UP­DAT­ED: New Kaiser analy­sis shows how lim­it­ing price ne­go­ti­a­tions to tar­get­ed drugs may bet­ter fo­cus up­com­ing leg­is­la­tion

As Con­gress con­sid­ers whether to adopt sweep­ing new leg­is­la­tion to low­er pre­scrip­tion drug prices across the board, the Kaiser Fam­i­ly Foun­da­tion is out with a new re­port on Mon­day show­ing how a more tar­get­ed ap­proach on a sub­set of drugs might be a more ef­fi­cient way to save gov­ern­ment funds.

“This analy­sis shows that Medicare Part D and Part B spend­ing is high­ly con­cen­trat­ed among a rel­a­tive­ly small share of cov­ered drugs, main­ly those with­out gener­ic or biosim­i­lar com­peti­tors,” wrote Juli­ette Cuban­s­ki, deputy di­rec­tor of the pro­gram on Medicare pol­i­cy at KFF, and Tri­cia Neu­man, SVP of KFF. “Fo­cus­ing drug price ne­go­ti­a­tion or ref­er­ence pric­ing on a sub­set of drugs that ac­count for a dis­pro­por­tion­ate share of spend­ing would be an ef­fi­cient use of ad­min­is­tra­tive re­sources, though it would al­so leave some po­ten­tial sav­ings on the ta­ble.”

The re­port found that in 2019, 60% of net to­tal Part D spend­ing came from 250 top-sell­ing drugs in Medicare’s Part D pro­gram with one man­u­fac­tur­er and no gener­ic or biosim­i­lar com­pe­ti­tion, which was 7% of all Part D cov­ered drugs.

“For the top 250 drugs, the av­er­age net cost per claim was $5,750, more than twice as much as the av­er­age net cost per claim for the re­main­ing 2,208 drugs with one man­u­fac­tur­er ($2,555), and more than 13 times greater than the av­er­age net cost per claim for all oth­er cov­ered Part D drugs ($422) (pri­mar­i­ly gener­ic drugs),” the analy­sis shows.

In ad­di­tion, the top 50 drugs cov­ered un­der Medicare Part B, rep­re­sent­ing just 8.5% of all Part B cov­ered drugs, ac­count­ed for 80% of to­tal spend­ing in the pro­gram.

“In con­sid­er­ing whether to broad­en these pro­pos­als to fo­cus on all pre­scrip­tion drugs, pol­i­cy­mak­ers may want to con­sid­er whether do­ing so would achieve suf­fi­cient sav­ings to jus­ti­fy the added ad­min­is­tra­tive bur­den and as­so­ci­at­ed costs,” Cuban­s­ki and Neu­man wrote.

De­moc­rats are hop­ing to use sav­ings from ma­jor drug pric­ing re­forms to help pay for an in­fra­struc­ture bill lat­er this year, rather than try to work through stand­alone pric­ing leg­is­la­tion, which would re­quire 60 votes in the Sen­ate.

“I would look for leg­is­la­tion com­ing out of the Sen­ate to be more along the lines of what Sen­a­tor Wyden pro­posed with Sen­a­tor Grass­ley in 2019, which was more mod­est if on­ly in that it didn’t in­clude the ne­go­ti­a­tion pro­vi­sion in HR 3,” Cuban­s­ki told End­points.

Mov­ing Out of the Clin­ic with Dig­i­tal Tools: Mo­bile Spirom­e­try Dur­ing COVID-19 & Be­yond

An important technology in assessing lung function, spirometry offers crucial data for the diagnosis and monitoring of pulmonary system diseases, as well as the ongoing measurement of treatment efficacy. But trends in the healthcare industry and new challenges introduced by the COVID-19 pandemic are causing professionals in clinical practice and research to reevaluate spirometry’s deployment methods and best practices.

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Sanofi, Glax­o­SmithK­line jump back in­to the PhI­II race for a Covid vac­cine — as the win­ners con­gre­gate be­hind the fin­ish line

Sanofi got out early in the race to develop a vaccine using more of a traditional approach, then derailed late last year as their candidate failed to work in older people. Now, after likely missing the bus for the bulk of the world’s affluent nations, they’re back from that embarrassing collapse with a second attempt using GSK’s adjuvant that may get them back on track — with a potential Q4 launch that the rest of the world will be paying close attention to.

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SCO­TUS de­clines to re­view En­brel biosim­i­lar case, tee­ing up 30+ years of ex­clu­siv­i­ty and $20B more for Am­gen’s block­buster

As the House Oversight Committee is set to grill AbbVie CEO Richard Gonzalez on Tuesday over tactics to block competition for its best-selling drug of all time, another decision on Capitol Hill on Monday opened the door for billions more in Amgen profits over the next eight years.

