GSC started the pilot switching programme with three of its plan sponsors during the summer and autumn of 2018. The initiation of the pilot followed the announcement in February 2018 that GSC would preferentially list biosimilars [1]. This meant that the group would only cover the originator products in exceptional circumstances for naïve patients starting biological therapy.

GSC’s Biosimilar Transition Program currently focuses on switching patients being treated for ankylosing spondylitis, psoriatic arthritis and rheumatoid arthritis from originator infliximab (Remicade) and originator etanercept (Enbrel) to their respective biosimilars. This is just the beginning though, GSC says that ‘as the evidence on transitioning to biosimilars grows, more indications for the existing biosimilars are approved, and new biosimilars enter the market, the number of drugs and indications eligible for the GSC program will grow’.

The decision to transition patients was made by GSC after investigating the emerging scientific evidence examining the safety and efficacy of transitioning from an originator biological to its biosimilar. In addition, the group also consulted with the Arthritis Consumer Experts, a leading national, patient-led organization that provides evidence-based education in Canada.

During the pilot, 41% of plan members transitioned from the originator biological (Remicade or Enbrel) to a biosimilar and 26% chose to remain on the originator at the reimbursement level of the biosimilar. This meant that 67% of participants were reimbursed the cost of the biosimilar resulting in significant savings. This resulted in average savings of CA$8,500 per member per year for the population participating in the pilot. The switching pilot was initially launched with a 60-day transition period, but this was changed to 90 days based on feedback from participating plan sponsors.

During the pilot plan members were given access to a dedicated team of care-coordinator nurses, who followed a detailed case management process to provide plan members with the assistance they required. The nurses had regular contact with patients during the transition – one month, three months and six months after the switch – to address any issues and answer questions. In addition, patients had access to a dedicated phone line that plan members could call at any point during their transition should they need additional support.

GSC says that most plan members understood the change being made to their plan and were receptive. In fact, some proactive plan members had already discussed transitioning to a biosimilar before receiving the letter. Questions raised during the pilot included: reasons for the change, amount covered under the plan, cost difference between the originator and the biosimilar, efficacy of the biosimilar and next steps.
Although some plan members had questions about the efficacy of the biosimilar and their potential response to it compared with their experience on the originator biological, GSC says that their concerns were satisfactorily addressed by the care-coordinator nurses.

Due to the success of the switching pilot GSC says that it will now ‘offer this innovative program to all GSC plan sponsors’.

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Reference
1. GaBI Online - Generics and Biosimilars Initiative. Green Shield Canada preferentially lists biosimilars [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2019 Mar 8]. Available from: www.gabionline.net/Policies-Legislation/Green-Shield-Canada-preferentially-lists-biosimilars

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