B.C. arthritis, diabetes patients have 6 months to switch to cheaper ‘biosimilar’ drugs

British Columbians on certain drugs for arthritis and diabetes will have six months to transition to equivalent less-costly drugs, as the province expands use of “biosimilars.”

The move is expected to save $96 million over the first three years.

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Biosimilars are developed after the patent for the original bio-engineered drugs, known as biologics, expire. They are highly similar copies of the original brand-name drugs, but cost 25 to 50 per cent less.

The province says its goal is to use the savings to in part cover the cost of new or expensive drugs still under patents and expand coverage for others.

Effective Monday, the B.C. Health Ministry added three biologic drugs for coverage.

Biologics are made using living organisms — yeast or bacteria, for example — to produce proteins that are purified to treat various health conditions.

Given by injection, biologics are prescribed to control immune-system responses and treat chronic diseases including diabetes, inflammatory bowel disease, psoriasis, rheumatoid arthritis and some forms of cancer.

“B.C. is leading the country by promoting the widespread use of biosimilars, which have been proven to work just as safely and effectively as higher-priced biologics,” B.C. Health Minister Adrian Dix said at the B.C. legislature Monday. “No one has done this in Canada and really not in North America either, so it’s a major shift.”

Dix said biologics are the single biggest expense for public drug plans. In 2018, B.C. spent $125 million on three biologic drugs — Lantus, Enbrel and Remicade — that treat chronic conditions including diabetes, arthritis and Crohn’s disease.

Dr. John Esdaile, a Vancouver rheumatologist and scientific director for Arthritis Research Canada, applauded the switch to biosimilars, saying many people have been “badgering” the province to make the move for years. “It’s a great day for British Columbians. This will be a very safe transition for our patients.”

Even with the original biologic, no two batches are identical, he said. He likened it to identical twins, genetically identical but slightly different.

Esdaile said B.C. has been spending money it doesn’t need to on expensive biologics, instead of using biosimilars that are proven to work just as well.

In Europe, he said, biosimilars have saved health-care systems billions of dollars.

Cheryl Koehn, who has had rheumatoid arthritis for three decades and is president of Arthritis Consumer Experts, said the transition is “long overdue” and great news for patients.

Endocrinologist Dr. Tom Elliott, medical director of B.C. Diabetes, said what might be a “nuisance” for those who have to switch drugs could be life-changing for those who will benefit from the drugs that will now be covered.

Across Canada, Health Canada-approved biosimilar versions of off-patent biologics are being prescribed.

B.C. will be the first province, however, to mandate that more than 24,000 long-time patients already using original biologics will switch to the biosimilar version.

This year, Dix himself transitioned from a long-acting insulin called Lantus to a biosimilar called Basaglar for his Type 1 diabetes. He was one of 18,000 British Columbians on the original biologic. “I am one of the people affected by this,” said Dix. “If I’m asking other people to do it, I have to lead.”

The health minister said even though the biosimilar drug is virtually the same and taken in the same way, “it’s still a moment when you make the transition.

“I have some empathy for that. For some people, it will take time to adjust to the idea of change.”

About 20,400 British Columbians living with ankylosing spondylitis, diabetes, plaque psoriasis, psoriatic arthritis or rheumatoid arthritis will be required to work with their doctors to transition their prescriptions by Nov. 22. After that, PharmaCare will no longer provide coverage for the original biologic for these diseases, apart from exceptional cases. “They will have to work through their doctor, as I did,” said Dix. “That’s why we are giving people six months.”

About 2,700 Crohn’s and ulcerative colitis patients will also be transitioning to a biosimilar option in the coming months, the Health Ministry said. Further information for gastroenterology patients will be available this summer, said Dix.

Under the move to biosimilars:

• Rheumatology patients will transition from the entanercept biologic Enbrez to the biosimilar Brenzys or Erelzi

• Dermatology and rheumatology patients will transition from the infliximab biologic Remicade to the biosimilar Inflectra or Renflexis

• Endocrinology patients will transition from insulin glargine biologic Lantus to the biosimilar Basaglar

• Gastrointestinal patients will transition from the infliximab biologic Remicade to the biosimilar Inflectra or Renflexis, with more information to come in the coming months.

The Health Ministry said it is following evidence-based results from several countries with a decade of experience with biosimilars.

With the savings from biosimilars, PharmaCare will cover the cost of:

• Jardiance (empagliflozin), used to manage Type 2 diabetes and now listed as a limited coverage benefit under PharmaCare. About 22,000 patients are forecast to benefit from this new coverage. It will cost the province about $4.1 million this fiscal year and $18.9 million over three years.

• Psoriatic arthritis drug Taltz (ixekizumab), as a limited coverage benefit.

As well, criteria will be expanded for existing arthritis drugs, such as extending coverage periods. Drugs affected include DMARDs, certolizumab, leflunomide, rituximab, tocilizumab and tofacitinib. That will help more British Columbians living with arthritis to find the treatment that works best for them, the Health Ministry said.


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