Cancer patients who receive prescriptions for biosimilars, generics, and clinically appropriate lower-cost drugs instead of established, costlier drugs can effectively reduce the total cost of care by 5 percent or more and still maintain quality of care. Even small shifts towards lower-cost drugs can result in significant reductions in the total cost of care, according to a study presented at the 2022 ASCO Quality Care Symposium. The cumulative savings were $26 million, $32.3 million, and $32.9 million per consecutive 6-month interval between July 2019 and December 2020.
"Our study shows that smarter spending can be achieved while also boosting quality of cancer care," said co-author Erica Feinberg, PharmD, BCPS, Senior Clinical Data Analyst at The U.S. Oncology Network in The Woodlands, Texas. "The big challenge for providers and pharmacists is balancing preferred options from a variety of insurers, as well as the storage, prior authorization, and billing specificity that accompany having to use different biosimilars or drugs for patients with differing insurance plans. These are complex circumstances that we hope our study will help sort out and result in lowering costs for everyone."
About the Study
An Affordable Care Act initiative called the Oncology Care Model was developed by the Centers for Medicare & Medicaid Services (CMS) in 2016 to encourage better oncology care. The model included 24-hour access to doctors for people undergoing cancer treatment and emphasized coordinated, personalized care aimed at rewarding the value of care rather than volume. Participating practices received monthly care management payments for each Medicare beneficiary to support the transformation of how cancer care was provided.
Patients who were enrolled in the model were evaluated every 6 months. The clinical appropriateness of choosing one drug over the other was based on the treating provider's medical judgement of whether the patient could tolerate the medication, as well as whether the drug had any potential interactions with other treatments. The use of lower-cost medication alternatives is a critical strategy to bend the cost curve, the researchers noted, adding that therapeutic interchange with lower-cost generic/biosimilar/therapeutic alternative medications offer significant cost savings to payers and patients while maintaining equivalent quality of care.
Eight less expensive drugs or supportive care treatments became available during, or just prior to, the implementation of the Oncology Care Model. Medicare Part B (primarily physician services) and D (drug costs) claims for 14 practices in the US Oncology Network participating in the model were used to evaluate the impact of the eight medication substitutions during the final 18 months of the 5-year program. The substitutions included changing therapy from reference products to biosimilars (bevacizumab, trastuzumab, rituximab, pegfilgrastim, and filgrastim), from brand to generics (abiraterone, imatinib, and fosaprepitant), and from high cost to lower cost (aprepitant to fosaprepitant and denosumab to zoledronic acid) when clinically appropriate.
Key Findings
Switching to biosimilars contributed $6.6 million in savings in the first 6 months of 2020 and $12.2 million in the last 6 months of 2020. Overall, the switches reduced the total cost of oncology drug care by 2.78 percent, 4.13 percent, and 5.25 percent in 6-month intervals of the Oncology Care Model between July 2019 and December 2020, consecutively. The researchers note that there is room for this benefit to continue as long as price differences exist between two interchangeable products.
In conclusion, the researchers stated: "Therapeutic interchange to biosimilars, generics, and clinically appropriate lower-cost medication alternatives is an effective way to reduce the total cost of care while maintaining quality care in the Oncology Care Model. Even small shifts in utilization towards lower-cost alternatives can generate a significant reduction in total costs. Physician-supported, pharmacist-led therapeutic interchange initiatives are critical to bending the cost curve within oncology."
The researchers will continue to track the benefits of biosimilar and generic interchanges in the Oncology Care Model. CMS recently announced a new 5-year pilot program-The Enhancing Oncology Model-that the researchers hope to study at some point. They also continue to track the pipeline of generic drugs and biosimilars to optimize the value of any similar opportunities with other drug classes (both therapeutic and supportive care).
"This study shows that, with the use of lower-cost alternatives, patients can benefit from lower copays and lower out-of-pocket expenses without forgoing quality care," noted Julie R. Gralow, MD, FACP, FASCO, Chief Medical Officer and Executive Vice President of ASCO. "This is a proverbial win-win situation where the patient benefits not only from the same quality of care, but is able to access it at a lower price."
Mark L. Fuerst is a contributing writer.