April 2023
Ontario joins the shift to biosimilars
On December 20, the Ontario government announced that it will shift from biologics to biosimilars for everyone covered by the Ontario Drug Benefit (ODB) program. By expanding the use of biosimilar drugs, Ontario is following in the footsteps of British Columbia, Alberta, New Brunswick, Quebec, Nova Scotia, and the Northwest Territories.
The program, which came into effect on March 31 , should cover the majority of biosimilars , including Remicade™ and Humira™. As a new prescription is necessary to obtain the biosimilar version of a biologic drug, ODB recipients have until December 29, 2023, to make the switch. The brand-name biologic drug can still be used beyond this date in exceptional cases.
It should be noted that these transition policies are aimed at ensuring the financial sustainability of drug insurance plans. By opting for biosimilars, the savings achieved can reach 50% of the cost of the reference biologic drug. In addition to providing substantial savings, these policies will help bring other biosimilars to the Canadian market.
Insurers have come up with various approaches to managing biosimilars, including imposing a mandatory switch, foregoing the transition, or letting plan holders decide the best course of action. The transition announced by the Ontario government will help legitimize the decision by private plans to move forward with the switch. While most insurers were waiting for the provincial program to switch to biosimilars, others had already begun the transition in recent months.
The transition has been successful among insurers who’ve made the switch to biosimilars, with few exceptions. From a financial perspective, plans in other provinces that have made the switch have seen savings, which will allow them to remain financially sustainable.
Based on the experience in other Canadian provinces, a six-month period is sufficient to carry out the transition. Some contractual modifications are to be expected, which may require discussions between employers and union representatives. As for private plan sponsors, they’ll need to communicate with plan members to make them aware of the change and put their minds at ease.
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