Whether the OCM has worked out is debatable, but it has apparently encouraged the use of biosimilar versions of filgrastim.
When evaluators from Abt Associates compared the use of biosimilars of filgrastim, a recombinant non-pegylated granulocyte colony-stimulating factor (GCSF), to the originator product, they found what they described as a “strong, consistent and statistically significant impact of OCM on increasing use of the biosimilar.”
In both the OCM practices and those in a comparison group, prescriptions of the biosimilar versions of filgrastim jumped between the baseline period and the OCM intervention period, which for the purposes of this evaluation started in July 1, 2016, and ended December 31, 2017. But the increase was greater in the episodes of care delivered by the OCM practices.
More specifically, they found that OCM was associated with a greater than 20 percentage point impact on the use of biosimilar filgrastim for the three cancers they studied: breast (a 20.9% differece), lung (22.5%), and colorectal (27.5%).
Here are the percentages for biosimilar filgrastim use among episodes of care by the OCM practices:
And here are the percentages for the biosimilar filgrastim use among episodes of care by the comparison group:
There are two biosimilar filgrastim products currently on the market, Zarxio (filgrastim-sndz) and Nivestym (filgrastim-aafi). Neupogen is the originator product.
OCM is a CMS program designed to push oncologists toward value-based care, which is supposed to mean less costly care that is equal to, or even better, in quality.
Whether OCM is a success or failure is debatable, but CMS is gearing up to start a successor program, called Oncology Care First, next year. The Abt Associates evaluation, which came out in May, was showed that OCM had no overall impact on per-episode payment levels of cancer care and that it resulted in net losses for Medicare because of bonus and other payments to the participating practices. By the end of the third performane period, 191 practices were participating.
Granulocyte colony-stimulating factors (GCSFs)stimulate white blood cell production. They are often given prophylactically with the first chemotherapy treatment to stave off neutropenia (low neutrophil levels), vulnerability to infection that is the result of neutropenia, and fever.
The American Society of Clinical Oncology has said that oncologists sometimes prescribe GCSFs unnecessarily for cancer patients with a low risk of developing neutropenia. The Abt Associates evaluation says that there was evidence that that the model had led to less use of discretionary and “potentially low-value” use of GCSFs in breast cancer patients but not in lung and colorectal cancer patients.
Pegfilgrastim is a longer lasting form of filgrastim, but it is more expensive, so from an economic point of view, filgrastim might be preferable — although it means daily infections for 5-10 days compared with just one injection of pegfilgrastim. The OCM evaluators said the program had limited effect on the substitution of filgrastim for pegfilgrastim. The evaluation did not compare the use of biosimilar pegfilgrastim — the FDA has several biosimilars — to the originator product, Neulasta.