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Biosimilar Adoption Within the Oncology Industry
How the AON Pharmacy Operations team is increasing the usage of biosimilars as treatments for cancer patients.
Back in September 2017, the U.S. Food and Drug Administration (FDA) approved the first biosimilar used for cancer treatments. Mvasi was created as the biosimilar alternative to the brand medication Avastin, which is used to treat various cancers. From colorectal and lung cancers to kidney cancer and brain cancer, Mvasi’s formulation was determined biosimilar when treating these cancers. Since 2017, over twenty biosimilars for cancer treatments have been approved.
The growth within the biosimilar market increases with the acceptance and adoption of these prescription alternatives by oncologists and other healthcare leaders who are taking the initiative to improve cost-savings for millions of cancer patients. AON is one such organization that is taking the lead to publicize the benefits — including the cost savings — of biosimilars..
Related: Understanding Biosimilars
AON’s Biosimilar Substitution Program
The biosimilar substitution program, the brainchild of the AON Pharmacy Operations team, was created to encourage the use of biosimilar products when a biosimilar is covered by the payer and the cost is lower, as an effective cost-saving strategy without negatively impacting the efficacy of the patient’s treatment.
By definition, a biosimilar is highly similar to and has no clinically meaningful differences from its reference product with cost-saving potential. A biosimilar is approved by the U.S. Food and Drug Administration (FDA) after rigorous evaluation and testing to show the same efficacy and same safety profile when compared to its reference product. Expanding access to biosimilars can help to improve health equity and provide more treatment options for patients.
Acquiring biosimilar products can be challenging for various reasons. One of the more common barriers is health insurance coverage and requirements as it varies from state to state as well as how the insurer’s formulary is designed. While these hindrances may slow adoption, the AON Pharmacy Operations team recognizes the benefits of biosimilar products to not only the patient but to the healthcare provider and health insurer.
The switching model employs key persons within the process and equips them with the processes and tools needed to communicate and drive forward biosimilar substitutions. Originally, AON regional clinical pharmacists (RCPs) assisted in biosimilar product selection. Under the new biosimilar substitution program, the RCPs transitioned into an intermediary position between the pharmacy, healthcare providers, administrators and financial teams at each practice. Using the electronic health record (EHR) system empowers RCPs to communicate directly with financial teams and send switch requests (requests to switch to a biosimilar product) directly to the healthcare provider who can easily approve within the system.
The AON Pharmacy Operations team measured the impact of the program for one year and reported positive results:
- There was an increase in all AON-preferred biosimilar products after program implementation. The total number of biosimilars now in use is 17.
- The average in the United States for biosimilar usage is 65% whereas AON sits comfortably 20% higher.
- There was an increase in cost savings for healthcare providers, payers and patients totaling $56.21 million for 2022 and $131.32 million since AON’s inception.
The AON Pharmacy Operations team hopes that sharing the program’s successes will encourage other clinicians and those in healthcare to switch and use biosimilars when appropriate.
Related: Expanding Options: What’s Next for Biosimilars in Oncology?
Study: Infusion Therapy in Community Oncology Practices Less Costly than Hospital-Based Care
Prices for biologics, chemotherapies and other infused cancer drugs and hormonal therapies provided by in-hospital outpatient departments were double those paid in physician offices, according to a recent Health Affairs study that looked at prices paid in 2019 by Blue Cross Blue Shield health plans. Per the findings, prices paid for these drugs were 99%-104% higher in hospital outpatient departments than those paid in physician offices for infused cancer drugs and 68% higher for infused hormonal therapies.
The biggest takeaway from the study is that it is much less expensive to provide the same level of care in a community oncology practice than in a hospital-based outpatient center – as much as 35% less in some cases. In the study’s cohort, the savings reached would have been nearly $1.3 billion.
That is significant.
