Our members in clinical practice continue to be negatively impacted by pharmacy benefit managers (PBMs) formulary placement practices of paying certain biosimilars at rates lower than the practice acquisition cost.
This leaves GI practices “underwater,” and forces them to stop infusions. It is ultimately detrimental to patient care when stable IBD patients are forced to switch therapies.
This is unacceptable.
We partnered with other GI societies, including the American College of Gastroenterology (ACG), American Society for Gastrointestinal Endoscopy (ASGE), Crohn’s and Colitis Foundation (CCF), Improve Care Now (ICN) and the North American Society for Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN), in a letter to CareFirst BlueCross BlueShield to express our concern and request that reimbursement for biologic products with preferred status match provider acquisition cost.
Additionally, we asked that the policy not mandate a switch to a preferred biologic for patients who are stable on existing therapy.
Practices should not have to stop providing infusions because of significant financial loss due to insurer policies. More importantly, patients should not be at risk of repeatedly being forced to switch on and off different biologics when they have stable treatment. Studies have shown that adults and children who are forced to switch on and off face increased health risks.
We will continue to advocate for GI practices to be able to acquire affordable biosimilars and fight for PBM reform so you can provide quality care to patients. This is an issue we’re regularly discussing with lawmakers and bringing attention to through media placements.
