Please ensure Javascript is enabled for purposes of website accessibility
Free Article Join Over 1 Million Premium Members And Get More In-Depth Stock Guidance and Research

Anika Therapeutics (ANIK) Q4 2018 Earnings Conference Call Transcript

By Motley Fool Transcribing - Updated Apr 18, 2019 at 2:53PM

You’re reading a free article with opinions that may differ from The Motley Fool’s Premium Investing Services. Become a Motley Fool member today to get instant access to our top analyst recommendations, in-depth research, investing resources, and more. Learn More

ANIK earnings call for the period ending December 31, 2018.

Logo of jester cap with thought bubble with words 'Fool Transcripts' below it

Image source: The Motley Fool.

Anika Therapeutics ( ANIK 3.06% )
Q4 2018 Earnings Conference Call
Feb. 21, 2019 5:00 p.m. ET


Prepared Remarks:


Good evening, ladies and gentlemen, and welcome to Anika Therapeutics fourth-quarter 2018 earnings conference call. [Operator instructions] As a reminder, this conference call is being recorded. I will now turn the call over to Sylvia Cheung, chief financial officer. Please proceed.

Sylvia Cheung -- Chief Financial Officer

Thank you, Ashley. Good evening, everyone, and thank you for joining our fourth-quarter and full-year 2018 earnings call. With me on the call today is Anika's President and Chief Executive Officer Joseph Darling. During today's call, Joe and I will review our fourth-quarter and full-year 2018 financial results and key business highlights, which were summarized in our earnings release issued today.

A copy of the earnings release is available in the Investors Relations section of our website at In addition, a slide presentation is posted on our website in the investor relations section under the events and presentations tab. We invite you to take a moment to open the file and follow the presentation along with us. Please turn to Slide No.

1. Before we begin, please remember that certain statements made during this conference call constitute forward-looking statements as defined in the Securities and Exchange Act of 1934. These statements are based on our current beliefs and expectations and are subject to certain risks and uncertainties. The company's actual results could differ materially from any anticipated future results, performance or achievements.

Please see our SEC filings for more information about factors that could affect our results. Please turn to Slide No. 2 as I now turn the call over to our CEO Joseph Darling. Joe?

Joe Darling -- Chief Executive Officer

Thank you, Sylvia, and good evening, everyone. Welcome to our fourth-quarter and full-year 2018 earnings call. 2018 was a pivotal and dynamic year for Anika as we continued to deliver strong earnings and cash flow while building on the foundation that will drive Anika's next phase of growth. Our fourth-quarter and full-year results are a snapshot of a company undergoing a transformation.

The 2018 performance highlights our ability to capably manage the elements of our business that are within our direct control with strict financial discipline and an eye toward generating cash and returning value to our shareholders. More importantly, we continue to focus on strategic growth initiatives to address near-term challenges relating to the structure of our legacy contracts. Overall, Anika remains a profitable and cash producing growth company and I am very confident in our future. We are executing against our strategic vision of being a global commercial company that delivers a continuum of innovative orthopedic therapies.

We are assured of our value proposition to patients, physicians and our shareholders. And I know that by leveraging our strong foundation and executing on our new and ongoing strategic and operational initiatives, we have multiple opportunities, as well as the resources to drive revenue and earnings growth over the next several years. We are also making solid progress toward developing and finalizing our five-year strategic plan, which will guide our continued transformation into a global commercial company. While we have indicated some of the broad elements of that plan, we look forward to sharing specific details later this year following board review and approval.

Last quarter, I spoke about our people, our pipeline and profitability being the key drivers of our future growth. Through that lens, 2018 marked the beginning of a transformative period. Just look at what we have achieved. First, we expanded our leadership team by appointing a new vice president of operations in the U.S.

to drive operational efficiencies and a vice president of international sales to evaluate and improve our international performance. We also added two new highly qualified independent directors to our board of directors who we believe will bring new perspectives and drive enhanced value for our company. Later I will discuss additional plans to strengthen our organization. We also made significant progress toward developing and deploying a hybrid commercial model as we work to launch our first surgically delivered regenerative therapy for bone repair procedures in the U.S.

later this year. We completed an initial prototype for our second surgically delivered regenerative therapy for rotator cuff repairs and remain well-positioned to deliver a series of innovative new treatments to the global orthopedic community over the next several years. We also resumed global production and distribution of HYALOFAST, HYALOGRAFT-C and HYALOMATRIX in the fourth quarter as planned following our voluntary non-safety related recall of these products in the second quarter of 2018. We saw improved product gross margin from this and other related initiatives.

