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Saturday, October 15, 2022

New Biden order wants CMMI to test payment models that tackle high drug prices

 President Biden is calling for new payment and delivery models that will lower drug prices in a new executive order. 

The order released Friday calls on the Department of Health and Human Services to craft a report outlining the payment models that will test how to improve access to innovative drugs and lower costs for those in Medicare and Medicaid. While the order doesn’t grant any new authorities to HHS, it underscores the administration’s next steps in lowering drug prices.

“Too many Americans face challenges paying for prescription drugs,” the order said. “On average, Americans pay two to three times as much as people in other countries for prescription drugs, and one in four Americans who take prescription drugs struggle to afford their medications.”

The order applies to models that can be tested under the Center for Medicare and Medicaid Innovation.

The center has been working to incorporate drug price reform in some of its models. For example, CMMI rolled out the Enhancing Oncology Model back in June, which seeks to steer oncology practices towards more high-value drugs and not necessarily the most expensive pharmaceuticals.

The push to consider drug prices at CMMI comes as the center is incorporating new provisions to address gaps in health equity, including a new requirement in the ACO REACH model for participants to craft an equity plan. Improving health equity is another major health priority for the Biden administration. 

The new order comes as the administration is implementing drug price reforms passed as part of the Inflation Reduction Act earlier this year. The law for the first time grants Medicare the power to negotiate prices on a small subset of Parts B and D drugs starting in 2026.

Starting this month, CMS also implemented a new cap on out-of-pocket monthly costs for drug prices that go beyond the rate of inflation. A report released last month by HHS showed that more than 1,200 products rose prices past inflation last year, underscoring the potential impact of the new inflationary cost cap. 

Another part of the Inflation Reduction Act is a $35 cap on monthly insulin costs for Medicare patients.

https://www.fiercehealthcare.com/payers/new-biden-order-wants-cmmi-test-payment-models-tackle-high-drug-prices

Despite pandemic slowdown, biosimilars keep gaining market share in the US: Amgen report

 In terms of approvals and launches, the biosimilars industry experienced a slowdown during the pandemic. But in the lab, there has been no such stagnation in the development of the copycats.

Even as the industry nears a critical moment in the U.S., the field appears to have picked up some significant momentum in the last few years, Amgen said in its "2022 Biosimilar Trends Report."

After biosimilars entered the scene in the U.S. in 2015, approvals and launches gained steam each year through 2019. In that year, 10 biosimilars won approvals and seven launched in the U.S., Amgen's report said. But in the pandemic years of 2020 and 2021, there were just a combined seven approvals and eight launches in the U.S.

By contrast, during this period, the number of biosimilars in development has steadily increased. A global snapshot from March of each of the last four years shows 77 programs in development in 2019, followed by 79 (2020), 90 (2021) and 96 (2022).  

The most potentially impactful biosimilars are coming to the U.S. market in 2023, when copycats of AbbVie’s mega blockbuster Humira are set to debut. Amgen’s report shows how the introduction of Humira biosimilars in Europe three years ago sliced the branded med's share of sales there to 34%, while the top three biosimilars from Amgen, Sandoz and Samsung Bioepis now account for 20%, 19% and 15% of the market share, respectively.

Amgen points out that comparing biosimilar uptake in the U.S. and Europe is a dicey proposition because of their differing healthcare systems. To illustrate this, the report adds that there are significant differences in biosimilar uptake from country to country in Europe, ranging from Amgen’s 41% share in the U.K. with its Humira biosim Amgevita to its 19% share in France.

The report, in its ninth edition, also points to evidence of the growing commercial impact of biosimilars in the U.S. For therapeutic areas in which biosimilars launched before 2019, their average market share after three years was 39%. For biosimilars launched in the last three years, their average share is 75%.

Biosimilar drugs are providing some pricing relief, too. In the U.S., most biosimilar drugs are covered under the medical benefit, which covers medicines typically administered by a doctor. For biosimilars covered under this benefit, they have launched with a wholesale acquisition cost between 10% and 57% lower than their branded counterparts, the report says.

Similarly, savings by the U.S. healthcare system because of biosimilars has increased steadily and significantly in each quarter since they were introduced. Total savings to the system over the last six years has been $21 billion, Amgen estimates. In the second quarter of this year alone, the figure was $3.2 billion.

https://www.fiercepharma.com/pharma/all-signs-point-growing-impact-biosimilars-amgen-says

Atara on verge of landmark approval for first allogeneic T-cell therapy

 With a thumbs up from Europe’s Committee for Medicinal Products for Human Use (CHMP), Atara Biotherapeutics’ Ebvallo is poised to become the first allogeneic T-cell therapy approved in the world.

