The Biosimilars Forum Objects to Consolidate Billing of Biosimilars

WASHINGTON, D.C. (February 12, 2019)—During today’s House Ways & Means Committee Hearing, “The Cost of Rising Prescription Drug Prices,” two panelists proposed Medicare billing code consolidation for biosimilars and their reference biologic product in their written testimonies, found here and here. The Biosimilars Forum objects to this recommendation and has issued the following statement:

“A separate coding and payment policy for biosimilars could offer greater savings to the Medicare program, as well as encourage greater price competition and uptake of biosimilar products in the marketplace. Ultimately, patients would benefit the most from a payment policy that enhances access, achieves long-term savings, and supports a competitive marketplace.”

“The proposed idea of a shared billing and payment code would mean that biosimilars would be solely reimbursed based on price, without calculating important patient-centric factors into the reimbursement. Factors that are important to consider in biosimilar reimbursement include the variation in the delivery devices, patient support programs, and reliability of the manufacturer to supply the product. Failure to allow for differentiation in pricing based on these factors discourages – and arguably makes cost prohibitive – a focus on quality and patient needs.”

The proposals are similar to a current CMS biosimilar reimbursement policy finalized in the CY 2016 Medicare Physician Fee Schedule, which assigns all biosimilars to the same reference biologic to a single Healthcare Common Procedure Coding System code and blend the Medicare Part B Average Sales Prices for each into a single payment rate. This policy had led to widespread dissension from many critical stakeholders, including patients, providers, payers, Members of Congress, and manufacturers.