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Green Shield Canada

Episode 6: Financial health

Episode 6: And now for something completely indifferent
In episode 6, hosts Sarah Murphy and David Willows invite GSC’s health innovation leader Peter Gove back to the studio to discuss financial health and its impact on broader mental health. Sarah and David also introduce the first edition of the Ask the Pharmacist podcast, this one addressing the quality of care in Canadian pharmacies and what the average patient can do to maximize the experience. 
And now for something completely indifferent

And now for something completely indifferent

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Episode 6 Transcript


[0:00:14.9] SM: Hello and welcome to another episode of GSC’s Podcast; And Now For Something Completely Indifferent, where we’ll be discussing the hottest topics and trends in Canadian health benefits. I am one of your hosts, Sarah Murphy.

Before we get stated with today’s episode, we would like to remind our faithful listeners that the views expressed in this podcast are those of the individuals speaking and not necessarily the views of GSC. We will sometimes talk about sensitive and possibly controversial subjects and we therefore reserve the right to potentially offend and are apologizing for it upfront.

You can download this podcast from our website at\podcast, or subscribe to it from wherever you get your podcasts. We also encourage you to read our publications, specifically the inside story and follow the script, which you can also download from our website. Please be sure to follow the conversation on Twitter and LinkedIn.

Now let’s get started.


[0:01:11.9] SM: Today’s episode is once again hosted by David Willows, GSC’s Chief Innovation and Marketing Officer. Hello David.

[0:01:19.9] DW: Hi, Sarah. Or maybe I should say welcome back.

[0:01:23.2] SM: Thank you.

[0:01:24.2] DW: Frequent listeners of our podcast will know that Sarah’s often on vacation, always in Florida where it’s always cold, am I right?

[0:01:30.8] SM: That’s right.

[0:01:31.2] DW: Yes, yes. Another cold vacation in Florida?

[0:01:33.8] SM: Another cold one – we were there for a week, and the first few days were quite chilly for middle of March. Then it warmed up by the end. Yeah, we’re a little cursed.

[0:01:42.8] DW: Okay. Well, thank goodness. During your absence, listeners to this episode should know that a first has occurred in that we recorded our full interview without your presence, which meant that I had to be trained really and you speak to me like I am a dog. A smart dog, but a dog, to press four buttons and record the half hour that people would hear today.

I thought it went pretty well, but the technological process of this is that you press stop and it gets uploaded into some –

[0:02:19.9] SM: Cyber space.

[0:02:21.1] DW: Yeah, I don’t know understand any of that. You immediately get access to it. You were down in Florida.

[0:02:25.7] SM: That’s right.

[0:02:26.6] DW: What did you hear when 10 minutes later, you got to hear this recording?

[0:02:30.7] SM: The e-mail came in. I got the bing, that the recording was there. I immediately got off the beach, went to my computer, turned it on, opened the file and heard silence. There was nothing there. You recorded this episode, you were so proud of yourself for having achieved the –

[0:02:49.8] DW: Technical proficiency.

[0:02:51.7] SM: Right. There was nothing recorded.

[0:02:53.9] DW: You wrote me in a panic. I think you were trying to be diplomatic, because I may have just wasted two guests’ time and my own ego is going to be greatly destroyed by this. The fact is you sent it to me and I played it here and the beautiful sound of three people talking about biosimilars in Canada emerged. You are wrong. I was right. I did it right. But what were the descriptions of me in your mind at that point that you had for my perceived failure here?

[0:03:24.3] SM: I’m not going to share that over the podcast what I was thinking, or what I was going to write to you. Something along the lines of it was only four buttons that you had to hit. How could you screw that up? It’s all good. I won’t repeat some of the words that were in my head at the time.

[0:03:40.8] DW: For the record, I didn’t screw it up. I nailed it.

[0:03:44.9] SM: You nailed it.

[0:03:46.0] DW: Okay. Let people hear. They could decide whether they like the content or not, but it exists.

[0:03:50.5] SM: Yeah. The quality is good.

