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UBC Theses and Dissertations

Evaluating biosimilars uptake and policy in Canada McClean, Alison


BACKGROUND Despite representing less than 2% of prescriptions, biologics accounted for nearly three of every ten dollars spent on prescribed medicines in Canada in 2018. Similar to generics for small molecule drugs, biologic biosimilars are one potential way in which payers can reduce drug spending. In 2019, the government of British Columbia became the first in North America to mandate switching from reference biologics to biosimilars. While a number of other provinces have followed, the impact of these policies remains unclear. Therefore, this thesis examined the current state of biosimilars use in Canada. METHODS This dissertation focused on uptake of and spending on infliximab, etanercept, and insulin glargine using two primary data sources: (1) data from the IQVIA Canadian Drugstore and Hospital Purchases Audit representing all Canadian provinces except Newfoundland and Labrador, and (2) British Columbia health administrative data from Population Data BC. Interrupted time series analysis was used to quantify the results of two eras of biosimilars policies in British Columbia, including mandatory biosimilars use for new starters and subsequently mandated switching for all users, among individuals with inflammatory arthritis and psoriasis. RESULTS We found that prior to 2019 uptake of biosimilar infliximab, etanercept, and insulin glargine was low across Canada. Coinciding with the introduction of mandatory switching policies, there was a large increase in utilization thereafter in a number of provinces. In British Columbia, we determined that the introduction of mandatory switching among individuals with inflammatory arthritis and diabetes mellitus resulted in an increase in biosimilars utilization beyond what would have occurred if payers maintained new start policies only. CONCLUSION Government-mandated switching policies have the ability to greatly increase use of biosimilars even in the context of a multi-payer system. Although the ability to ascertain savings is limited due to the proprietary nature of drug pricing in Canada, the enhanced use of biosimilars will likely create a more favorable environment for price-based competition among pharmaceutical manufacturers. Future work should continue to examine the impact of mandatory switching on patients and prescribers as well as on the market for biologic drugs on a longer time horizon.  

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