Our Solutions

How can we act now to deliver these savings?

Congress and the Administration can make small but meaningful policy changes right now to save patients, employers and health care providers money by helping patients access these lower-cost medicines and fixing the backwards incentives stopping physicians from prescribing lower-cost biosimilars.

The CMS Medicare program can take action to reduce patient out-of-pocket costs for biosimilars. Reducing patients’ out-of-pocket costs for biosimilars can save up to $5.2B in taxpayer dollars over ten years, following increased use of these lower-cost therapies. In addition to saving federal tax dollars, seniors in Medicare can save as much as $3.3 billion in out-of-pocket costs over the same period.

H.R. 4597 — Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars (ACCESS) Act 
  • Sponsors: Representatives Scott Peters (D-CA), Pete King (R-NY), and Anthony Brindisi (D-NY)

S. 3466 — ACCESS for Biosimilars Act of 2020 

  • Sponsors: Senators Martha McSally (R-AZ) and Doug Jones (D-AL)

CMS should utilize the Center for Medicare & Medicaid Innovation (CMMI) to implement models that create physician incentives to utilize biosimilars, including a “shared savings” model whereby Medicare savings associated with prescribing a biosimilar will be shared with providers. $3B in tax dollars can be saved over the next ten years if the U.S. were to implement this policy.

H.R. 6179 — Increasing Access to Biosimilars Act of 2020
  • Sponsors: Representatives Tony Cardenas (D-CA), Richard Hudson (R-NC), Angie Craig (D-MN) and Brian Fitzpatrick (R-PA)

S. 4134 – Increasing Access to Biosimilars Act of 2020

  • Sponsors: Senators John Cornyn (R-TX) and Michael Bennet (D-CO)

CMS should increase the add-on payments for prescribers of biosimilars for a two-year period. This policy will incentivize biosimilars use by increasing the amount doctors in Medicare Part B are reimbursed for administering these lower-cost therapies. By increasing add-on payments for prescribers of biosimilars, the U.S. can reduce as much as $8.2B in health costs over the next decade.

H.R. 4455 – Bolstering Innovative Options to Save Immediately on Medicines (BIOSIMS) Act
  • Sponsors: Representatives Kurt Schrader (D-OR) and Greg Gianforte (R-MT)

Section 104 of S. 2543 – Prescription Drug Pricing Reduction Act

  • Sponsors: Senators Mike Enzi (R-WY) and Tom Carper (D-DE)
  • CBO score: $0 over 10 years

This legislation 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.

H.R. 4629 – Star Rating for Biosimilars Act 
  • Sponsors: Representatives Paul Tonko (D-NY) and Bob Gibbs (R-OH)

Section 132 of S. 2543 – Prescription Drug Pricing Reduction Act

  • Sponsors: Senators Bill Cassidy (R-LA) and Bob Menendez (D-NJ)
  • CBO score: $0 over 10 years