[0:03:51.7] DW: Yes, yes, yes. We’re going to talk our colleague Ned Pojskic and special guest Cheryl Koehn, and we’re going to talk about getting people on biosimilars in Canada.


[0:04:05.6] DW: Today in the wellness room/podcast studio we have a couple of guests with us. One is familiar to previous podcast listeners; it is my colleague Ned Pojskic, who is our leader of pharmacy health provider relations; Ned’s new title. We’re not going to get into that today. That’s a holder in can of worms, that we’ll talk about at some future podcast.

Welcome Ned. You’ve talked to us before about medical marijuana. Now you’re back to talk about the world of biosimilars. A very special guest from outside of GSC that we have here today is Cheryl Koehn. She is the founder and president of our Arthritis Consumer Experts. Cheryl, tell us what is Arthritis Consumer Experts.

[0:04:47.7] CK: Well, first of all thank you for asking me into this fabulous wellness room. I feel better already.

[0:04:53.4] DW: Yeah. You’re very safe here.

[0:04:54.2] CK: Yes, exactly. As my title suggests, I am a person who decided to form an organization 20 years ago. The reason I decided that was because I was diagnosed 10 years prior to that with rheumatoid arthritis. At the time, I couldn’t look out on the horizon and see anybody like me looking back. There was no formalized community of patients, people living with inflammatory types of arthritis. I have rheumatoid arthritis as I mentioned.

I wanted to change that. I actually wanted to build a community of people who could share experience, share voice, educate, inform and do all of those things. 20 years later we have a membership and subscribership of 50,000 people across the country.

[0:05:43.1] DW: It’s remarkable.

[0:05:44.7] NP: Yeah, doing all of our work in both official languages in Canada. Yeah, we are very busy. Now I look across the horizon and I see a lot of people like me looking back. I feel like I have big family for somewhat selfish motivation David, for forming an organization. It’s been really fruitful I think in terms of an education and informational perspective.

[0:06:06.3] DW: I’m sure the end results are not at all selfish and lots of people are being helped. An interesting dynamic today in the studio, because we have basically an insurance company, pharmacy benefit manager who is taking certain policy steps around medications that are so critical to your community, but we wanted very much to have the voice of the patient/even consumer in some respects from here.

This is a bit of a thorny topic in our industry. The cost of biologics, the emergence of biosimilars and strategies around how do we get people to biosimilars. Perhaps, now we’re talking specifically in this podcast about how do we move people from taking a biologic to taking a biosimilar.

I am going to start with the industry perspective and ask Ned some questions. Green Shield I think has tried to take a bit of a leadership position on this particular question, but let’s talk about the background and why we’re doing that. Ned, what is the story about biosimilar uptake in Canada?

[0:07:08.1] NP: I think the story really goes back to late 2014 actually when the first biosimilar was approved, which was Inflectra for several indications. When it came to market, there was a big question around how is the medical community, the patient community going to embrace this new product?

There were serious questions around whether – in particular the focus on the medical community, wasn’t it going to be prescribing those products? Because there had been years, maybe 15 years of experience with the originated products, namely Remicade, and now there is where the experience had just simply taken hold of physicians, knew those products, they prescribed them routinely, they know the impact of those products, they know the ramifications, they know they work for their patients.

The question became is the medical community going to be comfortable with something brand new? With the perception leaving the language around biosimilar is similar good enough, should it be identical? Etc.

Our position really was developed by that complete societal understanding of what the impact of those drug is going to be once it hit the market. We quickly identified to a review to literature that no, physicians are not going to be embracing these projects, that the healthy community is going to have to really build acceptance of them.

We saw ourselves as the agents of that process, if you will. If we as a payer took a leadership position and said that these products are after a thorough review are both equally efficacious and safe, then why don’t they have a preferred place on our formulas in such a way that would allow their uptake to grow, and for that to flourish and for that market to continue to thrive?

I think that if you look at the story of biosimilars, we always go back to drug plan managers, the challenge you always face is how do you put a price on certain aspects of health, right? The typical scenario you face is one of new product comes to market, three times more expensive, yet it has 10% better efficacy. Now you as a drug plan manager have to make a choice of is that 10% worth three times the cost?

