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Medicare Part D and beneficiaries could realize significant spending reductions with increased biosimilar use
Medicare Part D and beneficiaries could realize significant spending reductions with increased biosimilar use
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, March 2022
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Biosimilar Pharmaceuticals
Drug Costs -- legislation & jurisprudence
Government Regulation
Medicare Part D -- economics
United States
United States. Department of Health and Human Services
Centers for Medicare & Medicaid Services (U.S.) - Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. Biologics—usually large, complex molecules produced in a living system—are some of the most expensive drugs available, and spending for biologics is growing in Medicare Part D because they treat diseases common among Medicare beneficiaries. Biologics are estimated to cost Part D upwards of $12 billion annually. A biosimilar is a lower-cost biologic that is highly similar to an existing biologic approved by the Food and Drug Administration (FDA (i.e., the biosimilar’s “reference product”). Although a limited number of biosimilars are currently available for Part-D-covered reference products, multiple biosimilars for Humira—the best-selling prescription drug in the world—are expected to be available in 2023, thereby presenting an opportunity to significantly decrease Part D drug costs. How OIG Did This Review. We analyzed biosimilar utilization and spending in Part D from 2015 to 2019. We also calculated multiple estimates to explore how Part D and beneficiary spending in 2019 could have changed with increased utilization of biosimilars. Lastly, we determined the extent to which Part D plan formularies encouraged the use of biosimilars rather than reference products. Specifically, we examined whether biosimilars were included on Part D plan formularies and, if so, whether they were on a less preferential tier or were subject to different utilization management requirements than their reference products.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (33 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918434087206676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918434087206676