Mandatory Biosimilar Switching Pays Off for Canada

April 22, 2021
Tony Hagen

For Alberta and Green Shield Canada, savings are beginning to add up from switching initiatives for multiple reference biologics.

Recognizing the swift upward march of biologics prices and the savings potential of biosimilars, which are cheaper versions of original brand biologics, various entities in Canada have imposed switching policies to get patients off costly reference drugs. They have been successful thus far, officials reported at the recent Festival of Biologics USA.

In December 2019, the Canadian province of Alberta initiated mandatory biosimilar switching for patients enrolled in government drug plans for individuals without private coverage, seniors, and low-income groups.

Chad Mitchell, assistant deputy minister for Alberta Health, said biologics account for 72% of total drug spending in the province and that the cost of these agents has been going up 14% yearly. Just 4 originator drugs have accounted for as much as 75% of the biologics spend: Remicade (infliximab), Humira (adalimumab), Enbrel (etanercept), and Stelara (ustekinumab).

The COVID-19 pandemic has forced the government to stretch out the switching transition, but Alberta anticipates $30 million in savings from biosimilars annually. Under the switching program, coverage is initiated on biosimilars once they become available, and access to biologics is tiered so that patients must try cost-effective therapies first, including biosimilars.

In Alberta, patients were switched from infliximab, etanercept, pegfilgrastim, and filgrastim originator biologics. They were also switched from insulin glargine and glatiramer originators, although in the United States there are no official biosimilars for these products yet.

Alberta ran into some problems. For example, some pharmacies began stocking only preferred biosimilars, which meant that patients and their providers could not choose. Alberta has attempted to remedy this problem.

The government has succeeded in switching over 60% of patients from reference infliximab to biosimilar infliximab, but there has been opposition. In addition, more than 15% of patients moved to a different biologic and roughly 15% dropped or terminated their government coverage, Mitchell said. The government is attempting to find out the reasons for these coverage departure and treatment changes.

For the originator insulin glargine product Lantus, more than 40% of patients moved to a different biologic after switching was initiated, and 15% of beneficiaries dropped or terminated their coverage. Mitchel said 10% to 20% of beneficiaries in other biosimilar categories terminated coverage. More investigation is needed to understand the significance of these trends, he said.

Green Shield Canada

On the payer side, Green Shield Canada (GSC) reported success with biosimilar switching initiatives for patients with rheumatic conditions. Nedzad Pojskic, PhD, MSc, vice president of Pharmacy Benefits Management for GSC, said the key to success was ensuring that patients and providers had an incentive to use the lower-cost biosimilar. Simply having biosimilars on formulary is not enough, he said. It’s important to make sure biosimilars have preferred status.

Pojskic said 55% of patients in the GSC program have transitioned to a biosimilar and $8500 of savings has been generated per member annually. GSC announced in February 2018 that it would initiate a pilot program preferentially listing biosimilars on formulary for treatment-naïve patients.

For more about Pojskic’s presentation, click here.