Sec. 812. Addition of new measures based on access to biosimilar biological products to the 5-star rating system under medicare advantage

333 words·~2 min read·/bill/116/hr/3/eh/section-812

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Section 1853(o)(4) of the Social Security Act ( 42 U.S.C. 1395w–23(o)(4) ) is amended by adding at the end the following new subparagraph: For 2021 and subsequent years, the Secretary shall add a new set of measures to the 5-star rating system based on access to biosimilar biological products covered under part B and, in the case of MA–PD plans, such products that are covered part D drugs. Such measures shall assess the impact a plan’s benefit structure may have on enrollees’ utilization of or ability to access biosimilar biological products, including in comparison to the reference biological product, and shall include measures, as applicable, with respect to the following:

Assessing whether a biosimilar biological product is on the plan formulary in lieu of or in addition to the reference biological product. Assessing tier placement or cost-sharing for a biosimilar biological product relative to the reference biological product. Assessing whether and how utilization management tools are used with respect to a biosimilar biological product relative to the reference biological product. Assessing the percentage of enrollees prescribed the biosimilar biological product when the reference biological product is also available.

In this subparagraph, the terms biosimilar biological product and reference biological product have the meaning given those terms in section 1847A(c)(6). In developing such measures, the Secretary shall ensure that each measure developed to address coverage, preferencing, or utilization management is constructed such that patients retain equal access to appropriate therapeutic options without undue administrative burden. . To the extent the Secretary of Health and Human Services applies the 5-star rating system under section 1853(o)(4) of the Social Security Act ( 42 U.S.C. 1395w–23(o)(4) ), or a similar system, to prescription drug plans under part D of title XVIII of such Act, the provisions of subparagraph

(E)of such section, as added by subsection

(a)of this section, shall apply under the system with respect to such plans in the same manner as such provisions apply to the 5-star rating system under such section 1853(o)(4).

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42 USC 1395w–23(o)(4)

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Sec. 812

Addition of new measures based on access to biosimilar biological products to the 5-star rating system under medicare advantage

Cite42 USC 1395w–23(o)(4)

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