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Alberta Health Biosimilars Initiative

CDHF

Written by: CDHF

Updated: October 27th, 2022

* Deadline date change: The deadline for patients taking a biologic drug to switch to a biosimilar version has been changed from July 1, 2020 to January 15, 2021 due to the COVID-19 pandemic.

CDHF is Canada’s trusted source for timely information on the Alberta Health Biosimilars Initative

What is Changing?

As of January 15, 2021 Alberta Health will only cover the biosimilar versions of infliximab: Inflectra and Renflexis, for patients living with Crohn’s disease or ulcerative colitis. Those who wish to maintain their Alberta Health coverage for the drug molecule will be required to switch from a biologic drug to the biosimilar by January 15, 2021, to avoid any disruption to coverage.

This initiative will apply to adult members enrolled in one of these government sponsored drug plans provided through Alberta Blue Cross:

Non-Group Coverage (Group 1)
Coverage for Seniors (Group 66)
Palliative Coverage (Group 20514)
Child and Family Services (Group 20403)
Alberta Child Health Benefit (Group 20400)
Children and Youth Services (Group 19824)
Income Support (Group 19823)
Learners Program (Group 22128)
Assured Income for the Severely Handicapped (Group 19823)
Alberta Adult Health Benefit (Group 23609)

If you are currently receiving Remicade® to treat your Crohn’s disease or ulcerative colitis and you depend on Alberta Health coverage, you need to contact with your health care professional to discuss this policy change. An exceptions process will be in place should your prescriber believe there is a medical reason why a patient cannot switch to a biosimilar. For individuals starting a biologic or changing their biologic drug, a tiered framework will apply, requiring patients to try a number of first-line therapeutic options prior to being able to access a second-line agent. Patients and health providers will still have numerous treatment options, including other biologics, covered through the government sponsored drug plans.

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Frequently Asked Questions

1. What is a Biologic?

Biologic (reference) drugs are medications made by using living organisms (such as yeast or animal cells) to produce complex proteins that are purified then administered to affect certain processes in the human body.

2. What is a Biosimilar?

A biosimilar is a drug demonstrated to be highly similar to a biologic (reference) drug, that has been authorized for sale in Canada.

3. What do experts say about the safety and efficacy of biosimilars?

Health Canada is responsible for ensuring the safety, efficacy, and quality of all new drugs including biologics and biosimilars. For a biosimilar drug to be approved in Canada, Health Canada must find no meaningful differences in safety and effectiveness compared to the biologic.

4. Do I have to switch to a biosimilar?

If you receive coverage through Alberta Health and you currently take Remicade® for the treatment of Crohn’s disease or ulcerative colitis, you must switch to the biosimilar version before the end of the transition period (January 15,  2021) to avoid any disruption to your coverage.

There may be medical reasons why some patients cannot switch to a biosimilar. Your gastroenterologist can help you determine if it is medically necessary to remain on a biologic (originator) drug. An exception process will be in place should a prescriber believe there is a medical reason why their patient cannot switch to a biosimilar.

5. Why is the change happening?

Alberta spent more than $238 million in the 2018 to 2019 fiscal year on biologic drugs, and these costs are increasing every year. Costs per patient for originator biologics can be more than $25,000 per patient per year, with biosimilar versions costing up to 50% less than originator biologics.

Alberta is implementing the Biosimilar Initiative which will save approximately $30 million annually that can be invested into other health care services for Albertans.

6. How do I maintain my Infliximab® coverage?

To maintain your coverage:

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