At Arbutus Financial, an important role we play is in identifying cost containment strategies to help our business clients in managing their benefits costs. In Fall 2019, changes to BC Pharmacare are coming. Read on to learn how this will impact your business and the financial investment you make in your employees and their families.
B.C. government says expanding biosimilars will save nearly $100 million over three years
British Columbia is expanding its use of biosimilars, effective November 2019.
The move is expected to create opportunities for new drug listings and increase current coverage for patients, according to a press release from the B.C. government. The first two drugs to come into immediate effect are Jardiance, a diabetes drug, and Taltz, an arthritis drug.
It will change the game considerably, says Suzanne Lepage, a private health plan strategist. “If a big government is doing it, then will everybody else follow suit? B.C. is different because they’re doing switching and no other province is doing it.”
As for how it might impact plan sponsors, Lepage says it could save them money, “but on the flip side, we don’t know what the health risks are.”
The B.C. government said Canada has a very low usage rate for biosimilars. While other countries sit at upwards of 50 to 95 per cent usage, Canada is currently at eight per cent. “B.C. is leading the country by promoting the widespread use of biosimilars, which have been proven to work just as safely and effectively as higher priced biologics,” said Adrian Dix, minister of health for the province, in the release. “Biosimilars are a necessary step to ensure PharmaCare provides existing coverage for more people and funds new drugs well into the future.”
The increase of biosimilars is expected to save the province about $96.6 million over the first three years. The provincial government also noted these funds will be redirected “to support additional drug listings and improved patient coverage.”
While it seems B.C. consulted the majority of key opinion leaders, not all physicians are on the same page, says Joanne Jung, pharmacy practice leader at Willis Towers Watson. “We want to make sure there are enough resources for these patients and I think the province probably looked at that, but you do have to go back to your doctor to switch to the biosimilar; a pharmacist just can’t switch you.”
From a private plan point of view, Jung says the big concern is the cost shifting to plan sponsors. “Right now, [B.C.] Pharmacare is paying for Lantus, Enbrel and Remicade. And then after November, they will not be, so how are they going to deal with that? In a unionized environment, is this switch something that’s feasible under the collective agreements? If not, that’s something to think about as well.”
The B.C. government noted exceptions could be granted to patients whose physicians determine they’re medically unable to transition to a biosimilar drug. “Exceptional coverage requests will be reviewed by PharmaCare’s special authority branch on a case-by-case basis, in consultation with physician-led advisory committees as needed.”
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If you’d like to discuss this topic in greater detail or have any questions, please reach out to a member of your Arbutus Financial Team.