The Biosimilars Forum Reacts to CMS Report on Increased Medicare Premiums for Seniors
WASHINGTON, DC – Following the Centers for Medicare & Medicaid Services’ announcement on rising seniors’ premiums for physician-administered drugs, the Biosimilars Forum issued the following statement:
“It is unfortunate that despite the fact that 9 biosimilars are available in Part B and cost an average of 30 percent less than their reference biologic, seniors are often denied access to or unaware a lower-cost option exists due to misaligned incentives that favor the higher-cost product. For years, Americans have been demanding lower drug prices, and with multiple biosimilars available, it is disappointing to see instead they are watching their premiums rise.
“Biosimilars are a bipartisan and recognized solution to help ease the financial burden on our nation’s seniors and taxpayers—but Congress and the Administration must act to unlock their full savings potential. Small policy changes, including elimination of out-of-pocket cost for Medicare Part B patients that could save seniors as much as $3.3 billion in the coming decade should quickly be enacted to increase use and access to biosimilars—unlocking billions in Medicare savings.”
In the last two months, three bipartisan bills have been introduced to help increase access and use of lower-cost biosimilars to address rising drug prices.
- Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars (ACCESS) Act – H.R. 4597
Sponsors: Representative Scott Peters (CA-52), Representative Pete King (NY-02), Representative Anthony Brindisi (NY-22)
Overview of Policy: This legislation would eliminate a patient’s copay for a biosimilar under Medicare Part B through subsidies, regardless of the patient’s type of coverage, and without any other changes to the underlying coverage.
- Bolstering Innovative Options to Save Immediately on Medicines (BIOSIM) Act – H.R. 4455
Sponsors: Representative Kurt Schrader (D-OR-05), Representative Greg Gianforte (R-MT)
Overview of Policy: This legislation will temporarily increase reimbursements for biosimilar drugs and boost their utilization by doctors. CMS would provide an ASP+8% (of the reference product ASP) reimbursement for biosimilars for a five-year period.
- Star Ratings for Biosimilars Act – H.R. 4629
Sponsors: Representative Paul Tonko (D-NY), Representative Bob Gibbs (R-OH)
Overview of Policy: This legislation will implement an access measure to incentivize Medicare Advantage and Part D plans to improve access to biosimilars on their formularies. An access measure would evaluate the impact of a plan’s benefit structure on patients’ utilization of and/or ability to access biosimilar products, sometimes compared to originator products. Types of measures could include: coverage, preferencing, utilization management, and the rate of uptake.
For more information on the potential savings that can be realized with increased access to biosimilars, visit supportbiosimilars.com.
The eight member companies of the Biosimilars Forum that supports this policy include Boehringer Ingelheim, Coherus BioSciences, Fresenius Kabi SwissBioSim, Merck and Co., Inc., Pfizer, Samsung Bioepis, Sandoz, and Teva.