Premanufactured from unrelated donor cells, Ebvallo differs from current autologous T-cell therapies—such as Bristol Myers Squibb’s Abecma and Breyanzi and Gilead’s Yescarta and Tecartus—which are derived from a patient's own immune cells.

The positive recommendation comes for the treatment of Epstein-Barr virus-positive, post-transplant lymphoproliferative disease in patients who have undergone at least one prior therapy—most often chemotherapy for solid organ transplant recipients. After the CHMP decision, Atara expects a formal sign-off from the European Commission this year.

Under a recently amended commercialization deal with Pierre Fabre, the company stands to get a $30 million milestone payment upon European approval.

Ebvallo's forthcoming approval stands to become landmark achievement for the San Francisco-based company after a difficult year attempting to advance its T-cell treatments. 

After a patient died in Atara’s trial of an autologous T-cell candidate, enrollment in the study was halted and commercial partner Bayer pulled out of a $670 million partnership. 

But the company did disclose a piece of good news from the FDA this summer. After the agency previously recommended the company run a clinical trial for Ebvallo with finished commercial product, the company reported in August that the agency has identified a potential path toward a submission without a new trial.

The CHMP recommendation is “further validation for our unique EBV T-cell platform,” Atara CEO Pascal Touchon said in a release. “(Ebvallo) has the potential to change the treatment paradigm for patients with relapsed or refractory EBV+ PTLD who face a poor prognosis and dismal median survival of only weeks to a few months.”

Other CHMP decisions

It wasn't just Atara making news at CHMP this week. Regeneron has secured a positive opinion for Libtayo for the treatment of cervical cancer. Already approved in Europe and the U.S for basal cell carcinoma, advanced cutaneous squamous cell carcinoma and advanced non-small cell lung cancer, Libtayo is the first treatment to demonstrate improved survival to chemotherapy in second-line setting regardless of PD-L1 expression status or tumor history, Regeneron said.

Also receiving a CHMP blessing is Mirum Pharmaceuticals for Livmarli to treat patients with the rare, progressive liver disease Alagille syndrome. Livmarli won U.S. approval in September of last year. San Francisco-based Mirum is in a battle with Albireo’s Bylvay to treat three pediatric liver disorders.

The CHMP also recommended approvals for Eladynos’ abaloparatide for the treatment of osteoporosis; Spevigo’s spesolimab for pustular psoriasis; Pluvicto’s lutetium for prostate cancer; and Locametz’s gozetotide, a radiopharma agent to diagnose prostate cancer.

Three generics also got nods—Teva’s dimethyl fumarate for MS, Baxter’s pemetrexed for mesothelioma and Accord’s plerixafor for lymphoma and multiple myeloma.

https://www.fiercepharma.com/pharma/atara-verge-landmark-approval-first-allogenic-t-cell-therapy

How 5 payers are reforming prior authorization systems

 Though providers have been largely critical of payers for what they say are slow or ineffective prior authorization reforms, these are five innovative systems introduced by payers this year: 

BCBS Massachusetts said Oct. 12 it partnered with AI company Olive for a prior authorization pilot at Boston-based New England Baptist Hospital. Eighty-eight percent of prior authorization submissions were processed automatically in real time, and approval times went from an average of nine days to an average of less than one day.

Regence and MultiCare Connected Care in Tacoma, Wash., said Oct. 11 they have launched the nation's first HL7 FHIR-based prior authorization system to allow providers to submit requests directly from MultiCare's EHRs.

Blue Cross Blue Shield of Wyoming and Eden Prairie, Minn.-based Itiliti Health said May 2 they are partnering to create a cloud-based automatic prior authorization system for providers. The new system will allow providers to quickly determine if they need to submit a prior authorization request without contacting BCBS and has been shown to reduce requests by 30 percent.

Optum on Feb. 17 launched Specialty Fusion, a new solution from the UnitedHealth Group subsidiary that allows payers and providers to manage specialty drug treatments with real-time data. It also looks to address burdens associated with prior authorization by giving providers the ability to kick off the approval process from one portal.

Florida Blue became the first U.S. payer to use AI-powered clinical reviews to automate its prior authorization process in February through a partnership with Olive. The company said requests with immediate responses saw turnaround timelines shrink by 10 days and unnecessary requests were reduced by 27 percent.

