10 June 2019 11:30
British Columbia has recently announced its decision to transfer the patients treated with drugs of biological origin to treatment with biosimilar drugs for ankylosing spondylitis and psoriatic arthritis, psoriasis and diabetes. This gesture should allow the company to save millions of dollars annually.
The Quebec and private insurers should be guided by this province and make greater use of these drugs to benefit in turn of the significant gains that allow biosimilars ?
Yet little is known of the population and are ignored or under-exploited by several physicians, biosimilars are copies of biological drugs already in use, but whose patents have expired. They should not be confused with generics, which are small molecules that are chemically synthesized. Biosimilars are created in living cells rather than chemicals. They must be very similar to biologic drugs that they replace, in their composition and in their effects on the body, both positive and adverse.
Biosimilars have been introduced in Europe in the mid-2000s and in Canada ten years later. The country, therefore, acknowledge a decade of delay in their application to patients.
Pharmacist in a university hospital in Quebec, Marc Parent is an expert of these drugs. He also gives a conference on the subject at the congress of Segic which will take place on 25 September in Montreal.
Biosimilars, ” he says in an interview at the Journal of insurance, are used to treat the same diseases as the original drugs they copy. Clinically, the use of biosimilars rather than a biologic drug should have no advantages or disadvantages for the patient. Their asset, it is their prices that are less than the biologics they are replacing. “The challenge, he says, is to have a therapy that is comparable at a cheaper price. “
It is, however, unable to estimate with any accuracy the total savings that they can cause in Quebec, because their cost is the subject of confidential negotiations on the part of the Régie de l’assurance maladie du Québec (RAMQ). We know, however, that the prices of catalogue of biosimilars are lower by an average of 30 % for organic products which they can be substituted as a range that can go from 10% to almost 50 %. As biosimilars replace the more often drugs are very expensive, the savings that they can bring could amount to tens of millions of dollars.
Marc Parent cites a concrete example of a substitution of a biologic product, insulin brand Lantus, by a biosimilar cheaper, the Basaglar. In a community pharmacy where we proceeded to check out, the price difference between the two for five pens is about $ 20, both for MEDICARE as private insurers.
In August 2017, the RAMQ announced that it was terminating the insurance coverage of the Lantus and that it would not be reimbursed for new patients because of the registration in the List of medications of the Basaglar.
Role of doctors and pharmacists
Biosimilars are available in Quebec, and lead already to savings for payors, both public and private. So why not use it-it not more ? Some doctors prescribe, but this is certainly not the norm, ” said Marc Parent. He explains this reserve for different reasons.
In general, he says, doctors often don’t know the equivalent products that are available, and they tend to prescribe the name of the original product that they know well. Historically, these are the pharmacists who had the responsibility to suggest the transfer to a substitute product. Marc Parent notes, however, “great discomfort” to the do to biosimilars, except for insulin. For other diseases treated with biologics such as cancer and severe diseases such as Crohn’s disease and arthritis, they have not been, to date, very “aggressive” to proceed with the replacement, the judge does it.
In all of the medical community and pharmaceutical quebec, he observes, there is still great caution in the face of the introduction of biosimilars, an attitude that it deems to be correct also. This doubt is probably maintained by the manufacturer of the original product who has an interest in protecting its market. Marc Parent talks about caution, or even suspicion on the part of doctors and pharmacists. But, he says, there would have been no problems that would have occurred in the use of biosimilars in Europe.
“It was all on this side of the Atlantic to be reassured “, he believes. Studies conducted in particular in Norway have confirmed that the transfer of biologics to biosimilars does not cause harm to the patients at the clinic.
In Canada, that is British Columbia, which goes the furthest to date with the policy it has announced, because even patients already being treated with biological medicines will be transferred to biosimilars.
“There are no scientific arguments that are opposed to this decision. After that, it’s still political arguments and economic “, reacts Marc Parent. In Quebec, in the case of insulin is less, the RAMQ will not reimburse more than the biosimilar, but only for new patients. We do not transfer required for the former. This is a difference of size.
The private insurers and biosimilars
According to the pharmacist in quebec, private insurers could play an important role in a shift to these less expensive medicines that form biosimilars by stating that they decline to pay more for the original product as organic and that they promote only the biosimilar, which would force the hand to the doctors.
“This is tricky, because professionals are usually ticklish when choice of drugs are made by third-party payers or an organization that issues a standard of practice,” says Marc Parent. But for a drug worth $ 1000 to the cost, we are talking about a saving of about 30 %. Insulin can cost many thousands of dollars per patient per year. Some biosimilars may cost anywhere from $ 40 000 to $ 50 000 for a treatment : 30 % savings per patient, there is a great potential for significant cost savings for a diet and payers, and millions of dollars in total. “
Follow in the footsteps of British Columbia ?
Quebec should, in the near future, emulate British Columbia and decide not to repay that biosimilars for certain diseases ? Biosimilars are expected to be used more in the future in the province ?
“I believe that the sustainability plans required,” said Marc Parent. Is this desirable in view of the growth of the cost of the drugs ? The answer is : probably. This kind of decisions is happening at several levels, political, economic, and it will have to sell it to the population even if it does not seem sexy and it can arouse some suspicion in the population. “
The founder of Segic, Danny Baker, a great believer in this shift towards biosimilars and sees there, self-management and self-insurance, an opportunity to realize significant savings. “Everyone will benefit from it “, pleaded he.