Action required by December 30, 2023 for plan members in Ontario who take a biologic drug
Ontario will complete its biologic drug transition period on December 30, 2023. The province began migrating patients in March, 2023. Empire Life has sent letters directly to plan members and/or their dependants affected by this change to remind them of the need to discuss switching to a biosimilar with their doctor by December 30, 2023.
Empire Life will continue to cover biologic drugs throughout the provincial transition period to give plan members time to secure an appointment with their doctor. Plan members who choose to remain on a biologic drug that is covered by a biosimilars initiative will be responsible for the full cost of the drug once the provincial transition period is over. If a plan member is unable to make the switch for medical reasons, their doctor can request an exception.
Ontario is the latest province to move patients from biologic drugs to biosimilars once a biosimilar has been approved by Health Canada and added to the provincial Biosimilars Initiative.
Provinces have been switching patients to biosimilars over the past few years as biologic drugs come off patent protection and biologics come to market. The map illustrates the most recent provincial switching dates. In addition to Ontario, New Brunswick and Yukon also have upcoming cutover dates.
Each provincial biosimilar initiative differs slightly; however, the intent everywhere is the same: to avoid, as much as possible, the high cost of specialty drugs by migrating patients to less costly, but therapeutically equivalent, biosimilars.
The Empire Life approach is to follow the provincial lead and help transition plan members to biosimilars—except where we have a pricing agreement with the drug manufacturer that makes it more cost-effective for the plan member to stay on a biologic.
Plan members taking a biologic covered by a preferential pricing agreement will not be asked to switch since Empire Life has negotiated agreements with pharmaceutical companies to reduce the cost of specific biologic drugs to that of the biosimilar.
- Biologic drugs generally cost over $10,000 per patient per year. These high costs are due to biologic drugs having a more intricate production process, longer research and development phases and a smaller population taking them.
- Biologics are drugs made with living organisms rather than being synthetically manufactured and are often used to treat patients with chronic health conditions such as rheumatoid arthritis, inflammatory bowel disease, and diabetes. An originator biologic is the first version of a biologic drug.
- Biosimilars are similar to biologic drugs and enter the market after the patents or data protection rights for the originator biologic expire. A biosimilar drug is highly similar but not identical to its reference biologic. That’s because biosimilars are composed of living cells rather than chemicals. They have similar effectiveness, safety, and quality as the originator biologic and have been approved for use in Canada by Health Canada.
- Biosimilar drugs are not the same as generic drugs. Generic drugs are chemically produced and contain identical medical components to their brand-name counterparts.
Links to more provincial biosimilar information:
- Alberta - May 1, 2022
- British Columbia - May 29, 2022
- Ontario - December 30, 2023
- Quebec - April 13, 2022
- Yukon - May 8, 2024
- Saskatchewan - March 31, 2024
- Newfoundland and Labrador - April 1, 2024
- Nova Scotia - February 3, 2023
- Northwest Territories - April 13, 2022
- New Brunswick - February 28, 2024
- Prince Edward Island - June 30, 2024