Practice-Based Infusion Therapy
Lower cost to the patient is one of a host of benefits associated with practice-based infusion therapy. Unfortunately, for many community-based oncology practices, the price of these drugs and associated infrastructure can make it difficult to offer these services in-house. Unless, that is, they are part of a national network like American Oncology Network (AON), which has the contracting power and management experience to give our practices access to a wide formulary of oncology and non-oncology medications that may not be available to or are financially out of reach of smaller private practices.
Further, some independent practices may not have the time or manpower to fully manage infusion therapy. AON manages all that with standardized education, training, processes and evidence-based clinical guidance. AON provides user friendly tools for clinicians and staff to access that are rooted in the latest clinical publications in oncology. Further, our electronic medical records system allows access to standardized protocols for oncology and non-oncology treatments.
With the power of AON in their corner, our practice partners can provide their patients with an important therapeutic service that goes far beyond lower costs for their care. This extends specialty infusions for patients who need treatment for non-oncology disorders such as asthma, genetic and skin disorders, rheumatoid diseases, and Crohn’s disease and other gastrointestinal problems.
Receiving infusions at their community-based oncology practice makes for a convenient, cost-effective experience for patients, who benefit from being treated by specialized nurses and physicians without having to travel long distances. AON practices can provide the same level of evidence-based care for patients close to where they live at less cost. Also, along with saving on the cost of the drugs themselves, patients won’t incur the facility fees they would have to pay at a hospital, further easing the financial burden.
Patients First
At AON, we’ve built our entire business model around providing the support our partner practices need to stay independent and focus on patients instead of paperwork. This includes putting our size to work negotiating the drug prices that enable them to provide comprehensive care in the community – including infusion therapy.
The quality of the care provided in the community oncology setting is second-to-none. That it is less expensive, as demonstrated by the Health Affairs study, is simply one of its many benefits.
A Smooth Path for Onboarding New AON Practices
When an oncology practice joins American Oncology Network (AON), how clinical and administrative operations are brought under the AON umbrella can have a significant and long-term impact on staff, clinician, patient, and community satisfaction. To help ensure a positive and smooth experience, AON’s transition team leverages its deep experience and proven processes to anticipate obstacles and clear hurdles with minimal disruption to day-to-day clinic operations.
A typical transition takes up to four months. And while each transition is unique, over the course of onboarding more than 20 new AON practices we have established a proven formula that is effective, flexible and, most importantly, customer centric.
Project Management at the Helm
The first step in every transition strategy is establishing a dedicated project management team responsible for bridging all communications between the practice and AON. That team also oversees the project roadmap, ensuring all milestones and deadlines are met, managing change and practice expectations, and triaging priorities.
The team is the face of the more than 200 individuals involved in the transition process, each of whom brings to the table a unique set of skills and expertise. It also represents more than 20 departments, ranging from operations and legal to finance and revenue cycle.
The project management team is in constant contact with every individual involved in the transition process and works closely with representatives from the practice, typically office administrators with involvement from physician and clinical leadership.
A 3-Stage Roll Out
Under the guidance of the dedicated project management team, the transition process will typically roll out in three stages:
- Due Diligence: This starts with creating a communications plan that forms the foundation upon which AON’s relationship with the practice is built. This is also when we collect necessary data such as provider, payer and facility information, employee census, contracts, and marketing materials – everything there is to know about the practice and its operations.
- Implementation: Next is acting on the data collected during due diligence. This includes meetings with employees, establishing new contracts with payers and pharmaceutical companies, setting up other legal contracts and assignments, etc. The implementation checklist encompasses more than 1,000 individual tasks which the project management team manages behind the scenes, ensuring every item is completed on time and without overwhelming the practice team.
- Go-Live: At this point, it is time for the clinic to open its doors under the AON footprint. To deliver a positive experience for everyone – including patients – we expand our on-site presence to conduct staff training on new processes and workflows and assist with change management needs. This ensures the practice’s clinical and administrative staffs are proficient with new systems and processes and can proceed with confidence under the AON banner.
Once go-live is complete – the staff is fully trained and there are no more kinks to work out – a regional team takes over for the project management team, remaining engaged with the practice and serving as its dedicated AON liaison for any future needs.
