Alberta & Biosimilars: Action required for members on biologics.

What’s changed?

Following BC, the Alberta government has announced its Biosimilar Initiative – expanding the use of biosimilars in place of biologics for certain conditions. This means Albertans using certain biologic drugs covered by an Alberta government program will need to switch to the biosimilar version to continue to receive coverage through the provincial plan.

When is the change happening?

It depends on what the member is taking the biologic drug for. Alberta is introducing these changes on two dates – the first on January 15, 2021 and the second on March 1, 2021.

Please refer to the tables below to see when each biologic is affected.

Effective January 15, 2021:

Drug Name

Biologic

Biosimilar

Taking biologic for:

 

Etanercept

 

Enbrel

Brenzys

Ankylosing Spondylitis

Rheumatoid Arthritis

Erelzi

Ankylosing Spondylitis

Psoriatic Arthritis

Rheumatoid Arthritis

Infliximab

Remicade

Inflectra

 

Renflexis

Ankylosing Spondylitis

Plaque Psoriasis

Psoriatic Arthritis

Rheumatoid Arthritis

Crohn's Disease

Ulcerative Colitis

Insulin glargine

Lantus

Basaglar

Diabetes (Type 1 and 2)

Filgrastim

Neupogen

Grastofil

Neutropenia

Pegfilgrastim

Neulasta

Lapelga

Fulphila

Ziextenzo

Neutropenia

Rituximab*

Rituxan

Truxima  

Riximyo

Ruxience

Rheumatoid Arthritis

Glatiramer1

Copaxone

Glatect

Multiple Sclerosis

*   Please note that for those taking Rituximab for Granulomatosis Polyangiitis or Microscopic Polyangiitis, the effective date is March 1, 2021 – see below.

Effective March 1, 2021:

Drug Name

Biologic

Biosimilar

Taking biologic for:

Rituximab

 

Rituxan

Ruxience*

Granulomatosis Polyangiitis

Microscopic Polyangiitis

What does this mean for Alberta residents taking a biologic?

Albertans over the age of 18 with coverage under the provincial plan, taking one of the biologic drugs listed for one of the conditions noted, will need to switch to the approved biosimilar version in order to receive continued coverage from the provincial plan. They need to make the switch before the effective date noted above. After this date, the Alberta provincial plan will only cover the biosimilar version – not the biologic.

How does this affect Manulife drug plans for members in Alberta?

For Manulife plan members over the age of 65, we are aligning to the coverage that is offered through the Alberta provincial plan.  As such, these plan members will be required to make the switch to the biosimilar drug as noted in the chart above to receive continued coverage under their Manulife plan.

For members that make the switch before the deadline, there is no change to the process. We will consider claims for any portion unpaid by the Alberta provincial plan for biosimilars. We won’t consider claims for biologic drugs after the effective date. This is supported by our current contract wording and no changes to the contract or booklet will be required.

How will our plan members know?

Alberta Health has communicated these changes publicly and provided resources for doctors and pharmacists to share with their patients. It is likely many affected members are already aware of the change. In some cases, they may have already made the switch. Also, we are directly communicating with affected members to let them know what is happening and when.

What if a member is unable to switch to a Biosimilar?

Alberta Health will consider exceptions on a case-by-case basis for members who are medically unable to transfer to a biosimilar. The member’s doctor would need to submit a request for exceptional coverage on their behalf. If approved, the member would need to provide Manulife with proof of their approval and Manulife will consider balances for the biologic drug according to policy provisions.

For more details, visit the Alberta website or talk to your Manulife representative.

1 Glatiramer is a non-biologic complex drug.