Author: Randy Chase

Did you hear it too?

We are talking about hearing the melody to the old Queen song….. Anther One Bites the Dust!

The one biting the dust is Kroger Supermarkets. 

As numerous specialty pharmacies before them, Kroger just announced that they are spinning off their specialty pharmacy division as it no longer fits their strategic plans.

Should this sale be a surprise to anyone? No.

If you have an asset that is not delivering a satisfying ROI then it may be high time to sell. Also, given the Byzantine nature of drug access and purchasing, it requires larger and larger volumes to get the best acquisition prices and access to limited drugs, payer contracts, etc. Kroger has just not been able to break into the SP fast lane.

What is more interesting is the buyer in this deal….. Elevance Health.

Now pay attention…. this is complicated

• Elevance is the fancy new branding of the former Anthem.
• In mid-2022 Elevance Health launched new brands for two of its subsidiaries under one umbrella, called Carelon. 
• Carelon includes the Elevance (Anthem’s) in-house pharmacy benefit manager Ingenio Rx now under CarelonRx
• And…. Beacon Health Options, a behavioral health provider
• And myNEXUS, a home healthcare company. 
• And… Paragon Healthcare which operates more than 40 ambulatory and home infusion centers in eight states 
• And….the acquisition of BioPlus specialty pharmacy in 2023…… which closes the loop on understanding the Elevance Health’s CarelonRx’s acquisition of the Kroger specialty pharmacy business.

That’s a very busy acquisition schedule! 

The company says that Carelon now serves 1 in 3 people in the U.S. in one way or another.

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Kroger to sell specialty pharmacy business to Elevance Health’s CarelonRx

March 18, 2024 

(Reuters) – Grocer Kroger said on Monday it had entered a definitive agreement for the sale of its specialty pharmacy business to CarelonRx, a unit of U.S. health insurer Elevance Health.

The financial terms of the deal were not disclosed.

The retailer’s specialty pharmacy business serves patients with chronic illnesses that require complex care.

Kroger Specialty Pharmacy is separate from other Kroger Family of Pharmacies, including in-store retail pharmacies and The Little Clinics, which are not included in the deal.

The deal, subject to customary closing conditions and regulatory approvals, is expected to close in the second half of 2024. It is not expected to impact Kroger’s 2024 fiscal forecasts.

……..catching up on FDA approvals

The FDA recently approved a new ORAL therapy, Truqap (capivasertib) from AstraZeneca Pharmaceuticals (AZ), for co-administration with Faslodex (fulvestrant) for adult patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative locally advanced or metastatic breast cancer with one or more PIK3CA/AKT1/PTEN-alterations, as detected by an FDA-approved test, following progression on at least one endocrine-based regimen in the metastatic setting or recurrence on or within 12 months of completing adjuvant therapy.

Breast cancer is the most common cancer and one of the leading causes of cancer-related death worldwide. HR-positive breast cancer (expressing estrogen or progesterone receptors, or both), is the most common subtype, with more than 65% of tumors considered HR-positive and HER2-low or HER2-negative. Collectively, mutations in PIK3CA, AKT1 and alterations in PTEN occur frequently, affecting up to 50% of patients with advanced HR-positive breast cancer.

Published cost of Truqap oral tablets, in either 160 mg or 200mg strengths, is around $24,000 for a supply of 64 tablets. Approved dosage of Trugap is 400 mg orally taken twice daily for 4 days followed by 3 days off. That translates into 4 tablets per day, 16 per week over the 4 ‘on’ days, which therefore translates into 4 weeks of therapy in a 64 tablet bottle. Therapy may continue until disease progression or unacceptable toxicity.

Since approval, AZ has named Biologics by McKesson as its specialty pharmacy dispensing partner.