Another large prior authorization reform from a healthcare organization this year was the Ohio Hospital Association partnering with Columbus-based Rhyme in June to improve efficiencies within prior authorization at hospitals and health systems across the state. The platform replaces the process with intelligent collaboration between payers and providers by integrating into providers' existing workflows to make interactions faster.

https://www.beckerspayer.com/payer/how-5-payers-are-reforming-prior-authorization-systems.html

Bringing immune cells up to speed

 Cancer cells use an unusual mechanism to migrate into new tissue and form metastases there. The same process probably also keeps some immune cells on their toes. This is the result of a recent study led by the University of Bonn. According to the study, certain structures, the centrioles, increase in number. This makes it easier for them to maintain their direction and thus migrate more quickly to the lymph nodes, where they activate other immune cells. The results have now been published in the Journal of Cell Biology.

Like the police, the immune system relies on division of labor. First of all, there are the dendritic cells. They search the tissue around the clock for traces of suspicious intruders, called antigens. If they are successful, they rush to the lymphatic vessels and from there to the draining lymph nodes. There they present their findings to a powerful search team, the T cells. These endogenous troops now know which enemy to fight.

This attack must take place before the invaders cause major damage or multiply too much. It is therefore important that dendritic cells migrate as quickly as possible to the briefing in the lymph node. "We have discovered a mechanism that helps them doing this," explains Prof. Dr. Eva Kiermaier from the LIMES Institute (Life and Medical Sciences) at the University of Bonn. "To do so, they form more of certain structures called centrosomes. These help them maintain their direction for longer and thus reach the lymphatic vessels more quickly."

Important function in cell division

Centrosomes belong to the organelles -- these are molecular complexes that are responsible for specific tasks in cells, much like the organs in the body. Normally, there is exactly one centrosome in each human cell. Shortly before cell division, it doubles. The two copies migrate to opposite poles of the cell and stretch a bundle of fibers between them, the microtubules. With them, they pull the chromosomes (which have also doubled) apart during division. Each of the resulting daughter cells thus receives a complete set of genetic material as well as one of the two centrosomes.

"However, centrosomes are also responsible for organizing the cytoskeleton during cell migration," emphasizes Kiermaier, who was brought to the Rhine from Lower Austria (IST Austria, Klosterneuburg) in 2017 through the returnee program of the state of North Rhine-Westphalia. "By this we mean fiber-like structural proteins that give the cell its shape and provide it with stability." The cytoskeleton also decides where "front" and "back" are in a cell. And that, in turn, affects its direction of movement. "We have now been able to show that dendritic cells form multiple centrosomes as soon as they come into contact with an antigen," says Ann-Kathrin Weier. The PhD student at the LIMES Institute shares first authorship of the publication with her colleague Mirka Homrich. Both performed important parts of the experiments.

Staying the course longer to reach the destination more quickly

Dendritic cells have a problem: they do not know where the next lymphatic vessel is via which they can reach the lymph node. In their search, they proceed according to the strategy of "trial and error": they run in one direction for a short while and then change it if they have not encountered a vessel in the process. "The more centrosomes they have, the longer they stay on course before continuing to search in a different direction," says Mirka Homrich. "We were able to show in computer simulations that this allows them to find the lymphatic vessels much faster than they normally would." In the process, the proliferation of centrosomes adjusts their staying power just right -- so they don't stick too stubbornly to their direction. This would increase the risk of them going astray and getting completely lost.

The mechanism identified in the study was previously completely unknown in healthy cells. Cancer cells were assumed to use it to form metastases. However, the multiplied centrosomes must not be freely distributed inside the cells. Otherwise, they would severely disrupt functions such as cell division. In both tumor and dendritic cells, the organelles therefore congregate at a single site -- they cluster. "There are now agents that disrupt this clustering of centrosomes," says Kiermaier, who is also a member of the ImmunoSensation2 Cluster of Excellence and the Transdisciplinary Research Area "Life and Health" at the University of Bonn. "As a result, the cancer cells can no longer divide correctly, but die."

However, it is also possible that these substances interfere with the immune system -- after all, the centrosomes cluster there as well. "We've tested several of these agents in cell cultures," she says. "We've actually found evidence that they could significantly impair the effectiveness of the immune defense." If that will be confirmed in clinical trials, it would be bad news as there could be considerable side effects if the active substances were used in cancer therapy.

Participating institutions: In addition to the University of Bonn, the Charles University in Vestec, Czech Republic, and the Institutes of Science and Technology in Austria and Spain were involved in the work.


Story Source:

Materials provided by University of BonnNote: Content may be edited for style and length.