[0:08:59.2] DW: In this day and age we’re talking about tens of thousands of dollars.

[0:09:01.8] NP: Exactly. In the biosimilar space, it was a very choice because it’s the same level of efficacy and safety, but lower cost. Where is the dilemma?

[0:09:10.5] DW: Okay. Now in Canada when you look at both the private and public funders, what do we see the rates of acceptance of biosimilar is at? Or is it getting better, or is it still quite poor?

[0:09:23.4] NP: From a formula replacement perspective, in other words where we put these drugs on formulae, we’re seeing public payers increasingly across Canada now embrace the notion that biosimilars do have a preferential role to play on public drug plan. You see it in Ontario, you see it in BC, you see it across Canada.

Those policies have been really helpful, because I think they stimulate what we did back in 2015, which is to say this is the right approach to list these products preferentially, but despite that, despite those policies what you would think would guarantee and create a place for biosimilars, the uptake has still been abysmally small.

In fact, as a percentage of market share I think Inflectra, and sort of first by similarly still hovering around 2% to 5%. Shocking, considering when you compare that to the generic situation, when you have a generic come to market over the course of the first year, you see the originated product drop, plummet down to almost nothing. It’s a very different curve here. Again, the rationale for that is still not fully clear.

[0:10:15.7] DW: Okay. How does Canada compare at this than others?

[0:10:22.5] NP: Again, if we compare it to the European market in particular, where European Union issued a very  interesting paper, which showed that it effectively across the 11 years that they’ve had biosimilars and 20 different biosimilars that have improved that had no safety or efficacy concerns, their uptake has been very high.

They do employ a number of different strategies, which Canada hasn’t seen yet. They are definitely from their perspective a lot more supportive about and some is across the market. They have seen great uptakes; some cases up to 70%, 75% of all claims. Norway being a prime example of that.

[0:10:55.6] DW: Excuse me. How many years ahead of us are they at this point?

[0:10:58.4] NP: If we take a look at the sheer number why, I mean they’ve had 11 years of since the first biosimilar was approved. In Canada we’ve had one this 2015, so we’re about three years in. Not counting the very first biosimilar ever approved in 2009, which is a small molecule, not a major impact. They are definitely ahead, so they’re eight years ahead. We’re hoping that we’re –

[0:11:16.1] DW: We’re not trending well.

[0:11:17.3] NP: No. There are differences in the system itself that allow them to enforce those kinds of policies very differently than the way we can in Canada.

[0:11:25.2] DW: Okay. What have you and your team tried to do over the last few years for GSC to play a part in a more rapid adoption of biosimilars?

[0:11:35.0] NP: I think the key part for us was our biosimilar policy. The notion was that if we tier biosimilars preferentially, in other words we put them as deep products in our formularies that that would then require physicians to start to think about prescribing them, to put patients on it, grow their acceptance, their familiarity and then the whole system will flourish according to that.

We’re certainly seeing that. We’ve seen some of that and I think the activity around Inflectra was very helpful. The numbers and the fact that we are responsible for the bulk of the prescriptions, despite a small market share was all encouraging and all helpful. There is a bigger system thing that needs to happen here both public and private going forward.

The system needs to accept the fact that I think these products do have a role to play and that they’re essential to creating the necessary room to continue to list new drugs as they come to market.

[0:12:22.1] DW: Have others followed suit? Are we still the only ones?

[0:12:25.2] NP: From a private payer perspective, yes. From a private payer perspective, we do see it now as almost a de factor standard that these products are listed exactly the same way as GSC list them. From a private payer perspective, the only foray we’ve seen is from one competitor who has added – as a LC, if you will, the lowest cost of turning. In other words, allowing both products, but paying down to the cost of one product. The rest of the products will continue to be equally placed on formularies.

[0:12:51.1] DW: I mean, you talk to – It’s a small community. We talk to our competitors, mainly our friends. What is the hesitation on their part to do what we’re doing?

