Changes to Quebec’s policy on the use of biosimilars in its public drug plan could result in savings for private benefits plans, says one expert.
On April 13, 2022, the Régie de l’assurance maladie du Québec will delist certain biologic drugs from its formulary, requiring patients covered by the plan to switch to a biosimilar replacement. The policy makes exceptions for pregnant women, paediatric patients and those with chronic illnesses who’ve experienced two or more therapeutic failures and are being treated with a biologic drug for that condition.
Philippe Laplante, a principal responsible for the group benefits practice in Eckler Ltd.’s Montreal office, says while many insurers will follow the RAMQ replacement rules — resulting in reduced costs for private plans — those with product listing agreements for biologics may continue to offer these drugs to plan members.
“With this policy, insurers that don’t have PLAs will follow in the footsteps of what Quebec is requiring and plan members will be required to switch unless they’re in one of the exempted groups. For insurers with PLAs, some will switch and some will offer the option [of biologics] to plan members. For plan sponsors, depending on the insurer, they could look at different options.”
And with more plan members switching to biosimilars, the policy may lead to additional savings for plan sponsors through reduced pooling charges, says Laplante. In Quebec, the private drug industry is pooled through the Quebec Drug Insurance Pooling Corp.
“A lot of plans have a pooling threshold in place and from a certain level of claims, it goes to the insurer’s block of business. This [policy] might translate to less pooling charges over the years. . . . There are a lot of factors, because you also have new high-cost drugs approved that will increase the pooling amount, but if you’re using biosimilars, it should make a difference. We’ll see in 2023 or 2024 whether those costs stop increasing.”