Premier Continuum of Care | June 2020
Coronavirus Disease 2019 (C VID-19): What We Know
PLUS • Introducing the Premier Continuum of Care Biosimilars Program • Category Spotlight: COVID-19 Recovery Portfolio Premier Continuum of Care | June 2020 1
EDITORIAL STAFF EDITOR IN CHIEF
Gary Feit, MS Vice President, Corporate Communications
CLINICAL EDITOR
Liya Davydov, PharmD, BCPS, BCGP Vice President, Clinical Pharmacy Services
MANAGING EDITOR
Eric Rodriguez Director, Corporate Communications
DESIGNER
Jaclyn Alvarado Creative Director, J2 Design NYC
COPY EDITOR Tina Harlan
PROOFREADER Laura F. Yandell
Table of Contents
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Insight | June 2020
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Coronavirus Disease 2019 (COVID-19): What We Know
Introducing the Premier Continuum of Care Biosimilars Program
Category Spotlight: COVID-19 Recovery Portfolio
555 West 57th St., 12th Floor New York, NY 10019 phone 888.258.3273 fax 646.638.2641 premierinc.com/alternatesites
Insight magazine is published by Premier and is complimentary for Premier members. For membership information, please call 888.258.3273. To submit ideas for editorial consideration, please contact Eric Rodriguez at 212.901.1242 or eric_rodriguez@premierinc.com. This publication is intended to provide general information on issues of interest to the members of Premier Healthcare Alliance, L.P., and its affiliates (collectively, “Premier�) and the general public. It does not constitute, nor should it be used as a substitute for any business, legal, or regulatory advice. Premier hereby disclaims all warranties, express or implied, as to the accuracy of any of the information contained herein, whether such information is up-to-date, or its fitness for any particular use or purpose. Nothing contained in it is intended as a treatment recommendation for any particular patient or group of patients. Treating institutions and/ or physicians must make all clinical decisions regarding the use of pharmaceuticals and other products on a case-by-case basis. You should always refer to federal, state, and local laws, rules, and regulations governing the operation of your organization and should consult your own legal counsel. The opinions expressed by the authors of articles included in this issue do not necessarily reflect those of Premier, its affiliates, or its representatives. Furthermore, some of the content contained herein may have been originally prepared by or funded by organizations with financial interests in products or services related to the topics discussed in such article. While every effort was made to ensure the accuracy of information conveyed in this magazine, Premier, its affiliates, and its representatives do not accept responsibility and cannot be held liable for any errors that may exist within the publication. Premier is not responsible for the contents of any Web pages that are referenced by this communication. Links from this communication to other sites do not constitute an endorsement by Premier. These links are for convenience only. It is the responsibility of the user to evaluate the content and usefulness of information obtained from other sites. Premier has no control over and is not responsible for the information, practices, or content of these or any other sites. The contents of this publication are protected by copyright and are the property of Premier. They may not be reproduced or transmitted in any form without the express written permission of Premier.
Coronavirus Disease 2019 (C VID-19): What We Know Liya Davydov, PharmD, BCPS, BCGP Vice President, Clinical Pharmacy Services, Premier Alternate Site Programs
[Current as of April 6, 2020]
Premier Continuum of Care | June 2020
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Origin and date first recorded The new coronavirus disease of 2019, abbreviated as COVID-19, was first identified in China, and the World Health Organization (WHO) was notified of the outbreak in late December 2019.1,2 Since that time, the virus has spread globally.1,2 The disease was categorized as a worldwide pandemic by the WHO on March 11, 2020 – the first pandemic caused specifically by a coronavirus.3 As of the first week of April 2020 more than 150 countries/regions have reported confirmed COVID-19 cases.4
Risk factors for severe symptoms or fatal outcomes While there is much to learn about this disease, some patterns have emerged. For instance, certain groups appear to be more affected by the disease and have more severe outcomes, including fatalities. Those at higher risk include people who are older (age 60 and above), long-term care facility residents, or anyone who has underlying conditions (including uncontrolled diabetes, hypertension, obesity with body mass index of at least 40 or higher, chronic lung disease [including moderate/severe asthma], heart disease, kidney failure, liver disease or compromised immunity [due to chemotherapy, smoking, immune deficiencies, etc.]). These populations tend to be more affected by the disease and have more severe outcomes, including fatalities.5,6
Signs and symptoms While this is a novel disease, and not all manifestations are well known yet, there are a number of signs and symptoms that have been identified to date. The apparent hallmark signs/ symptoms include cough, fever and shortness of breath, and if they do develop, it usually takes place within 2-14 days after contact with an infected individual (with a tendency for symptom development around day five).7,8 The disease can present with mild symptoms or may progress to severe sickness culminating in death.7 Some of the severe symptoms, which require urgent 2
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attention, include difficulty breathing/ drawing breath, persistent pain/pressure in the chest region, lips/face turning bluish color and inability to wake up or newly-developed confusion. It’s very important to understand that as more is discovered about the disease, additional signs/symptoms of the disease may become apparent, and as such, the above list of the manifestations is not all-inclusive.7 Once patients get sick, mild disease can linger for about 2 weeks, while severe/critical disease can take up to 6 weeks to clear.9 It is not yet known if it’s possible to be re-infected with COVID-19 after recovering from an original infection with COVID-19, or if a re-infected patient can develop symptoms more than once.10 There are some reports from China, however, indicating that those who tested negative after originally testing positive (meaning they have recovered), are now testing positive again. It is unclear if those patients were asymptomatic carriers or if they were developing a second round of disease. Testing errors are also a possibility.11 Patients who had COVID-19 symptoms and were in self-isolation, if they are not being tested to see if their tests are now negative, are allowed to leave isolation after at least 72 hours have passed since the last fever, and the patient has been afebrile for the past 72 hours without using any anti-pyretic medications. Additionally, at least seven days should have passed since the onset of symptoms.12 New research indicates, however, that in some patients, the virus can still be detected for as long as eight days after the disease clears.13
