Alberta, Canada, Sees Early Success From Switching Patients to Biosimilars

Following the launch of its Biosimilars Initiative in December 2019, Alberta, Canada, has succeeded in switching 16% of patients from use of 7 reference products to approved biosimilar versions, according to a presenter at the Terrapinn Festival of Biologics Basel 2020.

Alberta’s switching program launched 6 months after British Columbia began a similar initiative, which is further ahead with converting patients to biosimilars.

Alberta hopes to switch all patients on the 7 reference drugs to biosimilars by January 15, 2021, a deadline that was extended as a result of the coronavirus disease 2019 pandemic. Originally, authorities had hoped to complete the full conversion by July 1, 2020, said Graham Statt, the assistant deputy minister of the Pharmaceutical and Supplementary Benefits Division for Alberta Health, in the presentation.

According to a breakdown of the switching progress so far, 30% of patients receiving infliximab in Alberta switched to a biosimilar and 56% of those enrolled in a biosimilar patient support program.

Alberta officials hope the program will help save money on health care and improve access to biosimilars.

The 4 most frequently used reference products accounted for 75% of the province’s total net payment for biologics from 2019 to 2020, or US $200 million. Those products are Remicade (infliximab), Humira (adalimumab), Enbrel (etanercept), and Stelara (ustekinumab). In Alberta, there are etanercept and infliximab biosimilars available, but not for adalimumab and ustekinumab.

Also, the average annual growth rate of biologics use in Alberta over the last 5 years was 13.9%.

“Over the next 4 years, this initiative will save us between [US $173 million and US $290 million] once fully implemented. These savings will go back into the health system to help ensure we can provide the high-quality care Albertans deserve,” said Tyler Shandro, Alberta’s minister of health, in a 2019 statement about the launch of the initiative.

According to Statt, the Canadian province’s plan is similar to British Columbia’s, where physicians are given a window of time to prepare patients for the switch from selected reference products to biosimilars. Physicians were encouraged to use research and educational materials to help manage patient concerns about medication changes. “We provided the numerous research and clinical studies on the efficacy and safety of switching patients from [originator] biologics to biosimilars, so people could be confident in the change,” said Statt.

The reference products that patients are being switched from include Remicade, Enbrel, Lantus (insulin glargine), Neulasta (pegfilgrastim), Neupogen (filgrastim), Copaxone (glatiramer), and Rituxan (rituximab). Alberta Health added Rituxan to its list after biosimilar Riximyo received regulatory approval from Health Canada in June 2020. Riximyo launched across Canada in August 2020. Two other rituximab biosimilars, Truxima and Ruxience, were also added to the list of alternatives for Rituxan.

The switches aren’t mandatory. Statt clarified that according to the plan, patients enrolled in one of the Alberta Blue Cross government sponsored plans will no longer receive coverage for the reference product. Patients may submit an exception request to continue being administered the reference product, and if approved, pay out-of-pocket under their current plan policy or can change to another form of drug coverage under Alberta’s Blue Cross programs.

“I think this is actually an important point. We’re not forcing people to take a certain drug here in Alberta,” said Statt. "What we're saying is that if you want to maintain coverage for the drugs, it has to be the drugs that we provide. In some cases, people may choose to stay on a particular drug, and they're welcome to do that."

As of early October, only 1.4% of patients had submitted exception requests and approximately one-fourth of those were approved, according to Statt.

In preparation for the switching deadline, he said that patients and physicians were sent reminder letters in October. Statt added that the next steps for the program include tracking patient drug usage, health outcomes of patients, and feedback from physicians and patients.