The Centers for Medicare & Medicaid Services (CMS) has issued biosimilar reimbursement coverage memos to plan sponsors outlining its requirements for Medicare parts B and D drugs, as well as for state Medicaid agencies.
“The framework for Part D doesn’t change and the pharmacy benefit management model of excluding drugs remains intact,” said Timothy Trysla, partner in Alston & Bird’s Health Care Group.
One possible reason for the Part D coverage documents could be attributed to the U.S. Food and Drug Administration’s recent approval of Zarxio, which is the first biosimilar to receive the agency’s approval and which is reimbursed via Part D in a few instances.
“I think they put it out to frame the issues. I wouldn’t be surprised if we started to see more details trickle out slowly,” said Trysla.