Patients frustrated by high out-of-pocket health costs could soon see some relief, thanks to a bipartisan proposal gaining support on Capitol Hill.
Democratic Congressmen Anthony Brindisi of New York and Scott Peters of California have teamed up with Republican Congressman Pete King of New York in an effort to expand patient access to biosimilars, which are near exact copies of biologic drugs. For some patients, biosimilars are an effective treatment that comes at a lower cost.
Both biologics and biosimilars are heralded as innovative treatment options for patients living with rare diseases and chronic conditions, including autoimmune disorders, arthritis, colitis, Crohn’s disease, and various types of cancer.
“Patients need access to affordable and innovative treatments,” says Terry Wilcox, co-founder and executive director at Patients Rising, a patient advocacy non-profit organization that helps patients reduce their health care costs and overcome insurance obstacles. “Patients need access to every treatment option, and that includes access to both biologics and biosimilars.”
HR 4597, dubbed the Acting to Cancel Copays and Ensure Substantial Savings for Biosimilars (ACCESS) Act, would eliminate patients’ copays for biosimilars, if they normally would pay the full cost of a biologic drug under Medicare Part B.
“Every day I hear from Upstate New Yorkers who cannot afford the medication they need, and it is way past time for Democrats and Republicans to take action,” said Rep. Brindisi, who represents New York’s 22nd congressional district. “Our bill will eliminate out of pocket costs for millions of seniors. I am proud to work with Rep. Peters and Rep. King on this legislation to help increase competition and bring drug costs down for seniors and working families.”
HR 4597: No Co-Pays for Biosimilars
Patient advocates see the legislation as a meaningful step toward expanding patient access to treatments and reducing out-of-pocket costs.
“HR 4597 empowers patients to take control of their health care decisions,” said Wilcox of Patients Rising.
Patients in Europe have more than 40 biosimilar products available for their use. However, the United States has lagged behind, with fewer than 2 percent of patients in the United States using biologic treatments, according to a report by the Congressional Research Service.
The biggest barrier to widespread access to biosimilars: insurance companies and pharmacy benefit managers.
Under the current health care payment system, insurance companies work with corporate middlemen pharmacy benefit managers to receive kickbacks for a list of preferred drugs. Biosimilars, which are cheaper for patients, are often excluded from these insurance formularies that dictate which treatments get covered by insurance.
“If we eliminate copays on biosimilars, it will increase their widespread use and provide a market incentive to drive down overall drug costs,” said Rep. Peters, who represents California’s 52nd congressional district. “I am committed to lowering health care costs and expanding treatment options for all Americans, and the bipartisan ACCESS Act does just that.”
Biosimilars Could Save $54 Billion Over Next Decade
In addition to empowering patients, the bill could save taxpayers money by reducing Medicare spending on prescription drugs.
“This legislation represents an important step toward containing drug prices for some of the most expensive therapies,” said Rep. King, who represents New York’s 2nd congressional district. “By increasing patient access and encouraging development of more biosimilars this legislation would save Medicare beneficiaries and taxpayers billions of dollars.”
In 2017, RAND Health, an independent policy research group, estimated that biosimilars could save as much as $54 billion over the next decade. Last year alone, the FDA estimated biosimilars could have reduced health care spending by $4.5 billion.
“Biologics account for the fastest-growing segment of prescription drug spending, but biosimilars have the potential to help slow some of the increase,” Andrew Mulcahy, lead author of the 2017 Rand study, stated in a press release. “However, there remain many important industry, regulatory and policy decisions to be made that will influence whether such savings are realized.”
Take Action: Tell Your Member of Congress to Support Biosimilar Access
Patients Rising NOW is urging patients to contact their Members of Congress in support of Access to Biosimilars.
Here are two ways to take action:
- Get Involved – Become an Advocate: Join Patients Rising NOW and help other patients get access to care.
- Share Your Voice: Send your representatives a message by visiting Patients Rising NOW’s Get Involved page.