Just an update/reminder. This will initially affect those over age 65 on the Ontario Drug Benefit (ODB) Program (for seniors etc), but watch for private insurers to follow suit over the coming year(s). Biosimilars are anywhere from 25 to 50% less than the biologic (which is often $15,000-$40,000 a year), so the savings can be huge to all parties.
PENSION & BENEFITS MONITOR MAGAZINE
Ontario Drug Benefit (ODB) recipients who are on an originator biologic will begin to transition to a Health Canada-approved biosimilar version starting March 31. While this is good for the provincial healthcare budget, the decision may have a significant financial impact on private plans that provide coverage supplementary to the ODB, without restrictions, says an Eckler ‘GroupNews.’ Ontarians receiving coverage under the ODB program (residents 65 years old and over) for biosimilars to treat conditions such as arthritis, diabetes, inflammatory bowel disease, and psoriasis will be required to switch to a biosimilar or pay out-of-pocket for the reference product by December 29. Exemptions will be considered for patients in certain clinical circumstances on a case-by-case basis in consultation with their healthcare provider. It says plan sponsors may wish to examine their drug plan language and their own philosophy to avoid cost-shifting from ODB to their private plan. It is anticipated that private plans may also adopt similar initiatives that require plan members to switch to available biosimilars in an effort to sustain affordable plan costs while continuing to provide safe and effective medication options. Ontario is the seventh province ‒ and eighth jurisdiction in Canada ‒ to announce a biosimilars switching policy. British Columbia, Alberta, New Brunswick, Quebec, the Northwest Territories, Nova Scotia, and Saskatchewan had previously done so.