October 1, 2019
For business owners, plan administrators, and sponsors
What’s changed?
Earlier this year, British Columbia announced its Biosimilar Initiative – strengthening its PharmaCare program by switching patients to biosimilars in place of biologics, for certain indications. The affected biologic drugs are Remicade®, Enbrel® and Lantus®.
Health Canada has indicated that authorized biosimilars are as safe and effective as any other biologic drug*.
When is the change happening?
It depends on what the member is taking the biologic drug for. BC PharmaCare is introducing these changes in two phases – the first happens on November 26, 2019 and the second happens on March 6, 2020.
Please refer to the tables below to see when each biologic is affected.
| Drug | 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 |
| insulin glargine | Lantus® | Basaglar™ | Diabetes (Type 1 and 2) |
| Drug | Biologic | Biosimilar | Taking biologic for: |
|---|---|---|---|
| infliximab | Remicade® | Inflectra® Renflexis® |
Crohn's Disease Ulcerative Colitis |
What does this mean for BC members taking a biologic?
Members currently taking one of the biologic drugs for the indications listed will need to switch to the approved biosimilar version by the date noted above in order to receive continued coverage. After this date, BC PharmaCare will only cover the biosimilar version – not the biologic.
How will members know?
BC PharmaCare has been proactive in communicating these changes and providing resources for prescribers and pharmacists. 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.
How does this affect drug claims considered under the Manulife plan going forward?
For members that make the switch before the deadline, there is no change to the process. We will consider any portion unpaid by BC PharmaCare for biosimilars. We won’t consider payments for biologic drugs after the effective date (unless an exception has been granted – see below). This is supported by our current contract wording and no changes to the contract or booklet will be required.
What if a member is unable to switch to a Biosimilar?
BC PharmaCare 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 Special Authority Request to BC PharmaCare. If approved by BC PharmaCare, they would need to provide Manulife with a copy of their approval and Manulife will consider balances for the biologic drug according to policy provisions.
For more details, visit the BC PharmaCare website or talk to your Manulife representative.
* Biosimilar biologic drugs in Canada: Fact Sheet, Health Canada, 2019