Pharmacy Practice News (01/29/16) Blum, Karen

Speakers at CBI's 11th Summit on Biosimilars, held recently in Alexandria, Va., noted that the Centers for Medicare & Medicaid Services (CMS) is working to define its policies for biosimilars. According to John Carlsen, vice president of access and commercial strategy for Covance Market Access Services, CMS will reimburse for biosimilars, though reimbursement for Medicare Part B will depend on the regulatory pathway by which the biosimilar was cleared. Carlsen noted that certain biosimilars--such as those approved under the Food and Drug Administration's abbreviated biosimilar pathway--will be reimbursed at the biosimilar's average sales price (ASP) plus 6 percent of the ASP of the reference product. The goal is to remove financial incentives for choosing either an innovator product or biosimilar over the other. Additionally, follow-on biologics approved through a biologics license application can earn a distinct Healthcare Common Procedure Coding System (HCPCS) code and will be reimbursed based on ASP, Carlsen said. That HCPCS code will then apply to all future biosimilar versions of the same reference product. CMS will post new biosimilar HCPCS codes and manufacturer-specific modifiers online, he added.

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