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As the Canadian debate about biosimilars has moved from West to East, the drug that has received the most attention is Remicade, an intravenous treatment for rheumatoid arthritis and inflammatory bowel disease (IBD) that was the first blockbuster biologic to face competition from biosimilars.

Chris Donovan/The Globe and Mail

Drug policy experts and a leading arthritis doctor are praising Ontario for adopting a policy that favours cheaper drugs called biosimilars, while patient advocates who’ve been fighting the move say the government failed to meaningfully consult them.

The Globe and Mail reported Thursday that Premier Doug Ford’s cabinet has approved a policy that will switch some patients on provincial drug insurance to less-expensive versions of their medications, saving tens of millions of dollars.

Cabinet signed off on the change in a closed-door session on Jan. 30, according to two senior government sources who The Globe is not naming because they are not authorized to speak publicly on the matter.

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John Esdaile, the scientific director of Arthritis Research Canada, said it is “very important” that Canada’s most populous province is joining British Columbia and Alberta in switching some patients to biosimilars.

“The [Ontario] government has a deficit they’re concerned about,” he said. “Why would you pay 100 per cent too much for a drug when there’s a [biosimilar] available? That would make no sense at all.”

Dr. Esdaile, also a Vancouver rheumatologist, has been one of the Canadian medical community’s most vocal supporters of biosimilars, which are less expensive near-copies of biologic drugs whose patents have expired.

Biologics, unlike simple chemical pills, are drugs manufactured in living organisms. They tend to be expensive: Three of the top five drugs in terms of public spending in Canada are biologics.

Ontario moves forward with biosimilars despite pressure from Remicade maker Janssen

As the Canadian debate about biosimilars has moved from West to East, the drug that has received the most attention is Remicade, an intravenous treatment for rheumatoid arthritis and inflammatory bowel disease (IBD) that was the first blockbuster biologic to face competition from biosimilars.

Remicade maker Janssen Inc., a unit of Johnson & Johnson, deployed pressure tactics to try to convince Ontario to keep funding the drug, including hiring a former senior adviser to Mr. Ford and other Progressive Conservative insiders to lobby on its behalf.

The company offered Ontario a confidential discount on the price of Remicade that would have made it slightly cheaper than biosimilars made by rival pharmaceutical giants Pfizer and Merck, according to a 19-page slide presentation of a proposal Janssen made to Ministry of Health bureaucrats.

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The company’s confidential document, reviewed by The Globe, also revealed that Janssen gave free Remicade to thousands of new patients in Canada over the past four years in an effort to circumvent provincial policies favouring biosimilars.

“Our intent in making proposals to the government is to ensure treatment decisions continue to be based on what a physician determines is in the best interest of each patient,” Jennifer McCormack, a spokeswoman for Janssen, said by e-mail.

“We will review any government announcement on this matter in that context.”

Some gastroenterologists and advocates for IBD patients are worried about a switch to biosimilars, despite Health Canada and regulators around the world saying biosimilars are as safe and effective as the drugs they mimic.

A handful of patient advocacy groups reacted angrily to news that the Ontario government has approved a biosimilar switching policy while consultations on the matter are still under way.

Several organizations concerned about forced switching have a meeting scheduled with Health Minister Christine Elliott for next week.

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“They’ve already made their mind up. It’s so disingenuous from my perspective,” said Gail Attara, president and chief executive officer of the Gastrointestinal Society, who is based in British Columbia and booked a flight to Ontario for the meeting.

Mina Mawani, president and CEO of Crohn’s and Colitis Canada, called Ontario’s decision disappointing. “We have tried to present evidence to governments across Canada and no one’s paying attention,” she said.

Travis Kann, a spokesman for Ms. Elliott, said the ministry has met with more than 60 stakeholders, including several patient groups, since starting biosimilar consultations in November.

Ms. Attara argued that the Ontario government could have saved the same amount of money by accepting Janssen’s offer to lower its price for Remicade while allowing patients to keep taking their current medications.

But Mina Tadrous, a pharmacist and drug policy researcher at Women’s College Research Institute, said governments are better off setting broad policy directions for biosimilars.

Enforcing wider use of biosimilars could be a big money saver for the Ontario government, which spent $1.1-billion on biologic medications in 2018, nearly three times the $359.9-million it spent on biologics in 2010, according to a recent study co-authored by Dr. Tadrous.

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“If we don’t start making sure that we have an environment in which biosimilars want to enter the market,” he said, "we’re actually putting into question the sustainability of the [public drug] program.”

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