Zahid Salman is the president and CEO of Green Shield Canada
The fastest-growing segment of our health-care system is prescription drugs – now constituting the second-highest category of spending after hospitals and ahead of physician services. The rapid growth of prescription-drug spending is not projected to stop any time soon, driven largely by innovative yet costly therapies, particularly biologic drugs -- those which are uniquely manufactured from biological sources or living organisms.
To keep drug plans sustainable, we at Green Shield Canada, along with other public (provincial health plan) and private (health insurer) payors, manage lists of drugs that are eligible for reimbursement. Each and every drug is evaluated on the basis of need, safety and effectiveness. Not every drug makes the cut – and each time a decision is made, the ramification of those decisions is heavily considered for both the patients and their employers.
These decisions are extremely difficult to make. Do we extend the life of a 45-year-old cancer patient for one more year or improve the lung function of a child with cystic fibrosis by three per cent? And what if, over time, with escalating costs, we can’t do both? These decisions will get even harder as we enter the age of gene and cell therapies with price tags upwards of $2-million a treatment.
Sometimes though, a confluence of factors comes together in incredibly fortuitous ways – scientific progress marries marketplace access and our collective job gets easier. That happened in 2014, when Health Canada approved Inflectra, defined as a biosimilar drug to originator Remicade, which was used to treat conditions including rheumatoid arthritis and Crohn’s disease.
Biosimilars - drugs that are nearly identical to the original product, but produced by a different company – are a rarity in health care: An opportunity to provide patients with a treatment that works just as well, but at – sometimes – half the price. The decision to embrace biosimilars is not a difficult one – it’s just logical. Yet, four years post-approval, Inflectra commands well below 10 per cent of the Canadian market, while Remicade is by most accounts the most successful drug to ever hit the market in Canada, with 2018 sales over $1-billion.
As we’ve seen through investigative reporting by The Globe and Mail, the fascinating story of biosimilars, and Remicade in particular, is not a pretty one. It paints a picture of financially interested parties driven to extreme measures to protect profits and sales, resorting to generating fear around the progress biosimilars represent. As a result, Canada has seen a very low uptake of biosimilars, thus diminishing an incredible opportunity to drive sustainability without compromising patient safety. Biosimilar adoption in European jurisdictions is close to, or at, 100 per cent. In fact, Europe has approved 46 biosimilar drugs over 12 years with no safety concerns.
Recent initiatives by provincial governments to prefer biosimilar drugs on provincial formularies are starting to take effect, but more is needed. This is where the recent decision by the government of British Columbia government to implement biosimilar transitioning is not only forward-thinking, but is essential to maximizing opportunities in health care.
Biosimilar transitioning has been well-established in scientific literature as safe and effective. In fact, more than 90 individual studies with 14,000 patients across seven disease states and eight countries have demonstrated the safety and effectiveness of this approach. This mountain of evidence is rarely seen in any other health-care decision making. However, this evidence is often forgotten or drowned out by a sea of perceived and potential concerns that have no basis in practical reality or evidence.
We at Green Shield Canada applaud the B.C. government’s decision to implement a biosimilar transitioning program and we encourage provincial governments across the country to embrace the same approach. As the first private payor in the country to implement the transitioning approach to biosimilars in 2018, we have witnessed the safety and positive impact this approach has for both patients and long-term system sustainability.
Yes, health-care sustainability is hard and is not achieved by any one decision. But it’s a collection of smart decisions, over time, driven by solid evidence. Biosimilars are a prime example of that smart decision making that will ultimately protect the existence and viability of the Canadian health-care system.
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