January 29, 2020
Gail Attara
President & Chief Executive Officer, Gastrointestinal Society
President, Canadian Society of Intestinal Research
Forced Switching Policies: Will Ontario be Next?
Government-led initiatives have never shown us so clearly how invasive their roles can become in the determination of our healthcare treatments. “Life in the hands of your doctor not the government!” exclaimed a protest sign in Edmonton in the wake of a forced non-medical switch policy mandated a few days later.1 What was once decided in the confines of a clinical room between a patient and physician is now in the hands of politicians and bureaucrats.
Along with my colleagues from the Institute for Optimizing Health Outcomes, Crohn’s and Colitis Canada, and Diabetes Canada I have been advocating on behalf of patients – the ones who desperately need the right medicines at the right time – to governments and their agencies. Although we’ve communicated these concerns with the Ontario government and refused to sign a non-disclosure agreement to hear what plans they are making, we believe that the province may be next to jump into the recent wave of forced switch policies implemented across the country.
Our position is that forcing a patient to switch their medicine for non-medical reasons takes healthcare management away from doctors and might put patients at risk. Most Canadian gastroenterologists and their association do not support a forced-switch policy. Research is absent on the long-term impacts such a policy can have on the safety of inflammatory bowel disease (and other) patients. This doesn’t mean to discourage those who do want to switch or to disparage the biosimilar drugs themselves. Fundamentally, this is about preserving the right for patients and their physicians to choose what their treatment should be. After all, it is their lives on the line, not the government’s.
Government bodies are framing policy options around biosimilars as if we can only choose among non-medical switching approaches. Immediately, patient-physician choice was off the table. Yet, we’ve given evidence-based reasons and patient experiences on why we must uphold patient-physician choice and suggests a much safer and more effective policy. A thoughtful, balanced policy alternative is available and it means that governments need to come back to the negotiating table and ensure the originator biological pharmaceutical companies lower their prices so patients don’t have to switch to a biosimilar for cost reasons. A forced non-medical switch will affect tens of thousands of patients across the country. Some will respond well to switching treatments and some won’t. The latter group is who gravely concerns us.
BC advertises its Biosimilars Initiative as a leader in the country in implementing cost savings and improving patient care. However, it’s not working as well as they claim. As a patient group, we hear directly from the individuals that these changes affect. Despite rejections for Special Access from the government, a mother continues to fight for her daughter to stay on the originator biologic. A woman allergic to the biosimilar infusion leaps from medication to medication trying to find an affordable and appropriate alternative. A man spent days in the hospital after switching because he developed a life-threatening intestinal blockage. These are only some of the experiences patients with inflammatory bowel disease are going through. We’ve informed governments the importance of preventing issues such as these, but they aren’t listening.
Whether this directly affects you or not, I urge you to pay close attention because these short-sighted policies reveal the governments’ direction in wanting to play doctor without going to medical school. I sincerely invite you to read our Open Letter to the Ontario Premier Doug Ford and Deputy Premier and Minister of Health Christine Elliott. I also invite you to contact your local elected official and share your concerns.
