In a recent publication in the Journal of Clinical Oncology, researchers indicated that the availability of oncology biosimilars has a significant role in managing financial risk in the Oncology Care Model (OCM) and other value-based payment (VBP) models; however, there is still uncertainty with regard to its real-world effect.
In this study, researchers used real-world data and sought to measure the impact of biosimilar adoption on the oncology provider’s financial risk under the OCM.
By modeling the methods (episode framing, pricing, and risk adjustment) of the OCM, the researchers projected the impact of biosimilar adoption on provider financial risk from 2019 to 2021. Cancer episodes were identified from the 5% Medicare Limited Data Set (LDS).
The study sample comprised oncology-treatment episodes using any of the following agents or their biosimilars: bevacizumab, rituximab, trastuzumab, and three supportive-care agents.
The researchers defined financial risk as the difference in the observed total cost of care versus OCM target episode cost.
The primary outcome was the difference in financial risk (expressed in nominal U.S. dollars) under observed use of reference and/or biosimilars versus hypothetical use of 100% reference agent.
The study sample included 8,851 6-month episodes launching between January 2019 and June 2021. Biosimilar adoption led to an average cost decrease of $1,020 per episode versus hypothetical 100% use of reference agents.
Moreover, the use of biosimilars augmented noticeably over the study horizon—with 24% of episodes with a biosimilar in Half (H)1 2019, increasing to 65% by H1 2021, and propelled by increased use of antineoplastic (1%-36%) versus supportive-care biosimilar agents (23%-34%).
The authors wrote, “Mean financial risk reduction grew with the rapid adoption of biosimilars over this period. The average risk reduction in episodes initiating in H1 2021 was approximately 10 times larger than that seen in episodes initiating in H1 2019 ($2,060 vs. $201). The observed mean cost was below the OCM target cost ($48,808) in H1 2021 but exceeded the target cost in all other periods (range: +$1,451 to +$4,966).”
Based on their findings, the authors concluded that from 2019 to 2021, swift implementation of biosimilars in Medicare fee-for-service beneficiaries included in the LDS resulted in significant cost savings and decreased risk for cancer episodes assessed under the OCM methods.
Lastly, the authors noted that the expansive implementation of biosimilars is a significant approach that providers in oncology VBP models must consider controlling financial risk.
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