Financial impact of generic therapeutic interchange of abiraterone in the oncology care model for the U.S. Oncology Network.

Abstract

e17019 Background: Therapeutic interchange (TIC) to lower-cost generic products offers significant cost savings to payers and patients while maintaining equivalent quality of care. The Oncology Care Model (OCM) is a value-based care program from Medicare that rewards practices for decreasing the total cost of care (TCOC) compared to historical baseline prices that are adjusted by a trend factor to account for rising cost trends in oncology. One strategy for bending the cost curve is to utilize lower cost medications. A generic version of abiraterone acetate (FDA approved for treatment of Prostate Cancer) was first introduced into the market in late 2018. This led to a concerted approach to interchange the brand product with the generic equivalent in The US Oncology Network (The Network) as an opportunity to reduce TCOC. Here we describe utilization and the financial impact of abiraterone TIC in The Network during OCM performance period 8 (PP8) which enrolled patients from 1/2/2020 to 7/1/2020. Methods: Prescription drugs dispense data for the 14 US Oncology Network practices participating in the OCM were used to determine brand and generic abiraterone utilization. The impact of TIC on TCOC was measured by comparing the cost of the generic product vs. the estimated cost of the brand agents. Results: TIC resulted in an increase in generic abiraterone use from prior performance periods. Generic abiraterone increased from 0% in PP4 to 24% in PP5, 55% in PP6, 67% in PP7 and 80% in PP8 within the Network. We compared the actual cost of all abiraterone dispenses in PP8 vs. the calculated cost (based on Average Wholesale Price less 17.5%) of the brand product if the more expensive brand drugs were used instead. The difference in the actual cost vs estimated cost led to a savings of $4.37 million in PP6, $6.34 million in PP7 and $9.37 million in PP8 (about 1% of TCOC) by using generic versus brand abiraterone alone. Conclusions: TIC from brand to generic abiraterone in The Network generated significant savings for OCM. Continued shift towards lower cost generics will increase savings to CMS in the Oncology Care Model. We estimate that 100% Network adoption of the generic abiraterone could save nearly 1.25% of the TCOC compared to continued use of brand product.