Mandatory switching policies increased etanercept, infliximab biosimilar use in Canada
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Mandatory switching policies for biosimilars are “much more” effective in increasing adoption than focusing on new start strategies, according to a study of Canadian health spending data published in Arthritis Care & Research.
“Biosimilars offer one potential avenue to decrease spending on biologics, and projections suggest that they could reduce drug expenditures by $215 billion globally between 2022 and 2026,” Alison R. McClean, PharmD, MSc, of the University of British Columbia, in Vancouver, and colleagues wrote. “Despite this potential, biosimilar uptake has been low in some countries, including the US and Canada.
“For the most part, Canadian policymakers have encouraged biosimilar uptake through passive new start policies, which require individuals initiating a biologic for the first time to begin treatment with a biosimilar,” they added. “However, in 2019, the province of BC became the first region in North America to require individuals established on therapy to switch to a biosimilar in order to maintain provincial drug coverage. Under the first phase of these switching policies, individuals living with inflammatory arthritis and psoriasis and receiving reference etanercept and infliximab were given 6 months to switch to the relevant biosimilar.”
To evaluate the impact of various biosimilar prescription uptake strategies, McClean and colleagues analyzed information from the Population Data BC databases from January 2003 to November 2020. The researchers used the linked, anonymized databases to identify patients who would have received infliximab (Remicade, Janssen) or etanercept (Enbrel, Amgen), then searched for those who received these medications. Policies of interest included mandates to start biologic therapy with a biosimilar following approval, or to switch to available biosimilars.
The McClean and colleagues examined biosimilar uptake during the new start period in British Columbia, which ran from Feb. 16, 2016, through July 18, 2017, when patients were to begin treatment with biosimilars. They compared the results with uptake during the switching era in 2019, using PharmaNet to investigate pharmaceutical claims for the reference and biosimilar drugs in question. Additionally, the researchers examined monetary expenditure in public and private settings, as well as the proportions of prescriptions and spendings made up of biosimilars.
The analysis included a total of 208,984 patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis or psoriatic arthritis, 5,884 of whom used infliximab or etanercept. Following the initiation of the new start policy, the researchers noted a “small gradual increase” in the proportion of biosimilar etanercept prescriptions, resulting in an increase of 0.65% per month (95% CI, 0.44-0.85).
However, following the wide adoption of the switching policy, there was a “sustained increase” in the proportion of both biosimilar etanercept and infliximab prescriptions — 76.98% for etanercept (95% CI, 75.56-78.41) and 58.43% for infliximab (95% CI, 52.11-64.75), according to the researchers. There was also increased spending on biosimilar versions of these drugs.
“Overall, our study clearly shows that a mandatory switching policy was much more effective than a new starter policy at increasing the use of biosimilars,” McClean and colleagues wrote. “Thus, although new start policies may result in some small gradual increases in biosimilar use, payers can substantially influence the use of biosimilars through the implementation of mandatory biosimilar switching policies. Given the clinical similarity in their effect and potential savings, other jurisdictions and payers should seriously consider the use of these policies.”
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