Biosimilars Can Play a Key Role in Value-Based Care, Review Says

Given the high burden of cancer in the senior population, and given the increasingly high cost of cancer care, there is a growing interest in value-based oncology care payment models, particularly within CMS. 
Kelly Davio
November 01, 2018
Given the high burden of cancer in the senior population, and given the increasingly high cost of cancer care, there is a growing interest in value-based oncology care payment models, particularly within CMS. 

A recent review, authored by The Center for Biosimilars® advisory board member Kashyap Patel, MD, and colleagues, provides an overview of value-based care models and discusses the role of biosimilars in meeting these models’ objectives. 

The review, appearing in Cancer Management and Research, notes that US spending on cancer care grew from $27 billion in 1990 to $124 billion in 2010, with spending levels expected to reach $157 billion in 2020. Globally, spending on oncology and supportive care reached $100 billion in 2014. Among the fastest-growing drug classes in oncology are monoclonal antibodies—many of which are targeted by biosimilar developers—which account for 35% of US oncology spending. 

To help address skyrocketing costs, CMS has developed value-based care programs that reward providers with incentives for improving the quality of care they provide to Medicare beneficiaries. These programs seek to move away from the fee-for-service (FFS) model that incentivizes high-quantity (though not necessarily high-quality) care. 

In 2016, CMS implemented the Quality Payment Program, which offers payment to providers either through the Merit-based Incentive Payment System or through Advanced Alternative Payment Models, one of which is the Oncology Care Model (OCM). 

The OCM is a voluntary program that seeks to provide higher-quality care at the same or lower cost to Medicare than traditional FFS payments. The OCM links payments to provider performance based on meeting quality metrics and making practice reforms. 

Biosimilar therapies offer increased affordability and access—as well as improved outcomes and improved health-related quality of life—to patients treated in the OCM model; using lower-cost biosimilar granulocyte-colony stimulating factor therapies, for example, can reduce the incidence of neutropenia, allowing for increased dose administration of patients’ primary treatments and improved survival. 

Not only may biosimilars, themselves, be offered at more affordable prices than biologics—as has been demonstrated in experience with biosimilar filgrastim—but they also may drive down overall prices in a given class as a result of market competition, producing substantial US cost savings. These savings, which have the potential to grow with upcoming availability of biosimilar epoetin alfa and biosimilars of targeted therapies, could help physicians to meet the OCM objective of improving patient care while reducing costs. 

However, write Patel and colleagues, “Realization of cost savings possible from biosimilars…will require that biosimilars are utilized.” Current gaps in physician education on biosimilars have limited use of these agents, making the need for provider education all the more pressing. 

Reference
Patel KB, Arantes LH, Tang WY, Fung S. The role of biosimilars in value-based oncology care. Cancer Manag Res. 2018;10:4591-4602. doi: 10.2147/CMAR.S164201.

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