From 1 November 2020, the Alberta Biosimilars Initiative has been updated with a number of changes that affect adult members on Alberta government-sponsored drug plans. These include the addition of the Erelzi (etanercept) biosimilar on the Alberta Drug Benefit List (ADBL) and subject to the Biosimilars Initiative for the indication of plaque psoriasis. In addition, from this date, all Special Authorization requests for new treatment of plaque psoriasis with etanercept will be assessed for coverage with Erelzi. Patients currently taking the reference product, Enbrel, for plaque psoriasis will be required to switch to the biosimilar version by 1 May 2021. It is also noted that, in terms of Special Authorization, Erelzi will be added to the list of first-line therapeutic options for plaque psoriasis that patients should try before gaining access to the tier 2 drug, Stelara.

In their announcement, the Alberta government also highlighted that as of 15 January 2021, patients will only be provided coverage for the biosimilar version of certain drugs through Alberta’s government sponsored drug plans. These are Remicade, Enbrel (all indications except plaque psoriasis and paediatric juvenile idiopathic arthritis), Lantus, Neupogen, Neulasta, Copaxone and Rituxan (for the indication of rheumatoid arthritis). It is noted that this is the case unless an exception has been granted for the originator biological. The Alberta government also encourages prescribers to start the switching process for patients as early as possible, to ensure sufficient time for discussion and for patients to enroll in new patient support programmes or to book an appointment with the infusion clinics, if required.

This is the new deadline for the delayed forced medication switch in the province [1]. It is thought that, once fully implemented, switching to biosimilars will save between CA$227 million and CA$380 million over the next four years. Despite this, the policy has met some opposition [2, 3]. The province of British Colombia was the first to introduce a policy of switching rheumatology patients to biosimilars in May 2019 [4].

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References
1. GaBI Online - Generics and Biosimilars Initiative. Alberta delays deadline for forced medication switch by six months [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Nov 20]. Available from: www.gabionline.net/Policies-Legislation/Alberta-delays-deadline-for-forced-medication-switch-by-six-months 
2. GaBI Online - Generics and Biosimilars Initiative. Opposition party in Alberta Canada fights biosimilar switching policy [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Nov 20]. Available from: www.gabionline.net/Policies-Legislation/Opposition-party-in-Alberta-Canada-fights-biosimilar-switching-policy 
3. GaBI Online - Generics and Biosimilars Initiative. Arguments against Alberta’s plans to switch patients to biosimilars [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Nov 20]. Available from: www.gabionline.net/Biosimilars/Research/Arguments-against-Alberta-s-plans-to-switch-patients-to-biosimilars 
4. GaBI Online - Generics and Biosimilars Initiative. Law and ethics of switching to biosimilars in Canada [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Nov 20]. Available from: www.gabionline.net/Biosimilars/Research/Law-and-ethics-of-switching-to-biosimilars-in-Canada 

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