What’s changing for plan members
All patients covered by the public drug plan currently on a biologic drug targeted by RAMQ will have to switch to the biosimilar by April 12, 2022. RAMQ will delist the originator biologics from its formulary. There will, however, be certain exceptional cases where RAMQ will continue to cover the biologic.
What does this change mean?
Overall, we expect the financial impact of this change to be low. On average in our block of business, a low proportion of Quebec claimants are subjected to coordination of benefits. Although the impact may vary by Client, we have a Biosimilar management approach in place to help reduce financial risks.
Our approach remains the same
Biosimilars are drugs that are very similar to their originator biologic counterpart. However, they aren’t interchangeable the way traditional generic drugs are with their brand counterparts. They offer a valuable treatment option to plan members for many different medical conditions.
When managing biosimilar drugs, Sun Life takes a flexible, Client-centred approach that helps support you and your plan members. We manage biosimilar drugs through a number of cost containment programs. These programs generate significant savings and lessen your financial risks. They also ensure that plan members have access to a broad range of treatments. For example, in some cases, Sun Life will negotiate the originator biologic price to bring it in line with its biosimilar options. In other cases, we may choose to consider listing a biosimilar drug as a preferred treatment option.
In consultation with their treating physician, plan members can choose to switch from an originator biologic to a biosimilar. We’ll continue to work proactively to assess the impact of biosimilars on group benefit plans. We do this to offer you sustainable solutions, while giving plan members choice and providing timely, disruption-free access to therapy.
Questions? We’re here to help.
If you have fewer than 50 employees, please contact the Client Relations Representative Team at 1-866-606-8936.
If you have more than 50 employees, please contact your Sun Life Group Benefits representative.