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CMS Encouraged to Revise Reimbursement, Payment Policies for Biosimilars

September 20, 2017

The Centers for Medicare and Medicaid Services (CMS) are being urged to make changes that could improve savings for patients and health care payers, as well as expand patient access to biosimilars.

The comment period for the Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for 2018 proposed rule has concluded.

The Biosimilars Council—along with multiple physician groups—put forth comments before the closing period, encouraging CMS to revise the reimbursement policy for biosimilars in Medicare Part B and amend the current payment policy for these drugs.

The Council, which is a division of the Association of Accessible Medicines (AAM), urged CMS to revise their payment and coding policy for biosimilars administered in outpatient settings. Instead of implementing a single payment code for non-interchangeable biosimilars, the Biosimilars Council noted that CMS should provide unique reimbursement codes for all biosimilars.

"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, Senior Vice President of Policy & Strategic Alliances, AAM, in a statement (September 11, 2017). "This is a critical opportunity for policy to have a positive impact on the future viability of the biosimilars market."


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The Biologics Prescribers Collaborative and other physician groups asked CMS to adopt unique Healthcare Common Procedure Coding System billing codes for biosimilars instead of taking a generic approach. Doing so, the groups argue, will promote competition and help foster a more robust market for biosimilars while simultaneously protecting patient safety.

Other comments submitted to CMS include:

  • biosimilars are not generic drugs and CMS should not treat these as such;
  • a single J-code policy does not properly recognize interchangeability;
  • grouping biosimilars of the same reference product into one J-code could create barriers for physicians to choose the most appropriate biosimilar;
  • blended reimbursement may lead to inappropriate non-medical switching; and
  • single J-codes could reduce investment in the biosimilars market and stifle therapeutic choices.

The groups acknowledged their appreciation of CMS to allow for additional stakeholder comments on this issue.—Zachary Bessette

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