Biotechnology INITIATION REPORT Member FINRA/SIPC

Total Page:16

File Type:pdf, Size:1020Kb

Biotechnology INITIATION REPORT Member FINRA/SIPC INSTITUTIONAL RESEARCH Biotechnology INITIATION REPORT Member FINRA/SIPC Toll-Free: 561-391-5555 ⬧ www.DawsonJames.com ⬧ 1 North Federal Highway - Suite 500 ⬧ Boca Raton, FL 33432 Jaguar (NASDAQ/JAGX) January 3, 2019 BUY It’s Time for a Natural Solution Jason H. Kolbert Head of Healthcare Research 646-465-6891 It's time for a natural solution. Crofelemer, brand name Mytesi, is a natural product derived from an abundant source, the Corton lechleri tree. It treats diarrhea at its [email protected] source by normalizing secretion of water into the gut. Mytesi is the only FDA approved antisecretory diarrhea treatment on the market today. Investment Highlights Current Price $0.28 Mytesi revenues are starting to build, reflecting Jaguar's focused product launch Price Target $1.00 efforts. Chronic diarrhea is a common side-effect of HIV therapy and annually Estimates F2017A F2018E F2019E impacts greater than 250,000 people in the U.S. Jaguar is looking to address this Revenues ($000s) $ 4,361 $ 4,620 $ 16,054 population with a new salesforce that is now actively promoting the drug. Sales growth 1Q March $ 822 $ 804 $ 2,482 since promotion efforts began in 2017 looks favorable. We estimate Mytesi could 2Q June $ 897 $ 884 $ 3,085 3Q September $ 1,100 $ 1,132 $ 4,542 reach $4.4M in revenues this year, $15.7M in 2019, and $28.7M in 2020, driving the 4Q December $ 1,542 $ 1,800 $ 5,946 company to break-even. We estimate that by 2028 Mytesi in HIV alone can reach F2017A F2018E F2019E $76M in revenues, which would represent less than 10% of the total HIV market. We EPS (diluted) $ (0.66) $ (1.80) $ (0.09) see the potential for Mytesi to be a big drug, not just in HIV chronic diarrhea, but in 1Q March $ (0.33) $ (0.78) $ (0.05) multiple other markets such as cancer therapy diarrhea (CTD), irritable bowel 2Q June $ (0.12) $ (0.44) $ (0.03) 3Q September $ 0.07 $ (0.51) $ (0.01) syndrome (IBS), short bowel syndrome (SBS), and congenital diarrheal disorder 4Q December $ (0.27) $ (0.07) $ 0.00 (CDD). Like many micro-capitalized emerging growth companies, raising capital has been challenging. On a positive note Jaguar successfully completed a $9M capital EBITDA/Share ($0.79) ($1.15) ($0.08) raise in September 2018. The raise was anchored by a corporate partner (Knight EV/EBITDA (x) 9 10 139 Therapeutics; TSX: GUD; not rated) which acquired distribution, licensing, and Stock Data 52-Week Range $0.12 - $6.60 supply rights in Canada and Israel. We estimate that Jaguar ended the year with close Shares Outstanding (mil.) 24.6 to $6.3M in cash. This should be enough capital, depending on top-line revenues, to Market Capitalization (mil.) $7 support operations for the next year. We view the weakness in the stock as an artifact Enterprise Value (mil.) $11 of the company's capital raises and as such an opportunity as Mytesi fundamentals Debt to Capital 155% appear solid. We are therefore initiating coverage of Jaguar with a Buy rating and a Book Value/Share $2.46 $1 price target. Price/Book 0.9 Average Three Months Trading Volume (K) 4,270 Insider Ownership 35.3% It's time for a natural solution. Crofelemer, brand name Mytesi, is a natural product Institutional Ownership 13.3% derived from an abundant source, the Croton lechleri tree. It treats diarrhea at its source Short interest (mil.) 2.2% by normalizing secretion of water into the gut. Mytesi is the only FDA approved Dividend / Yield $0.00/0.0% antisecretory diarrhea treatment on the market today. The initial indication is for HIV- Jaguar Health, Inc. (JAGX) associated noninfectious diarrhea, but plans are underway to expand the label for CTD Volume (Thousands) Price (USD) Volume Jaguar Health, Inc. followed by additional indications in areas like IBS and IBD. In CTD, two 5 investigator-led studies, one supported by Genentech, a division of Roche (RHHBY; 4 not rated), now underway, and a second study, sponsored by Puma Biotechnology (PBYI; not rated), still in the planning stage, are being designed to evaluate the effects 3 of crofelemer to mitigate the diarrhea which causes patients to terminate their therapy 2 course early. These market segments represent greater than 500K possible patients 40,000 1 translating into an estimated $1B market opportunity. As Jaguar is not the sponsor, 0 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec timing of data is uncertain, though we may see some data by 1Q19. We believe good Source: FactSet Prices data could help attract a corporate partner which could pay our estimated $12.6M in Initiation - January 3, 2019 - Buy - Price Target $1.0 expenses for the company to run a Phase 2, Proof of Concept (POC) study. Please find Important Disclosures beginning on Page 22. Page 1 of 23 www.dawsonjames.com