[0:13:00.2] NP: There is a perception and I’m really glad Cheryl is here to talk about it as well. There’s a perception that patients, physicians will not be happy with any kind of policies that restrict choice and access, despite the rationality of that particular direction. There is a reluctance by other payers to rock the boat, if you will, or to do anything that might be I guess progressive in a way that might challenge some people, I would argue.

[0:13:23.1] DW: Yeah. Our industry has done generic substitution for how long? That wasn’t necessarily met with resistance right?

[0:13:29.8] NP: True. I mean, the other aspect too is that I think if you look at the general landscape there is a perception out there, despite the cost pressures in the system on the private payer plans today, there is a sense that employers aren’t yet necessarily making those really hard choices to be more aggressive in formulating a match, but we still see low penetration of managed formularies as an example of those things. There’s a sense that we’ll still keep to what we’ve been doing for fear of offending, or certain constituencies.

[0:13:56.0] DW: Okay. Cheryl, let me ask you, you’ve just heard what Ned told us about sort of self-effectively about our industry and some of the hesitation that we genuinely might have. Obviously, we’ve tried to push that away in our organization. It is important that you’re – interesting and important that you’re in our studio today, and your organization has a certain position on transitioning people from biologics to biosimilars. You’ve come out I think with some cautious support of this.

It is interesting, given Ned’s point of view here that we are [inaudible 0:14:28.5] we dont want to rock the boat with doctors and patients that you’re okay with this. Tell us your thinking inside the organization.

[0:14:38.6] CK: Sure. First the point, I think an important point of distinction, biosimilars are biologics. There is originators and there is biosimilars. They are both biologics and there has been a carefully crafted worldwide regulatory process in each jurisdiction that has responsibility for safety and efficacy.

Those frameworks have been built very carefully and with consultation with the organization I’m privileged to lead, as well as other patient and charitable organizations. We’ve all been well apprised about the regulatory process and have been in varying degrees involved in it. In other words, we’ve had skin in the game. I think that’s really important for your podcast listeners to understand.

David as the patients have been there, voices are maybe not necessarily identical to ours. I think we are ACE. The acronym stands for Arthritis Consumer Experts, stands not alone but maybe head. As we in our infancy grew up as an organization alongside researchers, we formed really out of my experience in the Canadian arthritis network and the absolute commitment following science, and letting science and the evidence and translating that evidence into information and education that patients like me can put their hands on and read and interpret and then take action with their own healthcare. It doesn’t matter whether you’re publicly looked after in terms of medication, or privately.

I think that’s fundamentally the difference for ACE and our voice and our position and our views on biosimilars, versus others in our community. We were actually really satisfied with the evidence that as Ned I think mentioned very early on in his remarks, biosimilars, biologic biosimilars are not, cannot be classified as generics because they’re a living cell line.

They so mimic the originator that while can’t be called generics, they are so similar to their originator what is generic like is the outcome in patients, in the results of treatment. Those are virtually identical; the clinical trials, the studies, the registries, all of the data that Ned referenced, it shows a mirror image in terms of safety and efficacy. ACE’s view is that’s very good.

We also understand that physicians and prescribers in general build up a clinical distalt with the product. Ned, I think you referenced this. They get comfortable writing a script for something.

[0:17:26.8] NP: This is not the fairiest at all either. It’s natural for a human being.

[0:17:30.2] CK: Absolutely not.

[0:17:31.0] NP: If it’s worked, I’ved always said – if something’s worked for me for 10 years, why would I change it?

[0:17:34.6] CK: Absolutely not. I think where the nuance is here with biosimilars is you can have the same result at a much lower cost. ACE is committed to a societal viewpoint, which I think is where Norway, Denmark, Germany, Sweden, wherever the countries in Europe who truly have a national healthcare system. Canada doesn’t. Then when you look at the provision in reimbursement for medicines, it’s even more fractured.

ACE really embraces that societal view. David, our wish is that all people with inflammatory arthritis can get access, can get reimbursement access to biologic, whether it’s an originator or a biosimilar.

