Ontario’s New Biosimilar Drug Initiative and It’s Affect On Employee Benefit Plans
As of March 2023, Ontario Drug Benefits (ODB) patients that are on biological drugs are required to begin the transition to the biosimilar equivalent. A biosimilar is a biologic drug that is highly similar to a biologic drug that was already authorized for sale. These biologic medications enter the market once the patents or data protection rights for the original biologic expire. Biosimilars are approved by Health Canada, offering similar effectiveness, safety, and quality as their originator counterparts. This move allows for cost-effective alternatives while ensuring patients receive high-quality treatments.
Effective March 31, 2023, Ontario Drug Benefit (ODB) recipients using originator biologic medications will begin transitioning to Health Canada approved biosimilar versions. Biosimilars undergo a rigorous approval process by Health Canada, demonstrating comparable effectiveness, safety, and quality to the original biologic drugs. By implementing this initiative, Ontario aims to maintain the quality of patient care while optimizing healthcare spending.
Between March 31 and December 29, 2023, ODB-covered patients using specific medications such as Copaxone®, Enbrel®, Humalog®, Humira®, Lantus®, NovoRapid®, Remicade®, and Rituxan® will be required to transition to the corresponding biosimilar alternative. To facilitate a smooth process, patients are encouraged to engage in discussions with their healthcare providers via in-person, telephone, or virtual visits. In exceptional cases, exemptions may be considered on an individual basis, taking specific clinical circumstances into account and consulting with the healthcare provider.
This decision follows the successful adoption of biosimilars in the European Union for more than 15 years. Biosimilars provide more cost-effective alternatives to originator biologics. By embracing these alternatives, Ontario aims to allocate resources to innovative therapies, enhance patient care, and contribute to the availability of publicly funded life-saving medications.
How Could This Affect Your Benefits Plan?
Some major carriers, such as Manulife, have already announced that they will align their coverage with this new government initiative. This means that plan members in Ontario may be required to switch to a Biosimilar in order to continue receiving the same level of coverage. This will primarily affect patients who are also covered under the Ontario Drug Benefit (Such as plan members who are age 65 and over).
What Should You Do?
The transition period will end on December 29th, 2023. If you are currently taking a medication affected by this change, your first step should be to talk to your doctor. They will help to decide whether switching medications is right for you.
If you have any question about how this change may affect you or your benefits plan, don’t hesitate to reach out to have a conversation with one of our advisors.