Press Releases

ACR Applauds CMS for Reversing Biosimilar Reimbursement Policy, Assigning Unique Billing Codes to Biosimilars

The American College of Rheumatology (ACR) today applauded the Centers for Medicare and Medicaid Services’ (CMS) decision to revise its policy for reimbursing biosimilars under the Medicare Part B program as a part of the 2018 Physician Fee Schedule Final Rule. The agency will now assign separate billing codes for biosimilars, instead of grouping all biosimilars from the same reference product into the same code.

“This announcement is a major victory for rheumatology patients and the arthritis community-at-large,” said Dr. Angus Worthing, MD, FACP, FACR, Chair of the ACR’s Government Affairs Committee. “It is critical now more than ever that CMS implement a sound reimbursement policy that fosters innovation among manufacturers while making biosimilar therapies more affordable for patients.”

The FDA has approved multiple biosimilars for the treatment of rheumatic diseases and is expected to process additional applications in the future. By assigning each of these their own Healthcare Common Procedure Coding System (HCPCS) code, CMS will help ensure that there is a robust marketplace for biosimilars. Furthermore, rheumatology practices will gain additional protection from financial risk and price unpredictability while patients will preserve access to treatments at their preferred site of service.

Jocelyn Givens
jgivens@rheumatology.org

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The American College of Rheumatology (ACR) is the nation’s leading advocacy organization for the rheumatology care community, representing more than 9,500 rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care.