Last Updated : December 10, 2021
New-generation biologics have been shown to be more effective for treating plaque psoriasis; however, old-generation biologics continue to be used. To optimize value in this class of drugs, formulary management strategies could be employed. Examples of those are the pursuing of negotiations with the pan-Canadian Pharmaceutical Alliance to lower costs for old-generation biologics that do not have biosimilar versions or establishing tiered formularies to prioritize the reimbursement of old-generation biosimilars and new-generation biologics for the treatment of plaque psoriasis.
Biologics: a class of drugs derived through complex manufacturing procedures that use human or animal tissue or micro-organisms as the starting material, rather than being synthesized by chemical reactions.
Biosimilars: a new, highly similar but not exact copy of a biologic drug that comes to the Canadian market after the patent for the original biologic has expired. Biosimilars are less expensive than biologics.
Exclusivity Status: a function of patent and data protection.
Patent Protection: a 20-year period offered to innovative drugs from the date of filing their Notice of Compliance with Health Canada. Patent protection can be applied in different ways such as chemically or for changes in the use of the drug.
Data Protection Regulations: provide data protection for an 8-year term after receiving their notice of compliance from Health Canada. These regulations started in 2006 and are governed by the Food and Drug Regulations in Canada.
Plaque psoriasis is a chronic inflammatory condition whereby inflamed, scaly patches of skin develop on the body. These patches are associated with itching, redness, pain, discomfort, and lowered quality of life. It is estimated that 1% to 3% of people in Canada are affected by psoriasis. There are many first-line treatments for the management of plaque psoriasis, including phototherapy, topical steroids, topical vitamin D, and oral systemic anti-inflammatory medications (e.g., methotrexate). Adults who have moderate to severe plaque psoriasis and do not respond to first-line treatment can be treated with biologic medications. Biologics for plaque psoriasis can be divided into 2 groups based on their mechanisms of action (how they work to produce an effect on the body) and when they received market authorization. Older-generation biologics for plaque psoriasis include anti–tumour necrosis factor (TNF) agents (etanercept, adalimumab, infliximab, and certolizumab pegol) and an anti-interleukin (IL)-12/ IL-23 inhibitor (ustekinumab). More recently, a new generation of biologics have been approved for plaque psoriasis use. These include anti–IL-17 inhibitors (secukinumab, ixekizumab, brodalumab) and anti–IL-23 inhibitors (guselkumab, tildrakizumab, and risankizumab)
Given the significant cost of biologics to public drug plans, the loss of exclusivity for the oldgeneration biologics, and the new-generation biologics becoming available, there is a need to assess how biologics used to treat adults with moderate to severe plaque psoriasis are reimbursed.
Given the significant cost of biologics to public drug plans, the loss of exclusivity for the oldgeneration biologics, and the new-generation biologics becoming available, there is a need to assess how biologics used to treat adults with moderate to severe plaque psoriasis are reimbursed.
We undertook an Environmental Scan to summarize the regulatory status, exclusivity status, our review status, reimbursement status, and utilization patterns for biologic and biosimilar use in plaque psoriasis.
A grey literature search was conducted to inform this Environmental Scan.