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Summary

Recent Avalere analysis finds decreases in utilization of oncology and autoimmune treatments across all care settings since the onset of the health crisis.

The COVID-19 pandemic and associated stay-at-home orders established across the US in March and April limited patient access to in-person care and have impacted patients’ ability to receive provider-administered drugs. Although the Centers for Medicare & Medicaid Services (CMS) has granted more remote service flexibility to providers, Avalere found that the volume of oncology and immunology drugs and services declined notably between April 2019 and April 2020. In particular, billing for chemotherapy infusion services dropped by 33%, while other drug infusions declined by 56% (Figure 1).

Figure 1: Relative Change in Billing Frequencies for Infusion Services for Chemotherapy vs. Other Drugs (February, March, and April 2019 vs. February, March, and April 2020)
Figure 1: Relative Change in Billing Frequencies for Infusion Services for Chemotherapy vs. Other Drugs (February, March, and April 2019 vs. February, March, and April 2020)

Avalere compared the utilization for specific oncology and immunology drugs and services between relevant time periods in 2019 and 2020 to assess how recent treatment disruption associated with COVID-19 may have affected patient access since the disease garnered international attention in February 2020.

To understand the impact in each therapeutic area (TA), Avalere also analyzed changes in the billing frequency for specific therapies between 2019 and 2020. The products included in the analysis represent the top 10 branded provider-administered therapies in oncology and immunology, defined as the Healthcare Common Procedure Coding System (HCPCS) codes with the highest Medicare Part B spending in 2018. Avalere found that utilization of the top 10 oncology drugs, which include both chemotherapies and immuno-oncology products, declined by an average of 40% between April 2019 and April 2020 (Figure 2). Similarly, utilization for the top 10 autoimmune biologics reviewed declined by an average of 24% during the same period (Figure 2).

Figure 2: Relative Change in Billing Frequencies for the Top 10 Oncology and Top 10 Immunology Products (February, March, and April 2019 vs. February, March, and April 2020)
Figure 2: Relative Change in Billing Frequencies for the Top 10 Oncology and Top 10 Immunology Products (February, March, and April 2019 vs. February, March, and April 2020)

In addition, Avalere observed a steady decline in total checkup patient visits across all TAs, reaching a total of 65% reduction in provider codes for evaluation and management (E/M) services between April 2019 and April 2020 spanning all sites of care (e.g., hospital outpatient, physician office, home) (Figure 3).

Figure 3: Percent Relative Change in Billing Frequencies for E/M Services (February, March, and April 2019 vs. February, March, and April 2020)
Figure 3: Percent Relative Change in Billing Frequencies for E/M Services (February, March, and April 2019 vs. February, March, and April 2020)

While some services may have shifted remotely, the reduction in billing frequency during this period indicates a large gap likely remains in patient care. These delays and reductions in care could have significant long-term consequences for costs and outcomes as patients’ diseases may progress due to these gaps in treatment.

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 research datasets to estimate the number of procedures that were billed for administration of oncology and immunology products. The data comprised submitted, pre-adjudicated codes and represent approximately 5%–7% of the total Medicare fee-for-service volume nationally on average.

Drawing on this resource, Avalere compared specific HCPCS code utilization in February, March, and April 2019 with the same months during 2020 to evaluate the impact of COVID-19-related stay-at-home orders on service delivery. Avalere assessed several metrics in 2019 and 2020, including:

  • Billing frequency for chemotherapy administration (96413)
  • Billing frequency for intravenous infusion (96365)
  • Billing frequency for top 10 brand oncology products (by total Medicare Part B spending in 2018)
  • Billing frequency for top 10 brand autoimmune products (by total Medicare Part B spending in 2018)
  • Billing frequency for evaluation and management (E/M) visits (99201-99205; 99211-99220)
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