Biosimilars Forum Announces Support for Policies that Would Save Taxpayers and Seniors Billions

New Analysis of Policies Incentivizing Biosimilars Could Save U.S. Taxpayers Billions in Health Care Costs and Medicare Beneficiaries up to $3.3B in out-of-pocket costs over 10 Years.

WASHINGTON, D.C. – The Biosimilars Forum today released new scoring analysis, which it commissioned from Avalere Health, on three policy proposals to increase use of and patient access to biosimilars. The policies are estimated to save billions in federal health care costs and Medicare beneficiaries up to $3.3B in out-of-pocket costs over the next ten-year budget window. The Forum called on Congress to consider the policies to lower health care costs.

Biologics are currently the biggest driver of drug spending in the Medicare program. Despite being FDA approved, equally safe and effective, and lower in cost than specialty biologics, biosimilars have faced barriers in the public and private insurance markets, preventing their rapid adoption in the U.S.

As Congress works to lower health care costs, the Forum believes this analysis demonstrates biosimilars are an obvious solution to quickly lower costs for both patients and American taxpayers. Already, the administration’s FY2020 budget proposal calls for “harnessing payment and cost-sharing incentives to increase biosimilar adoption.”

“It’s clear that incentivizing biosimilars will lower health care costs for patients and taxpayers,” said Juliana Reed, President of the Biosimilars Forum. “Today’s scoring analysis proves that biosimilars need to be part of the solution to lower health care costs, but it will require proactive policy action to unlock these savings. By reducing patients’ out-of-pocket costs and encouraging doctors to use biosimilars instead of the more expensive biologic, the U.S. can save billions for patients and Medicare.”To determine the economic impact of increased use of biosimilars, the Forum commissioned Avalere Health to score three policy solutions to understand the potential costs or savings to the federal government. To evaluate the potential impact on government spending of such a proposal, Avalere prepared 3 scenarios based on a range of assumptions. Based on the findings from the high scenarios, each policy could lead to billions in cost savings each year. The three policies and their respective estimated savings are below:

1. Reducing Patient Out-of-Pocket Costs for Biosimilars:

  • Reducing patients’ out-of-pocket costs for biosimilars in the Medicare Part B program could save up to $5.2B in taxpayer dollars in the fiscal year 2020-2029 budget window, following increased use of these lower-cost therapies.
  • In addition to reducing federal costs, it is estimated also to save seniors as much as $3.3 billion in out-of-pocket costs over the next decade.

2. Biosimilars Shared Savings Program for Providers:

  • $3B in tax dollars could be saved in the fiscal year 2020-2029 budget window if the U.S. were to implement a biosimilars shared savings program for Medicare Part B providers. This policy would encourage doctors to use biosimilars over a more expensive reference biologic by sharing some of the new-found Medicare savings with the prescribers.

3. Additional Add-On Payment for Biosimilars:

  • The U.S. could save $8.2B in health costs in the fiscal year 2020-2029 budget window by increasing add-on payments for prescribers of biosimilars. This policy would incentivize biosimilars use by increasing the amount doctors in Medicare Part B are reimbursed for administering these lower-cost therapies.

The complete details of the three policies proposals and scoring analysis can be found at