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The latest news on provincial drug formulary listing decisions

Arthritis Consumer Experts (ACE) maps out the latest news for you about provincial drug formulary listing decisions. It contains information about important changes to provincial drug formularies and what it means for Canadians living with inflammatory arthritis. The changes covered in this update affect people living with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA).

The following medications have been added to the online version of ACE’s Arthritis Medications Report Card:

  • adalimumab (Amgevita®)
  • adalimumab (Hadlima®)
  • adalimumab (Hulio®)
  • adalimumab (Hyrimoz®)
  • adalimumab (Idacio®)
  • rituximab (Riabni®)

ACE Arthritis Medications Report Card Highlights:

  • Ontario has retained its top-ranking position due to the addition of six medications to its drug plan, meaning more patients have received affordable access to medications they need.
  • Provinces whose ranking improved due to the addition of medications include:
    • New Brunswick (up to 3rd in May 2021 from 6th in September2020);
    • Newfoundland and Labrador (up to 7th in May 2021 from 9th in September 2020);
    • Alberta (up to 2nd in May 2021 from 3rd in September 2020); and,
    • Non-Insured Health Benefits for First Nations (NIHB) (up to 10th in May 2021 from 11th in 2020).
  • Provinces whose ranking declined due to the high number of medications “under review” include:
    • Quebec (down to 5th in May 2021 from 2nd in September 2020);
    • Manitoba (down to 9th in May 2021 from 6th in September 2020);
    • Nova Scotia (down to 8th in May 2021 from 6th in September 2020);
    • British Columbia (down to 4th in May 2021 from 3rd in September 2020);
    • Saskatchewan (down to 6th in May 2021 from 5th in 2020); and,
    • Prince Edward Island (down to 11th in May 2021 from 10th in September 2020).
  • Yukon has retained the lowest position on the Report Card due to the relative low number of new additions to their formularies and the high number of medications “under review,” reducing affordable access to medications patients need.

British Columbia

A listing criteria update has occurred for the following medications:

  • adalimumab (Humira®) for the treatment of RA, AS, JIA, and PsA
  • tofacitinib citrate (Xeljanz®) for the treatment of RA

The following medications have been listed for reimbursement on the provincial drug formulary:

  • adalimumab (Amgevita®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hadlima®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hulio®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hyrimoz®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Idacio®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Brenzys®) for the treatment of JIA and PsA
  • infliximab (Avsola®) for the treatment of RA, AS, and PsA

The following medication has been declined for listing in the provincial drug formulary:

  • baricitinib (Olumiant®) for the treatment of RA

Update to the coverage of rituximab (Rituxan®)

Effective February 19, 2021, PharmaCare no longer covers Rituxan. To receive PharmaCare coverage, patients with approved conditions must, in consultation with their prescriber, obtain a prescription for an authorized biosimilar (Truxima™, Riximyo™, or Ruxience™). Note: biosimilars are limited coverage benefits that must meet Special Authority criteria.

For patients who are medically unable to switch to a biosimilar option, a prescriber may submit a new SA request for exceptional coverage of Rituxan, which will be reviewed by Special Authority on a case-by-case basis. This request must have been submitted before February 19, 2021 to ensure continued coverage.

Alberta

A listing criteria update has occurred for the following medications:

  • adalimumab (Humira®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Brenzys®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Enbrel®) for the treatment of JIA
  • etanercept (Erelzi®) for the treatment of RA, AS, JIA, and PsA
  • golimumab (Simponi®) for the treatment of RA, AS, and PsA

The following medications have been listed for reimbursement on the provincial drug formulary:

  • adalimumab (Amgevita®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hadlima®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hulio®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hyrimoz®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Idacio®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Brenzys®) for the treatment of JIA and PsA
  • infliximab (Avsola®) for the treatment of RA, AS, and PsA
  • rituximab (Truxima®) for the treatment of vasculitis

Update to the coverage of rituximab (Rituxan®)

Due to the Biosimilar Initiative, Rituxan has been delisted effective March 1, 2021. If you are unable to switch to the biosimilar version for medical reasons, your health care professional can help determine whether to request exceptional coverage of the originator biologic.

Update to the coverage of etanercept (Enbrel®)

The Alberta government-sponsored drug programs previously covered the following drug product. Effective May 1, 2021, the listed product will no longer be a benefit. A transition period will be applied and as of May 31, 2021 claims will no longer pay for this product:

  • Enbrel 50 mg/syringe injection

Saskatchewan

A listing criteria update has occurred for the following medications:

  • adalimumab (Humira®) for the treatment of JIA
  • etanercept (Brenzys®) for the treatment of RA and AS
  • etanercept (Enbrel®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Erelzi®) for the treatment of RA, AS, JIA, and PsA
  • rituximab (Rituxan®) for the treatment of RA and vasculitis

The following medications have been listed for reimbursement on the provincial drug formulary:

  • infliximab (Avsola®) for the treatment of RA, AS, and PsA
  • etanercept (Brenzys®) for the treatment of JIA and PsA
  • rituximab (Riximyo®) for the treatment of RA and vasculitis
  • rituximab (Ruxience®) for the treatment of RA and vasculitis
  • rituximab (Truxima®) for the treatment of RA and vasculitis

Please note:

As of March 1, 2021, all listed Enbrel indications have a biosimilar etanercept option. As such, new patients (i.e., patients without previous EDS approval for Enbrel) will be eligible for one of the listed biosimilar formulations of etanercept.

