Doctors warn Crohn's, arthritis patients will pay a price as province pulls drug funding

Doctors say 2,000 patients in Alberta will pay a price as the government stops funding Remicade, a drug used to treat people with Crohn's, ulcerative colitis, or certain types of arthritis.

Alberta announced last week it is switching from covering biologics to biosimilars, a cheaper alternative type of medication. It's a move the health minister said will save the province hundreds of millions of dollars but will affect around 26,000 Albertans.

Biologics are proteins, complex medicines created from living cells, whereas biosimilars are developed to be highly similar to the more complex biologics. Both types of drugs are used to treat everything from rheumatoid arthritis to diabetes to cancer. 

The biologic Remicade, also known as infliximab, and its biosimilar treatments, are done by IV, usually at private clinics contracted by pharmaceutical companies. Remicade is expensive — costing twice as much as biosimilar alternatives.

'A lot of anxiety'

Red Deer gastroenterologist Dr. Dave Ryan says 177 patients in the area will have to switch from Remicade to a biosimilar but there's only one infusion clinic where they can receive the new treatments — and it only has capacity for 30 patients.

"It's caused a lot of anxiety, not only moving centres and working with new staff and a new company providing medication," said Ryan, "but also a great worry that if they can't receive their medication in a timely fashion that they will indeed … have a flare up, all of which could have been mitigated by simply speaking to frontline workers and developing a comprehensive plan for switching patients. That hasn't been done."

If people don't receive treatment every eight weeks, it could cause a flare up, he said. Or patients could develop resistance, which means neither the new drug, nor the original, will work.

Ryan stressed, however, that gastroenterologists will make every effort possible to advocate for their patients and ensure that there's as safe a transition as possible from one medication to another.

"I find it's going to uproot the patients," said Lethbridge gastroenterologist Dr. Kaleb Marr.

"If they have to switch drugs, they might end up driving to a different centre in order to get a different drug which puts a lot of stress and burden on that. And on top of that, if there's no centre within driving range … it could mean they're going to emergency rooms."

Marr said roughly 80 patients who are currently on Remicade will need to be absorbed at other clinics. 

He said he hasn't been contacted by the province about the plan.

Government says there won't be loss of access

A spokesperson for Alberta Health Minister Tyler Shandro said there will be "little or no loss of access." 

"There are currently 39 infusion sites across the province where patients can receive infliximab biosimilars. These sites are in comparable locations to the infliximab originator (biologic) clinic locations," an emailed statement read. "In many instances, patients will be able to keep going to the same infusion clinic as many are not under exclusive contract to any manufacturer."

The province said it's working closely with biosimilar manufacturers to ensure comparable patient support.

But Marr said he doesn't feel the province has spoken to enough experts in the field.

"I don't know if they've done their due diligence to find out exactly what the impact is from a patient standpoint … all they're looking at is the bottom-dollar impact and quite frankly, when Janssen [the company that makes Remicade] is capable or willing to price match, there's no argument even for the bottom dollar," Marr said.

Janssen has said it has reached out to the government to offer its product at a cost comparable to biosimilars.

"We are reviewing the new government policy and its impact on the treatment patients prescribed Remicade currently receive though infusion clinics," the company said in an emailed statement. 

When asked in November about Janssen's offer, a health ministry spokesperson said they're aware of Janssen's offer, but are "not going to negotiate with any company through the media."

Pfizer and Merck, which both produce biosimilar drugs patients can switch to, said in emailed statements they are committed to providing support for patients.

Pfizer said it has 22 Alberta clinics patients can switch to, and that it's adding capacity to meet patients' needs — including a plan to open a new Red Deer clinic in January.

Merck said there are currently 12 infusion clinics in Alberta, and that it has retained the service of a third party to infuse its drug.