Radar on Specialty Pharmacy

While the COVID-19 pandemic continued to impact the specialty pharmacy and home infusion spaces for the second straight year, other events also played a role. AIS Health spoke to some industry experts about 2021’s impact.

AIS Health: Looking back over the past year, what do you think were the most noteworthy occurrences within the specialty pharmacy industry, and why?

Dea Belazi, Pharm.D., M.P.H., president and CEO of AscellaHealth: Some of the noteworthy trends in SP have included the continued rise of the cost of specialty agents within health care expenditures, the continued emergence of ultra-high-cost specialty agents for rare and orphan diseases and the continued vertical integration of specialty pharmacies into health care organizations.

Dec. 8: The FDA gave another approval to Foundation Medicine, Inc.’s FoundationOne CDx as a companion diagnostic for current and future BRAF inhibitors used to treat melanoma, including monotherapies targeting BRAF V600E and BRAF/MEK inhibitor combination therapies targeting BRAF V600E or V600K mutations. The agency first approved the test on Nov. 30, 2017.

Dec. 9: The FDA granted premarket approval to Thermo Fisher Scientific’s Oncomine Dx Target Test as a companion diagnostic to help identify people with non-small cell lung cancer whose tumors have epidermal growth factor receptor (EGFR) exon 20-insertion mutations who may be candidates for treatment with Rybrevant (amivantamab-vmjw) from Janssen Biotech, Inc., a Johnson & Johnson company. The agency initially approved the test on June 22, 2017.

CMS issued a final rule on Dec. 29 that rescinded the Most Favored Nation model. The mandatory model would have priced Medicare Part B drugs on the U.S. market based on their prices in certain countries. An interim final rule that was published in November 2020 had been blocked from being implemented on Jan. 1, 2021.

CMS published a proposed rule on Jan. 12 that would rein in direct and indirect remuneration (DIR) fees, which pharmacies have long complained about. The proposal would save consumers about $21.3 billion but cost the federal government $40.0 billion from 2023 through 2032.

Biosimilars are finally starting to bring down the prices of their innovator products across a range of indications, research shows. The FDA often approves biosimilars across some or all of the innovator drug’s indications even if applicant companies have not conducted studies in those uses. But two professional societies have been pushing back against payers’ allowance of two Avastin (bevacizumab) biosimilars in untested ocular indications.

Walgreens Boots Alliance recently revealed that it is making a majority investment in Shields Health Solutions through its subsidiary Walgreen Co. The deal will expand Walgreens’ position within the growing hospital-based specialty pharmacy space.

Shields is a specialty pharmacy integrator that partners with health systems to help them create and grow a hospital-owned specialty pharmacy program. The hospitals own the pharmacies while Shields manages them.

✦ Sept. 15: The FDA granted another indication to BeiGene, Ltd.’s Brukinsa (zanubrutinib), giving it accelerated approval for the treatment of people with relapsed or refractory marginal zone lymphoma following treatment with at least one anti-CD20-based regimen. The agency first approved the drug on Nov. 14, 2019. The recommended dose of the capsule is 160 mg twice daily or 320 mg once daily. Website Drugs.com lists the price of 120 80 mg capsules as more than $14,094.00.

✦ Over the past five years, biosimilars created competition that resulted in savings of $9.8 billion. That’s according to Amgen Inc.’s 2021 Biosimilar Trends Report, its eighth edition. The therapies also have the potential to save people out-of-pocket costs of $238 million in the nine classes in which the agents have been approved. The drugs are launching with wholesale acquisition costs that are generally between 15% and 37% less than those of their reference products.

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