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Drug coverage · Canada

Does your plan require a biosimilar?

Some public drug plans require a switch from a brand-name biologic to a biosimilar. Choose your medication and plan to see what applies and what to do next.

Check your switching rules

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Your treatment comes first. Do not change or stop treatment without speaking to your prescribing care team.

What these words mean

NIHB (Non-Insured Health Benefits) is the federal program for First Nations and Inuit. A biosimilar is a Health Canada approved version that is highly similar to the original biologic. An exception is a request for the plan to keep paying for the original brand. It is not guaranteed.

We read Health Canada's biosimilars fact sheet on October 11, 2026. A biosimilar is not a generic drug. Health Canada expects no difference in effectiveness or safety after a change in routine use, for a use it has authorized. Its authorization is not a declaration that a pharmacist may switch you. Each province and territory decides that. Authorization does not mean your plan will pay. A biosimilar may be authorized for fewer uses than the original biologic. The product monograph in the Drug Product Database lists the authorized uses. Ask your prescriber or pharmacist. Keep the brand name, the non-proprietary name, the DIN, and the lot number. If you have a side effect, tell your care team and ask how to report it to Canada Vigilance. The fact sheet says those identifiers belong in the report, and it points to the Canada Vigilance Adverse Reaction Online Database. We did not open a separate reporting form.

The same Health Canada fact sheet says no differences are expected in effectiveness or safety after a change in routine use between a biosimilar and its reference biologic, for a use Health Canada has authorized. If you have questions about changing from one biologic to another, talk with your health care practitioner. This page does not tell you to switch.

Health Canada: biosimilars fact sheet

Official sources

Other help

These organizations publish information for patients. MyEligible is not their partner. They have not endorsed this page. They do not decide coverage. Canada's Drug Agency handout, Biosimilar Drugs: Your Questions Answered, is a general explainer. The English file we opened is dated February 2017. The French file is dated April 2021. The page that lists those files was last updated October 2, 2019. It is not a current coverage rule.

Common questions about a biosimilar switch

Do I have to stop taking Stelara?

Not necessarily, and not on your own. It depends on your plan and your age. For NIHB, the deadline may apply only if you are 19 or older, NIHB covers you, and you take Stelara or Actemra. The updates page says October 22, 2026. The Pharmacy Benefits Guide says those brands are no longer covered on October 23, 2026. Pick your plan.

Can I get an exception?

Sometimes, and it is not guaranteed. Who sends the request depends on the plan. Pick your plan and read the exception line. Ontario's example is a negative reaction to at least two biosimilars. That is an example, not a rule for every plan.

Can I switch back?

The RAMQ prescriber page says that once you switch to a biosimilar, you cannot go back to the reference biologic and still be reimbursed, even if you meet an exception. The citizen page section we read does not repeat that sentence. The Alberta and other pages we read do not all state a switch-back rule. Where we could not verify it, the plan card says to check the official source. Do not stop or restart a drug on your own.

What to ask your prescriber and pharmacist

Print this list and take it to the visit. You ask. Your care team answers.

Before switching

  1. Which biosimilar would you prescribe, and does my plan pay for it?
  2. Do you need to send a form? Which form, and where does it go?

Coverage and approval

  1. If I cannot switch, how do you ask for an exception?
  2. Can I switch back to the original brand later if needed? Please check my plan's rule. On the RAMQ prescriber page, a return is not reimbursed after a switch. Please confirm that this applies to me.
  3. Pharmacist: does my current approval carry over, or do I need a new one?
  4. If a claim is refused, what exact message should we read, and who fixes it?

Cost and continuity

  1. Pharmacist: what would I pay at the counter? Do not guess an amount.

This page covers biosimilar switching rules. For other coverage questions, use the drug coverage checker. Open the drug coverage checker

Biosimilar switch in Canada: check your plan | MyEligible