Radar on Specialty Pharmacy

With more and more oncolytics targeting specific alterations in tumors, the area of precision oncology is developing rapidly. To help bring some insight into this market, Magellan Rx Management, a division of Magellan Health, Inc., and Trapelo Health, a wholly owned subsidiary of NeoGenomics Bioinformatics, recently unveiled a collaboration aimed at helping both providers and payers navigate this complex space and ultimately improve patient outcomes.

The offering combines Magellan Rx’s comprehensive oncology management solution and Trapelo’s precision-medicine platform, which provides fast, accurate testing and treatment decision support. Trapelo links providers, laboratories and payers by providing access to molecular testing information, allowing providers to order tests from preferred labs and interpreting those results, including identifying appropriate, evidence-based treatments. It offers automated prior authorization, incorporates health plan policies and eliminates unneeded medical redocumentation. These services will support Magellan Rx’s medical pharmacy program, which addresses various aspects of cancer care such as guideline-supported prior authorization, drug waste, personalized dosing, oral oncology management, post-service claim edits and provider network management.

Chimeric antigen receptor T cell (CAR-T) therapies have been available in the U.S. since August 2017. While the list prices for the one-time treatments are known, a recent study from Prime Therapeutics LLC examined their total cost of care and clinical events following administration and found that payer costs for the therapies varied widely. Payers could use this information to help forecast costs for these drugs and strike value-based deals, says one author of the study, which was presented at the Academy of Managed Care Pharmacy’s AMCP 2021 virtual conference in April.

Study Examined First Two CAR-Ts

Researchers examined the first two CAR-Ts on the U.S. market. Yescarta (axicabtagene ciloleucel) from Kite Pharma, Inc., a Gilead Sciences, Inc. company, was approved Oct. 18, 2017, for the treatment of adults with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy (RSP 11/17, p. 8). The drug — which gained FDA approval for relapsed or refractory follicular lymphoma after at least two forms of treatment on March 6 (RSP 4/21, p. 8) — is priced at $373,000.

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.