Technologies for total joint repair, the backbone of the orthopedics industry, have occupied most of the development resources of orthopedic companies, but there are gaps in the continuum of care when it comes to tendon and ligament repair. ACL reconstruction and rotator cuff repair thus are attractive niches for start-ups, worth anywhere from $500 million to $1 billion. Soft tissue repair expertise is outside the core skill-sets of big ortho, but those companies have been willing to partner and acquire smaller innovative players. Today, the opportunity is even more attractive; sports medicine--the realm of soft tissue repair--enjoys an economic resiliency not seen in total joint replacement. Ligament tears more closely resemble trauma applications, which must be treated as soon as possible.

Each year more than 1.6 million patients undergo surgeries for the repair of tendons, ligaments and cartilage in the shoulder, knee and ankles. The lack of efficacy of some of past offerings in soft tissue repair has created a pent-up demand for new treatment tools.

The other seven drugs on the initial list for negotiation are already heavily rebated and CMS could choose not to go much lower than current net prices, SSR Health report points out.