CLICK HERE for Prescribing Information

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FDA approves capivasertib with fulvestrant for breast cancer  

CLICK HERE to read the FDA press release

……..catching up on FDA approvals

The FDA approved a new ORAL therapy, Ogsiveo (nirogacestat) to SpringWorks Therapeutics Inc., for adult patients with progressing desmoid tumors who require systemic treatment.  Ogsiveo is the first drug to be approved for the treatment of patients with desmoid tumors, a rare subtype of soft tissue sarcomas. 

Desmoid tumors are diagnosed in about 3 to 5 people per million a year. Previous treatments included surgery, chemotherapy, radiation and tyrosine kinase inhibitors, Unfortunately, recurrence rates have remained high. The tumors commonly invade into surrounding structures and organs, resulting in pain, issues with being able to move, and decreased quality of life.

SpringWorks announced that Ogsiveo will be sold in the U.S. at a list price of $29,000 for a 30-day supply.  Since launch the company also announced that Ogsiveo would be available through select specialty distributors or through its limited specialty pharmacy network which includes Onco360 and Biologics by McKesson.

CLICK HERE for prescribing information

CLICK HERE for the FDA press release

Let’s see if we can get your attention……

“The market structure we have right now—three big PBMs dominating the market—will probably not be the one we will be with over the long run.”

That statement is central to the article we suggest today for your reading pleasure. It strongly suggests that the way PBMs operate, and the service offerings they are already offering in response to market pressures, are shifting the ground under which healthcare is delivered. We suggest that providers in the delivery channel also need to understand these changes to survive and thrive.

The article starts out by detailing how Blue Shield of California chopped its well established PBM in favor of a tutti frutti solution that includes —–

• Amazon Pharmacy – fulfillment
• Mark Cuban Cost Plus Drug Company – simple, transparent, pricing 
• Abarca – claims technology
• Prime Therapeutics – negotiate savings with drug manufacturers toward value-based models 
• CVS Caremark – will continue supporting specialty pharmacy services

The article is thought provoking as it is a peek behind the curtain of what appears to be the next generation of PBM hegemony. Most staff are only generally familiar with the ‘OG’ PBM model so this article should be considered required reading. 

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PBMs Are Evolving. Here’s What HR Needs to Know

When nonprofit health insurer Blue Shield of California announced in August that it was making a significant shift in how it administers pharmacy benefits for its 4.8 million members, the health insurance industry took notice, and so did the financial markets: CVS Health, the parent company of the insurer’s outgoing pharmacy benefits manager (PBM), saw its stock plummet 8 percent the day Blue Shield made its decision public.

The Oakland-based insurer’s new model, called Pharmacy Care Reimagined, includes new relationships with four entities in addition to the CVS PBM, known as CVS Caremark. In announcing the new model, Blue Shield said……………………………

CICK HERE to read the full article

……catching up on FDA approvals

The FDA approved an oral therapy, Zurzuvae (zuranolone) from Biogen Inc./ Sage Therapeutics, Inc.)  Zurzuvae is a neuroactive steroid gamma-aminobutyric acid (GABA) A receptor positive modulator indicated for the treatment of postpartum depression (PPD) in adults. 

About 1 in 8 women in the U.S. (that’s about .5 million out of 3.7 million live births in the US) experience symptoms of postpartum depression following birth.  Postpartum depression lasts for weeks or months. It generally starts about 1-3 weeks after giving birth.

This approval came about a number of months ago….. but the companies indicated that launch would be delayed till Q1-2024. 

The package insert specifies that Zurzuvae should be administered with fat-containing food. It has a recommended dosage is 50 mg orally once daily in the evening for 14 days.  Other strengths are available to down dose in the event of CNS effects, Renal, or Hepatic impairment. Approval included a black box warning….. especially related to CNS concerns. There is no mention relative to continuation of this therapy past the initial 14 days.

Most noteworthy is the price set by the companies….. $15,900 for just the two-week course of treatment.

Biogen /Sage has yet to issue any details as to distribution. Given its price, relatively limited demand, and need to monitor for warnings and reactions, it is likely going to be made available through limited distribution.

