Skip to main content
The Globe and Mail
Support Quality Journalism.
The Globe and Mail
First Access to Latest
Investment News
Collection of curated
e-books and guides
Inform your decisions via
Globe Investor Tools
per week
for first 24 weeks

Enjoy unlimited digital access
Enjoy Unlimited Digital Access
Get full access to
Just $1.99 per week for the first 24 weeks
Just $1.99 per week for the first 24 weeks
var select={root:".js-sub-pencil",control:".js-sub-pencil-control",open:"o-sub-pencil--open",closed:"o-sub-pencil--closed"},dom={},allowExpand=!0;function pencilInit(o){var e=arguments.length>1&&void 0!==arguments[1]&&arguments[1];select.root=o,dom.root=document.querySelector(select.root),dom.root&&(dom.control=document.querySelector(select.control),dom.control.addEventListener("click",onToggleClicked),setPanelState(e),window.addEventListener("scroll",onWindowScroll),dom.root.removeAttribute("hidden"))}function isPanelOpen(){return dom.root.classList.contains(}function setPanelState(o){dom.root.classList[o?"add":"remove"](,dom.root.classList[o?"remove":"add"](select.closed),dom.control.setAttribute("aria-expanded",o)}function onToggleClicked(){var l=!isPanelOpen();setPanelState(l)}function onWindowScroll(){window.requestAnimationFrame(function() {var l=isPanelOpen(),n=0===(document.body.scrollTop||document.documentElement.scrollTop);n||l||!allowExpand?n&&l&&(allowExpand=!0,setPanelState(!1)):(allowExpand=!1,setPanelState(!0))});}pencilInit(".js-sub-pencil",!1); // via darwin-bg var slideIndex = 0; carousel(); function carousel() { var i; var x = document.getElementsByClassName("subs_valueprop"); for (i = 0; i < x.length; i++) { x[i].style.display = "none"; } slideIndex++; if (slideIndex> x.length) { slideIndex = 1; } x[slideIndex - 1].style.display = "block"; setTimeout(carousel, 2500); } //

In Norway, 98 per cent of patients with conditions such as rheumatoid arthritis, Crohn’s disease or ulcerative colitis are treated with infliximab, a biosimilar.

In Canada, only 8 per cent of patients with those same conditions receive a biosimilar; the vast majority get an expensive originator biologic, sold under the brand name Remicade. Why?

The short version is that Norway pays far more attention to getting value for money for its public drug spending than Canada. They also don’t fall for the marketing bumpf about brand-name biologics somehow being magically better than biosimilars. Research has shown, time and time again, that they are “highly similar.”

Story continues below advertisement

With biologics now accounting for more than 23 per cent of public drug spending – $3.4-billion of $14.5-billion paid by public drug plans last year – governments are finally starting to wake up to this issue.

Both B.C. and Alberta have announced that they will switch patients on government-sponsored programs from biologics to biosimilars. What the other provinces are waiting for to act is not clear. Likely just run-of-the-mill, money-wasting inertia.

Needless to say, pharmaceutical companies are pushing back. Remicade alone has sales in excess of $1-billion a year for Janssen Inc. in Canada.

In response to Alberta’s announcement, one company offered the province a price cut equivalent to $100-million, which provincial Health Minister Tyler Shandro rejected, saying switching to biosimilars would save more money. He also said a deal would undermine the pan-Canadian Pharmaceutical Alliance, the group that negotiates drug prices on behalf of federal, provincial and territorial governments.

The list price of infliximab biosimilars is about 45 per cent cheaper than Remicade’s list price, but we don’t actually know what negotiated price provinces are paying for originator drugs.

Advocacy groups representing patients and specialist physicians are also getting in on the discussion, largely to advocate for the status quo. Crohn’s and Colitis Canada, for example, argues that “biosimilars are a safe and effective treatment … but firmly believe that switching from a biologic to its biosimilar for non-medical reasons is not in the best interest of patients.”

The group is arguing that drug prescription decisions belong strictly to physicians and their patients. That is true. But it is nonsensical to suggest that every drug prescribed by a doctor must be covered by an insurer, either public or private.

Story continues below advertisement

Resources are limited, so insurers must ensure that the drugs that are covered provide value for money. There is no question that treatment-naive patients should be started on biosimilars. Currently, fewer than half of new infliximab patients begin on a biosimilar. That’s unacceptable. Whether patients who are stable on their current medications should be switched is a thornier issue.

Getting patients with chronic degenerative conditions, such as rheumatoid arthritis, to a point where they are in remission and stable can take a long time. A treatment plan for a complex illness should not be trifled with because medication changes that fail can result in costly hospitalization.

So it would not be unreasonable to grandfather patients who are stable now and focus on getting new patients or patients whose drugs are not working on to biosimilars. This approach, known as preferential reimbursement, would soothe some fears. Another complementary approach is tiered reimbursement – covering originator biologics only after a patient has failed one or more biosimilars. These policies are already in place in some provinces.

We should not forget either that private insurers are struggling with these issues as much as public insurers (in Canada, only 43 per cent of the $34.3-billion in prescription drugs spending is publicly funded). Some private insurers have begun transition programs, reimbursing the cost of a biosimilar, but allowing clients who wish to remain on an originator biologic to pay the difference out-of-pocket. Not everyone can afford this, but in some cases, manufacturers provide them with rebate coupons.

However, not all the burden for cutting costs should fall on patients. Canada is slow to approve new biosimilars; since 2006, Health Canada has approved only six, compared with 13 approvals by the European Medicines Agency. We also have among the highest prices in the world for both biologics and biosimilars, so more co-ordinated and aggressive price negotiations are required. As drugs change in fundamental ways, so too must we change what and how we reimburse.

Biologics and biosimilars are the first large-scale test of how governments will navigate this complex new world and, to date, Canada’s public drug plans have largely shown themselves to be hopelessly adrift.

Your Globe

Build your personal news feed

  1. Follow topics and authors relevant to your reading interests.
  2. Check your Following feed daily, and never miss an article. Access your Following feed from your account menu at the top right corner of every page.

Follow the author of this article:

Follow topics related to this article:

View more suggestions in Following Read more about following topics and authors
Report an error Editorial code of conduct
Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to If you want to write a letter to the editor, please forward to

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

If you do not see your comment posted immediately, it is being reviewed by the moderation team and may appear shortly, generally within an hour.

We aim to have all comments reviewed in a timely manner.

Comments that violate our community guidelines will not be posted.

Read our community guidelines here

Discussion loading ...

To view this site properly, enable cookies in your browser. Read our privacy policy to learn more.
How to enable cookies