Prevention Practicing social distancing from others, not touching your hands to your mouth/eyes/nose/face, washing your hands frequently with soap and water for at least 20 seconds (or using alcohol-based sanitizer which should contain at least 60 percent alcohol) are all recommended preventative measures.14 Sneezes or coughs should be contained with a tissue, which should then be expediently disposed of into the trash.14 Additional protection measures, such as the use of masks and gloves, apply in circumstances when a person is already sick with COVID-19,
and should be worn by either the patient (if it’s feasible, because it may exacerbate difficult breathing patients may already experience) or by the caregivers, when the patient is not able to.14,15 Moreover, to protect themselves and others, it is advisable by the Centers for Disease Control and Prevention (CDC) that a covering be placed over nose/mouth when people go to public places (it doesn’t have to be an actual surgical mask, as those are to be reserved for healthcare providers, but something like a scarf, a home-made cloth mask, or a bandana would be advisable, though those coverings have their own associated downfalls).15,16 Patient items such as utensils, toiletries, bed sheets/pillow cases, etc. should not be shared with other members of the household and should be washed (sanitized) separately.15 Furthermore, surfaces that are touched often, and may harbor the virus, should be disinfected every day with an appropriate disinfectant (e.g., bleach solutions, alcohol solutions [containing 70 percent alcohol or higher]).14
Testing A lack of specific approved treatments and difficulty in preventing disease spread have been worldwide dilemmas. But the U.S. has faced yet another obstacle – the slow ramp-up of testing.17,18 The tests that were initially available were designed to provide results within several days.18,19 As of April 6, 2020, 28 tests had been approved by the Food and Drug Administration (FDA).20 The approval of Abbott’s ID NOW™ COVID-19 test, on March 27, 2020, was a huge step forward.21 This test is able to show positive COVID-19 results in five minutes, with negative results available in less than 15 minutes, and would be immensely useful on front lines for rapid testing, and in any type of healthcare setting (e.g., urgent care entities, health care practitioners’ offices, etc.).21 The company advised that it will be manufacturing about 50,000 units per day, to meet the demand, beginning the week of March 30, 2020.21 Another breakthrough was the April 1, 2020, approval of a test by Cellex, which identifies COVID-19 antibodies in blood. Test results are available in about 20 minutes from an authorized laboratory.22
These tests were moved forward under an Emergency Use Authorization (EUA), which allows the FDA to issue approvals more quickly during a public health emergency. Approvals of this type are valid only for the duration of the specified emergency.20,23 Still eagerly awaited is the introduction of an at-home test for COVID-19 antibodies that would indicate if an individual has ever had COVID-19. This is under development by Scanwell Health.24 The company has filed an EUA application with the FDA and expects a decision some time in June 2020.24 If approved, this would allow at-home testing and results within a few hours of a simple finger stick.24
Treatment Treatment is primarily supportive at this time. It varies by severity of symptoms and may include use of ventilators, oxygen, etc. (in more extreme cases).25 While there are as yet no approved pharmacological treatments or vaccines specifically for COVID-19, several existing drugs as well as newly developed medications and novel vaccines are undergoing extensive testing.25-28 Table 1 describes drugs that are currently undergoing investigational studies or have already had studies conducted.25-28 Earlier, a small study highlighted the combined use of hydroxychloroquine with azithromycin, which resulted in previously positive patients testing negative for COVID-19 by day five of treatment.29 Recently, the FDA granted (under emergency authorization) healthcare providers permission to use certain antimalarial drugs (i.e., hydroxychloroquine and chloroquine) to treat hospitalized patients with COVID-19.30-32 As per FDA’s EUA for hydroxychloroquine, the suggested dosing regimen in qualifying hospitalized patients who weigh at least 50 kg (110 lbs.) is 800 mg the first day (loading dose), followed by 400 mg/day for four to seven days of total treatment duration.31 The American Society of Health-System Pharmacists (ASHP) has released an evidence-based chart of all current potential treatments under investigation for COVID-19, with applicable proposed dosing regimens.28
Table 1.* Promising treatment modalities under consideration.25,26,28,29,31,32,41-65 Antiviral Drugs
Antimalarial Drugs
Disease-modifying Anti-rheumatic Drugs
Miscellaneous Drugs
Favipiravir (Avigan®, Favilavir)
Chloroquine phosphate
Anakinra
Ascorbic acid
Remdesivir
Hydroxychloroquine sulfate (Plaquenil®)
Sarilumab (Kefzara®)
Azithromycin
Tocilizumab (Actemra®)
Lopinavir-ritonavir (Kaletra®)**
Umifenovir (Arbidol®)
Methylprednisolone (DEPOMedrol®, SOLUMedrol®) Nitric Oxide gas inhalation Sirolimus *Only select treatment modalities with an anticipated potential for treating COVID-19 are listed in the table. **A recent study did not show benefit in severely ill hospitalized patients with COVID-19,41 but another study is currently ongoing to find out if the drug may be useful in patients with milder symptoms.42
