The next step in drug plan innovation: Green Shield Canada’s (GSC’s) Biosimilar Transition Program
In 2016, GSC unveiled a new standard approach around biosimilars for patients newly starting biologic therapy: Under GSC formularies, biosimilars are listed as preferred products, and the originator products are covered only in exceptional circumstances.
In keeping with our commitment to provide innovative solutions in pharmacy benefit management, GSC is taking the management of biosimilar drug products a step further with the Biosimilar Transition Program.
A program based on evidence…
Since introducing our biosimilar standard, GSC has been closely monitoring the emerging scientific evidence examining the safety and efficacy of transitioning from an originator biologic product to the biosimilar counterpart.
The evidence has rapidly accumulated over the last two years, and it is all pointing in the same direction: patients can safely transition from an originator biologic to a biosimilar product with no loss of clinical benefit and no compromise in safety. Over 1,500 patients have now been involved in 13 transition studies, conducted across 11 countries. This is a staggering amount of evidence that outpaces the evidence available for any new drug entering the market today. In addition to the robust clinical-trial evidence, there is also a tremendous amount of “real-world” data emerging from Europe, where biosimilars have been available since 2006. This evidence is complementary and supports the clinical trial information.
Taken together, all the evidence strongly supports safe and effective patient transitioning to biosimilars and underpins the basis of GSC’s Biosimilar Transition Program.
The Biosimilar Transition Program in detail
Initially the Biosimilar Transition Program will focus on Remicade® and Enbrel® for three rheumatic conditions:
- Rheumatoid arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
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.
This program will not be automatically added to all our prescription drug plans; plan sponsors will be given the opportunity to opt in to the program later in 2018. Note that the program will apply only to situations where GSC is the primary payor (i.e., not for coordination of benefits claims) and will not be available for residents of Quebec (where GSC has to provide the same level of coverage as RAMQ, which is not transitioning its plan members to biosimilars).
How was the Biosimilar Transition Program developed?
In addition to examining the scientific evidence, GSC developed the program, including the criteria, in consultation with the medical and scientific advisory board members of Arthritis Consumer Experts (ACE), a leading national, patient-led organization that provides evidence-based education and strategic, sustained government advocacy in Canada.
ACE actively supports biosimilar use and provides research-based information on biosimilar safety and effectiveness to inform consumers and patients.
The plan member experience…
The program is expressly designed with a strong support system to help plan members transition from an originator product to a corresponding biosimilar by working closely with a dedicated team of care-coordinator nurses who will assist patients with the transition process.
Plan members currently taking Remicade or Enbrel for one of the targeted conditions will be sent a letter explaining the program, the evidence for transitioning, and next steps. The letter outlines the two available options:
1. To go ahead with a one-time transition to the biosimilar after discussing it with their doctor.
2. To continue treatment with the originator biologic and pay the difference in cost between the two products.
Plan members who decide to transition to the biosimilar are directed to call a dedicated phone line staffed by a care-coordinator nurse who will guide patients through the transition process.
Reduction in a plan member’s claim reimbursement will begin 60 days after the date of the letter. Claims won’t be denied, we will simply base reimbursement on the biosimilar price regardless of the drug submitted on the claim.
We are currently piloting the Biosimilar Transition Program with a select group of GSC clients. This pilot is taking place through the first half of 2018, and we expect to have the program available for the remainder of our book of business in the latter part of 2018.
In the meantime, we strongly encourage you to speak to your GSC account team about the benefits of GSC’s Biosimilar Transition Program and the potential cost impact to your plan.