January 3, 2019 Unlock Mytesi’s potential. Mytesi was launched in late 2016 by Napo Pharmaceuticals, which in July 2017 became a wholly owned subsidiary of Jaguar Health. Capital constraints of both Napo initially and later Jaguar restrained the commercial launch. Today, Jaguar has a dedicated salesforce of 15 representatives and in June 2018, entered into a co-promote agreement for Mytesi with RedHill Biopharma. Sales trends are showing growth with 1Q18 revenues of $627K, 2Q18 revenues of $884K, and 3Q18 revenues of $1.1M. RedHill is now working with Jaguar to promote Mytesi. Under the terms of the agreement with RedHill, that company's specialized, GI-focused U.S. field salesforce numbering 36 salesmen, plans to promote Mytesi to healthcare practitioners in 38 territories within the U.S. that contain significant numbers of HIV patients and healthcare practitioners that are not currently covered by Napo's field salesforce. RedHill field representatives plan to target lower-decile infectious disease specialists in regions currently covered by Jaguar's salesforce. In addition to these efforts four internal (telephone marketing) RedHill sales representatives plan to actively target healthcare practitioners in other regions not covered by Jaguar or other RedHill field representatives. We see the co-promotion as synergistic to Jaguar's own efforts and believe that building awareness and achieving critical mass is important at this early stage of the launch of a new product in a competitive market environment. Based on our conversations with management we assume Jaguar captures between 85-90% of all related revenues that RedHill generates. A unique MOA, treating diarrhea at the source. Crofelemer's mechanism of action separates it from other diarrhea treatments available on the market. As an antisecretory, it normalizes the secretion of chloride ions, and subsequently water, into the intestinal lumen, while the only other options on the market are either adsorbents like Pepto-Bismol or antimotility drugs like Imodium and more restrictive options like tincture of opium that may not be appropriate for chronic treatment. Crofelemer acts locally in the gut to block calcium-activated chloride channel anoctamin-1 (CaCC) and the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channels with a maximum inhibition of 90% and 60%, respectively. By blocking these channels, the concentration of calcium ions in the gut is reduced, which normalizes the secretion of sodium ions and water. Crofelemer is selective for these two channels and is not absorbed into the bloodstream as such crofelemer is excreted (not metabolized). Beyond HIV: Multiple indications such as CTD, IBS, IBD, SBS, and CDD. Over time, Jaguar plans to expand Mytesi's label with new indications, the most significant of which is for CTD, which is a large market. We model 436K potential Mytesi patients. Two investigator sponsored trials are using crofelemer, one at Georgetown University sponsored by Genentech, a subsidiary of Roche, and one at UCSF sponsored by Puma Biotechnology, which has just begun. We may see data in 1Q-19 from the Georgetown study. As both these trials are investigator run, timing for start or data is uncertain. Beyond CTD, and with a partner who can pay the development costs and bring in up-front capital, there are also indications of IBS and inflammatory bowel disease (IBD) and idiopathic diarrhea. Two interesting indications which may represent a shorter development time to the market are the orphan indications of CDD and SBS. We expect Jaguar to develop a modified formulation of crofelemer, specific to the indication and priced at a premium. Jaguar is also developing a second-generation product, SB-300 for cholera. The cholera indication could result in the company being granted a Priority Review Voucher (PRV) which can be sold in the marketplace. PRV's values range but they have been previously sold for greater than $100M in revenue. As SB-300 is still in the planning stages, we do not include any valuation for it in our model, although we are aware that the company has completed GMP manufacturing of the API. Not just people, animals too. Before the merger with Napo, Jaguar was focused on animal health. The company has several products still being commercialized today and is completing the final stages of some additional crofelemer-related products for animals including dogs, calves, and race horses. We model very modest revenues for these products as the focus now is on the human indications. With that said, we believe in future years, with additional resources, the company could build out its animal health platform. Valuation. We model revenues for Mytesi in HIV-related diarrhea followed by CTD in 2021. We apply a 30% probability of success in the CTD indication as the company lacks the capital to fund the required pivotal trial today.
