In 2018, Green Shield Canada launched its pilot Biosimilar Transition Program, through 3 plan sponsors, under which patients already receiving biologics were switched to biosimilars. Now that the pilot is complete, the payer is calling the program a success.
In 2016, not-for-profit health benefits company Green Shield Canada (GSC) started to give biosimilars preferred product listings on its formularies, covering reference biologics only in exceptional circumstances for patients who were new to biologic therapy. Then, in 2018, GSC launched a pilot Biosimilar Transition Program, through 3 plan sponsors, under which patients already receiving biologics were switched to biosimilars. Now that the pilot is complete, the payer is calling the program a success.
Patients who were members of the 3 sponsored plans and who were receiving reference infliximab or etanercept therapy were sent letters explaining the pilot program and detailing 2 available options. First, patients could proceed with the one-time switch to biosimilar infliximab or etanercept after discussing it with their prescriber. Second, they could continue to receive their originator biologic and pay the difference in cost between the 2 drugs out-of-pocket.
In total, 41% of members opted to switch to a biosimilar, while 26% chose to remain on the originator product and pay the difference in cost. Another 9% were approved to continue on the originator product after providing clinical justification, while 3% changed to a different treatment entirely for reasons unrelated to the program (the final 21% of patients had not yet submitted a claim at the time of the pilot’s conclusion). GSC’s analysis shows an average savings of $8500 ($6395 USD) per member per year under the program.
GSC notes that, while it originally launched the pilot with the goal of a 60-day timeline to the switch, it amended that goal to 90 days based on feedback from plan sponsors.
It also notes that it partnered with HealthForward, a payer service provider that has dedicated care-coordinator nurses who follow a case management process to provide patients with the assistance that they need. The nurses ensured that there was contact with the patient at 1 month, 3 months, and 6 months to address any issues or answer questions, and HealthForward provided a dedicated phone line for patient support.
GSC says that there were no unexpected questions or concerns during the pilot; most patients were receptive to the switch, and some had even considered switching to a biosimilar prior to the pilot program’s commencement.
Questions asked by patients included the rationale for the change, the cost difference between the products, the efficacy of the biosimilar, and next steps for switching. Among patients who had concerns about the efficacy of the biosimilar, “Their concerns were satisfactorily addressed by the HealthForward care-coordinator nurses,” says GSC in a statement on the program.
On the heels of the successful pilot, GSC is opening the program to any plan sponsor who wants to take part.
The Trump Administration’s Drug Price Actions and Why US Prices Are Already Sky-High
May 17th 2025While the Trump administration’s latest executive order touts sweeping drug price cuts through international benchmarking, the broader pharmaceutical pricing crisis in the US reveals a far more complex web of development costs, profit incentives, and absent price controls—raising the question of whether any single policy, including potential drug tariffs, can truly untangle it.
Escaping the Void: All Things Biosimilars With Craig & G
May 4th 2025To close out the Festival of Biologics, Craig Burton and Giuseppe Randazzo from the Association for Accessible Medicines and the Biosimilars Council tackle the current biosimilar landscape and how the industry can emerge from the "biosimilar void."
Samsung Bioepis Report Signals Turning Point for US Biosimilars
May 1st 2025A wave of biosimilar approvals, aggressive pricing strategies, and a regulatory sea change are setting the stage for unprecedented momentum in the US biologics market, with 2025 already proving to be a landmark year in reshaping cost, access, and innovation across therapeutic areas.
How AI Can Help Address Cost-Related Nonadherence to Biologic, Biosimilar Treatment
March 9th 2025Despite saving billions, biosimilars still account for only a small share of the biologics market—what's standing in the way of broader adoption and how can artificial intelligence (AI) help change that?
Eye on Pharma: Sandoz Files Antitrust Suit; Yuflyma Interchangeability; Costco’s Ustekinumab Pick
April 22nd 2025Sandoz's antitrust suit against Amgen, the FDA’s interchangeability designation for Celltrion’s adalimumab biosimilar, and the inclusion of an ustekinumab biosimilar in Costco’s prescription program highlight growing momentum to expand biosimilar access and affordability for patients with chronic inflammatory diseases.
President Trump Signs Executive Order to Bring Down Drug Prices
April 16th 2025To help bring down sky-high drug prices, President Donald Trump signed an executive order pushing for faster biosimilar development, more transparency, and tougher rules on pharmacy benefit managers—aiming to save billions and make meds more affordable for everyone.