Alberta Makes It Official With Move to Biosimilars for Those on Public Drug Plans

Alberta became the most recent Canadian provincial government to mandate a nonmedical switch to biosimilars for certain patients on taxpayer-funded drug plans.

Six months ago, British Columbia was the first province to require eligible patients currently on a reference product to switch to a biosimilar. Manitoba announced a similar program recently, and Ontario appears to be thinking about it.

The change begins July 1, 2020 for patients on government-sponsored pharmaceutical plans.

In a statement Thursday, Alberta’s minister of health said switching to biosimilars will save between $227 million (US $172 million) and $380 million (US $289 million) over the next 4 years.

Alberta, which is calling the plan the Biosimilar Initiative, said spending for originator biologics has increased from $21 million (US $16 million) to $238 million (US $181 million) over the past 10 years.

Medical exception requests will be reviewed by specialists from rheumatology, gastroenterology, endocrinology, and neurology, and pediatric patients and pregnant women are exempted from the policy.

However, the announcement drew criticism from Crohn’s and Colitis Canada, which called the decision “very shortsighted and potentially harmful.” In particular the organization criticized the decision to include what they described a restrictive tiering component.

"The tiering component forces patients onto intravenous therapy, meaning at least 6 to 10 days per year where they must seek treatment at an infusion center,” said Mina Mawani, president and chief executive officer of Crohn’s and Colitis Canada. “Taking away the option of a subcutaneous [inflammatory bowel disease] therapy is a hard fit for young people in the workforce and those in remote areas of the province,” she said adding that it is also a quality-of-life issue.

According to The Globe and Mail, the tiered framework will limit pharmaceutical choices for patients with rheumatoid arthritis and Crohn disease who are starting therapy for the first time. The paper said the list price for infliximab, when sold as the brand name Remicade, is $962.68 (US $731.35) per vial, while the biosimilars Inflectra and Renfeixis cost $525 (US $398.85) and $493 (US $374.53) per vial, respectively.

The policy will also cover Enbrel, Lantus, and Neulasta, and Neupogen, as well as patients currently taking glatiramer acetate (Copaxone) for multiple sclerosis, even though it is not technically a biologic.

About 26,000 patients are affected.

In a related statement, Adrian Dix, the minister of health for British Columbia, congratulated Alberta on the move. Dix also said they estimate that in British Columbia up to 70% of infliximab and etanercept patients have switched to a biosimilar, as well as 33% of those on insulin glargine.

The head of Biosimilars Canada also cheered the move.

"The decisions of the Alberta and British Columbia governments to implement biosimilar switching initiatives demonstrate continued confidence in biosimilars as a way to manage costs while supporting positive patient outcomes," said Jim Keon, president of Biosimilars Canada. "Switching to biosimilar treatments is the responsible choice for drug programs, and it is time for other provinces to bring the benefits of biosimilar switching programs to their patients, health care providers and taxpayers."

The Biosimilars Forum also praised the decision. “Following Europe’s lead, [3] Canadian provinces have now recognized the substantial cost-savings associated with increased patient utilization of biosimilars…it’s clear that policymakers need to take action to foster and sustain a robust biosimilars market that lowers costs for patients and the health care system at-large,” said the organization in a statement.