CMS outlines biosimilar reimbursement

In biosimilar reimbursement documents issued Tuesday, CMS removed an incentive for physicians to prescribe more expensive Medicare Part B innovator drugs and opened the door to formulary exclusions of innovator drugs under Medicare Part D.

For physician-administered Part B drugs, CMS said a biosimilar would be reimbursed at its average sales price (ASP), plus 6% of the ASP for the innovator product. Physicians typically are reimbursed ASP plus 6% for the specific branded Part B drug being prescribed, giving them an incentive to prescribe higher priced drugs. The reimbursement method for biosimilars, which CMS expects to be priced 15-30% lower than corresponding innovator products, would remove the incentive to prescribe the higher priced innovator drug. ...