Journal Reference:

  1. Ann-Kathrin Weier, Mirka Homrich, Stephanie Ebbinghaus, Pavel Juda, EliÅ¡ka Miková, Robert Hauschild, Lili Zhang, Thomas Quast, Elvira Mass, Andreas Schlitzer, Waldemar Kolanus, Sven Burgdorf, Oliver J. Gruß, Miroslav Hons, Stefan Wieser, Eva Kiermaier. Multiple centrosomes enhance migration and immune cell effector functions of mature dendritic cellsJournal of Cell Biology, 2022; 221 (12) DOI: 10.1083/jcb.202107134


Developing broad-spectrum antiviral therapies

 Researchers have identified a promising strategy for development of broad-spectrum antiviral therapies that centers around promoting a strong immune response capable of stopping a number of viruses in their infectious tracks.

Experiments in cell cultures and mice showed that blocking the function of a specific enzyme present in all cells triggers a powerful innate immune response, the body's first line of defense against any foreign invader. When challenged by several types of viruses in the study, this response dramatically lowered replication of viral particles and protected mouse lungs from damage.

There are still several avenues to explore, but the scientists say the finding could help change the approach to developing antiviral medications.

"Typically, in antiviral development, the saying is, 'one bug, one drug,'" said Jianrong Li, co-senior author of the study and a professor of virology in The Ohio State University Department of Veterinary Biosciences and Infectious Diseases Institute.

"A drug that can stimulate the immune system to have broad antiviral activities would be very attractive -- one drug against multiple bugs would be an ideal situation."

The study is published in the journal Proceedings of the National Academy of Sciences.

This discovery was enabled in part by a technique the researchers used to map the precise location of an RNA modification they were studying, and to see which enzyme made the modification. The mapping led them to determine that this enzyme's work happens not in viruses, but in mammal hosts that viruses want to infect.

"If you can detect the modification, then you can study it and target it. But it took a while to figure this out -- in the beginning of the pandemic, a lot of people, including our lab, were studying RNA modifications in hosts and viruses," said co-senior author Chuan He, John T. Wilson Distinguished Service Professor of chemistry, biochemistry and molecular biology at the University of Chicago. "It turns out the key here is not a viral RNA modification, but a host RNA modification, and it triggers a host immune response."

Viruses tested against the immune response in this study included two that can cause severe respiratory infections in infants and the elderly, human respiratory syncytial virus and human metapneumovirus, as well as a mouse respiratory virus called Sendai virus, the vesicular stomatitis virus found in cattle and the herpes simplex virus, a DNA virus. Replication and gene expression of all of these viruses were significantly reduced when the enzyme was blocked, and the researchers said preliminary data from earlier studies in cell cultures suggested the SARS-CoV-2 virus could be similarly controlled by this antiviral strategy.

The RNA modification itself, known as cytosine-5 methylation, or m5C, is actually what needs to be altered to trigger the immune system response. It is one of roughly 170 known chemical modifications on RNA molecules in living organisms that affect biological processes in a variety of ways.

In lieu of targeting the modification, researchers were able to inhibit the function of a key enzyme in that process, called NSUN2, to stop the RNA change. Suppressing NSUN2 using gene knockdown techniques and experimental agents, they found, sets off a cascade of cell activities that leads to robust production of type 1 interferon, one of the most potent fighters in the innate antiviral response.

"Amazingly, blockage of NSUN2 almost completely shuts down the replication of vesicular stomatitis virus, a model virus that normally kills the host cells within 24 hours and replicates to a very high titer, and strongly inhibits both RNA and DNA viruses," said study co-first author Yuexiu Zhang, a PhD student in Li's lab.

It turns out that blocking NSUN2's function in cells exposes RNA snippets that, despite belonging to the host, are seen as foreign invaders, which triggers the type 1 interferon production. Once available at this high level, the protein will stop the real threat: viruses trying to cause infection.

The researchers verified this sequence of events during experiments in multiple types of cells and human lung models before observing the effects of blocking NSUN2 in mice.

"We compared NSUN2-deficient mice with wild-type mice to see how the viruses act," Li said. "Once we inhibited NSUN2, viral replication in the lung decreased and there was less pathology in the lung, and that correlated with enhanced type 1 interferon production.

"This finding in mice and our other experiments proved that NSUN2 is a druggable target."

Next steps include developing a drug designed specifically to suppress NSUN2's function, the researchers said.

This study was supported by grants from the National Institutes of Health and the Howard Hughes Medical Institute, where He is an investigator.

Li-Sheng Zhang, a postdoctoral researcher in He's lab, was co-first author of the work. Additional co-authors include Mijia Lu, Elizabeth Kairis, Valarmathy Murugaiah, Jiayu Xu, Rajni Kant Shukla, Xueya Liang, Estelle Cormet-Boyaka and Amit Sharma of Ohio State; Qing Dai and Zhongyu Zou of the University of Chicago; Phylip Chen and Mark Peeples of Nationwide Children's Hospital; and Jianming Qiu of the University of Kansas Medical Center.

