January 8, 2026
Most biologic and biosimilar drugs, due to their high cost, are considered speciality drugs and payment of these types of drug claims for members and their eligible dependents requires approval through prior authorization process conducted by the Cubic Health FACET team. The FACET team conducts independent, unbiased, evidence-based assessments of new prior authorization claims for complex disease states using the clinical expertise of licensed healthcare professionals. Since September 1, 2020, for any new approval for a specialty biologic drug were a biosimilar is available coverage has been limited that of the biosimilar.
On February 13, 2025, the OSSTF ELHT Board approved a motion to have those members who were approved for certain biologic drugs prior to Sept.1, 2020 to also now be switched to an available preferred biosimilar effective September 1, 2025.
This decision to transition from certain reference biologics to biosimilars was made by the OSSTF ELHT Board after much consideration and based on clinical evidence. Health Canada has confirmed that switching from a biologic to a biosimilar is both safe and effective as biosimilars provide the same therapeutic benefit. As per Health Canada: “Patients and health care providers can have confidence that biosimilars are effective and safe for each of their authorized indications. No differences are expected in efficacy and safety following a change in routine use between a biosimilar and its reference biologic drug in an authorized indication.”
The transition to biosimilars also aligns with national and international standards. As of August 2024, all ten Canadian provinces and two territories have adopted biosimilar switching initiatives within their public drug plans. These programs are backed by years of real-world evidence confirming the safety and effectiveness of biosimilar transitions.
In cases where a member or eligible dependent in consultation with their treating physician determine that switching to a biosimilar is not medically appropriate there is a provision to request ongoing coverage for the reference biologic by applying for an exception to the FACET team. Requests can be faxed to1-844-446-1575 or emailed to OTIP@facetprogram.ca.
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