Physician Views: CMS guidance on biosimilar reimbursement – what do oncologists and rheumatologists think?
Recent FDA approval of the first US biosimilar product has spurred the Centers for Medicare and Medicaid Services (CMS) to publish new guidance relating to biosimilar reimbursement and usage (ViewPoints: New CMS documents should grease the wheels of adoption for biosimilars).
Under Medicare Part B, where products are administered by physicians, the CMS has provided clarification on how biosimilars will be reimbursed: at the average sales price (ASP) of the biosimilar in question plus 6 percent of the ASP of the equivalent branded reference product. This guidance is designed to remove a disincentive for a physician to prescribe a biosimilar. As a result, biosimilars and equivalent branded products will have separate billing codes under Medicare Part B.
Under Part D schemes – for pharmacy administered products – new CMS guidance considers a biosimilar and its equivalent branded reference product to be the same, meaning that a branded product could effectively be replaced with a biosimilar (assuming the plan in question maintains access to two products within a drug class). It has been suggested that this decision implies potential 'de facto' interchangeability status for biosimilars.
Reasons to Purchase
To help provide FirstWord Pharma PLUS readers a unique analysis of this development, this week we are polling US-based oncologists and rheumatologists in two separate polls to ascertain initial physician sentiment to the CMS guidance.
In our first poll, focused on Part B reimbursement, we are asking oncologists…
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