Bedford woman concerned about change to Pharmacare coverage

The province says those getting coverage for certain biologic drugs need to switch to biosimilar versions

CITYnews halifax \ Meghan Groff

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A Bedford woman is concerned about a recent announcement from the provincial government.

Earlier this month, Nova Scotia’s Department of Health and Wellness sent out a news release saying those getting Pharmacare coverage for certain biologic drugs would need to switch to biosimilar versions.

“The policy change involves certain insulins used to treat diabetes, as well as drugs that are used for arthritis, inflammatory bowel disease and psoriasis,” the department said.

Shannon Stevenson was diagnosed with Crohn’s disease about 13 years ago.

She began taking Remicade, a biologic, and went into remission for about a decade.

However over the past year or so, her symptoms have started to flare up again. Her medical team believed she was building up antibodies to that medication, so she was switched to a new biologic therapy called Humira.

“I’m working at getting back into remission and I’m feeling well and healthy again,” she told CityNews Halifax.

Stevenson said any biotherapy is extremely expensive. Some of her cost is covered by insurance and some is paid through Pharmacare.

“Usually it takes a couple of avenues to help cover the thousands of dollars for treatment,” she explained.

“Right now there are currently four biologic therapies for people who have Crohn’s and colitis, or [inflammatory bowel disease], two of those are being affected by this new policy that the provincial government is imposing because they have biosimilars.”

Those two are Humira and Remicade.

According to the province, “a biosimilar drug is a highly similar but less expensive version of the original biologic medication, known as an originator drug.”

It’s kind of like switching to a generic version of a medication, but Stevenson said that’s not a totally accurate comparison.

“They’re not a generic because they aren’t an exact copy,” she explained. “They are similar and they kind of get a similar result by potentially a different method.”

Several provinces have already implemented a biosimilar policy and our Department of Health and Wellness says tens of thousands of Canadians have safely made the switch.

The province says it consulted doctors, prescribers and patient advocacy groups while developing the new policy, which it expects will save an estimated $13 million annually once fully implemented.

“The evidence is clear that biosimilars are a safe and effective form of drug therapy for many patients,” said Michelle Thompson, the department’s minister in the news release on February 4.

“If we’re able to provide the same high-quality treatment to our patients for lower cost, it’s our duty to do so. The cost savings from this change will be reinvested in healthcare, meaning even more people will get the care and treatment they deserve.”

Crohn’s and Colitis Canada has put out a statement reacting to the new policy saying biosimilars work great for some patients, but others may find their bodies don’t respond the same way.

“Many patients take years and go through a series of trial and error to find a treatment that works in achieving stability,” stated the organization.

“Health decisions should be made by patients and their physicians, not the government,” it added. “This is a one-size-fits-all approach that is neither scientific nor responsive to the needs of those living with a complex autoimmune disease.”

The province said affected patients have up until February 3, 2023 to change over to biosimilars.

“In very specific circumstances in which the patient is not able to transition to the biosimilar version, the prescriber can request an exemption to continue coverage of the existing product,” the Department of Health and Wellness said.

Stevenson said she’s in the process of consulting with her doctors on how to go forward based on what is best for her health and her finances.

“But there’s some people … the province is covering their whole drug expense. They’ll have no option but to switch under this new policy,” she said.