From Specialty Pharmacy News

How Will New Factor Products Impact Hemophilia Management?

Reprinted from SPECIALTY PHARMACY NEWS, a monthly newsletter designed to help health plans, specialty pharmacies, pharma companies, providers and employers contain costs and improve outcomes related to high-cost specialty products. Subscribe today!

By Angela Maas, Managing Editor
October 2017Volume 14Issue 10

The hemophilia space has seen multiple products come onto the market in recent years. In other therapeutic classes experiencing a similar trend, this often leads to payers preferencing a product. But that strategy hasn’t been one that commercial health plans in particular are turning to, at least not so far.

Among respondents for the seventh edition of the Magellan Rx Management Medical Pharmacy Trend Report, released in April, 12% of 42 commercial health plans and 27% of eight Medicare plans said they preferenced an antihemophilic factor.

The relative lack of preferencing “might change as more products enter the category,” says John Louis, director of category management at Diplomat Specialty Infusion Group. “Today there are 16 products FDA-approved for the treatment of hemophilia A and eight for hemophilia B. In 2012, there were 10 for hemophilia A and only four for hemophilia B.”

According to Louis, “The greatest advancement in recent years is the introduction of longer-acting products.” This, he tells AIS Health, “has had the greatest impact on hemophilia B patients, where the half-life of products has allowed patients to decrease their infusion frequency in half. Longer-acting factor VIII products have had a smaller impact on the market, with more modest half-life improvements.”

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These products, says Kirstin Schmidt, national clinical director – bleeding disorder program at infusion services provider Option Care, part-owned by Walgreen Co., can decrease “the number of infusions a patient may need to prevent spontaneous bleeding episodes. The expanded product choice has made the marketplace more competitive, but this has not led to a decrease in cost.”

“This increase in options has opened the possibility for health plans and PBMs to start looking into product management,” asserts Haita Makanji, Pharm.D., vice president of clinical strategy and programs at Magellan Rx, the PBM unit of Magellan Health, Inc. “Furthermore, there have been several extended-acting products approved that can reduce injection frequency and improve the patient experience. Many of these agents also come with increased costs, and because of this, it is important to ensure that these agents are used responsibly and appropriately. Every patient metabolizes a drug differently, and Magellan Rx advocates use of personalized pharmacokinetic testing to ensure ideal dosing regimens are selected.”

Magellan Rx, she explains, “has completed a thorough clinical review of these products and has identified areas to optimize cost-effective care. The goal is not to drive patients to a single preferred product, but rather to identify the most cost-effective therapy for each individual patient through the use of additional clinical data (i.e., PK testing) and patient history.”

And the pipeline shows no signs of a slowdown. “Innovative therapies including monoclonal antibodies for inhibitor patients are anticipated in the near future,” says Makanji. “Gene therapy, which may be a potential cure to hemophilia, is also being studied. These therapies could be associated with extremely high cost and may need to be managed carefully to ensure that the patients are receiving the most valuable services.”

View the Magellan Rx report at

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