Un­der fire for Tru­va­da US pric­ing at House hear­ing, Gilead chief O'­Day touts R&D costs, as­serts gov­ern­ments patents are void

Gilead chief Daniel O’Day spent more than three hours de­fend­ing the $2000 month­ly price of its HIV pre­ven­tion pill, Tru­va­da, at a US House com­mit­tee on over­sight and re­form hear­ing Thurs­day, in re­sponse to a tsuna­mi of rage from AIDS ac­tivists, law­mak­ers and pa­tients re­gard­ing its pric­ing pol­i­cy.


Im­age: Daniel O’Day at the hear­ing. C-SPAN

Tru­va­da — emtric­itabine/teno­fovir diso­prox­il fu­marate (TDF/FTC) — was ap­proved in 2004 to treat HIV. In 2012, it was sanc­tioned by the FDA as a pre­ven­ta­tive treat­ment or PrEP (pre-ex­po­sure pro­phy­lax­is), in which in­di­vid­u­als at high risk for HIV take med­i­cines dai­ly to low­er their chances of con­tract­ing the in­fec­tion. Ac­cord­ing to the CDC, dai­ly PrEP re­duces the risk of get­ting HIV via sex­u­al in­ter­course by more than 90%.

A coali­tion of HIV/AIDs ac­tivists — the PrEP4All Col­lab­o­ra­tion — es­ti­mates that few­er than 10% of at-risk in­di­vid­u­als in the Unit­ed States re­ceive Tru­va­da as PrEP, and in­fec­tion rates re­main high (rough­ly 38,700 Amer­i­cans be­came new­ly in­fect­ed with HIV in 2016, ac­cord­ing to US gov­ern­ment es­ti­mates) par­tic­u­lar­ly among peo­ple of col­or and men who have sex with men. Gilead sells Tru­va­da for PrEP at about $1,600 to $2,000 per month in the Unit­ed States, while gener­ic ver­sions are avail­able else­where for as lit­tle as $6 per month, ad­vo­ca­cy or­ga­ni­za­tion Health GAP said in its tes­ti­mo­ny to the com­mit­tee: “While un­der-uti­liza­tion of PrEP is caused by mul­ti­ple fac­tors, it is clear that price is a bar­ri­er that in­hibits broad ac­cess.”

In March, the Yale Glob­al Health Jus­tice Part­ner­ship pub­lished a re­port that found CDC sci­en­tists were the first to de­ter­mine that the drugs Gilead’s Tru­va­da com­pris­es could be used to pre­vent HIV trans­mis­sion. As such, the agency was grant­ed a patent in 2015 that cov­ers HIV PrEP with a com­bi­na­tion of emtric­itabine and teno­fovir diso­prox­il fu­marate, the two drugs that make up Tru­va­da. Two oth­er patents were grant­ed lat­er. The Yale analy­sis con­clud­ed that Tru­va­da ap­peared to in­fringe the CDC’s patents for PrEP and that the US gov­ern­ment could as­sert the patents and seek mon­e­tary dam­ages.

“Gilead bore the risk and cer­tain­ly the vast ma­jor­i­ty of the cost of re­search and clin­i­cal stud­ies to demon­strate Tru­va­da’s ef­fi­ca­cy and safe­ty as part of com­bi­na­tion HIV ther­a­py,” a Gilead spokesper­son told End­points News last month. “The HHS patents on the drug’s use for PrEP were filed more than a year af­ter the drug had been dis­cussed by sci­en­tists for PrEP, had been rec­om­mend­ed and even pre­scribed off-la­bel by physi­cians for pre­ven­tion of HIV in­fec­tions, and ap­peared in guide­lines pub­lished by the CDC and oth­er health care or­ga­ni­za­tions for post-ex­po­sure pro­phy­lax­is (PEP) and PrEP. As such, the gov­ern­ment did not in­vent PrEP, Tru­va­da or Tru­va­da for PrEP and its patents should not have been grant­ed.”

O’Day on Thurs­day re­it­er­at­ed Gilead’s po­si­tion on Tru­va­da’s patents — in pre­pared tes­ti­mo­ny, he ref­er­enced in­stances in which sci­en­tists had re­searched use of the drug for PrEP, be­fore the CDC filed its patent ap­pli­ca­tion in 2006. Gilead has not chal­lenged the CDC patents be­cause the Fos­ter City, CA-based com­pa­ny val­ues the “col­lab­o­ra­tive re­la­tion­ship” with the agency, he told law­mak­ers.