As we refine and finalize our strategic plan, we are confident in our strengths, understand our challenges and are working to capture the incredible opportunity that we have to make a difference in the lives of patients. Anika has a robust product pipeline spanning beyond osteoarthritis pain management to tissue repair and regeneration and cartilage restoration. We remain focused on delivering innovative solutions for patients to drive the next phase of our growth. The important steps that we are now taking will help pave the way for new product lines, increased control over the commercial management of those products and create value for our physician users, patients and our shareholders.

As I noted last quarter, enhancing our profitability won't happen overnight, but I know that we have the right team in place which we will continue to strengthen with experienced leaders including in the regulatory and quality area, as well as the product innovation area to execute our strategy to drive sustained growth and enhance shareholder value. Anika also continues to have a healthy balance sheet that we can leverage as we identify additional growth opportunities in the years ahead, which I will discuss further shortly. Please now turn to Slide No. 3.

I'd now like to provide an update on CINGAL. We recently met with the FDA to discuss our clinical data, including data from the 17-02 extension study and talked about the pathway for CINGAL approval. As the meeting occurred a short time ago, we have not yet received the written meeting minutes from the FDA. While we believe it was a productive discussion, it has become clear that we will need to conduct another Phase 3 clinical trial before we can obtain approval for CINGAL in the U.S.

While we did obtain clarity that additional clinical data are needed and we have understanding on the broad outlines of the study, there are additional matters that need to be worked out in order to finalize the design. As I have discussed on previous investors calls, we were aware that we might have to gather additional clinical data to support U.S. approval and include the South com in our contingency planning. We will work with the agency and pursue the most expeditious path to FDA for approval for CINGAL.

As we have further discussions and interactions with the FDA to obtain alignment on approval requirements and trial parameters, we won't be able to provide substantive details about the nature, design, timeframe and cost of a potential clinical trial at the appropriate point in time. We continue to believe that our clinical trial data together with the real-world evidence gathered in markets around the world demonstrate the efficacy, safety and clinical utility of this novel treatment. Importantly, we continue to experience strong international demand for CINGAL in Canada and Europe, which further reinforces our conviction in its market opportunity. For the full-year 2018, CINGAL OUS revenue increased 34% year over year and we are aggressively pursuing near-term revenue growth by expanding our global footprint for CINGAL and the orthobiologics business.

To that end, we added eight new international distributors in 2018, expanding the presence of our franchise in Europe, Asia, Africa and South America. I will now turn to an update on the MONOVISC Phase III trial to support the expanded hip OA indication conducted by our U.S. commercial partner. After analyzing interim data as required by the clinical protocol during the fourth quarter of 2018, our partner informed us that they discontinued the study.

We have not yet had the opportunity to review the interim data underlying this decision internally. We intend to thoroughly examine our options including by vetting the recent regulatory development regarding FDA's intention to begin treating the use of HA for osteoarthritis as a drug rather than a medical device, which has been the regulatory status for decades. While the changes in the regulatory environment present challenges for companies developing HA products, we do believe that such changes may deliver positive benefits for established companies like Anika with extensive product and clinical development capabilities as they could increase the barriers for competing products to reach the market, potentially limit new competition and possibly even stabilize pricing. More importantly, our product development strategy has already expanded beyond visco supplements with newer surgical products that purposefully move away from this legacy pathway.

This is a nice segue to HYALOFAST, our innovative cartilage repair solution. Please turn to Slide No. 4. We are continuing to pursue strategies to accelerate enrollment in our Phase 3 trial to support FDA approval.

Patient enrollment has advanced over 50% and we continue to see a very high level of enthusiasm among physicians and patients for this unique regenerative treatment. In fact, numerous surgeons have noted how the product properties greatly enhance the surgical procedure. We continue to view HYALOFAST as an important product with significant future revenue potential. Conservatively, we estimate the U.S.

market size for HYALOFAST to be greater than $0.5 billion annually. As noted on Slide 5, we remain on track to launch our first HA base surgically delivered regenerative therapy for bone repair procedures in the U.S. in the second half of this year. This is a momentous catalyst for Anika as it will be our first domestic surgical product developed internally and launched under our hybrid commercial model.

