The Underwater Biosimilars Coalition shared with the Centers for Medicare & Medicaid Services concerns about problems arising from the average sales price payment methodology and discussed potential options for addressing these challenges.
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ACR-Led Coalition Working Toward Legislative Solutions for Underwater Biosimilars
The Underwater Biosimilars Coalition will meet with the Medicare Payment Advisory Commission to discuss concerns about inadequate reimbursement for certain biosimilars, which has limited beneficiary access to these lower-cost alternative therapies.
ACR-Led Coalition on Underwater Biosimilars Grows, Charts Next Steps
New members include rheumatology state societies, specialty partners in gastroenterology and patient-facing organizations representing digestive and inflammatory diseases. The ACR and coalition partners are strategizing additional steps to ensure practices receive adequate reimbursement for biosimilars.
The ACR to the CMS: What You Need to Know About Biosimilars and G2211
On May 23, Drs. Chris Phillips and Rebecca Shepherd, chairs of the ACR’s Committee on Rheumatologic Care and Insurance Subcommittee, respectively, and members of the ACR’s advocacy staff team met with officials from the Centers for Medicare & Medicaid Services to discuss concerns on underwater biosimilars and restrictions on billing G2211.
Commercial Payers Update Reimbursement for Underwater Infliximab Biosimilars
Three commercial health insurance payers have increased reimbursement for infliximab biosimilars in response to concerns that formulary requirements are leaving practices underwater.
Biosimilars to Denosumab Approved with an Interchangeable Designation
The FDA has approved the first interchangeable biosimilars for denosumab.
UnitedHealthcare Updates Reimbursement for Infliximab Biosimilars
On April 1, UnitedHealthcare updated reimbursement for infliximab biosimilars in response to concerns that formulary requirements are leaving practices underwater.
ACR Advocates with Payers Against Insufficient Reimbursement for Biosimilars
The ACR is engaging with payers regarding formulary requirements that would leave practices underwater when treating patients with rheumatic diseases.
When Switching Patients to Biosimilars, Communication & Expert Nurses Reduce the Nocebo Effect
In a recent study, researchers designed an intervention centered on communication and led by nurses to address discontinuation rates among patients who had switched to a biosimilar. The nurses’ insight and experience reduced the nocebo effect during the intervention, which had an 84% retention rate for patients taking a biosimilar after one year.
New Clinical Trials for Ustekinumab & Denosumab Biosimilars Begin Recruitment
Clinical trials of biosimilar treatments, including a phase 1 study of SB17, which is biosimilar to ustekinumab, and two phase 3 studies investigating of SB16, which is biosimilar to denosumab, are currently recruiting.
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