This resource is available at www.ashp.org/-/media/assets/pharmacy-practice/ resource-centers/Coronavirus/docs/ASHP-COVID-19-Evidence-Table. ashx?la=en&hash=B414CC64FD64E1AE8CA47AD753BA744EDF4FFB8C.28 The chart also lists drugs that would be best avoided in patients who have tested positive for COVID-19.28 Specifically, there is a theory, which is not confirmed, that use of non-steroidal anti-inflammatory agents (NSAIDs) such as ibuprofen, naproxen, etc. should be avoided in patients with COVID-19, as they worsen the course of the disease.26, 28, 33 The FDA issued an advisory regarding the use of NSAIDs in COVID-19, indicating that patients taking these drugs for reasons other than COVID-19 should continue them.26,34 Further, some have theorized that, given the pathway that the virus uses to replicate, use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensinreceptor blockers (ARBs) may need to be discontinued.26,28,35 However, the American Heart Association (AHA), American College of Cardiology (ACC), the Heart Failure Society of America (HFSA), and the European Society of Cardiology (ESC) continue to recommend that ACEIs and ARBs continue to be taken as prescribed and not discontinued arbitrarily. Stopping these drugs abruptly in select patient populations could lead to negative health outcomes.36-38 In addition to the investigational treatments for the disease, there are over 35 unique vaccines in various stages of development.27 The very first vaccine trial (Moderna mRNA vaccine), funded by the National Institutes of Health, began on March 16, 2020.39 In the absence of an approved vaccine for COVID-19, however, convalescent sera is being investigated as a potential modality to provide passive antibody therapy either to prevent people from getting sick with COVID-19, or even to patients who are experiencing early COVID-19 symptoms.26,40 Premier Continuum of Care | June 2020
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Summary and additional information COVID-19 is an unfolding pandemic, with seemingly daily discoveries about the disease. Multiple treatment regimens are under consideration, without a single FDA-approved modality specifically for COVID-19. Newly approved rapid tests should enhance testing efficiency, help streamline treatment, and slow the spread of the virus. For additional up-to-date information on COVID-19, please visit the CDC page dedicated to coronavirus at www.cdc.gov/coronavirus/2019-ncov/index.html. For a snapshot of all medications under consideration as investigational agents, current thoughts on their effectiveness, and an explanation of drugs that should potentially be avoided in patients with COVID-19, please refer to this resource developed by ASHP: www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Coronavirus/docs/ASHPCOVID-19-Evidence-Table.ashx?la=en&hash=B414CC64FD64E1AE8CA47AD753BA744EDF4FFB8C. For current information on vaccine research for COVID-19, please refer to the vaccine tracker at www.raps.org/newsand-articles/news-articles/2020/3/covid-19-vaccine-tracker. For updated information on testing for COVID-19, visit the FDA’s page, which lists all currently approved diagnostic tests for this disease under EUA: www.fda.gov/medical-devices/emergency-situations-medical-devices/emergencyuse-authorizations#covid19ivd. For additional resources and to learn more about Premier’s COVID-19 response, visit www.premierinc.com/covid-19-response.
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28. American Society of Health-System Pharmacists, “Assessment of Evidence for COVID-19-Related Treatments,” accessed April 5, 2020. https://www.ashp.org/-/media/
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29. P. Gautret et al. “Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial,” International Journal of Antimicrobial Agents 105949 (2020). Epub ahead of print: DOI: 10.1016/ijantimicag.2020.105949.
30. “FDA Permits Emergency Use of Experimental Treatments for COVID-19.” Drug Topics (March 30, 2020). https://www.drugtopics.com/latest/fda-permits-emergency-useexperimental-treatments-covid-19?rememberme=1&elq_mid=11362&elq_cid=756025&GUID=B036063C-D02F-4370-B973-9BAB20E55A28.
31. U.S. Food and Drug Administration, “Fact sheet for health care providers. Emergency use authorization (EUA) of hydroxychloroquine sulfate supplied from the strategic national stockpile for treatment of COVID-19 in certain hospitalized patients,” accessed April 5, 2020. https://www.fda.gov/media/136537/download.
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Dong et al. “Discovering drugs to treat coronavirus disease 2019 (COVID-19),” Drug Discoveries & Therapeutics 14, no. 1 (2020): 58-60. DOI: 10.5582/ddt.2020.01012. 52. “Sanofi and Regeneron begin global Kevzara® (sarilumab) clinical trial program in patients with severe COVID-19,” Sanofi US, March 16, 2020. http://www.news.sanofi. us/2020-03-16-Sanofi-and-Regeneron-begin-global-Kevzara-R-sarilumab-clinical-trial-program-in-patients-with-severe-COVID19. 53. P. Mehta et al. “COVID-19: consider cytokine storm syndromes and immunosuppression,” Lancet 395, no. 10229 (March 16, 2020): 1033-1034. Epub ahead of print. DOI: 10.1016/S0140-6736(20)30628-0. 54. “Roche initiates Phase III clinical trial of Actemra/RoActemra in hospitalised patients with severe COVID-19 pneumonia,” F. Hoffmann-La Roche Ltd., March 19, 2020. https://www.roche.com/dam/jcr:f26cbbb1-999d-42d8-bbea-34f2cf25f4b9/en/19032020-mr-actemra-covid-19-trial-en.pdf. 55. National Institutes of Health, U.S. National Library of Medicine, “Ascorbic acid/Vitamin C studies,” accessed April 6, 2020. https://clinicaltrials.gov/ct2/ results?cond=COVID19&term=ascorbic+acid&cntry=&state=&city=&dist=. 56. Dawei Wang et al. “Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China,” Journal of The American Medical Association 323, no. 11 (2020): 1061-1069. DOI: 10.1001/jama.2020.1585. 57. “Sobi to initiate a clinical study to evaluate whether anakinra and emapalumab may relieve complications associated with severe COVID-19 disease,” Swedish Orphan Biovitrum AB (publ) (Sobi™), March 18, 2020. https://www.sobi.com/sites/default/files/pr/202003183346-1.pdf. 58. National Institutes of Health, U.S. National Library of Medicine, “Efficacy and Safety of Emapalumab and Anakinra in Reducing Hyperinflammation and Respiratory Distress in Patients With COVID-19 Infection,” March 27, 2020. https://clinicaltrials.gov/ct2/show/study/NCT04324021. 59. Chaomin Wu et al. “Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China,” Journal of The American Medical Association Internal Medicine (March 13, 2020). DOI: 10.1001/jamainternmed.2020.0994. 60. Josh Farkas, COVID-19 Internet Book of Critical Care (EMCrit Project, 2020), https://emcrit.org/ibcc/COVID19/. 