AAM’s Biosimilars Council Urges CMS to Revise Biosimilars Reimbursement Policy

Monday September 11, 2017

Diverse Stakeholders Call for Changes to Ensure Development of Biosimilars Market, Greater Patient Access

WASHINGTON, DC (September 11, 2017) — To ensure patients have access to more affordable versions of expensive biologic medicines, the Biosimilars Council today urged the Centers for Medicare and Medicaid Services (CMS) to revise its reimbursement policy for biosimilars in Medicare Part B. CMS is assessing the effects of the current coding and payment policy for biosimilars and has solicited comments on their Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 proposed rule (CMS-1676-P).

The Council, a division of the Association for Accessible Medicines (AAM), asked CMS to revise their payment and coding policy related to biosimilars administered in outpatient settings. Instead of using a single payment code for non-interchangeable biosimilars, CMS should provide each with a unique reimbursement code. The Council believes that the current policy creates a framework that significantly reduces incentives for the development of a robust biosimilars market in the United States, which in turn could lead to reduced access to patients.

“Shifting biosimilar reimbursement to unique codes will help facilitate the creation of a thriving market and greater, more affordable, patient access to these medicines,” said Christine Simmon, Executive Director of the Biosimilars Council and Senior Vice President of Policy & Strategic Alliances at AAM. “This is a critical opportunity for policy to have a positive impact on the future viability of the biosimilars market.”

The competition stimulated by this change in policy could create substantial savings for patients and healthcare payers. Ultimately, the changes proposed by the Council will help CMS expand patient access through these affordable, life-saving, biosimilar medicines.

In a group letter to Administrator Verma, a diverse coalition of stakeholders bolstered the Council’s position that all non-interchangeable biosimilar products should receive individual code and payment calculations. “Only by encouraging a strong and sustainable market within Medicare Part B can the potential for savings tied to the development of biosimilars and, most importantly, the opportunity for expanded patient access to these innovative therapies, be fully realized,” stated the group.  The full letter can be viewed here.

The letter was signed by leading health care organizations and consumer groups, including:

Citizens Against Government Waste, CVS Health, Express Scripts, FreedomWorks, National Association of Chain Drug Stores (NACDS), National Taxpayers Union, Pharmaceutical Care Management Association (PCMA), and Prime Therapeutics.

Media Contact: Rachel Schwartz, [email protected]

About the Biosimilars Council

The Biosimilars Council, a division of the Association for Accessible Medicines (AAM), works to ensure a positive environment for patient access to biosimilar medicines. The Biosimilars Council is a leading source for information about the safety and efficacy of more affordable alternatives to costly brand biologic medicines. Areas of focus include public and health expert education, strategic partnerships, government affairs, legal affairs and regulatory policy. More information is available on our about page.

About AAM

AAM is driven by the belief that access to safe, quality, effective medicine has a tremendous impact on a person’s life and the world around them. Generic and biosimilar medicines improve people’s lives, improving society and the economy in turn. AAM represents the manufacturers and distributors of finished generic pharmaceuticals and biosimilars, manufacturers and distributors of bulk pharmaceutical chemicals, and suppliers of other goods and services to the generic industry. Generic pharmaceuticals are 90 percent of prescriptions dispensed in the U.S. but only 23 percent of total drug spending. Additional information is available at www.accesiblemeds.org.

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