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The management of biosimilars will be a challenge for insurers, according to Medavie Blue Cross


Justine Montminy

November 21, 2018 09:30

Photo : Freepik

The management of biosimilar drugs represents a major challenge for insurers, said Marie-Hélène Dugal, manager of product portfolio management solutions for insurance medicine for Medavie Blue Cross, at its annual seminar.

According to data shared at the event, in the past five years (between 2012 and 2017), biological drugs have experienced an upward trend of over 70 %. “The use of biological drugs has increased because they are used to treat more and more assignments are different,” says Ms. Dugal.

Biologic medications are more expensive, as they involve the use of living organisms. Called biosimilar the option least expensive of these drugs, as it is a drug with living organisms, it is impossible to make a copy, as we see with the generic drug.

However, to switch from one biologic drug brand to a biosimilar, it is necessary to have a doctor’s prescription. Thus, a pharmacist may not make the change itself to the biosimilar, as it could do with a generic drug.

The different approaches of insurers

Biosimilars are an interesting way for plan sponsors to save costs, ” says Marie-Hélène Dugal. Insurers use many methods to do this.

First of all, it is possible to offer the therapy-by-step. An insurer may require the use of the biosimilar as the first treatment, and if the latter is not suitable for patients, first to repay the organic brand.

The Régie de l’assurance maladie du Québec (RAMQ) instead uses the biosimilar prime. “From a certain date, the sponsor only approves the drug biosimilar. It is possible to have special provisions so as not to interrupt the treatment of a patient who is already on the biological. We have seen cases outside Quebec where we asked the patients to change for the treatment the least expensive. The change is made for financial reasons and not medical, ” says Ms. Dugal. She adds that although it is the method that generates the most savings, the data are not clear as to whether it is safe and profitable for the long term.

It is also possible to require a maximum price allowable. The biologic and the biosimilar will be covered by the sponsor, but the maximum amount refunded will be that of the biosimilar. “It is a method to push people to choose the biosimilar, because it will not necessarily be affordable for a patient to make up the difference,” says Ms. Dugal.

Finally, some insurers choose listing agreements. It is a question of financial arrangements with pharmaceutical companies for lower prices on drugs biosimilar or brand-name medications on the condition of applying certain rules. “This way, we may identify amounts that equivalent probably to the impact that it would have been if we had pushed the clients to the biosimilar,” said Ms. Dugal.

The increase in the cost of medicines

The increase in the cost of drugs represents a challenge for plan sponsors since the increase is noticed for several years. More and more new drugs and innovative treatments appear, as noted by experts in the field at the congress of the Association québécoise des pharmaciens propriétaires (AQPP).

“New treatments are good news for patients, but it involves costs. The proponents must identify savings to be certain to be able to pay for these new treatments, ” said Ms. Dugal. She adds that it is important to choose drugs with a better return on investment.

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