During the months of September and October, three op-eds by ASBM Executive Director Michael Reilly ran in numerous Canadian papers throughout Quebec, New Brunswick, and Ontario. Quebec and New Brunswick recently announced they would be adopting forced biosimilar switching policies. Ontario has considered, but not yet implemented such a move.

Read the Quebec op-ed here (French)
Read the New Brunswick op-ed here (English)
Read the Ontario op-ed here (English). 

From the op-eds:

A survey of 403 Canadian specialists found that 73% are uncomfortable with a third party initiating a biologic switch for non-medical reasons (typically the cost), as occurs in the British Columbia and Alberta policies. These findings were affirmed by Quebec’s own government (INESSS) in a May 2020 report which concluded that “Non-medical switching in patients being treated with a reference biologic is generally not accepted by learned societies and the consulted clinicians.”

The Canadian Association of Gastroenterology (CAG) released a paper objecting to the B.C. policy; noting that BC Pharmacare’s substitution policy went against the recommendations of 14 gastroenterology societies throughout Canada and Europe. Many patient advocacy organizations also opposed these policies, including the Gastrointestinal Society and Crohn’s and Colitis Canada.

“It was a very long, difficult 2 1/2 year journey to find [the originally-prescribed] drug. All other drugs failed,” said one B.C. arthritis patient who was forced to switch. “I am shocked and appalled that this government is taking the decision away from physicians and patients, where it belongs.”

The New Brunswick and Quebec announcements cited 15 years of experience with biosimilars in Europe to justify forced switching. However, as the op-ed explains:

Automatic substitution of biologics is almost universally prohibited in Europe. In nearly every European country, physicians are free to choose between multiple products, including the originators, and the payer will reimburse them – resulting in both high biosimilar usage and high savings while preserving patient and physician control of treatment decisions.


Read ASBM’s new whitepaper “A Critical Review of Substitution Policy for Biosimilars in Canada”. This paper highlights the stark contrast between the forced-substitution policies recently enacted by some Canadian provinces and the pro-competition policies which have proven successful in driving biosimilar uptake in Europe and the U.S.