British Columbia (BC) introduced a policy in May 2019 stopping coverage of originator biologicals and switching patients to biosimilars for certain indications. Rheumatology patients in BC had six months – until 25 November 2019 – to switch from the originator biological (Enbrel) to the etanercept biosimilar (Brenzys or Erelzi). After that time, the province’s healthcare system, PharmaCare, no longer provided coverage for the originator biologicals for these indications, except for exceptional cases [1]. Then, in November 2019, the province of Alberta also announced a similar policy that would apply to the approximately 30,000 patients in Alberta living with inflammatory bowel disease (IBD) [2].

On 27 February 2020, the Ontario Cabinet announced that it had approved a policy (signed on 30 January 2020) that will switch some patients on provincial drug insurance to less-expensive versions of their medications. A move that the cabinet expects to save the province tens of millions of dollars.

However, while drug policy experts and some rheumatologists are praising Ontario for adopting a policy that favours biosimilars. Others have concerns about non-medical switching of stable patients.

Crohn’s and Colitis Canada, Gastrointestinal Society, Diabetes Canada and the Institute for Optimizing Health Outcomes collectively express their concerns to Ontario Premier Doug Ford and Hon. Christine Elliot, the Deputy Premier and Minister of Health, about the risks of a non-medical switch policy in an open letter. They say that the Ontario Government failed to meaningfully consult the patients who will be directly impacted.

On the other hand, advocates of the move point to the savings to be made. John Esdaile, the scientific director of Arthritis Research Canada, said it is ‘very important’ that Canada’s most populous province is joining British Columbia and Alberta in switching some patients to biosimilars. He added that ‘the [Ontario] Government has a deficit they’re concerned about’. ‘Why would you pay 100 per cent too much for a drug when there’s a [biosimilar] available? That would make no sense at all.’ Dr Esdaile, also a Vancouver rheumatologist, has been one of the Canadian medical community’s most vocal supporters of biosimilars.

Related article
Law and ethics of switching to biosimilars in Canada

References
1. GaBI Online - Generics and Biosimilars Initiative. Canada’s British Columbia to switch patients to biosimilars [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Mar 6]. Available from: www.gabionline.net/Policies-Legislation/Canada-s-British-Columbia-to-switch-patients-to-biosimilars
2. GaBI Online - Generics and Biosimilars Initiative. Concerns raised as Canada’s Alberta plans to switch patients to biosimilars [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Mar 6]. Available from: www.gabionline.net/Policies-Legislation/Concerns-raised-as-Canada-s-Alberta-plans-to-switch-patients-to-biosimilars

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