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Biogen, Sage set price of postpartum depression pill at $15,900

Biogen and Sage Therapeutics will charge a sticker price of nearly $16,000 for a two-week course of their new postpartum depression drug Zurzuvae, the companies revealed Tuesday.

CLICK HERE to read the full article

The FDA recently approved a new therapy, Omvoh (mirikizumab-mrkz) from Eli Lilly and Company, for the treatment of moderately to severely active ulcerative colitis (UC) in adults. 

Most noteworthy is that Omvoh is available in both Infused and Subcutaneous forms. 

· The recommended induction dosage is 300 mg by intravenous infusion at weeks 0, 4, and 8.

·    The recommended maintenance dosage is 200 mg administered by subcutaneous injection (given as two consecutive injections of 100 mg each) at Week 12, and every 4 weeks thereafter. 

Ulcerative colitis is a type of inflammatory bowel disease (IBD). It causes inflammation and ulcers, or sores, in the large intestine. Scientists still do not know the main cause of ulcerative colitis, however, environmental factors, imbalance in the gut and immune system are suspected leading contributors. Genetics also play a role in ulcerative colitis, as well as age (most are diagnosed between the ages of 15 and 30.) and ethnicity as Caucasians and those of Ashkenazi Jewish descent are at a higher risk for developing the disease.

Symptoms range from mild to severe with periods of worsening symptoms — called flares — and diminished symptoms — called remission — occurring over time.

Common symptoms of ulcerative colitis include:

·        nausea

·        diarrhea

·        bloody stools with mucus

·        abdominal pain or cramping

·        inability to pass stools despite frequent urges

·        rectal bleeding

·        fatigue

·        unintentional weight loss

·        loss of appetite

·        dehydration

Omvoh has a list price of $9,593 per month for the IV formulation and $10,360 per subcutaneous administration. It is presumed that access to the IV form will be through national distributors. Lilly has not announced whether the subcutaneous form will be restricted to limited distribution.

CLICK HERE to read prescribing information

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FDA Approves Lilly’s Omvoh (mirikizumab-mrkz), A First-in-Class Treatment for Adults with Moderately to Severely Active Ulcerative Colitis

·        Omvoh delivered significant improvement in bowel urgency, reported by people with UC 

·        Lilly’s first approved treatment for a type of inflammatory bowel disease

INDIANAPOLIS, /PRNewswire/ — Eli Lilly and Company (NYSE: LLY) announced that the U.S. Food and Drug Administration (FDA) has approved Omvoh™ (mirikizumab-mrkz) infusion (300 mg/15 mL)/injection (100 mg/mL), the first and only interleukin-23p19 (IL-23p19) antagonist for the treatment of moderately to severely active ulcerative colitis (UC) in adults.

Marking a significant milestone, Omvoh is the only UC treatment that selectively targets the p19 subunit of IL-23, which plays a role in inflammation related to UC.

CLICK HERE to read the full Lilly press release

Mark Cuban can now be called a pharmacy trend setter. 

We’ve read about his cost-plus drugs model….. and it seems that Express Scripts (ESI) feels that offering a similar pricing model to their clients is a great idea. 

Yeah, one PBM may not qualify as a trend….. but it is a start.

ESI has begun to offer a product called ClearNetwork to clients using Wholesale Acquisition Cost, Predictive Acquisition Cost, or National Average Drug Acquisition Cost to decide on the ‘’estimated’ price for each drug in their formulary. A pharmacy fee and a second fee of 15% then added (not clear if that is a combined 15% or two separate fees). ESI has been quoted as saying that the fees will be transparent to clients and pharmacies (no mention of patients, however).

According to the article below, “The option will apply to a plan sponsor’s list of covered generic, branded and specialty medications.” This model is being offered to the 65,000 retail pharmacies in its network. It is not clear is participation is part of the recontracting going on where pharmacy reimbursements are being cut significantly.

ESI will add fees onto each prescription to cover its cost for providing its package of PBM services.

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Express Scripts’ New Option Models Mark Cuban’s Cost Plus Drugs

This is the latest offering by Express Scripts that aims to bring transparency to prescription drug costs.