61. National Institutes of Health, U.S. National Library of Medicine, “Nitric Oxide Gas Inhalation Therapy for Mild/Moderate COVID-19 (NoCovid),” March 12, 2020. https://clinicaltrials.gov/ct2/show/NCT04305457?cond=NCT04305457&draw=2&rank=1. 62. National Institutes of Health, U.S. National Library of Medicine, “Nitric Oxide Gas Inhalation in Severe Acute Respiratory Syndrome in COVID-19 (NOSARSCOVID),” March 12, 2020. https://clinicaltrials.gov/ct2/show/NCT04306393?cond=NCT04306393&draw=2&rank=1. 63. National Institutes of Health, U.S. National Library of Medicine, “NO Prevention of COVID-19 for Healthcare Providers (NOpreventCOVID),” March 18, 2020. https://clinicaltrials.gov/ct2/show/NCT04312243?cond=NCT04312243&draw=2&rank=1. 64. C.H. Wang et al. “Adjuvant treatment with a mammalian target of rapamycin inhibitor, sirolimus, and steroids improves outcomes in patients with severe H1N1 pneumonia and acute respiratory failure,” Critical Care Medicine 42, no. 2 (2014): 313-321. DOI: 10.1097/CCM.0b013e3182a2727d. 65. Y. Zhou et al. “Network-based drug repurposing for novel coronavirus 2019-nCoV/SARS-CoV-2,” Cell Discovery 6, no. 14 (March 16, 2020): 1-18. DOI: 10.1038/s41421-020-0153-3. DISCLAIMER: Many personal protective equipment (PPE) are regulated by FDA, NIOSH and other authorities. Government regulations restrict the sale, distribution and donation of PPE without proper authorization. While Premier Healthcare Alliance, L.P., and its affiliates (collectively, “Premier”), are not encouraging the sale or distribution of PPE, etc., individuals or entities that decide to make PPE for personal use or use in clinical or other settings do so at their own risk. Consult local hospital requirements, clinical guidelines for COVID-19 safety or applicable FDA, CDC, NIOSH or other government agency guidelines for additional information or guidance, etc. Premier is not responsible for any errors or omissions, or for the results obtained from the use of the information provided in this communication (the “Information”). The Information is being provided for informational purposes and any use of the Information is at the user’s own risk. Premier is not a health care provider, regulatory agency or manufacturer, and it and its affiliates do not actively monitor or approve any Information and are not responsible or liable for verifying the accuracy of the Information. Premier provide this Information and these materials on an “as is” basis, with no representations or warranties of any kind, including with respect to accuracy, completeness, quality, non-infringement, or fitness for a particular purpose. No representation is made that the Information is free of the rightful claim of any third person by way of infringement or the like. Any use of the Information in violation of any third-party patent or other intellectual property rights, including without limitation those held by affiliates of Premier, is specifically prohibited. Violation of patent or other intellectual property rights may result in the imposition of substantial money damages or other civil remedies against you, as well as potential criminal penalties. Premier will not be liable for any damages of any kind arising from the use of, or reliance on, any Information made available to you by Premier including but not limited to direct, indirect, incidental, consequential, special or punitive damages. All other rights reserved. By accessing Premier’s websites, including this page, you agree to be bound by the full Terms & Conditions. See the full Terms & Conditions at www.premierinc.com/terms-conditions.
Premier Continuum of Care | June 2020
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This is an advertisement.
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| Insight
Introducing the Premier Continuum of Care Biosimilars Program
Giving alternate site healthcare providers the tools needed to thrive in the era of biosimilars Eric Rodriguez, Director, Corporate Communications, Premier Alternate Site Programs
Premier Continuum of Care | June 2020
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As key biologics continue to lose their patent protections,1 biosimilars are poised to play a vital role in reshaping treatment options for some of the most complex, chronic illnesses. In addition to producing clinically equivalent outcomes to their reference products, biosimilars are also projected to help lower overall healthcare costs. This paradigm shift is creating new opportunities for alternate site healthcare providers to implement biosimilar strategies and advance efforts to have the products included on formularies. To determine which biosimilars are suitable for inclusion, providers must evaluate both the overall savings opportunity and the specific value proposition offered by each product.
The Current Biosimilars Landscape According to a 2018 report published by RAND Health Quarterly, biosimilars offer a total savings potential of $54 billion from 2017 to 2026.2 However, realizing these savings will require providers to overcome potential industry-related constraints and adopt biosimilars more readily than in the past. One of the most significant obstacles to the uptake of biosimilars during the last three years has been reimbursement.3
disparities in reimbursement between biosimilars and their reference products — such as the removal of the biosimilar exclusion from the Medicare Part D coverage gap discount program4 — financial hurdles remain. For instance, many private payers list innovator biologics (i.e. the original, branded drugs) as their preferred agents and require a different prior authorization process for the reimbursement of non-preferred formulary products, creating an additional administrative burden for providers.3 Moreover, some payers will only cover biosimilars if the patient has an intolerance or an ineffective response to the innovator biologic, presenting yet another challenge for providers looking to switch to a specific biosimilar.3 “Although biosimilars are projected to be priced up to 30 percent below their branded counterparts, today’s intricate biosimilar reimbursement landscape has created a situation where biosimilar adoption doesn’t automatically lead to enhanced post-reimbursement value,” says John Klosek, Senior Vice President, Alternate Site Contract and Clinical Services, Premier. “When it comes to biosimilars, providers must keep up-todate on the changing reimbursement policies of each payer in order to continue providing high-quality, low-cost patient care.”
