Stiffer rules could prevent over-prescribing to U.S. patients, federal health minister says

Click to play video: 'Health Matters: B.C. limits access to Ozempic to Canadians only'
Health Matters: B.C. limits access to Ozempic to Canadians only
Amid surging demand from Americans, B.C. is taking steps to protect the province's supply of the diabetes drug ‘Ozempic'. Global BC Medical Contributor Dr. Birinder Narang discusses that, plus he shares the results of a new study that looks at whether it's unhealthy to lose weight and then gain some of it back again. – Mar 29, 2023

The federal health minister says regulations governing medical practice may have to be strengthened in each province to prevent “incompetence” by doctors who could write thousands of prescriptions for drugs that go to patients outside of Canada.

Jean-Yves Duclos said that at the very least, regulatory colleges may have to better enforce current regulations so medications such as the diabetes drug Ozempic — also used off-label to lose weight — are available to Canadians who need them.

Concern over potential drug shortages arose after a Texas-based doctor licensed in Nova Scotia wrote 17,000 prescriptions for Ozempic over three months, but for people living in the United States.

Regulatory colleges and provinces should guard against a similar issue arising if access to other medications such as the abortion drug mifepristone is restricted in some parts of the United States, Duclos said.

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“I will be raising this issue with my counterparts, health ministers, because this is one example of possibly future examples,” Duclos said Thursday in an interview.

“It’s incompetence,” he said, adding that’s how the College of Physicians and Surgeons also described the actions of the Texas doctor.

“The number is completely out of proportion to the reality of what a good physician would need to do according to medical guidelines.”

Click to play video: 'B.C. to limit sales of Ozempic to non-Canadians'
B.C. to limit sales of Ozempic to non-Canadians

Each province and territory has its own legislation for health-care providers and those regulations would have to be amended by individual governments.

The Nova Scotia college issued an interim suspension of the Texas doctor’s licence last week based on provisions in the Nova Scotia Medical Act, which says such a penalty can be levied where there are probable grounds to believe patients are at risk of harm or injury.

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The college said an investigation is continuing.

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The drugs were dispensed by two pharmacies in British Columbia and shipped to the United States.

B.C. Health Minister Adrian Dix said that in the coming weeks, his province will amend regulations of the College of Pharmacists of British Columbia to stop exports to the United States of any drug to avoid a potential shortage.

He said the Ozempic case came to light when the province noticed a high volume of prescriptions filled by two pharmacies through a network called PharmaNet, which tracks every prescription filled in a community pharmacy.

“I was already concerned when we announced the extension of Pharmacare coverage for Ozempic at the beginning of January. We focused on it,” Dix said.

“I’m satisfied we’re taking action and we’ll deal with B.C. I’m encouraging the federal government to get involved so we address this issue for Canada.”

Click to play video: 'Weight loss drug Ozempic takes centre stage at Oscars'
Weight loss drug Ozempic takes centre stage at Oscars

Duclos said Health Canada would consider restricting the bulk export of any drug through the Food and Drugs Act to preserve supplies for Canada.

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“The key word here is bulk — that planes and trucks of the drug that is in shortage will be leaving Canada to go elsewhere.”

However, Dix said thousands of individual doses are also problematic and demand a national response, especially if U.S. drug prices far exceed those in Canada and spur Americans to order drugs from Canadian pharmacies.

Better data sharing between provinces and territories may also allow quicker action against doctors who prescribe vast amounts of a particular drug, Duclos said.

“It’s challenging for individual provinces and territories and individual colleges of all sorts to do that work in silos. In this case, it was a physician (licensed) in Nova Scotia, but next time it may well be someone in Ontario or Manitoba.”

Dr. Akshay Jain, an endocrinologist who specializes in the management of diabetes and obesity in Surrey, B.C., said overweight patients should have access to Ozempic because they too need to treat a chronic disease.

“About 36 per cent of Canadians live with obesity and an additional 24 per cent are overweight. So that’s over 60 per cent of Canadian adults, whereas only 11 per cent of adults have diabetes,” said Jain.

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Jain said a month’s supply of the drug costs about $200 in Canada, compared to $1,100 in the United States.

Most provinces do not cover medications for obesity, he said, and left untreated that can lead to complications including diabetes, hypertension and the need for hip and knee replacements due to excess body weight.

That costs the health-care system more money in the end, he said.

Ozempic is a brand-name diabetes medication manufactured by Novo Nordisk, but the medical ingredient in it is called semaglutide.

Semaglutide works by mimicking a hormone called glucagon-like peptide-1 (GLP-1), which stimulates the release of insulin and helps to reduce blood sugar spikes.

It also slows down the emptying of the stomach and movement of food through the gut, making a person feel full longer and stabilizing blood sugar levels.

But that’s not all that semaglutide has been shown to do — it’s also effective at regulating diet by targeting areas of the brain that make a person feel more full.

Novo Nordisk actually manufactures two drugs where semaglutide is the only medical ingredient: Ozempic for type 2 diabetes, and Wegovy for obesity.

Wegovy was approved by Health Canada in 2021 but is still not available in Canada.

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A spokeswoman with Novo Nordisk said it is working to make Wegovy commercially available but could not say when that could happen.

Both Wegovy and Ozempic are administered through weekly injections. The only difference between the two is that Wegovy can be injected at a higher dosage.

Another very similar drug — liraglutide — works almost identical to Ozempic and Wegovy but but involved daily injections.

For diabetes it is sold under the name Victoza but for weight loss, it is labeled as Saxenda and the injection pen puts out a larger dose.

Saxenda and Victoza are also manufactured by Novo Nordisk.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

— With files from Karen Bartko, Global News

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