Zilretta has several things going for it. It’s not an opioid painkiller—a plus at a time when opioid addiction is a nationwide issue. It appears to be safer in diabetics than standard-of-care steroid shots. And it’s a longer-acting version of those traditional injections, meaning relief lasts longer.

But so far, the drug’s launch hasn't exactly taken off: Analysts expect 2018 sales of just $28 million. How is Flexion going to steer Zilretta toward that $1 billion in peak sales pharma watchers are expecting?

A midyear rollout for direct-to-consumer advertising, for one thing. More progress on getting reimbursement deals with payers. And continuing its push to get the brand into doctors' minds as a new option for patients with osteoarthritis.

The latter has been tough going. When Zilretta was approved last October, Flexion told analysts its 103-rep sales team could reach more than 9,000 orthopedists and rheumatologists, covering more than three-quarters of the market. Now, more than five months into its launch, a physician survey shows Flexion has work to do to boost awareness. RBC Capital, which polled 38 orthopedic surgeons, found that 15 of them (39%) hadn't even heard of Zilretta.

Of course, it's still early days, and Flexion's commercial chief, Dan Deardorf, said in March that his team is focusing on "depth versus breadth of our interactions with prescribers." And until DTC ads launch in a few months—following the traditional six-month waiting period after a new drug launch—getting the word out to doctors will still be job one.

"We want to make sure that we’ve got a solid base of physicians out there utilizing the product, so that when we activate the patient [with advertising] they’ve got a significant likelihood of receiving Zilretta when they go to ask about it," CEO Mike Clayman said during the company's fourth-quarter earnings call.

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