The Plan That Convinced Canada to Switch to Biosimilars

The Canadian provinces have begun to line up behind automatic substitution of biosimilar infliximab for Remicade®, after the announcement of British Columbia’s policy change in May 2019. Ned Pojskic, Leader, Pharmacy & Health Provider Relations, Green Shield Canada, offered some background into the decision on biosimilar switching at the World Biosimilar Congress on March 2 in San Diego.

Canada is a heavy user of biologics, weighing in at 22.5% of total healthcare spending, and rising, said Mr. Pojskic. This is second only to the US.

Ned Pojskic, Green Shield Canada

Green Shield Canada is a private, nonprofit plan. Most pharmaceutical costs are covered through the private health system (not the provincial health systems) in Canada, according to Mr. Pojskic.

Currently in Canada, the list price for infliximab biosimilars is between 47% and 51% below that for the reference product. Throughout the country, annual Remicade sales are $1 billion, which accounts for an outsized proportion of total Remicade revenue for Janssen Biotech. But with only 5% penetration of biosimilar infliximab in Canada, “we were at ground zero,” he said. “We could achieve around $800 million in savings overall for all launched biosimilars. But we’re not. This is mostly due to pharma company tactics.

“The ‘Biologic Savings Partnership’ is the name given by Janssen to the opaque pricing discount used to keep Remicade on the formulary,” explained Mr. Pojskic. “If you keep it on the formulary, you get discounts on other Janssen portfolio products. The big question is, how to disentangle yourself?” He pointed out that if other manufacturers lowered their net prices, Janssen would simply unveil new discount deals to preserve Remicade marketshare.

In 2016, Green Shield Canada announced its new pilot policy: All patients who were newly prescribed infliximab (or other available biosimilars) were required to be given the biosimilar. However, patients already receiving treatment with a reference drug had a choice: The plan would pay the cost of the biosimilar only, but patients could pay the difference between that and the cost of the reference brand if they wished. “It was important to give patients the belief that they had a choice,” he said.

The biopharmaceutical industry was not ready to give in to biosimilar switching, however. “Nineteen percent of those on Enbrel® (etanercept) stayed on the reference product,” Mr. Pojskic stated. “We assumed patients were paying the difference, but it turned out that the reference manufacturer was paying the difference for them.” On the other hand, Janssen decided it would not similarly “bridge” patients already taking Remicade. Under the pilot, Green Shield Canada saved approximately $8,500 per member using these biologics.

Plan members understood the change and were receptive to it, and began talking to their physicians about transitioning to the biosimilar agents. The provisional governments began evaluating the program, he explained, and British Columbia decided in 2019 to roll out their own biosimilar switching program. Alberta and Ontario followed. Today, more than 60% of the country participates in a mandatory switch program.

The physician societies have gotten behind the new policies, as well. Mr. Pojskic said that physicians have preferred to use the originator drugs, largely because of comfort levels with these biologics. The rheumatology community has been quicker than the gastroenterology community to embrace the policy, but “the GIs have been coming around,” he said.

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