Recommended publications
  • Crofelemer Oral Delayed Release Tablet
    Contains Nonbinding Recommendations Draft – Not for Implementation Draft Guidance on Crofelemer This draft guidance, when finalized, will represent the current thinking of the Food and Drug Administration (FDA, or the Agency) on this topic. It does not establish any rights for any person and is not binding on FDA or the public. You can use an alternative approach if it satisfies the requirements of the applicable statutes and regulations. To discuss an alternative approach, contact the Office of Generic Drugs. Active Ingredient: Crofelemer Dosage Form; Route: Tablet, delayed release; oral Strength: 125 mg Recommendations for the Assessment of Identity and Quality of Botanical Raw Material (BRM): Crofelemer is a botanical drug derived from BRM, the crude red latex of Croton lechleri Müll. Arg. [Fam. Euphorbiacae], which is also called dragon’s blood (sangre de drago). Generic drug applicants should use the same plant species and perform BRM assessment: 1. Crofelemer BRM should be collected from the crude red latex of Croton lechleri. The plant species should be correctly identified and authenticated based on techniques such as macroscopic/microscopic and/or analysis of genetic material. 2. Crude red latex as BRM should be collected from the mature tree with defined eco- geographic regions (EGRs). Implementing and enforcing established good agricultural and collection practice (GACP) procedures will minimize variations in BRM and ensure batch- to-batch consistency of crofelemer. 3. BRMs should be analyzed for their crofelemer content, total phenolics and taspine content, as well as heavy metals and pesticides. Recommendations for Demonstrating API Sameness: API sameness can be established by showing equivalence between Test API and API from the reference listed drug (RLD) product with the three criteria described in detail below.
    [Show full text]
  • Supplementary Information
    Supplementary Information Network-based Drug Repurposing for Novel Coronavirus 2019-nCoV Yadi Zhou1,#, Yuan Hou1,#, Jiayu Shen1, Yin Huang1, William Martin1, Feixiong Cheng1-3,* 1Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA 2Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA 3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA #Equal contribution *Correspondence to: Feixiong Cheng, PhD Lerner Research Institute Cleveland Clinic Tel: +1-216-444-7654; Fax: +1-216-636-0009 Email: [email protected] Supplementary Table S1. Genome information of 15 coronaviruses used for phylogenetic analyses. Supplementary Table S2. Protein sequence identities across 5 protein regions in 15 coronaviruses. Supplementary Table S3. HCoV-associated host proteins with references. Supplementary Table S4. Repurposable drugs predicted by network-based approaches. Supplementary Table S5. Network proximity results for 2,938 drugs against pan-human coronavirus (CoV) and individual CoVs. Supplementary Table S6. Network-predicted drug combinations for all the drug pairs from the top 16 high-confidence repurposable drugs. 1 Supplementary Table S1. Genome information of 15 coronaviruses used for phylogenetic analyses. GenBank ID Coronavirus Identity % Host Location discovered MN908947 2019-nCoV[Wuhan-Hu-1] 100 Human China MN938384 2019-nCoV[HKU-SZ-002a] 99.99 Human China MN975262
    [Show full text]
  • Compare and Contrast: IBS/IBD Irritable Bowel Syndrome: Diagnosis
