The Oncology Care Model (OCM) rewards practices for decreasing total cost of care (TCOC) when compared with historical baseline prices that are adjusted by a trend factor accounting for the rising cost of oncology care. Biosimilar options were introduced for 3 mainstay therapeutic classes in oncology, bevacizumab and trastuzumab in 2019, and rituximab in 2020. This led to a concerted approach for biosimilar adoption in The US Oncology Network (The Network) as an opportunity to reduce TCOC. In a study presented at the 2022 ASCO Annual Meeting, Lalan S Wilfong, MD, Texas Oncology, The US Oncology Network, Dallas, TX, and colleagues describe utilization and the financial impact of biosimilar adoption in The Network during OCM performance period 8 (PP8) that enrolled patients from January 2, 2020 to July 1, 2020.

The researchers examined claims data for the 14 practices within The Network participating in the OCM. These data were used to determine biosimilar utilization for bevacizumab, trastuzumab, and rituximab therapeutic classes. The impact of biosimilar utilization on TCOC was measured by comparing the cost of each dose of a biosimilar with the estimated cost if the more expensive innovator agent had been used instead.

Biosimilar utilization increased for each therapeutic class from prior performance periods. Biosimilar use for bevacizumab was 0% in PP6, 5% in PP7 and 43% in PP8. For trastuzumab, utilization was 0% in PP6, 4% in PP7 and 33% in PP8. Rituximab biosimilar utilization was 0% in PP6, 2% in PP7 and 41% in PP8. The authors then compared the actual cost of these three medications in OCM claims in PP8 vs. the calculated cost based on Medicare reimbursement as ASP + 6% minus sequestration if the more expensive innovator drugs had been used entirely. The difference in the actual cost vs estimated cost led to a savings of $6.61 million by using the biosimilars over innovator drugs.

“The increased utilization of biosimilars in The Network generated significant savings in OCM. Continued adoption of biosimilars will increase savings to Medicare in the Oncology Care Model,” wrote Dr  Wilfong and colleagues. “We estimate that 100% Network adoption of these three biosimilars could save nearly 1.5% of the TCOC in our Network compared to continued use of innovator drugs.” 

Source:

Wilfong S, et al. Financial impact of biosimilar adoption in the oncology care model for the U.S. Oncology Network. Abstract presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago, IL, and virtual. Abstract e18749.