What we’re talking about now is the community who’s been left outside, and that’s one we’re very concerned with and why we have been supportive of based on evidence, mind you. Always based on the evidence and the outcomes of patients.

While patients think, or physicians may think a policy such as the one that GSC has implemented may be removing choice, we don’t believe that to be true actually. What it shows is Infliximab is Infliximab. The science is crystal clear that a biosimila of Infliximab has the same outcomes from a patient perspective.

Where the community, some in our community may still be comfortable is transitionng. Moving someone who’s stable on therapy. The data for the most part actually supports it. Therefore, we don’t oppose transition. There is though some data and we think is upcoming needing at the European league against rheumatism, the European science expose, if you will, it’s the place where all science comes in Europe to be presented once a year. We’ll going to that in June.

We think there will quite a number of papers that look at what’s being called a nocebo effect. Where transition hasn’t been successful, it’s where there is lack of confidence and a lack of conversation between patient and physician. In this regard, this is where prescribers in our community, ACE and other arthritis organizations are aligned. That there has to be a conversation, there has to be full knowledge, a full package of information which I know you have developed in our providing year plan sponsors and plan members.

That’s actually critical data to success with this policy. If you as a prescriber write a script for a biologic originator and aren’t really convinced it’s the right one, guess what? The outcome isn’t going to probably be as good short-term. That’s called nocebo. It’s the opposite of placebo.

Whether we’re talking about originator or biosimilar, it’s the conversation betweent the physician and the patient, which is really paramount. That’s where we live and breath everyday, it’s to provide the evidence in easy to understand language. That’s a very long-winded answer to your question, but I think it’s fundamentally what distinguishes ACE from others perhaps who aren’t maybe as advanced in this conversation.

We view the generic compound, the generic name of the originator and the biosimilar, that’s what we look at, not the brand name extension. What does the science say about them? The science is very elegant and shows safety and efficacy that mirrors each other.

[0:21:29.7] DW: Okay. Terrific. Now you have I presume an ongoing dialogue with a physician community.

[0:21:35.6] CK: Sure.

[0:21:37.1] DW: We talk about your embrace of the science. Is the science getting through to them, and this is just a matter of what we call in our role, just change management depending and comfort? Or do they still despite – maybe you’ve read more of the science and have more of the evidence at your fingertips, they have busy jobs, but is the science infiltrating their thinking?

[0:22:00.8] CK: Yeah. One thing that needs to be clear is our rheumatology community, most of them are involved in the discovery and the deliver of science. They’re running a clinical research program and as do most specialty physicians as you know.

We have about 400 full-time practicing rheumatologists in this country and they are my personal heroes. They’re unbelievable. I would say arguably, the vast majority are not only is up to speed on the science as I am, far more so than I am. That’s your job.

[0:22:33.9] DW: Good to hear. Okay, good.

[0:22:34.4] CK: Yeah, we have ultimate faith in our rheumatology community and their level of knowledge. Where I will go next is to say that in every community, there are leaders who are comfortable with change and there those who would like to follow the leaders. I think probably in our estimation, we do have very good relationships right across the country, our own board comprises a number of these leading experts in our country.

They’re very comfortable with the notion and policy transition. Would be willing to do it if government told them, if in the public system said this is what we’re doing, they will have no problem doing that. Again, it’s the quality of the conversation, and that’s where we have headed, which is helping people have the conversation.

There are still some and I think they’re the minority, not the majority now, because the science is so clear. Because our European colleagues have shown us the way to take societal benefit with policy, deliver savings and hopefully brought in access, reimbursement access to biologics, they’ll come along. I really do believe that. There’s also some nuances about relationships with industry, that I think have to be transparent.

[0:23:49.9] DW: You’re talking about us?

[0:23:50.9] CK: No. No, I’m actually talking about the actual manufacturers of the medicines.

[0:23:55.7] DW: Okay. I was going to get to that on a second.

[0:23:57.7] CK: The industry, pharmaceutical industry in many ways does a huge service to public healthcare. They drive science. They’re responsible, because they’re going to make profit off the science for delivering quality, safe and effective medicines. They do that time and again.

