Patient Groups, Others Ask HHS to End Part B Cost Sharing for Biosimilars

More than 20 groups, representing patients, employers, and others, are asking HHS to end cost-sharing for Medicare Part B patients when a provider administers a biosimilar rather than a reference biologic.

The letter was sent to HHS Secretary Alex Azar and cites the slow adoption of biosimilars in the United States, where originator products dominate. Available biosimilars, on average, shave 20% off the reference product’s price, the letter says, and are predicted to save the United States as much as $54 billion over the next decade. Increased affordability of these medicines will help improve patient adherence to treatment and lead to better health outcomes, the letter says.

In order to develop the US market, incentives must align, the letter notes; in addition, out-of-pocket savings in Medicare Part B could influence the rest of the payer market, as many commercial payers take their cues from CMS payment policies.

The proposal is also in line with HHS’ initiative to “harness payment and cost-sharing incentives to increase biosimilar adoption,” the letter says.

Evidence points to “a lack of physician, patient, and payer incentives impeding use of biosimilars, blocking potential savings,” and “nearly 15% of Medicare Part B enrollees pay the full 20% coinsurance for their reference biologic, while others only have supplemental insurance that only covers a portion of the 20%,” the letter says.

Reducing or eliminating patient out-of-pocket costs for biosimilars with lower Average Sales Prices than their references, the signatories argue, would increase affordability and access to biologic therapy, and would help develop the biosimilars market in the United States. “Indeed, your agency’s own FY2020 budget proposal calls for harnessing payment and cost-sharing incentives to increase biosimilar adoption,” they write to Azar, adding that the increased affordability will help improve patient adherence to medications, leading to better health outcomes, reducing health care costs, and creating savings for taxpayers by reducing Medicare spending.

The Center for Biosimilars^® reached out to HHS for comment, but a response was not immediately available.

The letter was signed by more than 20 stakeholders, including the American Cancer Society Cancer Action Network, the Association of Community Cancer Centers, Employers Health, the Pacific Business Group on Health, the Leukemia and Lymphoma Society of America, CVS Health, and others.

The push for action to spur uptake comes amid a debate playing out as to whether biosimilar use will ever truly take hold in the United States. On Thursday, health economist Amitabh Chandra, PhD, Ethel Zimmerman Wiener professor of public policy and director of health policy research at the Harvard Kennedy School of Government, weighed in, saying that we cannot expect biosimilars to succeed purely by relying on market forces.

Other ideas to encourage use of biosimilars in Medicare Part B have included creating new innovation models, using a shared savings program, or upping add-on payments.