The article below speaks to a variety of inefficiencies in Specialty Pharmacy Information Technology.

What an opportunity to create a new acronym…. SPIT.

The article makes the case that SPIT has followed the market rather than leading as IT has done in many other industries. In short, it has been slow on the uptake. 

The article makes the case that dispensing software is at the heart of the problem.  That’s true to a degree as many pharmacies are averse to replacing their dispensing platforms due to ‘transition angina’ and cost. 

But the article misses pointing out that real SPIT has blossomed and is now available from a number of developers. These very sophisticated platforms enable SPs to provide highly tailored patient journey management that is fully integrated with dispensing functionality. Customizable modules are available by disease state and even by the drug being dispensed. Of key importance, these platforms can also generate the kind of highly detailed reporting that makes pharma partners salivate. Now that’s impressive SPIT.

But is SPIT growing? 

The number of potential SP customers that can afford state-of-the-art SPIT platforms are microscopic compared to the number of retail pharmacies that get by using only traditional dispensing platforms. For an industry to grow more customers are needed and a couple of developments are making this possible. First, hospitals / health systems have more than doubled the potential customer base seeking SPIT in the last few years. They also have the funding to afford the best SPIT. Secondly, creative  vendors have developed software-as-a-service options that offer even retail pharmacies access to affordable online SPIT programs.

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Information Technology Inefficiencies Within Specialty Pharmacy

Although specialty pharmacy has mirrored health care IT’s explosive growth and market innovation over the past several decades, the industry has not advanced significantly in dispensing software.

Information technology (IT) has revolutionized the health care industry, allowing pharmacy services to expand dramatically over the past 30 years. Virtual dispensing platforms have improved efficiency and patient outcomes; automated prescription dispensing robots cut the time to fill scripts and improve accuracy of fills; pharmacy applications connect patients with their health care in ways that improve treatment engagement and adherence—the list can go on and on.

The specialty pharmacy market has experienced a similar transformation over the past few decades, beginning from a single pharmacy supporting dispensing………….

CLICK HERE to read the full article

Just about every specialty pharmacy has already obtained specialty pharmacy accreditation if they want to be a serious player in the SP market. The most serious SPs have not one, but two, or even three SP accreditations….. and even niche distinctions such as in rare diseases.

Accreditation is not easy but it is cathartic in practice. Well defined standards provide targeted guidelines for these companies to achieve, maintain, and nourish on a daily basis. 

Many SOs find it difficult to stay the course. But, even for those that may stray from the righteous path, the day of reconning will arrive when their accreditation expires, a new application is required, and the process needs to be repeated.

The several leading accrediting companies are aware of the challenges for all SPs and are working to make improvements and efficiencies on their end. The article below is a good read that details many changes that SPs can expect when they ramp up…. or resurrect…. their accreditation process.

CLICK HERE to access the full article

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Many Changes in Pharmacy Accreditation on the Horizon

New specialty pharmacy and infusion standards and a benefits-laden path for becoming certified as a center of excellence are just two noteworthy developments in accreditation and credentialling for specialty and health-system pharmacies, experts noted during two recent conferences.

URAC

On Oct. 3, URAC released Specialty Pharmacy Accreditation 5.0, the latest version of its accreditation standards for specialty pharmacy operations. In February 2023, the Accreditation Commission for Health Care (ACHC) will release the annual updates of its portfolio of standards, including specialty pharmacy and infusion pharmacy. These updates follow ASHP’s new credentialing program, the ASHP Certified Center of Excellence in Medication Use Safety and Pharmacy Practice, which it released in the fall of 2021.

Heather Bonome, PharmD, URAC’s director of pharmacy, described the process of developing version 5.0 in a session at the National Association of Specialty Pharmacy (NASP) 2022 Annual Meeting & Expo. “Our last major revision to this standard was in October of 2019, and we didn’t just update it for the sake of updating,” she said. “We have standards that work that specialty pharmacies are used to, and we didn’t change those. Instead, we combed through feedback from our applicants over a three-year period about what worked and what didn’t. We also consulted all accredited organizations, various industry associations, consultants and leaders in SP. Standard by standard, we asked questions, got feedback and revised again. It was a very iterative process.”

One change that should please most applicants is this: “There has been a lot of streamlining,” Dr. Bonome said. “When you submit the application, there are about 50% fewer uploads and linking that you will need to do.”

The sections of specialty pharmacy accreditation 5.0 now include:

• Foundational focus areas
• Pharmacy operations
• Medication distribution
• Patient services and communications
• Patient management

Dr. Bonome noted that a separate focus area has been created on medication distribution management, which is no longer a part of pharmacy operations. “We heard a lot about medication distribution in our feedback, and that it was a burden to always do ongoing testing the way it had been done in the past,” she said.

Dr. Bonome gave an example for medication distribution: To achieve full accreditation, a specialty pharmacy must demonstrate the ability to maintain distribution, even in the face of weather such as hurricanes.

