Highlights from Academy of Managed Care Pharmacy (AMCP) Nexus 2022

Laura R. Bobolts, PharmD, BCOP

Senior Vice President, Clinical Strategy and Growth
OncoHealth
Ft. Lauderdale, FL

AMCP Nexus 2022 took place October 11-14th in National Harbor, MD. AMCP (Academy of Managed Care Pharmacy) represents pharmacy leaders at health plans, PBMs, specialty pharmacies, and biopharmaceutical companies among others working within managed care pharmacy. The conference hallways at AMCP Nexus were a-buzz as this meeting likely drew in more attendees than pre-pandemic. The meeting fostered a positive learning environment for pharmacists, especially those in the growing field of oncology managed care.

Below are educational sessions focused on oncology managed care, highlighted for our HOPA members:

• “Oncology Biosimilars: Formulary Trends, Evidence, and Strategies from the Payer and Patient Advocate Perspective”1
  
  This presentation focused on therapeutic oncology biosimilars. Real-World evidence of biosimilar bevacizumab, trastuzumab, and rituximab products, demonstrated similar safety and efficacy outcomes as compared to historical reference product controls. One-year overall survival was non-inferior with bevacizumab-awwb versus bevacizumab in a metastatic colorectal cancer study. A single center, Italian study found similar safety profiles among patients switching from reference rituximab to biosimilar rituximab versus those continuously treated with reference rituximab. One study of 507 US providers highlighted that provider choice of unique product, biosimilar versus reference, was driven by formulary and insurance with providers and patients caring about efficacy and safety, then cost.
  
  Speakers:
  • Timothy Mok, PharmD, BCPS, BCOP, Hematology Oncology Pharmacy Research Analyst, Clinic Administered and Specialty Medications, Kaiser Permanente Drug Use Management
  • Therese Mulvey, MD, FASCO, Director Quality Safety and Value, Massachusetts General Hospital, Harvard Medical School
• “The Accelerated Approval Pathway: Current Challenges and the Managed Care Impact”2
  
  Speakers discussed eye-opening statistics and payer challenges managing medications approved via accelerated approval. 72% of drugs FDA approved under the accelerated approval pathway from 1992 to 2021 were for the treatment of cancer. 38% of accelerated approvals within the past 30 years have not converted to a full approval, with 11% withdrawn. 28% of outstanding confirmatory studies have no data available to indicate the confirmatory study has even begun. A BMJ study was highlighted that evaluated 18 oncology accelerated approval indications with negative post-approval studies in which 61% were voluntarily withdrawn, 6% had the indication revoked, yet 33% remain on the market unrestricted. Despite its many successes, some drugs approved via the accelerated approval pathway may provide low-value prompting discussion of potential payer management strategies.
  
  Speakers:
  • Leslie Fish, RPh, PharmD, VP of Pharmacy, IPD Analytics, LLC
  • Michelle Rogers, PharmD, BCPS, Director Clinical Pharmacy, IPD Analytics, LLC
• “Oncology Pipeline 2022: Spotlight on Trends and Agents to Watch”3
  
  This session covered recently approved and upcoming approvals of high-impact oncology specialty drugs and potential managed care impact such as cost, place in therapy, and competitors. Pipeline bispecific antibodies, immune checkpoint inhibitors (ICI), cell therapies, tumor agnostic therapies, radiopharmaceuticals, and small molecules were highlighted. PD-1/PD-L1 inhibitors were a hot topic given their high budget spend for payers. Speakers discussed the FDA’s review of China-only PD-1 studies, ICI expansion into earlier neoadjuvant and adjuvant treatment settings, and the status of PD-1/PD-L1 inhibitor disruptors thought to enter the market at a discount. Hopes of driving down spend through competition may be blunted. The rapid pace of FDA approvals for PD-1/PD-L1 inhibitor combination regimens could impede the market disruption of anticipated lower-cost PD-1 agents without combination indications.
  