As we prepare for the launch, we look forward to showcasing the advantages of this therapy to the global orthopedic surgery community at multiple upcoming industry conferences, including the American Academy of Orthopaedic Solutions Surgeons, AAOS; the International Cartilage Regeneration and Joint Preservation Society, also known as ICRS; and the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine known as ISAKOS. Engaging with orthopedic medicine thought leaders at these meetings is critical to our success and we look forward to their feedback as we move toward commercial launch. Importantly, we are confident that we are well positioned to deliver on the estimated 250 to 300 million market opportunity for bone repair. We are also continuing to develop the initial prototype we created for our second surgically delivered regenerative therapy for rotator cuff repair procedures.

This product is designed to be used in both partial and full thickness rotator cuff tears and would be a unique therapy that complements our growing portfolio of regenerative medicine products. We anticipate that we will be completing key preclinical work in early 2019 and we will be focused on surgical instrumentation development for the remainder of 2019. This therapy represents another significant growth opportunity for Anika. With more than 650,000 procedures reported in the U.S.

each year, this treatment represents a 150 to $200 million market opportunity in the U.S. alone. Further, given the potential addressable international market, we believe it can become a large global franchise. In summary, our organic product launch plans over the next several years will provide a continuum of new products to fuel our growth in the orthobiologics sector.

I'll now turn the call over to Sylvia to review our fourth-quarter and full-year 2018 financial results before I provide more details about our ongoing initiatives to drive near and long-term growth. Sylvia?

Sylvia Cheung -- Chief Financial Officer

Thank you, Joe. Please turn to Slide No. 6. Total revenue for the fourth quarter was $27 million, compared to 29.4 million for the fourth quarter of last year.

Total revenue for the full year of 2018 was 105.6 million, compared to 113.4 million for 2017. As we anticipated, the decrease in both periods was primarily due to lower U.S. visco supplement pricing and the impact of the voluntary recall. Prior-year full-year results included $5 million in milestone revenue generated in 2017, which did not recur in 2018.

For the full year of 2018, global MONOVISC revenue increased 12% and CINGAL international revenue grew 34% showing the strength and the uptick in adoption of our single injection product lines. As a result, global visco supplement revenue was up slightly for the year despite lower pricing in the United States. For the full year, U.S. ORTHOVISC end user sales volume experienced a 6% decrease while MONOVISC end user volume increased by 26%.

On a full-year basis, pricing for ORTHOVISC and MONOVISC in the U.S. experienced a decrease in the low to mid double-digit percentage range. While pricing pressure is impacting the overall U.S. visco supplement market, we continue to see strong total patient and volume growth for our visco supplement products driven by demographic trends, the reliable safety profile of our brands and the efforts of our U.S.

partner with investments in their field-based organization. Product gross margin increased to 74% for the fourth quarter, compared to 69% for the third quarter of 2018 and 70% for the fourth quarter of last year. The increase in product gross margin is primarily due to the improved manufacturing efficiency and changes in product mix. For the full year of 2018, we delivered a strong product gross margin of 70%.

Total operating expenses in the quarter were $17.2 million, compared to 19.7 million in the fourth quarter of 2017. For the full year, total operating expenses were 83.8 million, compared to 67.7 million for 2017. The increase for the year was due primarily to three factors. First is a one-time charge of 8.4 million, which consisted mainly of non-cash stock-based compensation expense related to the retirement of Anika's former CEO; second is an approximate $2 million of non-recurring CINGAL U.S.

prelaunch market research activities in the first half of 2018; and lastly, increased personnel and professional costs. Net income for the quarter was 7.7 million or $0.54 per diluted share, compared to net income of 8.1 million or $0.53 per diluted share in fourth quarter of 2017. For the full year, net income was 18.7 million or $1.27 per diluted share, compared to 31.8 million or $2.11 per diluted share for 2017. The decline in net income for the year was due primarily to decrease in total revenue and increase in operating expenses previously discussed.

The non-recurring charges mentioned previously impacted diluted EPS by nearly $0.70 on a full-year basis. We remain focused on increasing efficiency in our cost structure and maintaining our culture of disciplined cost management in the year ahead while advancing the regulatory and commercial plans Joe just discussed. For the 12-month period ending December 31st 2018, we generated approximately $35 million of cash from operations. We are in a strong financial position with cash and investments totaling 159 million at the end of the fourth quarter.

Last July we completed a $30 million accelerated share repurchase program and repurchased a total of approximately 800,000 shares under the program. Our cash deployment strategy remains focused on making organic investments to drive top-line growth, pursuing strategic M&A to complement organic growth and returning capital to shareholders through share repurchases. Please now turn to Slide No. 7 to review our guidance for 2019.