In April, a cadre of US sen­a­tors in a let­ter to the US gov­ern­ment asked why Gilead was mar­ket­ing Tru­va­da for us­es patent­ed by the US gov­ern­ment. “Al­though Sec­re­tary Azar has stat­ed that ne­go­ti­a­tions are on­go­ing, Gilead has re­port­ed­ly reached no agree­ment with the gov­ern­ment that would al­low them to make use of these patent­ed meth­ods,” they wrote. At the time, a Gilead spokesper­son told End­points News that there were “no on­go­ing ne­go­ti­a­tions be­tween Gilead and HHS with re­spect to the patents owned by the gov­ern­ment.”

How­ev­er, a Wash­ing­ton Post re­port sug­gest­ed that the US De­part­ment of Jus­tice is re­view­ing the gov­ern­ment PrEP patent, cit­ing a source.

Gilead gen­er­at­ed glob­al Tru­va­da sales of near­ly $3 bil­lion last year, of which about $2.6 bil­lion came from the Unit­ed States. A gener­ic ver­sion of Tru­va­da is sold by My­lan $MYL in high-in­come Eu­ro­pean coun­tries and Aus­tralia, and the CDC is col­lect­ing a “small” roy­al­ty on those sales, af­ter the gener­ic drug­mak­er un­suc­cess­ful­ly chal­lenged the CDC patent in the Eu­ro­pean Patent Of­fice, STAT re­port­ed in April.

Ear­li­er this month, Gilead $GILD agreed to al­low one gener­ic drug­mak­er Te­va $TE­VA to be­gin sell­ing a copy­cat ver­sion of the drug by 2020 — about one year ahead of three oth­er com­pa­nies who have at­tempt­ed to launch their own ver­sions (Am­neal, Au­robindo and My­lan). A coali­tion of AIDS ac­tivists al­so dis­rupt­ed Gilead’s an­nu­al gen­er­al meet­ing of share­hold­ers, with de­mands that Gilead stop ob­struct­ing ac­cess to Tru­va­da.

“Typ­i­cal­ly, with on­ly one gener­ic on the mar­ket, its price is on­ly set about 20% low­er than the brand name drug. Te­va can ex­pect to be­come PrEP4All’s next tar­get if they don’t launch their own pa­tient as­sis­tance pro­grams. This sweet­heart deal with Te­va is like­ly un­con­sti­tu­tion­al, as are the deals keep­ing the oth­er three gener­ics off the mar­ket un­til 2021,” HIV ac­tivist and PrEP4All co-founder Pe­ter Sta­ley wrote in a Face­book post.

One day lat­er, Gilead notched a deal to pro­vide the CDC with up to 2.4 mil­lion bot­tles of the HIV-pre­ven­tion pill an­nu­al­ly for unin­sured Amer­i­cans at risk for HIV.  The do­na­tion, which ex­tends up to 2030, will tran­si­tion to its im­proved HIV drug De­scovy if it is ap­proved for use as PrEP. At the time, Gilead ac­knowl­edged that on­ly about 200,000 of the es­ti­mat­ed 1.1 mil­lion Amer­i­cans at risk for HIV cur­rent­ly re­ceive Tru­va­da for PrEP.

On Thurs­day, Health GAP chas­tised the CDC deal:

Gilead’s do­na­tion pro­gram is de­cep­tive and in­suf­fi­cient in sev­er­al ways. First, it pro­vides free TDF/FTC and sub­se­quent TAF/FTC for 200,000 unin­sured peo­ple, which is ad­mit­ted­ly use­ful, but Gilead will con­tin­ue to charge full price for the re­main­ing 800,000 to 900,000 el­i­gi­ble for PrEP. In essence, in terms of po­ten­tial mar­ket earn­ings, Gilead has of­fered a 20% price re­duc­tion off its list price of $20,000 per pa­tient per year. The net price for all PrEP users, es­pe­cial­ly af­ter they have been switched to the patent- and da­ta-pro­tect­ed TAF/FTC will be $16,000 per per­son per year times 800,000 users equals $12.8 bil­lion per year. Ad­di­tion­al­ly, Gilead will most cer­tain­ly re­ceive a ma­jor tax break on the do­na­tion val­ue of the do­nat­ed PrEP, which might al­so add as much as $1 bil­lion a year to their bot­tom line.

Alexan­dria Oca­sio-Cortez

At the hear­ing, O’Day em­pha­sized that since 2000, Gilead has spent $6 bil­lion on HIV/AIDS re­search, and has ef­fec­tive­ly rel­e­gat­ed the dis­ease from a death sen­tence to a man­age­able con­di­tion.

De­mo­c­ra­t­ic rep­re­sen­ta­tive Alexan­dria Oca­sio-Cortez told O’Day that the com­mit­tee wasn’t out to ques­tion his char­ac­ter, but the in­cen­tive sys­tem in the Unit­ed States that has en­gen­dered the norm of as­tro­nom­i­cal drug pric­ing.

