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 combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading specialty brands.
Commercial payers with half of lives are undecided as to whether they will undergo first-line contracting efforts (see chart). Those with about one-third of lives said they are likely to increase these efforts. These respondents said that Revlimid (lenalidomide) from Bristol Myers Squibb subsidiary Celgene Corp., Takeda’s Velcade (bortezomib) and Ninlaro (ixazomib) from Takeda subsidiary Millennium Pharmaceuticals, Inc. (daratumumab) are the top therapies on which they will focus.
Almost half of payers are not likely to increase their second-line contracting efforts. Among those that anticipate increasing these efforts, Revlimid, Darzalex from Janssen Biotech, Inc., a Johnson & Johnson company, and Velcade are the top agents on which payers will focus. Among oncologists, Revlimid and Velcade were the multiple myeloma agents prescribed most often.
On Aug. 5, 2020, the FDA gave accelerated approval to GlaxoSmithKline’s Blenrep (belantamab mafodotin-blmf) for the treatment of adults with relapsed or refractory multiple myeloma after at least four lines of therapy, including an anti-CD38 monoclonal antibody, a proteasome inhibitor and an immunomodulatory agent. Payers with 85% of covered lives said they expect to manage it to label. More than half of oncologists said they are likely to prescribe it over certain fourth-line treatments (see chart).
While multiple myeloma treatments may result in remission, people often relapse and require multiple lines of therapies. Payers with more than half of covered lives said Revlimid is their most ideal first-line treatment. For second-line therapies, payers with more than one-third of lives said Amgen Inc.’s Kyprolis (carfilzomib) was No. 1. And for third-, fourth- and fifth-line agents, Pomalyst (pomalidomide) from Celgene Corp., a Bristol Myers Squibb company, was most ideal. Across all lines, Velcade ranked second.
On May 1, 2020, the FDA approved Janssen’s Darzalex Faspro (daratumumab and hyaluronidase-fihj), a new subcutaneous formulation of Darzalex, an intravenous infusion, for use in four regimens across five indications in people with multiple myeloma. The new product reduces administration time from several hours to approximately three to five minutes and decreases infusion-related reactions. Almost two-thirds of payers expect to prefer Darzalex Faspro over Darzalex as a monotherapy, and more than two-thirds of oncologists expect to do the same.
Message: “RFI review completed of distribution channel. Selection of two unnamed specialty pharmacies to be distributors. Unknown positioning in 340B or on payer formulary.”
Payer Thoughts: “Specialty selection may give preference to PBM-owned pharmacies. Profitability is expected to be low on drug if access is available. How will Revlimid be affected? Timing interesting given BMS buyout of Celgene.“
Multiple Myeloma Poses Management Challenges
Multiple myeloma, an incurable blood disease that starts in the bone marrow and can be a relatively rare cancer, has an array of products available to treat it, and new agents — including the first gene therapy for the disease — continue to gain FDA approval. However, as the therapies are different types of drugs, management of the space can be challenging.
Sarclisa Will Be Managed Same as Similar Drugs
On March 2, 2020, the FDA approved Sanofi’s Sarclisa (isatuximab-irfc) for the treatment of multiple myeloma. The move added another therapy to a class full of products, both indicated for the condition and used off label. Almost half of payers responding to a Zitter Insights survey said they anticipate their company will manage the new treatment on parity with other multiple myeloma drugs that have a similar indication.