Biosimilars Initiative saves precious health dollars in a time of COVID-19

Monday, Feb 22, 2021

​As the first health insurance provider in BC to align our drug policies with BC PharmaCare’s Biosimilars Initiative, we’re playing a leading role in reducing drug costs on behalf of British Columbians.

In 2019, the BC PharmaCare program implemented the first phase of its progressive Biosimilars Initiative, becoming the first jurisdiction in North America to transition patients prescribed three biologic drugs used to treat diabetes, certain types of arthritis, and psoriasis to biosimilars.

These three biologics cost the Ministry of Health $125 million in 2018. In contrast, the biosimilars of these “originator” drugs cost between 25% and 50% less, while offering patients similar levels of safety and effectiveness. Since then, another biologic has been transitioned to its biosimilar, and more is expected in the coming years. The Ministry projects savings of $100 million over a period of three years as a result of this program—and the savings will only continue to grow.

As the first health insurance provider in BC to align our drug policies with the Biosimilars Initiative, Pacific Blue Cross plan sponsors and members are experiencing similar cost avoidance—to the tune of $27 million in 2020.

Managing drug costs are critically important

Health Insurance providers have been examining different biologic vs. biosimilar strategies, but the early move to align with the BC PharmaCare initiative ensures that Pacific Blue Cross is taking a leadership role in managing the long-term sustainability of their employee benefit plans.

“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,” says John Crawford, President and CEO of Pacific Blue Cross. “This makes it more financially difficult to ensure the plan can meet the health care needs of its remaining members, and it could lead to coverage reductions or the inability to add new benefits, such as virtual care or mental health programs, to the plan in the future.”

Stewardship for member health

But helping plan sponsors is not the only objective we have. Because many employee health plans have a lifetime coverage maximum, members on a more expensive biologic to treat a chronic condition, like diabetes or rheumatoid arthritis, will reach these limits much more quickly. Shifting them to a less expensive—but equally effective—drug ensures their private coverage lasts longer, which helps them better manage their health care needs.

We are also the first insurance provider to automate the special authority process. “By linking our system directly with BC PharmaCare, we immediately know when a drug has been approved for coverage,” says Anar Dossa, Director, Pharmacy Services for Pacific Blue Cross. “This ensures our members get the medicines they need as quickly as possible, and reduces the administrative burden for patients, prescribers, and pharmacists.”

To date, 99% of Pacific Blue Cross plan sponsors have adopted the Biosimilars Initiative.

Read the full article at Business in Vancouver.