“We will do anything to survive outside of bankruptcy.” CEO Saundra Pelletier has spent the past year watching her pharma company, Evofem Biosciences, slowly slip to the brink of failure. She also spent the past two months talking to me about her company’s struggles, offering Fortune’s readers a rare window into how top executives manage through—and try to avert—the ultimate business disaster.

Evofem’s shares have been delisted from the Nasdaq, and its sales aren’t growing fast enough to overcome its losses (or its debt load). Last month, the San Diego company parted ways with most of Pelletier’s remaining staff, including members of her C-Suite: her CFO resigned, her chief commercial officer was laid off, and her 35 remaining employees took salary cuts of 20%. (Pelletier’s own salary was slashed by 40%, to $520,000.)

Still, Pelletier isn’t giving up yet. Evofem’s latest round of blood-letting will cut about $4.3 million in expenses, buying her company another few months of operating budget, while she keeps searching for a buyer or investor or another savior.

“We are on life support,” she says. But “there’s nothing I would not do for this company to succeed.”

There are many reasons for Evofem’s current predicament, including some of Pelletier’s own making, as I report in a new profile and investigation for Fortune. The company, which makes a prescription contraceptive gel called Phexxi, has survived expensive regulatory limbo; product setbacks; and even some personal tragedies, including plane crashes and cancer diagnoses.

But the biggest financial challenges facing Evofem—and all the entrepreneurs and executives trying to innovate in its crucial market—involve our broken health care system. It’s part of a much bigger story about how reluctant big drugmakers are to invest in women’s health—and about how much power big insurance companies wield over small pharma companies like Evofem, to block their innovation and growth.

“We’ve never clawed our way back in the public market because now we’ve got to face the insurance companies,” says Al Altomari, the CEO of Agile Therapeutics, another small company that launched a new contraceptive called Twirla in 2020—and quickly ran into some of the same financial obstacles as Evofem.

Check out the full story, which follows Pelletier’s tireless efforts to save her company—while diving into the systemic, industry-wide problems facing Evofem, Agile, and the 73 million U.S. women who are their prospective customers.

Maria Aspan
maria.aspan@fortune.com
@mariaaspan

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Big deal

More Americans worry about inflation and the economy than any of the other key problems facing the U.S., according to Gallup’s annual survey. Six in 10 Americans surveyed expressed “a great deal” of concern about these issues. This year, more are also worried about the affordability of health care (54% in 2023 vs. 49% in 2022), and federal spending and the budget deficit (52% vs. 48%), according to the report.

Going deeper

"Finding the Model That Captures Investment Risks, but Not Mispricing of Assets," a report in Wharton's Business Journal, shows fund managers a way to isolate the mispricing of securities to weigh the role of risks. Robert F. Stambaugh, the Miller Anderson & Sherrerd professor of finance at Wharton, is a co-author of a research paper that tests the ability of five prominent models to predict future returns by evaluating only risks, assuming that there is no mispricing, according to the report.

Leaderboard

Janet Yang, EVP and CFO at W&T Offshore, Inc. (NYSE: WTI), an independent oil and natural gas producer, announced she will leave the company on May 11, following the release of the first quarter earnings and the filing of the 10-Q. Yang disclosed that, for family reasons, she and her family will be relocating to another city. Trey Hartman, VP and chief accounting officer, will serve as interim CFO. A formal search for a permanent CFO will be initiated shortly, according to the company.

Conor McCarthy was named CFO at MariaDB plc (NYSE: MRDB), a generation cloud database company, effective April 10. McCarthy has over 30 years of experience leading finance organizations. Previously, he was CFO at Ideanomics, a cleantech company. Before Ideanomics, McCarthy was CFO at OS33 and CFO at Intent Media Inc. He also spent nine years at wholesale brokerage firm GFI Group Inc., now part of BGC Partners, where he was CFO-Americas.

Overheard

“The bond market has gone berserk. For once, I’m on the side of equity markets. I don’t see a recession coming.”

—Dominique Dwor-Frecaut, a senior market strategist at the research firm Macro Hive Ltd., told Bloomberg. Dwor-Frecaut previously worked in the New York Fed’s markets group.