Step Therapy bill is Alive, PartD and Biosimilar coding

Article Type: 
Blog

Dear ARxC Partners,

 

We hope everyone is having a wonderful summer. We have some news and Calls to Action to please consider:

 

STEP THERAPY BILL HB 519 is Alive!

The Rx in Reach Ga Coalition (members attached, that ARxC leads)  along with MAG,ACR and other health centered, industry colleagues, worked hard last legislative session with  our sponsor, Rep. Sharon Cooper to craft Step Therapy legislation. After much collaboration with a few coalition representatives, Rep. Cooper decided on language that would pass the House. I am alerting you that HB 519 is Alive in Georgia and Rep. Cooper will carry this bill in our next legislative session. Here is the link to HB 519: http://www.legis.ga.gov/legislation/en-us/display/20172018/hb/519.

I am assuring you that HB 519 will be moved forward to a vote in the next legislative session.

 

Sign onto The Partnership for Part D Access Letter

The Partnership for Part D Access has prepared a letter to Secretary Price, US Department of Health and Human Services, highlighting the importance to patients of the Medicare "Six Protected Classes" policy.  ARxC and dozens of other organizations signed onto the letter. Please consider supporting this effort.  

 

Please sign onto urging CMS to reconsider Biosimilar Reimbursement Policy

On July 13, 2017, the Centers for Medicare and Medicaid Services (CMS) published the CY 2018 Proposed Rule for the Medicare Physician Fee Schedule (MPFS). The Proposed Rule includes a solicitation for public comment on the effects of its biosimilar payment policy.  This represents an opportunity for stakeholders to comment on the payment methodology for biosimilars.

CMS is soliciting new or updated information on the effects of its biosimilar payment policy that is based on experience with the U.S. marketplace. CMS is also soliciting data to demonstrate how individual HCPCS codes could impact the market, and whether or not there are other novel payment policies should be considered.

The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection.  Please see pages 414-417 for their discussion on biosimilars.

CMS will accept public comments on the rule until Sept. 11, 2017 and intends to issue the final 2018 MPFS by Nov. 1, 2017

Comments may be submitted online at: https://www.regulations.gov/document?D=CMS-2017-0092-0001.

The current policy requires all biosimilars that are related to a reference product to be given a shared Healthcare Common Procedure Coding System (HCPCS) code. For Medicare Part B, reimbursement is then calculated based on the average sales price (ASP) of all of the biosimilars with that HCPCS code plus 6% of their reference product’s ASP.CMS implemented the policy in the CY 2016 MPFS Final Rule.

We are asking that CMS reconsider a simple, but very important policy change in how biosimilars will be paid by CMS – instead of blending prices for multiple biosimilars into a single code with one payment rate, each biosimilar should be assigned a unique HCPCS code for billing and payment effective January 1, 2018. The proposed rule states “[CMS is] not making a proposal to change the existing payment policy in this proposed rule.” For the reasons discussed, it is imperative that this policy be reversed as soon as possible, and to take effect in CY 2018, in order to prevent lasting damage to the viability of this nascent biosimilars market.

 

Please let me know if you are submitting public comment for the Biosimilar single coding policy and/or joining The Partnership for Part D Access letter.

 

Thank you for your hard work! We are planning a Capitol Day for the Step Therapy Legislation. Will keep you updated. Please let me hear from you.

 

Staying Strong,

Dorothy

 

Description: Description: arxc_logo[1]Dorothy Leone-Glasser, RN, HHC.

Executive Director, Advocates for Responsible Care (ARxC)

Advocacy and Disparities Chair, Leadership Council Arthritis Foundation, SE Region

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Rx in Reach GA Coalition, Chair

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