Thursday, March 26, 2020

Nation's HIV Drug Supply Secure Despite Coronavirus Pandemic

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

****UPDATED APRIL 24, 2020 - 5:22 P.M. EST*****

The ADAP Advocacy Association has fielded countless inquiries from people living with HIV/AIDS expressing concerns over the novel Coronavirus ("COVID-19") and its impact on the nation's drug supply chain. Namely, their concerns have centered around potential drug shortages of the anti-retroviral medications for the treatment of HIV/AIDS. No such drug shortages are foreseen for these medications over the coming year, thanks to the assurances extended by the drug manufacturers AbbVie, Janssen Pharmaceuticals, Gilead Sciences, Merck. Theratechnologies, and ViiV Healthcare.

Drug Supply
Photo Source: master control.com

The ADAP Advocacy Association contacted each company about the patient community concerns, and the respective drug manufacturers provided the following statements.
  • ABBVIE STATEMENT:
"AbbVie is closely monitoring product demand and supply levels throughout our global network to ensure adequate and effective distribution. While helping respond to the COVID-19 crisis is a high priority, AbbVie is committed to protecting the supply of Kaletra/Aluvia for HIV patients. AbbVie is actively assessing the increased demand for Kaletra/Aluvia and has taken steps to increase supply for COVID-19 patients without impacting treatment supply for HIV patients. Our priority is to ensure uninterrupted supply for HIV patients around the world."

Read the AbbVie statement online.
  • GILEAD SCIENCES STATEMENT:
"Over the last several weeks, we know you have heard from many of your constituents who are concerned the novel coronavirus pandemic could impact their ability to obtain HIV medication. We wanted to reach out to assure you there are currently no manufacturing concerns or supply shortages with any Gilead products, including our HIV portfolio.

Gilead’s global commercial supply chain is robust and resilient with the right processes in place, geographic diversity in our supply chain and enough of the materials required to make our medicines. We have done this purposefully and carefully to enable continued supply of Gilead’s medicines in a challenging situation like the one we face today. As a result, we are not seeing, and we do not anticipate, shortages of Gilead marketed products, including our HIV medicines, in the foreseeable future.

Our supply network provides both flexibility and redundancy, and our inventory levels are robust, with no immediate or foreseeable risk to our supply chain. For more information, please see this article on Gilead.com. We are also working closely with our partners to monitor travel restrictions and border closings. There are currently no restrictions or delays limiting the transport of goods, including medications.

Some wholesalers have proactively implemented allocation limits on several pharmaceutical products, including HIV medications. In the event that pharmacies experience a temporary lack of inventory, they should contact their wholesaler to request an exception to these limits. When necessary and approved by the wholesaler, Gilead is able to drop-ship directly to a pharmacy. A complete list of authorized distributors can be found here.

Additionally, while we have paused enrollment for some clinical studies, we have made important exceptions for studies where patient outcomes are critically impacted. This includes studies of our investigational HIV capsid inhibitor GS-6207 in people who have multi-drug resistant HIV and therefore have limited treatment options. We will also continue to prepare for new study initiations in the face of temporary delays to most study enrollments.

During this uncertain time, it is more important than ever that we stay in close communication. We do not see any potential disruption to our supply chain now or in the foreseeable future. Gilead is committed to ensuring you have up-to-date information on our efforts to help the HIV community respond to the novel coronavirus pandemic and will keep you apprised of any changes."

Read the Gilead Sciences statement online.
  • JANSSEN PHARMACEUTICALS STATEMENT:
"In our role as a global health leader, Johnson & Johnson is closely monitoring the COVID-19 (coronavirus) situation and taking steps to help prevent the spread of the virus as well as exploring the potential for a vaccine.

We have robust business continuity plans in place across our global supply chain network to prepare for unforeseen events and to meet the needs of the patients, customers and consumers who depend on our products.  These steps include maintaining critical inventory at major distribution centers away from high-risk areas and working with external suppliers to support our preparedness plans.

We are closely monitoring product demand and supply levels across our global network to ensure adequate and effective distribution, and working diligently to meet patient, customer and consumer need.

Below is a summary by sector:

​​​​​​​- Pharmaceutical: While this remains a dynamic situation, we do not foresee pharmaceutical supply interruptions related to COVID-19 at this time.

