Pharmacist Clint Hopkins holds bottles of the HIV prevention drugs Descovy (L) and Truvada, Oct. 7, 2019, in Sacramento, CA (Rich Pedroncelli, AP Images)

In 60 days, most in­sur­ers will be re­quired to cov­er HIV pre­ven­tion drugs and re­lat­ed ser­vices with no cost-shar­ing

The fed­er­al gov­ern­ment is­sued guid­ance Mon­day stat­ing that al­most all health in­sur­ers must cov­er HIV pre­ven­tion drugs — such as Gilead’s Tru­va­da and De­scovy — with no cost-shar­ing, as well as as­so­ci­at­ed lab test­ing and fol­low-up vis­its.

In­sur­ers were al­ready re­quired to quit charg­ing out-of-pock­et fees for the drugs, called HIV Pre­ex­po­sure Pro­phy­lax­is (PrEP), by Jan­u­ary of this year. But now in­sur­ers have 60 days to com­ply with the ad­di­tion­al re­quire­ments, in­clud­ing no-cost ser­vices like base­line and fol­low-up test­ing, as well as mon­i­tor­ing, ac­cord­ing to the guid­ance.

The news comes about two years af­ter the US Pre­ven­tive Ser­vices Task Force grant­ed an “A” rat­ing to PrEP treat­ments, re­quir­ing clin­i­cians to of­fer “ef­fec­tive an­ti­retro­vi­ral ther­a­py to per­sons who are at high risk of hu­man im­mun­od­e­fi­cien­cy virus (HIV) ac­qui­si­tion.”

Tru­va­da was ap­proved back in 2004 to treat HIV, and was sanc­tioned by the FDA as a pre­ven­ta­tive treat­ment in 2012. Ac­cord­ing to the CDC, dai­ly PrEP re­duces the risk of get­ting HIV via sex­u­al in­ter­course by more than 90%.

AIDS ac­tivists, law­mak­ers and pa­tients have crit­i­cized Gilead over the years re­gard­ing the price of Tru­va­da, which cost near­ly $2,000 for a one-month sup­ply with­out in­sur­ance back in 2020. In May 2019, ad­vo­ca­cy or­ga­ni­za­tion Health GAP tes­ti­fied to the US House com­mit­tee on over­sight and re­form that gener­ic ver­sions in oth­er coun­tries were be­ing sold for as lit­tle as $6 per month.

“While un­der-uti­liza­tion of PrEP is caused by mul­ti­ple fac­tors, it is clear that price is a bar­ri­er that in­hibits broad ac­cess,” the group said.

Gilead spent a pri­or­i­ty re­view vouch­er to clear De­scovy for PrEP back in 2019, just be­fore Tru­va­da gener­ics were set to hit the mar­ket in 2020. Last year, Gilead’s HIV prod­ucts raked in $16.9 bil­lion, up 3% from 2019. Te­va launched the first gener­ic ver­sion of Tru­va­da in Oc­to­ber, charg­ing $48.51 per tablet.

In No­vem­ber 2020, the HIV+He­pati­tis Pol­i­cy In­sti­tute re­port­ed that come 2021, “many plans” would not be in com­pli­ance with the le­gal re­quire­ment to of­fer PrEP treat­ment with­out cost-shar­ing, and urged in­sur­ers to take cor­rec­tive ac­tion.

“The HIV com­mu­ni­ty and pub­lic health lead­ers have been work­ing for years to get to the day when in­sured peo­ple who are at risk of HIV can ac­cess PrEP with­out cost-shar­ing,” ex­ec­u­tive di­rec­tor Carl Schmid said at the time. “Un­for­tu­nate­ly, it ap­pears that some in­sur­ers and in­sur­ance reg­u­la­tors do not share our en­thu­si­asm. I hope that will be cor­rect­ed im­me­di­ate­ly.”

While PrEP will soon be read­i­ly avail­able for in­sured pa­tients, unin­sured pa­tients could still be left with no pro­tec­tion. Ac­cord­ing to an NBC News re­port, Gilead pro­vides PrEP for free to low­er-in­come peo­ple who aren’t in­sured, but it doesn’t cov­er as­so­ci­at­ed ser­vices. And, safe­ty net clin­ics are set to lose $100 mil­lion in an­nu­al HIV pre­ven­tion funds due to a re­cent de­ci­sion by Gilead.

What Will it Take to Re­al­ize the Promise and Po­ten­tial of Im­mune Cell Ther­a­pies?

What does it take to get to the finish line with a new cancer therapy – fast? With approvals in place and hundreds of immune cell therapy candidates in the pipeline, the global industry is poised to create a fundamental shift in cancer treatments towards precision medicine. At the same time, unique challenges associated with cell and process complexity present manufacturing bottlenecks that delay speed to market and heighten cost of goods sold (COGS) — these hurdles must be overcome to make precision treatments an option for every cancer patient. This series of articles highlights some of the key manufacturing challenges associated with the production of cell-based cancer therapies as well as the solutions needed to transcend them. Automation, process knowledge, scalability, and assured supply of high-quality starting material and reagents are all critical to realizing the full potential of CAR-based therapies and sustaining the momentum achieved in recent years. The articles will highlight leading-edge technologies that incorporate these features to integrate across workflows, accelerate timelines and reduce COGS – along with how these approaches are enabling the biopharmaceutical industry to cross the finish line faster with new treatment options for patients in need.

