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FDA Approves Biosimilar to Actemra – Avtozma

The FDA recently approved another biosimilar, Avtozma (tocilizumab-anoh) from Celltrion, as a third biosimilar to Actemra. As with the reference brand, Avtozma is indicated for the treatment of multiple diseases including rheumatoid arthritis (RA), giant cell arteritis (GCA), polyarticular juvenile idiopathic arthritis (pJIA), systemic juvenile idiopathic arthritis (sJIA) and coronavirus disease (COVID-19).

Avtozma is available in both intravenous (IV) and subcutaneous (SC) formulations. Approval for Avtozma specifies infused administration for RA. The other approved indications are eligible for SC administration.

Avtozma was also approved with a Black Box Warning similar to the reference product.

Dosing of Avtozma is weight based and varies widely by disease indication and dosing schedule. Dosing strength varies widely, from as little as 12mg (juvenile) to 162mg (recommended adult dosing).

Genentech announced that the average monthly cost of Actemra administered via IV runs between $2,308 to $4,616, depending on dose a person receives. The average monthly cost of Actemra administered subcutaneously ranges from about $2,478 to $4,956 based indication and frequency.

CLICK HERE to access prescribing information

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U.S. FDA approves Celltrion’s AVTOZMA® (tocilizumab-anoh), a biosimilar to ACTEMRA

CLICK HERE to access the article

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FDA Approves a 35 Year Old Drug for New Indication – Spravato

The FDA recently approved a very old drug, Spravato (esketamine) from Janssen Pharmaceuticals, for a very new indication. Esketamine was originally approved by the FDA in 1970, a mere 35 years ago!

Spravato is indicated for the treatment of:

• Treatment-resistant depression (TRD) in adults, as monotherapy or in conjunction with an oral antidepressant.

• Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior in conjunction with an oral antidepressant.

Spravato (56mg or 84mg) is administered intranasally and only under the supervision of a healthcare provider. It was approved with a Black Box Warning and an associated REMS program. Dosing is twice weekly in weeks 1-4, once weekly in weeks 5-8, and once every two weeks in weeks 9 and after.  

The cost of Spravato ranges between $700 and $1200 per dose. 

Year 1 cost will range between $23,800 (56mg) and $40,800 (84mg).

Janssen also announced specialty pharmacy distribution options as follows;

“The specialty pharmacy pathway is the process of acquiring Spravato through a REMS-certified specialty pharmacy. This pathway allows treatment centers to treat patients who are covered under the pharmacy benefit. The pharmacy pathway does not require your treatment center to purchase Spravato but does require shipment coordination before each treatment session. Using the specialty pharmacy pathway, your treatment center receives patient-assigned product from a REMS-certified pharmacy and bills only for associated healthcare services.”

The following SPs are REMS certified and were included because of their geographic coverage, health plan coverage, and fulfillment capabilities.

  • AllianceRX — (Walgreens/Prime)
  • CVS Specialty — (CVS Caremark)
  • Humana Specialty — (Humana)
  • AcariaHealth —  (Centene)

CLICK HERE to access the J&J brochure detailing specialty pharmacy access

CLICK HERE for prescribing information

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Recent Limited Distribution Updates

Announcements for newly approved specialty drugs often state that the product will be available through specialty pharmacy in limited distribution. However, the early press releases rarely specify the specialty pharmacy(ies) selected as the designated partner(s).

Here are ten LD deals that have been publicly confirmed subsequent to their approvals.

Onco360 to Distribute Vyloy 

Onco360 has been selected as a national pharmacy partner by Astellas for Vyloy (zolbetuximab-clzb), approved in combination with fluoropyrimidine- and platinum-containing chemotherapy for the first-line treatment of adult patients with locally advanced unresectable or metastatic human epidermal growth factor receptor 2 (HER2)-negative gastric or gastroesophageal junction adenocarcinoma whose tumors are claudin (CLDN) positive, as determined by an FDA-approved test.

