British Columbia’s Biosimilar Switching Program Saves $732 Million in 5 Years

British Columbia's Biosimilars Initiative successfully saved about $732 million over 5 years by switching over 40,000 patients from reference biologics to biosimilars, while maintaining equivalent health outcomes and reinvesting the savings into the province's public payer program (BC PharmaCare) to enhance drug coverage and health care services.¹

The province published its 5-year results in a report on the program’s impact on patients and BC PharmaCare spending. The program began in 2019 and British Columbia was the first Canadian jurisdiction to adopt a biosimilar switching policy.² Since, 10 other jurisdictions (Alberta, New Brunswick, Northwest Territories, Nova Scotia, Newfoundland and Labrador, Quebec, Saskatchewan, Newfoundland, Yukon, and Ontario) have adopted their own policies.³

Biologics sales in Canada have grown steadily over time, representing over one-third of total pharmaceutical sales in 2020. Adalimumab is one of the top expenditures for BC PharmaCare, costing $97.66 million between 2020 and 2021 and is expected to grow annually by 14.2%.

“We are focused on reducing pharmaceutical costs to ensure people in [British Columbia] have a sustainable health-care system now and in the future, and our biosimilar initiative continues to do just that,” said Adrian Dix, Minister of Health for the province, in a statement.⁴ “Since our province led the country with the use of biosimilars in 2019, thousands of people have switched to a biosimilar, saving money and allowing us to expand our BC PharmaCare program and coverage further.”

Key features of British Columbia's standardized framework for biosimilar switching include:

• A 6-month transition period for switching from the reference biologic to its biosimilar to maintain BC PharmaCare coverage
• A requirement for a new prescription from a prescriber for the switch
• Support fees for prescribers and pharmacists assisting patients with the transition
• Lists of patients needing to switch, provided to prescribers
• Ongoing consultations with patient groups, clinicians, professional bodies, insurers, and drug sponsors
• Educational and support tools for patients and health care providers
• Coordinated communications through various outlets
• Monitoring of biosimilar utilization
• Exceptional coverage for patients who cannot switch for clinical reasons
• Delisting of reference biologics after the transition period

This framework ensures patients and providers have time to manage the transition, discuss concerns, and receive accurate information to minimize negative expectations and promote positive treatment experiences. It also includes administrative support for the transition process and options for exceptional coverage if needed.

The adoption of biosimilars among BC PharmaCare patients was substantial, ranging from 91% to 95% for various biologics, 24 months following the transition period. The authors noted a low rate of patient switching back to reference biologics was particularly noteworthy. For instance, only 1% of infliximab users reverted to the reference biologic, with similarly low rates observed for rituximab and adalimumab biosimilars. The author said that the findings suggested a high level of acceptance and continued utilization of biosimilars within the BC PharmaCare patient population.

Biosimilars for adalimumab, enoxaparin, and rituximab—which were added to the program during the second or third phase—experienced more rapid uptake compared with the earlier phases. This accelerated adoption is likely indicative of increased familiarity and confidence among both patients and prescribers in the biosimilar policy. Although most biosimilars achieved a switch rate of over 95% after the transition period, rapid-acting insulins (insulin aspart and insulin lispro) did not reach this level. This was attributed to the fact that Health Canada has not yet approved rapid-acting biosimilar insulins for use in all brands of insulin pumps. Consequently, the Ministry of Health extended coverage for the reference rapid-acting insulin for patients who use specific insulin pumps.

The majority of reinvestments from savings generated by biosimilar adoption was directed toward enhancing the BC PharmaCare program through improvements in consultation with clinicians, patients, and caregivers. The potential upcoming drug listings that may be facilitated by biosimilar savings include:

1. Lumasiran (Oxlumo) for the treatment of primary hyperoxaluria type 1
2. Maribavir (Livtencity) for the treatment of posttransplant cytomegalovirus infections
3. Foslevodopa/foscarbidopa (Vyalev) for the treatment of Parkinson disease
4. Glecaprevir-pibrentesvir (Maviret) sachets for the treatment of chronic hepatitis C in pediatric patients
5. Vericiguat (Verquvo) for the treatment of heart failure
6. Mavacamten (Camzyos) for the treatment of hypertrophic cardiomyopathy

References

1. British Columbia government. B.C.’s biosimilars initiative: a report on patient and financial impact. British Columbia government. June 14, 2024. Accessed June 17, 2024. http://news.gov.bc.ca/files/BCBiosimilarsInitiativeAReportonPatientandFinancialImpact_June%202024.pdf

2. Davio K. British Columbia becomes the first Canadian province to mandate a switch to biosimilars. The Center for Biosimilars^®. May 28, 2019. Accessed June 17, 2024. https://www.centerforbiosimilars.com/view/british-columbia-becomes-the-first-canadian-province-to-mandate-a-switch-to-biosimilars

3. Jeremias S. Prince Edward Island announced new biosimilar switching policy. The Center for Biosimilars. October 14, 2023. Accessed. June 17, 2024. https://www.centerforbiosimilars.com/view/prince-edward-island-announces-new-biosimilar-switching-policy

4. B.C.’s biosimilar initiative saves money, reinvests to expand drug coverage. News release. British Columbia government. June 14, 2024. Accessed June 17, 2024. https://news.gov.bc.ca/releases/2024HLTH0081-000927