Radar on Specialty Pharmacy

The FDA is requiring revisions about increased risk of serious heart-related events such as heart attack, stroke, cancer, blood clots and death to the labels of the Janus kinase (JAK) inhibitors indicated for inflammatory conditions: Pfizer Inc.’s Xeljanz/Xeljanz XR (tofacitinib), Eli Lilly and Co.’s Olumiant (baricitinib) and AbbVie Inc.’s Rinvoq (upadacitinib). The move follows the agency’s review of a large, randomized safety clinical trial of Xeljanz. The FDA also is limiting the approved uses for all the drugs to certain people who have not responded to or cannot tolerate at least one tumor necrosis factor (TNF) inhibitor. While some payers may already have had TNF inhibitors as a first step, they need to make sure that they have utilization management strategies in place to help ensure these drugs are used in the second-line setting, recommend industry experts.

The trial compared Xeljanz with TNFs in people with rheumatoid arthritis (RA) and showed an increased risk of blood clots and death with a lower dose of Xeljanz. A prior study whose results Pfizer disclosed on Jan. 27, 2021, showed the same results but at a higher dose.

The FDA approval of the first biosimilar for ocular use is poised to bring savings to a costly class, particularly in Medicare. However, ophthalmologists’ and retinologists’ lack of experience with biosimilars is a potential roadblock to these drugs’ uptake. Payers should focus on provider education and outreach ahead of these drugs’ launches in order to ease concerns about their use, say industry experts.

On Sept. 20, the FDA approved Samsung Bioepis Co., Ltd. and Biogen Inc.’s Byooviz (ranibizumab-nuna) for the treatment of neovascular (wet) age-related macular degeneration (AMD), macular edema following retinal vein occlusion (RVO) and myopic choroidal neovascularization (mCNV) (see brief, p. 8). The drug is a biosimilar of Roche Group unit Genentech USA, Inc.’s Lucentis (ranibizumab). Under an agreement with Genentech, Samsung Bioepis and Biogen will be able to market the therapy in the U.S. in June 2022.

Biosimilars are finally starting to bring down the prices of their innovator products across a range of indications, research shows. The FDA often approves biosimilars across some or all of the innovator drug’s indications even if applicant companies have not conducted studies in those uses. But two professional societies have been pushing back against payers’ allowance of two Avastin (bevacizumab) biosimilars in untested ocular indications.

Roche Group unit Genentech USA, Inc.’s Avastin is commonly used off-label in ophthalmic indications (see story, p. 1). The drug, first approved in 2004, has undergone clinical trials supporting its use in eye disorders, but Genentech has not filed for FDA approval in those indications. This use requires the drug to be compounded and repackaged — and because this is a much lower dose than the drug’s oncology doses, it costs about $50 per injection, compared with thousands of dollars for the vascular endothelial growth factor (VEGF) inhibitors approved for eye diseases.