FDAnews Drug Daily Bulletin
Pharmaceuticals / Regulatory Affairs

Members of Congress Urge CMS to Set Individual Billing Codes for Biosimilars

May 22, 2017

Fifty-two representatives and nine senators sent letters to HHS Secretary Tom Price and CMS Administrator Seema Verma, urging them to reverse current Medicare policy for the reimbursement for biosimilar products.

Under a CMS final rule issued in October 2015, each biosimilar product uses the same reimbursement code as its reference product, and will be reimbursed at a single payment rate based on an average of their average sales price under Medicare Part B.

The members of Congress said the policy should be changed to allow separate, unique billing codes and reimbursement rates for individual biosimilar products.

In two letters, they wrote that the change would encourage a robust biosimilars market, and would bring Medicare policies more in line with current statutes.

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