Bipartisan Legislation Introduced to Increase Transparency, Use of Biosimilars in Medicare Plans

Congressmen Paul D. Tonko (D-NY) and Bob Gibbs (R-OH) have introduced the Star Rating for Biosimilars Act, HR 2855, which aims to create a biosimilars access measure in the Centers for Medicare and Medicaid Services’ Star Ratings Program.¹

“In our capital region and across the nation, families are forced to pay unacceptably high prices for treatments to debilitating and even deadly diseases,” Tonko said in a press release. “Biosimilars are a safe, effective, and cost-saving option, but unjust profitable dynamics in America’s health care system are blocking access to these alternatives, forcing patients to pay a far higher price for substantially similar medical care.”¹

The Medicare Advantage Star Ratings Program is a 5-star rating system for assessing the quality of Medicare Advantage plans and prescription drug plans based on measurements of both health management and patient outcomes. The new legislation aims to incentivize Medicare Advantage plans to increase patient access to biosimilars by implementing a quality measure to capture elements of biosimilars access.²

“As the next generation of generics, biosimilars are newer, lower-cost alternatives to brand name biologics,” said Meaghan Smith, executive director of the Biosimilars Forum, in a press release. “We know biosimilars are just as safe and effective as the biologics they reference, yet the majority of patients still don’t have access to these lower-cost options.”²

The access measure will specifically evaluate the impact that a plan’s benefit structure can have on patients’ utilization of and access to biosimilars compared to brand name biologics.² Biosimilars cost 30% less than biologics on average, according to a press release from Tonko.¹ If passed, Smith said the measure will ultimately allow for more reforms that encourage biosimilar use and will help alleviate financial burdens on patients and taxpayers.²

“Despite the fact that biosimilars can save the health system billions, access to and affordability of biosimilars can vary across Medicare plans due to several factors such as coverage, tier placement, and utilization management,” Smith said in the release. “Bipartisan policy solutions like this are needed to drive savings in the system. Implementing a Star Ratings measurement for biosimilars will ultimately help bring transparency to all stakeholders to understand which plans are offering access to lower cost biosimilars, which in turn help inform patient decision-making when selecting a plan.”²

Similar legislation to improve access to biosimilars had bipartisan support in both the House and the Senate last Congress, according to the press release. That legislation was passed as part of HR 3 and was included in the Senate Finance Committee drug pricing plan.²

“My bill shines a spotlight on existing barriers in current health plans, provides meaningful transparency where plans fall short, and allows for reform to unlock the billions in savings for patients and taxpayers,” Tonko said in the press release. “No family should have to choose between paying their prescription or putting food on the table. It’s past time Congress act to make these lifesaving treatments more accessible to all.”¹

REFERENCES

1. Tonko, Gibbs Introduce Bipartisan Bill to Lower Prescription Drug Costs for American Consumers [news release]. Paul D. Tonko; April 26, 2021. https://tonko.house.gov/news/documentsingle.aspx?DocumentID=3332. Accessed April 27, 2021.

2. Congressmen Tonko and Gibbs Introduce Bipartisan Legislation to Increase Transparency and Use of Biosimilars in Medicare Plans [news release]. Biosimilars Forum; April 27, 2021. https://biosimilarsforum.org/2021/04/27/congressmen-tonko-and-gibbs-introduce-bipartisan-legislation-to-increase-transparency-and-use-of-biosimilars-in-medicare-plans/?preview=true. Accessed April 27, 2021.