Background/Purpose: Inflectra (infliximab) was the first biosimilar for inflammatory bowel disease and/or arthritis, approved by Health Canada on the belief that it is as safe and effective as its bio-originator Remicade. We assessed recent use of Inflectra versus Remicade (regardless of indication), within Canadian provincial publicly financed drug benefit programs.

Methods: We used aggregate claims data from the National Prescription Drug Utilization Information System (NPDUIS), for 2016. This contains public drug plans data from across Canada except Quebec. Aggregated data were obtained by province, sex, and age groups. We described patients for whom the public drug plan/program accepted at least part of 1 or more claims for Inflectra or Remicade, either towards a deductible (if applicable) or payment. We also calculated total number of claims and recorded amounts paid by the public drug plan (drug cost and pharmacy fees).

Results: In 2016, there were 218 beneficiaries with at least one Inflectra dispensation,, with a total of 856 claims approved. During this time, at least 12,912 individuals were dispensed Remicade, with a total of 80,862 approved claims. No other infliximab biosimilar was dispensed under public drug plans in 2016. Stratified information (sex, age group, province financing the claim) was available for 184 Inflectra and 12,904 Remicade users. Most patients were dispensed Inflectra in Ontario (146 /186, 79%) or in British Columbia (38/186, 21%). Excluding Quebec, other provinces with Inflectra dispensation were Alberta, Newfoundland and Labrador, New Brunswick, Saskatchewan, and Manitoba. There was a significantly higher proportion of seniors receiving Inflectra (71/184, 38%) versus Remicade (2362/12912, 18%) and more females (see Table).

The estimated total cost recorded according to public plans for Remicade in Canada (exclusive of Quebec) in 2016 was $361,502,867 Canadian, representing an average cost per claim of Remicade of $4,471 (versus Inflectra, $1,934). If half of the Remicade claims had been Inflectra instead, the cost difference would have been over $102.5 million. This does not consider undisclosed rebates/discounts which may have been in place.

The findings are limited in terms of our inability to stratify by indication. We were unable to establish if subjects were primarily new-users. No analyses of drug persistence (which may reflect safety and effectiveness) were done.

Conclusion: In 2016, there were 12,912 Remicade users and 218 Inflectra users in Canada, exclusive of Quebec; Remicade’s recorded price tag was over $361.5 million, not including rebates/discounts. Although cost savings of using biosimlars are potentially large, our estimates do not account for other considerations, such as safety and effectiveness, and rebates/discounts offered by drug companies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inflectra-and-remicade-use-and-cost-in-canada-under-provincial-drug-plans-in-2016/