In addition, rare disease management has been changed from a designation to a center of excellence certification, and mail service pharmacy accreditation also has received a new-version update. Its content mirrors that of specialty pharmacy, with the sole exception of patient management, which does not appear in mail service pharmacy accreditation.

If your specialty pharmacy has already begun getting accredited under version 4.0 of the standards, you don’t need to reconfigure your application for 5.0, Dr. Bonome stressed. “When you sign up for accreditation, you sign up under a specific version, and you can continue with the process under that version even though the new standards have come out,” she explained. “Then, when you apply for reaccreditation in three years, you will do it under the new version.”

A Deeper Dive Into URAC’s Upgrading Process

During the year that URAC spent revising its specialty pharmacy accreditation standards to the newly released version 5.0, “we really heard a lot from you that the accreditation process took too long,” Heather Bonome, PharmD, the director of pharmacy for the accrediting organization, told a group of webinar attendees in October.

“So we took a step back and asked ourselves, ‘How can we keep the vigor but shorten the review process?’“ The first move “was really to streamline the standards,” she said.

Streamlining meant reassessing every aspect of the accreditation process, she noted, from client application uploads to URAC’s months-long desktop reviews, to ensure the revised product continued to reflect specialty pharmacy’s exacting safety and quality measures.

The result of the examination was a six-month reduction in specialty pharmacy’s accreditation time line, according to Jennifer Richards, PharmD, JD, URAC’s product development principal. “We did this in several ways,” she said. For one, the number of supporting documents required in the application process “was reduced by up to 50%.” Part of the reduction came from eliminating standards that duplicated ones set forth by state boards of pharmacy, she added.

“This is what the time line looks like for the revised program,” said Dr. Bonome, pointing to a graphic in the slide presentation. “There is now a two-month period for submitting applications and four months for URAC to conduct the desktop review, validate the review and render its decision.”

Reducing the time it takes to complete the approval process isn’t new. “For the last year-plus, every new or revised program we’ve released has followed this same process,” Dr. Bonome said.

“With every revision,” she added, “we learned how to make the process better for pharmacies seeking accreditation and reaccreditation. It’s been an opportunity to make sure that the best practices of the industry are reflected in the standards so patients are getting the best high-quality care—because at the end of the day, that’s really what it’s all about.”

When to Move Up to 5.0 Among Key Questions

A question-and-answer portion of the webinar served as a forum for revealing more details about URAC’s accreditation updates. Drs. Bonome and Richards fielded the questions from attendees, of whom about 80% represented specialty pharmacies. Here is a sampling of their responses.

Q. When does an organization have to move up to the 5.0 version of the specialty pharmacy accreditation standards?

A. You need to remain compliant with your current standards until it is time to seek reaccreditation. The clock starts ticking on the new version on the day you submit your reaccreditation application.

Q. What if we were recently accredited under 4.0 and a standard in that version is no longer included in 5.0? Do we still need to comply with it?

A. Yes, because that was the version you committed to for the full three years of the accreditation cycle. There are a lot of really good, solid standards that remain the same, so we’ll look for continued compliance with them. When it comes time for reaccreditation, the program that is currently available—assuming it’s still 5.0—is what you’ll need to focus on.

Q. Do we have an option to apply for version 5.0, if we signed a contract for 4.0 within the last month or so?

A. Yes. If you recently signed a contract for 4.0 but haven’t started working on your application and desktop review process and you want to update to 5.0, you can reach out to your client relations manager and work through that with them.

Q. What crosswalks are available, and is there a 3.1 to 5.0 version?

A. Three crosswalks are currently available through AccreditNet (URAC’s client access portal). The first is the 4.0 to 5.0 crosswalk. The second one, 5.0 to 4.0, reverses the data exchange and allows people to use whichever one works for them, depending on their organization’s own internal operations. We also have a 3.1 to 4.0 crosswalk. Currently there is no 3.1 to 5.0 crosswalk, but we might consider one if there is a significant number of requests.

ACHC Updates Annually

ACHC’s 2023 updates are part of the group’s practice of releasing updates to its standards annually, said Ralph McBride, RPh, the interim program director for all ACHC pharmacy programs, during the NASP session. “[Pharmacy is] a dynamic industry that is changing rapidly, and we listen to feedback from providers as we revise our standards. We believe in a rigorous process, but in incremental steps.”

Beyond specialty pharmacy accreditation, ACHC offers other accreditations to set a pharmacy apart, including ambulatory infusion, infusion pharmacy, mail order pharmacy, and compounding pharmacy (both sterile and non-sterile). “We also have designations in HIV, oncology, and rare and orphan diseases that can add distinction to your accreditation, as well as nutritional support and hazardous drug handling,” Mr. McBride said.

ASHP Tailor-Made to Health Systems

ASHP’s new Certified Center of Excellence in Medication Use Safety and Pharmacy Practice designation differentiates high-performing hospital and health-system pharmacy departments, said Lynnae Mahaney, the senior director of pharmacy accreditation, in a separate interview. “No one had previously offered an accreditation or certification specifically designed for health-system pharmacy, be it for one hospital or multiple hospitals,” she noted. “Pharmacists in the health-system world have been talking about this for quite some time, and we are now able to offer a standard that recognizes innovative, high-quality, safe and effective hospital pharmacy services.”

