Radar on Specialty Pharmacy

Recently, health insurers have begun focusing on social determinants of health (SDOH) and the role these factors play on health outcomes. Then the COVID-19 pandemic put even more of a spotlight on the issue, disproportionately affecting people of color and low-income communities. Recognizing the impact that SDOH can have, AllianceRx Walgreens Prime is partnering with Highmark Inc. to launch a pilot outreach program focused on the impact of SDOH on people with multiple sclerosis (MS).

According to the Healthy People 2030 initiative from HHS’s Office of Disease Prevention and Health Promotion, SDOH “are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” These include financial strain, transportation needs, food insecurity and housing instability.

✦ Spending on specialty medications accounted for more than half of total drug spend for the first time last year. That’s according to the Evernorth 2020 Drug Trend Report, released in March, which noted that less than 2% of the population used these drugs. The company also reported that plans participating in its SafeGuardRx programs had lower spending across each of the therapeutic areas. Top conditions for year-over-year trend included inflammatory conditions and cancer. For more information, visit www.evernorth.com/drug-trend-report.

✦ In 2021, 45 states and Washington, D.C., have at least one health insurance plan offered through the Affordable Care Act marketplaces that have a copay accumulator adjustment policy (CAAP), according to a new report by The AIDS Institute. Of those, a CAAP is offered in at least two-thirds of the plans, and of those, a CAAP is included in every plan in 14 states. Legislation prohibiting the policies is in place in five states and Puerto Rico. Researchers also found it difficult to track down information about these policies, including whether they were actually in place. Download the report at https://bit.ly/3upJ090.

✦ March 3: The FDA expanded the label for Pfizer Inc.’s Lorbrena (lorlatinib) to include the first-line treatment of people with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) as detected by an FDA-approved test (see brief below). The agency also converted the 2018 accelerated approval for ALK-positive metastatic NSCLC whose disease has progressed on crizotinib and at least one other ALK inhibitor or those whose disease has progressed on alectinib or ceritinib as the first ALK inhibitor for metastatic disease to full approval (RSP 11/18, p. 8). Recommended dosing for the tablet is 100 mg once daily. Website Drugs.com lists the price of 30 100 mg tablets as more than $18,480. Visit www.lorbrena.com.

✦ March 4: The FDA approved an additional indication for Roche Group member Genentech USA, Inc.’s Actemra (tocilizumab) for slowing the rate of decline in pulmonary function in adults with systemic sclerosis-associated interstitial lung disease. The agency initially approved the interleukin-6 inhibitor on Jan. 8, 2010 (RSP 1/10, p. 6). It gave the newest indication priority review. The recommended dose for the new use is 162 mg once every week as a subcutaneous injection. Drugs.com lists the price of one 162 mg/0.9 mL solution as more than $1,130. Visit www.actemra.com.

Women diagnosed with multiple sclerosis (MS) and being treated with disease-modifying therapies (DMTs) who become pregnant often discontinue those agents, as none are approved for use during pregnancy. But a recent study by AllianceRx Walgreens Prime, in conjunction with parent company Walgreens, demonstrates that when these women remain adherent to DMTs, this may reduce their nonmaternity inpatient and outpatient costs.

The findings were presented at the virtual Americas Committee for Treatment and Research in Multiple Sclerosis Forum 2021, which was held at the end of February.

The renal cell carcinoma (RCC) therapeutic class boasts multiple agents, but a recent entrant is offering a new tool for certain patients. A Zitter Insights survey shows that the majority of oncologist respondents are likely to prescribe Aveo Oncology’s Fotivda (tivozanib) for advanced RCC.

On March 10, the FDA approved Fotivda for the treatment of adults with relapsed or refractory advanced RCC who have received at least two prior systemic therapies. It is the first FDA-approved therapy for this use.