Head to head: Should private drug plans require biosimilar non-medical switching?

The Institute for Optimizing Health Outcomes recently published a scorecard rating the biosimilar policy frameworks of European countries across seven success factors for biosimilar sustainability, defined broadly as “. . . improv[ing] patient access and physician prescription choice of safe and high-quality biologic medicines, in a framework that considers the needs of all stakeholders . . . and provides a means to manage existing health-care budgets while safeguarding a healthy level of competition and supply.”

Read: 2020 Drug Plan Trends Report: Developments, data and design

Canada’s public drug plans would have scored at the bottom, having chosen a path that entrenches the health research company IQVIA Inc.’s three major hurdles to biosimilar sustainability: lack of physician and patient education; limited benefits to physicians to encourage use; and unsustainable purchasing policies. By taking away physician prescription choice, eliminating tendering and mandating non-medical biosimilar switching, the government has set up a non-sustainable situation. Patients lashed back at the disregard for their biologics management challenges and anxieties about switching.

Considering how private drug plans can avoid short-term mistakes and contribute to biosimilar sustainability, here are seven strategies adapted from the IQVIA: Engage with patients. Support the 60 per cent who accept biosimilars and the 80 per cent who rely on their physician’s recommendation and don’t force those who aren’t ready to switch; reinforce physician prescription choice while providing education, transition support and non-restrictive incentives; assure safe and quality biologics; address the needs of all stakeholders through continuous dialogue; promote competitive pricing among biosimilars and include originators; negotiate adequate and sustainable drug budgets that accommodate new medicines and aren’t dependent on price reductions; and avoid potential biologics shortages with adequate supply chain of multiple biosimilars and originator products.

Kelly Lendvoy, vice-president of communications and consumer affairs, Arthritis Consumer Experts

As annual spending on biologics continues to rise dramatically for private drug plans in Canada, 33 Health Canada-approved biosimilar biologics are now available, including biosimilar options for two of the country’s biggest-selling originator biologics — Humira and Remicade.

With a roughly 40 to 50 per cent discount on the price of originators (depending on molecule), biosimilars can offer significant savings to private and public drug plans. However, Canada ranks well below the Organisation for Economic Cooperation and Development median for biosimilars market penetration, meaning most of our private and public drug plans haven’t realized the savings seen by many other countries, such as France, Germany, Italy, Norway, Sweden and the U.K.

Read: A legislative update on provincial biosimilar policies

There are now successful biosimilar initiatives underway in public and private drug plans that can serve as best practice for private health insurers. Underlying these initiatives is a foundation of evidence supporting biosimilar transition — or switching — that includes more than 178 studies, of which 140 are based on real world evidence and more than 21,000 patients who’ve been successfully transitioned.

Since British Columbia implemented a biosimilars transition policy in May 2019, it has reported that thousands of patients have been transitioned with no compromise to patient safety, effectiveness or quality of care. According to the B.C. government, its biosimilars initiative anticipates savings of more than $227 million during the policy enactment’s first three years and is reinvesting those savings back into its health-care system, including adding new medicines to the drug formulary and enhancing existing drug coverage for chronic disease patients.

In 2021, the question isn’t whether private drug plans should require biosimilar transitioning. Instead, private insurers should be asking themselves: “Why are we not capturing biosimilar savings to ensure sustainability of employer-sponsored plans and to maintain and improve benefits that plan members rely on?”

Read: B.C. government says expanding biosimilars will save nearly $100 million over three years