Mandated Switching to Biosimilars Begins in British Columbia, May Spread to Other Provinces

The issue of whether to switch patients currently taking biologics to biosimilars has been playing out in Canada over the past week.

Earlier this year, British Columbia became the first Canadian province to mandate that patients currently taking reference biologics for rheumatology indications and for diabetes must be switched to biosimilars over a 6-month period if they use the publicly funded PharmaCare program.

That switch begins this week.

In British Columbia, patients officially begin switching if they take reference products for diabetes, arthritis, and some skin conditions; the move will switch patients to insulin glargine (Lantus), etanercept (Enbrel), and infliximab (Remicade) instead of the reference product.

To mark the move, insurer Pacific Blue Cross created sponsored content to run on a business website cheering the plan and said it was following the same path.

“Biosimilars have similar effectiveness and safety with the same outcomes as the originator drugs at a fraction of the cost,” said Anar Dossa, director of pharmacy services, Pacific Blue Cross. “In response to the Ministry’s decision and in keeping with our longstanding integration with BC PharmaCare, we immediately recommended to our plan sponsors that employees on originator drugs be transitioned to the biosimilar to maintain BC PharmaCare and Pacific Blue Cross coverage.”

The company cited rising drug costs for its decision. Earlier this year, a report said Canada's use of biosimilars has been low relative to other countries because of a combination of factors, including limited awareness of clinical and scientific evidence supporting their use and strong efforts by brand-name biologic companies to retain market share, the report said. The report said that biosimilars make up less than 7% of the biologic market in 2017 while the Organisation for Economic Co-operation and Development average is more than 30%. Seven of the top 10 prescription drugs in Canada are biologics.

Meanwhile, in Ontario and Alberta, patients are being urged by a biologic drug maker to fight any possible switch. A report published a few days ago said that Ontario will begin considering a biosimilar switching policy before the end of the year; Alberta is planning to unveil a new policy later this year.

Both governments said it was too early to say whether they will copy the BC plan.

However, Janssen, a unit of Johnson & Johnson, is warning patients by mail that their provincial governments are considering forced switching from infliximab.

A spokeswoman for Janssen said that the letters were distributed by a third party that provides administrative services for Janssen’s patient-support program, BioAdvance.

Mandated, nonmedical switching has drawn the ire of patient groups. Crohn’s and Colitis Canada and the Canadian Association of Gastroenterology recently published a joint position paper about the topic.

In addition, Diabetes Canada recently put out a statement that the decision to use a biologic or a biosimilar insulin must be made jointly by patients and providers, even as it said that follow-on insulins may be preferred by some.