Manitoba

  • A listing criteria has occurred for adalimumab (Humira®) for the treatment of JIA

The following medications have been listed for reimbursement on the provincial drug formulary:

  • rituximab (Riximyo®) for the treatment of RA
  • rituximab (Ruxience®) for the treatment of RA and vasculitis
  • rituximab (Truxima®) for the treatment of vasculitis

Ontario

The following medications have been listed for reimbursement on the provincial drug formulary:

  • adalimumab (Amgevita®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hadlima®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hulio®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hyrimoz®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Idacio®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Brenzys®) for the treatment of JIA and PsA
  • infliximab (Avsola®) for the treatment of RA, AS, and PsA
  • rituximab (Truxima®) for the treatment of vasculitis

Quebec

The following medications have been listed for reimbursement on the provincial drug formulary:

  • adalimumab (Amgevita®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hulio®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hyrimoz®) for the treatment of RA, AS, and PsA
  • adalimumab (Idacio®) for the treatment of RA, AS, and PsA
  • etanercept (Brenzys®) for the treatment of JIA and PsA
  • rituximab (Riximyo®) for the treatment of RA

Nova Scotia

A listing criteria update has occurred for the following medications:

  • adalimumab (Humira®) for the treatment of JIA
  • etanercept (Enbrel®) for the treatment of RA, JIA, and PsA
  • rituximab (Rituxan®) for the treatment of RA and vasculitis
  • tofacitinib (Xeljanz®) for the treatment of RA

The following medications have been listed for reimbursement on the provincial drug formulary:

  • certolizumab (Cimzia®) for the treatment of RA, AS, and PsA
  • rituximab (Riximyo®) for the treatment of RA
  • rituximab (Ruxience®) for the treatment of RA and vasculitis
  • rituximab (Truxima®) for the treatment of RA and vasculitis
  • sarilumab (Kevzara®) for the treatment of RA

New Brunswick

A listing criteria has occurred for the following medications:

  • adalimumab (Humira®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Brenzys®) for the treatment of RA and AS
  • rituximab (Rituxan®) for the treatment of RA and vasculitis
  • tocilizimab (Actemra®) for the treatment of vasculitis (Giant Cell Arteritis)

The following medications have been listed for reimbursement on the provincial drug formulary:

  • adalimumab (Amgevita®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hadlima®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hulio®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hyrimoz®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Idacio®) for the treatment of RA, AS, JIA, and PsA
  • etanercept (Brenzys®) for the treatment of JIA and PsA
  • infliximab (Avsola®) for the treatment of RA, AS, and PsA
  • rituximab (Riximyo®) for the treatment of RA and vasculitis
  • rituximab (Ruxience®) for the treatment of RA and vasculitis
  • rituximab (Truxima®) for the treatment of RA and vasculitis

Please note:

Effective March 18, 2021, adalimumab biosimilars will be added to the Formulary as a special authorization (SA) benefit according to the criteria listed below.

All new SA requests for coverage of adalimumab will be approved for the biosimilar brand of adalimumab only. Patients who received SA approval for the Humira® brand of adalimumab before March 18, 2021 will continue to have this brand covered. They will also be eligible for coverage of the biosimilars.

Newfoundland & Labrador

  • A listing criteria has occurred for rituximab (Rituxan®) for the treatment of RA

The following medications have been listed for reimbursement on the provincial drug formulary:

  • adalimumab (Amgevita®) for the treatment of RA, AS, JIA, and PsA
  • adalimumab (Hulio®) for the treatment of RA, AS, JIA, and PsA
  • infliximab (Avsola®) for the treatment of RA, AS, and PsA
  • rituximab (Riximyo®) for the treatment of RA

Prince Edward Island

There are no updates to the provincial formulary for Prince Edward Island.

NIHB

  • A listing criteria has occurred for adalimumab (Humira®) for the treatment of JIA

The following medications have been listed for reimbursement:

  • infliximab (Renflexis®) for the treatment of RA, AS, and PsA
  • rituximab (Riximyo®) for the treatment of RA
  • rituximab (Ruxience®) for the treatment of RA and vasculitis
  • rituximab (Truxima®) for the treatment of RA and vasculitis

Yukon

The following medications have been listed for reimbursement on the Yukon drug formulary:

  • etanercept (Brenzys®) for the treatment of JIA
  • etanercept (Enbrel®) for the treatment of JIA
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