    Irritable Bowel Syndrome: Treatment Disclosure Overview Focusing on Newly Approved Medications • I, or an immediate family member, including spouse or partner, have no financial relationship(s) relevant to the contents of this Southwest Florida Society of Health System Pharmacists continuing education activity Jose Barboza, Pharm.D., C.D.E. Faculty Pharmacotherapeutics & Clinical Research University of South Florida College of Pharmacy Objectives Irritable Bowel Syndrome: Definition • Gastrointestinal (GI) syndrome 1. Describe the pathophysiology of Irritable – Altered bowel function – Abdominal pain or discomfort Bowel Syndrome • Diarrhea predominant – Altered bowel habits (IBS‐D) 2. Review the treatments for Irritable Bowel – Absence of organic cause • Constipation Syndrome • Recurring symptoms predominant (IBS‐C) – Incomplete evacuation • Constipation/ diarrhea 3. Discuss the use of rifaximin and – Urgency (IBS‐M) eluxadoline in treating diarrhea – Bloating • Undefined (IBS‐U) predominant irritable bowel syndrome Compare and Contrast: IBS/IBD Irritable Bowel Syndrome: Diagnosis Irritable Bowel Inflammatory Bowel Rome III Criteria for Irritable Bowel Syndrome Syndrome (IBS) Disease (IBD) Recurrent abdominal pain or discomfort Three episodes per month Pain/ Discomfort Last 3 months associated Chronic inflammation Change in Bowel habits Two or more of… of the intestines Absence of organic cause 1 Improvement with defecation 2 Onset associated with change in frequency of stool Diarrhea (IBS‐D) Crohn’s disease (CD) Constipation (IBS‐C)
    [Show full text]
  • Federal Register/Vol. 85, No. 224/Thursday, November 19, 2020/Notices PRODUCTS—Continued
    73726 Federal Register / Vol. 85, No. 224 / Thursday, November 19, 2020 / Notices information on the cover sheet and not guidances are posted on FDA’s website TABLE 2—REVISED DRAFT PRODUCT- in the body of your comments and you and announced periodically in the SPECIFIC GUIDANCES FOR DRUG must identify this information as Federal Register. The public is PRODUCTS—Continued ‘‘confidential.’’ Any information marked encouraged to submit comments on as ‘‘confidential’’ will not be disclosed those recommendations within 60 days Active ingredient(s) except in accordance with 21 CFR 10.20 of their announcement in the Federal and other applicable disclosure law. For Register. FDA considers any comments Fluphenazine hydrochloride more information about FDA’s posting received and either publishes final Hydrocortisone acetate of comments to public dockets, see 80 guidances or publishes revised draft Isotretinoin (multiple referenced listed drugs) Levorphanol tartrate FR 56469, September 18, 2015, or access guidances for comment. Guidances were Lomitapide mesylate the information at: https:// last announced in the Federal Register Methylphenidate hydrochloride www.govinfo.gov/content/pkg/FR-2015- on August 26, 2020. This notice Pimavanserin tartrate 09-18/pdf/2015-23389.pdf. announces draft product-specific Propranolol hydrochloride (multiple ref- Docket: For access to the docket to guidances, either new or revised, that erenced listed drugs) read background documents or the are posted on FDA’s website. Tofacitinib citrate electronic and written/paper comments II. Drug Products For Which New Draft received, go to https:// For a complete history of previously Product-Specific Guidances Are www.regulations.gov and insert the published Federal Register notices Available docket number, found in brackets in the related to product-specific guidances, go heading of this document, into the FDA is announcing the availability of to https://www.regulations.gov and ‘‘Search’’ box and follow the prompts new draft product-specific guidances for enter Docket No.
