Forcing Canadians to switch from life-changing drugs saves governments millions. Do patients pay a price?

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When Olivia Roman was a pre-teen, she started to notice alarming changes in her digestive system.

Every time she ate, she felt sick. She had no energy, and began throwing up after nearly every meal. Then she started losing weight.

Roman was diagnosed with Crohn's disease at the age of 11, and spent her early teenage years relying on an overnight feeding tube to manage the painful, incurable digestive condition.

"At school everyone's having lunch and I'm just, like, there with nothing — and then I go home and I eat while I sleep, through my nose," the now-20-year-old recalled.

Everything changed once Roman started taking a biologic drug called Remicade. Part of a complex, cutting-edge class of medications, the Johnson & Johnson medication is given to her every eight weeks through an intravenous infusion, and now enables the university student to eat almost every type of food and lead an active, social life.

But starting this spring, the Ontario government is forcing Roman and all other patients on biologics to switch from drugs they know are working to similar ones that are also expected to keep their illness at bay — all part of similar cost-saving measures which have already rolled out in seven other Canadian jurisdictions. 

Proponents of what are known as "biosimilar" drugs say massive financial savings and similar effectiveness of the drugs makes them worth the switch at a population level. Critics question just how much cash they'll save long-term, and whether it's worth forcing patients to swap trusted therapies for the uncertainty of a different drug, however effective it might be.

Meanwhile hundreds of thousands of Canadians suffering from chronic, often-debilitating conditions — including auto-immune diseases like Crohn's, ulcerative colitis, diabetes, and rheumatoid arthritis — are getting caught in the middle.

"What if I'm not like most people? That's something that I don't really feel the need to find out, nor do I want to find out," said Roman, who spoke to CBC News at her childhood home in Caledon, Ont.

Ontario's planned switchover, and the hesitation felt by Canadians like Roman, is just the latest chapter in a years-long saga with stakeholders on all sides of the debate, from rival drugmakers to frugal government officials to wary patient advocates and physicians.

The issue has heated up as more biosimilars have become available. Patents on the original biologic drugs continue to expire, allowing other companies to begin manufacturing similar options and offer them at a cheaper price.

It's a bit like generic drugs — more-affordable alternatives to brand-name products — but in the case of biologics versus biosimilars, the processes and differences are more complex.

While many drugs are made through basic chemical reactions, like simply mixing ingredients together in a lab, biologics involve growing specially-engineered cells in carefully-controlled conditions, which can then develop proteins that will be used to make specific treatments.