Canadian Health Plan to Switch Patients to Biosimilar Etanercept and Infliximab

Green Shield Canada (GSC), a not-for-profit health benefits company that offers employee group health benefits that supplement government-sponsored provincial health plans, has announced a new program to switch patients to biosimilar therapies.

Beginning in 2016, GSC began to prefer available biosimilars and follow-ons (which it then referred to as “subsequent-entry biologics”) on its formulary, and required patients initiating treatment to use these preferred products. GSC’s next effort is to implement a “biosimilar transition program” in which patients already receiving originator biologics will switch to biosimilars.

“The evidence has rapidly accumulated over the last [2] years, and it is all pointing in the same direction: patients can safely transition from an originator biologic to a biosimilar product with no loss of clinical benefit and no compromise in safety,” said the payer in a statement.

The program will initially apply to a select group of plans for patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis who are currently receiving branded etanercept (Enbrel) and infliximab (Remicade). As more biosimilars and more indications are approved, and as evidence on the feasibility of switching accumulates, the plan will increase the number of drugs and indications eligible for the transition program.

To help ensure a successful switch, the GSC says that it will use a “strong support system” that includes a dedicated team of care-coordinator nurses to help guide patients through the process, and news of the switch will be communicated to patients via a letter that outlines their options. First, patients may choose to undertake the switch after having discussed it with their provider. Second, they may choose to continue on their current treatment and pay the difference in costs between the biosimilar and the reference starting 60 days after the date of the letter. No claims for originator biologics will be denied; all claims will be paid based on the price of the biosimilar.

GSC has long been vocal in its calls for private payers in Canada to make greater use of biosimilars for the purpose of cost containment. In a statement in September 2017, the payer said that, though it has just 7% market share in Canada, due to its policy of beginning new starts on biosimilars, it generated 37% of claims for biosimilar infliximab (Inflectra) in the private market.

The payer has called on fellow companies to stop “signing up for the easy deals” in contracts with reference product sponsors to secure formulary placement. “We’re hoping to see more of our friends in the industry join us to support building a viable biosimilar market in Canada through forward-looking strategies. We did it for generics last decade, so we can do it again.”