FDA Issues Further Guidance About Makena®

ST. LOUIS, July 2, 2012 /PRNewswire/ -- K-V Pharmaceutical Company (the "Company") (NYSE:  KV.A/KV.B) today addressed the additional guidance provided by the U.S. Food and Drug Administration (FDA), which issued a Questions and Answers document on June 29 to clarify its June 15, 2012 statement on compounded versions of hydroxyprogesterone caproate (the active ingredient in Makena®).  FDA provides further guidance to healthcare providers and pregnant women at high risk for recurrent preterm birth, recommending the use of FDA-approved Makena® rather than compounded drug formulations of hydroxyprogesterone caproate.  The agency also describes its enforcement policy towards compounded formulations of hydroxyprogesterone caproate.  Makena® is the only FDA-approved medication indicated to reduce the risk of preterm birth in women with a singleton pregnancy who have a history of singleton spontaneous preterm birth. 

FDA's June 29, 2012 Q&A can be found here: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm310215.htm

FDA's Questions and Answers document recommends that healthcare providers prescribe FDA-approved Makena® first-line for clinically indicated patients and provides guidance on how patients can know if they are receiving Makena®.  FDA states, in part:

• "If there is an FDA-approved drug that is medically appropriate for a patient, the FDA-approved product should be prescribed and used."
• "Makena® was approved based on an affirmative showing of safety and efficacy. The company also demonstrated the ability to manufacture a quality product. The pre-market review process included a review of the company's manufacturing information, such as the source of the API used in the manufacturing of the drug, proposed manufacturing processes, and the firm's adherence to current good manufacturing practice."
• "Compounded drugs do not undergo the same premarket review and thus lack an FDA finding of safety and efficacy and lack an FDA finding of manufacturing quality."

"It is important for healthcare providers to take the time to read and understand FDA's Questions and Answers document issued on June 29, and counsel patients accordingly," said Douglas Laube, M.D., M.Ed., Professor, Department of Obstetrics and Gynecology, University of Wisconsin Medical School, and Former President, ACOG.  "I encourage the medical community to help resolve issues in disparity of care that may have resulted from confusion about the differences between FDA-approved and compounded products, and work together towards addressing the issue of prematurity in the United States."

FDA also describes its enforcement policy towards compounded formulations of hydroxyprogesterone caproate.  FDA states:

• "The compounding of any drug, including hydroxyprogesterone caproate, should not exceed the scope of traditional pharmacy compounding ... The FDA does not consider compounding large volumes of copies, or what are essentially copies, of any approved commercially-available drug to fall within the scope of traditional pharmacy practice."
• "The FDA's June 15, 2012 statement should not be interpreted to mean that the FDA will take enforcement action only if the agency identifies a particular safety problem."
• "The FDA may take enforcement action against pharmacies that compound large volumes of drugs that are essentially copies of commercially available products and for which there does not appear to be a medical need for individual patients to whom the drug is dispensed."

Tens of thousands of pregnant women at high risk for recurrent preterm birth are being denied FDA-approved Makena® by certain payers whose coverage policies cite outdated March 2011 statements from FDA and the Center for Medicare and Medicaid Services (CMS).  As a result of these unreasonable coverage policies, in certain states, Medicaid participants, in particular, have been denied access to the only FDA-approved medication for their condition - despite the clinical judgment made by many healthcare providers that FDA-approved Makena® is the appropriate choice for their patients, and despite FDA's repeated statements that Makena® offers greater assurance of safety and effectiveness than compounded 17P formulations. 

Low-income pregnant women are known to be at higher risk for premature birth.  Policies imposed by certain state Medicaid agencies force a pregnant woman at high risk for recurrent preterm birth to "try and fail" or be "unable to tolerate" compounded 17P formulations before the state will approve Makena® for her; others require that she and her physician must demonstrate "medical necessity" for Makena® instead of compounded formulations.  These coverage policies disregard guidance issued by FDA and CMS, including the most recent statements.  Notably, some states with such policies in place also have prematurity rates above the national average of 12.2 percent - an outcome with heartbreaking results for families and the potential for high life-long medical costs, a significant portion of which will likely be borne by Medicaid.