For the full year of 2019, we expect total revenue to be approximately 3% to 6% below the prior-year level. That said, we expect Q1 2019 total revenue to be slightly above prior year's first quarter due to the variability of quarterly orders by our distributors, which is inherent to our current business. Licensing, milestone and contract revenue is expected to be flat for the year. As we discussed in prior quarters, under the terms of our U.S.

partnership agreement, we have limited visibility into or control over pricing, which creates a sub-optimal environment for forecasting and managing based on real-time information. As a result, our current expectations are based on recent trends in the U.S. visco market and existing information on hand. Given the pricing dynamics we observed in the market, we noted last quarter that a $5 million MONOVISC milestone payment was under review by us, as well as by our partner.

Following this review, we have determined that the ongoing pricing pressure and the terms of the contract make its achievement unattainable. Total operating expenses are expected to be in the high 70 million up to $80 million range. While we have not included an additional CINGAL trial in our estimated operating expenses for 2019, we do have the cash resources to invest in an additional study as necessary. Adjusted EBITDA is expected to be in the low $30 million range based on a net income expectation in the mid-teen to around $20 million range.

Adjusted EBITDA is defined by the company as U.S. GAAP net income excluding depreciation and amortization, interest and other income or expense, income taxes and share-based compensation expense. Capital expenditures are expected to be between 5 and $8 million primarily for manufacturing and operations automation initiatives. In 2019, our disciplined financial plan is focused on key ongoing initiatives including No.

1, launching the company's first HA based surgically derived regenerative therapy for bone repair procedures in the second half of '19. Two, international expansion of orthopedics and dermal product portfolios. Three, develop and finalize a regulatory strategy for CINGAL in the United States. Four, advancing our HYALOFAST, rotator cuff therapy, and other development programs.

I'd like now to turn the call back to Joe to discuss our near and long-term growth drivers.

Joe Darling -- Chief Executive Officer

Thank you. Sylvia. Please turn to Slide No. 8.

As we look ahead to the remainder of 2019, we are continuing to take important steps to transform our business with an emphasis on our people, our pipeline and ultimately on maximizing profitability. We will continue to take advantage of the multiple levers we have to advance our long-term goal of returning to double-digit revenue growth. Our first lever is the development of our hybrid commercial model. We intend to structure any new partnership contract to provide more favorable economics in greater control over market access, sales and marketing, minimum annual growth objectives and pricing than our previous commercial partnerships have had historically.

We are confident that this hybrid commercial model will deliver the greatest value to Anika and our shareholders and it will enable us to better control our own destiny toward increased profitability and growth. We are actively evaluating a number of potential commercial partners with established orthopedic surgical sales forces that would fit with our organization and can support the launch of our bone repair therapy planned for the second half of this year. We are already implementing brand development initiatives and measured operational scale up activities. We plan to hire a small field-based team of elite and highly skilled regional sales directors in the second quarter of this year who will be strategically located to effectively drive prelaunch activities and awareness, build relationships with key surgeons and accounts and train our partner sales force when appropriate.

Our second lever is the continued international expansion of our orthobiologics franchise mainly MONOVISC, CINGAL and HYALOFAST. I am confident that with the new leadership on the ground, we can drive greater growth in these products and continue to expand our commercial network. Additionally, our new VP of international sales is actively directing, refreshing and upgrading our international distribution network and we look forward to seeing operating and commercial results from these efforts in 2019. The third lever is advancing our multiple clinical programs.

We have an established culture of innovation spanning more than 25 years and remain committed to advancing our orthobiologics and regenerative medicine pipeline programs. Our goal is to deliver a steady cascade of product launches over the next several years. This year we intend to continue R&D investments to execute the ORTHOVISC-T post market clinical study, HYALOFAST Phase 3 trial for U.S. approval and advance the development of our regenerative therapy for rotator cuff tears.

We also plan to further strengthen our development and regulatory expertise with new executive hires in these areas. In the next several weeks, we plan on announcing a new leader for the R&D team that will focus his or her efforts on innovative therapies in the sports medicine space. We look forward to their contributions as we advance our clinical programs, develop regulatory strategies worldwide and continue to the full potential of our strong technology platform. That brings me to our fourth growth lever.

We have the financial strength to invest in the right opportunities that will generate value to our business and our shareholders. We have been diligently screening candidates for targeted partnership and evaluating potential acquisitions to augment organic growth. We are actively focused on evaluating smaller tuck-in acquisitions, which would complement our existing product portfolio, supplement our technology, or enhance our commercialization capabilities.As we have said, we are interested in targets that are aligned with our core competencies in orthopedics and potentially have a strong distribution channel in place, as well as the potential to generate sustained double-digit revenue and earnings growth. We are confident that these levers will drive increased and sustainable value for Anika and our shareholders over time.