    [Show full text]
  • Patent Application Publication ( 10 ) Pub . No . : US 2019 / 0192440 A1
    US 20190192440A1 (19 ) United States (12 ) Patent Application Publication ( 10) Pub . No. : US 2019 /0192440 A1 LI (43 ) Pub . Date : Jun . 27 , 2019 ( 54 ) ORAL DRUG DOSAGE FORM COMPRISING Publication Classification DRUG IN THE FORM OF NANOPARTICLES (51 ) Int . CI. A61K 9 / 20 (2006 .01 ) ( 71 ) Applicant: Triastek , Inc. , Nanjing ( CN ) A61K 9 /00 ( 2006 . 01) A61K 31/ 192 ( 2006 .01 ) (72 ) Inventor : Xiaoling LI , Dublin , CA (US ) A61K 9 / 24 ( 2006 .01 ) ( 52 ) U . S . CI. ( 21 ) Appl. No. : 16 /289 ,499 CPC . .. .. A61K 9 /2031 (2013 . 01 ) ; A61K 9 /0065 ( 22 ) Filed : Feb . 28 , 2019 (2013 .01 ) ; A61K 9 / 209 ( 2013 .01 ) ; A61K 9 /2027 ( 2013 .01 ) ; A61K 31/ 192 ( 2013. 01 ) ; Related U . S . Application Data A61K 9 /2072 ( 2013 .01 ) (63 ) Continuation of application No. 16 /028 ,305 , filed on Jul. 5 , 2018 , now Pat . No . 10 , 258 ,575 , which is a (57 ) ABSTRACT continuation of application No . 15 / 173 ,596 , filed on The present disclosure provides a stable solid pharmaceuti Jun . 3 , 2016 . cal dosage form for oral administration . The dosage form (60 ) Provisional application No . 62 /313 ,092 , filed on Mar. includes a substrate that forms at least one compartment and 24 , 2016 , provisional application No . 62 / 296 , 087 , a drug content loaded into the compartment. The dosage filed on Feb . 17 , 2016 , provisional application No . form is so designed that the active pharmaceutical ingredient 62 / 170, 645 , filed on Jun . 3 , 2015 . of the drug content is released in a controlled manner. Patent Application Publication Jun . 27 , 2019 Sheet 1 of 20 US 2019 /0192440 A1 FIG .
    [Show full text]
  • Mississippi Division of Medicaid Universal Preferred Drug List
    MISSISSIPPI DIVISION OF MEDICAID EFFECTIVE 01/01/2021 UNIVERSAL PREFERRED DRUG LIST Version 2021.13a Updated: 8-30-2021 (For All Medicaid, MSCAN and CHIP Beneficiaries) Conduent’s SmartPA Pharmacy Application (SmartPA) is a proprietary electronic prior authorization system used for Medicaid fee for service claims. MSCAN plans may/may not -have electronic PA functionality. However, they must adhere to Medicaid’s PA criteria. THERAPEUTIC PREFERRED AGENTS NON-PREFERRED AGENTS PA CRITERIA DRUG CLASS ACNE AGENTS ANTI-INFECTIVE clindamycin gel (generic Cleocin-T) ACZONE (dapsone) Maximum Age Limit clindamycin lotion AKNE-MYCIN (erythromycin) • 21 years – all agents except clindamycin solution azelaic acid isotretinoins AMZEEQ FOAM (minocycline) AZELEX (azelaic acid) CLEOCIN-T (clindamycin) CLINDAMYCIN PAC (clindamycin) CLINDAGEL (clindamycin) clindamycin foam clindamycin gel daily (generic Clindagel) dapsone ERY (erythromycin) ERYGEL (erythromycin) erythromycin gel, swabs, solution EVOCLIN (clindamycin) KLARON (sulfacetamide) sulfacetamide RETINOIDS RETIN-A (tretinoin) adapalene tretinoin cream AKLIEF (trifarotene) ALTRENO (tretinoin) ARAZLO (tazarotene) ATRALIN (tretinoin) AVITA (tretinoin) DIFFERIN (adapalene) FABIOR (tazarotene) PLIXDA (adapalene) 1 Drug coverage subject to the rules and regulations set forth in Sec. 1927 of Social Security Act.This is not an all-inclusive list of available covered drugs and includes only managed categories. Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the P&T Committee. PREFERRED BRANDS will not count toward the two brand monthly Rx limit. Drugs highlighted in yellow denote a change in PDL status. An * denotes existing users will be grandfathered; grandfathering is defined as approving a Non-Preferred agent for an existing user; all other changes will not qualify for grandfathering.
