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Friday, August 9, 2019

Canada Takes U.S., Switzerland Off Drug Pricing Comparison List

The Canadian government’s Health Canada released final regulations to decrease the price of patented drugs. The agency indicates it would save Canadians C$13.2 billion ($10 billion, US) over a decade. The reforms were met by opposition from the pharmaceutical industry.
“We are taking the biggest step in a generation to lower the price of drugs in Canada by moving forward with these regulations,” stated Minister of Health Ginette Petitpas Taylor.
A significant aspect of the new rules is how the country’s federal drug price regulator, the Patented Medicine Prices Review Board (PMPRB), sets prices by making comparisons to how drugs are priced in other countries. Specifically, they were dropping the United States and Switzerland from their comparator list. The U.S. and Switzerland have the highest prices. The PMPRB will also take into account cost-effectiveness of new drugs.
This is an area where the U.S. is considering changes as well. Earlier this year, the U.S. Department of Health and Human Services (HHS) proposed a new policy called the International Pricing Index (IPI). The IPI would set specific drug prices based on an international benchmark.

Recently, the U.S. Chamber of Commerce Global Innovation Policy Center (GIPC) conducted an investigation into the possible negative impacts of the IPI, and a roundtable presented the results. Previous research into countries that utilize an IPI and that were referenced in HHS’s new proposal, were generally found to have access to fewer new drugs compared to the U.S. The American Cancer Society Cancer Action Network, for example, noted that the IPI “could actually make it harder for cancer patients, especially those living in rural areas, to find the right provider to treat their cancer with the right drug.”
The new Canadian regulations will also force pharmaceutical companies to provide information about some confidential discounts to the PMPRB.
The new regulations were initially planned to go into effect in January but were delayed reviewing feedback. They are now expected to trigger within a year.
Pharmaceutical companies, not surprisingly, were generally opposed to the plan. Johnson & Johnson, Merck & Co. and Amgen all voiced opposition. In a February report, Reuters said that lobbying groups for the pharmaceutical industry had offered to give up C$8.6 billion in revenue over 10 years, freeze prices or decrease the cost of rare disease therapies in order to prevent the Canadian regulation changes.
The lobbying group Innovative Medicines Canada (IMC) argues that lower prices could cause slower drug launches and decrease investment in Canadian life science companies.
Meanwhile, the Trump administration announced it was evaluating proposals to allow consumers to buy drugs legally from Canada. HHS Secretary Alex Azar said that the Trump administration will consider new rules that would allow states, pharmacies and other parties to bring drugs from Canada as part of pilot projects. In addition, the U.S. Food and Drug Administration (FDA) might allow manufacturers to import the U.S. version of their drugs that they sell internationally.
Canada, however, is opposed to this policy. An April briefing for Canadian officials stated, “Canada does not support actions that could adversely affect the supply of prescription drugs in Canada and potentially raise costs of prescription drugs for Canadians.” The briefing was prepared by the Canadian foreign ministry to be used by Canadian officials speaking with U.S. officials.
In a follow-up with Canadian ministry officials at Health Canada, the ministry told Reuters they had “made Canada’s position clear” to federal and state officials in the U.S. and was prepared to “take action to ensure Canadians have uninterrupted access to the prescription drugs they need.”

Immunoglobulin Shortages Hit Hospitals, Manufacturers as Patients Suffer

There is currently an acute shortage of a medicine called immunoglobulin (Ig) in the U.S. Immunoglobulin, sometimes called immune globulin, is a versatile drug used to treat a variety of immune disorders and other diseases. And companies that manufacture it are having a problem keeping up, leaving some patients in limbo, waiting for treatment.
The shortage isn’t new, although it appears to be hitting more of a crisis point. In January of this year, John G. Boyle, president and chief executive officer of the Immune Deficiency Foundation (IDF), wrote an article, “Immunoglobulin Product Availability Issues: The Sky Is Not Falling but the World Needs More Plasma.”
Eight months later the sky may not be falling, but the problem seems to have gotten worse. Boyle notes that manufacturing and distribution if Ig is complex because it is derived from plasma. It is also considered a specialty drug, meaning it’s not usually available at the local pharmacy. And the supply of plasma is tight in the U.S. and around the world.
Boyle wrote, “The companies within the plasma and Ig supply and delivery chains make contracts with each other based on historic usage and future projections, and they’re usually accurate enough so shortfalls aren’t experienced regularly.”

