Biosimilars were first introduced in the United States about five years ago to treat patients with various medical conditions including diabetes, cancer and autoimmune disorders. They offer the same clinical outcomes as high-cost brand biologics while promoting patient access and savings through lower costs. There are currently 29 biosimilars approved by the Food and Drug Administration (FDA). Roughly two-thirds of the approved biosimilars have launched, and that number will continue to rise over time. However, the slower-than-expected adoption of biosimilars has policymakers, health care advocates, payers and others seeking solutions that will provide better access and more savings to America’s patients.
A new report by the IQVIA Institute highlights the role of provider reimbursement in biosimilar adoption. IQVIA found that biosimilar adoption is more favorable where relative reimbursement to physicians (the difference between the reimbursement for the product and its acquisition cost) is higher for the biosimilar.
In addition, the study found that biosimilar adoption was higher for providers participating in the CMS Oncology Care Model. This payment demonstration program holds providers accountable for the total cost of care.
The results highlight the opportunity for policymakers to encourage biosimilar adoption and therefore increase patient access and savings by aligning Medicare payment policies to reward the use of lower-cost biosimilar medicines instead of higher-priced brand biologics. This can be done in both Medicare Part B, for provider-administered medicines, and in Medicare Part D.
For instance, policymakers could increase the Medicare Part B add-on payment for biosimilars and/or establish a shared savings program. Each of these would reward providers when they use lower-cost biosimilars. Likewise, Congress could update the Medicare Part D program to ensure that it encourages health plans to prioritize use of lower-cost medicines such as biosimilars.
The Biosimilars Council supports two recently re-introduced bi-partisan bills that would advance, respectively, these solutions:
- The BIOSIM Act (H.R. 2185) to increase biosimilar reimbursement in Part B to ASP+8%, sponsored by Rep. Kurt Schrader (D-OR) and Rep. Adam Kinzinger (R-IL); and
- The Ensuring Access to Lower-Cost Medicines for Seniors Act (H.R. 2846) to improve patient access to generic and biosimilar medicines in Medicare Part D, sponsored by Rep. David McKinley (R-WV) and Rep. Ann Kuster (D-NH).
As the public discourse on health care costs, sustainability and affordability continue, policymakers must evaluate how current policies and economics drive decision-making. Biosimilars play an important role in this discussion, promising lower costs and greater patient access. It is time to act to encourage their adoption.
