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Access to Medicare Part B Drugs Remains Challenging During COVID-19

Summary

Avalere continues to find a significant drop in utilization of key physician-administered therapies in 2020 relative to 2019.

The COVID-19 pandemic and stay-at-home orders continue to impact patients’ ability to access care. An earlier Avalere analysis compared the utilization of select autoimmune and oncology drugs and services in February, March, and April of 2020 relative to the same period in 2019 to understand how the coronavirus affected the use of physician-administered drugs.

As new data continue to become available, Avalere refreshed the analysis and found that the volume of top Medicare Part B therapies administered continues to lag significantly below 2019 levels, despite the partial reopening of the economy and the healthcare system. Specifically, according to data collected as of the end of June 2020, utilization of key autoimmune, oncology, and osteoporosis drugs in May 2020 was respectively 44%, 50%, and 53% below May 2019 levels (Figure 1).

Figure 1: Relative Change in Billing Frequencies for Top 10 Autoimmune Products, Top 10 Oncology Products, and Select Physician-Administered Osteoporosis Products, February–May 2020 vs. February–May 2019
Figure 1: Relative Change in Billing Frequencies for Top 10 Autoimmune Products, Top 10 Oncology Products, and Select Physician-Administered Osteoporosis Products, February–May 2020 vs. February–May 2019

Similarly, the utilization of the Current Procedural Terminology codes for key drug administration services also declined significantly year over year. As of data collected by the end of June 2020, May 2020 billings for infusion services for chemotherapy and for other drugs were 54% and 69% below May 2019 levels, respectively, while claims for injection services were 64% lower (Figure 2).

Figure 2: Relative Change in Billing Frequencies for Infusion Services for Chemotherapy, Injections of Other Drugs, and Infusions of Other Drugs, February–May 2019 vs. February–May 2020
Figure 2: Relative Change in Billing Frequencies for Infusion Services for Chemotherapy, Injections of Other Drugs, and Infusions of Other Drugs, February–May 2019 vs. February–May 2020

While high variability between regions, between settings of care, and within therapeutic classes is likely, the findings may point to continued beneficiary access challenges to products that often lack clinical equivalents.

Funding for this research was provided by the Pharmaceutical Research and Manufacturers of America. Avalere maintained full editorial control.

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Methodology

Avalere used Inovalon provider-sourced clearinghouse data to estimate the number of procedures that were billed for administration of oncology, autoimmune, and osteoporosis products. The data comprised submitted, pre-adjudicated claims and represent approximately 5%–7% of the total Medicare fee-for-service volume nationally on average. Results of the analysis are valid as of June 30, 2020. Utilization changes may be impacted by potential lag in provider claim submissions.

Drawing on this resource, Avalere compared specific Healthcare Common Procedure Coding System code utilization in February, March, April, and May 2019 with the same months during 2020 to evaluate the impact of COVID-19-related restrictions and precautions on service delivery. Avalere assessed several metrics in 2019 and 2020, including the billing frequency for:

  • Chemotherapy administration (96413)
  • Intravenous infusion (96365)
  • Injection (96372)
  • The top-10 brand oncology products (by total Medicare Part B spending in 2018) – Pembrolizumab, Nivolumab, Rituximab, Bevacizumab, Trastuzumab, Daratumumab, Pemetrexed Disodium, Bortezomib, Pertuzumab, and Ipilimumab
  • The top-10 brand autoimmune products (by total Medicare Part B spending in 2018) – Ituximab, Infliximab, Abatacept, Certolizumab Pegol, Golimumab, Vedolizumab, Natalizumab, Tocilizumab, Ustekinumab, and Belimumab
  • Certain physician-administered osteoporosis products – Denosumab, Teriparatide, Ibandronate Sodium, Zoledronic Acid, Romosozumab-Aqqg, and Calcitonin-Salmon

Note: Biosimilars for the products listed above were included in the analysis where applicable.

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