The Biosimilars Calculator
When evaluating the savings potential of a biosimilar, providers must examine the initial acquisition cost, possible conversion opportunities, and payer reimbursement rates. To help alternate site healthcare members through this multifaceted evaluation process, Premier recently launched a biosimilars calculator. Developed with extensive feedback from members, the online-based tool helps estimate reimbursement for contracted biosimilar products from the Centers for Medicare & Medicaid Services (CMS) and from private payers. Once members input dosage requirements and negotiated reimbursement rates for the biosimilar products in question, the system generates estimated reimbursement for that specific product and dose. The calculations are based on the number of contract units entered (see Figure 1).
Figure 1: Biosimilars Contract Advantage Calculator
“One key benefit of the calculator is that it provides members with an estimation of potential revenue/loss before the drug is bought and administered,” says Liya Davydov, PharmD, BCPS, BCGP, Vice President, Alternate Site Clinical Pharmacy Services, Premier. “By using the tool, members will be able to preserve their existing business model, while ensuring that their patients are being treated in the most cost-effective fashion without sacrificing efficacy of a provided treatment.”
Drug Name
How does the calculator work?
Private Plan Reimbursement Per J-Code Per Billing Units
To view reimbursement estimates, members must: 1. Choose a drug from the drop-down menu.
While policy changes have been proposed or enacted to help ameliorate
Dosage
Medicare Part B Reimbursement Rate
Private Plan Reimbursement Rate
Billing Units
Billing Units
Reimbursement Per Billing Unit Differential Per Billing Unit
Contract Units
Reimbursement Per Billing Unit Differential Per Billing Unit
Contract Units
Reimbursement Per Contract Unit
Reimbursement Per Contract Unit
Differential Per Contract Unit
Differential Per Contract Unit
Differential Per Dosage
Differential Per Dosage
All information contained herein is rounded up to the nearest two decimal points and is subject to change with or without notice.
8
Enter the Premier Continuum of Care (COC) Biosimilars Program
| Insight
2. Enter the amount the commercial payer of the patient pays for one billing unit of the drug (based on the HCPCS code description, provided for the biosimilar next to the entry box). 3. Select the number of contract units needed for the patient. Once this data is entered, the calculator will then automatically generate two sets of results: reimbursement by CMS (Medicare Part B) and private plan reimbursement (a member’s private negotiated plan rate). “The generated calculations are based on Premier’s contracted price at the time when
Figure 2: U.S. Biosimilars in the Alternate Site Healthcare Setting
Therapeutic class
Hematopoietic agent
Biosimilars on contract
• Zarxio • Nivestym
• Fulphila • Udenyca • Ziextenzo
Reference biologic/ manufacturer
• Neupogen • Neulasta (filgrastim) (pegfilgrastim) [Amgen] [Amgen]
• Retacrit
• Procrit (Epoetin Alfa) [J&J] • N/A*
(Premier Contracted & Non-Contracted Biologic Products)
Tumor necrosis factor blocker • Inflectra • Renflexis
• Remicade (infliximab) [J&J]
Anti-neoplastic agent • Truxima • Ruxience
• Mvasi • Zirabev
• Kanjinti • Ogivri • Trazimera • Herzuma • Ontruzant
N/A**
N/A***
N/A****
N/A marks the original reference biologics that are NOT on contract with Premier at this time (note: please refer to the corresponding asterisks below for non-contracted original reference biologic product/manufacturer information). The rest of the listed reference biologics in the table above are currently on contract with Premier for various classes of trade. Additonally, the drugs highlighted in red signify biosimilars on contract ONLY for the Physician Practice class of trade (COT). *Epogen (epoetin alfa); Amgen [visit https://www.epogen.com/ for more information]. **Rituxan (rituximab); Genentech [visit https://www.rituxan.com/ for more information]. *** Avastin (bevacizumab); Genentech [visit https://www.avastin.com/ for more information]. **** Herceptin (trastuzumab); Genentech [visit https://www.herceptin.com/hcp.html for more information].
the inquiry is being made,” notes Davydov. “If a negotiated price isn’t currently available for a particular class of trade, then the calculator will automatically pull in the wholesale acquisition cost (WAC) of the drug and clearly indicate that WAC is being used for the calculations that are generated.”
The Premier COC Biosimilars Portfolio When examining the financial impact that a biosimilar product will have on an organization, it’s vital to understand the setting in which a biosimilar is administered, since reimbursement models and acquisition costs fluctuate based on sites of care. “With a growing number of biosimilars in the pipeline that are used in the alternate site healthcare setting, reimbursement becomes even more complex, and therefore, even more important for organizations to fully understand in terms of the potential cost savings that could be generated,” Klosek explains. Since 2015, Premier has been working closely with the manufacturers of biosimilars coming to market to successfully gain a contract position for various alternate site classes of trade (see Figure 2 for currently contracted biosimilars). “In a market which was once slow to add new products, there has recently been a flurry of activity that we anticipate will continue throughout the rest of the year,” says Klosek. “As of June 2020, there are 27 biosimilars approved, yet due to patent litigation, not all have been able to enter the market.”
Continuing Education (CE) Understanding that prescriber and pharmacist confidence in biosimilars
DID YOU KNOW? Premier offers alternate site healthcare members an entire suite of clinical calculators. In addition to biosimilars, we currently provide calculators for contracted IVIG and hemophilia products. To learn more about our suite of clinical calculators, please contact your representative at 888.258.3273 or email AlternateSitePrograms@premierinc.com. is a necessary component of building a successful biosimilar strategy, Premier has developed a number of educational offerings and training resources to help alternate site healthcare members on that front. “Our biosimilar-specific educational offering is designed to address common misconceptions and highlight information regarding the approval pipeline, efficacy, and safety,” notes Davydov. “As is customary for our valued-added CE-accredited educational programs, information is presented via a number of modalities, including monthly teleconferences, in-person programming, and written educational programs.”