    [Show full text]
  • Quantity Limit Drugs and Diabetic Supplies
    Quantity Limit Drugs and Diabetic Supplies Effective 2/1/2015 Class and Name Effective Date ALLERGEN EXTRACTS, GRASS POLLEN 34 Per Month Quantity Limit Grastek 7/1/2014 Oralair 9/26/2014 ALLERGEN EXTRACTS, RAGWEED 34 Per Month Quantity Limit Ragwitek 7/1/2014 ALZHEIMER'S AGENTS 34 Per Month Quantity Limit memantine 7 mg er 6/1/2013 memantine 14 mg er 6/1/2013 memantine 21 mg er 6/1/2013 memantine 28 mg er 6/1/2013 memantine er starter pack 6/1/2013 68 Per Month Quantity Limit memantine 5 mg 6/1/2013 memantine 10 mg 6/1/2013 memantine starter pack 6/1/2013 ANALGESICS/ANESTHETICS, TOPICAL 90 Patches Per Month Quantity Limit lidocaine topical 5% patch 10/1/2010 ANALGESICS, OPIOIDS, LONG-ACTING 4 Per Month Quantity Limit buprenorphine transderm 5 mcg/hr patch 2/1/2011 buprenorphine transderm 7.5 mcg/hr patch 10/1/2014 buprenorphine transderm 10 mcg/hr patch 2/1/2011 buprenorphine transderm 15 mcg/hr patch 10/1/2013 buprenorphine transderm 20 mcg/hr patch 2/1/2011 34 Per Month Quantity Limit Hydrocodone Products hydrocodone 20 mg er tab 1/1/2015 hydrocodone 30 mg er tab 1/1/2015 hydrocodone 40 mg er tab 1/1/2015 hydrocodone 60 mg er tab 1/1/2015 hydrocodone 80 mg er tab 1/1/2015 hydrocodone 100 mg er tab 1/1/2015 hydrocodone 120 mg er tab 1/1/2015 Tramadol Products tramadol 200 mg er 10/1/2011 tramadol 200 mg sr 9/1/2010 Page 1 of 16 Class and Name Effective Date ANALGESICS, OPIOIDS, LONG-ACTING (Continued) 34 Per Month Quantity Limit (Continued) Tramadol Products (Continued) tramadol 300 mg er 10/1/2011 tramadol 300 mg sr 9/1/2010 68 Per
    [Show full text]
  • 4Aug201701045346
    4AUG201701045346 June 25, 2020 DEAR FELLOW MEMBERS OF JAGUAR AND NAPO’S GLOBAL FAMILY: I was recently reading the adult noir fiction novel Bottle Grove by David Handler. As anyone who has children is likely aware, Daniel Handler is also known as Lemony Snicket, author of the great young adult A Series of Unfortunate Events stories. The series of thirteen novels comprising A Series of Unfortunate Events tell the story of three siblings who become orphans when an unfortunate event happens to their parents. Lemony Snicket’s stories struck me. In a very real sense, Mytesiா, our precious drug product, has been orphaned. A product granted approval for noninfectious diarrhea in adults with HIV/AIDS on antiretroviral therapy (ART)—our goal when we put Mytesi in clinical trials more than 15 years ago for the hundreds of thousands of people living with HIV (PLWH) and associated unrelenting diarrhea—is now orphaned. What does that mean? Yes, Mytesi is the only oral plant- based, non-opioid, fair trade-sourced medicine approved by the FDA under botanical guidance. Yes, our team fought and prevailed in a six-year legal battle to regain control of this first-in-class drug we developed which was allegedly being neglected by a commercial partner that had other potentially competitive plans in place. And now, here we are in 2020, recognizing that less than 5,000 PLWH are currently being prescribed Mytesi. Mytesi has been orphaned. Is that an unfortunate event? Is that not a success? What is success for an emerging drug discovery pharmaceutical company? I personally know several PLWH who are on Mytesi.
