Recently, the Centers for Medicare & Medicaid Services (CMS) released the 2021-2030 National Health Expenditure (NHE) report, prepared by their Office of the Actuary. The report serves as the authoritative estimate of total U.S. health spending and provides important clues as to what is (and is not) driving health care costs.1
As policymakers seek to respond to concerns about high drug costs, a recent report may provide a path forward. The Medicare Payment Advisory Commission (MedPAC) provides independent expert advice to Congress on Medicare payment policies and in a recent report to Congress, it recommends key changes to the Part D program that could serve as a foundation for sustainable savings through generic and biosimilar adoption.
Biosimilars provide more options for care at a lower cost for patients, but due to Medicare’s perverse incentives, many PBMs and health plans have been slow to prioritize biosimilars, leavings savings on the table. Last week, the HHS Inspector General (OIG) released an important analysis that drives home just how poorly Medicare plans are doing when it comes to making FDA-approved biosimilars available to America’s seniors.
WASHINGTON D.C. (April 1, 2022) – A new study from HHS’ Office of the Inspector General (OIG) finds increasing biosimilars use would result in “significant spending reduction” for Medicare Part D and its beneficiaries.
The Senate Finance Committee (SFC) convened a hearing March 16 titled, “Prescription Drug Price Inflation: An Urgent Need to Lower Drug Prices in Medicare.” AAM submitted a statement outlining concrete approaches to providing savings for seniors through policies to increase competition in the prescription drug market.
On a birthday trip to Chicago, KC found herself in the emergency room with a diagnosis of “off the charts” high blood pressure. Her doctor prescribed a few generic medicines that help her manage her condition. “It’s just not an issue for me anymore,” KC says. “I’m on Medicare, and when I pick up my prescriptions, it doesn’t cost me anything. That’s a pretty good deal.”
Because tens of millions of Americans entrust their health to generics and biosimilars, they saved $338 billion in 2020, and nearly $2.4 trillion in the last decade.
According to the latest U.S. Generic and Biosimilar Medicines Savings Report, Americans who took generics and biosimilars saved $338 billion in health care costs in 2020 and nearly $2.4 trillion in the last decade. These medicines provide budgetary relief throughout the U.S. health care system, and taxpayers in all 50 states benefit from the savings generated for Medicare and Medicaid enrollees. On average, states saved $6.6 billion from the use of generics and biosimilars in 2020.
Something is wrong when America’s patients pay the same or more for an FDA-approved generic version of a high-priced brand drug. It’s even worse when those costs go up each year. Generics provide competition for expensive brand drugs and savings for patients. In 2020 alone, generics and biosimilars have saved the Medicare program $109.6 billion.1
WASHINGTON D.C. (January 24, 2022) –Avalere's recent findings add to the growing body of evidence that Medicare Part D Plans are preventing patients from realizing the full value of low-cost generic drugs. For the third year in a row, fewer than half of all generic drugs are on generic formulary tiers, even as generic prices continue to decline. This forces America’s patients to unnecessarily pay more for their generic drugs.
Patient Access Would be Threatened Should Penalties Hit Generic and Biosimilar Medicines
Patients continue to struggle to afford the high cost of certain medications. High launch prices on new brand biologics and annual price increases on existing brand-name drugs, combined with an increasing trend of anti-competitive tactics designed to delay or prevent competition from more affordable biosimilars and generics, are pushing access to medicines out of reach for too many patients.