Is Your Organization Prepared for the Era of Biosimilars? With contending biosimilar versions of game-changing biologics already on the market, the era of biosimilars has officially
taken off. These important new drugs not only offer expanded therapeutic options for chronically ill patients, they also represent an enormous opportunity for alternate site healthcare providers to manage costs and bring additional value to their patients. Klosek sums it up: “The time is now for providers to establish a biosimilars strategy. To be successful in this endeavor, alternate site leaders need to proactively take steps to ensure their organization truly understands the market dynamics at play, including pricing strategies, payer and reimbursement influences, and regulatory policies.” Premier offers alternate site healthcare members comprehensive resources to help support their biosimilar evaluation and strategy development. For more information about our biosimilars program, suite of clinical calculators, or complimentary CE member offerings, contact us today.
REFERENCES 1. Suzanne Elvidge, “Why biosimilars could be market disruptors,” BiopharmaDive.com, January 23, 2017. https:// www.biopharmadive.com/news/why-biosimilars-could-be-market-disruptors/434392/. 2. Andrew W. Mulcahy et al, “Biosimilar Cost Savings in the United States: Initial Experience and Future Potential,” Rand Health Quarterly 7, no. 4: 3 (Epub: March 30, 2018). https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6075809/. 3. James Smeeding et al, “Biosimilars: Considerations for Payers,” P & T 44, no. 2 (January 2019): 54-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355057/. 4. Barbara A. Gabriel, “Medicare Part D Discounts Now Cover Biosimilar Drugs,” AARP.org, February 20, 2018. https://www.aarp.org/health/medicare-insurance/info-2018/biologics-save-money-fd.html.
Premier Continuum of Care | June 2020
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Category Spotlight: COVID-19 Recovery Portfolio
As parts of the country gradually re-open in the wake of COVID-19, healthcare practices face pressure to quickly adapt to a new reality. Your organization needs a strategy to:
Help ensure the safety of your employees and patients Strive to meet expectations for higher levels of cleanliness throughout your facilities Work to reduce the need for contact to the greatest extent possible
PPE & Medical Supplies (face masks, face shields, gloves, infrared & touchless thermometers)
Sanitizing Products (hand sanitizer, soaps, wipes & disinfectants)
Touchless Products (door entry, faucets & soap dispensers)
Shield Protectors and Barriers
As your group purchasing organization (GPO), we understand
that organizations like yours may need our support more than ever. We value the trust you have placed in us and want you to know that we stand ready to help. Through our purchasing program and stockd®, Premier’s online marketplace, your
Foodservice Disposables (paper goods, food and beverage containers & dispensers)
organization has access to an available supply of items you’ll need to get back in business:*
10 |
Insight
*Access to products are subject to availability from suppliers.
Group Purchasing Contracts/stockd Product Listing Contract Title
Contracted Supplier
Contract Number
Contract Expiration Date
PERSONAL PROTECTIVE EQUIPMENT (PPE) SUPPLIES 3 Ply Disposable Masks Black Nitrile General Purpose Gloves Disposable Non-Sterile Protective Apparel
stockd Marketplace
CLICK HERE >
stockd Marketplace
CLICK HERE >
Amd-Ritmed
PP-NS-1186
11/30/21
Encompass Group
PP-NS-1188
11/30/21
O&M Halyard
PP-NS-1189
11/30/21
S2S Global
PP-NS-1191
11/30/21
Sloan Medical
PP-NS-1192
11/30/21
Tronex International
PP-NS-1193
11/30/21
Welmed
PP-NS-1194
11/30/21
Ansell Healthcare Products
PP-NS-1225
04/30/22
Innovative Healthcare Corporation
PP-NS-1228
04/30/22
Medgluv
PP-NS-1229
04/30/22
O&M Halyard
PP-NS-1227
04/30/22
PlatinumCode
CO-NS-106
10/31/20
S2S Global
PP-NS-1231
04/30/22
Sempermed
PP-NS-1232
04/30/22
Tronex International
PP-NS-1233
04/30/22
stockd Marketplace
CLICK HERE >
stockd Marketplace
CLICK HERE >
stockd Marketplace
CLICK HERE >
stockd Marketplace
CLICK HERE >
Physical Therapy Products & Exercise Equipment
Performance Health Supply
PP-NS-1299
02/28/23
Reusable Textiles & Textile Services
American Dawn
PP-FA-702
11/30/21
Calderon Textiles
PP-FA-703
11/30/21
CareandWear II
PP-FA-704
11/30/21
Encompass Group
PP-FA-705
11/30/21
GoBioMed
CO-FA-102
10/26/20
Hinson & Hale Medical Technologies
PP-FA-706
11/30/21
Phoenix Textile Corporation
PP-FA-708
11/30/21
Standard Textile Co.
PP-FA-709
11/30/21
GM Nameplate
CO-OR-104
10/31/20
GoBioMed
CO-OR-120
10/31/20
Key Surgical
CO-OR-101
10/19/20
Label Source
CO-OR-109
10/31/20
Mobility Exchange
CO-OR-110
10/31/20
O&M Halyard
PP-OR-1691
12/31/22
PlatinumCode
CO-OR-107
10/31/20
Precept Medical Products
PP-OR-1692
12/31/22
Prestige Ameritech
PP-OR-1689
12/31/22
Exam Gloves
Face Shields Goggles Gowns KN95 Masks
Surgical & Isolation Masks
Premier Continuum of Care | June 2020 11
Contract Title
Contracted Supplier
Contract Number
Contract Expiration Date
Surgical & Isolation Masks
Project Graphics
CO-OR-116
10/31/20
(continued)
S2S Global
PP-OR-1688
12/31/22
Surain Industries
CO-OR-113
10/31/20
Thermometry Vinyl General Purpose Gloves
Tidi Products
PP-OR-1690
12/31/22
GoBioMed
CO-NS-123
10/31/20
stockd Marketplace
CLICK HERE >
DISINFECTANT/SANITIZING PRODUCTS Bottled Hand Sanitizer
stockd Marketplace
CLICK HERE >
Electrical & Plumbing Building Materials
Wesco
PP-FA-595
04/30/22
Fire & Life Safety Products & Services
Life Safety Services
PP-FA-741
06/30/22
American Hotel Register Company
PP-FA-798
02/28/23
Betco
PP-FA-635
04/30/21
Diversey
PP-FA-636
04/30/21
Midlab Incorporated
PP-FA-637
04/30/21
Procter & Gamble Distributing
PP-FA-638
04/30/21
Spartan Chemical Co.
