Ontario biosimilar initiative

July 19, 2023

The Ontario government has announced a biosimilar initiative to expand the use of biosimilar drugs (in place of biologics) for specific conditions. We are aligning our coverage to the Ontario plan, for members who have provincial plan coverage. This means Ontario members, who are age 65 and older and are taking certain biologic drugs (listed below) will need to switch to a biosimilar drug to continue to receive coverage through the Ontario Drug Benefit (ODB) and their Manulife plan.

Timing

This initiative is in effect now. The province is allowing a transition period until December 29, 2023, which gives members time to talk to their health care provider and get a new prescription for a biosimilar product to treat their current condition(s).

Communications

We will be informing impacted members in September. The province has communicated the changes to the ODB publicly, and provided information and resources to specialists, doctors, and nurse practitioners. It is likely many affected members are already aware of the change.

Biologic drugs affected by the Ontario biosimilar initiative

Example: A member age 65 and over, who is taking Humira for one of the listed conditions, must change their prescription to a biosimilar drug before December 29, 2023, to receive ODB coverage.

Claims and coverage

As of December 29, 2023, the Ontario provincial plan will only cover the biosimilar version of the drug – not the biologic.

There is no change to the Manulife claims process for affected members that switch to a biosimilar drug. We will consider claims for any portion unpaid by the Ontario provincial plan for biosimilars. We won't consider claims for biologic drugs after December 28, 2023. This is supported by our current contract wording and no changes to the contract or booklet will be required.

Exceptions

Ontario 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, through the ODB’s Exceptional Access Program. If approved, the member would need to provide us with proof of their approval, and we will consider balances for the biologic drug according to policy provisions.​

More information

For more information about the Ontario biosimilar initiative, please visit the Government of Ontario website or speak to your Manulife representative.

¹ Glatiramer is a non-biologic complex drug, however the ODB is including this drug in their biosimilar program.