Is billing chilling biosimilar adoption?
The biosimilars wave is here. The lower-cost versions of such pricy biologic drugs as Humira and Remicade are set to bring serious savings in the coming years, as long as they can clear hurdles that trade groups and manufacturers have identified.
The National Association of Chain Drug Stores recently noted that branded biologic drugs could cost the U.S. healthcare system $120 billion by 2024, based on projections from Express Scripts. But a 2017 Rand report found $54 billion in potential savings from biosimilars in the next 10 years.
With the selling point of biosimilars being their lower price than an origin drug — they are roughly 10% to 15% less expensive than a biologic — a big part of biosimilar adoption is getting them reimbursed properly. The Association for Accessible Medicines and the National Association of Chain Drug Stores are lobbying Congress and the White House for a change in the Centers for Medicare and Medicaid Services’ policy on reimbursement for biosimilar medicines. Such a change, AAM reported, also could yield significant savings to U.S. taxpayers.
“CMS currently groups all biosimilars of a reference biologic under a single billing code and payment rate,” the group noted recently. “A variety of stakeholders have raised concerns that this policy undermines patient access to affordable biosimilar medicines and stifles the creation of a robust biosimilars market.”
Sheila Frame, vice president and head of North American biopharmaceuticals at Sandoz, maker of the first FDA-approved biosimilar Zarxio (filgrastim-sndz) recently highlighted the need for proper reimbursement for biosimilars.
“Unique reimbursement codes are necessary to foster a competitive marketplace and support direct and indirect cost savings that will make our health system more sustainable,” she said.
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