John Crawford and Anar Dossa: Biosimilars Initiative applauded

Friday, Jan 8, 2021

In a bold move, the BC PharmaCare program implemented the first phase of its progressive Biosimilars Initiative at the end of November 2019, transitioning patients currently prescribed three brand name biologic drugs...

In a bold move, the BC PharmaCare program implemented the first phase of its progressive Biosimilars Initiative at the end of November 2019, transitioning patients currently prescribed three brand name biologic drugs used to treat diabetes, arthritis, and certain types of skin conditions to their biosimilar drug.

Pacific Blue Cross applauds their leadership and aligned our drug policies in support.

At the core of this decision was the health and wellbeing of our members. Biosimilars are similar to, and are as safe and effective as, the originator biologic—at a fraction of the cost. This was recently confirmed by the UBC-based Therapeutics Initiative, an independent group that does evidence reviews on prescription drug therapies, in a bulletin they published on their website as well as supported by patient and physician groups.

Many of the arguments against the move focus around physician choice, suggesting that the BC PharmaCare policy (and ours by extension) prevents physicians from prescribing medications they feel are the best option for their patients. This is untrue. Physicians are free to prescribe whatever they want. At issue is who pays the cost.

Benefit plan sponsors are increasingly worried that escalating drug costs—and the rising use of biologics in particular—shifts too much of their overall plan expenditures toward a smaller number of plan members. This makes it more financially difficult to ensure the plan can meet the health care needs of its remaining members, which in turn impacts plan sustainability.

Private insurers work with plan sponsors to adjust to these realities so they can keep benefits at an affordable level. For instance, lifetime maximums are set for individual plan members to manage risk; members on a more expensive biologic to treat a chronic condition like diabetes or rheumatoid arthritis will reach these limits much more quickly.

Thus, our move to align with the BC PharmaCare formulary ensures plan sustainability and provides plan sponsors with the flexibility they need to tailor their benefit options for all plan members.

Let’s also not lose sight of the disservice to British Columbians if the biosimilar industry isn’t supported: there will be fewer drugs for physicians to choose from to help patients meet their health care needs.

Drug manufacturers commonly offer inducements to governments and individuals that appear to reduce the cost paid for brand name biologics, so people continue using them instead of switching to the biosimilar. It’s true: deals can be made. But it comes at the expense of private insurers (and plan sponsors) and the entry of new biologics and biosimilars to the marketplace.

Use co-pay cards as an example. Manufacturers provide coupon (or co-pay) cards to patients, which provide financial support for the cost differential between the generic and the brand name drug. But many of those costs don’t go away. A study published in the November 11, 2019 issue of the Canadian Medical Association Journal shows that coupon cards actually increase private insurer costs by 46% compared to the associated generic, saying that the “increase in cost for the insurer occurs because the difference in cost between the branded product and generic is covered only for the patient and not for the insurance plan.”

While this study refers to generics, it’s easy to see how the practice could be applied to biosimilar drugs.

Biologic manufacturers recognize that biosimilars are disrupting their market share. If we simply acquiesce to their pricing tactics, we’re effectively driving down competition; biosimilar manufacturers will be hard pressed to find a market for their products over the long term and, without them, there is no incentive to drive down costs.

In a cost-constrained system, this type of incentive effectively reduces the number of new drugs that can be added to the provincial drug formulary to help more of us who need them. This point was made by BC Health Minister Adrian Dix when he announced the Biosimilars Initiative last May, and the resulting cost savings would be used toward covering two new drugs (for diabetes and psoriatic arthritis).

We chose to balance safety and efficacy with financial sustainability, for the benefit of all.