Doctor urges Alberta not to switch coverage to cheaper meds for patients with IBD

Alberta is looking to switch to covering a cheaper alternative medication for patients with inflammatory bowel disease (IBD) — a move an expert says could harm some patients' health.

Dr. Remo Panaccione, an internationally recognized expert in IBD with the University of Calgary, met with the province's health minister to urge him to change his mind.

Panaccione said around 2,300 Albertans are currently taking a group of drugs called biologics to treat Crohn's, a disease that causes inflammation of the digestive tract. The government plans to switch to biosimilars.

Biologics are proteins, complex medicines created from living cells, whereas biosimilars are developed to be highly similar to the more complex biologics. Both drugs are used to treat everything from rheumatoid arthritis to diabetes to cancer. 

Biosimilars are only approved for use by Health Canada if they are shown to have "no clinically meaningful differences in efficacy and safety" to the original biologic drug it's based on.

"We know from research over the last seven years that switch can harm patients. It doesn't harm all patients, biosimilars are good drugs. But anywhere between 20 to 30 per cent of patients in the first year may have an adverse effect," he said.

Doctor asked to sign non-disclosure

Panaccione said when he met with Health Minister Tyler Shandro he was first asked to sign a 10-year non-disclosure agreement, and when he disagreed, the minister wouldn't give him details about the switch.

"It puts me in a very bad position with my patients … there's no way as a physician in good faith I could enter into an agreement like that," Panaccione said, adding that it felt like a one-way conversation.

Health Minister Tyler Shandro said he was happy to meet with Panaccione and get his and other stakeholders' feedback.

"The prices of biologics are becoming more and more of, I suppose, an unsustainable situation," he said.

A spokesperson for the health minister said biosimilars are not just cheaper — they're completely safe. The spokesperson also said requesting a non-disclosure agreement is common practice for consultations on potential policy changes.

"We reject the claim that biosimilars put patients' lives at risk; it's not warranted by the evidence from B.C. or other jurisdictions. All drugs have a risk of rejection by some patients; we'll consider how to apply any change in coverage to specific groups of patients based on the evidence," an emailed statement from the minister's office read.

The minister's office said in the past decade, the province's spending on biologics has increased from around $20 million per year to more than $200 million.

Company offers drugs at lower cost

But the maker of Remicade, one of the biologics for Crohn's patients that would be impacted, said it has reached out to the government to offer its product at a cost comparable to biosimilars.

"We continue to engage with governments to provide the cost savings being sought while preserving patient and physician choice," a spokesperson for Janssen Inc., the drug's maker, said in an emailed statement. 

"We strongly believe the use of biosimilars in Canada should be based on what physicians determine is in the best interest of their patients rather than being driven by efforts that restrict treatment choice in any way."

The health ministry's spokesperson said they're aware of Janssen's offer, but are "not going to negotiate with any company through the media."