With Canadian biologic drug sales growing at a rate of 13 per cent annually over the last 10 years, plan sponsors are looking for ways to manage the related costs — and the introduction of biosimilars may help. At a recent Pfizer-sponsored webinar hosted by Benefits Canada, “Evidence to Policy — Biosimilar Transitioning in Canada,” two Canadian biosimilar switching program pioneers shared their experiences.
“Biosimilars are equally safe and effective as the reference biologic and offer lower price tags — up to 50 per cent off the cost of their reference biologic,” emphasized Ned Pojskic, vice-president, pharmacy benefits management, at Green Shield Canada. To increase the Canadian penetration of biosimilars, he said payers’ policies must be supportive of biosimilars. This includes requiring claimants to use biosimilars for new prescriptions and requiring existing biologic patients to switch to a biosimilar. He added that these measures are not widespread in Canada at this time.
Unlike generics, biosimilars cannot be automatically switched at the pharmacy because Health Canada regulations require that physicians authorize these switches. That means payers need to implement their own policies to safely increase the use of biosimilars and generate plan savings.
Making the case
In 2019, British Columbia became the first provincial drug plan to implement a biosimilar switching policy to increase uptake of biosimilars. Dr. Tijana Fazlagic, executive director, pharmaceutical, laboratory and blood services division, at the provincial Ministry of Health, speaking at the same webinar, said this policy was driven in part by a 2018 analysis that showed Canada’s biosimilar uptake of eight per cent lagged that of other Organisation for Economic Co-operation and Development countries with up to 50 per cent penetration. The Ministry of Health had also noticed that three biologics with lower-cost biosimilars were on BC PharmaCare’s list of the top 10 highest-costing drugs.
“Our objective was to improve drug plan sustainability, generate savings to reinvest in health programs and other drugs [and] stimulate the market to encourage more biosimilar launches,” said Fazlagic.
For its part, Green Shield Canada has employed biosimilar-first strategies since biosimilars entered the Canadian market in 2015, and it implemented Canada’s first biosimilar transition program in 2018. Pojskic said Green Shield Canada was motivated primarily by growing biologic drug claims that were responsible for 24.7 per cent of Green Shield Canada’s total drug costs in 2019 and by the arrival of biosimilars that offered potential cost savings of 17 to 50 per cent compared to biologics. In 2021 alone, Pojskic noted that Green Shield Canada expects to review 20 new biologics with an estimated annual cost greater than $100,000 per year.
“Taking advantage of biosimilar opportunities is important to the overall sustainability of drug plans,” he said.
BC PharmaCare prepared for its program launch by engaging stakeholders, such as physicians, pharmacists, insurers and patient groups. Patients were given six months to transition to the biosimilar, and resources were available to support the process. Additional fees were available to physicians or pharmacists who needed extra time to consult with patients about transitioning.
Green Shield Canada partnered with Arthritis Consumer Experts to design its biosimilar transition program and ensure patient-friendly communication. The company also provided access to dedicated nurse care coordinators to assist patients and physicians with the transition process.
Addressing concerns about the safety of biosimilar switching, Pojskic said, “There is an enormous amount of evidence that supports the safety and efficacy of switching patients from biologics to a corresponding biosimilar. In addition, there is a growing amount of real-world evidence, such as the BC PharmaCare switching program.”
To assess its program, BC PharmaCare monitored claims and analyzed patient health outcomes. The first year of the program generated $14 million in savings for the provincial drug plan — money that was reinvested to cover additional drugs and fund provincial health support programs.
In the program’s first year, 90 to 95 per cent of BC PharmaCare biologic patients started on or switched to a biosimilar, and 80 to 91 per cent of all biologic patients (including those with private coverage or who pay out of pocket) started on or switched to a biosimilar.
“This shows that the policy had impact beyond the BC PharmaCare budget,” said Fazlagic.
Furthermore, drug-specific reporting showed the vast majority (92 per cent) of Remicade users with a gastrointestinal condition, for example, switched to a biosimilar. Of the eight per cent who did not, 3.5 per cent switched to a different biologic and 1.6 per cent continued to use Remicade; the remainder did not switch to another biologic (1.8 per cent), were no longer covered (0.3 per cent) or their status is unknown (0.2 per cent). Analysis of health outcomes after switches from Remicade found no additional doctor or emergency room visits and no increased use of other drugs for disease flare-ups.
Initial analysis of Green Shield Canada’s program indicated that 55 per cent of patients transitioned to a biosimilar, and a further 14 per cent did not switch but were reimbursed based on a lower biosimilar price. The rest were either excluded from the program (five per cent), changed treatment (seven per cent) or had no further claims (20 per cent).
The Green Shield Canada program generated average annual savings of $8,500 per plan member enrolled in the program. However, Pojskic pointed out, “This is only for rheumatic conditions, so we expect that, with the addition of other conditions to the program, the savings will grow.”
“Payers are gatekeepers to biosimilar uptake, and strong interventionist policies are needed to ensure a viable biosimilar market,” said Pojskic.
Both speakers are keeping their eyes on the future. They noted that Humira had five new biosimilars launched in February 2021, offering more opportunities for drug plan savings.
“With previous biosimilars, we have seen low uptake and missed savings opportunities,” Pojskic said. He issued this challenge to webinar attendees: “Can Canadian payers embrace biosimilar policies, increase biosimilar use and generate increased savings?”