Two B.C. doctors are calling for greater access to a suite of potentially life-saving drugs that are only covered by public health care under certain circumstances.
Ozempic, billed as a revolutionary medication for Type 2 diabetics, for example, is on the province’s list of “special authority” medications. It is not regularly eligible for full coverage but may be approved by B.C.’s PharmaCare Special Authority team at the request of a patient’s physician.
In order to obtain that approval, however, a patient must first have exhausted a dual therapy of Metformin and insulin, or Metformin and sulfonylureas.
“In other words, my clinical decision-making is not what determines the best treatment for you, it’s what PharmaCare deems appropriate — meaning what’s cheapest,” Dr. Ali Zentner, a specialist in internal medicine, diabetes and obesity, told Global News.
“In the province of British Columbia, you have to fail the older and less effective — and in this case, more dangerous medications — in order for a patient to get coverage for a newer drug.”
According to the Ministry of Health, special authority list drugs such as Ozempic, or devices such as glucose monitors are not automatically covered in B.C. because they may only work for certain patients, or “provide less value for money than other drug treatments or devices.”
Decisions on whether to provide coverage are also informed by the evidence-based recommendations of the independent BC Drug Benefit Council, which examines patient input, ethical considerations, and clinic and economic evidence, the ministry added.
“Those are decisions made by B.C. PharmaCare and their clinical teams. We’re looking obviously at the evidence,” said Health Minister Adrian Dix at the legislature on Tuesday.
“It’s the way the system works most efficiently, to put that in the direction of our clinical teams.”
Ozempic, or semaglutide, is a weekly injection that, according to its website, helps the pancreas produce more insulin when blood sugar is high, helps prevent the liver from making or releasing too much sugar, and slows down food leaving the stomach.
Vancouver patient Colin Taylor has been on the drug for about two years, and said it has helped lower his blood sugar and contributed to a weight loss of more than 50 pounds.
“It’s just a quick injection as opposed to having to take a tablet every morning and every evening,” he told Global News.
“It’s made me more active, it’s made me slimmer … it should be available for everybody.”
Dr. Tom Elliott, medical director for BCDiabetes, has about 3,000 patients with Type 2 diabetes, half of whom are on Ozempic. Of that half, about 30 per cent have extended medical coverage, he added.
“Fifteen hundred of my patients are left without the ability to pay for it because they don’t have the finances or they don’t have the coverage,” he said.
“I’m qualified to decide who should get it and who shouldn’t. What qualifies a pharmacist at PharmaCare to do that?”
Elliott expressed concerns with one of the courses of treatment required by PharmaCare before Ozempic is considered, noting that glyburide — which falls under the sulfonylureas class of medicines — can have “dangerous” side effects, including hypoglycemia.
“I’m not willing to write a prescription for glyburide to satisfy PharmaCare’s conditions. The policy that they’ve embraced is a bad one,” he said.
“We now have classes of medication that are not just superior in terms of blood sugar-lowering effect, but have cardiovascular benefits and don’t cause hypoglycemia … why wouldn’t we be prescribing those agents first line?” added Zentner.
“Even when we follow their protocols, for example, I’m still getting refused.”
Zentner said the current system encourages physicians to either “fall in line” with a set of “archaic and inappropriate and dangerous guidelines,” or to lie by trying to show that a patient has indeed, exhausted one of PharmaCare’s required treatment courses first.
Dix said B.C. is reviewing the “clinical evidence” on whether Ozempic and other drugs should be eligible for first-line or second-line coverage in the province, and expects “some action soon.”
The Ministry of Health said it has a “rigorous and transparent” drug review process, and among Canadian provinces, provides “one of the most generous drug coverage programs.”
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