Bone remodeling in oncology strategy using MedDrive™

Bone cancer is rare, accounting for less than 1% of all cancers.¹ It usually takes the form of tumors in the long bones of the legs or pelvic region.

More common is bone metastases, which refers to cancers that start somewhere else in the body and have spread to the bones. This often indicates the original cancer has progressed to an advanced stage that isn’t curable.

Not all bone metastases progress rapidly. In some cases, they can progress more slowly and be treated as a chronic condition that needs careful management.² Treatment at this stage can slow its growth and improve quality and length of life.

Hypercalcemia is also associated with cancer that has started somewhere else in the body. It presents as elevated calcium levels in the blood and can affect up to 10% to 30% of cancer patients, most commonly patients with breast cancer, lung cancer and myeloma. Cancer-related hypercalcemia has a poor prognosis; most patients die within a year.³

Multiple myeloma is an uncommon blood cancer that affects the bone marrow, In multiple myeloma, bisphosphonates or denosumab are used as a preventative option for skeletal-related events for all patients receiving primary treatment. The preferred bisphosphonate in National Comprehensive Cancer Network (NCCN) guidelines is zoledronic acid for these events.

Zoledronic acid is a third generation bisphosphonate, approved for treatment of many types of bone metastasis. It is 100-times more effective than pamidronate.^4,5,6  Zoledronic acid has been shown to be clinically non-inferior to Xgeva^® (denosumab),⁷ and its generics deliver these health outcomes at less than 10% the cost.⁸

Prime currently has similar numbers of utilizers of zoledronic acid and Xgeva, but drug spend for Xgeva runs 10x high. Monthly cost per Xgeva claim was $3,998 compared to zoledronic acid at $333.⁸

Radiation and chemotherapy can also trigger bone loss

Treatment of cancer has been shown to trigger bone loss. Cancer cells interrupt the process of bone remodeling. Individual treatment plans will depend on:⁹

• the type of primary cancer
• the stage of the cancer
• which bones are involved
• prior cancer treatments
• the patient’s overall health

The launch of MedDrive signaled that Prime and its Blue Plan clients were going to get more aggressive about medical drug savings.

Prime’s recommended MedDrive strategy for oncology bone remodeling is to prefer generic zoledronic acid over Xgeva. Some of Prime’s Blue Plan clients already do this. Several others are now in the process of transitioning to this strategy.

Now that Prime has made its MedDrive recommendation to clients, we anticipate market share to increase and savings to build over the next year. Prime projects $40 to $50 million in annual savings for this zoledronic acid oncology strategy.

MedDrive medical solutions is a complete toolkit

MedDrive leverages the collective strength of Prime’s client membership to help control medical costs. Client savings are obtained through:

• Lower cost alternatives within the same therapeutic class
• Improved rebates from manufacturers
• Lower net costs with shift of use from expensive medical drugs to lower cost alternatives, including biosimilars

Prime’s Blue Plan clients are executing preferred medical drug programs are designed to save them hundreds of millions of dollars. We’ll continue to showcase these drugs and this analysis in coming weeks. For more information, contact your local Prime representative.

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References

1. Bone Cancer. © Mayo Foundation for Medical Education and Research (MFMER). Accessed at: https://www.mayoclinic.org/diseases-conditions/bone-cancer/symptoms-causes/syc-20350217
2. What to Expect When Cancer Spreads to the Bones. Written by Marjorie Hecht on December 18, 2018. Healthline Media. Accessed at: https://www.healthline.com/health/cancer-spread-to-bones-life-expectancy
3. Seccareccia D. Cancer-related hypercalcemia. Can Fam Physician. 2010;56(3):244-e92.. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837688/
4. Macedo F, Ladeira K, Pinho F, et al. Bone Metastases: An Overview. Oncol Rev. 2017;11(1):321. Published 2017 May 9. doi:10.4081/oncol.2017.321. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444408/
5. Wellington K, Goa KL. Zoledronic acid: a review of its use in the management of bone metastases and hypercalcaemia of malignancy. Drugs. 2003;63(4):417-37. doi: 10.2165/00003495-200363040-00009. PMID: 12558465. Accessed at: https://pubmed.ncbi.nlm.nih.gov/12558465/
6. McKeage K, Plosker GL. Zoledronic acid: a pharmacoeconomic review of its use in the management of bone metastases. Pharmacoeconomics. 2008;26(3):251-68. doi: 10.2165/00019053-200826030-00007. PMID: 18282018. Accessed at: https://pubmed.ncbi.nlm.nih.gov/18282018/
7. Denosumab vs Zoledronic Acid in Newly Diagnosed Multiple Myeloma With Bone Disease, By Matthew Stenger. 3/1/2018. ASCO Post. Accessed at: https://ascopost.com/News/58585
8. Prime book of business
9. Mouse Study Points to Strategy for Preserving Bone During Chemotherapy. Feb. 25, 2020. National Cancer Institute. U.S. Department of Health and Human Services. National Institutes of Health. Accessed at: https://www.cancer.gov/news-events/cancer-currents-blog/2020/bone-loss-chemotherapy-senescence