We are working diligently to execute on our initiatives and continue to Anika's transformation into a global commercial company. We are now happy to take your questions. Thank you. 

Questions and Answers:


Thank you. [Operator instructions] And our first question comes from the line of Mike Petusky with Barrington Research. Your line is now open.

Mike Petusky -- Barrington Research -- Analyst

Good morning. I'm sorry, good afternoon, sorry. Been a long week already, sorry.

Joe Darling -- Chief Executive Officer

Good afternoon, Mike.

Mike Petusky -- Barrington Research -- Analyst

Thank you. So anyway, so let's talk about CINGAL U.S. first. In terms of sort of the cadence of what you guys expect to happen, I mean do you think you'll have clarity in terms of sort of the go-forward path first half of this year and then start to execute in the back half or do you think this could sort of drag out and you not have a great sense for several months?

Sylvia Cheung -- Chief Financial Officer

Mike, thank you for the question. We, as Joe had mentioned, are waiting to receive the written minutes from the FDA and based on that, we'll look to have additional discussion with the FDA. Our plan and goal is to work expeditiously, but we have to also rely on the FDA's response and the timing of their response. So at this point, I don't have a specific -- we don't have a specific month, but we do expect that within 2019 we would have clarity surrounding the pathway in terms of study scope nature and all the critical elements related to that.

Joe Darling -- Chief Executive Officer

Mike, I'll just add to that. The key for us is first to Sylvia's point obtaining the written minutes, sitting down with FDA to make sure that we're in alignment on the pathway forward to get this done as expeditiously as possible. So just reinforcing, we like to do this as quickly as possible; but right now we're pretty much dependent on the pathway that the FDA is going to lay out here in a little bit.

Mike Petusky -- Barrington Research -- Analyst

Can I just ask, Sylvia, your guidance on OPEX? I'm assuming that sort of is -- assumes that there is some increased spend in R&D related to a new trial. Is that fair to say?

Sylvia Cheung -- Chief Financial Officer

I would say that there is not a significant amount in that. The guidance really reflects the development in clinical programs that we articulated in the script section meaning the continued enrollment of HYALOFAST or product development for the rotator cuff therapy, as well as some post-market clinical studies related to our European approvals, one is ORTHOVISC-T which is the tennis elbow products and the other one is our MONOVISC product. There will be some strategy related work and planning work on that, but not the actual study itself.

Mike Petusky -- Barrington Research -- Analyst

OK, all right. You didn't specifically give guidance around gross margin, but if I just sort of do the math of what you've sort of given, it feels like sort of upper 60%s. Is that in the ballpark of what you guys are sort of internally assuming on gross margin?

Sylvia Cheung -- Chief Financial Officer

We prefer to keep the guidance to what we just spoke about in terms of operating expenses. In terms of the product gross margin, as you know, it's impacted by our ability to continue to control cost, as well as the market impact of pricing. So the range that you stated I think is a reasonable expectation from your part, but we're not going to provide a specific quantified set of numbers at this time.

Mike Petusky -- Barrington Research -- Analyst

OK, all right. Just one more real quick. Joe, obviously there's a lot of interest and excitement around the longer-term potential of HYALOFAST, but there's probably a lot of internal frustration there that you guys can't seem to really get a footing in terms of enrolling that trial. Are there things that you guys can do to sort of juice the process a little bit and expedite things so we can see this progress a little bit?

Joe Darling -- Chief Executive Officer

Yes. I think what's important for us, Mike, and that's a great question, is a couple of things we're doing. One is we are getting our internal clinical team in the field to the study sites more frequently and helping in the patient selection criteria and keeping them educated on how to look for the appropriate patients. So, that's No.

1. No. 2 is we've increased our internal activities in what I would call weekly updates on how we're progressing on our clinical study. So, we're keeping a very close eye on this recognizing the enormous capabilities the product has in the market.

It is frustrating, but I think we've got a good plan in place to work with the study sites, increase the enrollment and try to get this done as quickly as possible.

Mike Petusky -- Barrington Research -- Analyst

Is there any kind of aspirational goal? I mean are you shooting for full enrollment by the end of this year or by the end of next year? I mean is there a way to think about this in terms of what you guys really want to accomplish?