The Supreme Court on Monday denied Novartis subsidiary Sandoz’s petition to review a Federal Circuit’s July 2020 decision concerning its biosimilar Erelzi (etanercept-szzs), which FDA approved in 2016 as a biosimilar to Amgen’s Enbrel (etanercept). Samsung’s Enbrel biosimilar Eticovo also won approval in 2019 and remains sidelined.

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No­var­tis' En­tresto takes its 2nd fail­ure of the week­end at ACC, show­ing no ben­e­fit in most dire heart fail­ure pa­tients

Novartis’ Entresto started the ACC weekend off rough with a trial flop in heart attack patients, slowing the drug’s push into earlier patients. Now, an NIH-sponsored study is casting doubt on Entresto’s use in the most severe heart failure patients, another black mark on the increasingly controversial drug’s record.

Entresto, a combination of sacubitril and valsartan, could not beat out valsartan alone in an outcomes head-to-head for severe heart failure patients with a reduced ejection fraction (HFrEF), according to data presented Monday at the virtual American College of Cardiology meeting.

Re­gen­eron's Evkeeza shows promise in curb­ing high triglyc­erides, but will ge­net­ic dis­par­i­ties lim­it use?

When Regeneron scored an early approval for lipid lowering antibody Evkeeza back in February, the drugmaker cracked open a new pathway to lower abnormally high cholesterol levels. Now, Regeneron is chasing high triglycerides as well with some promising mid-stage data — but will genetic restrictions limit the drug’s use?

Regeneron’s Evkeeza (evinacumab) cut median triglyceride levels by more than 800 mg/dL (57%) in patients with a rare disorder causing abnormally high triglyceride levels compared with an overall increase of 50 mg/dL (1.8%) in participants on placebo, according to Phase II data presented Sunday at the virtual American College of Cardiology meeting.

How to man­u­fac­ture Covid-19 vac­cines with­out the help of J&J, Pfiz­er or Mod­er­na? Bi­ol­yse sees the dif­fi­cul­ties up close

When Biolyse, an Ontario-based manufacturer of sterile injectables, forged a deal with Bolivia last week to manufacture up to 50 million J&J Covid-19 vaccine doses, the agreement kicked off what will prove to be a test case for how difficult the system of compulsory licenses is to navigate.

The first problem: When Biolyse asked J&J, via a March letter, to license its Covid-19 vaccine, manufacture it in Canada and pay 5% royalties on shipments to needy, low-income countries, J&J rejected the offer, refusing to negotiate. J&J also did not respond to a request for comment.

In­cyte keeps rolling on top­i­cal cream for JAK in­hibitor, pass­ing two PhI­II tests in vi­tili­go

As Incyte prepares to potentially hit the market with a topical formulation of its cash cow ruxolitinib in atopic dermatitis, the Wilmington, DE-based company is beefing up its data package for another indication: vitiligo.

Incyte released Phase III results from two of its clinical vitiligo programs Monday morning, saying both studies met their primary endpoints of patients achieving at least 75% improvement from baseline in repigmentation of the face. The data will likely lead Incyte to ask for approval in both the US and Europe for those older than 12 before the end of the year.

Tim Mayleben (L) and Sheldon Koenig (Esperion)

On the heels of a sting­ing Q1 set­back, Es­pe­ri­on's long­time cham­pi­on is ex­it­ing the helm and turn­ing the wheel over to a mar­ket­ing pro

Just days after getting stung by criticism from a badly disappointed group of analysts, there’s a big change happening today at the helm of Esperion $ESPR.

Longtime CEO Tim Mayleben, who championed the company for 9 years from early clinical through a lengthy late-stage drive to successfully get their cholesterol drug approved for a significant niche of patients in the US, is out of the C suite, effective immediately. Sheldon Koenig — hired at the end of 2020 with a resume replete with Big Pharma CV sales experience —  is stepping into his place, promising to right a badly listing commercial ship that’s been battered by market forces.

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Days ahead of Am­gen split, Cy­to­ki­net­ics reads out post-hoc da­ta sug­gest­ing heart drug works bet­ter in sick­er pa­tients — but can the CEO win over skep­tics?

While Cytokinetics’ heart drug technically met its primary endpoint back in November, it missed a key secondary endpoint — reduction in cardiovascular death — which eventually cost the company two partnerships. Now the team is back with data suggesting the drug works better in sicker patients, and it’s planning a trip to the FDA.

In a post-hoc analysis, which can be a very difficult sale at the FDA, Cytokinetics separated patients from the Phase III GALACTIC-HF study into four quartiles based on ejection fraction, a measurement of how well the left ventricle pumps blood with each heartbeat. Patients in the lower two quartiles — those with an EF of 22% or lower, and between 29% to 32% — saw a 15% and 17% relative risk reduction of heart failure events and cardiovascular death combined, Cytokinetics reported at ACC. No difference was seen in the upper two quartiles.