- Medical Devices: While this remains a dynamic situation, the vast majority of our global medical device manufacturing is running at or near normal capacity, and we are not experiencing product supply interruptions at this time.

- Consumer: We are experiencing increased consumer-driven demand with certain products and markets, which we are currently meeting in a controlled manner. We are taking all possible measures to maximize product availability.

As a leader in global health, our top priority remains our patients, customers and employees. We are partnering with global and local health authorities to address immediate and long-term health care needs, to ensure sustainable supply of our critical medicines, as well as to research potential vaccines and therapeutics.

We will remain on the front lines of this health crisis, bringing our full resources and minds to combat it."
  • MERCK STATEMENT:
"We continue to track the COVID-19 outbreak closely and are focused on the safety of our employees and their families, continuity of supply and clinical trials, and supporting communities affected by this outbreak. Our thoughts are with the people of all affected areas. We would also like to extend our sincere appreciation to the many health care providers and volunteers who are doing so much to help affected patients and communities.

While supply and demand vary by product, we are not aware of any significant near-term impacts from COVID-19 on the production and supply of Merck's medicines and vaccines.  We have also assessed potential longer-term impacts of the outbreak. The situation is fluid, but at this point we do not anticipate impacts to our supply chain unless the outbreak were to continue for an extended period of time."

Read the full Merck statement online.

Read the supplemental Merck statement online.
  • THERATECHNOLOGIES STATEMENT:
"At Theratechnologies, we presently have enough inventory, here in the U.S., for our 3 products and expect to be able to provide Trogarzo®, EGRIFTA SV™ or EGRIFTA® to all currently prescribed and new patients during the next 12 months. In addition, the production for all of our products is not affected at this stage by the COVID19 situation."
  • ViiV HEALTHCARE STATEMENT:
"In these uncertain times, the safety and well-being of our employees, customers, partners, and people living with HIV remains ViiV Healthcare’s top priority. As the coronavirus (COVID-19) continues to affect communities in the US and around the world, our hearts go out to those impacted, and we want to share our response to the evolving situation.

We have been closely monitoring the COVID-19 pandemic and its impact. We believe it is our responsibility to prioritize two things:

- our commitment to supporting the health and safety of our employees, customers, partners, and people living with HIV;

- protecting our ability to manufacture and supply medicines

Consistent with our values and role as the only global healthcare company solely focused on HIV, we will continue to make decisions informed by the latest science and in consultation with leading health authorities.

In-line with these principles, we have implemented a variety of measures to help prevent spread of disease and minimize disruption to our operations.

- Ensuring medicine supply and patient access. At this time, even with loosened restrictions on early and various quantity refills by US government and private payers, there is no impact to supply of our medicines in the US as a result of the COVID-19 pandemic. We are continuing to closely monitor the situation and will keep you updated on any changes. We have supply chain planning in place for our products, which includes measures to secure reliable supply, such as holding strategic stock as well as working with our wholesalers, pharmacies and direct purchasers to ensure they are responding to the demand for our medicines from providers and people living with HIV.

- Caring for our people and communities. We have taken several temporary measures to protect the well-being of our employees and the communities in which we operate. We have directed our field teams to suspend all face-to-face interactions and refrain from visits to clinical offices, healthcare centers and other customer offices. Virtual interactions will be implemented to ensure we continue to provide support and ensure adequate supply and access to resources and our medicines.

- Contributing to the fight against COVID-19. We are conducting some exploratory research to see if our medicines may have the potential to demonstrate impact, although it is too early to speculate on any benefit. We are pleased that our major shareholder, GSK, is contributing its science and expertise where they can have most impact on the outbreak. They recently announced a research collaboration with Clover Biopharmaceuticals, providing their pandemic vaccine adjuvant technology to scientists at Clover who will use their cutting-edge research to evaluate the combination of GSK’s adjuvant with its promising vaccine candidate, S-Trimer.

Patient focus is one of our core values and we are proud of our employees and their commitment to people living with HIV during these challenging times.

The situation is changing rapidly, and we are closely monitoring this as we seek to safeguard the health and well-being of our employees, limit the spread of the disease, and continue to make our products available to all who need them. We will continue our vigilance in assessing the situation."

Read the ViiV Healthcare statement online.