  Speakers:
  • Kaelyn C. Boss, PharmD, Clinical Consultant Pharmacist, Commonwealth Medicine University of Massachusetts Medical School
  • Bhavesh H. Shah, RPh, BCOP, Chief Pharmacy Officer Hematology/Oncology and Specialty Pharmacy, Boston Medical Center Health System
• “Understanding and Addressing Racial Disparities in Breast Cancer: A Payer, Provider, Patient, and Policy Analyst Perspective”4
  
  This panel started discussing the higher incidence of triple negative breast cancer (TNBC) experienced among black women, who also exhibit the lowest five-year TNBC survival at 71%. A TNBC survivor told her heart-felt story of her cancer journey. She began with her family tree and discussed the loss of her mother to metastatic TNBC at a young age. She detailed her struggles with dismissive providers and challenges with getting MRIs covered. She completed her story by showing her family tree – one family member after another faded into the power point background, passing away from cancer. A theme was evident—treat patients as individuals and fight hard to break down barriers to accessing high quality care. Certain races and ethnicities may be under-represented in clinical data that leads to the development of national screening guidelines. Payers need to have processes in place to treat cancer patients as individuals. Oncology is unlike other disease states. All stakeholders need to come together to address racial disparities and improve access to care.
  
  Speakers:
  • Laura R. Bobolts, PharmD, BCOP, SVP Clinical Strategy and Growth, OncoHealth
  • Latoya T. Hill, MPH, Senior Policy Analyst, Kaiser Family Foundation
  • Melanie A. Nix, MBA, Cofounder, Breast Cancer Comfort Site and Chief Visionary for Diagnosis to Destiny
  • Porscha Showers, PharmD, AAHIVE, Principal Medical Scientist, Gilead Sciences
  • Karen Winkfield, MD, PhD, Executive Director, Meharry-Vanderbilt Alliance

AMCP Nexus was a must-attend for this oncology managed care pharmacist! If you haven’t attended an AMCP conference, what are you waiting for? They include many hot topics in oncology, featuring top-notch BCOP speakers.

The meeting also included six oncology-focused satellite symposia covering managed care perspectives on HER2-low breast cancer, hormone receptor-positive/HER2-negative breast cancer, strategies for PARP inhibitors in ovarian cancer and a separate presentation in solid tumors, ROS1-targeted therapy in NSCLC, and BCMA-targeted therapies in multiple myeloma.

Additional sessions addressed prescription digital therapeutics, patient-centric value frameworks, best practices in addressing health disparities, changes in prior authorization and price transparency, specialty drug site of service, and Medicare Part B step therapy regulations.

If you missed Nexus, don’t worry, there is always next year! AMCP hosts two national meetings each year. The AMCP 2023 annual meeting will be in San Antonio, TX on March 21-24, 2023 (https://amcpannual.org/). AMCP Nexus 2023 will be in Orlando, FL on October 16–19, 2023 (https://amcpnexus.org/about/amcp-future-meetings).

I hope to see you at an AMCP conference in 2023!

Recommended Reading/References:

1. Mok T, Mulvey T. Oncology Biosimilars: Formulary Trends, Evidence, and Strategies from the Payer and Patient Advocate Perspective. AMCP Nexus 2022. October 12, 2022.
2. Fish L, Rogers M. The Accelerated Approval Pathway: Current Challenges and the Managed Care Impact. AMCP Nexus 2022. October 14, 2022.
3. Boss KC, Shah BH. Oncology Pipeline 2022: Spotlight on Trends and Agents to Watch. AMCP Nexus 2022. October 14, 2022.
4. Bobolts LR, Hill LT, Nix MA, Showers R, Winkfield K. Understanding and Addressing Racial Disparities in Breast Cancer: A Payer, Provider, Patient, and Policy Analyst Perspective. AMCP Nexus 2022. October 12, 2022.