BC was the first province in Canada to stop coverage of originator biologicals and switch patients to biosimilar versions. In 2019, the province began switching patients to biosimilars for etanercept (Enbrel) and infliximab (Remicade), inhibitors of tumour necrosis factor (TNF) used to treat inflammatory conditions, as well as insulin glargine [1]. Data released in 2020 showed that more than a quarter of patients with inflammatory bowel disease (IBD) in BC had switched to a biosimilar as a result of the programme [2].

On 9 April 2021, the government of British Columbia announced expansion of the switching programme to include adalimumab, a TNF inhibitor indicated for the treatment of inflammatory conditions including rheumatoid and psoriatic arthritis, ankylosing spondylitis, and IBD. Adalimumab has been sold under the brand name Humira by originator firm AbbVie and is the second top selling biological in Canada.

Between April and October 2021, almost 6,000 patients under PharmaCare, which provides access to prescription drugs for residents of BC, will be switched from Humira to an adalimumab biosimilar. Five adalimumab biosimilars will be available as part of the switching programme (Amgevita, Hadlima, Hulio, Hyrimoz and Idacio) for which pan-Canadian Pharmaceutical Alliance (pCPA) negotiations officially completed in January 2021.

According to Minister for Health in BC, Adrian Dix, switching patients to biosimilar adalimumab will save the province more than US$100 million over a period of three years. ‘This is in addition to savings from earlier phases of the programme that are being reinvested in our healthcare system. These savings have allowed us to expand coverage of treatments and add more drugs to our formulary to offer more affordable medications for British Columbians’, he said. PharmaCare spent approximately US$94 million on originator adalimumab between December 2019 and December 2020. Biosimilar versions are a fraction of this cost, being at least 40% cheaper.

In a further expansion of the switching programme, BC has added an extra indication for patients receiving etanercept treatment. Patients receiving etanercept for plaque psoriasis will now also be switched to a biosimilar version of the drug (Brenzys or Erelzi).

Mr Jim Keon, President of Biosimilars Canada, a national association representing Canada’s biosimilar industry, congratulated BC for supporting the increased use of biosimilars, adding: ‘The expansion of British Columbia’s biosimilar switching program demonstrates the province’s continued confidence in biosimilars as a way to manage costs and fund innovative new therapies while supporting positive patient outcomes’.

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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 2021 Apr 16]. Available from: www.gabionline.net/Policies-Legislation/Canada-s-British-Columbia-to-switch-patients-to-biosimilars 
2. GaBI Online - Generics and Biosimilars Initiative. British Columbia releases latest data on biosimilar switches [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2021 Apr 16]. Available from: www.gabionline.net/Biosimilars/General/British-Columbia-releases-latest-data-on-biosimilar-switches

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