Ontario biosimilar switching policy is coming soon
In December 2022, the Ontario Ministry of Health announced a biosimilars initiative under its public drug program. Starting March 31, 2023, the province will begin to transition Ontario Drug Benefit (ODB) recipients on certain reference biologic drugs to an approved biosimilar version.
What does this change mean?
By December 29, 2023, all Ontario plan members:
- covered under the ODB program and
- on certain reference biologic drugs will have to switch to a biosimilar drug.
After that date, the province won’t provide coverage for those reference biologic drugs. Exceptions apply for plan members who can’t use a biosimilar for a medical reason.
Plan members still have the choice to keep taking their current biologic drug or switch to a biosimilar drug. If they choose to remain on their current biologic drug, they’ll no longer receive repayment from the ODB program. This may impact plan member costs if their plan has a co-pay for drug expenses. We expect the overall effect to plan sponsors to be minimal based on our analysis, although it will vary by plan.
What’s next
Sun Life will send a letter directly to affected plan members later in 2023. Plan members should discuss with their doctor which treatment options are available to them.
Sun Life’s approach to biosimilar drug coverage
Our approach to biosimilars remains the same. We continuously assess the impact of biosimilars on group benefits plans. This allows us to offer you more sustainable solutions. We manage biosimilar drugs through several cost-containment programs. These generate significant savings and may lessen your financial risks. They also ensure that plan members have access to a broad range of treatments.
Questions? We’re here to help.
If you have fewer than 50 employees, please contact your Client Service Specialist at 1-877-786-7227.
If you have more than 50 employees, please contact your Sun Life Group Benefits representative.