The Lynx Group

Increased Biosimilar Use Translates to Substantial Savings for Oncology Practices

October 2022, Vol 13, No 5

The increased use of biosimilars within the US Oncology Network generated more than $6 million of savings in the Centers for Medicare & Medicaid Services’ Oncology Care Model (OCM) during the first half of 2020.

Under the OCM, practices are rewarded for reducing the total cost of care (TCOC), in part by using lower cost medications, compared with historic baseline prices that are adjusted by a trend factor accounting for the rising cost of oncology care. Biosimilars for bevacizumab (Avastin), trastuzumab (Herceptin), and rituximab (Rituxan) were introduced in the United States in 2019 and 2020, after which a concerted effort was made to adopt these biosimilars within the US Oncology Network to reduce TCOC.

Lalan S. Wilfong, MD, Vice President, Payer Relations, Texas Oncology, The US Oncology Network, Dallas, and colleagues assessed the utilization and financial impact of biosimilar adoption across their 14 network practices in the OCM performance period (PP) during which patients were enrolled from January 2, 2020, to July 1, 2020 (described as PP8). The 6-year OCM has a total of 11 PPs, with the final PP ending June 30, 2022. They compared the cost of each dose of a biosimilar with the estimated cost if the more expensive innovator drug had been used instead. They presented their findings in an abstract at the 2022 American Society of Clinical Oncology Annual Meeting.

During the PP examined, the use of the biosimilars of bevacizumab, trastuzumab, and rituximab increased compared with previous performance periods:

  • Biosimilar use for bevacizumab was 0% in PP6, increasing to 5% in PP7 and 43% in PP8.
  • Trastuzumab biosimilar 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 difference in the TCOC with adoption of the biosimilars over the estimated cost of the innovator products led to a savings of $6.61 million.

“The increased utilization of biosimilars in The [US Oncology] Network generated significant savings in OCM,” the investigators concluded. “Continued adoption of biosimilars will increase savings to Medicare in the OCM. We estimate that 100% Network adoption of these 3 biosimilars could save nearly 1.5% of the TCOC in our Network compared to continued use of innovator drugs.”

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