Canadian Payer Reports a Successful Switch to Biosimilars

In 2016, not-for-profit health benefits company Green Shield Canada (GSC) started to give biosimilars preferred product listings on its formularies, covering reference biologics only in exceptional circumstances for patients who were new to biologic therapy. Then, in 2018, GSC launched a pilot Biosimilar Transition Program, through 3 plan sponsors, under which patients already receiving biologics were switched to biosimilars. Now that the pilot is complete, the payer is calling the program a success.

Patients who were members of the 3 sponsored plans and who were receiving reference infliximab or etanercept therapy were sent letters explaining the pilot program and detailing 2 available options. First, patients could proceed with the one-time switch to biosimilar infliximab or etanercept after discussing it with their prescriber. Second, they could continue to receive their originator biologic and pay the difference in cost between the 2 drugs out-of-pocket.

In total, 41% of members opted to switch to a biosimilar, while 26% chose to remain on the originator product and pay the difference in cost. Another 9% were approved to continue on the originator product after providing clinical justification, while 3% changed to a different treatment entirely for reasons unrelated to the program (the final 21% of patients had not yet submitted a claim at the time of the pilot’s conclusion). GSC’s analysis shows an average savings of $8500 ($6395 USD) per member per year under the program.

GSC notes that, while it originally launched the pilot with the goal of a 60-day timeline to the switch, it amended that goal to 90 days based on feedback from plan sponsors.

It also notes that it partnered with HealthForward, a payer service provider that has dedicated care-coordinator nurses who follow a case management process to provide patients with the assistance that they need. The nurses ensured that there was contact with the patient at 1 month, 3 months, and 6 months to address any issues or answer questions, and HealthForward provided a dedicated phone line for patient support.

GSC says that there were no unexpected questions or concerns during the pilot; most patients were receptive to the switch, and some had even considered switching to a biosimilar prior to the pilot program’s commencement.

Questions asked by patients included the rationale for the change, the cost difference between the products, the efficacy of the biosimilar, and next steps for switching. Among patients who had concerns about the efficacy of the biosimilar, “Their concerns were satisfactorily addressed by the HealthForward care-coordinator nurses,” says GSC in a statement on the program.

On the heels of the successful pilot, GSC is opening the program to any plan sponsor who wants to take part.