Stakeholders Advocate for Zero Copay Policy to Lower Biosimilars Costs for Medicare Part B Patients

On August 20, 2021, a group of 16 organizations representing patients, consumers, providers, and taxpayers published an open letter to officials from the Centers for Medicare & Medicaid Services and the Department of Health and Human Services asking them to consider enacting a zero copay policy for Medicare Part B patients, a move the groups said would improve access to biosimilars and save seniors in Medicare as much as $3 billion in out-of-pocket costs.

“Despite Medicare’s protections, enrollees can face thousands of dollars in annual out-of-pocket costs for biologics, creating affordability and access barriers for patients in Part B. Nearly 15 percent of Medicare Part B enrollees pay the full 20 percent coinsurance for their reference biologic, while others have supplemental insurance that only covers a portion of the 20 percent,” the groups stated.¹

Signatories to the letter included the Allergy & Asthma Network, CancerCare, Consumer Action, the International Myeloma Foundation, and the National Consumers League.

To date, the FDA has approved 31 biosimilars across 11 molecules. Twenty biosimilars are currently on the market, with prices that average 30% less than their reference brand biologic. These lower costs provide savings directly to patients, such as Medicare beneficiaries who are responsible for 20% of the cost of their outpatient therapies.

In addition to savings, biosimilars have been shown to increase patient access to care. Since their introduction, these agents have been used in more than 121 million days of patient therapy and have supported almost 10 million incremental days of therapy—care that patients would not have received without the availability of lower-cost biosimilars.

Unfortunately, adoption has been slow, and biosimilars have “struggled to gain a foothold in the market while the originator biologics maintain a clear majority,” the advocacy groups stated.¹ They attributed this to a lack of physician, patient, and payer incentives, which are preventing the use of biosimilars and blocking potential savings.

“Alignment of incentives across Medicare programs that encourage the use of biosimilars are integral to the development of the U.S. market, leading to increased biosimilar usage and unlocking immense savings in the U.S. health care system,” they added.¹

Reference

1. Allergy & Asthma Network, Beyond Type 1, CancerCare, et al. Joint letter to Department of Health and Human Services secretary, Xavier Becerra, and Centers for Medicare & Medicaid Services administrator, Chiquita Brooks-LaSure. August 20, 2021. www.endocrine.org/-/media/endocrine/files/advocacy/society-letters/2021/august-2021/zero-copay-stakeolder-letter-final-pdf.pdf. Accessed October 20, 2021.