Atta Chowdhry, RPh, opens a discussion surrounding prophylactic treatment in patients diagnosed with hemophilia A.
Atta Chowdhry, RPh: The difference between hemophilia A and hemophilia B is that hemophilia A is primarily the deficiency of factor VIII, and hemophilia B is the deficiency of factor IX. There is no difference between reimbursement rates between hemophilia A and hemophilia B. Basically most of the factor is made out of the blood products and they require an extensive process to make that, and usually, they're pretty much priced at the similar level. And reimbursement depends on insurance to insurance, the insurance plans, deductibles, copay assistance program - all of that stuff factors in for the reimbursement of the factor products.
The standard of care for hemophilia A is defined by MASAC [National Hemophilia Foundation’s Medical and Scientific Advisory Council] guidelines. The National Hemophilia Foundation Document #267 says that all hemophilia patients should be seen by the hemophilia treatment center. Most of the major cities have hemophilia treatment centers located in pretty much every state. Then the standard of care is that either it is prophylactically on the factor product, or they can be in bispecific antibodies, like emicizumab. But those are the standards of care at this point for hemophilia A.
The clinical consideration in the initiation of prophylactic treatment is first, this is a hereditary disease, so we have newborn babies who end up having a joint bleed. With the factor product it's usually the physicians wait until the infant has their first joint bleed or they are older than 18 months because if the factor treatment is started earlier in life, the incidents of getting an inhibitor for those patients go up significantly. So, they usually wait on the product, but since the advent of this bispecific antibody in the market and introduction, they are putting these infants right off the bat on the bispecific antibody. And it's working really good for those infants, and it's working really good specifically for those patients.
Transcript edited for clarity.