"Babies born early put a very large financial strain on our healthcare delivery system, and many of these children have persistent developmental delay or lifelong disability.  The patient population for Makena® is known to be at particularly high risk for having repeat preterm births," said Casey Younkin, MD, Associate Professor, Division of General OB/GYN, Southern Illinois University School of Medicine.  "Potency and purity can vary in compounded formulations.  I want to ensure that all of my patients, regardless of their socioeconomic status, have access to FDA-approved Makena®.  It is important for State Medicaid programs - including my home state of Illinois - to examine their coverage policies to ensure they are in alignment with both FDA's guidance and evidence-based protocols.  No other form of progesterone has been determined by FDA to be effective in this patient population."

As part of its commitment to patients and healthcare providers, the Company has made substantial efforts to work with payers to facilitate insurance coverage of Makena®. The Company's significantly reduced pricing to both commercial and Medicaid payers make the cost of a full course of therapy a fraction of the average cost of a preterm birth.  Further, patient co-pays are averaging approximately $8 per injection (often less than the cost to patients for compounded drug formulations). The Company provides Makena® at no out-of-pocket cost to clinically-indicated uninsured women through its financial assistance programs.

KV President and CEO Greg Divis commented, "FDA's further guidance issued on June 29 underscores the need for payers who have made access to Makena difficult to promptly remove roadblocks that have prevented patients from receiving the only FDA-approved drug for their condition.  Changing their coverage policies is in the best interests of pregnant women."

About Makena® (hydroxyprogesterone caproate injection)
Makena is a progestin indicated to reduce the risk of preterm birth in women with a singleton pregnancy who have a history of singleton spontaneous preterm birth. The effectiveness of Makena is based on improvement in the proportion of women who delivered <37 weeks of gestation. There are no controlled trials demonstrating a direct clinical benefit, such as improvement in neonatal mortality and morbidity.

Limitation of use: While there are many risk factors for preterm birth, safety and efficacy of Makena has been demonstrated only in women with a prior spontaneous singleton preterm birth. It is not intended for use in women with multiple gestations or other risk factors for preterm birth.

Important safety information for Makena (hydroxyprogesterone caproate injection)

• Makena should not be used in women with any of the following conditions:
  • Current or history of thrombosis or thromboembolic disorders
  • Known or suspected breast cancer, other hormone-sensitive cancer or history of these conditions
  • Undiagnosed abnormal vaginal bleeding unrelated to pregnancy
  • Cholestatic jaundice of pregnancy
  • Liver tumors, benign or malignant, or active liver disease
  • Uncontrolled hypertension
• Makena should be discontinued if thrombosis or thromboembolism occurs
• Allergic reactions, including urticaria, pruritus and angioedema, have been reported with use of Makena or with other products containing castor oil
• Women receiving Makena should be monitored if they:
  • Are prediabetic or diabetic
  • Have conditions that may be affected by fluid retention, such as preeclampsia, epilepsy, cardiac or renal dysfunction
  • Have a history of clinical depression; Makena should be discontinued if depression recurs
  • Develop jaundice; consider whether benefit of use warrants continuation
  • Develop hypertension
• Certain pregnancy-related fetal and maternal complications or events were numerically increased in Makena-treated subjects as compared to placebo subjects, including miscarriage (2.4% vs. 0%) and stillbirth (2% vs. 1.3%), admission for preterm labor (16% vs. 13.8%), preeclampsia or gestational hypertension (8.8% vs. 4.6%), gestational diabetes (5.6% vs. 4.6%), and oligohydramnios (3.6% vs. 1.3%)
• The most common adverse reactions reported in >2% of subjects and at a higher rate in the Makena group than in the control group were injection site reactions (pain [35% vs. 33%], swelling [17% vs. 8%], pruritus [6% vs. 3%], and nodule [5% vs. 2%]), urticaria (12% vs. 11%), pruritus (8% vs. 6%), nausea (6% vs. 5%), and diarrhea (2% vs. 1%)

About K-V Pharmaceutical Company
K-V Pharmaceutical Company is a specialty branded pharmaceutical company with a primary focus in the area of women's healthcare. As such, we are committed to advancing the health of women across all the stages of their lives.

For further information about K-V Pharmaceutical Company, please visit the Company's corporate website at www.kvpharmaceutical.com.

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SOURCE K-V Pharmaceutical Company