CLICK HERE to read the full article

…………catching up on FDA approvals

The FDA has approved a new therapy, Wezlana (ustekinumab-auub) from Amgen, Inc., as a biosimilar to Janssen Biotech’s Stelara. Wezlana is available in a subcutaneous form as well as an infusible. . Wezlana joins the ranks of only a handful of biosimilars to also earn the title if interchangeability with the reference product. 

Wezlana is indicated for—–

Adult patients with:

• moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy, 
• active psoriatic arthritis;
• moderately to severely active Crohn’s disease; and
• moderately to severely active ulcerative colitis.

Pediatric patients 6 years of age and older with:

• moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy; and 
• active psoriatic arthritis.

Prescribing information specifies subcutaneous dosing and administration for Psoriasis and Psoriatic Arthritis while specifying intravenous dosing instructions for Crohn’s Disease and Ulcerative Colitis.

CLICK HERE for prescribing information

While Wezlana did not receive a Black Box warning there are a number of warnings and precautions.

Amgen intends to launch Wezlana in early 2025 when Stelara’s patent exclusivity expires. As such, pricing and distribution plans were not announced.

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FDA Approves Interchangeable Biosimilar for Multiple Inflammatory Diseases

CLICK HERE to read the FDA press release

Here’s an interesting new twist on hospitals and health systems opening their own specialty pharmacies….. PA-based Geisinger Clinic and NY-based Bassett Healthcare are getting hitched to do exactly that.

Hospital systems tend to be monolithic. However, as the master might say “There may be great wisdom, grasshopper, to share great burdens.” Let’s put that into business terms….. economy, efficiency, utility, scope, and leverage come to mind.

It is expensive to start a large SP operation from scratch…. so sharing costs…. Economy

Sharing operations… everything from IT to toilet paper…… Efficiency

Squeeze the best ROI from investments in hardware, dispensing gear, etc…. Utility

Size still matters when it comes to geography….. patients….. Scope

Last, and certainly not least, purchasing power with manufacturers and suppliers….. Leverage

Our list is not exhaustive but gives some insight on why the marriage may be made in pharmacy heaven. It is interesting that this is a home grown initiative with no mention of a third party specialty pharmacy ‘growth accelerator’ behind the curtain.

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Bassett Healthcare Network Partnering with Geisinger on Plans to Open Specialty Pharmacy in 2024

CLICK HERE to read the full article

There was a big development for DMA patients last June with the FDA approval of Elevidys (delandistrogene moxeparvovec-rokl) from Sarepta Therapeutics. Elevidys was the first and only gene therapy approved for Duchenne Muscular Dystrophy (DMD). But there was were two hitches in the giddyap…it was approved only for patients with a confirmed mutation in the DMD gene, and, its $3.2 million cost makes  access a real obstacle. 

We missed covering the more recent approval of another therapy for DMD that is not a gene therapy….. but one that has broad application in the category. The FDA approved Agamree (vamorolone) from Santhera Pharmaceuticals, a novel corticosteroid with favorable side effects.  It is provided in an oral suspension form. 

It is estimated that between 11,000 and 13,000 patients in the U.S. are affected by DMD, with approximately 70% of patients currently receiving concomitant corticosteroid treatment. DMD, is the most common form of muscular dystrophy, is a rare and life-threatening neuromuscular disorder characterized by progressive muscle dysfunction, ultimately leading to loss of ambulation, respiratory failure, and death. 

Click Here for prescribing information

Catalyst holds the exclusive north American license to commercialize Agamree.

Pricing for Agamree is not nearly as costly as the big ticket gene therapy at under $10,000 per year for most patients based on weight. There has been no update on limited distribution.

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Catalyst Pharmaceuticals Reports FDA Approval of AGAMREE® (vamorolone) for Duchenne Muscular Dystrophy Granted to Santhera Pharmaceuticals

CLICK HERE to read the full Catalyst press release