MMIT Reality Check on Follicular Lymphoma (4Q2022)

Payer Coverage:

A review of market access for follicular lymphoma treatments shows that under the pharmacy benefit, about 44% of the lives under commercial formularies are covered with utilization management restrictions. Around 37% of the lives under Medicare formularies are not covered for at least one of the drugs.

Under the medical benefit, about 68% of the lives under commercial policies are covered with utilization management restrictions. Almost 58% of the lives under Medicare Part B policies have access to at least one of the drugs without utilization management restrictions.

For about 95% of the covered lives, payer pharmacy benefit formularies do not require step therapy (ST). Of the lives that require ST, 44% require multiple steps. Around 79% of payer-controlled pharmacy benefit covered lives require prior authorization, with 5% of those lives covered by policies that are restrictive as compared with a product’s FDA-approved label.

Trends:

Dr. Reddy’s Launched Six Strengths of Lenalidomide

Dr. Reddy’s Laboratories Ltd. launched six strengths of lenalidomide, and two of them — 2.5 mg and 20 mg — are eligible for first-to-market 180-day exclusivity, the company said Sept. 7. The FDA approved those two strengths and gave tentative approval to the others on Oct. 14, 2021. Teva Pharmaceuticals Ltd. launched the first generics of the other four strengths of the generic of Bristol Myers Squibb’s Revlimid — 5 mg, 10 mg, 15 mg and 25 mg — on March 7. Lenalidomide is approved for six indications for the treatment of adults with (1) multiple myeloma in combination with dexamethasone; (2) MM as maintenance treatment following autologous hematopoietic stem cell transplantation; (3) transfusion-dependent anemia due to low- or intermediate-1-risk myelodysplastic syndromes associated with a deletion 5q abnormality with or without additional cytogenic abnormalities; (4) mantle cell lymphoma that has relapsed or progressed after at least two treatments, including bortezomib; (5) previously treated follicular lymphoma in combination with a rituximab product; and (6) previously treated marginal zone lymphoma in combination with a rituximab product. On Sept. 17, 2020, Dr. Reddy’s said that it had settled patent litigation with Bristol Myers subsidiary Celgene Corp. that would allow it to sell volume-limited amounts of the generic as of a confidential date after March 2022. As of Jan. 31, 2026, Dr. Reddy’s can sell lenalidomide without limitation.

FDA Expands Label of Breyanzi

In June 2022, the FDA expanded the label of Bristol Myers Squibb company Juno Therapeutics, Inc.’s Breyanzi (lisocabtagene maraleucel) for the treatment of adults with large B-cell lymphoma, including diffuse LBCL not otherwise specified (including DLBCL arising from indolent lymphoma), high-grade B-cell lymphoma, primary mediastinal LBCL and follicular lymphoma grade 3B who have refractory disease to first-line chemoimmunotherapy or relapse within 12 months of first-line chemoimmunotherapy; or refractory disease to first-line chemoimmunotherapy or relapse after first-line chemoimmunotherapy and are not eligible for hematopoietic stem cell transplantation due to comorbidities or age. The agency first approved the CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy on Feb. 5, 2021. The price for the one-time treatment is $410,300.

FDA Gives Kymriah Accelerated Approval

In May 2022, the FDA gave accelerated approval to Novartis Pharmaceuticals Corp.’s Kymriah (tisagenlecleucel) for the treatment of adults with relapsed or refractory follicular lymphoma after two or more lines of systemic therapy. The agency first approved the CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy on Aug. 30, 2017. One-time dosing for the treatment is $373,000.

Key Findings:

Market Events Drive Changes

In June 2022, the FDA expanded the label of Bristol Myers Squibb company Juno Therapeutics, Inc.’s Breyanzi (lisocabtagene maraleucel) for the treatment of adults with large B-cell lymphoma, including follicular lymphoma grade 3B who have refractory disease to first-line chemoimmunotherapy or relapse within 12 months of first-line chemoimmunotherapy. In May 2022, the agency gave accelerated approval to Novartis’s Kymriah (tisagenlecleucel) for the treatment of adults with relapsed or refractory follicular lymphoma after two or more lines of systemic therapy. The treatment of follicular lymphoma has shifted from use of chemotherapy alone to chemotherapy in combination with immunotherapy.

Competitive Market Landscape

Despite new treatments that improve overall survival, follicular lymphoma is regarded as an incurable malignancy with a relapsing and remitting pattern. Although patients in third or later line treatment for follicular lymphoma have multiple systemic therapies available, the efficacy of these regimens drops off rapidly in later lines. Throughout the lifetime of a relapsing patient, they may be exposed to a median of five lines of prior treatment, with an upper range of 12 lines. There also is an unmet need in people who are refractory to treatment or quickly relapse, who may exhaust treatment options while they are still healthy enough to receive active treatment.

Pharmacy, Medical Benefit Implications

Most medications, with the exception of Bayer AG’s Aliqopa (copanlisib) and Gilead Sciences, Inc. subsidiary Kite Pharma, Inc.’s Yescarta (axicabtagene ciloleucel), are covered with either no restrictions or with a prior authorization.

Key Players in Market:

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