Putting the Customer First
Change is hard, especially when it involves transitioning from an independent practice to one that is part of the AON network. Staff and patients alike will be impacted by the move, which is exacerbated by the growing pains that are change management’s constant companion – especially when the transition means learning new EMR and other information systems.
To calm fears and keep the transition as painless as possible, we put the customer first in everything we do. Each transition is undertaken as a partnership rather than a top-down corporate approach. We focus on the employee and patient experience from the start, for example by ensuring the employee onboarding journey is smooth and providing patients with transparent communications about AON. Finally, we make sure the facility is ready to operate under the AON banner so there are no glitches that can impact the practice’s ability to provide care or patient satisfaction.
Our transition strategy is centered on making sure all practice stakeholders are comfortable with every step of the process. We approach change management with sensitivity and positivity, communicating clearly why the move to AON is a good thing for everyone involved. We anticipate and address bumps along the way, so the transition experience is defined by our team’s ability to resolve issues – and not by the issues themselves.
This customer-centric, proactive, and transparent approach helps align cultures under a shared vision of what the future can be for patients, staff and the communities served.
The Benefit of a Centralized Pharmacy
Each day, American Oncology Network (AON) employees are doing everything they can to make sure our patients are as comfortable as possible as they undergo treatment. This includes the dedicated and knowledgeable team working at our centralized, state-of-the-art pharmacy, which is celebrating its two-year anniversary.
Our in-house specialty pharmacy offers patients access to the most current and effective oral cancer medications along with round-the-clock access to our pharmacists. Having an in-house pharmacy with a robust back-office infrastructure also eases individual practices’ administrative burden by taking care of the heavy lifting associated with refills, prior authorizations and financial assistance so their staff can concentrate on our top priority: our patients.
Access to Oral Oncolytics
Because of their tolerability and effectiveness, which can lead to a better quality of life for patients, the use of oral oncolytics is skyrocketing. AON’s ready access to 99% of these medications means we can rapidly fill and ship prescriptions right to the patient’s doorstep.
Oral oncolytics are beneficial because they allow patients to receive the treatment they need in the comfort of their own home rather than having to come to one of our clinics. This eliminates disruptions to their day and eliminates the need to miss work.
Oral medications are also a type of targeted therapy, which means they zero in on cancer cells and mostly leave a patient’s healthy cells alone. These drugs are better tolerated by patients and help them avoid some of the uncomfortable side effects such as nausea that accompany more traditional forms of therapy.
A Tool for Patients and Practices
AON’s centralized pharmacy not only benefits our practices, but the patients they treat too.
Our pharmacists have access to the charts and medical histories of all the patients in our network, allowing them to check lab work, notes and a host of other information that helps them make recommendations to clinicians. This allows for higher-quality, more personalized treatment than is possible at other pharmacies that don’t have ready access to such comprehensive patient information.
After the medications are shipped, pharmacists reach out to the patient to see how they are feeling and if they have any questions or concerns. Some medications have harsher side effects than others, so patients are educated before they start treatment about what to expect and how to diminish some of the discomfort. This is important, because patients who are aware of the side effects are much more likely to keep taking their medications, which of course leads to better results.
As for the practices in the network, AON handles all the administrative work, including assisting the patients and clinic in obtaining prior authorizations, financial assistance and refill requests. Finally, our pharmacists are available 24 hours a day, seven days a week to answer patient questions and provide advice, which cuts down on the number of phone calls that need to be handled by clinic staff.
Expanding Space and Benefits
American Oncology Network is consistently adding more practices and expanding staff. To accommodate the higher demand generated by this growth, we have opened a new 20,000-square-foot pharmacy in Fort Myers, FL.
The new location is equipped with high-tech automation and conveyor systems to make operations even more efficient and accelerate the process of filling and sending prescriptions, getting them into patients’ hands faster than ever before.
Our centralized, in-house pharmacy is one of the many benefits AON offers to its partner practices. It is part of our dedication to ensuring we are doing everything we can to support both a clinic’s staff and patients—leveraging our expertise to ensure they are comfortable and well on their way to a positive outcome.
