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How encouraging Subsequent Entry Biologics can reduce your premiums

Reformulary Infographic on SEBs
Reformulary Infographic on SEBs

You’ve probably heard of biologic drugs by now, which are highly expensive breakthrough drugs used to treat, and sometimes cure, illnesses. They are often described as ‘miracle drugs’, and can cost in the tens or hundreds of thousands of dollars per year.

These biologic drugs are frequently covered by insurance companies on employee benefit plans, on a list of of drugs called a ‘formulary’.

Biologic drugs by nature do not allow for identical generic drugs to enter the market after the patent has run out – however, they do have clinically equivalent counterparts called Subsequent Entry Biologics (SEB). SEBs, although expensive, are much less expensive than the original biologic drug.

These SEBs are safe, approved by Health Canada to treat the same conditions, and a new wave of them has begun entering the marketplace.

For example, according to the Reformulary Group, Inflectra is the SEB of Remicade, used for rheumatoid arthritis, psoriatic arthritis, among other uses. Inflectra can cost 15% to 30% less than Remicade to treat the same condition.

Why should you care?

If you are plan sponsor (employer), you may have already seen biologic drugs hit your claims history and therefore, drive your premiums upwards. By using the Reformulary drug plan through Beneplan and The Co-operators Life, you will be able to save money without affecting patient health because Reformulary will use SEBs in step-therapy. Step-therapy is the process of asking a patient to try one medication to see if it works first, before allowing coverage for its very expensive counterpart. Step-therapy is rarely used, and only used in situations when it is safe for the patient to do so, clinically equivalent, and the savings are substantial.

Contact Beneplan to start a conversation about how the Reformulary can reduce your premiums: 1-800-387-1670 or email patricia [at] beneplan [dot] ca.