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Canada B.C. enters second phase of plan to force patients onto cheaper versions of biologic drugs

B.C. Health Minister Adrian Dix during a press conference at Legislature in Victoria, B.C., on May 27, 2019.

CHAD HIPOLITO

The British Columbia government is expanding its promotion of cheaper medications called biosimilars, announcing Thursday that patients with inflammatory bowel diseases have until March to switch to less-expensive versions of the drug Remicade.

B.C. Health Minister Adrian Dix said about 1,700 patients with government-sponsored drug coverage and Crohn’s disease or ulcerative colitis will have six months to join their counterparts with diabetes, rheumatoid arthritis and other autoimmune diseases in trading their current biologic drugs for biosimilars.

Biosimilars are cheaper near-copies of biologics, which are complex drugs manufactured from living organisms.

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Biologics are among the biggest cost drivers in provincial prescription drug budgets, which is why B.C.'s NDP government announced in May that it would become the first province to stop broadly covering three original biologics: Remicade, Enbrel and Lantus, a type of long-acting insulin.

At the time, patients with Crohn’s disease and ulcerative colitis were temporarily exempted from the switching edict.

B.C.'s biosimilar policy, which is expected to save nearly $100-million over three years, has provoked some strong opposition.

Crohn’s and Colitis Canada, a national charity and patient advocacy group, released an updated position statement Thursday arguing that forcing people to switch without a medical rationale “is not in the best interest of patients."

As well, the company that makes Remicade ran full-page newspaper ads in June criticizing B.C.'s policy.

Those ads led Health Canada to rebuke Janssen Canada, a subsidiary of Johnson & Johnson, for “mispresent[ing] the department’s position with respect to biosimilars," which Health Canada says are as safe and effective as the biologics they mimic.

Teresa Pavlin, a spokeswoman for Janssen Canada, said by e-mail Thursday that the drug maker is urging the B.C. government to “reconsider this drastic change, which is based only on assumed cost savings and not on patient need.”

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A separate Crohn’s and Colitis Canada report, released last month, found that 69 per cent of 796 patients and caregivers who responded to an online survey either disapproved or strongly disapproved of policies that would force them to switch from their brand-name biologic to a cheaper biosimilar.

Mina Mawani, the group’s chief executive officer, said that while she understands public drug budgets are under pressure, “the bottom line is that cost cannot be the only factor in decision-making. [Governments] have to take into consideration patient-centred health.”

Crohn’s and Colitis Canada receives funding from Remicade-maker Janssen and from competitors Merck and Pfizer, each of which make biosimilar versions of Remicade, which is also known as infliximab.

Mr. Dix said he was not surprised that some patients feared transitioning to a different version of a familiar drug. “There’s always reluctance in change,” he said. "But the benefits of this are extraordinary.”

Last year, B.C. spent $84.2-million on Remicade alone. The infliximab biosimilars sell for about half of Remicade’s Canadian sticker price, Mr. Dix said.

Mr. Dix said B.C.'s savings would go toward beefing up nursing support and expanding public coverage of a non-invasive stool test for inflammatory bowel disease patients.

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Canada lags far behind many European countries when it comes to embracing cheaper biosimilars, Mr. Dix added.

Thanks in large part to public policies, 98 per cent of the infliximab sold in Norway last year was a biosimilar. That figure was 92 per cent in Britain, 79 per cent in Italy, 17 per cent in Mexico and just 8 per cent in Canada.

Brian Bressler, a professor of gastroenterology at the University of British Columbia and founder of the IBD Centre of BC, said Europe’s positive experience with biosimilars convinced him it would be safe to switch his patients.

“With confidence now," Dr. Bressler said, "I can tell you this decision [in Europe] has not led to any reduced ability for this drug to work, nor has it led to any increased safety concerns for this drug.”

When Mr. Dix unveiled the biosimilar policy in May, he said about 20,700 patients with diabetes, rheumatoid arthritis and three related autoimmune disorders would have until Nov. 25 to switch to a biosimilar.

On Thursday, the province said that as of Aug. 15, approximately 355 people, or 18 per cent of publicly covered patients taking Enbrel, have switched to a biosimilar version of that drug, while 70 people or 17 per cent of patients with rheumatoid arthritis and related diseases have switched to a biosimilar from Remicade.

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Some 2,078 people have traded their Lantus for an insulin biosimilar.

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