Canadian provinces encounter opposition in their move to implement forced switching of patients from reference products to biosimilars.
Multiple Canadian provinces aim to switch patients to biosimilars, in a sweeping effort to save money for pubic health, and the transition has provoked much comment, not all of it enthusiastic.
At least 4 of Canada’s 10 provinces—Ontario, Alberta, British Columbia, and Manitoba—have now announced intentions to switch patients to biosimilars from reference products.
Critics argue the change to a policy of nonmedical switching will adversely affect patient care and lead to higher long-term healthcare costs, according to a review in The Lancet Gastroenterology & Hepatology.
The cost-savings appeal of switching to biosimilars is evident in Alberta’s projections for reductions in expense: up to US $268 million over the next 4 years. The province will have switched at least 26,000 patients by the summer of 2020.
Cost of Biologics is Soaring in Alberta
Alberta’s government states that the cost of biologic drugs are going up an average of 16.2% each year, and “the originator biologic drugs Remicade [infliximab], Humira [adalimumab] and Enbrel [etanercept] are 3 of the top 4 drivers of drug spending in Alberta.”
In that province, patients will be switched from the reference biologics for etanercept, infliximab, insulin glargine, filgrastim, pegfilgrastim, and glatiramer.
Biologics have been shown to be effective in inducing remission and avoiding surgical interventions, not to mention improving quality of life for patients.
Anti-tumor necrosis factor therapies are the single highest expense for patients in the Canadian healthcare system, at a cost of US $14,132 annually for each patient, the report said. However, the Canadian Association of Gastroenterology and Crohn’s and Colitis Canada contend in a position paper that their evidence review supports a position against nonmedical switching from reference infliximab to biosimilars in patients with stable inflammatory bowel disease (IBD).
Even Reference Product Changes Over Time
That said, the Lancet authors note that even reference biologics differ from batch to batch, but such high standards are applied to the manufacture of these and biosimilars that “they are just as safe and effective.”
The authors cite Mina Mawani, president and chief executive of Crohn’s and Colitis Canada, who contends the nonmedical switch from reference product to biosimilar introduces variability that “is irresponsible and may jeopardize these patients’ health.”
Another issue raised is that some infusion centers in Canada have exclusive contracts with specific pharmaceutical companies and may not be available for infusion of biosimilars. This may require patients to switch centers and travel long distances for treatment, causing infusion centers to become overwhelmed with patients, according to critics.
The Canadian Association of Gastroenterology and Crohn's and Colitis Canada also contend that “1 patient may lose response to infliximab for every 11 patients undergoing nonmedical switching. Applying this data to the Alberta IBD population, this could lead to 63 avoidable surgeries if all Albertans on Remicade [infliximab] are switched to a biosimilar.”
The Growing Impact of Biosimilars in IBD Care
April 23rd 2025Biosimilars are proving to be a game-changing solution in the fight against inflammatory bowel disease (IBD), offering a cost-effective alternative to biologics with similar efficacy and safety, while innovative drug delivery systems promise to further enhance treatment outcomes and accessibility for millions worldwide.
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?
Biosimilar and Biologic Use Increasing in Greek Patients With IBD
April 19th 2025A retrospective study from a single inflammatory bowel disease (IBD) center in Greece reported that from 2018 to 2022, the use of biologics increased by 28% yearly, and the proportion of patients using biosimilars grew from 33% to 67%.
Will the FTC Be More PBM-Friendly Under a Second Trump Administration?
February 23rd 2025On this episode of Not So Different, we explore the Federal Trade Commission’s (FTC) second interim report on pharmacy benefit managers (PBMs) with Joe Wisniewski from Turquoise Health, discussing key issues like preferential reimbursement, drug pricing transparency, biosimilars, shifting regulations, and how a second Trump administration could reshape PBM practices.
How State Substitution Laws Shape Insulin Biosimilar Adoption
April 15th 2025States with fewer restrictions on biosimilar substitution tend to see higher uptake of interchangeable insulin glargine, showing how even small policy details can significantly influence biosimilar adoption and expand access to more affordable insulin.
Latest Biosimilar Deals Signal Growth Across Immunology, Oncology Markets
April 14th 2025During Q1 2025, pharmaceutical companies accelerated biosimilar expansion through strategic acquisitions and partnerships in hopes of boosting patient access to lower-cost treatments in immunology and oncology.