Advocacy & Practice Updates — Advocacy & Practice

ASRS and AAO Advocacy Prompts CMS to Prohibit MA Plans From Requiring the Use f Biosimilars Untested in the Eye

Today ASRS and AAO achieved a significant win in the fight against insurers who require the use of Avastin biosimilars (i.e. Zirabiv and Mvasi) that are untested in the eye. As a result of letters to and meetings with CMS, the agency notified Medicare Advantage (MA) plans that they could not require the use of these biosimilars as part of step therapy programs for ocular disease.

At a meeting with CMS earlier this fall, ASRS members noted that there is no clinical evidence to suggest the safety or efficacy of the existing Avastin biosimilars when used in the eye, like there is for Avastin. In the memo CMS, stated that “a drug may only be used in Part B step therapy indications…only when the off-label-use of the drug is supported by widely used treatment guidelines or clinical literature that CMS considers to represent best practices.”

This policy change is a direct result of ASRS member action to alert the society when payers introduce problematic policies and to help advocate directly. These actions have a positive impact on the profession and your patients! 

(Published 11.8.2021)