Sen. Mike Lee (R-Utah) unveiled legislation aimed at boosting competition among biologics and reducing consumer costs for the agents. Introduced on Nov. 17, the Biosimilar Red Tape Elimination Act (S.6) would do away with the FDA requirement for switching studies for biosimilars seeking the interchangeability designation. “Eliminating this barrier would increase access to lower-cost biosimilars and save payers and consumers billions over the next five years,” according to a press release from Lee’s office. In contrast to the European Union, whose European Medicines Agency (EMA) and the Heads of Medicines Agencies (HMA) recently clarified that all biosimilars approved in the EU are interchangeable, the FDA has created two levels of biosimilars: biosimilars and interchangeable biosimilars. Also quoted in the release was Sarfaraz Niazi, Ph.D., an adjunct professor of biopharmaceutical ciences at the College of Pharmacy at the University of Illinois Chicago, who pointed out that “according to the FDA, ‘biosimilars have no clinically meaningful difference with their reference product,’ so if there is no difference, they should be interchangeable without the extensive and expensive switching and alternating studies in patients.”
As researchers gain growing insight into the mechanics of what makes diseases tick, more and more genetic tests are coming onto the market to help make sure the right patient gets the right drug at the right time. While these diagnostics can help inform diagnosis and treatment for patients, the sheer volume of these tests may be overwhelming payers in their coverage decisions. Stakeholders should work together to help establish the clinical utility that payers need to make coverage decisions on these diagnostics, industry experts say.
Daryl Pritchard, Ph.D., senior vice president of science policy at the Personalized Medicine Coalition (PMC), describes the landscape of coverage for genetic testing as “uneven. Payers are increasingly considering coverage and reimbursement of genetic testing products and services.” However, he tells AIS Health, a division of MMIT, “there remain significant challenges in establishing coverage policies and payment rates for diagnostic tests that reflect the value of their care. As a result, many newer novel diagnostics are under-reimbursed or not covered at all. Such practices ultimately restrict patient access to some needed tests and to optimal care. Coverage and reimbursement policies vary widely among different payers, and decision-making processes are often inconsistent and not transparent.”
Two recently published studies by Prime Therapeutics LLC shine a light on specialty drug costs. In the first, researchers found that a newer agent for cystic fibrosis is effective, but it is so costly that its related savings in health care services avoided do not offset its cost. The second study showed that a focused communication effort for a transition to a preferred infliximab biosimilar, among other strategies, has resulted in millions of dollars in savings in only the first three months after implementation of the strategy.
Posters on the studies were presented at the Academy of Managed Care Pharmacy (AMCP) Nexus meeting.
Oncologists May Prescribe New Neutropenia Agent Over Others in Class, but Therapy Faces Another Challenge
The FDA recently approved the first novel long-acting granulocyte colony-stimulating factor (G-CSF) in more than 20 years. Payers say they are likely to manage the new agent similar to existing ones, but some oncologists have indicated that they are willing to prescribe it in place of other neutropenia agents, according to Zitter Insights. Still, the leader in the space has a unique quality that has allowed it to continue to retain market share, which may prove challenging for the new drug — at least for the time being.
On Sept. 9, the FDA approved Spectrum Pharmaceuticals, Inc.’s Rolvedon (eflapegrastim-xnst) to decrease the incidence of infection, as manifested by febrile neutropenia, in adults with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with clinically significant incidence of febrile neutropenia. The company developed the drug with South Korea’s Hanmi Pharmaceutical Co. The recommended dose is 13.2 mg administered subcutaneously once per chemotherapy cycle.
As FDA approvals of biosimilars continue and agents expand into new indications, more payers are using these drugs and seeing cost savings through that utilization, according to Zitter Insights.
When the FDA approved Fresenius Kabi’s Stimufend (pegfilgrastim-fpgk) on Sept. 1, it was the sixth biosimilar of Amgen Inc.’s Neulasta (pegfilgrastim) that the agency had approved. It also was the 38th biosimilar approved since the first one, Novartis Pharmaceutical Corp. division Sandoz Inc.’s Zarxio (filgrastim-sndz), was approved March 6, 2015, referencing Amgen’s Neupogen (filgrastim).
Oct. 21: The FDA granted another indication to AbbVie Inc.’s Rinvoq (upadacitinib) for the treatment of adults with active non-radiographic axial spondyloarthritis with objective signs of inflammation who have had an inadequate response or intolerance to tumor necrosis factor (TNF) inhibitors. The agency first approved the Janus kinase (JAK) inhibitor on Aug. 16, 2019. Dosing of the extended-release tablets for the newest indication is 15 mg once daily. The wholesale acquisition cost (WAC) of a 30-day supply is $5,671.26.
