Use of lower-cost drugs reduces cancer care costs while maintaining quality
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Lower-cost alternative drugs reduced total costs of care by approximately 5% while maintaining quality care among Medicare beneficiaries with cancer, according to study results presented at ASCO Quality Care Symposium.
Background and methodology
Use of lower-cost medication alternatives has been a key strategy to “bend the cost curve” in the Oncology Care Model, which CMS created in 2016 to encourage better oncology care, according to study background. The model included 24-hour access to physicians for patients undergoing cancer treatment and emphasized coordinated, personalized care aimed at rewarding the value of care vs. patient volume. Participating clinical practices received care management payments monthly for each Medicare beneficiary.
Researchers used Medicare Part B and Part D claims for 14 practices across The U.S. Oncology Network that participated in the Oncology Care Model to assess the impact of eight medication substitutions during the final 18 months of the 5-year model program. The substitutions replaced reference products with biosimilars, brand-name drugs with generics and high-cost drugs with lower-cost alternatives when deemed clinically appropriate. Enrolled patients underwent evaluation once every 6 months.
Key findings
Results showed cumulative savings of $26 million, $32.3 million and $32.9 million per consecutive 6-month interval between July 2019 and December 2020. These cost-savings resulted in reductions in total costs of oncology drug care by 2.78%, 4.13% and 5.25% during the 6-month intervals.
Changing to biosimilars resulted in a cost savings of $6.6 million during the first 6 months of 2020 and $12.2 million during the last 6 months of 2020.
“Our study shows that smarter spending can be achieved while also boosting quality of cancer care,” Erica Feinberg, PharmD, BCPS, senior clinical data analyst at The U.S. Oncology Network, said in a press release. “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.”
Implications
There is room for the cost savings to continue if price differences exist between two interchangeable oncology therapies, according to researchers.
Future research will continue to track the benefits of biosimilar and generic interchanges in the Oncology Care Model, researchers noted in a press release.
Researchers hope to study CMS’s new 5-year pilot program, dubbed Enhancing Oncology Model, and they continue to track the pipeline of generic drugs and biosimilars to optimize the value of any similar opportunities with other therapeutic and supportive care drug classes, according to the press release.
References :
- Ives H, et al. Abstract 5. Presented at: ASCO Quality Care Symposium; Sept. 30-Oct. 1, 2022; Chicago.
- Total cost of cancer care can be reduced with lower cost alternative drugs without compromising quality of care (press release). Available at: www.asco.org/about-asco/press-center/news-releases/total-cost-cancer-care-can-be-reduced-lower-cost-alternate. Published Sept. 27, 2022. Accessed Sept. 29, 2022.
Perspective
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Anthony Boyd, PharmD, BCPS
Oncology Care Model was a 5-year program that sought to provide quality and coordinated care to people with cancer while lowering costs for Medicare. The program ended in June. The next iteration, Enhancing Oncology Model, is a 5-year voluntary program that has similar goals to improve care coordination and enhance quality of care while reducing Medicare costs. This program will begin in July 2023. Given medication costs make up a significant amount of the total cost of cancer care, identifying lower-cost alternatives that maintain the same level of quality care is an important strategy to review.This study showed that Oncology Care Model-participating institutions within US Oncology Network demonstrated substantial savings over 6-month intervals and lowered total cost of care through medication substitutions from reference products to biosimilars, from brand to generic medications, and switches to lower-cost alternatives where clinically appropriate. These are important economic findings, and similar strategies are being taken by cancer centers across the country to lower total cost of care while providing similar level of quality.
As additional oncology biosimilar and generic medications are approved by the FDA, there are further opportunities to lower the cost of care while maintaining similar outcomes for patients. One challenge noted by the authors was ongoing requirements by payers to utilize a preferred agent, which creates challenges for institutions to operationalize. Further research could be expanded upon to demonstrate additional savings in the Enhancing Oncology Model, especially as additional biosimilar and generic medications are introduced to the market.
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Ives H, et al. Abstract 5. Presented at: ASCO Quality Care Symposium; Sept. 30-Oct. 1, 2022; Chicago.
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