Biosimilar Coding and Reimbursement under Medicare Part B

In this brief, Partners Christopher Stomberg and Richard Manning and Manager Ben Wolfert examine Medicare’s current reimbursement policy for biosimilar products, which are products the Food and Drug Administration has not approved as “interchangeable” with the reference biologic product. The study examines two existing Medicare Part B markets where circumstances similar to those that exist for biosimilars have progressed. The authors recommend two things: (i) the elimination of shared Average Sales Price (ASP) reimbursement and (ii) that biosimilar products be put on equal economic footing with both each other and the reference biologic by giving them a separate Healthcare Common Procedure Coding System and separate ASPs.