Policies to Save Patients and Taxpayers Billions

Biologics, medicines created by living cells, are currently treating some of life’s most challenging diseases, including cancers and autoimmune diseases. While they offer tremendous value to patients, they often have a high cost. Biosimilars are lower-cost alternatives with no clinically meaningful differences in safety or efficacy. These therapies provide an opportunity to improve the health and well-being of millions of Americans and, at the same time, save U.S. taxpayers billions in health care costs.

Despite the fact that biosimilars cost on average nearly 30 percent less than their reference biologic, patients are being locked into more expensive options. Patients need Congress and the Administration to enact policies that expand access to biosimilars and lower their health care costs.

The Biosimilars Forum supports the following policies to increase biosimilar use and reduce costs to the Medicare program by providing patients and providers an opportunity to share in the new savings.

Together, these policies can save seniors up to $3.3 billion and save U.S. taxpayers as much as $13.4 billion over ten years by allowing patients to use lower cost biosimilars.

Reducing Patients’ Out-of-Pocket Costs for Biosimilars in Medicare Part B

Reducing patients’ out-of-pocket costs for biosimilars can save up to $5.2B in taxpayer dollars over ten years, following increased use of these lower-cost therapies. In addition to saving federal tax dollars, seniors in Medicare can save as much as $3.3 billion in out-of-pocket costs over the same period. The Centers for Medicare and Medicaid Services (CMS) Medicare program can take action to reduce patient out-of-pocket costs for biosimilars.

Shared Savings Model for Biosimilar Providers in Medicare Part B

CMS should utilize the Center for Medicare & Medicaid Innovation (CMMI) to implement models that create physician incentives to utilize biosimilars, including a “shared savings” model whereby Medicare savings associated with prescribing a biosimilar will be shared with providers. $3B in tax dollars can be saved over the next ten years if the U.S. were to implement this policy.

Increase ASP-Add-on Payment Rate for Biosimilar Providers in Medicare Part B

The U.S. can reduce as much as $8.2B in health costs over the next decade by increasing add-on payments for prescribers of biosimilars. This policy will incentivize biosimilars use by increasing the amount doctors in Medicare Part B are reimbursed for administering these lower-cost therapies. CMS should increase the add-on payments for prescribers of biosimilars for a two-year period.

It is time for Congress and the Administration to harness these payment and cost-sharing incentives to increase biosimilar adoption, lower patient out-of-pocket costs and produce savings for the entire health care system.

The Biosimilars Forum provides evidence-based information to inform and support public policies that encourage awareness, access, and adoption of biosimilars in the United States. The founding members of the Biosimilars Forum represent the majority of companies with the most significant U.S. biosimilars development portfolios.

About The Biosimilars Forum

About The Biosimilars Forum

The Biosimilars Forum provides evidence-based information to inform and support public policies that encourage awareness, access, and adoption of biosimilars in the United States. The founding members of the Biosimilars Forum represent the majority of companies with the most significant U.S. biosimilars development portfolios.