Patient Advocacy Organizations Join Forces to Endorse BIOSIM Act

To improve biosimilar utilization, 28 patient advocacy organizations penned a letter of endorsement for HR 2815, a House bill that aims to increase Medicare reimbursement for health systems that prescribe biosimilars to patients.

The 60 Plus Association, Allergy and Asthma Network, CancerCare, and Texas Business Group on Health were among the organizations throwing their support behind HR 2815, also known as the Bolstering Innovative Options to Save Immediately on Medicines (BIOSIM) Act.

The bill, cosponsored by Representatives Kurt Schrader (D-OR) and Adam Kinzinger (R-IL), would revise the Medicare payment policy to increase a physician’s reimbursement for biosimilars from the average sales price (ASP) of the biosimilar plus 6% to the ASP of the biosimilar plus 8%, providing physicians more of an incentive to prescribe a biosimilar over a reference product.

“Efforts to increase awareness and educate patients and providers about the availability and benefits of biosimilar medicines are important. But misaligned financial incentives within the Medicare program continue to encourage the use of high-cost brand biologics even when a lower-cost biosimilar medicine is available,” wrote the advocacy groups.

The rationale is that under the current ASP-plus-6% policy, providers are incentivized to prescribe reference biologics that have a higher ASP than biosimilars in order to receive a better return, suggesting that most providers would not prescribe a lower-cost biosimilar unless they were committed to saving money for Medicare.

If passed, the BIOSIM Act would permit biosimilars to receive a higher reimbursement than the reference product, which would continue to be reimbursed at the ASP of the reference product plus 6%. Additionally, the policy would only apply to biosimilars that are priced lower than the reference product, which guarantees savings and reduces out-of-pocket costs for Medicare’s mostly senior beneficiaries.

The letter comes after biosimilar advocacy organizations the Biosimilars Forum and the Biosimilars Council, which represent producers and distributors of biosimilars and generic drugs, also gave their support of the act.

“Biosimilar medicines hold enormous potential to lower the cost of prescription drugs but face significant barriers to adoption. Congressional action on innovative solutions, like the BIOSIM Act, is critical to reducing costs and improving patient access to biosimilars in the US,” wrote the patient advocacy groups in the letter.