Biologic Drugs and Biosimilars – Here’s What You Need to Know

Biologic drugs can be life saving when plan members or their dependents become ill, but they can also be incredibly expensive, driving up the cost of your benefits plan. But what if there was a less expensive, yet highly effective solution?

That’s where biosimilar drugs come in. Biosimilars offer similar benefits as their native biologic, but at a fraction of the cost.

What Are Biosimilars?

Biologics tend to be larger and more complex than chemically made pharmaceuticals. They’re also more natural, as they are composed of living organisms.

According to Health Canada, a biosimilar is “a biologic drug that enters the market after a previously authorized brand version in Canada and with a demonstrated similarity to that reference biologic drug.” Due to the complex nature of biologics, biosimilars can only be “similarly” related to the original biologic – they’re not the exact same.

Biosimilars have gained widespread attention in recent years as a lower cost alternative to the original biologic drug. Many Insurer’s have increased the uptake of biosimilars through a biosimilar transition program. Under the Insurer’s formularies, biosimilars are listed as preferred products, and the originator products are covered only in exceptional circumstances. This allows easier access to the less expensive biosimilars to plan members.

Why are Biosimilars not Being Used All the Time?

If biosimilars are cheaper and do the exact same thing, why aren’t more people using them? It comes down to two big reasons (although there are others):

  • Stigma and misinformation. The perception of a biosimilar has proven difficult to overcome. Many ask, “Is similar good enough?” The other difficulty to overcome is the idea that if it’s cheaper, that must mean it’s not as effective or has added side effects.

  • Physician reluctance to prescribe. Biosimilars are still relatively new to the market when compared to their biologic counterparts. Physicians have been hesitant in adopting these new drugs because of their familiarity with biologics and the effects on their patients.

Both of these issues will take time to correct, but as insurers  continue to promote the benefits of biosimilars and stay the course with the transition program, uptake is expected to increase.

The Biosimilar Transition Program

A program based on evidence…

One such leader in Transitioning to Biosimilar’s is Green Shield Canada. Since introducing their biosimilar standard, GSC has been closely monitoring the emerging scientific evidence examining the safety and efficacy of transitioning from an originator biologic product to the biosimilar counterpart.

The evidence GSC have garnered has rapidly accumulated over the last two years, and it is all pointing in the same direction: patients can safely transition from an originator biologic to a biosimilar product with no loss of clinical benefit and no compromise in safety. Over 1,500 patients have now been involved in 13 transition studies, conducted across 11 countries. This is a staggering amount of evidence that outpaces the evidence available for any new drug entering the market today. In addition to the robust clinical-trial evidence, there is also a tremendous amount of “real-world” data emerging from Europe, where biosimilars have been available since 2006. This evidence is complementary and supports the clinical trial information.

Taken together, all the evidence strongly supports safe and effective patient transitioning to biosimilars.

The employee experience…

The program is expressly designed with a strong support system to help employee’s transition from an originator product to a corresponding biosimilar by working closely with a dedicated team of care-coordinator nurses who will assist patients with the transition process.

Employee’s currently taking one of the targeted conditions will be sent a letter explaining the program, the evidence for transitioning, and next steps. The letter outlines the two available options:

  1. To go ahead with a one-time transition to the biosimilar after discussing it with their doctor.

Or

  1. To continue treatment with the originator biologic and pay the difference in cost between the two products.

    Employee’s who decide to transition to the biosimilar are directed to call a dedicated phone line staffed by a care-coordinator nurse who will guide patients through the transition process.

 

 

Related Posts

Highlights from the Ontario Budget 2018

On March 28, Finance Minister Charles Sousa announced the Ontario 2018 budget. With a provincial election scheduled for June, the initiatives announced are likely dependent on the current government being re-elected. Here are a few highlights that may affect group benefits: 1. Expansion of OHIP+ to seniors 65 and older – August 2019 OHIP+ expands to include […]

Ontario Human Rights Tribunal

Ontario Human Rights Tribunal interim decision rules that it is discriminatory to deny group benefits to employees 65 and older. A case between an employee and employer was recently brought before the Ontario Human Rights Tribunal. The case related to the termination of health, dental and life insurance group benefits at age 65. In an interim decision […]

Bill 127, Stronger, Healthier Ontario Act

Bill 127, Stronger, Healthier Ontario Act includes changes to the Workplace Safety and Insurance Act, 1997 (WSIA) to allow compensation for work-related chronic mental stress under the Workplace Safety and Insurance Board (WSIB) if certain conditions are met. People with chronic mental stress with an accident date on or after January 1, 2018 must meet three conditions […]

Upcoming Changes in Employment Standards Act

Are aware, there have been changes within the Employment Standards Act and Occupational Health and Safety Act. The Fair Workplaces, Better Jobs Act, 2017 second phase effective January 1, 2019? EFFECTIVE JANUARY 1, 2019   Three Hour Rule:   Employees who regularly work more than 3 hours per pay, but are given less than 3 hours upon reporting to […]

Reminder about enrolment forms

When enrolling new plan members onto your plan, it is important to make sure that enrolment forms are completed by the plan member and submitted on time. The insurer must receive applications within 31 days after a plan member becomes eligible to join the group plan. When an enrolment form is not received on time, the plan […]

OHIP+ transitioning to second payer

OHIP+, Ontario’s new drug benefit program for children and youth, will become the second payer for those with private insurance coverage. Effective  January 1, 2018  the previous Liberal government agreed to fully cover the cost of prescription drugs eligible under the Ontario Drug Benefit (ODB) program for people under the age of 25, with no deductible or […]