In the case of biologics, it wasn’t incremental advance. It was a massive advance in my diseased state and many others. Full marks to the industry for doing that. Where we need to be care is where their support of practitioners and clinics and prescribing and things like that I think that need to be – people need to be aware.

We need to have a level field and a transparent field that says, “Here is a policy, here is the evidence, here is what it’s founded on.” Practice to in some ways mold – that might heresy to say it, but don’t shoot the messenger here, but is a tough thing to have to say. One of the reasons why the things that we do are fully transparent. People in the conversation at the public level have to show where all of their support comes from.

[0:25:07.9] DW: Okay. We’re glad to hear that the physician community has read, understood and embraces the science.

[0:25:13.3] CK: They’re topnotch, David. They’re topnotch.

[0:25:15.5] DW: Allows this to either of you. Are we still debating the science though with other groups, and potentially well-funded groups that force us to go backwards and still prove the efficacy of these products?

[0:25:30.8] NP: I mean, from my perspective and Cheryl please weigh in, the evidence is quite clear. If we go –

[0:25:36.1] CK: We’re talking just for clarification, other disease areas, or within arthritis?

[0:25:40.0] DW: Even the efficacy of biosimilars period.

[0:25:42.3] CK: Okay.

[0:25:43.6] NP: I mean, the regulators I could quite convinced that these products are safe efficacious in South Canada would never approve them to begin with. Furthermore, even if we just go to the switching side of things – we just recently produced a deck pulling all the different studies that have ever been done on switching. We saw 14,000 patients, 11 countries.

It’s just massive. It was like 40 slides of different studies that have been done, and not a single one of those had concluded in its conclusion that some of switching is not either safe, efficacious or affecting negatively in any way, shape or form.

What you do get is things that folks might pull out a chart out of one study and say, “Well, what about this?” Then it’s never going to be positioned as this is a problem. It was like, “Are there questions? Are there questions? Are there questions?”

[0:26:29.3] DW: Sowing the seeds of doubt.

[0:26:30.3] NP: Seeds of doubt and fear mongering quite frankly. I think that in many ways, the biosimilar conversation in Canada has brought the worst out in our healthcare system. All of those protectionism, fear mongering aspects have been ripe upfront and center, when in fact when you get down to bottom line, the evidence is quite clear as you’ve said yourself. Yeah.

[0:26:48.9] CK: Yeah. I think the fear mongering piece doesn’t serve patients. It just doesn’t serve patients. We try to really rise above that as we call it noise, and really again focus on the evidence. There are a couple of remaining questions frankly and particularly related to transition and that’s multiple transitions. There isn’t a big body of data here.

That’s not the policy where we’ve been talking about here on this podcast. We’re talking about a one-way transition. There is an abundance of evidence. They are large in the number of thousands as Ned has pointed out, registries where they’re systematically tracking patient outcome, safety and efficacy and know safety signals have a reason. I think that’s really important for patients to hear about.

There is also this notion that whenever you come up with the next gen, in a lot of product areas next generation is good. It’s intriguing that we’re thinking, or there were some early thinking that that wouldn’t be true with biosimilars as biologics. In fact, the science is pretty cool. It shows that the batches, the early batches of the biosimilars are even closer to the original batches of the originators and were showing this – in actual fact, the early production run.

There is improvements in manufacturing, there is all of those things, that should support patient confidence, which is supreme and physician confidence. We’re really talking about confidence here. I think as Ned has pointed out a couple of times, regulators are legally responsible for insuring safety and efficacy.

I’ve been volunteering on a number of working groups at Health Canada for the last 25 years. I have always viewed them to be very cautious in the interest of safety of the Canadian public. That’s not a question here at all. We’re talking about pricing mechanisms and policy mechanisms that potentially can bring more coverage with therapy addressing things like lifetime limits. These are important issues in my community.

