Hospital Impact: Reimbursement Models a Roadblock to Biosimilar Adoption

Opinion Piece from Navigant Life Sciences Experts in FierceHealthcare

While biosimilars have the potential to reduce overall treatment costs without negatively impacting outcomes, a new study suggests today’s biosimilar reimbursement model could be a major obstacle to broad adoption.

According to the Navigant analysis, en masse adoption of biosimilar alternatives to a single innovator brand such as Remicade could decrease annual profits by as much as $100M across physician offices and 340B and outpatient hospital infusion suites nationwide. Why? While Medicare offers a differential reimbursement model that’s higher for biosimilars, commercial payers do not, leading to reduced profits for most providers. These losses can add up: Individual providers with 50 patients on therapy could lose as much as $50,000 per year—an amount that would grow with additional adoption of biosimilars coming to market.

 
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