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Biosimilar Substitution In Medicare Part D Formularies Mid-Year Established In Final Rule

 
• By Cathy Kelly

Policy may be helpful in promoting acceptance of follow-ons in Medicare but is not expected to result in near-term savings to the program.

Biosimilar In, Reference Drug, Out • Source: Shutterstock

Medicare Part D plans can substitute interchangeable biosimilars for their reference drugs on formularies immediately on approval and can make mid-year formulary substitutions for non-interchangeable biosimilars as long as they give beneficiaries 30-days’ notice, according to the Centers for Medicare and Medicaid Services final rule.

Key Takeaways

  • Part D plans can substitute interchangeable biosimilars for their reference drug on formularies immediately on approval and non-interchangeable biosimilars can be substituted after 30-days’ notice, under final rule.

The rule, which covers Policy and Technical Changes to the Medicare Advantage Program and Medicare Prescription Drug Benefit Program...

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