Insurance

As of April 2022, the RAMQ will no longer reimburse claims for the purchase of biological drugs for which there is a corresponding biosimilar drug(1) for all insureds, with some medical exceptions.

Most insurers are welcoming this new measure that will ensure the long-term viability of group insurance plans, and will, therefore, adopt similar initiatives.

This means that a transition will be started immediately so that employees who are already taking a reference biologic drug(2), for which there is at least one biosimilar listed on the list of drugs covered by the Régie de l’Assurance Maladie du Québec (RAMQ), will now have to take a biosimilar version of their drug, under the supervision of their treating physician.

Groupe Censeo Inc. is currently analyzing the measures that will be implemented by each of the insurers to ensure a smooth transition. However, some of them have not yet taken a final position.

As of this November, insurers who have ruled on this matter will send a general notice to all policyholders. Only insured persons affected by this measure will receive a personalized letter and will be accompanied in this process by qualified intervening personnel of the insurers. A transition period will be provided and certain exclusions will apply. Upon receipt of this notification, we invite you to contact your Customer Service Advisor on our team who will be able assist you if needed.

The following is a list of targeted drugs as of September 1, 2021. This is a dynamic list that will evolve as pharmacological advances and changes are made to the RAMQ list of biologic drugs.

• Copaxone (glatiramer)
• Enbrel (etanercept)
• Humira (adalimumab)
• Neulasta (pegfilgrastim)
• Neupogen (filgrastim)
• Remicade (infliximab)
• Humalog (insuline lispro)
• Lantus (insuline glargine)
• Rituxan (Rituximab)

 

Biologic drug: A drug that is made from living microorganisms (e.g., yeast or animal cells) rather than by chemical processes. The composition of biological drugs is more complex than that of chemically synthesized pharmaceuticals, making them much more difficult to produce. Insulin, vaccines, and blood components are all biologics.

(1) Biosimilar drug: A drug that is very similar to a biologic drug that has already been authorized for sale. Health Canada authorizes the sale of biosimilar drugs to the same rigorous standards of quality, efficacy and safety as for all other biologic drugs. At the expiry of the patent for a reference biologic drug, other manufacturers may produce biosimilar versions. Since biosimilars are developed based of the work done to develop the corresponding reference biologic drug, they are cheaper to produce and result in considerable savings.

(2) Reference biologic drug: A proprietary biologic drug compared to the biosimilar drug.

More information on biologic and biosimilar drugs can be found on the Health Canada website.

 

Source: Groupe Censeo

 

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