    [Show full text]
  • Mytesi™ (Crofelemer)
    Pharmacy Medical Necessity Guidelines: Mytesi™ (crofelemer) Effective: November 10, 2020 Prior Authorization Required √ Type of Review – Care Management Not Covered Type of Review – Clinical Review √ Pharmacy (RX) or Medical (MED) Benefit Rx Department to Review RXUM These pharmacy medical necessity guidelines apply to the following: Fax Numbers: Commercial Products RXUM: 617.673.0988 Tufts Health Plan Commercial products – large group plans Tufts Health Plan Commercial products – small group and individual plans Tufts Health Freedom Plan products – large group plans Tufts Health Freedom Plan products – small group plans • CareLinkSM – Refer to CareLink Procedures, Services and Items Requiring Prior Authorization Tufts Health Public Plans Products Tufts Health Direct – A Massachusetts Qualified Health Plan (QHP) (a commercial product) Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans Tufts Health RITogether – A Rhode Island Medicaid Plan Note: This guideline does not apply to Medicare Members (includes dual eligible Members). OVERVIEW FOOD AND DRUG ADMINISTRATION-APPROVED INDICATIONS Mytesi (crofelemer) is indicated for symptomatic relief of non-infectious diarrhea in adult patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on anti-retroviral therapy. Mytesi (crofelemer) is an anti-diarrheal and is the first drug indicated for the treatment of diarrhea in patients with HIV/AIDS. It is also the second approved botanical product. Mytesi (crofelemer) is extracted from the sap of the Croton lechleri plant. Several studies have found that patients with HIV experience diarrhea at a higher rate than other populations. The management of idiopathic, noninfectious diarrhea, associated with HIV or protease inhibitor use has generally been nonspecific. Commonly used therapies include anti-motility agents (e.g., loperamide, diphenoxylate/atropine, opioids), adsorbents (e.g., bismuth subsalicylate), bulk- forming fiber supplements, calcium supplements, and at times, pancrelipase or octreotide.
    [Show full text]
  • 202292Orig1s000
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 202292Orig1s000 CROSS DISCIPLINE TEAM LEADER REVIEW CDTL Memo ● NDA 202-292 ● Fulyzaq (crofelemer) ● Diarrhea - HIV/AIDS on Anti-Retrovirals ● Salix Pharmaceuticals 1 Introduction This submission, received December 5, 2011, is the initial New Drug Application (NDA) for Fulyzaq® (crofelemer), a polymeric proanthocyanidin extracted from the red latex sap of the plant species Croton lechleri from the Amazon regions of South America. The Applicant’s proposed indication for crofelemer is: “…for the control and symptomatic relief of diarrhea in patients with HIV/AIDS on anti- retroviral therapy.” Based on in vitro and in vivo studies, crofelemer is believed to be an inhibitor of both the cAMP stimulated cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel and the calcium-activated chloride channels (CaCC); the inhibition is believed to block chloride secretion and high volume water loss that occurs with diarrhea. The proposed product is a delayed-release tablet. The proposed dose is 125 mg BID. All the review disciplines recommend in favor of approval, but several Phase 4 commitments were recommended. 2 Background 2.1 Diarrhea in HIV/AIDS Patients In the era of highly active antiretroviral therapies (HAART), diarrhea from opportunistic infections is uncommon.1 No pathogen can be identified in 15-46% of HIV-infected patients with diarrhea.2 HIV-associated diarrhea often has non-infectious causes including adverse effects of HAART (especially protease inhibitors), HIV enteropathy, HIV-associated malignancies, and pancreatitis.3 Mechanisms of HAART-associated diarrhea include increased calcium-dependent chloride conductance and cellular apoptosis, necrosis and decreased proliferation of intestinal epithelial cells.4 Diarrhea is reported in up to 60% of patients with HIV infection.5,6 However, precise prevalence estimates are difficult due to variations in defining HIV-associated diarrhea such 7 as duration (acute versus chronic), definition of diarrhea, and assessment tools.
