Reimbursement and access
In its first quarter earnings conference call, Portola Pharmaceuticals (PTLA) highlighted the stocking of Andexxa by 300 hospitals in the US with a reorder rate of 55%. The drug was stocked by 200 hospitals with a reorder rate of 50% at the end of fiscal 2018. In the first quarter, the company also secured C-code for seeking reimbursement for Andexxa, which has been effective since April 1, 2019. This development is expected to boost the uptake of this drug used to reverse the anticoagulation caused by Factor Xa inhibitors, even in smaller community hospitals.
On April 23, CMS (Centers for Medicare & Medicaid Services) issued the proposal for 2020 Medicare Hospital IPPS (Inpatient Prospective Payment System) and LTCH (Long Term Acute Care Hospital) Prospective Payment System, which includes updating the maximum inpatient NTAP (new technology add-on payment) from 50% to 65%, starting in fiscal 2020. CMS is expected to decide on this proposal by October 2019. If enforced, this rule is expected to increase the amount receivable from CMS for Andexxa from $14,000 per claim to around 18,000 per claim.
According to a first-quarter earnings investor presentation, Portola Pharmaceuticals is focused on establishing the FDA-approved Andexxa as a standard of care for reversing the effect of apixaban or rivaroxaban. The company plans to increase its presence at medical conferences and strive for inclusion of Andexxa in major clinical guidelines.
Portola Pharmaceuticals has trained 118 sales professionals and has launched print and digital marketing campaigns. Based on these efforts, the company expects to report hospital wins at a solid pace in fiscal 2019. Andexxa is currently targeting a patient pool of around 140,000 who are admitted for Factor Xa inhibitor-related bleed in the US.