Despite the safety and efficacy of biosimilars — and the potential cost savings they offer — uptake among private payers has been low historically and is only starting to gain steam, said Neda Nasseri, pharmacist and private payer product director at Desjardins Insurance, during Benefits Canada’s 2023 Face to Face Drug Plan Management Forum in December.
The insurer first developed a policy to promote biosimilar use back in 2016: when a plan member submitted a claim for a biologic, if there was at least one biosimilar on the market, only the biosimilar would be covered. In 2019, it began implementing biosimilar switching for existing patients, following in the footsteps of British Columbia, Saskatchewan and Quebec.
To date, the insurer has 94 per cent biosimilar penetration in those three provinces and 40 per cent in Ontario and the rest of Canada, where the switching policy went into effect on Jan. 1, 2024. It has made the switch from 12 reference biologics to their corresponding biosimilars, resulting in savings of between 15 per cent and 50 per cent. In Quebec alone, Desjardins said it has saved $10 million.
Nasseri noted it isn’t always easy for employers to make a decision that impacts employees’ health, but Desjardins’ plan sponsors went along with its evidence-based decision. The insurer also decreased its premium rates to boost uptake of the policy.
“We’ve been working with our plan sponsors to maximize biosimilar value. Not only were we giving them peace of mind, but we were also considering the [sustainability] of their drug plan. We had a long-term mindset; obviously one of the reasons we did this is because it’s going to stimulate competition, and when it does . . . it’s going to be a bit more affordable for everyone.”
Also speaking during the session, Ross Wallace, secretary of the Canadian Biosimilars Forum, noted while biosimilars are biologics, the most significant difference is price: biosimilars in Canada tend to have list prices of roughly 30 per cent to 50 per cent that of the originator biologic.
Under Desjardins’ policy, when a new biosimilar comes to market, the insurer sends personalized communications to all plan members taking the reference biologic. The communication sets out clear definitions for relevant terms like reference biologic, biosimilar and transition and includes a Health Canada poster on biosimilars. Since 2019, the insurer has sent out roughly 10,000 letters to plan members.
Plan members are given six months to make the switch and they receive a reminder roughly three months before the deadline. To help them along, Desjardins applies their existing prior authorization for the reference biologic to the biosimilar. “Offering personalized support is really the best way to make it easier for them to switch,” said Nasseri.
The insurer follows the same exception criteria as the provinces, including allowing reference biologics for pediatric use, during pregnancy and for people who have failed prior therapies. Just six per cent of plan members have used the exception. She noted that not only is biosimilar switching a “low-hanging fruit” for cost-savings, plan members can get faster access to treatment for some biosimilars.
Read more coverage of the 2023 Face to Face Drug Plan Management Forum.