Earlier this year Green Shield Canada (GSC) introduced our Biosimilar Transition Program, which we piloted with three of our plan sponsors through the summer and into the fall of 2018. The pilot is now complete, and following its success, we’re pleased to offer this innovative program to all GSC plan sponsors. In the meantime, here’s an overview of the program and the highlights of the pilot results.
Safely transitioning patients to a biosimilar
As you may recall, in 2016, GSC started listing biosimilars as preferred products under our formularies and covering the originator products only in exceptional circumstances for patients newly starting biologic therapy.
After introducing our biosimilar standard, GSC monitored and investigated the emerging scientific evidence examining the safety and efficacy of transitioning from an originator biologic product to the biosimilar counterpart. We also consulted with the Arthritis Consumer Experts, a leading national, patient-led organization that provides evidence-based education in Canada. Since all evidence pointed to patients safely transitioning from an originator biologic to a biosimilar product with no loss of clinical benefit and no compromise in safety, we launched GSC’s Biosimilar Transition Program and commenced the pilot.
What drugs and conditions?
The Biosimilar Transition Program currently focuses on Remicade® and Enbrel® for these rheumatic conditions:
REMICADE: Rheumatoid arthritis, Ankylosing spondylitis, Psoriatic arthritis
ENBREL: Rheumatoid arthritis, Ankylosing spondylitis
Note that as the evidence on transitioning to biosimilars grows, more indications for the existing biosimilars are approved, and new biosimilars enter the market, the number of drugs and indications eligible for the GSC program will grow.
Snapshot of the pilot
Eligible plan members were identified for the three GSC plan sponsors that participated in the pilot. Of these, 41 per cent of plan members transitioned from the originator biologic (Remicade or Enbrel) to a biosimilar product, and 26 per cent chose to remain on the originator at the reimbursement level of the biosimilar. This means that 67 per cent of participants were reimbursed the cost of the biosimilar resulting in significant savings. Our analysis showed an average savings of $8,500 per member per year for the population participating in the pilot.
Nine per cent of plan members were approved to continue on the originator biologic after providing valid clinical justification. Independently of this transition program, three per cent changed treatment to an entirely different drug. At the time of publication of this article, 21 per cent had not yet submitted a claim, so we’re unable to determine status of their transition.
The plan member experience
One of the goals of the pilot was to ensure that the processes we have in place result in an optimal plan member experience. We initially launched the pilot with a 60-day transition period, but changed it to 90 days based on feedback from participating plan sponsors. This was an important learning that resulted in a change to the program going forward.
To provide a strong support system to help plan members with the transition, GSC has partnered with HealthForward, the leading payer service provider for Medication Management in Canada focused on optimizing patient health outcomes and access to therapy. HealthForward’s dedicated team of care-coordinator nurses follows a detailed case management process to provide plan members with the assistance they need.
HealthForward care-coordinator nurses ensure there are regular touchpoints (beginning when the plan member first contacts HealthForward, one month later, three months later, and six months later) to check in with the plan member, address any issues, and answer questions. There is also a dedicated phone line that plan members can call at any point during their transition should they need additional support.
Both GSC and HealthForward have considerable experience in managing initiatives such as the Biosimilar Transition Program, and we didn’t encounter any unexpected questions or concerns during the pilot. Here are some highlights from the calls:
- Most plan members understood the change being made to their plan and were receptive.
- Some proactive plan members had already discussed transitioning to a biosimilar before receiving the letter.
- Questions included: reasons for the change, amount covered under the plan, cost difference between theo riginator and the biosimilar, efficacy of the biosimilar, and next steps.
- Some plan members had questions about the efficacy of the biosimilar and their potential response to it compared with their experience on the originator product. Their concerns were satisfactorily addressed by the HealthForward care-coordinator nurses.
- A number of plan members expressed appreciation for the support provided by the care-coordinator nurses.
What’s next?
With the completion of the pilot program, GSC is now opening up the program to any plan sponsor who wishes to add it to their plan. We strongly encourage you to speak to your GSC account team about opting in to the Biosimilar Transition Program. Note that the program currently applies only to situations where GSC is the primary payor (i.e., not for coordination of benefits claims) and is not available for residents of Quebec (where GSC has to provide the same level of coverage as RAMQ).
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