The new ASHP accreditation program “enhances the credibility and the value of your pharmacy services in the eyes of healthcare leaders, administrators, payors, and ultimately policymakers and patients,” Ms. Mahaney added.

The standard is very rigorous, she said. “We are expecting best-practice excellence and preparation time can be significant, depending on the organization. A unique aspect of this process is that the evidence of quality must include data: How are you measuring yourself, and how are you verifying that you are practicing at an excellent level and continuing to improve?”

In addition, ASHP is launching an individual certification for pharmacy leaders, the Certified Pharmacy Executive Leader, which recognizes core competencies in professionalism, leading people, leading the pharmacy enterprise, and leading within and across complex healthcare systems. This designation is currently in its pilot phase with an initial cohort. Certification will be valid for seven years.

A Long Process but Worth It

Estimating that it takes between four to six months to apply for and hopefully obtain specialty pharmacy accreditation from URAC, “there are fruits of that labor,” said Maribeth Bettarelli, PharmD, the executive director for Quality & Accreditation at CVS Caremark. “Achieving accreditation truly demonstrates an organization’s commitment, leadership and initiative,” Dr. Bettarelli said during a session focused on accreditation at the Academy of Managed Care Pharmacy (AMCP) Nexus 2022 meeting, in National Harbor, Md.

Dr. Bettarelli, who has participated in many accreditation processes for URAC and other organizations, said she is grateful to be part of a team at CVS Caremark that’s solely focused on reaching accreditation goals. She recommended that organizations that are just beginning the accreditation process partner with accrediting bodies early to conduct a gap analysis, so that they are in good shape when the accreditation review occurs.

Even if a specialty pharmacy has complete access to limited distribution drugs, Dr. Bettarelli noted several benefits of accreditation, such as improved staff engagement and the development of more individualized patient care plans. “Accreditation can really elevate the effectiveness of an organization in multiple ways,” she said.

Clinical Trials….. are you ready to give even a five minute standup presentation to a group of new employees to orient them to this integral, yet not frequently considered and even less frequently discussed, step in the drug approval process?

Every specialty pharmacy should offer ongoing education on the SP model and the broader healthcare industry….. especially if employees are in a customer service role. Clinicians should have an even greater depth of orientation especially if they interact with physicians, health care organizations and manufacturers.

The attached article offers a very good overview on the topic of CLINICAL TRIALS and can be used, as is, as an employee in-service presentation. Even industry veterans might benefit from reading the article as a refresher.

So….. can you speak to each of the following points?

• What is a clinical trial (in 100 words or less)?
• What are common trial procedures?
• What are Behavioral interventions?
• What are the three phases of Medical interventions?
• What are Observational Studies?
• Who is eligible for a clinical trial?
• Are clinical trials free?
• What’s a placebo?
• Are clinical trials ethical?
• and More……

Less than 15 minutes invested in this article might be a beneficial investment of your time.

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What Are the Different Types of Clinical Trials & Other FAQs

By Simon Spichak, MSc | January 4th, 2023

Clinical trials investigate new treatments, lifestyle interventions, or risk factors for developing treatments for a disease. By becoming a participant, volunteers move forward new insights and treatments for all diseases. 

These trials and studies come in different shapes and sizes. Understanding the type of research you’re participating in will help you understand its purpose and whether it is right for you.  

Clinical trials and studies are run from research centers or universities. Each study is headed by a principal investigator who is usually a physician and researcher, along with many doctors, nurses, and other healthcare staff.

They may also be sponsored by pharmaceutical companies testing out new drugs. Descriptors for the trial provide information about how far along a drug is in its development, or whether the trial involves a placebo — a sham version of the treatment to help scientists test its effects — is involved. (We’ll take a closer look at that below.) 

In general, there are two main clinical studies and trials, with many different design variations and goals. The goals, protocols, and other information about a clinical trial or study is posted before the start of the trial on clinicaltrials.gov. 

Here’s a quick run-down.

What is a clinical trial?

In a clinical trial, the general public signs up to help scientists learn critical information about illnesses and the interventions that treat them. These interventions might be medical, surgical, or behavioral. In the Alzheimer’s research space, there is much discussion of a number of ongoing clinical trials testing whether experimental, new drugs can help slow down or stop Alzheimer’s disease progression. There are also clinical studies that look at Alzheimer’s effects on the brain, and the factors that may cause it, make it more likely, or help prevent it. 

The goal of such studies is to gather vast amounts of data that then helps researchers understand whether, for example, a particular dementia treatment is safe and effective for people living with dementia — and whether it is better than other available treatments. 

Some of the interventions that are tested in trials include:

Drugs. Currently, there are several clinical drug trials testing whether anti-amyloid drugs like lecanemab are “disease modifying.” In other words, these trials are testing whether a drug can actually change the course of the disease, as opposed to only treating its symptoms.