The U.S. Food & Drug Administration (“FDA”) has made available information on the current drug shortages online at https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Thursday, March 19, 2020

HIV Medications and the Treatment of Coronavirus

By: Marcus J. Hopkins, Policy Consultant & Guest Contributor 

Over the past few months, numerous theories have been bandied about regarding the efficacy of certain HIV-centric drugs being potentially effective in treating novel coronavirus (SARS-CoV-2, or COVID-19). Moreover, stories continue to be published claiming that three drugs, in particular – ritonavir, lopinavir, and darunavir – may be used to “cure” COVID-19, a popular, yet untested idea because of the drugs’ effectiveness in treating certain other SARS (Severe Acute Respiratory Syndrome) strains (Journal of the American Medical Association, 2020). Again, these theories are untested.

Lab technician
Photo Source: Business Insider

Whenever a new pandemic arises, questions about why existing drugs aren’t being used to treat novel infections arise. Why, after over a century of medical innovations that, before the 19th Century, would’ve been labeled “Witchcraft,” are these pandemics catching us so frequently by surprise? The answer is that each virus is different; each straight of each virus family is different; not every drug that treats one strain of a virus will prove effective in another.

When I was first tasked with writing this piece, my prompt was:
There are lots of stories about coronavirus and the impact on HIV-positive folks. Yet, there are also lots of updates about HIV antiretrovirals being used to treat (and even cure) folks with the virus. So, does it stand to reason an HIV-positive person adherent to their therapy might be more protected?
So, I got down to some research. Sadly, the answer I’ve gotten from my own Infectious Disease doctor is:
There’s no real evidence to suggest that those specific HIV medications are 100% effective in treating COVID-19; there’s also no real evidence to suggest that people who are taking those medications and thus have them in their system are any more protected than anyone else.
The problem with novel viruses is that they often surface and retreat before any real, definitive testing can be completed. When a new one comes along, scientists rely upon things that have worked in the past to try to cobble together a workable solution in a short amount of time. Moreover, Janssen, maker of darunavir, released a statement on Monday, March 16th stating that there is “…insufficient evidence to suggest that…darunavir can effectively treat COVID-19,” and that “…HIV drugs are being considered as possible treatment options largely due to limited and ‘unpublished virological and clinical data’ that demonstrated they were effective in treating the SARS coronavirus” (Jagielski, 2020).

What is clear is that people living with HIV who have achieved viral suppression through adherence to a treatment regimen are shown to be generally healthier than people with higher levels of the HIV virus detectable in their blood. That doesn’t mean, however, that we are any more or less susceptible to opportunistic infections. Respiratory ailments, in particular, have historically been bad news for people living with HIV.

So, the verdict at this point is: “We don’t know what we don’t know, and therefore, should act with an abundance of caution.”

References:
  • Jagielski, D. (2020, March 16). Johnson & Johnson Says There's Insufficient Evidence Its HIV Drug Can Treat COVID-19. Alexandria, VA: The Motley Fool: Investing. Retrieved from: https://www.fool.com/amp/investing/2020/03/16/johnson-johnson-says-theres-insufficient-evidence.aspx
  • Young, B. E., Ong, S. W. X., Kalimuddin, S., et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. Published online March 03, 2020. doi:10.1001/jama.2020.3204 Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/2762688
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Thursday, March 12, 2020

Coronavirus & Living with HIV

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The World Health Organization ("WHO") this week declared the novel coronavirus ("COVID-19") a global health pandemic, which is a designation given to a global disease outbreak. Previously, such designations were given to the Spanish Flu in 1918, Asian Flu in 1957, and HIV/AIDS in 1981 (History.com). Increasingly, many people living with HIV are asking if they should be concerned about the coronavirus? This week's blog includes several important resources.

Photo Source: ABC57 - South Bend, Indiana

The U.S. Centers for Disease Control & Prevention ("CDC") website is making available real-time information about COVID-19, which is being made available online from the White House Coronavirus Task Force.
If social distancing isn't an option to reduce exposure to COVID-19, then please follow the WHO's basic protective measures against the new coronavirus.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

Thursday, March 5, 2020

I Benefit from HIV Co-pay Assistance Programs; CMS Wants to Change That

By: Guy Anthony, President/CEO, Black, Gifted & Whole Foundation, and Board Member, ADAP Advocacy Association

I found myself both shocked and appalled when reviewing the latest Notice of Benefit and Payment Parameters (NBPP) for 2021 issued by the Centers for Medicare and Medicaid Services (CMS) recently. The proposed NBPP, which is released annually, attempts to exclude manufacturer coupons from being counted towards a patient's annual deductible on cost-sharing.

