Sprycel® (dasatinib) Medicare Part D Reimbursement

Sprycel is an oral medication covered by Medicare Part D

Medicare Part D is a voluntary prescription drug benefit for Medicare patients that went into effect on January 1, 2006. Individuals who are enrolled in Medicare Part A or B are eligible to enroll in Medicare Part D. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). While these prescription drug plans are approved and regulated by the Medicare program, they are designed and administered by many different private health insurance companies so coverage may vary significantly from plan to plan.

Medigap is a supplemental coverage available only as part of Medicare Part A and B programs. Some people elect to purchase Medigap to help pay for the cost-sharing expense that is part of Medicare Parts A and B.

Coverage Gaps

All Medicare prescription drug plans (Part D) impose cost-sharing expenses on their plan members, in addition to the premiums that are paid. Cost-sharing expense takes a number of forms, including deductibles, co-insurance, and a coverage gap that is commonly known as the “doughnut hole.” After satisfying all of a member's deductible and “doughnut hole” expense, and some co-insurance expense, the member receives coverage at a higher level, often 95% of the cost of drug. In 2010, this benefit level is attained after the member has paid $4,550 out of pocket for drug costs.

To learn more about Medicare coverage, see “Bridging the coverage gap,” a printable brochure available at the Medicare Website.1

INDICATIONS

SPRYCEL® (dasatinib) is indicated for the treatment of adults with:

  • Chronic, accelerated, or myeloid or lymphoid blast phase Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) with resistance or intolerance to prior therapy including imatinib
  • Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) with resistance or intolerance to prior therapy

IMPORTANT SAFETY INFORMATION

Myelosuppression:

  • Treatment with SPRYCEL® (dasatinib) can cause severe (NCI CTC Grade 3/4) thrombocytopenia, neutropenia, and anemia, occurring more frequently in advanced phase CML or Ph+ ALL than in chronic phase CML. Myelosuppression was reported in patients with normal baseline laboratory values as well as in patients with pre-existing laboratory abnormalities
    • Perform complete blood counts (CBCs) weekly for the first 2 months and then monthly thereafter, or as clinically indicated
    • Myelosuppression was generally reversible and usually managed by dose interruption, dose reduction, or discontinuation
    • Hematopoietic growth factor has been used in patients with resistant myelosuppression

Bleeding Related Events:

  • Sprycel caused platelet dysfunction in vitro and thrombocytopenia in humans
    • In all clinical trials, severe central nervous system (CNS) hemorrhage, including fatalities, occurred in 1% of patients. Severe gastrointestinal (GI) hemorrhage, including fatalities, occurred in 4% of patients receiving SPRYCEL, which generally required treatment interruptions and transfusions. Other cases of severe hemorrhage occurred in 2% of patients
  • Most bleeding events were associated with severe thrombocytopenia
    • Exercise caution in patients required to take medications that inhibit platelet function or anticoagulants

Fluid Retention:

  • Sprycel is associated with fluid retention
    • In clinical trials, fluid retention was severe in up to 10% of patients. Ascites (<1%), generalized edema (<1%), and severe pulmonary edema (1%) were also reported
  • Patients who develop symptoms suggestive of pleural effusion such as dyspnea or dry cough should be evaluated by chest X-ray
  • Severe pleural effusion may require thoracentesis and oxygen therapy
  • Fluid retention was typically managed by supportive care measures that included diuretics or short courses of steroids

QT Prolongation:

  • In vitro data suggest that Sprycel has the potential to prolong cardiac ventricular repolarization (QT interval)
  • In 865 patients with leukemia treated with SPRYCEL in five phase 2 single-arm studies, the maximum mean changes in QTcF (90% upper bound CI) from baseline ranged from 7.0 ms to 13.4 ms
  • In clinical trials of CML patients treated with SPRYCEL (N=2440), 15 patients (<1%) had QTc prolongation as an adverse reaction. Twenty-two patients (1%) experienced a QTcF >500 ms
  • Administer Sprycel with caution to patients who have or may develop prolongation of QTc, including patients with hypokalemia, hypomagnesemia, or congenital long QT syndrome and patients taking anti-arrhythmic drugs, other medicinal products that lead to QT prolongation, and cumulative high-dose anthracycline therapy
    • Correct hypokalemia or hypomagnesemia prior to Sprycel administration

Congestive Heart Failure, Left Ventricular Dysfunction, and Myocardial Infarction:

Cardiac adverse reactions were reported in 5.8% of 258 patients taking Sprycel, including 1.6% of patients with cardiomyopathy, heart failure congestive, diastolic dysfunction, fatal myocardial infarction, and left ventricular dysfunction. Monitor patients for signs or symptoms consistent with cardiac dysfunction and treat appropriately.

