Biosimilars Forum Calls for Bipartisan Policies That Lower Drug Prices on Expensive Biologics Ahead of President Biden’s Joint Session of Congress Address
As President Biden prepares to address a Joint Session of Congress, the Biosimilars Forum called for common-sense policies that lower prices of expensive biologic drugs that are having an outsize impact on drug spending to be included as health care priorities. These policies have bipartisan support in both the House and Senate and have the potential to save billions of health care dollars.
Meaghan Smith, Executive Director of the Biosimilars Forum, issued the following statement:
Finding meaningful solutions to lower the cost of health care for Americans is more important than ever, especially as our country recovers from the economic devastation caused by COVID-19. With President Biden set to address a Joint Session of Congress, the Biosimilars Forum hopes he will use this unique opportunity to highlight common-sense, bipartisan solutions that will provide the billions in health care savings we need.
Biosimilars, medicines that are safe and effective lower-cost alternatives to brand name biologics, generate health care savings by encouraging competition and providing direct cost savings to taxpayers. We call on the administration to work with Congress on bipartisan policies that increase access to and use of biosimilars.
The Biosimilars Forum specifically supports policies including:
Reducing Seniors’ Costs for Biosimilars Through Zero Copay: The CMS Medicare program can take action to reduce patient out-of-pocket costs for biosimilars. This could save seniors in Medicare as much as $3.3B in out-of-pocket costs, and up to $5.2B in taxpayer dollars over ten years, due to increased use of these lower-cost therapies.
Enhancing Providers Reimbursement, Saving Money for Patients and Taxpayers:
- Option 1 – Increase ASP-Add On Payment Rate for Biosimilars: The Biden-Harris Administration can support recently introduced legislation that incentivizes biosimilars through a temporary increase in the reimbursement to providers for biosimilars from the average sales price (ASP) of the drug plus six percent to the average sales price (ASP) of the drug plus eight percent. This will help guide physicians to lower-cost, safe and effective treatment options that reduce the financial burden for both patients and taxpayers.
- Option 2 – Shared Savings Model: Direct the Centers for Medicare and Medicaid Services (CMS) to implement a “shared savings” model whereby Medicare savings associated with prescribing a biosimilar, as compared to a brand name biologic, would be shared with providers. This would incentivize use of biosimilars and offer patients lower-cost treatment options.
Leveraging Star Ratings to Encourage Insurers to Offer Lower-Cost Biosimilars: The administration can support recently introduced legislation that would require the addition of a new quality measure in the Medicare Advantage (MA) and Part D Star Rating system to include assessments of plan benefit and formulary design in encouraging patient access to biosimilars. This will help bring transparency to all stakeholders to know which Medicare Advantage and Part D plans are offering access to lower-cost biosimilars, which in turn will help inform patient decision-making when selecting a plan.
The savings potential from biosimilars is how the U.S. can address the biggest driver of prescription drug spending, as competition from biosimilars lowers prices and improves patient choice and access to lifechanging treatments.
A recent report by leading Harvard University and Harvard Medical School researchers published in the National Bureau of Economic Research demonstrates how competition from biosimilars is driving down the cost of all biologics in a drug class, including the brand name originator biologic. The findings show that each biosimilar entering the market brings down weighted average price ratios by up to 10 percentage points.