PP-FA-639
04/30/21
Hospitality Supplies, Equipment & Distribution Housekeeping Products
Intermediate-Level Disinfectant Wipes
Laundry Products & Maintenance
Maintenance, Repair & Operations Microfiber Products, Mats & Accessories
Non-healthcare Soaps, Lotions & Waterless Rinses
12 |
Insight
Wexford Labs
PP-FA-640
04/30/21
Certol International
PP-NS-1026
04/30/21
Clorox
PP-NS-1345
04/30/23
Diversey
PP-NS-1347
04/30/23
Metrex Research Corporation
PP-NS-1346
04/30/23
Professional Disposables International (PDI)
PP-NS-1344
04/30/23
Betco
PP-FA-719
12/31/21
Diversey
PP-FA-720
12/31/21
Gurtler Industries
PP-FA-721
12/31/21
Procter & Gamble Distributing
PP-FA-722
12/31/21
Spartan Chemical Co.
PP-FA-723
12/31/21
State Industrial Products
PP-FA-724
12/31/21
UNX Incorporated
PP-FA-725
12/31/21
AirSupply Tools
PP-FA-590
04/30/22
WW Grainger
PP-FA-591
04/30/22
American Dawn
PP-FA-654
01/31/21
Aramark Uniform and Career Apparel
PP-FA-690
01/31/21
Cintas Corporation
PP-FA-656
01/31/21
Contec
PP-FA-657
01/31/21
Encompass Group
PP-FA-658
01/31/21
Phoenix Textile Corporation
PP-FA-659
01/31/21
S2S Global
PP-FA-605
01/31/21
Standard Textile Co.
PP-FA-660
01/31/21
Unifirst Corporation
PP-FA-691
01/31/21
Betco
PP-FA-668
04/30/21
Buckeye International
PP-FA-675
04/30/21
Diversey
PP-FA-670
04/30/21
Contract Title
Contracted Supplier
Contract Number
Contract Expiration Date
Non-healthcare Soaps, Lotions & Waterless Rinses
Essity
PP-FA-671
04/30/21
Kimberly-Clark
PP-FA-674
04/30/21
Office Supplies & Business Services
American Office Products Distributors
PP-MM-479
07/31/20
FriendsOffice
PP-MM-476
07/31/20
Guy Brown
PP-MM-477
07/31/20
Office Depot
PP-MM-481
07/31/20
Staples
PP-MM-480
07/31/20
Afflink
PP-FA-606
10/31/20
Network Services Company
PP-FA-607
10/31/20
Office Depot
PP-FA-608
10/31/20
Strategic Market Alliance
PP-FA-609
10/31/20
The Home Depot Pro
PP-FA-610
10/31/20
Triple S
PP-FA-611
10/31/20
American Green Technology
PP-MM-496
01/31/21
Diversey
PP-MM-673
03/31/21
Patho3gen Solutions (fka Green Earth Medical Solutions)
PP-FA-810
03/31/21
Surfacide
PP-MM-501
03/31/21
TMG Health Technologies
PP-FA-816
03/31/21
TOMI Environmental Solutions
PP-MM-502
03/31/21
Tru-D Smart UVC
PP-MM-503
03/31/21
UltraViolet Devices (fka Clorox Sales Company)
PP-MM-497
03/31/21
Xenex Disinfection Services
PP-MM-504
03/31/21
Positive Promotions
PP-MM-739
08/31/22
GoBioMed
CO-NS-105
10/26/20
SC Johnson Professional
PP-NS-1085
09/30/20
Ecolab
PP-DI-1611
04/30/22
(continued)
Paper & Janitorial Supply Distribution
Room Environment Infection Prevention Products
Service Awards & Promotional Products Soaps, Lotions & Waterless Hand Rinses Warewashing Chemicals & Related Products
TOUCHLESS/BARRIER PROTECTION Cubicle Curtains, Tracks & Privacy Screens
Cube Care Company
PP-FA-711
11/30/21
Encompass Group
PP-FA-712
11/30/21
Silentia
PP-FA-716
11/30/21
Custom Solutions
Mobility Exchange
PP-IT-230
06/30/22
Doors, Frames & Hardware
ASSA ABLOY Sales and Marketing Group PP-FA-663
12/31/21
Foodservice Equipment & Supplies Distribution & Kitchen Design Services
Edward Don & Company
PP-DI-1734
05/31/23
Hubert Company
PP-DI-1736
05/31/23
Interior & Exterior Signage
Berry and Homer
PP-FA-787
02/28/23
Low Voltage Systems
Accu-Tech Corporation
CC-IT-007
07/31/22
Paper Towels, Tissues & Dispensers
Carlisle Foodservice Products
PP-FA-771
09/30/22
Essity
PP-FA-768
09/30/22
Georgia-Pacific
PP-FA-769
09/30/22
Kimberly-Clark
PP-FA-770
09/30/22
Premier Continuum of Care | June 2020 13
Contract Title
Contracted Supplier
Contract Number
Contract Expiration Date
FACILITY/LAUNDRY PRODUCTS & SERVICES Air Filtration Products
Can Liners
Environmental & Facility Management Services
AAF International
PP-FA-686
08/31/21
Camfil
PP-FA-687
08/31/21
Koch Filter Corporation
PP-FA-688
08/31/21
Tri-Dim Filter Corp.
