Payer coverage is key to Novartis’ plan to get Kymriah going, and the company is going to be getting some more of that.
England’s cost watchdog, the National Institute for Health and Care Excellence (NICE), has recommended the CAR-T med to treat adults with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) through its Cancer Drugs fund, where it’ll join head-to-head rival Yescarta from Gilead.
It’s an about-face for the cost-effectiveness gatekeeper, which initially shot down Kymriah over its high price. But as they often do, talks between the two parties led to a discount on Kymriah’s £282,000 sticker, making way for the therapy’s inclusion on the CDF.
“Recommending another revolutionary CAR T-cell therapy for adults with lymphoma represents a step forward for personalized medicine. We are pleased that patients are set to benefit from such an innovative therapy so rapidly because of joint working between NICE, NHS England and the company,” Meindert Boysen, director of NICE’s Centre for Health Technology Evaluation, said in a statement.
It’s the second NICE green light for Kymriah, which the body backed in September as a treatment for pediatric and young adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). That endorsement helped the slow-starting drug generate Q4 sales of $ 28 million and bring its total 2018 haul to $ 76 million.
Now, the drug will enjoy equal footing with Yescarta in England, where close to 4,700 patients were diagnosed with DLBCL—the most common form of non-Hodgkin lymphoma—in 2015. Gilead’s contender, which has gotten off to a sluggish start of its own thanks in part to reimbursement challenges, grabbed NICE’s favor back in October.
Meanwhile, Novartis is hoping it can turn the NICE win into a reimbursement hot streak. The company has snagged reimbursement for one or both of Kymriah’s indications in 10 markets outside the U.S. within four months after regulatory approval, Novartis oncology CEO Susanne Schaffert told investors this week on a conference call, and “we continue discussions with payers in the other markets,” she said.