House Committee Calls for CMS Action on Biosimilars

The House Appropriations Committee has asked for policy action by CMS that will support access to, use of, and competition from lower-cost biosimilars to provide savings for seniors, patients, and taxpayers.

The request came as the committee approved the fiscal year 2021 Labor, Health and Human Services, Education, and Related Agencies bill.

In a statement, the committee said it “is concerned about the underutilization of lower-cost biosimilars, particularly those in Medicare Part B, and encourages CMS to support development and implementation of new policies that may help increase biosimilar uptake when clinically appropriate, such as reducing patient copays or other mechanisms.”

During The Hill’s “Health Reimagined: The Future of Healthcare” event, which featured keynote speakers Anthony Fauci, MD, and HHS Secretary Alex Azar, experts said there is a need for healthy competition from biosimilars and policies in Congress that can lower costs for seniors, employers, and the health care system at large.

Juliana Reed, president of the Biosimilars Forum, outlined the cost-savings potential of biosimilars amid increased spending during the coronavirus disease 2019 (COVID-19) crisis. “As the United States battles the COVID-19 pandemic and Congress has authorized more than $3 trillion in critical funding to fight off the virus and help our economy, our health care system also needs to look forward to lowering drug costs. Estimates show that biosimilars could save the US health care system as much as $250 billion over the next 10 years. As we begin to rebuild the economy in a way that reduces the financial burden on patients, employees, and the health care system at large, biosimilars will play a key part in that solution.”

Annette Guarisco Fildes, president and CEO of the Erisa Industry Committee, identified the obstacles in place to ensure that patients consistently receive biosimilars.

“I think there is a misunderstanding about what biosimilars are and there’s a particularly unfortunate one in that people think that the FDA needs to designate a biosimilar somehow as interchangeable before it can be prescribed to a patient,” she said. “And that’s simply not the case. From large employers, where I sit, they do try to design their plans to align the incentives correctly, but the other systems in place create cross-purposes so that the most affordable drug isn’t necessarily prescribed to the patient each and every time. We need to do better as a country, and Congress and the FDA and CMS have important roles to play in all this. There are answers—and Congress and the administration just need to act.”

Alex Brill, founder of economic consulting firm Matrix Global Advisors and a resident fellow at the American Enterprise Institute, discussed a solution that Congress or the administration could approve that aligns the incentives of physicians and taxpayers to mitigate the rising costs of biologic spending.

“One of the ways to align these incentives would be for CMS, in particular the Center for Medicare & Medicaid Innovation, to launch a demonstration project, a shared savings program in Medicare Part B for biosimilars. This would reward physicians for increasing their utilization of biosimilars, which would both create that incentive for physicians and align that incentive with the desire of taxpayers to lower overall costs in the biologic spend category,” he said.

A few weeks ago, Senators John Cornyn, R-Texas, and Michael Bennet, D-Colorado, introduced bipartisan legislation to lower health costs by supporting biosimilars.