Medical devices. Medical device trials test devices. The devices category includes new diagnostics like Alzheimer’s blood tests which are currently being developed to provide earlier Alzheimer’s diagnosis for patients and, ultimately, better treatment and care.

Procedures

In the dementia research space, trials that test medical procedures might explore new ways of measuring cognitive function in people with Alzheimer’s and other forms of dementia. Tests that provide more accurate information about cognitive function could lead to improvements in diagnosis and treatment.

Behavioral interventions

There are also clinical trials that test certain “behavioral interventions,” like lifestyle changes, and their effects on health or illnesses. For example, a clinical behavioral intervention trial from Finland used a combination of interventions including dietary changes and exercise to examine whether these behaviors reduced participants’ risk of developing dementia. These clinical trials can last for several years.

Medical interventions

There are different phases of clinical trials. Each phase gathers information about safety and efficacy, which is then reviewed by regulating agencies. In the U.S., the agency is the Food and Drug Administration (FDA), which decides whether to approve new drugs and diagnostic tools so that they can become available to the general public. These are the different phases: 

• Phase 1. This phase is the earliest trial for any medical intervention. It is conducted in a small group of healthy participants to assess safety and, in the case of drug testing, appropriate dosage. 
• Phase 2. This is the middle phase of investigation and often the first phase where participants have a specific disease or condition. A Phase 2 trial provides information about preliminary effectiveness and dosages in a larger group of participants. 
• Phase 3. Phase 3 trials, sometimes combined with Phase 2 trials, test whether a drug works in a larger cohort of participants with a disease. Often, this pits a new intervention against the gold standard treatment for the condition or a placebo.*   

Observational studies

Observational studies are exactly what they sound like: They are very “hands-off.” The researchers do not introduce any new interventions or treatments to the participants. Instead, the researchers stand back, observe people over a long period of time, and gather data to answer questions like “Does drinking diet soda increase the risk of developing dementia?” or “Does Viagra cut dementia risk?” 

This can help explain the effects of certain interventions in the real world, sometimes providing evidence that drugs used for one indication may also reduce the risk or slow the progression of cognitive decline. If any promising drugs are found through this method, they are tested again in a more rigorous clinical trial.

Who is eligible for a clinical trial?

Each study or trial has a plan that outlines exactly what kind of participants a study is recruiting for. 

A list of necessary requirements for participating in such a trial is called the eligibility criteria. 

For example, in the case of an Alzheimer’s or dementia trial, eligibility criteria may include:

• Genetic risk factors like APOE4
• The stage of your disease and severity of the symptoms
• Presence of Alzheimer’s-associated biomarkers in your blood or brain
• Age
• Gender

There are also exclusion criteria for many clinical trials. For example, if you are taking other medications, such as blood thinners, or you have a co-occurring illness or condition, you may be excluded from participating in a clinical trial.

Are clinical trials free?

Typically, participants are reimbursed for any costs that might be incurred by participating in a clinical trial, such as the cost of procedures during the screening process, or travel to trial sites. Some clinical trials also pay compensation to the participants throughout the trial. 

However, this is not always the case. From a patient’s perspective, these trials often don’t cost them anything. Trial sponsors are typically reimbursed for procedures that are offered during the trial by Medicare if these procedures are eligible. The sponsor might still pay for the procedures so participants don’t incur additional costs.

The first stage of any trial involves a screening process which can sometimes last weeks or months, which helps trial administrators determine whether a potential participant may be eligible. Sometimes, a diagnosis is required to enter the screening process, according to Terrence Casey, director of communications and outreach at the Penn Memory Center. “It depends on the trial and the inclusion and exclusion criteria as determined by the study sponsor,” Casey told Being Patient.

Drug trials are often seeking people in a certain stage of a certain disease — for example, early-stage Alzheimer’s disease. However, Alzheimer’s and other forms of dementia are notoriously difficult to accurately diagnose. So, part of that eligibility determination depends on the confirmation of a patient’s diagnosis. This trial eligibility screening process usually doesn’t cost the patient anything. 

The bottom line: The situation may differ, from trial to trial, and sometimes, depending on diagnosis status, from patient to patient. While many trials do reimburse participants for the trial expenses, this is not always the case. Ask your trial administrator at the start of the eligibility screening process whether there will be out-of-pocket expenses for you in order to participate.

What’s a placebo?

To better understand whether drugs are effective without any bias, often, participants would be randomized to different treatment groups at the start of the trial. One group will receive a treatment while another group would receive a dummy that looks just like the treatment, which is called a “placebo” or “sham” treatment.

A placebo is a sugar-pill or other substitute given in lieu of a drug. In an Alzheimer’s drug trial, for example, all the participants in the study of a monoclonal antibody receive an infusion. But only one group of participants will receive an infusion with the drug being tested. A sham treatment is a simulation of a procedure, such as magnetic stimulation, that makes it hard for a participant to tell whether they receive the actual treatment. 

As a best practice, many Phase 2 and Phase 3 clinical trials will withhold this information from participants and clinicians until the very end. 