“I’m not here to vil­i­fy the work that you’ve done, be­cause you are re­spond­ing to set of in­cen­tives,” she said. “You could re­sign to­day, and there will still be some­one that would oc­cu­py this seat, us­ing the same in­cen­tives, mak­ing the same de­ci­sions […] So this isn’t about you, this is about the sys­tem of in­cen­tives that we have set up […] I don’t blame you, I blame us.”

Jim Jor­dan

Mean­while, the rank­ing Re­pub­li­can on the com­mit­tee, Jim Jor­dan, ac­cused his De­mo­c­ra­t­ic col­leagues of cru­ci­fy­ing Gilead.

“Folks are alive to­day be­cause of the work you’ve done, and we’re go­ing to beat you up,” he said to O’Day.

UP­DAT­ED: In sur­prise switch, Bris­tol-My­ers is sell­ing off block­buster Ote­zla, promis­ing to com­plete Cel­gene ac­qui­si­tion — just lat­er

Apart from revealing its checkpoint inhibitor Opdivo blew a big liver cancer study on Monday, Bristol-Myers Squibb said its plans to swallow Celgene will require the sale of blockbuster psoriasis treatment Otezla to keep the Federal Trade Commission (FTC) at bay.

The announcement — which has potentially delayed the completion of the takeover to early 2020 — irked investors, triggering the New York-based drugmaker’s shares to tumble Monday morning in premarket trading.

Celgene’s Otezla, approved in 2014 for psoriasis and psoriatic arthritis, is a rising star. It generated global sales of $1.6 billion last year, up from the nearly $1.3 billion in 2017. Apart from the partial overlap of Bristol-Myers injectable Orencia, the company’s rival oral TYK2 psoriasis drug is in late-stage development, after the firm posted encouraging mid-stage data on the drug, BMS-986165, last fall. With Monday’s decision, it appears Bristol-Myers is favoring its experimental drug, and discounting Otezla’s future.

The move blindsided some analysts. Credit Suisse’s Vamil Divan noted just days ago:

Endpoints News

Basic subscription required

Unlock this story instantly and join 53,400+ biopharma pros reading Endpoints daily — and it's free.

Novotech CEO Dr. John Moller

Novotech CRO Award­ed Frost & Sul­li­van Best Biotech CRO Asia-Pa­cif­ic 2019

Known in the in­dus­try as the Asia-Pa­cif­ic CRO, Novotech is now lead CRO ser­vices provider for the grow­ing num­ber of in­ter­na­tion­al biotechs se­lect­ing the re­gion for their stud­ies.

Re­flect­ing this Asia-Pa­cif­ic growth, Novotech staff num­bers are up 20% since De­cem­ber 2018 to 600 in-house clin­i­cal re­search peo­ple across a full range of ser­vices, across the re­gion.

Novotech’s ca­pa­bil­i­ties have been rec­og­nized by an­a­lysts like Frost & Sul­li­van, most re­cent­ly with the pres­ti­gious Asia-Pa­cif­ic CRO Biotech of the year award for best prac­tices in clin­i­cal re­search for biotechs for the fifth year. See oth­er awards here.

Bris­tol-My­ers star Op­di­vo fails sur­vival test in a matchup with Nex­avar aimed at shak­ing up the big HCC mar­ket

Bris­tol-My­ers Squibb has suf­fered an­oth­er painful set­back in its years-long quest to ex­pand the reach of Op­di­vo. The phar­ma gi­ant this morn­ing not­ed that their Check­mate-459 study com­par­ing Op­di­vo with Bay­er’s Nex­avar in front­line cas­es of he­pa­to­cel­lu­lar car­ci­no­ma — the most com­mon form of liv­er can­cer — failed to hit the pri­ma­ry end­point on over­all sur­vival.

This was a sig­nif­i­cant mile­stone in Bris­tol-My­ers’ tal­ly of PD-1 cat­a­lysts this year. Nex­avar (so­rafenib) has been the stan­dard of care in front­line HCC for the past decade, though Op­di­vo has been mak­ing head­way in sec­ond-line HCC cas­es, where it’s go­ing toe-to-toe with Bay­er’s Sti­var­ga (re­go­rafenib) af­ter re­cent ap­provals shook up the mar­ket.

Fol­low­ing news of job cuts in Eu­ro­pean R&D ops, Sanofi con­firms it’s of­fer­ing US work­ers an 'ear­ly ex­it'

Ear­li­er in the week we learned that Sanofi was bring­ing out the bud­get ax to trim 466 R&D jobs in Eu­rope, re­tool­ing its ap­proach to car­dio as re­search chief John Reed beefed up their work in can­cer and gene ther­a­pies. And we’re end­ing the week with news that the phar­ma gi­ant has al­so been qui­et­ly re­duc­ing staff in the US, tar­get­ing hun­dreds of jobs as the com­pa­ny push­es vol­un­tary buy­outs with a fo­cus on R&D sup­port ser­vices.

