Two B.C. doctors are calling for greater access to a range of potentially life-saving medicines that are only covered by public health care under certain circumstances.
For example, Ozempic, touted as a breakthrough drug for people with type 2 diabetes, is on the state’s list of “special authority” drugs. Not regularly covered by full coverage, but may be approved by BC. Pharma care A special authority team at the request of the patient’s attending physician.
However, for its approval, patients must first have run out of dual therapy with metformin and insulin or metformin and sulfonylureas.
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Dr. Ari Zentner, an expert in internal medicine, diabetes and obesity, told Global News:
“In British Columbia, patients must decline an older, less effective drug, in this case a more dangerous drug, in order to receive coverage for the new drug.”
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According to the Ministry of Health, special authorization list drugs such as Ozempic, or devices such as glucose monitors, are either effective only in certain patients or are “less cost-effective than other drug treatments and devices” and cannot be automated. generally not subject to BC. “
The decision to provide coverage is also informed by the evidence-based recommendations of the independent BC Drug Benefit Council. The panel will review patient opinions, ethical considerations, clinical and economic evidence, the ministry added.
“These are decisions made by BC PharmaCare and its clinical team. We clearly see the evidence,” Health Minister Adrian Dix told parliament on Tuesday.
“This is how the system works most efficiently and we can orient it towards the clinical team.”
Ozempic, or semaglutide, is a weekly injection. According to its websiteIt helps the pancreas to produce more insulin when blood sugar levels are high, prevents the liver from producing or releasing too much sugar, and slows food out of the stomach.
Colin Taylor, a Vancouver patient, has been on the drug for about two years, where it helped lower his blood sugar levels and contributed to a weight loss of over 50 pounds.
“It’s just a quick injection as opposed to taking a pill every morning and every night,” he told Global News.
“It made me more active and slimmer…it should be available to everyone.”
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BCDiabetes medical director Tom Elliott, PhD, has about 3,000 people with type 2 diabetes, half of whom are on Ozempic. Of that half, about 30% have expanded their health insurance coverage, he added.
“1,500 of my patients are left insolvent because they cannot afford it or have no insurance,” he said.
“I have the right to decide who should receive it and who should not. What are PharmaCare pharmacists qualified to do?”
Elliott expressed concern over one of the courses of treatment PharmaCare would need before Ozempic was considered, saying that glyburide (classified in the sulfonylurea class of drugs) had “dangerous” side effects, including hypoglycemia. I pointed out that it can cause
“I’m not going to write a prescription for glyburide to meet Pharmacare’s requirements. The policies they have are bad,” he said.
“There is now a class of drugs that are not only superior in terms of hypoglycemic effects, but also have cardiovascular benefits and do not cause hypoglycemia. Why not prescribe these drugs first?” Zentner Added.
“For example, I’m still rejected even when we’re following their protocol.”
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Zentner says the current system either requires doctors to “follow” a series of “old-fashioned, inappropriate and dangerous guidelines” or patients actually run out of one of PharmaCare’s required courses of treatment first. It encourages people to lie for the sake of others.
Dix said BC is reviewing “clinical evidence” about whether Ozempic and other drugs qualify for first-line or second-line coverage in the state, and “some action will be taken soon.” I hope that it will be taken.”
The Department of Health said it has a “rigorous and transparent” drug review process and offers “one of the most generous drug compensation programs” of any Canadian province.
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