Biosimilar Coding—Could There Be Billions in Hidden Savings?
We partnered with the Biosimilars Forum to publish an original study relating to CMS reimbursement of biosimilars. The study demonstrates the need for changes in CMS reimbursement for biosimilars under Medicare Part B.
Estimating the Budgetary Impact of Biosimilar Coding Policies Under Medicare Part B
Xcenda, working with the Biosimilars Forum, modeled alternative methodologies. While CMS’ policy is estimated to save the Medicare program $25.0 billion over 10 years, an alternative coding policy, which would provide each biosimilar with its own billing code and separate payment rate, could increase savings by an additional $15.1 billion, or 30% ($65.0 billion in total over 10 years). A separate coding and payment policy could provide larger savings to the Medicare program, as it could encourage greater price competition and uptake of biosimilar products in the marketplace, representing a win for patients and payers.
The study comes at a fortuitous time, as CMS announced just last month in the Medicare Physician Fee Schedule (MPFS) proposed rule it was revisiting the biosimilars coding and payment policy