Study Finds Filgrastim-sndz Substantially Lowers Out-of-Pocket Medicare Expenses

Researchers presented results from a simulation analysis that looked to identify the potential reduction in Medicare beneficiaries’ out-of-pocket costs through the use of biosimilar filgrastim-sndz (Zarxio, Sandoz) over the reference filgrastim at the 2018 San Antonio Breast Cancer Symposium held December 4-8, 2018, in San Antonio, Texas.

The analysis was based on data from more than 1600 claims and found that out-of-pocket expenditures were substantially less among Medicare beneficiaries with breast cancer undergoing chemotherapy who received prophylaxis for febrile neutropenia with biosimilar filgrastim over the reference product.

Researchers used ICD-10 codes to identify patients with breast cancer in this simulation, and Healthcare Common Procedure Coding System codes were used to identify those treated with filgrastim-sndz or the reference. The claims used in the simulation were extracted from the 2016 Medicare Limited Data Set. In total, the study authors extracted 233 claims for 300 mcg of biosimilar filgrastim (average price, $244.94) and 383 claims for 480 mcg of biosimilar filgrastim (average price, $421.15). Thus, the total number of included claims for filgrastim-sndz was 616, with a weighted average price of $362.79.

Conversely, 380 claims for 300 mcg of reference filgrastim were also extracted (average price, $283.92), and 684 claims for 480 mcg of reference filgrastim (average price, $478.32), for a total of 1064 claims at a weighted average price of $406.86.

In order to calculate the average Medicare payment to the provider and the average beneficiary out-of-pocket responsibility per claim for either product, researchers utilized Medicare’s payment calculation worksheet. According to the worksheet, beneficiaries were assumed to pay the provider 20% coinsurance; in the case of a secondary payer, the payment to the provider was 20% minus payment by the secondary provider.

Physicians were reimbursed by Medicare at 80% of the allowed cost for either product, with a 2% reduction calculated for prescriptions written during the sequestration period that began in 2013 and has continued ever since.

The total payment to the provider was found to be $221 for 300 mcg of filgrastim-sndz and $380 for 480 mcg of filgrastim-sndz, and $257 for 300 mcg of reference filgrastim and $433 for 480 mcg of reference filgrastim. Researchers found that the weighted average savings to Medicare for the use of filgrastim-sndz over the reference product was $32.87 per claim, reflecting the Medicare weighted average payments to providers of $284.06 and $316.93 per claim, respectively.

When extrapolated to 100,000 beneficiaries (1 million claims), the model estimated potential out-of-pocket savings to reach approximately $9.5 million for Medicare beneficiaries. Additionally, the study also found that Medicare saw reduced payments of $32.9 million.

“By weighted average, a beneficiary’s out-of-pocket responsibility for filgrastim-sndz was lower than that for reference filgrastim ($72.94 versus $82.45), creating a weighted average cost savings per claim of $9.51,” concluded the study authors.

Reference

Puckrein G, Xu L, Ryan A, et al. Potential Medicare beneficiary out-of-pocket cost reductions through use of biosimilar filgrastim-sndz over reference filgrastim among breast cancer patients: a simulation model analyses. Presented at: 2018 San Antonio Breast Cancer Symposium; December 4-8, 2018; San Antonio, Texas. Abstract P5-15-05.