Joe Darling -- Chief Executive Officer

Yes. Aspirationally...

Mike Petusky -- Barrington Research -- Analyst


Joe Darling -- Chief Executive Officer

Or yesterday, right? No, I mean we've got to be realistic too. We want to do the study the correct way so we want to make sure aspirationally that we're really holding the team accountable, getting them in the field more frequently and getting them in front of the surgical sites more often and frequently to help on the patient enrollment. But it's -- to put an aspirational goal in there I think is counterproductive. It's more what's realistic and working with the sites in tandem to make sure that we're optimizing the protocol.

Mike Petusky -- Barrington Research -- Analyst

OK. Fair enough. Thank you.


Thank you. And our next question comes from the line of Joe Munda with First Analysis. Your line is now open.

Joe Munda -- First Analysis -- Analyst

Good afternoon, Sylvia and Joe. Just a couple of quick questions here. First off, Joe, can you give us some color in regards to the meeting with the FDA? I know you had gone in, I think last we spoke you were putting this data package going in with your best shot. Coming out of there even though you don't have the minutes, you're convinced that you're still going to have to go into a Phase 3 trial.

Maybe could you give us some thoughts of the interactions with the FDA, it's been the constant talk among investors trying to figure out what the FDA would do here. So, I mean could you give us some color there? And then in addition, a little bit of talk about the growth outside the U.S. with CINGAL. Sylvia, if you can provide us with maybe what CINGAL was as a percentage of revenue.

I'll jump back in the queue and I'll come back with a follow-up.

Joe Darling -- Chief Executive Officer

Yes. First, good afternoon, Joe. Thank you for the question. I'll take the first part and Sylvia will take the second part.

So to give you a little color on the interaction with the FDA, it was a very productive meeting, lot of discussion back and forth obviously on the data. I think one thing that I would say is it clarified some key points that I think we've got to take into consideration, but it was a healthy amicable discussion around how to get this product into the market. And what's key for us now when you had that conversation, you've got to wait for the meeting -- excuse me, the meeting minutes to come through so that we can put pen to paper, develop a protocol that's acceptable and move forward. So I'm not quite sure what more color I can give you than that aside from it was a good conversation, productive, very upbeat; but obviously it's going to require some further clinical studies to get the product approved.

Joe Munda -- First Analysis -- Analyst

I guess what I'm looking for is I mean you presented the extension study data to them, were they dismissive of it in the fact that you have to -- you feel like you have to go back and do another trial or I mean are they supportive toward HA products being in the marketplace? Anything along those lines as you move forward here? Because as investors look at the company and they look at CINGAL as the near-term next leg of, if you will, growth; I think that any color you can provide as far as them being supportive where hey, yes, HA products being in the marketplace, I think investors would love to hear about that.

Joe Darling -- Chief Executive Officer

Yes. So first of all, the extension study was not part of the original FDA protocol so that was really more of a gimmick to get the extended time period -- excuse me, if you will, on the durability of pain relief. So, I want to make that clear. We felt we could use that data, but clearly because it wasn't part of the protocol, it didn't fall necessarily within the scope of what I would like to have seen FDA reaction from.

That being said, I think the agency is supportive of HA products, but they want to make sure that the clinical studies achieve their primary endpoints and that's their expectation. And they pretty much are holding hard lines now toward the primary endpoints as we've seen with not only us, but other companies. So we -- that's why I want to be a little cautious and waiting for the meeting minutes to come back from the -- the written ones, Joe, to come back from the FDA. Sylvia, you want to take the second part?

Sylvia Cheung -- Chief Financial Officer

Sure. With regards to international CINGAL revenue, year-over-year growth was 34% as we mentioned earlier and as a percentage of product revenue is close to 5%. And from a growth expectation standpoint, we do see that the product is very strong and should generate double-digit percentage growth in the next period in 2019.

Joe Munda -- First Analysis -- Analyst

I have just two more quick ones, if I may. You talked about milestone revenue not in your forecast for 2019. I think had it forecasted in our models, maybe a little bit of background there. And then as far as the split between MONOVISC and ORTHOVISC, if you can give us maybe a mix split for orthobiologics MONOVISC versus ORTHOVISC? Thank you.

Sylvia Cheung -- Chief Financial Officer

OK, sure. With regards to the milestones, I think you're referring to in the contract, there is a potential additional sales threshold milestone which we originally expected in 2018. Without the -- a little bit background information there. Without the pricing decline that we saw in 2018, that mix sales threshold milestone would have been achieved with the volume increase.