The Benefits of Working at American Oncology Network
A career in oncology offers all sorts of rewards. But working at American Oncology Network (AON) or one of its partner practices offers employees more than most. Not only do we offer competitive salaries and excellent benefit packages within a welcoming and nurturing workplace, but we are a network of community-based practices that allows our staff to grow familiar with the patients they see on a regular basis.
If you are looking to start or advance your career in healthcare, AON should be a top consideration.
The AON Advantage
Work-life balance is a priority at AON. While our employees work hard providing our patients with the best care and treatment possible, we stress the importance of maintaining a work-life balance to rejuvenate and spend quality time with family and friends.
Being part of a community-based practice lets members of our clinical staff establish relationships with patients and stay by their side throughout treatment. Not only does this help our nurses and physicians create the kind of true relationships with patients that can be difficult to achieve in other outpatient settings, but it means our patients have someone they can trust and rely on during stressful and anxious times. In fact, these relationships go beyond the care team to include our financial counselors and patient service specialists, all of whom contribute to the patient’s overall well-being.
We offer competitive total compensation packages that include comprehensive health insurance with a robust provider network. Our 401k, which offers a 100% match and investment options, is available to full-time and part-time staff members, and we feature a generous Paid Time Off (PTO) program. Further, while we encourage employees to take time off when needed, they have the opportunity at the end of the year to cash out a portion of their accrued and unused PTO.
Promoting from within is also a priority at AON, and we support our team members’ continued development through professional development programs and tuition assistance.
Taking Care of Our Employees
Our top priority is our patients. But at AON, we understand that we can’t provide our patients with the high-quality care they have come to expect unless our employees are prioritized in the same way.
During the COVID-19 pandemic, our IT team acted quickly to enable nearly 200 employees to start working remotely and helped make Telehealth appointments a reality for our patients within four days. We ensured our clinicians and physicians on the frontline were well-protected per the Center for Disease Control and Prevention (CDC) guidelines, supplying them with an abundance of personal protection equipment including masks, gloves and sanitizers, implementing daily screening and temperature checks, reconfiguring their workspace to ensure proper social distancing, and installing plexiglass dividers and sneeze guards throughout our AON offices. We extended our safety protocols, which are also aligned with CDC guidelines, to our patients by spacing appointments, requiring all patients to wear masks and screening patients for any possible COVID-19 symptoms or exposure before entering facilities, and ensuring proper social distancing by restricting visitors from accompanying patients into our clinics.
Our measures proved successful. A survey of AON team members found that their top concerns were a sense of safety and cleanliness, job security and up-to-date information. In all, more than 81% of respondents said they were satisfied with our pandemic response.
We enhanced our leave policies and provided all employees who were not participating in the company’s medical plan with affordable access to Telehealth through Teladoc, the first and largest supplier of telehealth medical consults in the country. In addition, we upgraded our EAP (employee assistance program) to ComPsych®, the worldwide leader in fully integrated EAP, behavioral health and wellness services and resources.
Staying connected with our employees during the pandemic continued to be a high priority. From turning on our cameras during Zoom meetings to hosting virtual trivia games, boosting employee morale and engaging our teams in meaningful ways is an intentional endeavor during these unprecedented and stressful times.
Strength Through Partnership
At AON, we are a network of independent oncology practices working together as one. To that end, we host annual summits each year for physicians, nurses and operational employees, giving our staff a chance to meet and collaborate with AON peers from across the country so they can learn from and teach others how to do their jobs better or more efficiently. We also offer training opportunities to ensure practice employees keep up with the trends and fluidity of oncology so they can help our patients achieve better outcomes.
Cancer touches everyone. Being able to make a difference in the lives of those fighting this disease is something our employees at AON cherish and never take for granted — especially when they get a chance to witness a patient celebrate their final day of therapy by triumphantly ringing the bell.
If you are looking for a company that offers rewarding and fulfilling experiences and celebrates patient victories each day, AON is a great place to start or further a career in healthcare.
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