Onco360 to Distribute Gomekli

Onco360 has been selected as a national pharmacy partner by SpringWorks Therapeutics, Inc. for Gomekli (mirdametinib) for the treatment of adult and pediatric patients 2 years of age and older with neurofibromatosis type 1 (NF1) who have symptomatic plexiform neurofibromas (PN) not amenable to complete resection.1

Orsini to Distribute Attruby

Orsini has been selected by BridgeBio to distribute Attruby (acoramidis), an orally administered treatment for cardiomyopathy of wild-type or variant transthyretin-mediated amyloidosis (ATTR-CM). ATTRUBY is a near-complete (≥90%) stabilizer of transthyretin for the treatment of adults with ATTR-CM, to reduce cardiovascular death and cardiovascular-related hospitalization. 

Orsini to Distribute Kebilidi

Orsini announced that it has been chosen by PTC Therapeutics as the exclusive specialty pharmacy provider for the adeno-associated virus vector-based gene therapy Kebilidi (eladocagene exuparvovec-tneq). Kebilidi is approved for the treatment of adult and pediatric patients with aromatic L-amino acid decarboxylase (AADC) deficiency.

Orsini to Distribute Yorvipath

Orsini is partnering with Ascendis Pharma for the distribution of Yorvipath, a FDA approved parathyroid hormone analog (PTH1-34) indicated for the treatment of hypoparathyroidism in adults

PantherRx Rare to Distribute Attruby

PantherRx Rare has been selected by BridgeBio to distribute Attruby (acoramidis), an orally administered treatment for cardiomyopathy of wild-type or variant transthyretin-mediated amyloidosis (ATTR-CM). ATTRUBY is a near-complete (≥90%) stabilizer of transthyretin for the treatment of adults with ATTR-CM, to reduce cardiovascular death and cardiovascular-related hospitalization. 

Panther Rx Rare to Distribute Yorvipath

PantherRx Rare is partnering with Ascendis Pharma for the distribution of Yorvipath, a FDA approved parathyroid hormone analog (PTH1-34) indicated for the treatment of hypoparathyroidism in adults

Panther Rx Rare to Distribute Tryngolza

PantherRx Rare was selected by Ionis Pharmaceuticals, Inc. for the distribution of Tryngolza (olezarsen), the first and only treatment approved by the FDA as an adjunct to diet to reduce triglycerides in adults with familial chylomicronemia syndrome (FCS).

Panther Rx Rare to Distribute Crenessity

PantherRx Rare was selected by Neurocrine Biosciences, Inc. for the distribution of Crenessity (crinecerfont), an oral selective corticotropin-releasing factor type 1 (CRF1) receptor antagonist indicated to improve androgen control and enable a reduced glucocorticoid dose in patients 4 years of age and older with classic congenital adrenal hyperplasia (CAH).

AnovoRx Specialty Pharmacy to Distribute Increlex

AnovoRx has been named the exclusive distributor of Increlex (mecasermin injection) from Eton Pharmaceuticals (following the acquisition of Increlex from Ipsen S.A. Increlex is a biologic product used to treat pediatric patients 2 years of age and older who suffer from the severe primary insulin-like growth factor 1 deficiency (SPIGFD) a rare condition.

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Time to Talk Cell Based Therapy Regulation

How well do you understand cell based therapy?

It’s complicated!

Given the pace of research and the number of already approved cell-based products it is now high on the list of essential knowledge for leaders in the pharma industry and for specialty pharmacies that want to play in that sandbox.

MSC-based cell therapy involves the administration of MSCs as a medicinal product. These cells are characterized by ways in which they can be used as a therapeutic agent in human treatments.

But, the mechanisms of MSC therapy are poorly understood. According to the NIH, MSC have a short survival time after infusion, it is believed that MSC pass on their effects to other cell types. The scientific stuff now goes on in language that is likely foreign for those without a doctorate degree. SO, this Report will increase your knowledge level, but only enough to make you dangerous.  

Here are some bullet points that you may want to consider —–

The Importance of Regulation in Ensuring Safety and Impact on Treatment Cost for Mesenchymal Stem Cell Therapies

CLICK here to access the full article

Regulation is essential to ensure the safety and efficacy of mesenchymal stem cell (MSC) treatments. It upholds high standards in production, application, and monitoring of these therapies. Without it, the risk of suboptimal quality and potential serious adverse effects increases.

Key Aspects of MSC Regulation:

Establishing guidelines for MSC isolation, expansion, and characterization.

Ensuring consistency, viability, and contamination-free cells in therapies.

