British Columbia Starts Second Phase of Switching Patients to Biosimilars, This Time for IBD

This week, British Columbia began the process of transitioning patients with inflammatory bowel disease (IBD) to biosimilars.

Patients with Crohn disease (CD) and ulcerative colitis (UC) will have 6 months to move from reference infliximab (Remicade) to either of the infliximab biosimilars, Inflectra and Renflexis. After March 5, 2020, PharmaCare, a publicly funded drug coverage program, will stop coverage for Remicade for these indications, except in certain circumstances.

Earlier this year, British Columbia became the first Canadian province to mandate that patients currently taking reference biologics for rheumatology indications and for diabetes must be switched to biosimilars over a 6-month period.

The province says the latest move will affect about 1700 gastroenterology patients. “The evidence clearly shows that these patients can transition from original biologics to biosimilars safely and effectively, which are key considerations that have always been our top priorities with this change,” says Adrian Dix, Minister of Health, in a statement. He says the switch will save about $96.6 million (US $73.4) over the next 3 years.

The savings will be returned to patients in the form of more resources for complex IBD patients, by funding more nursing support, and by granting full coverage of a noninvasive diagnostic test called the fecal calprotectin test. The test assesses intestinal inflammation and will help physicians and patients to better understand and manage their condition.

Canada has a significantly lower use rate for biosimilars, at approximately 8%. Other nations, mainly in the European Union, have upwards of 50% to 95%. Health Canada recently updated its biosimilar fact sheet in a bid to promote their use and give additional clarity to patients and for providers.

Last year, British Columbia spent $84.2 million on Remicade, and in 2017, Canada spent $1.1 billion on the drug. Since Remicade was first approved for sale by Canada in 2001, British Columbia has spent more than $671 million.

British Columbia also gave an update on its plan to transition patients from their rheumatoid arthritis or diabetes biologics to biosimilars by November 25, 2019.

As of August 15, 2019, about 355 people, or 18% of PharmaCare-covered patients taking the originator reference etanercept (Enbrel), have switched to biosimilar etanercept (Brenzys or Erelzi). Seventy people, or 17% of patients, switched from Remicade to Inflectra or Renflexis. In addition, infusion centers have been set up for biosimilars; physician use and patient enrollment is growing rapidly, the provincial government says.

For diabetes indications, 2078 people, or 11% of patients, moved from Lantus to Basaglar.

With the immediate savings gained from using biosimilars, 2 new drug listings were added to PharmaCare (empagliflozin, a diabetes drug sold under the name Jardiance, and ixekizumab, a biologic for psoriatic arthritis marketed as Taltz); in addition, coverage of several existing rheumatology drugs was enhanced to increase patient access.

Exceptions to switching may be granted for patients whose physicians determine they are medically unable to transition to the biosimilar drug. Exceptional coverage requests will be reviewed by PharmaCare.

“The use of biosimilars allows us to support new drug listings and improve patient care. I am proud of the enhancements that we have made to PharmaCare over the past year, and we will continue to find ways to better support patients by making improvements to the system as a whole,” Dix said.