Through responsible policy that built on evidence might be able to address, and address to the satisfaction of patients actually. If we’re going to keep patients at the center, that’s what we need to be thinking about; some of the things that we need to be thinking about. Not to diminish the role of the prescriber at all, but if we really are going to be patient-centered, these are some of the difficult questions we have to ask ourselves and answer based on evidence.

[0:29:52.5] DW: Yes, we’re big fans of difficult questions. Let me ask each of you this last question before we depart for the day. At this point in time on a scale of a very concerned to highly optimistic, what’s your thinking about biosimilar adoption in Canada?

[0:30:07.0] NP: From highly concerned to optimistic, I’d probably put myself maybe in the highly concerned, but I’d say concerned. I think that what the provinces have done has been enable – have helped to enable this new marketplace. There is always opposing forces and those sometimes do have a tendency to win over. I’m seeing a lot of that troubling activity marketplace today.

As I said, the adoption still continues to be low. I think we’ll continue to have biosimilars in Canada. I don’t think that they’re going to disappear tomorrow, but I think that we really do need to make those hard choices, to understand that if we’re – the entry of new drugs to market today is such that two out of three new products come into market at high cost. How can we sustain – how can employers were paying these bills at the end of the day sustain that if we don’t create those natural offsets with biosimilars and embrace the natural offsets?

I’m concerned we haven’t done that yet as an industry and we haven’t done that yet as a society. I’m optimistic, we’re moving in that direction, but we need to continue to accelerate that pathway.

[0:31:05.4] DW: Okay. Cheryl?

[0:31:06.3] CK: Yeah. I think, just by nature, I trend towards the positive in my viewpoint.

[0:31:12.1] DW: I could tell that already.

[0:31:13.9] CK: Yeah. There is no other way to live in the inflammatory. Actually the minute you turn negative, that you create negative. I am positive, because the products are excellent. There have been advances that have been made with biosimilars. The way the devices are injected, we know more about infusion procedures. We’ve learned lessons with the originators and thanks to the originator manufactureres, we’re bringing those products to market.

We’re living in a world now where those are off-patent and like in the generic world, things happen when a patent expires. I’m optimistic, because we are committed as an organization to see the people who need biologic therapy get on it. If biologic isn’t the answer, targets its small molecule is.

This isn’t just about biosimilars here. This is about innovation as I think you really focus on here as do your colleagues in other companies. As does I hope public payers. If we don’t constantly keep our eye in the bowl in terms of how we broaden, how we satisfy the unmet need decently of patients with autoimmune chronic diseases, we’re not doing our jobs. I think innovation, new things coming to the marketplace, how do we pay for those things?

That concerns us. We have medicines that are stuck at the public level and not being covered, because there’s no many to cover them. I think about those patients too. We think about all of our community. Not just those who are privileged to be on a biologic at the moment. People who are not on a biologic, we have people who need to go to a targeted small molecule from their biologic. It’s a complicated conversation and one we can’t just focus on one little piece. It’s the big picture that ACE I think is trying to look at and share information about.

[0:33:13.9] DW: Well, thank you to both of you for taking this complicated subject and I think making it more understandable for our listeners. I would be interested of the predictions that we’re making about how our industry will do on this if maybe we talk again on the future and see where we’re at.

[0:33:28.9] CK: It would be nice. Then we can then throw in a Toronto Raptor’s prediction too, how far they’re going to make it in the playoffs.

[0:33:34.6] DW: Okay. That’s very –

[0:33:36.3] NP: That’s something’s very close to my heart. I’m not going to start talking about that now.

[0:33:39.8] DW: Okay. Thank you very much.

[0:33:41.4] CK: Thank you.


[0:33:45.6] SM: Thank you to our listeners for tuning in to another episode of And Now for Something Completely Indifferent: A Canadian Health Benefits Podcast.

To be sure to get future episodes, please subscribe to this podcast wherever you get your podcasts, or you can visit our website at\podcast to download.

As a reminder, we talk about these issues consistently in our publications, which are available on our website. Specifically for today’s episode, you can check out our March 2018 GSC update about our biosimilar transition program.

Thanks for listening, and we’ll talk again soon.