Unfortunately, as a result of the continued pricing erosion which we reported on over the last few quarters now and under the existing contract's terms, we've come to the conclusion that achievement of that milestone is no longer attainable, which is the reason why we or why I made the statement earlier in terms of not expecting that in the revenue. With regard to the ORTHOVISC and MONOVISC revenue split, I think you're referring to the United States -- the domestic split. We actually see that for the full year of 2018, MONOVISC is slightly higher from a revenue standpoint over ORTHOVISC. So, we've now really turned the tide.

It used to be, as you remember, a heavier portion on ORTHOVISC. Now we're seeing that MONOVISC is taking over that split between the two product lines. Hopefully, that answered your question, Joe.

Joe Munda -- First Analysis -- Analyst

Thank you.


Thank you. And your next question comes from the line of Lisa Springer with Singular Research. Your line is now open.

Lisa Springer -- Singular Research -- Analyst

Good afternoon. Sylvia, I wanted to ask you about the product gross margin in the fourth quarter. You mentioned the improvement was a result of operating efficiencies and improved product mix. If you had to assign a weight each of those, what would it be and could you give us a little more color about the improvement in the product mix?

Sylvia Cheung -- Chief Financial Officer

Sure. To assign a portion of the product gross margin improvement between the two factors, I would say that it's heavier toward manufacturing efficiency and slightly lower on the product mix side. The second part of your question is related to kind of the details behind the initiatives that we have. As Joe mentioned before, our new VP of operation joined the company a few months ago and he has been very focused on looking at reducing product cost.

So, we have a pretty comprehensive view not only in terms of looking at efficiency, but also looking at raw material costs and so forth. And a lot of the manufacturing efficiencies that we are looking to achieve are through automation and scale. So, we are looking at every aspect of our manufacturing production to see that we can improve the efficiency, as well as reducing the per unit cost for our products.

Lisa Springer -- Singular Research -- Analyst

OK. Thank you. And I wanted to ask Joe a question about the tennis elbow product. Could you provide us with a little more detail regarding the progress toward partnerships to drive sales of the tennis elbow product in Europe and the status of the U.S.

Phase 3 clinical study?

Sylvia Cheung -- Chief Financial Officer

So, the tennis elbow product is currently CE marked as you know. One of our initiatives in 2019 is to commence a post-market study, which will help us get clinical information in the marketplace so that we can help to drive commercial demand in the OUS market. And from a commercialization standpoint, we utilize country level distributors to market our OVT or tennis elbow product outside of the United States. With regard to the domestic market, we are planning on employing a partnership approach on that product.

As you pointed out, we do have a protocol that the FDA had approved and from a prioritization standpoint, we're looking to focus on our -- focus our R&D effort on the programs that I discussed earlier and this one potentially will be a collaborative initiative on our part and on our partner's part. So, that is at a high level where we are in terms of the domestic and international tennis elbow programs.

Joe Darling -- Chief Executive Officer

Yes. Lisa, just point of clarification. OUS we use local distributors, U.S. obviously we're looking for that broader partnership domestically.

So, I just want to make sure that we were clear. There are independent distributors outside the U.S., but when we look for partnerships in the U.S., we're looking for the broader national partnership.

Lisa Springer -- Singular Research -- Analyst

Right. Thank you, Joe.


Thank you. And we have a follow-up question from the line of Mike Petusky with Barrington Research. You may proceed.

Mike Petusky -- Barrington Research -- Analyst

Yes. Just sticking on the partnership theme, Joe. Obviously you're targeting a commercial launch for bone repair in second-half '19. I mean is -- I guess are there multiple discussions taking place, are there end stage discussions taking place? Can you just kind of give a sense of is this likely to be sort of an early second-half launch? Are you close in terms of signing an agreement there and when you do sign an agreement, is that the type of thing that you guys would press release? Thanks.

Joe Darling -- Chief Executive Officer

Yes. So to answer the very end of your question, we would press release it. No question about it. Secondly, we are in multiple discussions, Mike.

We're at different stages so it's kind of hard to segment for you where those different stages are based upon the number of discussions we're having. I think the good news is there's a pretty high interest level in partnership opportunities in partnering with us for that particular product. And it's probably what you think it would normally be for what we're looking for and that is an established large orthopedic sales organization that has the capabilities for depth of reach into the physician community. So, I think we're in a pretty good spot.

