Navigating Coverage Support
Thorough education on biosimilars supports streamlined workflow integration, payer eligibility, and coverage navigation. With biosimilars being relatively new to the United States oncology market, it is necessary for oncologists to fully understand the intricacies of payer coverage and interchangeability to best leverage biosimilars and fulfill value-based requirements. This will become especially important as more oncology practices start participating in the Oncology Care Model (OCM), an episode-based payment model that encourages practices to improve patient care and lower costs through financial incentives.
Cancer care providers should also investigate the patient assistance program (PAP) the manufacturer has in place to support these complex class of therapies. The PAP should ideally consider managing patients’ needs, especially for those who are uninsured or underinsured.
Moreover, to reduce administrative work and optimize time to treatment for patients, oncology practices implementing biosimilars should consider having an automated benefit verification system in place to streamline the process of determining local coverage eligibility and accessing details about out-of-pocket costs for patients. Employing automated processes to monitor, communicate, and update changes to health plans and formularies ensures uncompromised accuracy and quality, as well as supporting faster access to potential treatment options for patients.
Physicians can use the cost savings from biosimilars, which have the potential to grow with upcoming approvals, to fulfill the OCM objectives of improving patient care while reducing costs.
OCM participants are required to fulfill multiple reporting requirements ranging from clinical data submission to cost reporting; much of this information must be entered manually. To achieve reimbursement benefits through the OCM, practices must report and submit data that effectively demonstrates the savings and outcomes they’ve achieved through biosimilars.
One potential option to streamline OCM reporting for maximized reimbursement without diverting physicians’ time is contracting a quality reporting engagement team. This team can assist practices in understanding changing quality measurements and ensure practices avoid costly missteps and maximize reimbursement.
Ultimately, biosimilars are a promising class of therapies and critical to the future of cancer care. If we, as a health care community, want to continue offering the most innovative care to patients, we must look for – and support with education – new pathways of accessible care. Learning about, embracing, and thoughtfully integrating biosimilars in community oncology practices is representative of the many ways health care professionals are forging ahead to improve patient outcomes and usher in a new era of care.
Rick Lozano, is Vice President of Biosimilars and Integrated Business Development, AmerisourceBergen; and Kashyap Patel, MD, is Chief Executive Officer of Carolina Blood and Cancer Care.
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