Payer Be Aware
July 16, 2018
In a category marked by caution and conservatism, a private payer, Green Shield Canada (GSC) has enacted a couple of highly innovative policies for biologic drugs.5,6 In this exclusive chat with 20Sense, Ned Pojskic, Leader, Pharmacy & Health Provider Relations at GSC, explains why GSC chose to take this bold step – and suggests a way forward for the biologic ecosystem.
20Sense: Can you briefly describe the biosimilar policies adopted by GSC?
Ned Pojskic: In 2016, we introduced a policy whereby patients starting on a biologic only get coverage for the biosimilar (assuming one exists), barring exceptional circumstances. And in early 2018 we launched our Biosimilar Transition Program. It’s the first program in the country that addresses transitioning for patients already on a biologic, as opposed to new starts. Under this new program, arthritis patients already on Remicade [infliximab] or Enbrel [etanercept] have the option to switch to the biosimilar versions of these drugs – or stay on the originators and pay the difference.
20Sense: What spurred GSC to adopt these policies?
NP: Our company philosophy is to follow the evidence, which in this case is very clear: biosimilars do not compromise either efficacy or safety, and theoretical concerns about increasing immunogenicity have not borne out. Fortunately our plan sponsors have stood behind us all the way, and it was vindicating to see public payers establish similar policies for new patients starting biologic therapy shortly after we introduced our 2016 program.
20Sense: What about the idea of letting people choose? Is this not a core value of our health system?
NP: Canadian physicians have shown reluctance to rock the boat, so if we as payers maintain a totally open choice, we’re simply going to funnel all uptake toward originators. The patient can always choose to pay more, but payer policies should rest on reason and evidence. This philosophy is part of a broader view that extends beyond any one drug or category. It’s a rational approach to distributing scarce health resources in our society.
20Sense: Can we learn from the experience of other countries?
NP: I think we can learn from European countries such as Norway and Sweden, where there’s a greater focus on evidence and payers have taken a more aggressive stance. Payer policies have also driven down biosimilar costs in countries such as Norway, where we’re seeing discounts of up to 75%. While it is true that these countries have single-payer systems for these drugs, some of their approaches could be adapted to the Canadian environment.
20Sense: What’s your advice to payers operating in the biologic [originator and biosimilar] space?
NP: At different points in their lives, patients sometimes move between public and private reimbursement, so ideally public and private payers should integrate their policies to facilitate such transitions. Above all, we payers need to keep presenting the evidence to doctors and policymakers. Sometimes it’s just a matter of time before the message gets across.
20Sense: Any parting advice for biologic drug manufacturers?
NP: For manufacturers of biosimilars, educate the payers to support new products and to understand they’re not losing out by adopting forward-looking policies. For manufacturers of originators, avoid fearmongering to preserve market share and take the long view: the more sustainable the market, the more room there is in benefit plans for new therapies coming to market.
To learn more, listen to this GSC podcast on biosimilars featuring Ned Pojskic as well as patient advocate Cheryl Koehn:
https://www.greenshield.ca/en-ca/podcast/episode-7-biosimilars
References
5. Green Shield Canada subsequent-entry biologic policy announcement, April 20, 2016: https://bit.ly/2MZgPrV
6. Green Shield Canada biosimilar transition program announcement, March 8, 2018: https://bit.ly/2u1kK0h