As part of GreenShield’s commitment to delivering an exceptional member experience, they will be modernizing their compound policy. This will be implemented in several phases, focusing on specific reimbursement conditions and compound categories. Phase 1 is projected to be implemented on September 3, 2024.

Biosimilar transitioning British Columbia

In May 2019, the British Columbia (B.C.) government implemented a biosimilar switching policy under its public prescription drug insurance plan. In December 2023, BC PharmaCare announced it would provide a six-month transitional period to allow those using Humalog (insulin lispro), used to treat diabetes, with an Omnipod, Ypsomed, Tandem, or Medtronic pump to transition to the biosimilar, Admelog by May 30, 2024. Health Canada has approved Admelog for use with these pumps, and it is a regular PharmaCare benefit. Patients with new approvals for insulin pumps are expected to use Admelog. Details can be found on the BC PharmaCare website.

In accordance with provincial coordination policies, GreenShield will expand their standard Biosimilar Transition Program in British Columbia to include Humalog for those using an Omnipod, Ypsomed, Tandem, or Medtronic pump. Unless an exception applies, the program will transition on July 22, 2024.

GSC have notified plan members that they must transition to Admelog by July 22, 2024. Plan members claiming Humalog and coordinating benefits with the BC PharmaCare Drug Plan will receive letters advising them of the upcoming transition. They also recommend consulting with their prescriber for transitioning support, including obtaining a new prescription for Admelog, if necessary. However, if BC PharmaCare grants an exception to allow a plan member to remain on Humalog, GreenShield will follow suit and pay for Humalog to enable continued coordination of claims.

Biosimilar transitioning Quebec

In April 2022, the Government of Quebec implemented a biosimilar switching policy under its public prescription drug insurance plan. On December 12, 2023, Régie de l'assurance maladie du Québec (RAMQ) announced as of December 13, 2023, the biologic Lucentis (ranibizumab), used to treat various eye conditions, will no longer be listed on the List of Medications and RAMQ patients being treated with Lucentis were required to transition to the biosimilar, Byooviz by May 22, 2024. Details can be found on the Infolettre RAMQ (available only in French).

GreenShield will also expand their standard Biosimilar Transition Program in Quebec to include Lucentis. Unless an exception applies, the transition date will be August 22, 2024.

GSC have notified plan members that they must transition to Byooviz by August 22, 2024. Plan members claiming Lucentis (including those coordinating with another drug plan) will receive letters advising them of the upcoming transition. They also recommend consulting with their prescriber or pharmacist for transitioning support, including obtaining a new prescription for Byooviz, if necessary.

Per RAMQ criteria, exemptions will apply to:

• Individuals who are pregnant will need to transition within 12 months after childbirth
• Patients with chronic illnesses who have experienced failure to two or more biologic therapies used to treat the same condition
• Pediatric patients must transition within 12 months after their 18th birthday
• Patients who only have one functional eye

If you have any questions, please contact Benefits@united-church.ca