As someone that has been living with HIV for over a decade, and a direct beneficiary of the drug manufacturer co-pay assistance program, I have an intimate understanding of the far-reaching and potentially devastating effects this decision could have on those in the HIV and HCV community.

Co-Payment
Photo Source: Sermo

How Many People Will Be Affected by the Changes?

Over one million people in the U.S. live with HIV and over three million live with chronic HCV. Those who have these conditions come from all walks of life. They're certainly not limited to the LGBTQIA+ community. However, those from disadvantaged backgrounds are much more likely to have the disease than those that hail from affluent socioeconomic backgrounds.

According to the Centers for Disease Control and Prevention (CDC), HIV prevalence in U.S. poverty areas matches those of countries designated as having a generalized HIV epidemic such as Burundi, Ethiopia, and Haiti. What's more, HIV prevalence rates in urban poverty areas are inversely related to annual household income – the lower the income, the higher the HIV prevalence rate.

In other words, the poorer you are, the more at risk you are of contracting the disease. Furthermore, due to the nature of chronic diseases such as HIV, those living with these conditions find it much harder to secure long-term work due to issues surrounding immunodeficiency. This is something I have experienced myself, and employment with HIV is not easy to maintain.

Since a great deal of HIV and HCV cases are found in lower-income households, these changes are going to have a dramatic impact on a considerable proportion of those one million-plus people living with the condition.

How Does Co-Pay Assistance Help Those with HIV?

As you know, those with chronic conditions such as HIV and HCV have had the financial burden of the disease reduced thanks to co-pay assistance programs provided by drug manufacturers in conjunction with additional support from the AIDS Drug Assistance Program (ADAP). Co-pay assistance ensures that financially-challenged individuals can receive the drugs they need to live with the disease.

Everyone living with HIV and HCV knows and appreciates how important these programs are to the community. I've long advocated as part of my awareness campaigns that co-pay assistance and ADAP are pretty much the reason why HIV is no longer a death sentence, since many patients can better "afford" to stay alive. But this move to exclude manufacturers coupons by the CMS is going to hit those who need financial relief the most.

What is the Likely Fallout from These Proposed Changes?

The most immediate ramification will come in the form of reduced medication adherence. Suddenly those that enjoyed financial relief will have to deal with the impact of high deductibles and high cost-sharing expenses. Most individuals living with HIV and HCV need to take at least two antiretroviral drugs every single day. It doesn't matter who you are; anyone can see that these changes will force some people to choose between money and medication. It makes me sick that we live in a country that people with chronic conditions such as HIV might not be able to get access to necessary drugs, as prescribed by their doctor, as a result of a lack of financial means.

I know of individuals who potentially face a situation of not being able to afford the medication they need to live a normal life. One of those people happens to be me. It seems that the constitutional right to life and liberty has been thrown out the window. I think this has a lot to do with the continued stigmatization of conditions such as HIV and HCV. I am no less of a person because I have HIV, no one chooses to have this disease, so why have the rights of individuals within this community being gradually eroded?

Novartis
Photo Source: Novartis

Help Us to Creat Change!

The CMS proposal to exclude manufacturer coupons would have genuinely concerning effects on the affordability of many medications within the regimens of HIV and HCV patients, including myself. In many cases, those living with these diseases will have to bear the financial burden as a result. For some, that burden will be too much.

As is the case for a lot of situations in life, it's going to be those without sufficient means that are going to find themselves the most adversely affected.

We need your help to stop this becoming a reality. Please contact your member of Congress and ask them to help stop this from happening to our community.

References:
  • Denning, MD, MPH, Paul, and Elizabeth DiNenno PhD (2019, December 11). Communities in Crisis: Is There a Generalized HIV Epidemic in Impoverished Urban Areas of the United States? Centers for Disease Control & Prevention. Retrieved online at https://www.cdc.gov/hiv/group/poverty.html.
  • McManus, K. A., Engelhard, C. L., & Dillingham, R. (2013). Current challenges to the United states' AIDS drug assistance program and possible implications of the affordable care act. AIDS research and treatment, 2013, 350169. https://doi.org/10.1155/2013/350169
Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.