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Physician Groups Call on CMS to Revise Reimbursement, Payment Policies for Biosimilars
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CMS recently closed its comment period for the Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 proposed rule. The Biosimilars Council and several physician groups submitted comments prior to the closing period and urged CMS to revise the reimbursement policy for biosimilars in Medicare Part B and to revise the current payment policy for biosimilars.
According to a release, the Biosimilars Council, a division of the Association of Accessible Medicines, noted CMS should provide unique reimbursement codes for all non-interchangeable biosimilars instead of a single payment code. This change could create substantial savings for patients and health care payers, as well as expand patient access to biosimilar medicines, the release noted.
“Shifting biosimilar reimbursement to unique codes will help facilitate the creation of a thriving market and greater, more affordable, patient access to these medicine,” Christine Simmon, executive director of the Biosimilars Council and senior vice president of Policy and Strategic Alliances at the Association of Accessible Medicines, said in the release. “This is a critical opportunity for policy to have a positive impact on the future viability of the biosimilars market.”
In a second release, the Biologics Prescribers Collaborative — along with the Alliance for Patient Access, American Association of Clinical Endocrinologists, American College of Rheumatology, American Gastroenterological Association and the Coalition of State Rheumatology Organizations — urged CMS to adopt unique Healthcare Common Procedure Coding System billing codes for biosimilars medicines instead of taking a generic approach. These physician groups noted that use of different reimbursement levels for different biosimilars will not only promote competition, but will help create a more robust market while protecting patient safety.
The comments submitted by the Biologics Prescribers Collaborative asked CMS to consider the following:
- 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 current reimbursement landscape is extremely complex. Unique J-codes for biosimilars help clarify for physicians that while ‘highly similar,’ biosimilars of the same reference product will likely still have product differences that should be considered in clinical decision-making,” Dennis R. Cryer, MD, co-convener of the Biologics Prescribers Collaborative, said in a release. “Grouping biosimilars in one blended reimbursement rate prioritizes price above all other features and has the potential to undermine patient care and safety.”
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