In this post we provide context for the upcoming change to coverage through Alberta’s government drug programs for biologic medications.
Many of us have seen advertisements for medications such as Embrel, Remicade, or Humira. Some of us may be using these medications to treat serious chronic conditions such as rheumatoid arthritis or Crohn’s disease.
What is a Biologic Medication?
These biologic medications are engineered using living organisms instead of being chemically synthesized. Because of the complexity of manufacturing, storing, and administering them, they are also extremely expensive. Often tens of thousands of dollars each year.
Unlike regular, chemically synthesized medications, biologics don’t have generic, or lower-cost alternatives. However, they do have biosimilars, which are engineered using the same composition as the originator biologic drug.
Biosimilars aren’t called generic equivalents because the living cells involved means that there will inevitably be variance in the composition of each batch of medication produced.
Why the change?
To provide additional context for the importance of this initiative, in 2018, there were approximately 8,000 patients submitting claims for Remicade, Humira, and Enbrel. The total amount paid by the government of Alberta for those 8,000 patients was over $167 million in one year.
With the number of claimants for these ultra high-cost drugs is expected to increase, the need to achieve a balance between covering the types of medications that these claimants require and protecting the sustainability of these publicly funded programs is clear.
Provinces across Canada are looking at cost-saving alternatives to be able to deliver these medications via provincial drug programs. British Columbia’s PharmaCare program was recently the first to replace more costly biologic medications with biosimilars.
The rollout in BC’s biosimilar initiative concluded in 2019.
Alberta’s drug Biosimilar initiative will take effect 1 March 2020.
What do you need to know?
If your prescription drug plan includes a cap on annual drug spend, plan members may need to be informed that coverage for their medication under the provincial non-group plan may change.
Patients who are taking these medications will have to work with their doctors to convert to the biosimilar equivalent or go through the process to have the brand name drug approved for specific clinical reasons.