If you sign up for a single-blinded trial, you will not learn until the end whether you receive the treatment being tested, or the placebo. In a double-blinded trial, neither the clinicians nor the participants will know whether they receive the treatment or the placebo. 

These practices make the results of a clinical trial more robust by controlling for the placebo effect: Clinician and patient expectations that can influence the results of the study.

Are clinical trials ethical?

The United States has a dark history when it comes to medical experimentation. Events like the Syphilis Study at Tuskegee or the mistreatment of Henrietta Lacks and the cloning of her cancer cells were unethical and exploitative of people of color. 

Today, there are safeguards in place that protect participants in clinical trials more than ever before. Months or years before anyone is ever recruited, researchers who want to conduct a study must fill out forms and explanations of the study which are then reviewed by an institutional review board. 

These boards consist of doctors, researchers, and people outside the medical community. Their goal is to make sure the trial is well designed so that it does not cause any unnecessary harm to participants.

The second line of protection is called informed consent. This helps participants and their families weigh the risks and benefits of participating in the study. Throughout this process, the researchers also assess how well a participant understands the study. 

Once everything is clear, the participant can choose to sign a consent form and join the trial. Participants can withdraw their consent at any time, even if the trial has not yet ended.

Should I participate in a clinical trial?

There are some risks to participating in any clinical trial or study. If the trial is randomized and blinded, you might not even receive the treatment. You could also experience some side effects. There is the risk that the treatment may not work. 

However, everyone who participates furthers our understanding of Alzheimer’s disease and dementia. Even studies where a drug or intervention is ineffective provide valuable information for researchers. You could also receive a treatment for a disease before it is available anywhere else. You will receive more frequent checkups. Importantly, you can also feel empowered by taking an active role in your health.

Ultimately, deciding whether to participate in a study is a decision for each individual patient.

How Do Alzheimer’s Clinical Trials Work? & Other FAQs

The FDA recently approved a new ORAL therapy, Jaypirca (pirtobrutinib) from Eli Lilly and Company, indicated for mantle cell lymphoma (MCL) after at least two prior lines of therapy, including a BTK inhibitor.

Jaypirca is the  fourth BTK inhibitor for blood cancer treatment —but with a big difference from the three other approved BTK inhibitors — AbbVie and Johnson & Johnson’s Imbruvica, AstraZeneca’s Calquence, and BeiGene’s Brukinsa.

The three earlier products can’t be used sequentially. Jaypirca binds to BTK differently and therefore can be used after progression on another BTK inhibitor. This key difference gives Jaypirca a unique edge allowing treatment of  patients who have failed on another BTK inhibitor.

Lilly released pricing and the  U.S. wholesale acquisition cost of Jaypirca will be $21,000 per 30 days of therapy for the 200 mg daily dose. Jaypirca will be available in the United States later this quarter.

Lilly did not release details on distribution. All of the three competing BTK products launched through limited distribution. As such, it is likely that Jaypirca will launch similarly.

CLICK HERE for prescribing information

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FDA grants accelerated approval to pirtobrutinib for relapsed or refractory mantle cell lymphoma

On January 27, 2023, the Food and Drug Administration (FDA) granted accelerated approval to pirtobrutinib (Jaypirca, Eli Lilly and Company) for relapsed or refractory mantle cell lymphoma (MCL) after at least two lines of systemic therapy, including a BTK inhibitor.

Efficacy was evaluated in BRUIN (NCT03740529), an open-label, multicenter, single-arm trial of pirtobrutinib monotherapy that included 120 patients with MCL previously treated with a BTK inhibitor. Patients had a median of 3 prior lines of therapy, with 93% having 2 or more prior lines. The most common prior BTK inhibitors received were ibrutinib (67%), acalabrutinib (30%), and zanubrutinib (8%); 83% had discontinued their last BTK inhibitor due to refractory or progressive disease. Pirtobrutinib was administered orally at 200 mg once daily and was continued until disease progression or unacceptable toxicity.

The main efficacy measures were overall response rate (ORR) and duration of response (DOR), as assessed by an independent review committee using Lugano criteria. The ORR was 50% (95% CI: 41, 59) with a complete response rate of 13%. The estimated median DOR was 8.3 months (95% CI: 5.7, NE), and the estimated DOR rate at 6 months was 65.3% (95% CI: 49.8, 77.1).

The most common adverse reactions (≥15%) in patients with MCL were fatigue, musculoskeletal pain, diarrhea, edema, dyspnea, pneumonia, and bruising. Grade 3 or 4 laboratory abnormalities in ≥10% of patients were decreased neutrophil counts, lymphocyte counts, and platelet counts. The prescribing information includes warnings and precautions for infections, hemorrhage, cytopenias, atrial fibrillation and flutter, and second primary malignancies.

The recommended pirtobrutinib dosage is 200 mg orally once daily until disease progression or unacceptable toxicity.

This review used the Assessment Aid, a voluntary submission from the applicant to facilitate the FDA’s assessment.

This application was granted priority review and fast track designation. FDA expedited programs are described in the Guidance for Industry: Expedited Programs for Serious Conditions-Drugs and Biologics. The application also was granted orphan drug designation.

