First Biosimilar Included in Medicare Reimbursement

Pfizer’s Remicade biosimilar will now be reimbursed by Medicare.

Pfizer recently announced that Medicare providers that prescribe the biosimilar Inflectra (infliximab-dyyb) will be reimbursed for the drug.

The Centers for Medicare and Medicaid Services included the Remicade (infliximab) biosimilar in the January Average Selling Price pricing file, according to a press release from Pfizer. This action was implemented on the first of the year.

Shipment of the drug began at the end of November 2016 in the United States, and the drug is now readily available for order from numerous wholesalers. Pfizer is also currently collaborating with other distributors to make Inflectra readily available to patients.

Inflectra can also provide a lower-cost alternative to Remicade, with Pfizer offering a wholesale acquisition cost at a discount of 15%, Pfizer wrote. Payers, providers, distributors, and other organizations also have the potential to purchase the drug at further discounts.

More information about Medicare claims processing is included in the MLN Matters Article Number MM9930, Pfizer reported.

Additionally, the manufacturer is offering access to the Pfizer enCompass progam, which is a reimbursement service and patient support program that offers assistance to patients and healthcare professionals. This program provides coding and reimbursement support for providers, co-pay assistance for patients who have insurance, and financial assistance to those who are uninsured or underinsured, according to the press release.

Inflectra’s approval was based on findings from studies that included structural and functional characterization, animal study data, human pharmacokinetic and pharmacodynamics data, clinical immunogenicity data, and other clinical safety and efficacy data to prove that Inflectra is biosimilar to Remicade.

By including Inflectra in Medicare reimbursement, it is likely that other government agencies will follow suit, which may provide manufacturers with incentive to create novel biosimilars.

“Biologics have revolutionized the treatment of many life-threatening and chronic diseases. By introducing Inflectra to the US marketplace, Pfizer is helping customers access an additional high quality treatment option that promises greater savings for the healthcare system,” Diem Nguyen, regional president North America of Pfizer Essential Health Business said in another press release. “We are proud of our global leadership in biosimilars, and will continue our efforts to advance a sustainable, competitive marketplace for these therapies to deliver a high quality, consistent supply of product and long-term savings and value for patients and physicians.”