Now, however, Ig manufacturers, which include Takeda Pharmaceuticals and CSL, indicated that there has been an increased demand for Ig and that more disorders requiring it have been diagnosed, including new uses for it. They also indicate they are increasing production. In a recent earnings call, Takeda executives said they had seen delays in Ig shipments.
In June, Pfizer informed its customers that their Ig product, Octagam, would be in limited supply through July. The company indicated it was related to third-party manufacturing delays, and referred questions to Octapharma, the manufacturer.
According to the University of Utah Drug Information Service, as of June 30, there were 282 active drug shortages in the U.S., up from 224 the year before.
In June, Cincinnati Children’s Hospital informed about 150 families of patients who receive regular Ig treatments that due to the shortages they would suspend or reduce treatment for some patients.
Although Ig presents its own manufacturing and supply chain issues, it underlines a sometimes-overlooked fact—sometimes healthcare providers have problems getting the drugs they need from manufacturers.
In fact, in January 2018, five healthcare systems formed Civica Rx, a not-for-profit generic drug company, to alleviate problems for hospitals with drug supply problems. The companies were the U.S. Department of Veterans Affairs (VA), Intermountain Healthcare, Ascension, SSM Health and Trinity Health. Since then, more than 30 health systems are members of Civica Rx, representing more than 900 U.S. hospitals and about 30% of all licensed hospital beds in the U.S.
Civica Rx was to initially focus on establishing price transparency and stable supplies of 14 generic drugs often used in hospitals. The idea was to depend on long-term contracts member organizations sign stating they will buy a fixed percentage of their drug volume from Civica Rx. One focus was on drugs that had a 50% or greater price increase between 2014 and 2016 and essential drugs that were on national shortage lists.
Civica Rx recently announced a five-year deal with London, UK-based Hikma Pharmaceuticals to manufacture and supply Civica’s members with 14 sterile injectable drugs as a private label distributor. Hikma will also use its Abbreviated New Drug Applications (ANDAs) and Civica’s labeling and National Drug Code (NDC).

At this time, the U.S. Food and Drug Administration (FDA) identifies three Ig product shortages, two from Takeda and one from Bio Products Laboratory. The FDA indicates it is working with manufacturers to mitigate the supply problems.
The American Society of Health-System Pharmacists uses different parameters to classify drug shorts, and lists other Ig products from CSL, Grifols SA and other companies as being in short supplies. Grifols stated it had increased its supply of Ig to meet demand.
In a statement, Takeda said increased demand “combined with the length of time it takes to produce plasma-derived products … has led to very tight supply and, in some cases, supply interruptions for certain products across the U.S. market.”
Meanwhile, patients are facing a great deal of uncertainty, increased health risks and pain. The Wall Street Journal cited three-year-old Farrah Swan, who receives Ig for juvenile dermatomyositis, which causes skin rashes and muscle weakness. After her infusion in July, her doctors said they needed to delay treatment because of the shortages. Her mother, Angela Swan, told the WSJ, “my concern is the risk of her getting an infection now and it causing a flare because she doesn’t have IVIG (intravenous immune globulin) to keep her symptoms at bay.”

Novartis: Sandoz US – Updated Formulary wins for SYMJEPI

Effective immediately, over 60% of commercially insured people in the US now have access to SYMJEPI (epinephrine) 0.3 mg and 0.15 mg Injections through National and Regional Payers.

Lexicon: Positive Data for Zynquista in Type 1 Diabetes

Lexicon Pharmaceuticals, Inc. (Nasdaq: LXRX), today announced positive 52-week cardiorenal results from a pooled analysis from the inTandem1 and inTandem2 studies of Zynquista (sotagliflozin) in adults with type 1 diabetes.
Zynquista demonstrated changes in clinical biomarkers such as estimated glomerular filtration rate (eGFR), hematocrit, serum albumin, uric acid, systolic blood pressure and urinary albumin-to-creatinine ratio (UACR) that suggest Zynquista may reduce cardiovascular risk and progression of chronic kidney disease. Zynquista was associated with short- and long-term renal hemodynamic changes. Importantly, after cessation of 52 weeks of therapy, eGFR was comparable to baseline and significantly higher than placebo in Zynquista-treated patients.
These results were recently published in Diabetes Care, the ADA’s peer-reviewed research journal dedicated to diabetes treatment and prevention. The online publication, ‘The Impact of Sotagliflozin on Renal Function, Albuminuria, Blood Pressure, and Hematocrit in Adults with Type 1 Diabetes’, may be accessed here https://doi.org/10.2337/dc19-0937.

Canada enacts drug price crackdown, in blow to pharmaceutical industry

The Canadian government on Friday announced final regulations to reduce patented drug prices it said would save Canadians C$13.2 billion ($10 billion) over a decade, overriding heavy opposition from pharmaceutical companies.

