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Ontario’s biosimilars policy and your drug plan

On December 20, 2022, the Ontario Ministry of Health issued a news release stating that transitioning to biosimilars will allow patients to continue receiving the same high-quality treatment and enable the government to fund more new drug therapies. As new biosimilars are approved by Health Canada and enter the Canadian market, additional biologic drugs may be included as part of this policy change. Ontario represents the eighth Canadian jurisdiction to adopt mandatory biosimilar transitioning.

Here’s what you need to know…

Under this new policy, Ontarians receiving coverage under the Ontario Drug Benefit (ODB) program for Copaxone®, Enbrel®, Humalog®, Humira®, Lantus®, NovoRapid®, Remicade®, and Rituxan® will be required to transition to the biosimilar version before December 29, 2023, or the expiry date of their current Exceptional Access Program (EAP) approval (whichever is earlier), to maintain ODB coverage for their biologic. As of December 29, 2023, ODB will no longer cover originator biologics for the affected indications unless an exception applies. If a patient has a medical reason for not switching to a biosimilar, their prescriber may request an exemption, which will be reviewed on a case-by-case basis, through the EAP.

What does this mean for GreenShield plan members in Ontario? 

All GreenShield plan members in Ontario taking an impacted originator drug and coordinating with the ODB program will be required to transition to a corresponding biosimilar in accordance with GreenShield’s provincial coordination policies. This new biosimilars policy will mainly impact seniors aged 65 and older. 

GreenShield will be issuing letters to affected plan members near the end of May (except for those on insulins which will follow at a later date) advising them to discuss a transition to the biosimilar with their physician before their applicable deadline. However, if the EAP grants an exception to allow a plan member to remain on the originator, GreenShield will follow suit and pay for the originator to enable continued coordination of claims.

Support for your plan members…

GreenShield has partnered with NKS Assist, the provider of our specialty drug program, to offer impacted plan members access to a team of care coordinator nurses to help them navigate the transition process. This includes reaching out to prescribers to obtain a new prescription, setting plan members up with a new infusion clinic (if applicable), assisting with enrolment in the patient support program associated with their new biosimilar, and answering any additional questions. To participate in this optional support program, plan members (excludes those on insulins) simply use the contact information provided in their letter to speak to a NKS Assist nurse. 

Questions?

Speak to your account team to learn more about Ontario’s biosimilar policy and its impact to your plan.