Developing clinical trial protocols to assess safety and effectiveness in various medical conditions.

Role of Regulatory Agencies:

Agencies like the FDA mandate rigorous testing for new treatments.

Approval is required before widespread use of MSC-based therapies.

Regulatory Challenges and Impact on Treatment Costs:

While regulation is crucial for MSC treatment safety, it also contributes to increased costs. The rigorous testing and validation, adherence to Good Manufacturing Practices (GMP), and the need for sterile, high-quality production facilities add significant expenses.

Factors Contributing to Increased Costs:

Time-consuming and expensive clinical trials with extensive participant involvement.

Maintenance of GMP compliant facilities for MSC production.

Impact on Treatment Availability:

Lengthy regulatory approval processes can delay treatment availability to patients.

Balancing Safety and Cost in MSC Therapies:

Despite the challenges, the regulatory framework is essential for maintaining the integrity of MSC therapies. The increased costs are an investment in the treatment’s long-term success, building trust among patients, healthcare providers, and stakeholders in regenerative medicine.

Benefits of a Strong Regulatory Framework:

Ensures patient safety and high-quality care.

Contributes to the long-term success and trustworthiness of MSC treatments.

Our next Report will be on yet another Cell Based therapy!

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Time to Plan for the Cell & Gene Tsunami?

Quiz me this…..!

What new technology emerged in the 1970s that truly changed the world?…. Certainly, you immediately thought of ‘the computer’ in your top 5 answers.

So, what new technology is now emerging in the 2020s that will truly change the world of specialty pharmacy?….. tick… tick… tick… time’s up! The answer that many of you may have thought of is…. Cell and Gene Therapy.

Yep, C&G is gonna’ have a huge impact on pharmacy across the board. If you play it out to the extreme, there will be, one day, a cell or gene therapy (or some other magical potion or gizmo) that will cure every ache and ill out there. Bye bye pharmacy!

OK, that may be a pipe dream… but it might be best to start planning for the tidal wave as opposed to a mere changing tide.

The article below is on point with the changing tide in pharmacy. It is worth a read… both intellectually and practically from a business perspective.

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8 Trends to Watch in the Cell and Gene Therapy Market

Click Here to access the article

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FDA Approves Oral Tx for Rare CAH – Crenessity

…………. catching up on recent FDA approvals

The FDA recently approved a new therapy, Crenessity (crinecerfont) from Neurocrine Biosciences, Inc., to be used together with glucocorticoids (steroids) to control androgen levels in adults and pediatric patients 4 years of age and older with classic congenital adrenal hyperplasia (CAH).

Classic congenital adrenal hyperplasia is a rare genetic condition affecting the adrenal glands, which produce hormones such as cortisol and androgens. Patients with classic CAH do not produce enough cortisol and produce too many androgens. These patients require high doses of glucocorticoids because the glucocorticoids also help to reduce the excess levels of androgens. Crenessity works by reducing excessive adrenal androgen production, which helps reduce the amount of glucocorticoid treatment needed.

Crenessity was granted an Orphan Drug designation. The estimated prevalence of CAH is 1/10,000. Annual incidence ranges from 1/5,000 to 1/15,000.

Dosing for adults on therapy are 2 capsules daily. Crenessity is also available as an oral solution for children who are dosed based on weight.

Neurocrine has set the US list price for Crenessity at approximately $38,333 for a 30-day supply for adults ($460,000 annually). For pediatric patients weighing less than 20 kilograms, the 30-day supply is priced at about $19,167 ($230,000annually).

Crenessity is available through limited distribution. PantherRx Rare Specialty Pharmacy has confirmed that they were selected as a limited distribution partner.

CLICK HERE to access prescribing information

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FDA Approves New Treatment for Congenital Adrenal Hyperplasia  

CLICK HERE to read the FDA press release

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FDA Approves Tx for Pancreatic and NSCLC Cancers – Bizengri

…………………. catching up on recent FDA approvals

The FDA recently approved a new infused therapy, Bizengri (zenocutuzumab-zbco) from Merus N.V., indicated for adults with pancreatic adenocarcinoma or non–small cell lung cancer (NSCLC) that are advanced unresectable or metastatic and harbor a neuregulin 1 (NRG1) gene fusion who have disease progression on or after prior systemic therapy.

