Alliance for Patient Access / Part B / Billing Codes Decision Could Aid Track-and-Trace Efforts

Billing Codes Decision Could Aid Track-and-Trace Efforts

A Trump administration decision about how biosimilar drugs will be billed could have an important benefit – making it easier to identify which drugs cause side effects for patients.

The 2018 Physician Fee Schedule reveals that biosimilars will each have their own distinct billing code.  This marks a shift from the Centers for Medicare and Medicaid Services’ previous policy, where all biosimilars with the same reference biologic shared a single billing code and were reimbursed at the same rate.  Critics argued that the approach would make it difficult for physicians to trace drug side effects to their exact source.

Biologics and biosimilars are cell-derived medications that treat a variety of chronic diseases, such as psoriasis, rheumatoid arthritis and some forms of cancer.  But they can also trigger immune system responses in patients.  Because biological drugs are often administered in a doctor’s office, billing records can help determine which of these similar but distinct drugs adversely affected a patient. Separate billing codes can allow doctors to keep accurate records and to adjust patients’ treatment as needed.

In addition to supporting pharmacovigilance, CMS’ decision also aligns with federal policies that acknowledge biosimilars as individually distinct drugs.  The Food and Drug Administration determined last year that biosimilars would have distinct nonproprietary names.

The new billing code policy will take effect on January 1.

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