The changes are the biggest reform to Canada’s drug price regime since 1987. They will save money for patients, employers and insurers including the government at the expense of drug company profits. They also could eventually cut the earnings of drugmakers in the United States, the world’s largest pharmaceutical market.
The Canadian Life and Health Insurance Association called the regulations “a crucial step to lower prescription drug costs for all Canadians.” The province of British Columbia also applauded the move, saying in a release: “People in B.C. and across Canada are now better protected against excessive drug prices set by manufacturers.”
The new rules were largely in line with a December 2017 draft. They came after months of delay prompted speculation the government would back down in the face of industry lobbying or simply run out of time before Canada’s October election.
“We are taking the biggest step in a generation to lower the price of drugs in Canada by moving forward with these regulations,” Minister of Health Ginette Petitpas Taylor said in an interview.
Petitpas Taylor said the new rules would lay the foundation for a new national pharmaceutical care program. Prime Minister Justin Trudeau’s government is expected to announce a program to cover the cost of prescription drugs for some or all Canadians, but the program’s scope is not yet clear.
Under the new rules, Canada will change the list of countries the federal drug price regulator, the Patented Medicine Prices Review Board (PMPRB), compares domestic prices to, dropping the United States and Switzerland where prices are highest. It will also let the agency consider the cost-effectiveness of new medicines.
It will also force drugmakers to disclose some confidential discounts to the PMPRB, which sets maximum prices.
Initially expected to go into effect in January, the regulations were delayed so the government could review feedback. They will now go into force on July 1, 2020.
The new features of the regulations, which take into account cost-effectiveness of medicines and their impact on government budgets, apply only to drugs approved by Health Canada after the rules are officially published later this month. Changes in the list of comparison countries could affect prices for some drugs already on the market.
POTENTIAL FOR COURT CHALLENGE
Canada’s approach to drug pricing is unusual. Rather than bargaining prices down, the PMPRB declares that some prices are an illegal abuse of patent rights.
Drugmakers base their list prices on the agency’s published guidelines. When there is disagreement, PMPRB staff can challenge drugmakers at an internal tribunal. Most cases are settled, but appeals go to federal court and beyond.
In the past, drug companies have gone as far as the Supreme Court of Canada to challenge PMPRB guidelines. With new regulations come new guidelines, and the potential for fresh court challenges.
“We anticipate a considerable uptick in litigation, at least initially, as the industry patentees test the boundaries of the new regime,” said Douglas Clark, executive director of the PMPRB, on a call with reporters. “That’s to be expected any time you substantially change rules.”
University of British Columbia professor Steve Morgan, who studies access to drugs and has advocated for a new national drug program, called the rules “a bold step forward”.
“Now the tricky part: implementation, with all the specifics concerning how rules will apply; and, no doubt, legal challenges from industry,” he wrote in a tweet.
REFORMS COULD AFFECT U.S. MARKET
Global drugmakers, including Johnson & Johnson, Merck & Co and Amgen Inc, argued against the draft plan.
While the government’s focus is on reducing domestic patented drug prices that are among the highest in the world, the new policy could eventually have consequences south of the border.
The Trump administration in July said it would allow U.S. states and other groups to start pilot programs related to importing drugs from Canada. It has also said it may start determining what the government healthcare program Medicare pays for certain medicines based on prices in some other countries, including Canada.
Reuters reported in February that pharmaceutical lobby groups had tried to head off the Canadian reforms with an offer to give up C$8.6 billion in revenue over 10 years, freeze prices or reduce the cost of treating rare diseases.
“The revised regulations could limit Canadian patients’ access to new innovative medicines by delaying, even discouraging the launch of new medicines in Canada,” said Innovative Medicines Canada, the main industry lobby group, in a statement. “They could also discourage investment in Canadian health research.”
The government has argued many countries with lower prices have more pharmaceutical industry investment and access to drugs that meets or exceeds Canada’s.

Cutera up 24% on Q2 beat

Cutera (CUTR +23.6%Q2 results:
Revenue: $47.8M (+12%).
Net income: $0.6M (+137%); EPS: $0.04 (+136%).
Non-GAAP EBITDA: $4.4M.
Cash flow ops: $4.0M (+14%).
2019 guidance: Revenue: $165M – 175M; non-GAAP EBITDA: $2M – 4M (both unchanged).

EPA seeks limits on state powers to block pipelines, terminals

The Environmental Protection Agency unveils a proposal that would curb state powers to block pipelines and other energy projects, as part of the Trump administration’s effort to boost development of domestic oil, gas and coal.
The EPA’s proposal is centered on changes to Section 401 of the Clean Water Act, which allows states and tribes to block energy projects on environmental grounds.
The measure would target New York and other states that have cited Clean Water Act authority in decisions that have blocked or delayed projects, EPA Administrator Andrew Wheeler says.
The proposal sets in motion a 60-day public comment period.
ETFs: XLEVDEXOPERXOIHERYDIGBGRGUSHFENYIYEDUGDRIPIEOFIFNDPPXERYEPXJ