    [Show full text]
  • (THMP) Medication Formulary and Maximum Quantities
    Texas HIV Medication Program (THMP) Medication Formulary and Maximum Quantities MAX Drug Name Priority Class Strength/Form Per Unit Qty/30- Notes day script If the THMP provides Aptivus, then the Norvir used as a Aptivus (tipranivir) ** 1 PI 250 mg capsules 120/btl 120 capsules boosting agent must be obtained thru the Abbott PAP. Atripla (Sustiva / Truvada) Sustiva 600 mg / Emtriva 200 mg / Atripla counts as 3 medications towards a 4 antiretroviral drug 1 STR 30/btl 30 tablets (Sustiva / Emtriva / Viread) Viread 300 mg tablets combination limit. Biktarvy Bictegravir 50 mg / emtricitabine Biktarvy counts as 3 medications towards a 4 antiretroviral drug (bictegravir/emtricitabine/tenofovir 200 mg / tenofovir alafenamide 25 1 STR 30/btl 30 tablets combination limit. alafenamide) mg Combivir counts as 2 medications towards a 4 antiretroviral drug Combivir (AZT / 3TC) 1 RTI AZT 300 mg / 3TC 150 mg tablets 60/btl 60 tablets combination limit. Emtriva 200 mg / Edurant 25 mg / Complera counts as 3 medications towards a 4 antiretroviral drug Complera (Emtriva/Edurant/Viread) 1 STR 30/btl 30 tablets Viread 300 mg tablets combination limit. Doravirine 100 mg /lamivudine 300 Delstrigo 1 STR mg/tenofovir disoproxil fumarate 30/btl 30 tablets 300 mg emtricitabine 200mg / tenofovir TAF Descovy 1 RTI 30/btl 30 tablets 25mg Dolutegravir sodium 50mg/ Dovato (dolutegravir/lamivudine) 1 STR 30/btl 30 tablets lamivudine 300mg Emtriva (emtricitabine) 1 RTI 200 mg capsules 30/btl 30 capsules Emtriva OS (emtricitabine) 1 RTI 10 mg/ml suspension 170 ml/btl 4 bottles Epivir (lamivudine, 3TC) 1 RTI 100 mg tablets 60/btl 60 tablets Epivir (lamivudine, 3TC) 1 RTI 150 mg tablets 60/btl 60 tablets Epivir (lamivudine, 3TC) 1 RTI 300 mg tablets 30/btl 30 tablets Epivir OS (lamivudine, 3TC) 1 RTI 10 mg/ml suspension 240 ml/btl (8 oz) 4 bottles Epzicom counts as 2 medications towards a 4 antiretroviral drug Epzicom (Epivir / Ziagen) 1 RTI Epivir 300 mg / Ziagen 600 mg 30/btl 30 capsules combination limit.
    [Show full text]
  • Anti-Infective Drug Poster
    Anti-Infective Drugs Created by the Njardarson Group (The University of Arizona): Edon Vitaku, Elizabeth A. Ilardi, Daniel J. Mack, Monica A. Fallon, Erik B. Gerlach, Miyant’e Y. Newton, Angela N. Yazzie, Jón T. Njarðarson Streptozol Spectam Novocain Sulfadiazine M&B Streptomycin Chloromycetin Terramycin Tetracyn Seromycin Tubizid Illosone Furadantin Ethina Vancocin Polymyxin E Viderabin Declomycin Sulfamethizole Blephamide S.O.P. ( Sulfanilamide ) ( Spectinomycin ) ( Procaine ) ( Sulfadiazine ) ( Sulfapyridine ) ( Streptomycin ) ( Chloramphenicol ) ( Oxytetracycline ) ( Tetracycline ) ( Cycloserine ) ( Isoniazid ) ( Erythromycin ) ( Nitrofurantoin ) ( Ethionamide ) ( Vancomycin ) ( Colistin ) ( Vidarabine ) ( Demeclocycline ) ( Sulfamethizole ) ( Prednisolone Acetate & Sulfacetamide ) ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIMYCOBACTERIAL ANTIMYCOBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIMYCOBACTERIAL ANTIBACTERIAL ANTIBACTERIAL ANTIVIRAL ANTIBACTERIAL ANTIBACTERIAL ANTIBACTERIAL Approved 1937 Approved 1937 Approved 1939 Approved 1941 Approved 1942 Approved 1946 Approved 1949 Approved 1950 Approved 1950s Approved 1950s Approved 1952 Approved 1953 Approved 1953 Approved 1956 Approved 1958 Approved 1959 Approved 1960 Approved 1960 Approved 1960s Approved 1961 Coly-Mycin S Caprocin Poly-Pred Aureocarmyl Stoxil Flagyl NegGram Neomycin Flumadine Omnipen Neosporin G.U. Clomocycline Versapen-K Fungizone Vibramycin Myambutol Pathocil Cleocin Gentak Floxapen
    [Show full text]