Quebec biosimilar initiative

Quebec members (18 years and older) using certain innovator biologic drugs will need to switch to a corresponding biosimilar before April 13, 2022. As of that date, the Régie de l'assurance maladie du Québec (RAMQ) will only cover the biosimilar version – not the innovator biologic. 

Health Canada has indicated that authorized biosimilars are as safe and effective as any other innovator biologic drug.^* 

Patients taking one of the innovator biologic drugs listed below will need to switch to the corresponding biosimilar before April 13, 2022 to receive continued coverage with the provincial plan.

Our approach to biosimilars helps control plan costs by ensuring the most cost-effective option is eligible: 

• We leverage integration with the provincial plan, compare the cost of the innovator biologic drug to the biosimilar drug, and in some cases list the biosimilar as the preferred option.  
• For many of the drugs on the biosimilar switching list, we have negotiated Product Listing Agreements (PLAs), bringing the cost of the innovator biologic drug in line with that of the biosimilar drug. 

In response to the Quebec announcement, we have assessed our coverage and will be asking all existing members make the switch to the biosimilar drug—except if there is a PLA and the member is not eligible to receive coverage under the Quebec provincial plan. 

For members that make the switch before the deadline, there is no change to the process. We will consider claims for any unpaid balance by the Quebec provincial plan for biosimilars. We won't consider claims for innovator biologic drugs as of April 13, 2022. This is supported by our current contract wording and no changes to the contract or booklet will be required. 

According to the information provided by the government of Quebec, healthcare professionals will get in touch with patients affected by the change. It is likely many affected members are already aware of the change. In some cases, they may have already switched. Also, in January 2022, we will directly communicate with those members who will be asked to make the switch to let them know what is happening and when.

The provincial drug program will continue to reimburse the innovator biologics for:

• Patients under the age of 18 – who should switch to a biosimilar within 12 months of their 18th birthday
• Pregnant patients – who should switch to a biosimilar within 12 months of giving birth
• Patients who had at least 2 treatment failures using other biologic drugs for the same chronic disease

For members with complementary coverage, we will require proof of coverage from the provincial plan before we will consider balances for the impacted biologic drug.  

For members with private coverage only, medically necessary exceptions may be considered on a case-by-case basis when appropriate medical information is received from the prescribing physician.  

For more details, visit the Quebec website or talk to your Manulife representative.