He is a scientific founder of the drug-development company Accent Therapeutics, and Li and He have filed a provisional patent.


Story Source:

Materials provided by Ohio State University. Original written by Emily Caldwell. Note: Content may be edited for style and length.


Journal Reference:

  1. Yuexiu Zhang, Li-Sheng Zhang, Qing Dai, Phylip Chen, Mijia Lu, Elizabeth L. Kairis, Valarmathy Murugaiah, Jiayu Xu, Rajni Kant Shukla, Xueya Liang, Zhongyu Zou, Estelle Cormet-Boyaka, Jianming Qiu, Mark E. Peeples, Amit Sharma, Chuan He, Jianrong Li. 5-methylcytosine (m 5 C) RNA modification controls the innate immune response to virus infection by regulating type I interferonsProceedings of the National Academy of Sciences, 2022; 119 (42) DOI: 10.1073/pnas.2123338119


DOJ Sued On Refusal To Explain Zero Protection For Conservative Supreme Court Justices' Homes

 by Matthew Vadum via The Epoch Times (emphasis ours),

A conservative group is suing the U.S. Department of Justice for refusing to explain why it won’t enforce a federal law forbidding what the group called “the recent intimidatory protests carried out by radical abortion supporters” outside the homes of conservative Supreme Court justices in connection with the reversal of Roe v. Wade earlier this year.

Raucous protests began at the homes of the six right-leaning justices in Maryland and Virginia in the wake of the unprecedented May 2 leak of a draft opinion foreshadowing the court’s June 24 decision to overturn the 1973 Roe v. Wade abortion precedent, and escalated after the ruling itself was issued.

Nicholas John Roske was arrested on June 8 for his alleged plan to assassinate Justice Brett Kavanaugh at his Maryland home. Roske reportedly said he wanted to kill Kavanaugh to prevent him from voting to overturn abortion rights and gun control laws.

Section 1507 of Title 18 of the U.S. Code makes it unlawful to picket or parade at or near a residence of a judge with the intent of “influencing any judge … in the discharge of his duty.” Violators face up to a year in prison, a fine, or both. The section has been challenged in previous legal proceedings but has survived constitutional scrutiny.

The case, Heritage Foundation v. Department of Justice, court file 22-cv-3102, was filed on Oct. 12 in U.S. District Court for the District of Columbia.

The Heritage Foundation’s Oversight Project filed suit, claiming the DOJ has refused to provide documents requested under the Freedom of Information Act explaining why it won’t enforce Section 1507. Heritage said its demands for records from various DOJ offices, including the Office of the Attorney General, Office of Legal Counsel, the FBI, and the U.S. Marshals Service weren’t complied with.

“The Biden DOJ’s silence on these radical protests and obviously intimidating tactics was, and remains to be, deafening,” Roman Jankowski, senior investigative counsel for the Oversight Project, said in a statement.

The American people deserve to know why Joe Biden and Attorney General Merrick Garland not only refused to publicly and unequivocally condemn this behavior, but also why they continue not to prosecute or hold accountable those who facially broke the law in an attempt to influence the proceedings of the Supreme Court. We think there are answers to those questions in the documents we have requested, and we have a right by law to those documents.”

On May 10, then-White House press secretary Jen Psaki refused to condemn the protests while insisting that the president supports “peaceful protest.”

Supreme Court Marshal Gail Curley, who is responsible for court security, wrote letters to Maryland officials on July 1 demanding they do more to protect justices whose lives have been threatened, as The Epoch Times previously reported. Curley urged officials to have the Maryland State Police enforce state law, citing 3-904(c) of the Maryland Criminal Code, which provides a person “may not intentionally assemble with another in a manner that disrupts a person’s right to tranquility in the person’s home.”

Maryland Gov. Larry Hogan, a Republican, and Montgomery County, Maryland, Executive Marc Elrich, a Democrat, sharply rebuked Curley, saying it’s the federal government’s job to protect the justices.

Hogan’s press secretary, Michael Ricci, replied to Curley on Twitter, accusing her of being misinformed and of providing “conflicting information.”

Ricci tweeted, “Had the marshal taken time to explore the matter, she would have learned that the constitutionality of the statute cited in her letter has been questioned by the Maryland Attorney General’s Office.”

But when pressed repeatedly, the office of state Attorney General Brian Frosh, a Democrat who isn’t seeking reelection in next month’s elections, has refused to confirm that it holds the view that the Maryland criminal law is unconstitutional.

https://www.zerohedge.com/political/doj-sued-over-refusal-explain-zero-protection-conservative-supreme-court-justices-homes