The treatment of chronic inflammatory diseases often requires use of costly biological drug products. Biosimilar drug products offer cheaper treatment options for patients and can ensure the sustainability of healthcare systems. However, in many nations, such as Canada, the uptake of biosimilars remains low.

A team based at the University of Toronto in Canada, set out to understand how biosimilars uptake is affected by public drug programme formulary listing approaches for innovator biologicals, which have been implemented to improve sustainable uptake of biological products. They focused on infliximab and etanercept innovator biologicals and their biosimilars in the province of Ontario. These have been made available on the Ontario Drug Benefit (ODB) programme with different formulary restrictions.

By carrying out a cross-sectional study of individuals dispensed a biological prescription for infliximab or etanercept through the ODB programme between January 2010 and June 2019, they found that the different formulary approaches have little effect on biosimilars uptake. Forecasts of quarterly utilization to the second quarter of 2022 also showed minimal increased uptake of biosimilars for the treatment of rheumatic conditions (RC) and inflammatory bowel disease (IBD).

The study highlights that, despite differing reimbursement restrictions between innovator infliximab and etanercept biologicals, the uptake of their biosimilars was low and not noticeably different in the treatment of RC.

It is also noted that, in several jurisdictions in Canada that have recently adopted different approaches to improve biosimilar uptake on public drug plans, improvements in uptake are being observed. These include tied reimbursement in Manitoba, switching of patient treatments from specific innovator to biosimilar products in British Colombia and a combination of the two approaches in Alberta.

The authors conclude that similar approaches should be considered in Ontario and globally, to further improve biosimilars uptake and reduce treatment costs.

Conflict of interest
This study [1] was funded by the Ontario Ministry of Health. The authors have no conflicts of interest to disclose.

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Reference
1. Fenna J, McCormack D, Kitchen S. Effect of listing strategies on utilization of antitumor necrosis factor biologics infliximab and etanercept: a cross-sectional analysis from Ontario, Canada. J Manag Care Spec Pharm. 2021;27(4):444-52.

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