BC PharmaCare’s Biosimilar Initiative

What does the BC government’s Biosimilars Initiative for Patients mean for UBC’s Extended Health plan members?

In this article, we provide details about the new program and the impact for those patients taking one of the three identified biologic drugs identified by BC PharmaCare.

Background

Earlier this year, the BC government announced its biosimilar initiative – a program to increase the use of biosimilar drugs with the goal of improving the long-term sustainability of the BC PharmaCare program.

The initiative will require patients to transition from a reference biologic drug to a biosimilar drug which is the same active ingredient and strength as the reference product. Biologics include a wide range of pharmaceutical products produced by living cells. According to the BC government, biosimilars are equally as safe and effective and have the same clinical outcomes as the reference biologic product. Biosimilars are typically less expensive and available after the patent for biologics expire.

For more information on this initiative, please visit the BC government’s website on Biosimilars Initiative for Patients.

What is changing?

Under the BC PharmaCare program, patients taking either of the three biologic drugs – Enbrel®, Remicade®, and Lantus® – must transition to biosimilars in order to receive coverage. The changes will happen over two phases:

Phase 1 – Effective Nov. 26, 2019

Patients have until Nov. 25, 2019, to consult with their physician to change their prescriptions to the applicable biosimilar based on the condition/indication listed below. After that, BC’s PharmaCare program will only provide coverage for Enbrel®, Lantus® and Remicade® for certain medical conditions on an exception basis.

Phase 2 – Effective Mar. 6, 2020

Patients have until Mar. 5, 2020, to consult with their physician to change their prescription to the applicable biosimilar based on the condition/indication listed below. After that, BC’s PharmaCare program will only provide coverage for Remicade for Crohn’s disease and ulcerative colitis on an exception basis.

What does this mean for UBC plan members?

Plan members (and their eligible dependents) taking biologics for the conditions/indications above prior to the changes:

UBC plan members receiving reimbursement under the Extended Health plan for any of the biologic drugs listed above prior to the changes will not be required to transition to the biosimilar. However, it is recommended that plan members discuss applicable biosimilar treatment options with their health care team. If current plan members choose to remain on the biologic, there are a few factors to be aware of:

1. Unless a plan member has received an exception to continue with their current biologic drug, the costs will no longer accumulate towards their BC PharmaCare family deductible or overall maximum. Find out more about the BC PharmaCare deductible here.
2. Other insurance carriers may no longer be covering the affected biologic drugs which may impact coordination of benefits through a spouse’s plan.
3. If a plan member leaves UBC or retires, the biologic may not be covered under their new plan, UBC’s retiree extended health plan, or the BC PharmaCare program.

Plan members (and their eligible dependents) submitting new prescription drug claims for the conditions/indications above:

Plan members submitting new prescription drug claims for one of the conditions/indications noted above will only be covered for the biosimilar drug provided they are approved under UBC’s FACET prior authorization drug program, aligning with the BC PharmaCare program initiative. Once the BC PharmaCare deductible has been satisfied, claims reimbursement will be coordinated with BC PharmaCare.

Visit the BC government’s Fair PharmaCare Plan for more information on the BC PharmCare program, including deductibles and maximums.

Questions?

BC PharmaCare has been proactive in communicating these changes and providing resources for prescribers and pharmacists. It is likely that many affected members are already aware of the change. However, if you have any questions, please contact benefitsinfo@hr.ubc.ca.