Radar on Specialty Pharmacy

Blue Cross and Blue Shield of Minnesota recently launched a new value-based agreement with VillageHealth focused on certain members with chronic kidney disease (CKD) or end-stage renal disease (ESRD). By working with VillageHealth, a DaVita Inc. subsidiary, the Blues plan hopes to improve member outcomes and reduce their total cost of care.

The Centers for Disease Control and Prevention estimates that more than one in seven adults in the U.S. — or 37 million people — have CKD, but most of them do not realize it. When the kidneys are damaged, this can result in high blood pressure, heart disease, stroke and early death. If the condition is not treated, it can progress to ESRD, which requires a transplant or dialysis.

From 2009 to 2019, commercial per-member per-month costs have almost doubled, from $17.28 to $32.73, an increase of 89%, according to the latest Medical Pharmacy Trend Report from Magellan Rx Management. The report also found that the cost of Remicade (infliximab), the top commercial drug, has grown two-and-a-half times during that same period.

For the first time, the top five PMPM commercial drugs have changed, with Ocrevus (ocrelizumab) ranked in the No. 3 spot, displacing Avastin (bevacizumab), which fell to the seventh spot. Researchers found that out of 32 surveyed payers, 72% preferred Avastin’s biosimilars over the reference product (see chart below).

More than 20 multiple sclerosis (MS) disease-modifying drugs (DMDs) currently are available in the U.S. But even with all the competition, prices for most of the agents are around $80,000 per year. Following updated professional treatment guidelines and the FDA approval of new therapies, including generics, Prime Therapeutics LLC recently conducted a study to determine spend and use of the agents over a two-year period. Spending for the class remained fairly steady, as generic use helped offset some costs. Payers should encourage use of these products to help contain their spend on this class, maintains a source from the PBM.

All of the drugs in the study are approved to treat relapsing forms of MS, the most common disease course. Only one — ocrelizumab — also is approved to treat primary progressive MS.

✦ The FDA’s Oncologic Drugs Advisory Committee voted to keep most indications for a handful of immune checkpoint inhibitors that target programmed death-1/programmed death ligand-1 (PD-1/PD-L1) and received accelerated approval pending further clinical trial data (RSP 4/21, p. 1). Receiving “yes” votes were Tecentriq (atezolizumab) from Roche subsidiary Genentech USA, Inc. for certain triple-negative breast cancers and urothelial carcinomas and Merck & Co., Inc.’s Keytruda (pembrolizumab) for certain urothelial carcinomas and hepatocellular carcinomas. Keytruda received a negative vote for certain gastric cancers and Bristol Myers Squibb’s Opdivo (nivolumab) did also for certain hepatocellular carcinomas. View the meeting materials at https://bit.ly/3uj4XqJ.

✦ Amber Specialty Pharmacy is partnering with MarkeTouch Media to enhance communication with patients via automated, targeted and responsive outbound notifications across services through the TouchPoint Management solution. The move frees up staff from performing routine tasks, allowing them to focus on patients, says the company. Visit www.amberpharmacy.com.

✦ April 6: The FDA approved a new dosing regimen for Eli Lilly and Co.’s Erbitux (cetuximab) of 500 mg/m2 as a 120-minute infusion every two weeks as a single agent or in combination with chemotherapy for people with K-ras wild-type epidermal growth factor receptor (EGFR)-expressing metastatic colorectal cancer or squamous cell carcinoma of the head and neck. The previously approved 250 mg/m2 per-week regimen remains an option. The drug’s monthly list price is $13,596.20. Visit www.erbitux.com.

✦ April 7: The FDA gave full approval to Gilead Sciences, Inc.’s Trodelvy (sacituzumab govitecan- hziy) for adults with unresectable locally advanced or metastatic triple- negative breast cancer who have received at least two systemic therapies, including at least one for metastatic disease. The agency gave the antibody-drug conjugate accelerated approval on April 22, 2020 (RSP 5/20, p. 8). The recommended dose of the intravenous infusion is 10 mg/kg once weekly on days one and eight of a continuous 21-day treatment cycle. Dosing for the first infusion is over three hours, which can be reduced to one to two hours if that dosing is tolerated. Website Drugs.com lists the price of one single-dose vial of 180 mg lyophilized powder as more than $2,173. Visit https://trodelvy.com.