The day has finally arrived.

The day when a biosimilar to Humira finally hits the market.

A total of 40 biosimilars have been approved since 2015, yet many were held up from marketing approval because of patent battles.  Amgen’s Amjevita was the fourth biosimilar ever approved but the first biosimilar to Humira in 2016.

Since then a total of eight….. yes 8….. Humira biosimilars have been approved. And why not? 

Humira has billions of $$$s of worldwide sales and even a one-eighth share would be a blockbuster for any of Humira’s offspring.

What is perhaps most curious is the way Amjevita is being launched. 

It will be available at two….. yes 2…..price points. 

You can buy Amjevita at a 5% discount to Humira….. or, you can buy adalimumab-atto at a 55% discount. To save you running the numbers, that translates into a price of $6,575 for Amjevita or $3100 for the non-branded product. No small difference!

Analysts are strongly suggesting that branded Amjevita will be the bigger seller. 

Why? 

In a word….. REBATES. Yes, PBMs are already pushing the more expensive, branded option so that scads of rebate dollars can be generated….. many of which may land in the coffers of the PBMs. What that means to patients (especially those with deductibles and coinsurance) appears to be irrelevant.

Acronyms….. they seem to be everywhere….. especially in healthcare. 

One acronym that has surfaced in the specialty pharmacy world is MIP. 

Scratching your head on what that one means? Well, it stands for Medically Integrated Specialty Pharmacy, one of the now hundreds of SPs that are owned and operated by Integrated HealthCare Systems (IHCSs) and hospitals. 

But wait…  there are more acronyms associated with MIPs….! How about DIRs? Yes, Direct and Indirect Remuneration (DIR) fees. Even MIPs are being hit by DIRs. 

But wait, there is now yet another acronym referencing the type of DIR fees being assessed by PBMs….. a GER which means Generic Effective Rate. Huh?  These new fees are calculated on a drug’s maximum allowable cost, wholesale acquisition cost, or average wholesale price (AWP).

Confused yet?

The article below is well worth a read even for those of us who think we are experts at understanding DIR fees. It covers a lot of ground and offers examples in fairly straightforward English. Any staff member who is less proficient on the topic would benefit from reading this article. 

An excerpt from the article follows…..

• Between 2010 and 2020, retroactive DIR fees increased by more than 100,000%.  DIR fees are charged by PBMs outside of administration fees and are often collected after the point of sale (POS) and do not reflect the pharmacy’s actual reimbursement at the time of dispensing. Traditionally, DIR fees are based on so-called pharmacy performance metrics.  DIRs have recoupment fees of up to 15% of the adjudicated price paid to the pharmacy for dispensing a prescription. PBMs develop and manage specific criteria used to score the contracted pharmacy. The scoring process varies from insurer to insurer and may include unachievable goals for specialty pharmacies focused on dispensing oncology medications [for example]. Unrealistic goals may include………….

CLICK HERE to read the full article — PBM Fees Put the “GER” in Danger for Specialty Pharmacies

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

Here are several LD deals that have been recently publicly confirmed subsequent to the approvals.

Rezlidhia HUB to be managed by AscellaHealth

December 13, 2022–(BUSINESS WIRE)–Optime Care, a member of the AscellaHealth Family of Companies, announced a contractual partnership with Rigel Pharmaceuticals, Inc., bringing its full suite patient support/HUB service capabilities to support Rezlidhia (olutasidenib), a recent FDA-approved treatment for adult patients with relapse or refractory acute myeloid leukemia (AML). Optime Care’s services for life sciences manufacturers include pre-commercialization and market access expertise, exclusive distribution partnerships, national medication fulfillment and high-touch patient support and HUB services for enhanced patient outcomes.

Rezlidhia now available at Biologics by McKesson

December 21, 2022 — McKesson Corporation recently announced that its independent specialty pharmacy, Biologics by McKesson, has been selected by Rigel Pharmaceuticals as one of two specialty pharmacies in a limited distribution network for Rezlidhia (olutasidenib). Rezlidhia is indicated for the treatment of adult patients with relapsed or refractory acute myeloid leukemia (AML) with a susceptible IDH1 mutation as detected by an FDA-approved test. 

KRAZATI now available at Biologics by McKesson

Dec. 14, 2022 — Biologics by McKesson has been selected by Mirati Therapeutics as one of two specialty pharmacies in a limited distribution network for KRAZATI (adagrasib), indicated for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with KRAS G12C mutation.

KRAZATI now available from Onco360 

December 15, 2022–(BUSINESS WIRE)–Onco360 has been selected by Mirati Therapeutics to be a specialty pharmacy partner for KRAZATI (adagrasib) indicated for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with KRAS G12C mutation.