Suf­fer­ing No­var­tis part­ner Cona­tus is pack­ing it in on NASH af­ter a se­ries of un­for­tu­nate tri­al events

The NASH par­ty is over at No­var­tis-backed Cona­tus. And this time they’re turn­ing off the lights.

More than 2 years af­ter No­var­tis sur­prised the biotech in­vest­ment com­mu­ni­ty with its $50 mil­lion up­front and promise of R&D sup­port to part­ner with the lit­tle biotech on NASH — ig­nit­ing a light­ning strike for the share price — Cona­tus $CNAT is back with the lat­est bit­ter tale to tell about em­ri­c­as­an, which once in­spired con­fi­dence at the phar­ma gi­ant.

Dean Hum. Nasdaq via YouTube

Gen­fit goes to Chi­na with a deal worth up to $228M for NASH drug

Fresh off the high of its Nas­daq IPO de­but, and the low of com­par­isons to Cymabay — whose NASH drug re­cent­ly stum­bled — Gen­fit on Mon­day un­veiled an up to $228 mil­lion deal with transpa­cif­ic biotech Terns Phar­ma­ceu­ti­cals to de­vel­op its flag­ship ex­per­i­men­tal liv­er drug — elafi­bra­nor — in Greater Chi­na.

The deal comes weeks af­ter Gen­fit $GN­FT is­sued a fiery de­fense of its dual PPAR ag­o­nist elafi­bra­nor, when com­peti­tor Cymabay’s PPARδ ag­o­nist, se­ladel­par, fiz­zled in a snap­shot of da­ta from an on­go­ing mid-stage tri­al. The main goal at the end of 12 weeks was for se­ladel­par to in­duce a sta­tis­ti­cal­ly sig­nif­i­cant im­prove­ment in liv­er fat con­tent, but da­ta showed that pa­tients on the place­bo ac­tu­al­ly per­formed bet­ter.

Alex­ion wins pri­or­i­ty re­view for Ul­tomiris' aHUS in­di­ca­tion; FDA ex­pands ap­proval of Ver­tex's Symdeko

→ Alex­ion $ALXN has scored a speedy re­view for Ul­tomiris for pa­tients with atyp­i­cal he­molyt­ic ure­mic syn­drome (aHUS) af­ter post­ing pos­i­tive da­ta from a piv­otal study in Jan­u­ary. The drug is the rare dis­ease com­pa­ny’s shot at pro­tect­ing its block­buster blood dis­or­der fran­chise that is cur­rent­ly cen­tered around its flag­ship drug, Soliris, which is a com­ple­ment in­hibitor typ­i­cal­ly ad­min­is­tered every two weeks. Ul­tomiris has a sim­i­lar mech­a­nism of ac­tion but re­quires less-fre­quent dos­ing — every eight weeks. The de­ci­sion date has been set to Oc­to­ber 19. Late last year, Ul­tomiris se­cured ap­proval for noc­tur­nal he­mo­glo­bin­uria (PNH) pa­tients.

Bet­ter than Am­bi­en? Min­er­va soars on PhI­Ib up­date on sel­torex­ant for in­som­nia

A month af­ter roil­ing in­vestors with what skep­tics dis­missed as cher­ry pick­ing of its de­pres­sion da­ta, Min­er­va is back with a clean slate of da­ta from its Phase IIb in­som­nia tri­al.

In a de­tailed up­date, the Waltham, MA-based biotech said sel­torex­ant (MIN-202) hit both the pri­ma­ry and sev­er­al sec­ondary end­points, ef­fec­tive­ly im­prov­ing sleep in­duc­tion and pro­long­ing sleep du­ra­tion. In­ves­ti­ga­tors made a point to note that the ef­fects were con­sis­tent across the adult and el­der­ly pop­u­la­tions, with the lat­ter more prone to the sleep dis­or­der.

Gene ther­a­py biotech sees its stock rock­et high­er on promis­ing re­sults for rare cas­es of but­ter­fly dis­ease

Shares of Krys­tal Biotech took off this morn­ing $KRYS af­ter the lit­tle biotech re­port­ed promis­ing re­sults from its gene ther­a­py to treat a rare skin dis­ease called epi­der­mol­y­sis bul­losa.

Fo­cus­ing on an up­date with 4 new pa­tients, re­searchers spot­light­ed the suc­cess of KB103 in clos­ing some stub­born wounds. Krys­tal says that of 4 re­cur­ring and 2 chron­ic skin wounds treat­ed with the gene ther­a­py, the KB103 group saw the clo­sure of 5. The 6th — a chron­ic wound, de­fined as a wound that had re­mained open for more than 12 weeks — was par­tial­ly closed. That brings the to­tal so far to 8 treat­ed wounds, with 7 clo­sures.