Biosimilars Initiative for Prescribers

PharmaCare launched the Biosimilars Initiative on May 27, 2019 with the goal of switching patients using Enbrel®, Remicade®, and Lantus® to their biosimilar versions by November 25, 2019. For details on the affected indications and biosimilar brands, see PharmaCare coverage changes below.

The three biologic drugs affected are among the largest drug expenditures in the province, totalling $125 million in 2018. Meanwhile, approved biosimilar versions that are more cost-effective and just as safe and effective are underused. The Biosimilars Initiative is a result of PharmaCare’s evidence-informed strategy to better optimize our public resources, getting the best value for new treatments and services.

During the transition period  (May 27 - Nov 25, 2019), PharmaCare will cover both biologic and biosimilar versions of the affected drugs, to allow time for patients to discuss the switch with their prescriber. Effective November 26, 2019, PharmaCare will cover only the biosimilar versions of etanercept, infliximab, and insulin glargine for the affected indications.

Phase One

Phase one of the Biosimilar Initiative occurs between May 27 and November 25, 2019. During this phase, patients taking originator drugs for the following indications will be switched to the biosimilar versions.

 
Drug Originator Biosimilar Indications
etanercept Enbrel ® Brenzys ®

Ankylosing Spondylitis

Rheumatoid Arthritis

Erelzi ™

Ankylosing Spondylitis

Psoriatic Arthritis*

Rheumatoid Arthritis

infliximab Remicade ®

Inflectra ®

Renflexis ®

Ankylosing Spondylitis

Plaque Psoriasis

Psoriatic Arthritis

Rheumatoid Arthritis

insulin glargine Lantus ® Basaglar ™

Diabetes (Type 1 and 2)

Patients using Enbrel for plaque psoriasis are not affected at this time.

Phase Two

In phase two, patients taking Remicade for Crohn’s disease or ulcerative colitis will be switched to the biosimilar versions shown below. The dates for phase two are yet to be determined, however more information may be available in the late summer of 2019.

 
Drug Originator Biosimilar Indications
infliximab Remicade ®

Inflectra ®

Renflexis ®

Crohn's Disease

Ulcerative Colitis

Prescribers play an important role in the switching process. As a trusted and experienced information source, a healthcare professional may set the tone of the discussion, facilitate continuity of care, and empower the patient to understand and realize the best outcomes. Follow the steps below to help an affected patient with their switch to a biosimilar before November 26, 2019. For tips on how to approach a neutral or positive discussion with a patient, see the Biosimilars FAQ for prescribers.
 

  1. Identify an affected patient.
  2. Discuss switching to a biosimilar with the patient.
  3. Initiate enrolment in the patient support program for the biosimilar (if applicable). Write your patient a new prescription, clearly indicating the chosen biosimilar brand.
  4. Submit the Biosimilar Patient Support Fee code with your MSP billing.
  5. For any patients unable to switch due to a medical reason, submit a new Special Authority request for exceptional coverage of the respective biologic.

You can complete and submit a Patient List Request [HLTH 5841] form.

Within two weeks, PharmaCare will send you a list of covered patients who have filled an originator prescription (Remicade, Enbrel, Lantus) written by you in the past six months.

For patients who are unable to switch for medical reasons, you may submit a new SA request for exceptional coverage of the originator drug. Clearly identify in the request why the patient cannot switch.

Exceptional requests are reviewed on a case-by-case basis by Special Authority. If additional input is required, the request may also be reviewed by the Drug Benefit and Adjudication Advisory Committee. Given the processing time involved, exceptional requests should be submitted as soon as possible to avoid uninterrupted coverage.

The Biosimilar Patient Support Fees are $50.00 fee items billable to MSP in addition to other services billed on the same date of service, using the Teleplan claims system. They are being offered in recognition of the additional effort involved in contacting patients and supporting their switch to a biosimilar product.

The fee can be claimed once per affected patient during the switch period, regardless of whether that patient switches to a biosimilar.

See the table below for fee codes, effective from May 27 to November 25, 2019. Note some claim fees are limited to certain prescribers.

 
Biosimilar Switch Prescriber Fee Code
Lantus to biosimilar insulin glargine   97011
Enbrel to biosimilar etanercept Rheumatologists, internal medicine specialists 97010
Remicade to biosimilar infliximab Gastroenterologists, rheumatologists, dermatologists, internal medicine specialists 97009

At this time, there are no changes in coverage criteria for insulin glargine, or infliximab for plaque psoriasis.

All other changes are listed in the PharmaCare Newsletter 19-003.

PharmaCare is committed to supporting health practitioners throughout the Biosimilars Initiative. For answers to frequently asked questions, please see the Biosimilars FAQ for prescribers.

If you are interested, the PharmaCare team will also host call-in information sessions during the transition period. Numbers for these sessions can be found in the print version of the Biosimilars Prescriber Guide* sent to you and not posted online to ensure you have priority access to the sessions. You can find an up-to-date schedule of information sessions below:

 
Dates to be determined

*If you require additional copies of the Biosimilars Prescriber Guide or patient information sheets, contact PharmaCare at Biosimilars.Initiative@gov.bc.ca

Further Reading Material:

Patient resources are available online at www.gov.bc.ca/biosimilars. There patients can find more detailed information about biosimilar switching, how it affects them, the difference between biologic and biosimilar drugs, answers to frequently asked questions, and more.

PharmaCare will have mailed you patient brochures. The same information is available as downloadable and printable Patient Information Sheets. If you would like more printed tri-fold brochures, please email PharmaCare at Biosimilars.Initiative@gov.bc.ca.

 

If you have further questions or feedback, please contact PharmaCare at Biosimilars.Initiative@gov.bc.ca.