Congressmen Tonko and Gibbs Introduce Bipartisan Legislation to Increase Transparency and Use of Biosimilars in Medicare Plans

New Bill Can Incentivize Medicare Plans to Increase Patient Access to Biosimilars

WASHINGTON, D.C. – Congressmen Paul D. Tonko (D-NY) and Bob Gibbs (R-OH) introduced the Star Rating for Biosimilars Act, H.R. 2855, to create a biosimilars access measure in the Centers for Medicare & Medicaid Services’ (CMS) Star Ratings Program to help Congress and stakeholders better understand patients’ ability to access lower-cost biosimilars in the Medicare Advantage and Part D health plans.

As the next generation of generics, biosimilars are newer, lower-cost alternatives to brand name biologics,” said Meaghan Smith, Executive Director of the Biosimilars Forum. “We know biosimilars are just as safe and effective as the biologics they reference, yet the majority of patients still don’t have access to these lower-cost options. The Forum is encouraged by Congressmen Gibbs and Tonko’s bipartisan work to shine a light on the plans where patients are blocked from biosimilars, which will ultimately allow for reforms that encourage increased biosimilar use and help alleviate the financial burden on millions of our nation’s seniors, patients and taxpayers.

The Medicare Advantage Star Ratings Program is a 5-star rating system established by the Centers for Medicare & Medicaid Services (CMS) for assessing the quality of Medicare Advantage plans and prescription drug plans based on measures of health management and patient outcomes. This legislation will incentivize Medicare Advantage plans to improve patient access to biosimilars through the implementation of a quality measure in the Star Ratings Program that captures elements of patients’ access to biosimilars. Specifically, the access measure will evaluate the impact that a plan’s benefit structure can have on patients’ utilization of and/or ability to access biosimilar products, compared to brand name biologics.

Despite the fact that biosimilars can save the health system billions, access to and affordability of biosimilars can vary across Medicare plans due to several factors such as coverage, tier placement and utilization management,” said Smith. “Bipartisan policy solutions like this are needed to drive savings in the system. Implementing a Star Ratings measurement for biosimilars will ultimately help bring transparency to all stakeholders to understand which plans are offering access to lower cost biosimilars, which in turn will help inform patient decision-making when selecting a plan.

Similar legislation to incentivize plans to improve access to biosimilars through the Medicare Advantage Star Ratings Program secured bipartisan support in both the House and Senate last Congress. That legislation passed the House as part of H.R. 3 and was included in the bipartisan Senate Finance Committee drug pricing plan.

For more information on the Biosimilars Forum or the policy proposals it supports, visit biosimilarsforum.org or supportbiosimilars.com.