Saskatchewan Biosimilar Initiative - Action required for members on biologics
20 January, 2023
What's changed?
The Saskatchewan government has announced its Biosimilar Initiative – expanding the use of biosimilars in place of biologics for certain conditions. This means Saskatchewanians using certain biologic drugs covered by the Saskatchewan government program will need to switch to the biosimilar version to continue to receive coverage through the provincial plan and their plan with Manulife.
When is the change happening?
The change is effective now and the province is allowing a transition period up until April 30, 2023, which gives patients time to talk to their health care provider to learn more about the change and get a new prescription for the biosimilar. Patients who are already receiving coverage through the drug plan for a reference biologic drug will receive a letter from the Saskatchewan government.
| Drug Name | Biologic (switch from) | Biosimilar (switch to) | Taking biologic for: |
|---|---|---|---|
| Adalimumab | Humira® | Abrilada® Amgevita™ Hadlima® Hulio® Hyrimoz® Idacio® Simlandi™ Yuflyma™ |
Auto-immune conditions, including: Ankylosing spondylitis Crohn's disease Hidradenitis suppurativa Juvenile idiopathic arthritis Plaque psoriasis Psoriatic arthritis Rheumatoid arthritis Ulcerative colitis Uveitis |
| Enoxaparin | Lovenox® | Inclunox® Noromby® Redesca™ |
Prevention and treatment of venous thromboembolic events |
| Etanercept | Enbrel® | Brenzys® Erelzi® |
Auto-immune conditions, including: Ankylosing spondylitis Juvenile idiopathic arthritis Plaque psoriasis Psoriatic arthritis Rheumatoid arthritis |
| Filgrastim | Neupogen® | Grastofil® Nivestym™ |
Low white blood cell count (non-cancer) |
| Glatiramer (a non-biologic complex drug) |
Copaxone® | Glatect™ | Multiple sclerosis |
| Infliximab | Remicade® | Avsola™ Inflectra® Renflexis™ |
Auto-immune conditions, including: Ankylosing spondylitis Crohn’s disease Plaque psoriasis Psoriatic arthritis Rheumatoid arthritis Ulcerative colitis |
| Insulin aspart | NovoRapid®* (cartridge) | Trurapi® | Diabetes |
| Insulin glargine | Lantus®* (cartridge, pre-filled pens) | Basaglar™ | Diabetes |
| Insulin lispro | Humalog®** | Admelog® | Diabetes |
| Rituximab | Rituxan® | Riximyo® Ruxience™ Truxima™ |
Auto-immune conditions listed in Appendix A of the Saskatchewan Formulary |
* NovoRapid® and Lantus® vials will remain covered at this time, until biosimilar(s) in a vial format are listed on the Saskatchewan Formulary. Coverage of NovoRapid® will continue to be available for patients who use insulin pumps while the biosimilar(s) undergo insulin pump certification.
** Transition for Humalog to the biosimilar drug (Admelog) has been paused by the Saskatchewan Provincial Plan and by Manulife until supply of the biosimilar is stabilized.
What does this mean for Saskatchewan residents taking a biologic?
Saskatchewanians under the provincial plan, taking one of the biologic drugs listed for one of the conditions noted, will need to switch to the approved biosimilar version in order to receive continued coverage from the provincial plan. They need to make the switch before the deadline on April 30, 2023. After this date, the Saskatchewan provincial plan will only cover the biosimilar version – not the biologic.
How does this affect Manulife drug plans for members in Saskatchewan?
For Manulife plan members, we are aligning to the coverage that is offered through the Saskatchewan provincial plan. As such, these plan members will be required to make the switch to the biosimilar drug as noted in the chart above by April 30, 2023, to receive continued coverage under their Manulife plan.
For members that make the switch before the deadline, there is no change to the process. We will consider claims for any portion unpaid by the Saskatchewan provincial plan for biosimilars. We won't consider claims for biologic drugs after the transition period. This is supported by our current contract wording and no changes to the contract or booklet will be required.
How will plan members know?
Saskatchewan Health has communicated these changes publicly and provided resources for doctors and pharmacists to share with their patients. The province will also be contacting impacted patients directly by letter. It is likely many affected members are already aware of the change. In some cases, they may have already made the switch. Additionally, in January we will be directly communicating with affected members to let them know what is happening and when.
What if a member is unable to switch to a Biosimilar?
Saskatchewan Health will consider exceptions on a case-by-case basis for members who are medically unable to transfer to a biosimilar. The member's doctor would need to submit a request for exceptional coverage on their behalf using the Exemption Request Form, along with clinical rationale, for review by the Provincial Drug Plan on a case-by-case basis. If approved, the member would need to provide Manulife with proof of their approval and Manulife will consider balances for the biologic drug according to policy provisions.
For more details, visit the Saskatchewan website or contact your MLI representative.