What Employers need to Know About Biologics… and Their Bottom Line Cost!

If you haven’t heard about Biologic drugs, you need to get your head out from under the sand. It’s terrifying when you look at high cost recurring drug claims, such as with biologics, and the subsequent increases in your plan costs down the road.  Here’s what you need to know…

What is a Biologic or Biosimilar?

A Biologic is a medicine made from living organisms or cells. A biosimilar is a copy of a biologic medicine that is similar, but not identical, to the original medicine. Although Health Canada uses the term “subsequent entry biologic”(SEB),  the term biosimilar is commonly used in Canada, Europe , the US, and around the world. Biotechnology-based medicines, or biologics, have greatly improved patient outcomes in many disease areas.

What type of disease do Biologics treat?

Diseases such as rheumatoid arthritis, cancer, rare blood disorders, multiple sclerosis, diabetes, HIV/AIDS can now be treated, where no effective therapies were previously available. Today there are over 200 biologics and vaccines on the market worldwide.

The importance to Employers:

Employers are facing some tough realities and tough decisions when it comes to benefit plans because of the rising costs of Biologic drugs in Canada. You have very expensive drugs which serve a small subset of employees within a plan.  It only takes one or two employees to have an impact in a smaller employer. For example, an employee at one of our organizations who was being treated for MS, changed medications, and the resulting change in cost….a $45,000 increase!  It is important that your claims experience is reviewed frequently, you know your Stop Loss Provision, and how recurrent claims are handled by your insurance provider.  We are here to help with solutions if Biologics become a problem with your company.

Paul Crossdale – January 2013

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