Mirroring a recent move by British Columbia, Alberta has declared that it is implementing a biosimilar switching program, under which eligible patients will be switched from an originator biologic drug to an equivalent and less expensive biosimilar drug.
In a press conference held Thursday, Alberta Health Minister Tyler Shandro noted that biologics represent 19% of the province’s total spending on drugs, despite being provided to fewer than 2% of patients.
“Fortunately, there is a solution … Albertans who are prescribed a biologic drug will be transitioned to a biosimilar by their physician over the next six months,” he said, noting that the move starting on July 1, 2020 is expected to save the province as much as $380 million over the next four years. Patients who get biologic drugs through private drug plans or out-of-pocket payments, as well as children or pregnant women, will not be affected.
Following the announcement, Biosimilars Canada congratulated Alberta for its decision, noting that biosimilars offer a way to manage costs while supporting positive patient outcomes. It cited Health Canada’s position that “no differences are expected in efficacy and safety” following a transition from biologics to biosimilars, adding that Pacific Blue Cross and Green Shield Canada also encourage the switch to biosimilars.
“Switching to biosimilar treatments is the responsible choice for drug programs, and it is time for other provinces to bring the benefits of biosimilar switching programs to their patients, health care providers and taxpayer,” said Biosimilars Canada President Jim Keon in a statement.
Some groups are disappointed with the decision. A statement from the Alliance for Safe Biologic Medicines (ASBM) estimates that 22,000 Albertans with diabetes, 2,000 with Crohn’s disease or ulcerative colitis, 1,400 with rheumatic diseases, 750 with multiple sclerosis, 450 with low white-blood cell counts, and 35 with plaque psoriasis will be impacted by the change.
“For the affected patients, Health Minister Tyler Shandro is supplanting the role traditionally played by their physician's medical judgment,” said ASBM Executive Director Michael Reilly. "In effect this creates two groups of Albertans- one who get medicine prescribed by their physician, and another who get medicine prescribed by politicians."
Citing a 2017 survey, the group said 83% of Canadian physicians shared the view that letting doctors decide on which is the most suitable biologic for patients is very important or critical, while 64% were not comfortable with a third-party switching a patient’s biologic medicine for non-medical reasons.
Crohn's and Colitis Canada also expressed extreme disappointment in Alberta’s policy, calling it “very short-sighted and potentially harmful” for people with inflammatory bowel disease (IBD).
“We provided the Alberta government with an evidence-based counter-argument against a non-medical switch for patients with IBD, fully supported by Canadian gastroenterologists and yet they still went ahead,” said Mina Mawani, President and CEO of Crohn's and Colitis Canada, in a statement. “The manufacturer of the biologic drug in question has publicly stated they will match the biosimilar price. No money will be saved – just cold policy affecting real people in Alberta.”
The group also criticized the switching policy’s tiering component, which it said will force Albertans with IBD to take intravenous therapy that requires treatment at an infusion centre for six to 10 days per year. “Taking away the option of a subcutaneous IBD therapy is a hard hit for young people in the workforce and those in remote areas of the province,” Mawani said.