Bizengri is a bispecific antibody that binds to the extracellular domains of HER2 and HER3 expressed on the surface of cells, including tumor cells, inhibiting HER2:HER3 dimerization and preventing NRG1 binding to HER3. The therapy is the first and only treatment approved for these indications. Approval for these indications may be contingent upon verification of clinical benefit in a confirmatory trial(s).

Bizengri was approved with a Black Box warning for Embryo-Fetal Toxicity.  

The company did not announce the price for Bizengri.

Similarly, the company did not announce plans for distribution.

CLICK HERE to access prescribing information

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Merus Announces FDA Approval of Bizengri (zenocutuzumab-zbco) for NRG1+ Pancreatic Adenocarcinoma and NRG1+ Non–Small Cell Lung Cancer (NSCLC) 

Click Here to read the full company press release

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FDA Approves Yet Another Stelara Biosimilar – Yesintek

The FDA recently approved a biosimilar, Yesintek (Ustekinumab-kfce) from Biocon Biologics Ltd, as a biosimilar to the reference product, Stelara (Ustekinumab).  

This approval is the newest biosimilar approval for a Stelara competitor. 

The currently approved biosimilars include — Selarsdi (ustekinumab-aekn), Pyzchiva (ustekinumab-ttwe), Otulfi (ustekinumab-aauz), Imuldosa (ustekinumab-srlf), Wezlana (ustekinumab-auub), and Yesintek (ustekinumab-kfce).

Yesintek 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

The company plans its product launch in the United States later in February following a settlement with J&J. Distribution details were not announced.  

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FDA Approves Biocon Biologics Ustekinumab Biosimilar, Yesintek

Click Here to read the full article

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FDA Approves Oral Tx for R/R Acute Lukemia – Revuforj

……….. catching upon FDA approvals

The FDA recently approved a new ORAL specialty therapy, Revuforj (revumenib) from Syndax Pharmaceuticals, for the treatment of relapsed or refractory (R/R) acute leukemia with a lysine methyltransferase 2A gene (KMT2A) translocation in adult and pediatric patients one year and older.  

Revuforj is the first and only menin inhibitor approved for the condition.  

The therapy was granted Orphan Drug status.

The company priced Revuforj at $39,500 per month, or $474,000 annually.

Revuforj was approved with a Black Box warning for differentiation syndrome, a potentially fatal condition in which leukemia cells rapidly release cytokines. 

CLICK HERE to access prescribing information 

Syndax announced that Revuforj launched through a network of specialty distributors and specialty pharmacies and full availability all doses by Q2-2025. An oral solution will be available through an expanded access program to allow for dosing of patients who weigh less than 40 kg.

As of this date only Onco360 has confirmed its selection to be an authorized dispensing pharmacy for Revuforj.

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Syndax Announces FDA Approval of Revuforj (revumenib), the First and Only Menin Inhibitor to Treat Adult and Pediatric Patients with Relapsed or Refractory Acute Leukemia with a KMT2A Translocation

Click here to access the full company press release

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FDA Approves T-Cell Tx for ALL – Aucatzyl

………… catching up on FDA approvals

The FDA recently approved a new infused therapy, Aucatzyl (obecabtagene autoleucel) from Autolus Inc., indicated for the treatment of adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). Aucatzyl is a CD19-directed genetically modified autologous T cell immunotherapy.

Acute lymphoblastic leukemia is a cancer in which B-cell lymphoblasts are found in the bone marrow and blood. ALL accounts for less than 1% of all cancers in the United States. The American Cancer Society estimates that in 2024 there will be about 6,550 new cases of ALL and about 1,330 deaths. Survival rates remain very poor in adult patients with r/r ALL, with median overall survival of eight months.

Aucatzyl was approved with a Black Box warning, however, the FDA did not impose a REMS program which is uncommon.

The company confirmed that the annual wholesale acquisition cost for Aucatzyl is $525,000. It is priced in the same general price bracket as two competing products, Kymriah and Tecartus.  

The company did not announce details on its plans for distribution.

CLICK HERE to access prescribing information

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FDA approves obecabtagene autoleucel for adults with relapsed or refractory B-cell precursor acute lymphoblastic leukemia  Aucatzyl

CLICK HERE to read the full FDA press release

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