for prescription drugs
The prescription drug program began on January 1, 2006
Many factors influence the possible impact to Gilead
Further, payment levels under the new Medicare program may be lower than the previous Medicare payment
Medicare patients will have to pay co-insurance, which may influence which products are recommended by physicians and selected by patients
Program enrollment is mandatory for those who are dually eligible for both Medicaid and Medicare
There is no assurance that our drugs will be recognized under the new Medicare Part D program for outpatient prescription drugs or paid at levels that reflect current or historical levels
Further, federal Medicare proposals, along with State Medicaid drug payment changes and healthcare reforms could also lower payment for our products
Our results of operations could be materially adversely affected by the reimbursement changes emerging in 2006, 2007 and beyond from the Medicare prescription drug coverage legislation
To the extent that private insurers such as Blue Cross and Blue Shield or managed care programs follow Medicaid coverage and payment developments, the adverse effects of lower Medicare payment may be magnified by private insurers adopting lower payment
Additionally, some states have enacted health care reform legislation
Further federal and state developments are possible
The impact of proposed legislation and other reforms is unclear, but it may result in pricing and reimbursement restrictions, which could adversely impact our revenues
We may not be able to obtain effective patents to protect our technologies from use by competitors and patents of other companies could require us to stop using or pay for the use of required technology
Our success will depend to a significant degree on our ability to: • obtain patents and licenses to patent rights; • preserve trade secrets; and • operate without infringing on the proprietary rights of others
We have a number of US and foreign patents, patent applications and rights to patents related to our compounds, products and technology
There is a risk, however, that issued patents will not be enforceable or provide adequate protection or that pending patent applications will not result in issued patents
Patent applications are confidential for at least some period of time until a patent issues
As a result, we may not know if our competitors filed patent applications for technology covered by our pending applications or if we were the first to invent the technology that is the subject of our patent applications
Competitors may have filed patent applications or received patents and may obtain additional patents and proprietary rights that block or compete with our patents
Patents do not cover the active ingredients in AmBisome
In addition, we do not have patent filings in China or certain other Asian countries covering all forms of adefovir dipivoxil, the active ingredient in Hepsera
Asia is a major market for therapies for HBV, the indication for which Hepsera has been developed
We may obtain patents for certain products many years before marketing approval is obtained for those products
Because patents have a limited life, which may begin to run prior to the commercial sale of the related product, the commercial value of the patent may be limited
However, we may be able to apply for patent term extensions
In addition, certain countries in Africa and Asia, including China do not permit enforcement of our patents, and manufacturers are able to sell generic versions of our products in those countries
Our competitors may file patent applications covering our technology
If so, we may have to participate in interference proceedings or litigation to determine the right to a patent
Litigation and interference proceedings are expensive even if we are ultimately successful
As part of the approval process of some of our products, the FDA has determined that the products would be granted an exclusivity period during which other manufacturers’ applications for approval of generic versions of our product will not be granted
Generic manufacturers often wait to challenge the patents protecting products that have been granted exclusivity until one year prior to the end of the exclusivity period
From time to time, we have received notices from manufacturers indicating that they intend to import chemical intermediates possibly 25 ______________________________________________________________________ [53]Table of Contents for use in making our products
It is, therefore, possible that generic manufacturers are considering attempts to seek FDA approval for a similar or identical drug through an Abbreviated New Drug Application, which is the application form typically used by manufacturers seeking approval of a generic drug
If our patents are subject to challenges, we may need to spend significant resources to defend such challenges and we may not be able to defend our patents successfully
Our success depends in large part on our ability to operate without infringing upon the patents or other proprietary rights of third parties
If we infringe the patents of others, we may be prevented from commercializing products or may be required to obtain licenses from these third parties
We may not be able to obtain alternative technologies or any required license on reasonable terms or at all
If we fail to obtain such licenses or alternative technologies, we may be unable to develop or commercialize some or all of our products
In addition, we use significant proprietary technology and rely on unpatented trade secrets and proprietary know-how to protect certain aspects of our production and other technologies
Our trade secrets may become known or independently discovered by our competitors
We may face significant liability resulting from our products that may not be covered by insurance and successful claims could materially reduce our earnings
The testing, manufacturing, marketing and use of our commercial products, as well as products in development, involve substantial risk of product liability claims
These claims may be made directly by consumers, healthcare providers, pharmaceutical companies or others
Although we maintain product liability insurance, a successful product liability claim against us may not be covered by our insurance or could require us to pay amounts beyond that provided by our insurance, either of which could impair our financial condition and our ability to clinically test and to market our products
Expensive litigation may reduce our earnings
We are named as a defendant in lawsuits regarding the use of average wholesale price and reimbursement rates under Medicaid
We have also been named as a defendant in a lawsuit alleging violations of the federal securities laws
Adverse results from these lawsuits could result in material damages that could significantly reduce our earnings or cash flows
Changes in our effective income tax rate could reduce our earnings
Various factors may have favorable or unfavorable effects on our effective income tax rate
These factors include, but are not limited to, interpretations of existing tax laws, our adoption of the Statement of Financial Accounting Standards Nodtta 123 (revised 2004), Share-Based Payment (SFAS 123R) relating to the accounting for stock options and other share-based payments, changes in tax laws and rates, future levels of research and development spending, changes in accounting standards, future levels of capital expenditures, changes in the mix of earnings in the various tax jurisdictions in which we operate and changes in overall levels of pre-tax earnings
The impact on our income tax provision resulting from the above-mentioned factors may be significant and could have a negative impact on our results of operations
Recently adopted changes in accounting for stock options will significantly reduce our earnings
The Financial Accounting Standards Board (FASB) recently issued SFAS 123R, under which we will be required to record additional compensation expense related to stock options and other equity incentives in 2006 and beyond
The impact on our earnings resulting from this new standard will have a significant negative impact on our reported results of operations compared to the results we have reported under prior accounting standards on stock options and other share-based payments