Council Urges CMS to Revise Biosimilar Reimbursement Policy in Medicare Part B


Current policy reduces incentives that would spur a robust biosimilars market, according to the Biosimilars Council.

To increase patient access to biosimilars and ensure that the marketplace can expand, the Biosimilars Council is urging the Centers for Medicare and Medicaid Services (CMS) to revise its current reimbursement policy for biosimilars in Medicare Part B.

The council is requesting CMS to revise the current payment and coding policy of biosimilars administered in the outpatient settings, according to a press release.

Rather than using a single payment code for non-interchangeable biosimilars, the council suggests that each biosimilar should have a unique reimbursement code.

“Shifting biosimilar reimbursement to unique codes will help facilitate the creation of a thriving market and greater, more affordable, patient access to these medicines,” said Christine Simmon, executive director of the Biosimilars Council and senior vice president of Policy & Strategic Alliances at the Association of Accessible Medicines. “This is a critical opportunity for policy to have a positive impact on the future viability of the biosimilars market.”

The current policy promotes a framework that significantly reduces incentives to develop biosimilars in the United States, according to the council.

Biosimilars are boasted as low-cost options to biologics; however, approval and uptake has been slow. A change in policy could help stimulate the biosimilar market and create significant savings for payers and patients, according to the Biosimilars Council.

A group letter by several leading health care organizations and consumers backed the council’s position.

“Only by encouraging a strong and sustainable market within Medicare Part B can the potential for savings be tied to the development of biosimilars and, most importantly, the opportunity for expanded patient access to these innovative therapies, be fully realized,” the group wrote.

The letter was signed by CVS Health, Express Scripts, Citizens Against Government Waste, FreedomWorks, National Association of Chain Drug Stores, Prime Therapeutics, National Taxpayers Union, and the Pharmaceutical Care Management Association, among others.

CMS is currently assessing the impact of the current coding and payment policy for biosimilars, and has requested comments on their Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 proposed rule (CMS-1676-P).

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