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Doctors say B.C. puts up unreasonable roadblocks to coverage for vital diabetes drug

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this story is part situation criticalis a CBC British Columbia series that reports on the barriers people in CBC British Columbia face in accessing timely and adequate health care.

Physicians in B.C. who treat diabetes have to overcome a variety of hurdles, including getting patients to try cheaper but more dangerous alternatives first, in order to get reimbursement for potentially life-saving drugs. He said he didn’t.

Dr. Ali Zentner, a specialist in internal medicine and obesity in Vancouver, says groundbreaking new drugs and devices for people with diabetes have emerged in recent years.

This includes medications such as Ozempic for type 2 diabetics, which also helps with weight loss and reduces the chance of heart attacks and strokes, and continuous glucose monitoring, which tracks glucose levels every few minutes.

But those options are expensive, and Zentner increasingly wants to prove that patients need insurance under PharmaCare, a public program that covers the cost of some drugs. It is requested to be of an unreasonable length.

“According to the Canadian diabetes guidelines, the American diabetes guidelines, and the European diabetes guidelines, there may be patients who have drugs that are ideal first- or second-line therapy for this patient,” said Zentner. .

“But according to PharmaCare, two other agents must have failed for me to be covered for this patient.”

The problem is that options like Ozempic and continuous glucose monitoring special authority.

This designation is given to certain medicines that are not covered by PharmaCare. Compensation is offered to patients only under certain circumstances requested by a doctor, and in such cases only when cheaper drugs fail.

“My clinical decision is not really what is best for you and the healthiest and safest for your long-term care, but what is actually the cheapest for this government. It should piss you off and scare you.

Old alternatives have serious side effects

Dr. Tom Elliott, medical director of BC Diabetes, said he was working on the same issue. means that you must

“I don’t prescribe these drugs because they are dangerous,” he said, explaining that these drugs can cause a person’s blood sugar levels to drop so low that they can faint, have seizures, or even die.

Elliott says he is very concerned about potential side effects and asks patients to fill out prescriptions. So even though we have a paper trail in the state database, we tell them not to take drugs.

The practice has led to complaints against him to the college of doctors and surgeons, he said.

Still, Elliott said some of his patients had “successive denials,” with PharmaCare constantly asking for more information or refusing it outright.

Ali Zentner, M.D., speaks with diabetic patient Janan Zamora at his clinic in Vancouver on November 17, 2022. (Bell Prix/CBC)

For Janan Zamora, one of Zentner’s patients, this is a familiar situation. It took her a year to get special agency approval to cover her Ozempic.

“She had to stand up for me and get through the hard times,” Zamora said of Zentner.

Zamora said she saw a “huge difference” compared to the insulin she was using previously.

“I gained weight. I had high blood sugar. I was very tired because I was obviously not active,” she said. “Thanks to Ozempic…I lost a little weight. I had a little more energy.”

Elliott spoke directly with Health Minister Adrian Dix about his concerns.

The CBC requested an interview with a Department of Health representative, but instead received a written statement that did not address the doctor’s concerns about the special authority process for diabetes care.

In the meantime, Elliott has also sent a letter to the minister asking for changes, and it doesn’t seem out of the question.

In an email Friday, Assistant Secretary of Health Mitch Moneo acknowledged Elliott’s concerns and said he was grateful for the special agency’s offer to help revise its guidelines.

“When I was able to reinvestigate SA [special authority] We look forward to getting in touch with you, hopefully in the near future, to discuss your recommendations further regarding standards for type 2 diabetes medications,” Moneo wrote.

However, no timeline for that process is provided.

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