PP-FA-689
08/31/21
I.B.S. Solutions Corporation
PP-FA-600
07/31/20
Novolex Holdings
PP-FA-599
07/31/20
Plastics Solutions
PP-FA-601
07/31/20
Aramark Uniform and Career Apparel
PP-SV-211
03/31/22
FacilitySource
PP-SV-212
03/31/22
Medtegrity Medical Laundry
PP-SV-216
03/31/22
Sodexo Operations
PP-SV-214
03/31/22
NeoGenomics Laboratories
PP-LA-485
09/30/23
Quest Diagnostics Incorporated
PP-LA-486
09/30/23
LAB TESTING Clinical Reference Laboratory Testing Services
THERMAL SCANNING SOLUTIONS Custom Solutions
Mobility Exchange (Temperature & environmental monitoring sensors and cameras)
PP-IT-230
06/30/22
Hardware & Software Resellers
PC Connection (Advantech infection prevention solution with video AI integration; Meridian temperature verification kiosk)
PP-IT-164
10/31/20
Low Voltage Systems
Accu-Tech Corporation (Herring technology mobile camera with thermal imaging)
CC-IT-007
07/31/22
Maintenance, Repair & Operations
WW Grainger (Infrared smart phone adapters)
PP-FA-591
04/30/22
Office Supplies & Business Services
Office Depot (Tidel intelligent entry scanner)
PP-MM-481
07/31/20
Staples (Meridian temperature verification kiosk)
PP-MM-480
07/31/20
Paper & Janitorial Supply Distribution
The Home Depot Pro (Meridian temperature verification kiosk; Tauri series temperature-check tablets)
PP-FA-610
10/31/20
Pulse Oximetry & Capnography Devices
Masimo Americas
PP-MM-615
04/30/21
Smiths Medical ASD
PP-MM-612
04/30/21
Anchor Packaging
PP-DI-1633
06/30/22
Cascades
PP-DI-1639
06/30/22
Dart
PP-DI-1629
06/30/22
Eco-Products
PP-DI-1632
06/30/22
Georgia-Pacific
PP-DI-1631
06/30/22
Handgards
PP-DI-1638
06/30/22
Hoffmaster
PP-DI-1636
06/30/22
Pactiv
PP-DI-1630
06/30/22
S2S Global
PP-DI-1637
06/30/22
PULSE OXIMETRY
FOODSERVICE DISPOSABLES Foodservice Disposables
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Sabert
PP-DI-1635
06/30/22
US Foods
PP-DI-1640
06/30/22
WNA
PP-DI-1634
06/30/22
Contract Title
Contracted Supplier
Contract Number
Contract Expiration Date
REMOTE WORK IT SERVICES/SOLUTIONS Call Center Services
AnswerNet Voice Products
PP-SV-244
09/30/22
Credit Card Services
Sun Communications
PP-SV-184
02/28/23
Hardware & Software Resellers
Insight
PP-IT-166
10/31/20
PC Connection
PP-IT-164
10/31/20
Zones
PP-IT-165
10/31/20
Konica Minolta
PP-IT-222
07/31/22
Managed Print Services, Devices & Accessories
PP-SV-241
09/30/22
REMOTE WORK TRANSPORTATION SERVICES Ride Sharing Services
Kaizen Health
PP-SV-226
01/31/21
Lyft
PP-SV-189
01/31/21
PP-SV-175
03/31/25
STAFFING Workforce Solutions - Staffing
AMN Healthcare
TELEHEALTH SOLUTIONS Television Hardware Software
Telehealth Services
PP-FA-794
02/28/23
Custom Solutions
Mobility Exchange
PP-IT-230
06/30/22
Eligibility is subject to supplier approval. While every reasonable effort has been made to make this listing accurate, information changes rapidly and Premier makes no guarantees of any kind, including guarantees as to the accuracy of this listing. The listing is for informational purposes only and does not create a legal agreement or place any obligations on Premier.
For real-time COVID-19 updates, please visit Premier’s COVID-19 response webpage, our Disaster Response Community on PremierConnect, and the Premier Safety Institute®.
DISCLAIMER:
Many personal protective equipment (PPE) are regulated by FDA, NIOSH and other authorities. Government regulations restrict the sale, distribution and donation of PPE without proper authorization. While Premier Healthcare Alliance, L.P., and its affiliates (collectively, “Premier”), are not encouraging the sale or distribution of PPE, etc., individuals or entities that decide to make PPE for personal use or use in clinical or other settings do so at their own risk. Consult local hospital requirements, clinical guidelines for COVID-19 safety or applicable FDA, CDC, NIOSH or other government agency guidelines for additional information or guidance, etc. Premier is not responsible for any errors or omissions, or for the results obtained from the use of the information provided in this communication (the “Information”). The Information is being provided for informational purposes and any use of the Information is at the user’s own risk. Premier is not a health care provider, regulatory agency or manufacturer, and it and its affiliates do not actively monitor or approve any Information and are not responsible or liable for verifying the accuracy of the Information. Premier provide this Information and these materials on an “as is” basis, with no representations or warranties of any kind, including with respect to accuracy, completeness, quality, non-infringement, or fitness for a particular purpose. No representation is made that the Information is free of the rightful claim of any third person by way of infringement or the like. Any use of the Information in violation of any third-party patent or other intellectual property rights, including without limitation those held by affiliates of Premier, is specifically prohibited. Violation of patent or other intellectual property rights may result in the imposition of substantial money damages or other civil remedies against you, as well as potential criminal penalties. Premier will not be liable for any damages of any kind arising from the use of, or reliance on, any Information made available to you by Premier including but not limited to direct, indirect, incidental, consequential, special or punitive damages. All other rights reserved. By accessing Premier’s websites, including this page, you agree to be bound by the full Terms & Conditions. See the full Terms & Conditions at www.premierinc.com/terms-conditions.
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