In today’s hyperpartisan and gridlocked political climate, we should seize any opportunity for bipartisan agreement that benefits the American public — especially one that can lower health care costs, like greater use of biosimilars.
During the eight-hour markup of Speaker Nancy Pelosi’s drug pricing bill (H.R. 3), more than 300 amendments were submitted. Only one passed: an amendment from Reps. Kurt Schrader (D-Ore.) and Greg Gianforte (R-Mont.), which they had previously introduced as a bipartisan bill called the BIOSIM Act. This amendment would provide incentives for wider use of lower-cost biosimilars by raising Medicare Part B reimbursement for biosimilars.
It’d be a miracle for Republicans and Democrats to agree on what to order for dinner during such a marathon markup, so for them to agree on the promise of biosimilars was a remarkable turning point in efforts to lower patient costs. And for good reason: Biosimilars could save the U.S. health care system as much as $150 billion over the next decade.
As policymakers continue searching for solutions to address the rising costs of health care, the promise of biosimilars is finally starting to break through. We need to take advantage of this momentum and pass bipartisan legislation that would stimulate the use and uptake of these lifesaving therapies.
Much as how generic drugs are similar to but cheaper than brand-name drugs, biosimilars are lower-cost alternatives to brand-name biologic medicines. They are safe, effective, and FDA-approved therapies that are used to treat some of life’s most complicated diseases, including cancer, rheumatoid arthritis, Crohn’s disease, and more. These medicines can cost up to 30% less than originator biologics.
Yet misaligned market incentives — like rebate practices that financially discourage providers from prescribing biosimilars — and lack of alignment among payers, physicians, and patients have stunted the growth of the biosimilars market, forcing patients to pay for more expensive treatments. Anticompetitive practices, like deliberate attempts by biologics manufacturers to sow misinformation and confusion about biosimilars, and regulatory barriers like patent thickets and exclusionary contracting, have combined to create inertia in the biosimilars market — only one biosimilar has been able to obtain a meaningful market share. That requires immediate and proactive reform.
The Schrader-Gianforte amendment is a step in the right direction. The Senate Finance Committee’s drug package also addressed payment issues for biosimilars. In addition, House legislators have introduced a series of bipartisan bills meant to accelerate the biosimilars market. In totality, these policy reforms would save patients and the United States billions of dollars annually.
Reps. Scott Peters (D-Calif.), Pete King (R-N.Y.), and Anthony Brindisi (D-N.Y.) introduced the bipartisan Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars (ACCESS) Act, which would waive patients’ out-of-pocket costs for biosimilars under Medicare Part B. A recent analysis showed that reducing patients’ out-of-pocket costs for biosimilars can save up to $5.2 billion in taxpayer dollars over 10 years and seniors in Medicare can save as much as $3.3 billion in out-of-pocket costs over the same period.
Before adding their bill as an amendment to H.R. 3, Schrader and Gianforte introduced it as the Bolstering Innovative Options to Save Immediately on Medicines (BIOSIM) Act. It would enhance reimbursements to providers by increasing the average sales price add-on payment rate for them in Medicare Part B. That would stimulate their use, since the current reimbursement system does not financially encourage biosimilar prescription. An increased add-on to the average sales price could reduce health care costs by as much as $8.2 billion over the next decade.
Bipartisan introduction of legislation from Reps. Paul Tonko (D-N.Y.) and Bob Gibbs (R-Ohio) would direct the Department of Health and Human Services to add a new set of measures so patients and the government could see in the Centers for Medicare and Medicaid Services’ Star Ratings Program how accessible biosimilars are. One of the new measures would gauge how well a biosimilar is available to patients in lieu of or in addition to the originator biologic, giving patients more options. This measure would help Congress and the industry better understand patients’ use of, or ability to access, lower-cost biosimilars in the Medicare Part D and Medicare Advantage plans, allowing for future reforms to the market.
Bipartisan solutions that help Americans save money and access needed treatments are a no-brainer, especially given their rarity. Despite the tough political climate, Congress has rightfully recognized that increasing access to biosimilars is a necessary part of the solution to America’s rising health care costs.
For those looking for a win heading into this election year, and more importantly for those committed to delivering real results for patients and taxpayers, policies that would stimulate the biosimilars market are an obvious solution.
Juliana Reed is the president of the Biosimilars Forum, which represents the majority of companies with the most significant U.S. biosimilars development portfolios and advocates for public policies that encourage awareness, access, and adoption of biosimilars in the United States.
