Posted by Michael Wonder on 30 Jan 2020
CMS payment policy plays role in biosimilar uptake
30 January 2020 - How does CMS payment policy for Medicare, Medicaid, and 340B hospitals affect biosimilar uptake? A speaker at the recent at the 2020 Specialty Therapies and Biosimilars Congress explained.
Biosimilar pricing dynamics undergo some interesting gyrations when public payer policies come into play, Molly Burich, MS, director of public policy for biosimilars and pipeline at the pharmaceutical giant Boehringer Ingelheim, said at the 2020 Specialty Therapies and Biosimilars Congress in Miami, Florida.
Take the 340B drug discount program, for example. Biosimilars are treated as innovator products and are accorded “pass-through status” under 340B policy, which means 340B hospitals that use them are reimbursed at the rate of average sales price (ASP) plus 6%, rather than ASP minus 22.5%, which applies to the older, brand products the biosimilars replicate, Burich noted.
This relatively recent policy has sparked debate, as it allows 340B hospitals to potentially obtain much higher payments for biosimilars than originator brands and incentivises them to prescribe biosimilars instead of original brands.