Oct. 21: The FDA approved AstraZeneca’s Imjudo (tremelimumab-actl) in combination with the company’s Imfinzi (durvalumab) for the treatment of adults with unresectable hepatocellular carcinoma. Dosing for people weighing at least 30 kg is 300 mg of Imjudo, a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor, via intravenous infusion plus 1,500 mg of Imfinzi, a programmed death-ligand 1 (PD-L1) inhibitor, also via intravenous infusion at cycle one/day and then Imfinzi as a single agent every four weeks. For those weighing less than 30 kg, dosing is 4 mg/kg of Imjudo plus 20 mg/kg of Imfinzi at cycle one/day one and then Imfinzi every four weeks.
Biosimilars have produced about $21 billion in savings for the U.S. health care system over the past six years, according to the 2022 Amgen Biosimilar Trends Report. That competition is resulting in decreasing average sales prices (ASPs) for both biosimilars and their reference products, found the ninth edition of the report, and uptake of biosimilars continues to increase. In the second quarter of 2022, drug spend savings were estimated to be $3.2 billion. Biosimilars for more classes, pharmacy benefit drugs and interchangeable biosimilars are among the trends expected over the next few years.
Rheumatologists are reporting a growing familiarity with biosimilars, with three-quarters of respondents to a Cardinal Health survey saying they are “very familiar” with the agents compared with 53% who said that in 2020. The Rheumatology Insights: October 2022 report found that, among other things, almost two-thirds of respondents said they are “very comfortable” with prescribing the drugs. New patients and existing patients whose payers have mandated the use of a biosimilar are the top categories of patients for whom respondents are likely to prescribe biosimilars, both cited by about 40% of respondents.
Since June, manufacturers of the three FDA-approved poly (ADP-ribose) polymerase (PARP) inhibitors have withdrawn their indications in the later line treatment setting for ovarian cancer. Payers should be reviewing their utilization management criteria to make sure they are covering the drugs in the appropriate setting, advises one industry expert.
In a Form 8-K filed with the U.S. Securities and Exchange Commission on June 16, Clovis Oncology, Inc. said it was voluntarily withdrawing the FDA approval for Rubraca (rucaparib) for the treatment of BRCA-mutated ovarian cancer after at least two chemotherapies based on overall survival (OS) data from the ARIEL4 clinical trial. The company also disclosed that it had requested withdrawal of that indication in Europe. The drug’s indications for the maintenance treatment of adults with recurrent epithelial ovarian, fallopian tube or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy and for the treatment of adults with a deleterious BRCA mutation-associated metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor-directed therapy and a taxane-based chemotherapy, the latter of which has accelerated approval, remain on its label.
Since the FDA’s approval of the first biosimilar — Zarxio (filgrastim-sndz) from Sandoz, a division of Novartis Pharmaceuticals Corp. — on March 6, 2015, the agency has approved almost 40 more agents via the 351(k) pathway established under the Biologics Price Competition and Innovation Act (BPCIA), itself part of the Affordable Care Act (ACA). Although not all of those agents have launched yet, and almost all of the ones that have are all professionally administered, industry experts say they expect to see more competition in the space, depending on interchangeability status, provider uptake and the impact of the Inflation Reduction Act.
Cell and Gene Therapies Hold Promise, but Stakeholders Must Overcome Challenges to Meet Their Full Potential
Researchers continue to make progress in developing cell and gene therapies that offer the promise of slowing a disease’s progression and even offering a potential cure to patients. And while these agents may offer hope to patients, some challenges exist, including access to the treatments. In order for these products to reach their full potential, stakeholders must work together to overcome these potential barriers.
With its Feb. 28 FDA approval, the Janssen Pharmaceutical Companies of Johnson & Johnson and Legend Biotech USA, Inc.’s Carvykti (ciltacabtagene autoleucel or cilta-cel) became the sixth chimeric antigen receptor T-cell (CAR-T) therapy approved in the U.S. In addition, the existing CAR-Ts continue to get additional FDA-approved indications added to their labels, including for use in earlier line settings. And in August and September alone, the FDA approved two bluebird bio, Inc. gene therapies: Zynteglo (betibeglogene autotemcel or beti-cel) and Skysona (elivaldogene autotemcel or eli-cel).