Medicare Advisers Assess Reimbursement Issues for Biosimilars


Advisers to Congress on Medicare payment issues last week discussed reimbursement issues for biosimilars because biosimilars are really and finally happening.

Biosimilars are drugs that are biologically similar to brand name or reference product biologics. The abbreviated approval process for biosimilars was set out in the Biologic Price Competition and Innovation Act in 2010, and it took five years before the first biosimilar was approved. Now there are four approved biosimilars with more applying for approval.

“This is no longer hypothetical,” said Jack Hoadley, a research professor at the Georgetown University Health Policy Institute, at the meeting of the Medicare Payment Advisory Commission (MedPAC) on Oct. 7.

“Unlike the situation where this was discussed in previous years, biosimilars [now] have been approved by the Food and Drug Administration. They're out there. And our goal is to see how to make it easier for consumers to access biosimilars without all the hoops that have currently to be gone through today,” Hoadley said.

At their meeting, Hoadley and the other MedPAC commissioners noted that some incentives and discounts that are available under Medicare for use of brand name, or reference, biologics can make them seem less expensive than biosimilars, which are supposed to be a lower-cost alternative.

Solutions the commissioners discussed were extending to biosimilars the coverage gap discount that currently applies to branded/reference biologics, and ensuring that plan incentives encourage the use of lower-cost products.

You can read my article here.

MedPAC discussed other topics as well. In an article by Bloomberg BNA reporter Michael D. Williamson, he describes how the commissioners said accountable care organizations—groups of doctors, hospitals and other providers working together to provide better, more coordinated care with the aim of lowering Medicare’s costs—haven’t created substantial savings for the government and some should be pushed to take on more risk. Michael’s article is here.

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