The biggest ques­tions fac­ing gene ther­a­py, the XLMTM com­mu­ni­ty, and Astel­las af­ter fourth pa­tient death

After three patients died last year in an Astellas gene therapy trial, the company halted the study and began figuring out how to safely get the program back on track. They would, executives eventually explained, cut the dose by more than half and institute a battery of other measures to try to prevent the same thing from happening again.

Then tragically, Astellas announced this week that the first patient to receive the new regimen had died, just weeks after administration.

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Lat­est news: It’s a no on uni­ver­sal boost­ers; Pa­tient death stuns gene ther­a­py field; In­side Tril­li­um’s $2.3B turn­around; and more

Welcome back to Endpoints Weekly, your review of the week’s top biopharma headlines. Want this in your inbox every Saturday morning? Current Endpoints readers can visit their reader profile to add Endpoints Weekly. New to Endpoints? Sign up here.

Next week is shaping up to be a busy one, as our editor-in-chief John Carroll and managing editor Kyle Blankenship lead back-to-back discussions with a great group of experts to discuss the weekend news and trends. John will be spending 30 minutes with Jake Van Naarden, the CEO of Lilly Oncology, and Kyle has a brilliant panel lined up: Harvard’s Cigall Kadoch, Susan Galbraith, the new head of cancer R&D at AstraZeneca, Roy Baynes at Merck, and James Christensen at Mirati. Don’t miss out on the action — sign up here.

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Mi­rati's KRAS drug looks like the fa­vorite in colon can­cer with new da­ta, putting the pres­sure square on Am­gen

With Amgen already providing proof-of-concept for KRAS inhibitors with its sotorasib, Mirati Therapeutics is piecing together a follow-up effort in lung cancer with data it thinks are superior. But in colon cancer, where solo sotorasib has turned in a dud, Mirati may now have a strong case for superiority.

Mirati’s adagrasib, dosed solo or in combination with chemotherapy cetuximab, showed response rates grater than sotorasib solo  and as part of combination study in a similar patient population also revealed this week at #ESMO21. Mirati’s data were presented as part of a cohort update from the Phase II KRYSTAL-1 study testing adagrasib in a range of solid tumors harboring the KRAS-G12C mutation.

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President Biden and Pfizer CEO Albert Bourla (Patrick Semansky/AP Images)

Chaot­ic ad­comm sees Pfiz­er/BioN­Tech boost­ers re­ject­ed for gen­er­al pop­u­la­tion, but rec­om­mend­ed for old­er and high-risk pop­u­la­tions

With just days before President Joe Biden’s Covid-19 booster rollout is set to go into effect, an FDA advisory committee appeared on the verge of not recommending boosters for anyone in the US before a last-minute change of wording laid the groundwork for older adults to have access to a third dose.

The FDA’s adcomm on Vaccines and Related Biological Products (VRBPAC) roundly rejected Pfizer/BioNTech booster shots for all individuals older than 16 by a 16-2 vote Friday afternoon. Soon after, however, the agency posed committee members a new question limiting booster use to the 65-and-older population and individuals at high risk of disease due to occupational exposure or comorbidities.

The best of the rest: High­lights from the be­low-the-fold pre­sen­ta­tions at #ES­MO21

This year’s ESMO Congress has had a major focus on Big Pharma drugs — most notably candidates from Merck and AstraZeneca — but there have also been updates from smaller biotechs with data looking to challenge the big-name drugmakers.

Today, we’re highlighting some of the data releases that flew under the radar at #ESMO21 — whether from early-stage drugs looking to make a mark or older stalwarts with interesting follow-up data.

As­traZeneca, Dai­ichi Sanky­o's ADC En­her­tu blows away Roche's Kad­cy­la in sec­ond-line ad­vanced breast can­cer

AstraZeneca and Japanese drugmaker Daiichi Sankyo think they’ve struck gold with their next-gen ADC drug Enhertu, which has shown some striking data in late-stage breast cancer trials and early solid tumor tests. Getting into earlier patients is now the goal, starting with Enhertu’s complete walkover of a Roche drug in second-line breast cancer revealed Saturday.

Enhertu cut the risk of disease progression or death by a whopping 72% (p=<0.0001) compared with Roche’s ADC Kadcyla in second-line unresectable and/or metastatic HER2-positive breast cancer patients who had previously undergone treatment with a Herceptin-chemo combo, according to interim data from the Phase III DESTINY-Breast03 head-to-head study presented at this weekend’s #ESMO21.

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Merck Research Laboratories CMO Roy Baynes

Mer­ck­'s Keytru­da un­corks full da­ta on lat­est ad­ju­vant win — this time in melanoma — adding bricks to ear­ly can­cer wall

In recent months, the battle for PD-(L)1 dominance has spilled over into early cancer with Merck’s Keytruda and Bristol Myers Squibb’s Opdivo all alone on the front lines. Keytruda now has another shell in its bandolier, and it could spell a quick approval.

Keytruda cut the risk of relapse or death by 35% over placebo (p=0.00658) in high-risk, stage 2 melanoma patients who had previously undergone surgery to remove their tumors, according to full data from the Phase III KEYNOTE-716 presented Saturday at #ESMO21.

Take­da scores a win for a rare type of lung can­cer, gear­ing up for a show­down with J&J

Four months after J&J’s infused drug Rybrevant scored the industry’s first win in a rare type of non-small cell lung cancer (NSCLC), Takeda is following up with an oral option for the small but desperate patient population.

The FDA granted an accelerated approval to Takeda’s oral TKI inhibitor Exkivity (mobocertinib) in metastatic NSCLC patients with EGFR exon 20 gene mutations who had previously undergone platinum-based chemotherapy, the company announced on Wednesday.

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