HEMGENIX: Orsini Specialty Pharmacy Selected as a Limited Distribution Partner

Dec. 20, 2022 /PRNewswire/ — Orsini Specialty Pharmacy was selected by CSL Behring as a limited distribution partner for Hemgenix (etranacogene dezaparvovec-drlb), the first and only one-time gene therapy option for hemophilia B. Hemgenix is indicated for the treatment of adults with hemophilia B who currently use factor IX prophylaxis therapy or have current or historical life-threatening hemorrhage or have repeated, serious spontaneous bleeding episodes.

The FDA recently approved a biologics license application (BLA) for a new infused therapy, Briumvi from TG Therapeutics, Inc., indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. Briumvi is a novel monoclonal antibody that targets a unique epitope on CD20-expressing B-cells. CD20 using monoclonal antibodies have proven effective in managing autoimmune disorders such as RMS.

Multiple sclerosis is a neurological disease in which the immune system attacks the brain cells causing physical disabilities.  The National Institutes of Health says that MS affects about 400,000 people in the United States.

The label for Briumvi indicates that there is the potential for serious, life-threatening or fatal, bacterial and viral infections in some Briumvi-treated patients. In MS clinical trials, the overall rate of infections was 56% compared to 54% in teriflunomide-treated patients. The rate of serious infections was 5% compared to 3% respectively. There were 3 infection-related deaths in Briumvi-treated patients.

TG Therapeutics did not announce plans for distribution.

Neither did TG Therapeutics confirm pricing at the time of the announcement. Industry analysts differ in their estimates for cost at launch with pricing ranging from a low of $30,000 to as much as $60,000 per patient per year. By comparison, Roche’s Ocrevus, also for MS, has a current list price of about $68,000 annually.

CLICK HERE for prescribing information

Earlier this month the FDA approved a new infused therapy, Leqembi (lecanemab-irmb) from Eisai R&D Management Co., Ltd., indicated for the treatment of Alzheimer’s disease. Therapy was approved for patients with mild cognitive impairment or mild dementia stage of disease. 

Alzheimer’s is an irreversible, progressive brain disorder affecting more than 6.5 million Americans that slowly destroys memory and thinking skills and, eventually, the ability to carry out simple tasks. Neither Leqembi nor Biogen’s Aduhelm are cures for Alzheimer’s. Neither medication reverses disease progression for those who have already developed symptoms of Alzheimer’s disease or to show clinically significant slowing of cognitive decline, memory loss, or personality and behavior changes.  

It is expected that Leqembi will need to comply with the same barriers as Aduhelm. Currently, Medicare eligible patients must be enrolled in a clinical trial to obtain coverage. Eisai said it doesn’t expect the requirements to be revised or removed in the near term.

Eisai confirmed a launch price of $26,500 year. Biogen cut Aduhelm’s price in the U.S. by about half, effective Jan. 1, 2022. For a 74 kg (163 pounds) patient, the annual cost of Aduhelm dropped to $28,200….. a difference of about $1700 annually vs. Leqembi.

Leqembi is infused every 2 weeks vs. every 4 week infusion schedule for Aduhelm. That burden may prove to be a drag on uptake for Leqembi especially with a requirement for frequent MRIs / PET scans to confirm therapy continuation.

Eisai did not disclose plans for distribution of Leqembi at the time of the announcement. However, a press release dated January 11 confirmed that Soleo Health Specialty Pharmacy has been named as the sole distributor of Leqembi.

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FDA Grants Accelerated Approval for Alzheimer’s Disease 

January 06, 2023 — Today, the U.S. Food and Drug Administration approved Leqembi (lecanemab-irmb) via the Accelerated Approval pathway for the treatment of Alzheimer’s disease. Leqembi is the second of a new category of medications approved for Alzheimer’s disease that target the fundamental pathophysiology of the disease. These medications represent an important advancement in the ongoing fight to effectively treat Alzheimer’s disease.

“Alzheimer’s disease immeasurably incapacitates the lives of those who suffer from it and has devastating effects on their loved ones,” said Billy Dunn, M.D., director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research. “This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s, instead of only treating the symptoms of the disease.”

Leqembi was approved using the Accelerated Approval pathway, under which the FDA may approve drugs for serious conditions where there is an unmet medical need and a drug is shown to have an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients. The results of a Phase 3 randomized, controlled clinical trial to confirm the drug’s clinical benefit have recently been reported and the agency anticipates receiving the data soon.

Researchers evaluated Leqembi’s efficacy in a double-blind, placebo-controlled, parallel-group, dose-finding study of 856 patients with Alzheimer’s disease. Treatment was initiated in patients with mild cognitive impairment or mild dementia stage of disease and confirmed presence of amyloid beta pathology. Patients receiving the treatment had significant dose- and time-dependent reduction of amyloid beta plaque, with patients receiving the approved dose of lecanemab, 10 milligram/kilogram every two weeks, having a statistically significant reduction in brain amyloid plaque from baseline to Week 79 compared to the placebo arm, which had no reduction of amyloid beta plaque. 

These results support the accelerated approval of Leqembi, which is based on the observed reduction of amyloid beta plaque, a marker of Alzheimer’s disease. Amyloid beta plaque was quantified using positron emission tomography (PET) imaging to estimate the brain levels of amyloid beta plaque in a composite of brain regions expected to be widely affected by Alzheimer’s disease pathology compared to a brain region expected to be spared of such pathology. 

