Market access for biosimilars in Canada still below OECD average

TELUS Health Annual Conference – The rate of penetration of biosimilar drugs in the Canadian market is increasing in response to various provincial initiatives put in place to coordinate the switch from biologics to biosimilars. However, adoption rates for biosimilars in Canada remain well below the OECD average. But, why? What exactly are these initiatives and what impact do they have on the development of the biosimilar market?

Presenting this exclusive and final webinar in the virtual conference series was Marc Parent, pharmacist and a specialist in the field of biosimilars, who shed light on the reality of biosimilars in Canada.

Strong growth in sales of biologic drugs.

“There are many biologic drugs being used in Canada,” said Parent. “Biologics account for about 26% of drug sales, which is higher than the OECD average.”

The sales trend grows stronger every year and is putting ever-increasing pressure on public and private health plans. The substitution of biologic products for biosimilar products can reduce insurance plan costs. “Generic drugs are economical and it’s the same logic that could be applied here, namely using biosimilar products when the patents on biological drugs expire,” Parent added. But how do you explain the low penetration of biosimilars in Canada?

Market access strategies.

In 2006, Europe was already fully committed to biosimilars with a strong vision that today makes European countries leaders in the field. In this respect, Canada and Quebec lag far behind Europe. The strategies put in place to facilitate the adoption of biosimilars have been marked by caution and slow progress, but also by a certain amount of cautiousness and hesitation, both at the federal and provincial level, which may have led to confusion in the development of the market. Consider Health Canada’s changing positions from 2010 to 2019 on the wording of its recommendation on the interchangeability or substitution of biologic drugs. “Having such significant changes from the Canadian authority on the subject could have hindered the development of the biosimilars market,” said Parent. This helps illustrate why Canada has been slow to catch up over the past decade and explain the resistance from some players accustomed to working in a fully integrated system, faced with the changes required to stimulate the growth of biosimilars.

A slowly evolving market.

In Canada, new strategies may be the signs of a major shift in biosimilars. For example, in 2019, the British Columbia provincial government implemented a forced reimbursement program that requires and funds the substitution of biologics for biosimilars for certain products. B.C. anticipates substantial savings of $100 million per year. Also in the West, the Alberta government has adopted a similar initiative, which is about to come into effect.

As for Quebec, in terms of potential savings, Parent said that it’s important to “fully understand the unique Canadian context of the Quebec system, where the terms of listing agreements negotiated by or for the government apply only to the public plan and not to private insurers, leaving the latter to deal with the official listed price of a drug.” The legal obstacles involved in developing agreements between the private sector and pharmaceutical companies, as well as the latitude health institutions in Quebec have in choosing the product on a local basis, further complicate the strategic and common implementation of tools to increase market access for biosimilars.

High economic potential without compromising safety.

“The ultimate goal is to control the growing share of biotherapies by maximizing our savings in the short-term, but also by creating the right conditions to maintain the economy in the mid- and long-term and, of course, in a context where there can be no compromise on the quality of care,” concluded Parent.

To better understand the issue, Parent recommends finding out which major biosimilar products have succeeded in penetrating the Canadian market, and grasp all the issues in their scientific, historical and political dimensions – including exciting topics such as multiple substitutions, the nocebo effect or the expectations of clinicians and other health professionals regarding their role in the adoption of biosimilars.