Bill to Create CMS Star Ratings Program for Biosimilars Introduced in House

Representatives Paul Tonko, D-New York, and Rob Gibbs, R-Ohio, have introduced H.R. 4629, the Star Ratings for Biosimilars Act, in the House. The bipartisan bill would require HHS to evaluate Medicare Advantage (MA) plans based on whether biosimilars are available to enrollees.

Under the proposed legislation, which would amend title 18 of the Social Security Act, starting in 2021, HHS would add a new set of measures to the current 5-star rating system based on biosimilar access in Part B and, for MA plans that offer prescription drug coverage, in Part D.

The measures include assessing the following: whether a biosimilar is on the formulary in lieu of or in addition to the reference, tier placement or cost-sharing for biosimilars relative to the reference, whether and how utilization management is applied, and the percentage of enrollees prescribed biosimilars rather than references.

The bill has now been referred to the Committee on Energy and Commerce and the Committee on Ways and Means.

According to a statement by Tonko, “certain profitable dynamics in America’s health care system are blocking access to these cost saving alternatives, meaning our patients and their families are forced to pay a higher price for substantially similar medical care. My bill will highlight the existing barriers in current health plans, provide for meaningful transparency where plans fall short, and allow for reform to unlock the billions in savings for America’s patients and taxpayers."

Trade group the Biosimilars Forum praised the provisions, saying in a statement on the bill that “CMS must take this opportunity to save seniors and taxpayers money. Congressmen Tonko and Gibbs understand the importance of identifying inefficiencies in health plans that are blocking patient access and use of lower-cost biosimilars to treat some of life’s most complex illnesses. Through this measurement, it will allow for reforms that will encourage health plans to drive significant savings in health care.”

In the Senate, parallel provisions have been put forth under S.2543, or the Prescription Drug Pricing Reduction Act of 2019, sponsored by Senator Chuck Grassley, R-Iowa. The Senate bill was introduced in the Senate in September, and which has been placed on the Senate legislative calendar under general orders.