EDMONTON -- An Albertan who has just figured out how to live life with an inflammatory bowel disease is worried the provincial government is about to force him to use a different medication by implementing a non-medical switch policy. 

Twenty-four-year-old Nish Naidoo was diagnosed three years ago with ulcerative colitis.

"At 21 when you’re trying to start your young adult life, it’s kind of like misery," he recalled to CTV News Edmonton.

"You spend more time in the bathroom than you (do) living your life."

Naidoo spent about a year and a half testing different medications and lifestyle changes before starting biologics, a kind of drug that is created inside a living organism. Last summer, he went into remission.

"I spent all this time trying to figure out what works for me," he said.

"And now there’s that uncertainty of what could happen."  

Alberta looks to implement non-medical switch policy

In finding health spending was the province's largest expenditure—at 43 per cent of total operating costs—Alberta's latest budget announced measures to bring costs in line with other provinces.

One of its endeavors was to address Alberta's higher drug costs by changing the design of its programs, including expanding the Biosimilars Initiative to limit drug benefit coverage to other clinically appropriate but cheaper alternatives.  

According to the province's health ministry, Alberta has seen the cost of biologic drugs rise from $20 million per year to $200 million per year in the last decade.

"The prices of biologics are becoming more and more, I suppose, an unsustainable situation," Health Minister Tyler Shandro commented to media earlier in the week.

"Drug claimants who are on biologics, maybe about two per cent—but they’re 17 per cent of the drug costs right now in this province."  

Alternatively, biosimilars are very similar to biologics in that they're manufactured from a reference biologic drug, but often at a cheaper price. Biosimilars are also approved for use and sale in Canada, and often considered a comparable alternative in terms of efficacy and safety.

In May, British Columbia announced $96 million in savings by moving some 20,000 residents from biologic prescriptions to biosimilar prescriptions.  

But stability isn't only on the mind of the Alberta government. Naidoo worries about what could happen to his health if he is forced to change treatments.

"(Remission) was like life came back to me," he told CTV News Edmonton.

"I spent all this time away from things I enjoy to finally reach that pinnacle of stability."  

'Small little differences can change the way the drug performs in individual patients': expert

According to a University of Calgary doctor, the majority of patients taking biologic medicines could transition without problems to biosimilars—except, perhaps, IBD patients like Naidoo.

Biologics are also used to treat conditions like psoriasis and rheumatoid arthritis. However, those patients have made the change from biologics to biosimilars with fewer issues than patients with inflammatory bowel disease for unknown reasons, Dr. Remo Panaccione said.

"If I could pick the patients I could switch, and be completely fine, I would be happy to support this policy," he told CTV News Edmonton, equating Alberta's potential non-medical switch policy to rolling dice.

"If you're on the winning side and nothing happens, all is good. In inflammatory bowel disease, if you happen to be on the losing side—that has significant consequences."

Panaccione estimated between 10 per cent and 30 per cent of all patients on biologics would experience trouble switching to biosimilars, from losing response to medication and experiencing adverse effects to relapsing.  

"Everything can look the same, but small little differences can change the way the drug performs in individual patients."  

Alberta's health ministry said it will release more details about the drug coverage change by the end of the year, after more consultation.

On Tuesday, Shandro met with stakeholders, including Panaccione, to discuss what impact could be felt by patients.

However, the doctor said he left the meeting disheartened and like a checked box:  "When someone doesn't have any questions in the room it usually suggests they have already made up their mind."

He added he'd like to see physicians and patients be able to make the choice to switch medications themselves, but in the case a non-medical switch policy is implement, is prepared to study what happens afterwards.

Naidoo hopes the government is seriously listening to public feedback.  

"When you mix health care and politics that’s when things will get messy," he said.

"We need to have compassion through this process, we need to be understanding of one another, and we need ensure we put ourselves in the other person's shoes and ensure they’re receiving the best care."

The government has said it will consider how to apply changes to specific groups, including possible exemptions.

With a report from CTV Edmonton's Nicole Weisberg