If any of your employees have a chronic condition such as arthritis or diabetes, certain biologic drugs that are currently covered under BC PharmaCare will be transitioned to equivalent less-costly drugs as the province expands the use of “biosimilars.”
Employees who are using the affected drugs risk the possibility of increased out-of-pocket costs if they choose not to switch from originator drug to a corresponding biosimilar.
The Government of British Columbia and BC PharmaCare have launched this initiative aimed at lowering provincial expenditure on prescription drugs. Beginning May 27th, users of Enbrel, Remicade and Lantus (prescription meds that cost the province over $125 million in 2018) will be transitioned to lower-cost, and similarly effective alternatives. The transition period ends November 26th, at which point those three drugs will no longer be covered under BC PharmaCare.
Here’s what you need to know about the initiative that’s predicted to save the province around $100 million over the next three years.
Which drugs are affected by this?
Understanding why Embrel, Remicade and Lantus are the focus of this initiative is easier to grasp when you’re provided a summary of the characteristics they have in common:
They’re medications used to treat serious chronic conditions you’re probably familiar with – diabetes, rheumatoid arthritis, psoriatic arthritis, and Crohns to name a few.
The annual cost of treating a patient year-round can be quite expensive (often in the tens of thousands of dollars).
They’re also categorized as Biologic drugs.
How do biologics work?
Biologics aren’t your typical drugs because they’re not chemically manufactured. Instead, they’re engineered using living organisms (such as yeast, bacteria or animal cells).
When new drugs (biologics included) enter development, the manufacturer is given patent-protection for upwards of twenty years.
After successfully gaining approval to be sold in Canada, the patent-protected medication enjoys a captive audience and leverage to dictate costs. However, once the patent expires, other pharmaceutical companies can use the “originators” composition to introduce competitive alternatives to the healthcare marketplace, aimed at treating the same conditions as the original. When it comes to biologics – biosimilars represent the new competitor.
How are biosimilars compare to biologics?
To be approved in Canada, a biosimilar must be engineered using the same composition as the “originator”. As we’ve pointed out, biologics/biosimilars are made up of living cells - so saying they’re complex would be an understatement. With living cells involved, variance in the exact composition of bio drugs is inevitable from one batch to the next (BC Gov’t Patient FAQ).
This holds true regardless of whether you’re dealing with biologics or biosimilars. To that point, biosimilars are recognized as safe alternatives to their biologic counterpart once it’s determined they introduce no meaningful differences in safety or efficacy. Therefore, unburdened by the cost of developing the medication, biosimilar manufacturers can offer their alternatives at a significantly lower cost without compromising the drug’s effectiveness and consequently patient outcomes.
BC being the first province to introduce a biosimilar switching initiative could certainly play a role in shaping how other provinces deliver healthcare moving forward. It will also put upward pressure on biosimilar drug utilization in Canada; an area where we lag behind other countries – notably in Europe, where the efficacy and safety of biosimilars have been studied extensively and the framework for approval was pioneered (more info on biosimilars in the EU here).
Shifting our focus a little bit, the savings derived from the switch can be viewed as a positive from the perspective that it will allow BC PharmaCare to direct funds towards updating their drug listing – most recently adding Jardiance and Taltz to their list of covered medications. Smarter spending means more comprehensive coverage for the residents of BC.
Give your employees a heads up that this change is coming up. Increased employee communication will help employees better understand their choices, be able to make more informed decisions and appreciate the value of the benefits they access.
This will allow them to check in with their physician to determine if this transition applies to them. Physicians have also been instructed to schedule appointments with affected patients prior to November 26th to properly educate them on the changes and provide details as needed. If they feel that the transition isn’t medically appropriate, a special authority request form can be submitted to BC PharmaCare asking for exceptional permission for continued use of the biologic medication.
Some conditions won’t be immediately affected or are exempt from the transition so check out the official Government of B.C announcement for more information on the initiative.
To learn more about drugs costs as a part of a benefits plan, download our white paper below.
Prescription For A Healthy Benefits Plan: Manage Rising Drug Costs
Download our guide to learn how to better manage rising drug costs and find better cost-saving opportunities to mitigate risks in your benefits plan.