Biosimilar Pegfilgrasim Cuts OCM Expense, ASCO Study Finds

Use of biosimilar pegfilgrastim amounted to significant cost savings in the Oncology Care Model (OCM), according to a study presented at ASCO20 Virtual, the annual meeting of the American Society of Clinical Oncology.

Investigators said they studied use of biosimilar pegfilgrastim since its introduction in mid-2018 until mid-2019 and found that it not only stabilized the increasing cost of pegfilgrastim per administration but also caused a decline in cost.

Specifically, cost of administration had been rising at the rate of $292 per administration per year over the 30 months since the start of the OCM in 2016. When biosimilar pegfilgrastim became available, the average cost declined by $93 over the first year.

A Key Supportive Agent

“Pegfilgrastim is a key supportive care agent in oncology patients, providing significant febrile neutropenia prophylaxis for patients on chemotherapy. However, pegfilgrastim also accounts for 5.3% of the total cost of cancer care for all patients in the Oncology Care Model (OCM),” investigators said.

The study was funded by Coherus BioSciences, which introduced the pegfilgrastim biosimilar Udenyca in January 2019. Another biosimilar pegfilgrastim (Fulphila) was available from July 2018. A third biosimilar, Ziextenzo, was approved during this time but launched after the study period, in November 2019.

The study has additional significance because the cost of Medicare billings is one measure by which the 175 practices participating in the OCM are judged. It can affect the payment incentives or cuts they receive.

Medicare payment for pegfilgrastim is 80% of average sales price plus 6%. The average reimbursement was $3636 per administration prior to the introduction of biosimilars and $3543 after.

Investigators said that, across the country, 88,847 Medicare patients received pegfilgrastim in 2018, amounting to $1.39 billion in Medicare payments.

“Assuming the patterns we’ve detected in our OCM data sample can be applied to the general Medicare population, we have estimated that the introduction of biosimilars resulted in $4.8 million in savings (1.39%) compared with what the total reimbursement would have been without biosimilars in the market in Q4 2018,” investigators wrote.

Bending the Curve

They said this “bending of the cost curve” could result in savings of $79.1 million (5.7%) in 2019 and $157.9 million (11.5%) in 2020.

The savings are a combination of patients using biosimilars and the restraining effect that biosimilar use has on the cost of the reference product (Neulasta), investigators said. “The introduction of biosimilars has caused even the branded agent to stabilize.”

They suggested there is potential for greater savings, because 90.6% of patients in the second quarter of 2019 were still receiving branded pegfilgrastim.

“Introduction of biosimilars has created enough pressure on the market to result in significant cost savings, increasing the overall value proposition of pegfilgrastim,” they concluded.

Reference

Webster J, Smith RE, Wieland D, et alCost savings of biosimilar pegfilgrastim in a Medicare OCM population. Presented at ASCO20 Virtual Scientific Program;May 30-31, 2020. Abstract e19362. https://meetinglibrary.asco.org/record/190722/abstract