Biosimilars Initiative for Patients

The Biosimilars Initiative was launched in 2019 to expand health care services in B.C. by switching patients from originator biologic drugs to biosimilar versions shown to be as safe and effective.

The Initiative has successfully switched many PharmaCare patients to an equally safe and effective biosimilar drug approved by Health Canada. Biosimilars are less costly than originators, which means that B.C. can spend money in other areas of our health care system. For example, PharmaCare will be able to cover more drug options.

Each switch period is six months. During that time, patients should talk to their prescriber to get a prescription for the biosimilar in order to keep their PharmaCare coverage. After the switch period ends, PharmaCare only covers the biosimilar version(s).

How do I keep my coverage?

  1. Make an appointment with your prescriber during the switch period.
  2. Your prescriber can explain the switch process, discuss your biosimilar option(s), and write you a new prescription. You may also want to talk to your pharmacist.
  3. Make sure you have a new prescription before the end of the switch period.

Latest biosimilar listings

March 22, 2022
Drug Originator Biosimilar Conditions include:
enoxaparin Lovenox®
Lovenox® HP
Inclunox®; Inclunox® HP; Noromby®; Noromby® HP; Redesca®; Redesca® HP
  • prevention and treatment of venous thromboembolism
filgrastim* Neupogen® Nivestym™
  • prevention and treatment of neutropenia

*Of note: the first filgrastim biosimilar Grastofil® was listed in 2017

Effective March 22, 2022, PharmaCare is de-listing Lovenox and listing biosimilar versions Inclunox, Noromby, and Redesca for the same indications, with the exception of cancer-associated thrombosis (CAT). Existing patients taking Lovenox will keep their PharmaCare coverage until it expires. As of March 22, only enoxaparin biosimilars will be covered for new starts or renewals of prior coverage.

For CAT, Limited Coverage criteria will change. Dalteparin and tinzaparin will both change to first-line treatment (from second-line), removing the requirement for patients to try warfarin first. Enoxaparin biosimilars will also be added as covered first-line treatment options for CAT. The biosimilar listings result in costs savings for the province, which offsets the costs for modifying treatment options for CAT.

Also effective March 22, 2022, PharmaCare is adding a second biosimilar filgrastim called Nivestym to its formulary. Most patients in BC have already successfully transitioned from the originator filgrastim (Neupogen) to the biosimilar Grastofil in 2017. However, a small number of patients who could not transition to Grastofil for reasons such as such as certain dosage formulations not being available, can now safely transition to Nivestym.


Current switch period

Switching insulin lispro (Humalog®) and insulin aspart (NovoRapid®):
November 30, 2021 to May 29, 2022
Drug Originator Biosimilar Conditions include
insulin lispro Humalog® Admelog®
  • type 1 diabetes
  • type 2 diabetes
insulin aspart NovoRapid® Trurapi®

On November 30, 2021, Admelog and Trurapi were added as regular benefits on the PharmaCare formulary. As of December 15, 2021, PharmaCare no longer covers Humalog and NovoRapid for new patients. Only the biosimilar versions (Admelog or Trurapi) are covered by PharmaCare if you are starting on insulin lispro or insulin aspart as of December 15.

From November 30, 2021 to May 29, 2022, PharmaCare covers both versions of insulin lispro (Humalog and Admelog) and insulin aspart (NovoRapid and Trurapi). If you need a new insulin pen, you can order one free of charge from a pharmacy.

Effective May 30, 2022, PharmaCare will no longer cover Humalog and NovoRapid.

If you had coverage for Humalog Mix25, Humalog Mix50 or NovoMix 30 before December 15, 2021, your coverage will not be affected; you will not need to switch.

Coverage extension of Humalog and NovoRapid for patients using certain insulin pumps

INSULIN PUMP USERS ONLY: Switching insulin lispro (Humalog®) and insulin aspart (NovoRapid®)
Insulin pump Rapid-acting insulin approved for compatible use PharmaCare coverage Conditions

Omnipod

Admelog® (insulin lispro biosimilar—regular benefit)

Indefinite

  • type 1 diabetes

  • type 2 diabetes

Omnipod

NovoRapid® (insulin aspart originator— non-benefit)

Until November 30, 2022

Medtronic

Ypsomed

Tandem*

Humalog® (insulin lispro originator— non-benefit)

NovoRapid® (insulin aspart originator— non-benefit)

Until November 30, 2022

*Tandem insulin pump is also approved for use with Admelog. PharmaCare coverage for this item may change to reflect this compatibility. 

Coverage for Humalog and NovoRapid is extended until November 30, 2022, only for those currently using Medtronic, Ypsomed and Tandem insulin pumps. Those using the Omnipod pump with NovoRapid will also be automatically covered until November 30, 2022.

The extension of coverage is automatic, and doesn’t require any additional Special Authority request.

At this time, only the Omnipod pump has been approved by Health Canada for compatibility with Admelog.

For more information, see PharmaCare Newsletter 22-005 (PDF).

If a pump is approved for use with a listed biosimilar before or after November 30, 2022, our coverage policy may change, with advance notice in the PharmaCare Newsletter.

Retail pricing for rapid-acting insulins

PharmaCare has also changed its pricing policy for rapid-acting insulins (RAIs), including the newly added biosimilars. Previously, all RAIs were covered up to a certain amount only. This meant that patients had to pay costs above that amount.

As of November 30, 2021, PharmaCare covers all listed RAIs at the retail price. This includes the biosimilars and insulin glulisine (Apidra®). The change means patients are fully covered for RAIs and the full retail price counts towards any Fair PharmaCare deductible and family maximum, similar to all other insulin products covered by PharmaCare. They no longer have unexpected out-of-pocket costs. 


