Zitter Pulse Check: Multiple Myeloma (December 2022)

Coverage

Multiple myeloma is a high-cost category with an increasing number of therapies that treat the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for multiple myeloma, Zitter Insights surveys a leading panel of pharmacy and therapeutics (P&T) decision makers at payers and integrated delivery networks. The Managed Care Oncology Index: Multiple Myeloma combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading oncology brands.

Payer Management

Payers with more than half of commercial lives said that managing branded treatments for multiple myeloma is a high priority for them, while those covering almost half of Medicare lives rated it an average priority. Payers representing almost two-thirds of commercial lives and almost half of Medicare lives said they are slightly aggressive in their management of the therapies. More than half of oncologists expressed average satisfaction with the available agents to treat the disease.

Around half of both payers and oncologists stated that moderate unmet need exists in the treatment of multiple myeloma. Payers with more than half of covered lives said that people with the condition have a high level of disease burden. Payers representing more than half of commercial lives and almost two-thirds of Medicare lives said that available treatments have a high or very high budget impact.

Key Findings

Physician Prescribing

In the year prior to the survey, Revlimid (lenalidomide) from Bristol Myers Squibb subsidiary Celgene Corp. was prescribed most often, with almost two-thirds of oncologists saying they wrote a scrip for the agent. Almost as many oncologists said they had prescribed Takeda’s Velcade (bortezomib). Those two drugs have the greatest amount of high prescribing oncologists — defined as oncologists who prescribe a medication to at least half of their patients — for multiple myeloma. On the opposite end was Pepaxto (melphalan flufenamide), which received accelerated approval on Feb. 26, 2021. Later that year, manufacturer Oncopeptides AB requested voluntary withdrawal of the agent’s New Drug Application, and then in early 2022, the company rescinded the request. The FDA’s Oncologic Drugs Advisory Committee voted in September 2022 that the drug is not favorable for adults with relapsed or refractory multiple myeloma. The drug is not currently marketed in the United States.

Carvykti

With its Feb. 28, 2022, approval, the Janssen Pharmaceutical Companies of Johnson & Johnson and Legend Biotech USA, Inc.’s Carvykti (ciltacabtagene autoleucel or cilta-cel) became the second chimeric antigen receptor T-cell (CAR-T) therapy to treat multiple myeloma following Bristol Myers Squibb and bluebird bio, Inc.’s Abecma (idecabtagene vicleucel), which was approved March 26, 2021. Both drugs are B-cell maturation antigen (BCMA)-directed agents with approval for the treatment of adults with relapsed or refractory multiple myeloma after at least four lines of therapy, including a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 monoclonal antibody. Among payers that had not conducted a P&T review of Carvykti, those with about two-thirds of commercial lives and more than half of Medicare lives said that with the availability of the new drug, patients have an average burden of disease. Payers covering approximately half of lives said that moderate unmet need exists in the treatment of multiple myeloma with the availability of Carvykti.

Social Determinants of Health

Among payers covering Medicare lives, the top social determinants of health initiatives for disadvantaged members with multiple myeloma are greater access to telehealth — which is offered by payers with almost all lives — services to support health/medicine literacy and services to assist in health/medicine language barriers. Commercial payers said they also prioritize these same measures, as well as newsletters/educational content about healthy living, all of which were cited by payers with at least half of lives. Physicians cited socioeconomic status, education and health literacy, and familial and other support as the top non-medical factors impacting the ability of people with multiple myeloma to access health care services and therapy.

Trends

Efficacy

Message: “Discussion regarding the use of Darzalex Faspro as a treatment option in the management and treatment of refractory/relapsed multiple myeloma. The Faspro formulation permits for an efficient subcutaneous administration vs. a lengthy IV infusion. The drug can be administered in under five minutes, improving efficiency of the practice and improving patient [quality of life]. The drug provides for a comparable efficacy to that of the IV formulation.”

Payer Thoughts: “Overall, Darzalex Faspro provides for an efficient, effective and well-tolerated formulation in the management of multiple myeloma. Patient satisfaction is improved, along with increased efficacy at clinic.”

More Cancer Indications With Accelerated Approval Are Being Withdrawn

On Nov. 22, 2022, GSK plc said it would withdraw its U.S. marketing authorization for Blenrep (belantamab mafodotin-blmf). The FDA granted the B-cell maturation antigen (BCMA)-directed antibody and microtubule inhibitor conjugate accelerated approval on Aug. 5, 2020, for the treatment of adults with relapsed or refractory multiple myeloma who have received at least four therapies including an anti-CD38 monoclonal antibody, a proteasome inhibitor and an immunomodulatory agent.

Subscribers to AIS’s RADAR on Specialty Pharmacy may read the in-depth article online

FDA Gives Accelerated Approval to Tecvayli

On Oct. 25, 2022, the FDA gave accelerated approval to the Janssen Pharmaceutical Companies of Johnson & Johnson’s Tecvayli (teclistamab-cqyv) for the treatment of adults with relapsed or refractory multiple myeloma who have received at least four lines of therapy, including a proteasome inhibitor, an immunomodulatory drug and an anti-CD38 monoclonal antibody. The recommended dose of the first-in-class bispecific B-cell maturation antigen (BCMA)-directed CD3 T-cell engager is 0.06 mg/kg via subcutaneous injection on day one, 0.3 mg/kg on day four and 1.5 mg/kg on day seven, again one week later and then once weekly. The agent’s list price is $39,500 per month.

Subscribers to AIS’s RADAR on Specialty Pharmacy may read the in-depth article online

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