Pegfilgrastim biosimilars have provided significant cost-savings to the Centers for Medicare & Medicaid Services among the Oncology Care Model population, possibly resulting from stabilization and reduction in net-acquisition-cost prices of reference pegfilgrastim rather than greater utilization of biosimilars.
A real-world data analysis characterized the impact of the clinical availability of 2 pegfilgrastim biosimilars on Centers for Medicare & Medicaid Services (CMS) reimbursement for pegfilgrastim in the prophylaxis of chemotherapy-induced febrile neutropenia; these results were reported at the 2020 American Society of Clinical Oncology Virtual Scientific Program.
Using a data sample from the Medicare Oncology Care Model (OCM) population, the average CMS reimbursement for pegfilgrastim biosimilar (Neulasta, Udenyca, and Fulphila) utilization between July 1, 2016, and June 30, 2019, was identified. The average reimbursement and the average change in reimbursement before and after the availability of biosimilars was compared.
In the third quarter of 2018 (prior to the availability of biosimilars), the Medicare Part B reimbursement of reference pegfilgrastim increased at a rate of $292 per year, resulting in an average reimbursement of $3636 per administration. In the time period from July 2018 through June 2019 coinciding with the availability of biosimilars, the average pegfilgrastim reimbursement remained stable, at $3543 per administration. The change in reimbursement decreased from $292 per year prior to availability of biosimilars to –$93 per year following the availability of biosimilars.
In the fourth quarter of 2018, applying the reimbursement patterns found in the Medicare OCM data to the general Medicare population, it was estimated that the utilization of biosimilars is associated with a $4.8-million cost-savings (1.39%) relative to the total expected reimbursement without biosimilars in the market. Higher cost-savings were projected in 2019 ($79.1 million; 5.39%) and 2020 ($157.9 million; 11.5%). Given that 90.6% of patients in the second quarter of 2019 were receiving reference pegfilgrastim, the authors attributed the projected cost containment largely to stabilization and reduction in net-acquisition-cost prices of reference pegfilgrastim rather than greater utilization of biosimilars.
These results indicate that the increased overall value proposition of pegfilgrastim is providing significant cost-savings to CMS, and could potentially benefit clinical practices participating in the OCM.
Reference
Webster J, et al. ASCO 2020. Abstract e19362.