How can I make sure the switch goes well for me?

Your mindset can influence your symptoms and sense of well-being. The nocebo effect is when negative expectations lead to negative outcomes. Misinformation from a variety of sources can cause nocebo effect.

To combat a potential nocebo effect, you can:

  • Acknowledge the nocebo effect
  • Seek out more information on biosimilars (see Resources for Patients)
  • Speak to your pharmacist or doctor about the switch and your biosimilar options
  • Keep a neutral or positive outlook

What if I can’t switch to a biosimilar?

Some patients cannot switch to a biosimilar for medical reasons. Your prescriber can help you determine if it is medically necessary for you to remain on the originator medication. If it is, they can submit a Special Authority request asking PharmaCare to consider continued coverage of the originator. Exceptional requests are considered on a case-by-case basis.

Can I still switch if the switch period has ended?

Yes, you can switch anytime, but coverage is not retroactive. You would be paying full price for the originator. If you would like to switch to the covered biosimilar, talk to your prescriber.

Through biotechnology, biologic drugs are created from living organisms like yeast and bacteria. Biologics treat patients with serious chronic conditions, including some autoimmune diseases. The first version of a biologic developed is known as the “originator or reference drug.” This is because they are the original version of a drug that a biosimilar is based on.

As patents expire for originator drugs, other manufacturers may produce new, similar versions. These new versions are called biosimilars. Since originator drugs are large and complex, biosimilars can be highly similar, but not identical. Many studies compare biosimilars to the originator drugs and find them to be as safe and effective. Originator drugs have already set the foundation of research and development for biosimilars, which means biosimilar drugs are more cost-effective to produce and lead to similar outcomes.

There are very small differences between different batches of an originator drug. This is because they are made using living organisms with some tiny natural differences. The same goes for the slight differences between a biosimilar and its originator drug, which are also not clinically meaningful.

 Drug decision summaries


Other resources


Additional reading

insulin aspart

insulin lispro

adalimumab

etanercept

infliximab

 

Since Initiative was launched in May 2019, many PharmaCare-covered patients have successfully switched from an originator to an approved biosimilar:

  • Phase One - 73% of patients transitioned
  • Phase Two - 78% of patients transitioned
  • Over 90% of PharmaCare patients taking infliximab, etanercept and insulin glargine are now taking biosimilars
Transition period (if applicable) Drug (Originator) Biosimilar(s) Conditions include
filgrastim (Neupogen®)
(January 31, 2017 to July 30, 2017)
filgrastim (Neupogen®) Grastofil®
  • prevention and treatment of neutropenia
Phase One
(May 27, 2019 to November 25, 2019)
etanercept (Enbrel®) Brenzys®
  • ankylosing spondylitis
  • rheumatoid arthritis
Erelzi®
  • ankylosing spondylitis
  • psoriatic arthritis
  • rheumatoid arthritis
infliximab (Remicade®) Inflectra®
  • ankylosing spondylitis
  • plaque psoriasis
  • psoriatic arthritis
  • rheumatoid arthritis
Renflexis®
insulin glargine (Lantus®) Basaglar®
  • diabetes (type 1 and 2)
Phase Two
(September 5, 2019 to March 5, 2020)
infliximab (Remicade®) Inflectra®
  • Crohn’s disease
  • ulcerative colitis
Renflexis®
Rituximab Phase
(August 20, 2020 to February 18, 2021)
rituximab (Rituxan®) Truxima®
  • granulomatosis with polyangiitis (GPA)
  • microscopic polyangiitis (MPA)
  • relapsing-remitting multiple sclerosis
  • rheumatoid arthritis
Riximyo®
Ruxience™
adalimumab (Humira®) and etanercept (Enbrel®)
(April 7, 2021 to October 6, 2021)
adalimumab (Humira®) Amgevita®
Hadlima®*
Hulio®
Hyrimoz®
Idacio®

*Hadlima is not indicated for pediatric Crohn’s disease.
  • ankylosing spondylitis
  • Crohn’s disease
  • hidradenitis suppurativa (for adults)
  • plaque psoriasis (for adults)
  • polyarticular juvenile idiopathic arthritis
  • psoriatic arthritis
  • rheumatoid arthritis
  • ulcerative colitis
etanercept (Enbrel®) Brenzys®
Erelzi®
  • plaque psoriasis (for adults)
insulin lispro (Humalog®) and insulin aspart (NovoRapid®)
(November 30, 2021 to May 29, 2022)
insulin lispro (Humalog®) Admelog®
  • type 1 diabetes
  • type 2 diabetes
insulin aspart (NovoRapid®) Trurapi®
enoxaparin (Lovenox®)
(Biosimilars listed March 22, 2022. No switching required. Existing PharmaCare patients taking Lovenox keep their currently approved coverage until it expires.)
enoxaparin (Lovenox®, Lovenox® HP) Inclunox®, Inclunox HP®
Noromby®; Noromby HP®
Redesca®, Redesca HP®
  • prophylaxis and treatment of venous thromboembolism (VTE)
filgrastim (Neupogen®)
(Biosimilar listed March 22, 2022. This is the second filgrastim biosimilar, and no switching is required for most patients).
filgrastim (Neupogen®) Nivestym™
  • prevention and treatment of neutropenia

Note: On February 18, 2021, the PharmaCare formulary added Brenzys for the treatment of psoriatic arthritis and the biosimilar infliximab, and Avsola™ for the treatment of ankylosing spondylitis, plaque psoriasis, psoriatic arthritis, and rheumatoid arthritis.

If you have questions, contact the Biosimilars team by: