“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. 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,” said ASCO Chief Medical Officer and Executive Vice President Julie R. Gralow, MD, FACP, FASCO.
ALEXANDRIA, Va. — Substituting biosimilars, generics and clinically appropriate lower cost drugs for established, costlier drugs was shown to be an effective way to reduce the total cost of care, by 5% or so, while maintaining the quality of care for patients with cancer. Even small shifts towards lower cost drugs resulted in significant reductions in the total cost of care, according to a study to be presented as part of the 2022 ASCO Quality Care Symposium.
Study at a Glance
Reducing total cost of cancer care while maintaining quality of care.
Patients with cancer receiving Medicare.
Substituting biosimilars, generics, and clinically appropriate lower cost drugs reduced the total cost of care by about 5% while maintaining the quality of that care for patients with cancer.
Cost of cancer care can be reduced while maintaining the quality of care.
“Our study shows that smarter spending can be achieved while also boosting quality of cancer care. 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,” said co-author Erica Feinberg, PharmD, BCPS, Senior Clinical Data Analyst, The U.S. Oncology Network, The Woodlands, Texas.
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 care1. 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.
In the model, enrolled patients were evaluated every six 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 was offered to bend the cost curve. 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) & D (drug costs) claims for 14 practices in the United States (U.S.) Oncology Network participating in the OCM were used to evaluate the impact of the eight medication substitutions during the final 18 months of the five-year OCM program. The substitutions included changing therapy from reference products to biosimilars (bevacizumab, trastuzumab, rituximab, pegfilgrastim, and filgrastim), from brand to generics (abiraterone, imatinib, fosaprepitant) and from high cost to lower cost (aprepitant to fosaprepitant and denosumab to zoledronic acid) when clinically appropriate.
The cumulative savings were $26.0 million, $32.3 million, and $32.9 million per consecutive six-month interval between July 2019 and December 2020. Switching to biosimilars contributed $6.6 million in savings in the first six months of 2020 and $12.2 million in the last six months of 2020. Overall, the switches reduced the total cost of oncology drug care by 2.78%, 4.13%, and 5.25% in six-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.
The investigators are continuing to track the benefits of biosimilar and generic interchanges in the Oncology Care Model. CMS recently announced a new five-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 received no external funding.
For your readers:
- Understanding the Costs Related to Cancer Care
- What Are Biosimilars in Cancer Treatment?
- Biosimilars and Cancer Care: An Expert Opinion
View the disclosures for the 2022 ASCO Quality Care Symposium News Planning Team: https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2022-QCS-NPT-Disclosures.pdf
View the disclosures for Dr. Gralow: https://coi.asco.org/share/CKD-HYVM/Julie%20Gralow
ATTRIBUTION TO THE 2022 ASCO QUALITY CARE SYMPOSIUM IS REQUESTED IN ALL COVERAGE.
 https://innovation.cms.gov/innovation-models/oncology-care: The Oncology Care Model. Updated August 4, 2022.
Founded in 1964, the American Society of Clinical Oncology, Inc. (ASCO®) is committed to the principle that knowledge conquers cancer. Together with the Association for Clinical Oncology, ASCO represents nearly 45,000 oncology professionals who care for people living with cancer. Through research, education, and promotion of high quality, equitable patient care, ASCO works to conquer cancer and create a world where cancer is prevented or cured, and every survivor is healthy. Conquer Cancer, the ASCO Foundation, supports ASCO by funding groundbreaking research and education across cancer’s full continuum. Learn more at www.ASCO.org, explore patient education resources at www.Cancer.Net, and follow us on Facebook, Twitter, LinkedIn, Instagram, and YouTube.