ICYMI: House Appropriators Encourage CMS to Support Biosimilars; Experts Point to Biosimilars to Help Lower Drug Costs, Call on Congress and Administration to Act

Washington, DC — Yesterday, the House Appropriations Committee approved the fiscal year 2021 Labor, Health and Human Services, Education, and Related Agencies bill. The Committee reinforced the need for policy action by CMS that will support access to, use of and competition from lower-cost biosimilars to provide savings for America’s seniors, patients, and taxpayers.

Language can be found here: “Biosimilar Utilization.—The Committee is concerned about the underutilization of lower cost biosimilars, particularly those in Medicare Part B, and encourages CMS to support development and implementation of new policies that may help increase biosimilar uptake when clinically appropriate, such as reducing patient copays or other mechanisms.”

Last week, during The Hill’s Health Reimagined: The Future of Healthcare event, that featured keynote speakers Dr. Anthony Fauci and HHS Secretary Alex Azar, experts underscore the need for healthy competition from biosimilars and policies in Congress that can lower costs for seniors, employers and the health care system at large. 

Juliana Reed, President of the Biosimilars Forum, outlined the cost-savings potential of biosimilars amid increased spending during the COVID-19 crisis:

“As the U.S. battles the COVID-19 pandemic and Congress has authorized more than $3 trillion in critical funding to fight off the virus and help our economy, our healthcare system also needs to look forward to lowering drug costs. Estimates show that biosimilars could save the U.S. healthcare system as much as $250 billion over the next ten years. As we begin to rebuild the economy in a way that reduces the financial burden on patients, employees, and the healthcare system at large, biosimilars will play a key part in that solution.”

Annette Guarisco Fildes, President and CEO of The Erisa Industry Committee (ERIC), identified the obstacles in place to ensure that patients consistently receive affordable and life-saving biosimilars:

I think there is a misunderstanding about what biosimilars are and there’s a particularly unfortunate one in that people think that the FDA needs to designate a biosimilar somehow as interchangeable before it can be prescribed to a patient. And that’s simply not the case. From large employers, where I sit, they do try to design their plans to align the incentives correctly, but the other systems in place create cross-purposes so that the most affordable drug isn’t necessarily prescribed to the patient each and every time. We need to do better as a country, and Congress and the FDA and CMS have important roles to play in all this. There are answers — and Congress and the administration just need to act.

Alex Brill, Founder of Matrix Global Advisors (MGA), an economic consulting firm, and a Resident Fellow at AEI, discussed a solution that Congress or the Administration could approve that aligns the incentives of physicians and taxpayers to mitigate the rising costs of biologic spending:

One of the ways to align these incentives would be for CMS, in particular the Innovation Center (CMMI) to launch a demonstration project, a shared savings program in Medicare Part B for biosimilars. This would reward physicians for increasing their utilization of biosimilars, which would both create that incentive for physicians and align that incentive with the desire of taxpayers to lower overall costs in the biologic spend category. 

Less than two weeks ago, Senators John Cornyn (R-TX) and Michael Bennet (D-CO) introduced new, bipartisan legislation to lower health costs by supporting biosimilars. This legislation is one of eight policy solutions introduced in Congress that would encourage competition and provide direct cost savings to employers and taxpayers by increasing use and access to biosimilars. For more information on the biosimilar policies in Congress visit: supportbiosimilars.com

The full discussion from The Hill’s Health Reimagined event can be watched here