Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care, told The Center for Biosimilars® in an interview that, as his practice has begun to implement the Oncology Care Model, it has moved 100% of its patients to biosimilar filgrastim, Zarxio, from the reference filgrastim, Neupogen.
The Oncology Care Model (OCM), a reimbursement model developed by CMS’ Center for Medicare and Medicaid Innovation, allows oncology practices to enter into payment arrangements that include financial and performance accountability for episodes of cancer care. The model is intended to improve health outcomes and produce higher quality care at the same cost or a lower cost to Medicare, and one practice participating in the model has seen firsthand that biosimilars have a role to play in achieving those objectives.
Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care, told The Center for Biosimilars® in an interview that, as his practice has begun to implement OCM, it has moved 100% of its patients to biosimilar filgrastim, Zarxio, from the reference filgrastim, Neupogen. With an approximate 15% difference in cost between the 2 products, the change has saved the practice—and Medicare—valuable resources, and Patel sees the potential for savings to be even greater once biosimilar anticancer therapies reach the US marketplace.
With the cost savings that his practice has been able to achieve so far under OCM, Patel says that his clinic has been able to institute drop-in hours for patients who have any health concerns—even concerns that aren’t related to their cancer treatment. “The patients love it,” he said, and the practice has been able to refer patients to other specialists to address comorbidities that are impacting their overall health.
To date, Patel says that his patients have not had concerns about using biosimilar filgrastim instead of its reference; in Patel’s rural South Carolina practice, “Some of my patients are still using flip phones,” he said; they aren’t particularly concerned about the nuances of biosimilarity or the technicalities of the biosimilar approval pathway. Instead, they care about whether a treatment has been FDA approved and whether it is effective in treating their condition.
“If I were practicing in Manhattan or in Beverly Hills,” he said, these conversations might be different, but even when anticancer biosimilars like trastuzumab and bevacizumab reach the clinic, Patel expects that mutual patient—provider respect will be the most important factor in patients’ acceptance of biosimilar drugs.
Provider education, said Patel, is a bigger hurdle than patient awareness in bringing biosimilars into the clinic to reduce costs and better implement OCM. Patel pointed to results of a National Comprehensive Cancer Network survey that assessed clinician awareness of biosimilars and found that only 3% of respondents rated themselves “extremely familiar” with biosimilars. In Patel’s view, awareness hasn’t gotten much better since that survey. Yet, he emphasized, oncologists have to start discussing these issues, given the high financial toxicity surrounding cancer care and the potential for biosimilars to bring down costs for patients and the healthcare system as a whole.
It’s not just the oncologist who has to become more knowledgeable about biosimilars: Nurses, said Patel, are a cornerstone of patient care.
“[Patients] spend 6 hours with the infusion nurse while they may spend 15 minutes with me,” he said, adding that it’s “human nature” for some patients to be reticent about asking their physician questions about their treatments. Many patients, he said, may be more willing to talk with an infusion nurse about any concerns with their therapies. As the anticancer biosimilars begin to make their way into the clinic, Patel plans to work on greater nurse education to help support and reassure patients as they undergo treatment.