Biosimilar net cost recovery
Compare what each product in a market recovers after acquisition cost, per billing unit and per administered dose.
- Pick a market and check the dose and payer mix.
- Enter your price for each package. Payment limits are already filled in from CMS.
- Read the result: the leader recovers the most per dose after paying for the drug.
Payment limits are prefilled from the CMS 4Q26 file. They reflect sales from about two quarters earlier (2Q26), so today’s prices may already differ. This is an estimate for planning. It is not billing, coding or financial advice.
Market, dose and payer
Net cost recovery per dose
Your prices by package
Payment limits per billing unit come from the CMS 4Q26 file; you can change any of them. Enter what you pay per package. Package sizes and billing units come from the CMS crosswalk. Untick Include to leave a product out of every result below.
Your prices and settings are saved only in this browser. They never leave it.
| Package | Billing units | Vial | Contract $ / pkg | 340B $ / pkg | Net cost / unit | Paid / unit | NCR / unit | Margin on cost |
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Per-dose detail
Each product uses the vial combination with the least discarded drug, then the lowest cost. Billed units include discarded drug only when JW billing is on.
| Product | Vials used | Administered | Discarded | Billed units | Acquisition | Payment | NCR / dose | NCR / year | vs. leader / year |
|---|
What you would buy in a year
Packages needed for the doses given per year, by strength, if every dose used that product.
| Product | Packages per year, by strength | Drug spend per year | Payment per year | NCR per year |
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Breakeven price
The price each package would need for its NCR per unit to match the leader’s best package. Use it as a negotiation target.
| Product | Package | Current $ / pkg | Breakeven $ / pkg | Change needed |
|---|
How the numbers are calculated
Payment limit. Each product’s per-unit payment limit is prefilled from the CMS 4Q26 quarterly file by its HCPCS code. For a reference product it is ASP + 6%. For a qualifying biosimilar it is the biosimilar’s ASP plus 8% of the reference product’s ASP, so a biosimilar can pay more per unit than its own price suggests. Confirm each product’s add-on period. Limits reflect sales from about two quarters earlier, so use the limit-change slider to test erosion.
Doses. Doses round up to whole billing units. Without leftover reuse, multi-dose vials are drawn first so any waste falls on single-dose vials, where JW billing can apply. With reuse, single-dose vials are drawn first and the multi-dose remainder is saved, so only the drug actually used is costed. Vial selection minimizes discarded drug rather than maximizing billable waste.
Packages per year. The vials used per dose times the doses given per year. With multi-dose reuse on, multi-dose vials are counted by the drug actually used, so those counts are approximate (marked ≈).
340B. Medicare Part B pays the same payment limit whether or not a drug was bought under 340B, so turning 340B on changes only your cost. Each package’s cost becomes a mix of its 340B price and the price you pay for other patients, weighted by the 340B share. The rebate applies only to the non-340B price. When the 340B share is between 0% and 100%, the summary also shows which product leads for 340B doses and for other doses, because they can differ. Some 340B hospitals cannot buy through a group purchasing organization (GPO) for their other patients; enter the price you actually pay.
Not modeled. Patient coinsurance collection, manufacturer discarded-drug refunds, administration fees, commercial payers that pay differently for 340B drugs, Medicaid duplicate-discount rules, and payer step or preferred-product rules. A payer that requires one product makes NCR moot for those patients.
Products and packages. Which products compete in each market comes from the site’s biosimilar groups list, checked by hand; it is not a CMS file. Package sizes come from the CMS 4Q26 NDC–HCPCS crosswalk, which lists the billing units in each package. Whether a vial is single- or multi-dose and the default doses come from the FDA labels and can be changed. Example prices are made up for illustration and are not real contracts; there are no example 340B prices.