Responding to Ontario’s biosimilar switch initiative
We are changing coverage for some biologic drugs in Ontario in response to the province’s biosimilar initiative. These changes will help protect your clients’ plans from additional drug costs that may result from this government policy while providing access to equally safe and effective lower-cost biosimilars.
Ontario’s provincial biosimilar initiative Announced in December 2022, Ontario’s biosimilar switch program ends coverage of eight biologic drugs for Ontario residents covered by the Ontario Drug Benefit (ODB). The transition to biosimilar versions of these drugs began on March 31, 2023. ODB recipients using these drugs will be required to switch to biosimilar versions of these drugs by December 29, 2023, to maintain their provincial coverage
Equitable Life’s response
To ensure this provincial change doesn’t result in your clients paying additional and avoidable drug costs, we are changing coverage in Ontario for most biologic drugs included in the provincial initiative.
Beginning October 1, 2023, plan members in Ontario will no longer be eligible for most originator biologic drugs if they have a condition for which Health Canada has approved a lower cost biosimilar version of the drug.** These plan members will be required to switch to a biosimilar version of the drug to maintain coverage under their Equitable Life plan.
Communicating this change to plan members
We will inform any affected plan members in early August of the need to switch their medications so that they have ample time to change their prescriptions and avoid any interruptions in treatment or coverage.
Will this change impact my clients’ rates?
Any cost savings associated with the change will be factored in at renewal.
What is the difference between biologics and biosimilars?
Biologics are drugs that are engineered using living organisms like yeast and bacteria. The first version of a biologic developed is known as the “originator” biologic. Biosimilars are highly similar to the drugs they are based on and Health Canada considers them to be equally safe and effective for approved conditions
Questions?
If you have any questions about this change, please contact your Group Account Executive or myFlex Sales Manager.
** The list of affected drugs is dynamic and will change as Ontario includes more biologic drugs in its biosimilar initiative, as new biosimilars come onto the market, and as we make changes in drug eligibility.
