Policy that forced patients to switch to cheaper medications saved B.C. $730-million, report says

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A British Columbia provincial policy that forced people with chronic illnesses such as Crohn’s disease and rheumatoid arthritis to switch to cheaper medications saved the province more than $730-million over five years, according to a new government report.

The B.C. government said Friday that the money freed up through its biosimilar switching plan allowed the province to expand public coverage of other drugs and devices, including Trikafta, a life-changing treatment for cystic fibrosis and continuous glucose monitors for people with diabetes.

“When this policy was introduced, it was highly controversial,” said Michael Law, a University of British Columbia professor who holds a Canada Research Chair in Access to Medicines. “B.C. really took the lead in North America on implementing this policy and now we’re seeing, five years later, that they’re essentially reaping the benefits.”

Nearly every other province and territory has since implemented a similar policy.

Biosimilars are near-copies of the original, brand-name versions of biologics, a class of drugs manufactured from living cells. Insulin is a biologic. Other examples include infliximab, originally sold under the brand name Remicade, and adalimumab, sold first as Humira. Patients usually take the high-cost drugs for life.

In 2018, 27.3 per cent of spending by public and private drug plans in Canada went to biologics, despite the class accounting for less than 2 per cent of prescription volumes.

As the first biologics came off patent, Health Canada began approving biosimilars that were almost like generics but were treated differently in practice and policy. Biosimilars aren’t interchangeable at the pharmacy, which means doctors must write new prescriptions for the less-expensive product. Early biosimilars struggled to gain a toehold in the Canadian market.

Some doctors, patient advocacy groups and brand-name biologics makers lambasted the B.C. government for forcing patients with public drug coverage to take biosimilars, arguing the change was an unnecessary risk that could harm patients.

B.C. Health Minister Adrian Dix said Friday that his government took those concerns seriously.

“We didn’t just say, ‘well you’re wrong,’” Mr. Dix said. “We said, ‘We disagree and we’re proceeding with this policy, but we’re going to assess it, and we’re going to continue to assess it to make sure that patients are getting the care they’ve had and that they need.’”

The new report concluded that B.C. patients who took the cheaper versions logged a similar number of physician visits, emergency hospital admissions and antibiotic and steroid prescriptions as patients who used the original, brand-name biologics before 2019. Of 1,599 B.C. patients with inflammatory bowel disease who switched to a biosimilar of Remicade, only 17 switched back within two years.

Mr. Dix has diabetes and switched to biosimilar versions of insulin.

The savings produced by the policy increased each year as more patients and more biosimilars were added. Savings hit $226.4-million in 2023-2024. Mr. Dix said there are 11 B.C. ministries with budgets smaller than that.