Pregnancy:

Sprycel may cause fetal harm when administered to a pregnant woman. There are no adequate and well-controlled studies of Sprycel in pregnant women. Women of childbearing potential should be advised of the potential hazard to the fetus and to avoid becoming pregnant when taking Sprycel.

Nursing Mothers:

It is unknown whether Sprycel is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue Sprycel.

Drug Interactions:

Sprycel is a CYP3A4 substrate and a weak time-dependent inhibitor of CYP3A4.

  • Drugs that may increase Sprycel plasma concentrations are:
    • CYP3A4 inhibitors: Concomitant use of Sprycel and drugs that inhibit CYP3A4 should be avoided. If administration of a potent CYP3A4 inhibitor cannot be avoided, close monitoring for toxicity and a Sprycel dose reduction or temporary discontinuation should be considered
      • Strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole). If Sprycel must be administered with a strong CYP3A4 inhibitor, a dose decrease should be considered
      • Grapefruit juice may also increase plasma concentrations of Sprycel and should be avoided
  • Drugs that may decrease Sprycel plasma concentrations are:
    • CYP3A4 inducers: If Sprycel must be administered with a CYP3A4 inducer, a dose increase in Sprycel should be considered.
      • Strong CYP3A4 inducers (eg, dexamethasone, phenytoin, carbamazepine, rifampin, rifabutin, phenobarbital), should be avoided. Alternative agents with less enzyme induction potential should be considered. If the dose of Sprycel is increased, the patient should be monitored carefully for toxicity
      • St John’s Wort may decrease Sprycel plasma concentrations unpredictably and should be avoided
    • Antacids. Antacids may decrease Sprycel drug levels. Simultaneous administration of SPRYCEL and antacids should be avoided. If antacid therapy is needed, the antacid dose should be administered at least 2 hours prior to or 2 hours after the dose of Sprycel
    • H2 antagonists/proton pump inhibitors, such as famotidine and omeprazole. Long-term suppression of gastric acid secretion by use of H2 antagonists or proton pump inhibitors is likely to reduce Sprycel exposure. Therefore, concomitant use of H2 antagonists or proton pump inhibitors with Sprycel is not recommended
  • Drugs that may have their plasma concentration altered by Sprycel are:
    • CYP3A4 substrates such as simvastatin. CYP3A4 substrates with a narrow therapeutic index should be administered with caution in patients receiving Sprycel

Adverse Reactions:

The safety data reflect exposure to Sprycel in 2182 patients with imatinib resistant or intolerant CML or Ph+ ALL in clinical studies (minimum of 2 years follow-up).

The majority of Sprycel-treated patients experienced adverse reactions at some time. Patients aged 65 years and older are more likely to experience toxicity. In patients resistant or intolerant to prior imatinib therapy, Sprycel was discontinued for adverse reactions in 15% of patients in chronic phase, 16% in accelerated phase, 15% in myeloid blast phase, 8% in lymphoid blast phase CML, and 8% in Ph+ ALL.

  • In patients resistant or intolerant to prior imatinib therapy:
    • The most frequently reported serious adverse reactions included pleural effusion (11%), gastrointestinal bleeding (4%), febrile neutropenia (4%), dyspnea (3%), pneumonia (3%), pyrexia (3%), diarrhea (3%), infection (2%), congestive heart failure/cardiac dysfunction (2%), pericardial effusion (1%), and CNS hemorrhage (1%)
    • The most frequently reported adverse reactions (reported in ≥20% of patients) included myelosuppression, fluid retention events, diarrhea, headache, dyspnea, skin rash, fatigue, nausea, and hemorrhage
    • Grade 3/4 laboratory abnormalities in chronic phase CML patients resistant or intolerant to prior imatinib therapy who received SPRYCEL 100 mg once daily included neutropenia (36%), thrombocytopenia (23%), anemia (13%), hypophosphatemia (10%), and hypokalemia (2%)
  • Grade 3/4 elevations of transaminase or bilirubin and Grade 3/4 hypocalcemia, hypokalemia and hypophosphatemia were reported in patients with all phases of CML, but were reported with an increased frequency in patients with myeloid or lymphoid blast phase CML
    • Elevations in transaminase or bilirubin were usually managed with dose reduction or interruption
    • Patients developing Grade 3/4 hypocalcemia during the course of Sprycel therapy often had recovery with oral calcium supplementation

References:

  1. Bridging the coverage gap. Available at: www.medicare.com. Accessed February 20, 2009.

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