Biosimilar and Biologic Drugs
May 8, 2023
Biosimilar and Biologic Drugs
Recently, you may have heard about your group benefits plan switching to coverage for biosimilar drugs. In this month’s blog post, we hope to answer any questions you may have about this change.
What are Biosimilar and Biologic Drugs?
Originator biologic drugs are a class of medications made from living cells.
Biosimilar drugs are similar versions of the originator biologic that are available at a fraction of the cost. A biosimilar enters the market after the exclusive patent on a biologic drug expires. A biosimilar can achieve the same health outcomes than the original biologic drug.
Biosimilar drugs are manufactured to the same regulatory standards and are authorized after a scientific evaluation by Health Canada. They work the same way, have the same strength and dosage, and can be taken the same way as the originator biologic medication.
Where is this change happening?
Some provinces are announcing a Biosimilar Initiative that requires their residents to switch from a biologic drug to a biosimilar equivalent. For example, the British Columbia government announced in 2019, that BC PharmaCare is requiring that patients taking three biologic drugs – Enbrel®, Remicade®, and Lantus® – transition to biosimilars. More recently, the Government of Saskatchewan has announced a new Biosimilar Initiative which will require residents of Saskatchewan to switch from an originator biologic drug to a biosimilar equivalent drug. Saskatchewan will be the seventh Canadian drug plan to implement this initiative. Alberta has also expanded their Biosimilar Initiative.
How does this affect my benefits plan?
Your group plan coordinates with provincial government plans. To coordinate your benefits plan with the provincial drug plan, residents of Saskatchewan, BC and Alberta (age 65+ in AB), covered under a provincial prescription drug plan will need to transition from the originator biologic drug to the equivalent biosimilar drug.
The benefits carrier of the plan through your employer will now reimburse, according to plan maximums, for biosimilar drugs. The carrier will no longer cover the biologic drug if an equivalent biosimilar is available. To be covered, you will need to switch to the biosimilar equivalent.
What if I cannot take the biosimilar equivalent?
Your doctor can submit a special authority request if you should be on the biologic drug. If the request is approved, your benefits provider will cover the biologic drug based on the plan’s coverage. Contact our office for more information on the special authority procedure.
If you have any questions about your coverage, please feel free to contact our office. Be sure to have the DIN (drug identification number) available if you would like us to check on the coverage of a prescription.
Resources
BC Biosimilars Initiative for Patients https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/what-we-cover/biosimilars-initiative-patients
Alberta Biosimilar Initiative https://www.alberta.ca/biosimilar-drugs.aspx