The Quebec government Biosimilars Initiative came into effect in April this year, which means the Régie de l'Assurance Maladie du Québec (RAMQ) will only cover the cost of biosimilar drugs and not the cost of biologics
According to Health Canada, ”A biosimilar biologic drug, or biosimilar, is a biologic drug that is highly similar to a biologic drug that was already authorized for sale. There are no expected clinically-meaningful differences in efficacy and safety between a biosimilar and the biologic drug that was already authorized for sale.”
How will Empire Life manage biologic/biosimilar claims in Quebec?
We’re asking plan members taking a biologic drug to switch to the biosimilar—except where pricing for a specific biologic drug aligns with the biosimilar alternative. Our approach helps control plan costs by ensuring the most cost-effective option is applied while maintaining coverage for these important medicines.
We’ve written to affected plan members to inform them of the change, suggest they consult with their doctor, and explain that if they choose to remain on a biologic drug that costs more than the biosimilar, they will be responsible for the full cost.
Three exceptions for plan members
There are three exceptions for persons under the provincial switching policy:
1. Pregnant women, who should be transitioned to biosimilars in the 12 months after childbirth.
2. Pediatric patients, who should be transitioned to biosimilars in the 12 months after their 18th birthday.
3. Patients who have experienced two or more therapeutic failures while being treated with a biologic drug for the same chronic disease.
If a plan member or a member of their family meets any of the criteria above, they are asked to consult with their primary care physician or a qualified medical professional for further guidance.