Alberta changing coverage for thousands of residents on biologic drugs

The Alberta government will change drug coverage for 26,000 residents in an effort to save money, it announced today – meaning those with diabetes, rheumatoid arthritis and Crohn's disease will soon have to switch to cheaper treatments.

In announcing the switch during a press conference held Thursday, Health Minister Tyler Shandro said biologics represent 19 per cent of Alberta's total spending on drugs and are provided to fewer than two per cent of patients.

"Fortunately, there is a solution … Albertans who are prescribed a biologic drug will be transitioned to a biosimilar by their physician over the next six months," he said.

Biologics are complex medicines created from living cells, while biosimilars are developed to be highly similar to the more complex biologics. Biosimilars, which are approved by Health Canada, are based on expired patents and can be delivered at a lower cost.

The switch is expected to save up to $380 million over the next four years, according to Shandro, and follows Manitoba and British Columbia. B.C. shifted to biosimilars earlier this year.

• B.C. shifting to cover cheaper 'biosimilar' drugs, health minister says

Changes will not affect patients on private drug plans or those paying out of pocket, and won't apply to children or pregnant women.

"We understand that this is a change for patients and a change for health professionals, and change is not always easy," Shandro said. "But this is the right thing to do. We're continuing to provide Albertans with a safe, effective treatment at much lower cost."

Doctors concerned about switch

Dr. Remo Panaccione, an internationally recognized expert in inflammatory bowel disease (IBD) at the University of Calgary, previously met with Shandro to urge him not to switch to the cheaper medication.

Panaccione said the numbers cited by Shandro reflected the efficacy of biologics – but said it was difficult to look at that dollar figure in isolation.

"What's resulted, at least in the IBD space, is reduced hospitalizations and reduced surgeries. We've published data from Alberta that's shown a marked decrease in both of those ever since we've started using the biologic," Panaccione said. "That translates in these patients going back to work, being productive, paying taxes."

Panaccione also said he was "completely baffled" to see representatives at Thursday's press conference stress the safety and efficacy of biosimilars.

"That's not what's in question. Biosimilar medications, everything they said about the efficacy and safety is absolutely true," he said. "What we're arguing against is the switch – taking patients off medication that's working for them and switching them to a biosimilar."

According to Panaccione, patients could have an adverse reaction to switching from biologics to biosimilars, even though the medication itself is safe and effective.

What we're arguing against is the switch.- Dr. Remo Panaccione, University of Calgary professor

"Individual patients [are not] going to respond to that medication exactly the same [way], regardless of how similar it is," he said. "Because of that, everywhere in the world, even where they say it's been endorsed, the recommendations are that switching should be [a decision] made by the patient and the physician."

Mina Mawani, president of Crohn's and Colitis Canada, said the organization was "shocked" at the government's policy.

"We are extremely disappointed in Minister Shandro and his very short-sighted and potentially harmful policies," Mawani said. "He is actually risking the health of people with inflammatory bowel disease … we've always said biosimilars are safe and effective. The issue here is about the non-medical switch, mandated by government."

Dr. Gilaad Kaplan, a professor at the University of Calgary, said many will do fine switching from biologics to biosimilars, but others will be adversely affected.

"There will be some that will lose responsiveness to the drug. For those patients, there will be dire consequences," Kaplan said. 

According to a report conducted by Kaplan and Panaccione and submitted to CBC, moving 2,000 patients off of Remicade could result in more than 60 avoidable surgeries.

In the press conference held Thursday, Shandro refuted that analysis, citing advice gathered during consultation.

"It's been a broad range of physicians. I don't think, necessarily, that physicians, even within one patient group, are speaking with one voice," he said.

Drugs were offered at lower cost

Before today's announcement, Janssen, the makers of Remicade – one of the biologics for Crohn's patients impacted – said it had reached out to the government to offer the product at a cost comparable to biosimilars.

"Each of our proposals to the Alberta government has been rejected," said a spokesperson for Janssen in an email to CBC.

During Thursday's press conference, Shandro said there were a couple reasons why the government had rejected Janssen's offers.

First, he cited the pan-Canadian Pharmaceutical Alliance, established in 2010. That group negotiates drug prices on behalf of multiple provinces and territories.

"I think that this ad-hoc, one-time, short-term backroom deal would not only undermine the alliance, it would also undermine the rest of the initiative," Shandro said. "Offering us a payment of $100-million, that would undermine the rest of the initiative… The purpose of it is to prevent other manufacturers from being able to come into the marketplace, then it undermines the entire initiative."

Second, Shandro said the move was focused on "other people's healthcare."

"This is about us being able to spend more in the healthcare system on other people's healthcare. I would just like to make that point," he said. "It's not just about dollars, it's about other people's care."

Panaccione said the health community hadn't received a reputable answer as to why the government wouldn't accept the offer.

"You could have had the cost savings without switching. Tell us why you didn't do that," he said. "Make it a competitive landscape, make the [pharmaceutical] companies race to the bottom, get the best price you can from everyone who makes the molecule, save money, treat patients.

"We don't understand why you wouldn't let competition drive the price down."

"It's devastating"

Nick Arrand was officially diagnosed with Crohn's disease just more than six years ago after experiencing a few months of what he said was "blinding gut pain."

"Sometimes, it would last an entire weekend," he said. 

Doctors eventually put Arrand on Remicade – a drug he said has been "instrumental in keeping me alive."

Though Arrand currently receives health coverage for Remicade under his wife's plan, were she to lose her job he would have to switch medications.

"My reaction to this news is that it's devastating," he said. "It's quite devastating."