In recent months, New Brunswick and Quebec have announced that they will stop reimbursing biologics taken by thousands of patients and used to treat diseases like cancer, rheumatoid arthritis and diabetes. Instead, they will force these patients to switch to less expensive “biosimilars”. Ontario has also considered this policy, but so far, wisely, has failed to implement it at a time when COVID is already taxing its health care system. Here’s why forced substitution is not the right policy for patients:
Change announcements in New Brunswick and Quebec cite the recent implementation of forced substitution policies in British Columbia and Alberta. They fail to mention, however, that these policies have been fiercely opposed by many physicians and patient groups in these provinces.
Biosimilars are very similar to the original drugs that they copy, but unlike generics, they are not exact copies. Safe and effective products in their own right, they offer physicians new treatment options for their patients and can help control costs. But because biosimilars are different, patients whose conditions are under control with a biologic cannot be assured that a change will give them the same relief – changing drugs can be unsettling and often painful for patients.
A survey of 403 Canadian specialists found that 73 percent are uncomfortable with a third party like the government initiating a biological change for non-medical reasons (usually cost), as occurs in health policies. British Columbia and Alberta.
Likewise, a survey of Canadian patients showed that more than 70 percent were opposed to the policy. Many patients have to try multiple medications over the years in order to stabilize their condition. Patients forced to give up these drugs by the new policies have come forward to share their experiences: “It was a very long and difficult two and a half year journey to find (the drug originally prescribed). All other drugs have failed, ”said an arthritis patient in British Columbia who was forced to switch drugs. “I am shocked and dismayed that this government is taking the decision away from doctors and patients, where it belongs. “
“After I was diagnosed, I was so grateful to find something that helped me,” said one patient from Crohn’s. “Having it ripped from under me was really hard. It was like I was back to square one. Patients in Alberta have written similar letters, complaining of treatment interruptions and loss of stability and urging their health departments to reconsider their decision. “You can’t put a price on your health. The government is trying to save money but, in the end, how would they feel if it turned on them and they were sick? Another patient said after being forced to change. “It’s not fair at all.”
The announcements from New Brunswick and Quebec also cited 15 years of experience with biosimilars in Europe to justify the forced switch. But what does the experience of Europe really look like?
Automatic substitution of organic products is almost universally prohibited in Europe. In almost all European countries, doctors are free to choose between several products, including the original products, and the payer will reimburse them, resulting in both high use of biosimilars and significant savings while preserving the patient and physician control over treatment decisions.
Like their Canadian counterparts, European physicians are strongly opposed to third-party substitution of biologic drugs. These specialists’ 15 years of experience with biosimilars have taught them that treatment decisions should be made by doctors and patients, not bureaucrats.
Biosimilars are an important tool to help control healthcare costs, but how they are introduced matters to doctors and patients. Forced substitution puts Canadian provinces on the wrong track and represents a radical departure from other advanced countries. Ontario would be wise to continue to reject this misguided policy.