Changes Made in Medicare Biosimilars Reimbursement
The entry if new biosimilars in the market will not only reduce prices but also increase competition. This new development will help patients get access to innovative medication. However, regulatory burdens and high manufacturing costs make it difficult for biosimilar contract manufacturers to reduce prices to the same extent as generics. On the other hand, there is apprehension among biosimilar manufacturers that reducing prices significantly will eliminate the incentive for them to enter the biosimilar space. Addressing these difficulties presents an opportunity to lower drug costs and improve patient access. What’s the Current Practice? For outpatients, reimbursement for medicines administered by providers is based on the Average Sales Price. Medicare pays the provider Average Sales Price + 6% of the medicine. Due to the lag between published Average Sales Price data and product launch, payers depend on Wholesale Acquisition Cost until the Average Sales Pric...