Study: EviCore Improves Biosimilar Adoption Rates, Cancer Care Affordability

Peer-reviewed study shows EviCore was able to increase biosimilar usage for eight health plan clients 285% faster for trastuzumab, 153% faster for rituximab, and 53% faster for bevacizumab compared to the control group.

Effort led to a medical claim cost reduction of 15.1% ($0.42 PMPM) compared to the market prior to biosimilar introductions for these reference products, and a 5.4% ($0.15 PMPM) reduction in claim cost compared to plans with no active management strategy.

Stephen Hamilton, MD

Associate Chief Medical Officer for Oncology Programs

I’m proud to share that the Journal of Clinical Pathways has published a peer-reviewed study written by our EviCore oncology subject matter experts: “Improving Biosimilar Adoption Rates and Affordability With Oncology Pathways.” It shows how EviCore helped speed the adoption of biosimilar drugs for eight of our health plan clients, making cancer care more affordable without sacrificing the quality of treatment patients receive. To me, this effort epitomizes our company’s work to combine deep clinical expertise with technology to enable better patient care and outcomes. I encourage you to read the study, as it provides greater detail on our methodology and outcomes, but I’ve summarized our findings below.

What are biologics and biosimilars?

For some context, biologic drugs are made from living sources, and they’re the fastest growing class of therapeutic products in the country. They offer some of the most advanced treatments available today for many complex conditions, including cancer. They’re different from the majority of drugs in your medicine cabinet, which are made from chemicals.

Because biologics are created from living systems, they’re often expensive and difficult to replicate. As of 2019, they made up 43% of invoice-level medicine spending ($211 billion). However, more affordable biosimilars are thankfully on the rise. Biosimilars are biologic products that have no clinically meaningful difference from an existing biologic drug. In that sense, they’re similar (though not exactly the same) to generic options for conventional drugs. To be FDA-approved, biosimilars must demonstrate they’re as safe and effective as the original biologic.

Among all biologic products on the market today, a little more than half face biosimilar competition now or will face competition in the next 10 years. This means billions of dollars could be saved if biosimilars are made available to patients, without sacrificing the quality of care they receive.

Speeding the adoption of biosimilars – and the related cost savings

Given the cost savings and clinical effectiveness of biosimilars, it may obvious to opt for them, but in many cases, their use remains low. EviCore wants to change that.

In the study, we looked at three biologic drugs commonly used for cancer treatment – trastuzumab, rituximab, and bevacizumab – which have approved biosimilars. Utilization of these biosimilars remains low without an effective mechanism to steer providers toward them. That’s where EviCore comes in. Our clinical decision support technology, coupled with peer-to-peer consultations, enables us to guide doctors to biosimilars in clinically appropriate situations.

The study looked at the period beginning July 1, 2020, when we began offering the option for our payer clients to implement a biosimilar preferencing policy. This policy requires the use of a biosimilar drug before the reference brand for trastuzumab, bevacizumab, and rituximab. Exceptions are made for patients who are already using a biologic drug for their treatment or for people with clinical circumstances that preclude the use of the biosimilar product. Eight of our clients adopted this policy (“policy group”), which left us with a “control group” of clients who didn’t have the policy in place.

In our study, the policy group saw an immediate, significant impact that was sustained over time. Biosimilar adoption was increasing at a modest rate organically prior to the program, but even when accounting for that, biosimilar usage in the policy group increased 285% faster for trastuzumab, 153% faster for rituximab, and 53% faster for bevacizumab compared to the control group.

In terms of the cost impact, it's helpful to know the average sale price (ASP) for these drugs, which is calculated by the Centers for Medicare & Medicaid Services (CMS). The ASPs for trastuzumab and bevacizumab’s reference products (Herceptin and Avastin) are about 20% to 22% higher than the ASPs for their biosimilars. The ASP for rituximab’s reference product (Rituxan) is more than 25% higher than its biosimilars. At the same time, the way the CMS standard fee schedule works, biosimilars are reimbursed in such a way that providers won’t lose revenue.

This demonstrates that EviCore’s biosimilar preferencing policy produces significant cost savings.

Positive impacts for patients, providers, payers, and the broader healthcare system

Our findings show the positive impact active management can play in the coming years as more biologics – and, subsequently, biosimilars – hit the market.

For patients, this means more affordable cancer care, which is critical as rising costs continue to impact them through higher deductibles and copays, increased cost shifting, and growing premiums. According to the CDC, a quarter of cancer survivors reported material financial hardship, and more than one-third reported psychological financial hardship, so we should be doing everything we can to help them get cutting-edge care that’s more affordable.

For providers, it’s hard to stay on top of the explosion of biologic drugs and biosimilars. In the study, we found that most clinicians in the policy group were comfortable changing to the biosimilar. That indicates that the slower organic adoption of these drugs isn’t because doctors have concerns about their effectiveness; rather, they tend to prescribe the products they’re used to out of habit. Using EviCore’s clinical decision support model helps providers select the most clinically appropriate, highest-value treatment regimens for their patients.

For payers and the health care system at large, encouraging more rapid adoption of biosimilars brings down the cost of care without sacrificing the quality, which is a win for everyone. Biologic drugs are an area of tremendous innovation, which is almost inevitably coupled with higher costs. EviCore’s biosimilar preferencing policies show that costs can be managed in a way that continues to provide patients access to the latest medical advances while ensuring the long-term stability and vibrancy of the health care system.

For more information about our approach and findings, please check out the full study here.

Dr. Hamilton is EviCore’s Associate Chief Medical Officer for Oncology Programs. Prior to joining EviCore, he was a practicing hematologist/oncologist for over 20 years in a community-based multidisciplinary oncology practice he co-founded in 1997 in a suburb of Oklahoma City. During this time, he also served as a hospice medical director and chief of staff for his local community hospital.