The 1-year gap after the end of the Oncology Care Model (OCM) means some practices have to make hard decisions regarding cost of care or the financial health of the practice, explained Lalan Wilfong, MD, vice president of Payer Relations & Practice Transformation at The US Oncology Network.
Practices have hard decisions to make with the 1-year gap between the end of the Oncology Care Model and the start of the Enhancing Oncology Model, including whether or not to stick with biosimilars or return to the better reimbursement of brand drugs, explained Lalan Wilfong, MD, vice president of Payer Relations & Practice Transformation at The US Oncology Network.
Biosimilars helped drive savings in the Oncology Care Model. With a gap in CMS oncology models, are there concerns that utilization of biosimilars may erode?
With the gap [between the end of] the Oncology Care Model [and start of the Enhancing Oncology Model (EOM)], practices have to think about their financial health. With the Oncology Care Model, we focused on things that were more cost-effective and made changes like the switch to biosimilars where we were able to generate significant savings because the cost of care was much lower than the brand drugs. However, in a fee-for-service world, as a practice, you have better reimbursement typically with the brand drugs than you do with biosimilars.
So, practices have to make hard decisions sometimes, you know? What we want to do to lower costs of care vs the financial health of the practice. The gap highlights that. And practices are having to make significant decisions about, “Do we stick with our biosimilar strategy? Do we need to switch back, because we're now not financially incentivized as much to use the lower-cost drugs?”
So that is an area of concern that I have, that practices will go back to things they did before that they need to maintain the financial health of their practice. Now, it is good that the EOM is starting. It's hard to switch drugs back and forth all the time. So, it is good that EOM is starting, so we still have an incentive out there, but the gap is challenging.