Lower Medicare Part D Cost Sharing for Biosimilars

Medicare Part D beneficiaries will be able to access biosimilars at lower costs beginning in 2019.

Under a provision in the “Bipartisan Budget Act of 2018” (Public Law 115-119), biosimilars will be eligible for beneficiary cost-sharing reductions in the Medicare coverage gap, also known as the donut hole. Beneficiaries will now pay 25% of costs of biosimilars and other products in the donut hole; manufacturers will provide a 70% rebate, and plans will be responsible for 5% of costs.

The Medicare Part D 2019 final rule also includes a provision to reduce cost-sharing of biosimilars for beneficiaries eligible for low-income subsidies.