Reimbursement Coding

BPC believes that unless a biosimilar is deemed by the FDA to be “interchangeable” with the reference biologic, the Centers for Medicare and Medicaid Services (CMS) should provide each biosimilar a unique J-code. Shared J-codes that force biosimilars into one blended rate cause confusion, potential misuse and can potentially have a negative impact on the future biosimilars marketplace. BPC urges CMS to rethink its payment policy for biosimilars and not take a generic approach for medicines that are, by definition, not generic. BPC supports a revised CMS policy requiring unique J-codes to support increased treatment options and innovation. Additional perspective on this issue provided in our related material.

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