The prescribing information for Leqembi includes a warning for amyloid-related imaging abnormalities (ARIA), which are known to occur with antibodies of this class. ARIA usually does not have symptoms, although serious and life-threatening events rarely may occur. ARIA most commonly presents as temporary swelling in areas of the brain that usually resolves over time and may be accompanied by small spots of bleeding in or on the surface of the brain, though some people may have symptoms such as headache, confusion, dizziness, vision changes, nausea and seizure. Another warning for Leqembi is for a risk of infusion-related reactions, with symptoms such as flu-like symptoms, nausea, vomiting and changes in blood pressure. The most common side effects of Leqembi were infusion-related reactions, headache and ARIA.

As specified in the prescribing information, Leqembi is indicated for the treatment of Alzheimer’s disease. The labeling states that treatment with Leqembi should be initiated in patients with mild cognitive impairment or mild dementia stage of disease, the population in which treatment was studied in clinical trials. The labeling also states that there are no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied.

The FDA granted this application Fast Track, Priority Review and Breakthrough Therapy designations. 

The approval of Leqembi was granted to Eisai R&D Management Co., Ltd.

The FDA recently approved a novel gene therapy, Adstiladrin (nadofaragene firadenovec-vncg) from Ferring Pharmaceuticals A/S, indicated for the treatment of adult patients with high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary tumors. 

According to the Centers for Disease Control and Prevention, about 57,000 men and 18,000 women are diagnosed with bladder cancer annually, and roughly 12,000 men and 4,700 women die from the disease each year in the United States.

Adstiladrin is administered three times annually via intravesical catheter.

Ferring did confirm that Adstiladrin will be commercially available in the US in the second half of 2023. Ferring did not release pricing information at the time of approval. Industry sources expect the therapy to be priced in the $160k-$260k price range. Given cost and need to track outcomes and patient experience, Ferring will likely distribute this product through SP distribution.

CLICK HERE for prescribing information

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FDA Approves First Gene Therapy for the Treatment of High-Risk, Non-Muscle-Invasive Bladder Cancer

December 16, 2022 — Today, the U.S. Food and Drug Administration approved Adstiladrin (nadofaragene firadenovec-vncg), a non-replicating (cannot multiply in human cells) adenoviral vector based gene therapy indicated for the treatment of adult patients with high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) with or without papillary tumors.

“This approval provides healthcare professionals with an innovative treatment option for patients with high-risk non-muscle invasive bladder cancer that is unresponsive to BCG therapy,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “Today’s action addresses an area of critical need. The FDA remains committed to facilitating the development and approval of safe and effective cancer treatments.”

Bladder cancer, one of the more common forms of cancer, is a disease in which malignant (cancer) cells form a tumor in the tissues of the bladder. These abnormal cells can invade and destroy normal body tissue. Over time, the abnormal cells can also metastasize (spread) through the body. Most newly diagnosed bladder cancers (75% to 80%) are classified as NMIBC – a type of cancer that has grown through the lining of the bladder but hasn’t yet invaded the muscle layer. This type of cancer is associated with high rates of recurrence (between 30 to 80%) and the risk of progression to invasive and metastatic cancer. 

Treatment and care of patients with high-risk NMIBC, including those with carcinoma in situ, or CIS (abnormal cancer cells found in the place where they first formed and that have not spread to nearby tissue), often involves removing the tumor and the use of BCG to reduce the risk that the cancer will recur. Few effective treatment options exist for patients who develop BCG-unresponsive disease. The failure to achieve a complete response, or the disappearance of all signs of cancer as seen on cystoscopy, biopsied tissue, and urine, is associated with an increased risk of death or a disease-worsening event. Without treatment, the cancer can invade, damage tissues and organs, and spread through the body. 

The safety and effectiveness of Adstiladrin was evaluated in a multicenter clinical study that included 157 patients with high-risk BCG-unresponsive NMIBC, 98 of whom had BCG-unresponsive CIS with or without papillary tumors and could be evaluated for response. Patients received Adstiladrin once every three months for up to 12 months, or until unacceptable toxicity to therapy or recurrent high-grade NMIBC. Overall, 51% of enrolled patients using Adstiladrin therapy achieved a complete response (the disappearance of all signs of cancer as seen on cystoscopy, biopsied tissue, and urine). The median duration of response was 9.7 months. Forty-six percent of responding patients remained in complete response for at least one year.

Adstiladrin is administered once every three months into the bladder via a urinary catheter. The most common adverse reactions associated with Adstiladrin included bladder discharge, fatigue, bladder spasm, urinary urgency, hematuria (presence of blood in urine), chills, fever, and painful urination. Individuals who are immunosuppressed, or immune-deficient should not come into contact with Adstiladrin. 

This application was granted Priority Review, Breakthrough Therapy, and Fast Track designations.

The FDA granted approval of Adstiladrin to Ferring Pharmaceuticals A/S.