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.
This legislation would increase the add-on payment for a biosimilar product from ASP+6% of the biologic product to ASP+8% of the biologic product for a period of five years. This will help guide physicians to lower-cost, safe, and effective treatment options that reduce the financial burden for both patients and taxpayers.
- Sponsors: Representatives Kurt Schrader (D-OR) and Adam Kinzinger (R-IL)
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.
- Sponsors: Representatives Paul Tonko (D-NY) and Bob Gibbs (R-OH)
This legislation would push Congress to treat biosimilars and brand biologics equally within the Coverage Gap Discount program to keep patients from paying for higher-cost treatments. Specifically, this would amend the Part D coverage gap discount program to classify biosimilars as “applicable drugs” in the Coverage Gap Discount Program. This change would allow biosimilar manufacturers to pay the 50 percent discounts paid by their brand competitors and participate on a level playing field to compete for placement on Part D plans’ formularies.