Managed Care - January 2009 - (Page 49)

TOMORROW’S MEDICINE daily tablet and titrated by 25 mg increment to the desired endpoint. Both are titrated, but of interest is that eltrombopag is typically started as a 50 mg dose except in patients who are of east Asian ancestry, where a starting dose of 25 mg per day is recommended. The maximum dose of eltrombopag is 75 mg per day. There is no weight adjustment for eltrombopag as there is for romiplostim. Cessation of therapy is recommended for both treatments after four weeks if the desired increase in platelet count is not reached. The price of the drugs varies significantly also. Eltrombopag carries a wholesale acquisition price (WAC) of $1,650 for a 30-day supply of 25 mg tablets and $3,300 for the 50 mg dose. To obtain the 75 mg dosage, multiple tablets must be administered each day. At a maximum dose of 75 mg, eltrombopag would cost just shy of $5,000 per month. For romiplostim, the dose varies based upon weight and titration. At the maximum dose for a 70 kg (150 lb) individual the monthly cost would be about $12,000. What’s New on PTcommunity.com? Formulary Kits Visit PTcommunity.com and review the latest formulary kits, including: • Arimidex (anastrozole) • Aromasin (exemestane tablets) • Boniva (ibandronate sodium) • Eraxis (anidulafungin IV) • Faslodex (fulvestrant injection) • FreeStyle Navigator (continuous monitoring glucose system) • Fosrenol (lanthanum carbonate) • Gelclair (bioadherent oral gel) • Lialda (mesalamine) • Nexium (esomeprazole magnesium) • Revlimid (lenalidomide) • Sancuso (granisetron transdermal system) • Tev-Tropin [somatropin (rDNA) for injection] • Vaprisol (conivaptan hydrochloride injection) • Veramyst (fluticasone furoate) A stepped care approach Obviously, if eltrombopag successfully treats ITP, the cost might be considerably less per month than the biologic romiplostim. But eltrombopag is accompanied by more monitoring because of the potential of liver abnormalities. Since romiplostim carries weight-dependent dosing, treating obese patients can have significant cost implications. In addition, there are convenience and administration issues that might sway patients and physicians in the choice. Overall, a stepped care approach may be of interest to managed care organizations to take advantage of the differences. But of more importance is the fact that science has progressed to the point where small molecules and biologic drugs are now competing in the marketplace for the same receptor and clinical endpoints, an event that again proves the importance of developing Tomorrow’s Medicine! MC The author is a director in the value-based health department at Genentech Inc. During the last three years, before taking the Genentech position, he received honoraria or other financial benefits from: Amgen, Amylin Pharmaceuticals, AstraZeneca, Biogen Idec, Centocor, Galderma, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Novo Nordisk, Pfizer, Procter & Gamble, Q-Med, Sanofi-Aventis, Teva Pharmaceuticals Industries, UCB, and Wyeth. The views expressed in Tomorrow’s Medicine are the author’s alone. P&T Digest These peer-reviewed publications provide health care providers with up-to-date information about the most efficacious and cost-effective medical treatments. Features and Resources Subscribers have access to the Triple i Drug Database (an online resource for reliable clinical drug information), P&T Clinical Briefs, and hospital pharmacy benchmarking forms. Product Profilers • Revlimid • Remicade JANUARY 2009 / MANAGED CARE 49 http://www.PTcommunity.com http://www.PTcommunity.com http://www.PTcommunity.com

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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