Our target is soft launch in Q3 so we hope to have the partnership announcement by the end of the first half of this year, but we've got flexibility in that. The soft launch just for clarity is where you go out and you start to build market awareness and you develop your key opinion leader base, you start getting some trials and usages with it, then you go into the full hard launch. So I think we're in a pretty good spot, feel pretty good about it. Feel good about the number of discussions we're having and the depth of those discussions.

Mike Petusky -- Barrington Research -- Analyst

OK. Very good. Thank you.


Thank you. And we have a follow-up question from the line of Joe Munda with First Analysis. Your line is now open.

Joe Munda -- First Analysis -- Analyst

Just really one quick follow-up in regards to the bone repair product. Where -- is that going to be booked in surgical and I'm guessing does the guidance -- 2019 guidance reflect contribution from bone repair and if so, ballpark what are you guys looking for as far as maybe potential revenue first half of your launch? Thank you.

Sylvia Cheung -- Chief Financial Officer

The bone repair product would be included in orthobiologics because of its orthopedic intended use. The surgical franchise is primarily anti-adhesion related surgical products. With regards to the revenue expectation; given the timing of soft launch in the third quarter and a full launch toward the end of the year, we expect that the revenue contribution would be less than $1 million in 2019. And sorry, Joe, remind me about the last question, I think there was a three-part question.

Joe Munda -- First Analysis -- Analyst

Just I was looking for expectations in '19 for the soft launch and where you guys were going to be booking the revenue. I think that's all I had.

Sylvia Cheung -- Chief Financial Officer

Yes, I think I answered both.

Joe Munda -- First Analysis -- Analyst



Thank you. Ladies and gentlemen, this concludes today's Q&A session. I would now like to turn the call back over to management for any closing remarks.

Joe Darling -- Chief Executive Officer

So, thank you for your time today. We are pleased with the progress that we are collectively making across our organization to transform Anika into a global commercial company and gain greater control of our future. We are very excited about our growth prospects and we look forward to continuing to update you as we execute on our strategic initiatives in the year ahead. Thank you and have a great evening.


[Operator signoff]

Duration: 52 minutes

Call Participants:

Sylvia Cheung -- Chief Financial Officer

Joe Darling -- Chief Executive Officer

Mike Petusky -- Barrington Research -- Analyst

Joe Munda -- First Analysis -- Analyst

Lisa Springer -- Singular Research -- Analyst

More ANIK analysis

This article is a transcript of this conference call produced for The Motley Fool. While we strive for our Foolish Best, there may be errors, omissions, or inaccuracies in this transcript. As with all our articles, The Motley Fool does not assume any responsibility for your use of this content, and we strongly encourage you to do your own research, including listening to the call yourself and reading the company's SEC filings. Please see our Terms and Conditions for additional details, including our Obligatory Capitalized Disclaimers of Liability.

10 stocks we like better than Anika Therapeutics
When investing geniuses David and Tom Gardner have a stock tip, it can pay to listen. After all, the newsletter they have run for over a decade, Motley Fool Stock Advisor, has quadrupled the market.*

David and Tom just revealed what they believe are the 10 best stocks for investors to buy right now... and Anika Therapeutics wasn't one of them! That's right -- they think these 10 stocks are even better buys.

See the 10 stocks

*Stock Advisor returns as of January 31, 2019

This article represents the opinion of the writer, who may disagree with the “official” recommendation position of a Motley Fool premium advisory service. We’re motley! Questioning an investing thesis – even one of our own – helps us all think critically about investing and make decisions that help us become smarter, happier, and richer.

Invest Smarter with The Motley Fool

Join Over 1 Million Premium Members Receiving…

  • New Stock Picks Each Month
  • Detailed Analysis of Companies
  • Model Portfolios
  • Live Streaming During Market Hours
  • And Much More
Get Started Now

Stocks Mentioned

Anika Therapeutics, Inc. Stock Quote
Anika Therapeutics, Inc.
$39.71 (3.06%) $1.18

*Average returns of all recommendations since inception. Cost basis and return based on previous market day close.

Related Articles

Motley Fool Returns

Motley Fool Stock Advisor

Market-beating stocks from our award-winning service.

Stock Advisor Returns
S&P 500 Returns

Calculated by average return of all stock recommendations since inception of the Stock Advisor service in February of 2002. Returns as of 12/02/2021.

Discounted offers are only available to new members. Stock Advisor list price is $199 per year.

Our Most Popular Articles

Premium Investing Services

Invest better with the Motley Fool. Get stock recommendations, portfolio guidance, and more from the Motley Fool's premium services.