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Ontario limiting access to Ozempic to conserve supply for those with diabetes

The Ministry of Health said Wednesday that moving Ozempic from the general benefit category to limited use under its Ontario Drug Benefit (ODB) program means any patient seeking a prescription of Ozempic must meet clinical criteria, which includes the treatment for Type 2 diabetes. (Lee Smith/Reuters - image credit)
The Ministry of Health said Wednesday that moving Ozempic from the general benefit category to limited use under its Ontario Drug Benefit (ODB) program means any patient seeking a prescription of Ozempic must meet clinical criteria, which includes the treatment for Type 2 diabetes. (Lee Smith/Reuters - image credit)

The Ontario government is taking steps to restrict access to Ozempic and conserve its supply for people with Type 2 diabetes under a province-funded program amid shortages due to popular demand for the drug for weight loss.

Starting Wednesday, people who don't have Type 2 diabetes will no longer have coverage for the drug under the Ontario Drug Benefit (ODB) program, according to the Ministry of Health.

"This move has been taken to conserve supply for those who need Ozempic most and aligns Ontario with many other provinces who have taken steps to protect their supply," Ministry of Health spokesperson Hannah Jensen said in a statement to CBC News Wednesday.

Ozempic, one of several brand names for a drug known as semaglutide, is a weekly injection that helps lower blood sugar levels by helping the pancreas create more insulin, and belongs to a class of drugs known as glucagon-like peptide1, or GLP1s.

Currently, ODB and OHIP+ cover most of the cost of roughly 5,000 prescription medications for all seniors above the age of 65, or people aged 24 or younger who are not covered by a private insurance plan, people living in long-term care homes, as well as for people receiving Ontario Works, Ontario Disability Support Program funding or are enrolled in the Trillium Drug Program.

The ministry said that moving Ozempic from general benefit category to limited use under its program means any patient seeking a prescription of the drug must meet clinical criteria.

The change, which aims to help pharmacies and patients grappling with shortages for Ozempic and similar drugs, is one that is necessary at this time, said Sanjeev Sockalingam, scientific director for Obesity Canada and professor of psychiatry at the University of Toronto. But the ministry should also reconsider the limitations for individuals struggling with obesity, Sockalingam said.

"I understand that the government's response to do this to limit it to people who qualify for Type 2 diabetes," said Sockalingam.

"I think this decision really speaks to the shortages of Ozempic or semaglutide more broadly that's in the system and this class of medications that are being used both for diabetes, but for those living with obesity as well."

Dr. Sanjeev Sockalingam is the scientific director of Obesity Canada.
Dr. Sanjeev Sockalingam is the scientific director of Obesity Canada.

Sanjeev Sockalingam, scientific director of Obesity Canada, said obesity needs to be recognized as a chronic and complex medical condition similar to diabetes and other chronic conditions. (Obesity Canada)

Patients under the program who will no longer qualify for the drug under the new "limited use" criteria will have to pay out of pocket for the drug if it is intended for weight loss. Sockalingam says that means anywhere between $450 and $500 monthly.

Ontario woman 'felt robbed' during shortage

Whitby, Ont., resident Lynda Williston uses Ozempic to treat Type 2 diabetes. She said the drug was a significant help in keeping her blood glucose in control until the shortage hit and she could no longer get her hands on the shot last year.

"Unfortunately, when there was a shortage of it, I had to be taken off and that's when I noticed how much it had been helping me," Williston said.

Williston said she was prescribed a similar medication, but it was not as strong. When Ozempic was back in stock at pharmacies, she got back on the drug and noticed a big difference.

"It was very disturbing because I knew some people were taking it for their weight issues and while that's wonderful for them, it was taking medicine away from me and that was very disturbing and very upsetting," Williston told CBC News.

"I felt robbed because I knew it was something that was helping me medically. And I just thought that would be like someone walking up to you and taking your crutches away and then saying 'Yeah you can walk, you're still okay,' but you're not."

Drug should be considered for obesity: health professionals

Kyro Maseh, pharmacist and owner of Lawlor Pharmasave in Toronto, said his pharmacy, like all others in the province, has experienced shortages of Ozempic over the past six months.

"It's important to allocate the medication for diabetic patients. But in the future, I think it should be considered also for obese patients," Maseh said Wednesday.

"Obesity carries a very heavy social burden and health and has a lot of healthcare costs."

Maseh said he has seen firsthand the positive outcomes that some patients have after losing weight as a result of being on the drug.

"It may be anecdotal from my perspective, but it's definitely worth looking at from the provincial perspective and looking at the impact that a decrease in obesity rates would have on the overall cost of healthcare," he said.

Sockalingam shares that view, saying obesity needs to be recognized as a chronic and complex medical condition similar to diabetes and other chronic conditions.

"It's important for us to take a look more broadly at a policy level, whether it's provincial government formularies as well as health insurance and private health insurance," he said.

"We have treatments available and we need to think about how do we value those treatments the same as other medical condition to make sure they're accessible. It's not just for this medication but for all the available medications that are now approved and indicated for obesity. We really need to think about how do we get them to the patients who need them the most."