When generic prescriptions for weight-loss drugs come out, public plans should cover them, experts say

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When Bonnie Ivy entered her mid-60s, she gained weight suddenly and quickly. She spent two years trying to lose it, working out almost every day, even when sick or injured, and trying all kinds of diets.

Ms Ivy, 67, said she felt “uncomfortable and hopeless” and eventually asked her doctor about GLP-1 medication. She was prescribed the blockbuster drug Ozympic, but had to pay out of pocket because she didn’t meet the narrow criteria for coverage.

Ms. Ivey, who lives in Ottawa, tried Ozympic for six weeks — not enough time for her to lose weight. She said it was very difficult to continue.

“Paying out of pocket, I didn’t renew my prescription,” she said. “It was so expensive.”

Cost is a major barrier for Canadians to access diabetes and obesity medications, preventing pioneer patients like Ms. Ivy from seeking treatment early or preventing others from starting altogether. But obesity experts say the problem can — and should — be reduced with the advent of generics.

According to our correspondents, something will change in Canada when generic Ozympic hits the market

Provinces and territories only cover Ozympic for people with type 2 diabetes, even though it is used off-label for weight loss. This means Canadians are paying out of pocket or relying on private insurance.

About two-thirds of Canadians are covered by private health insurance. However, one-third are left behind, some relying on public plans to cover drugs, including seniors and people receiving social assistance.

Obesity experts say an immediate solution to help those who are prescribed medication by their doctors but can’t afford it financially is to implement public health plans. As GLP-1 becomes cheaper, it’s no longer a question of whether provinces and territories should cover them but how, said Yoni Fredoff, medical director of the Institute of Bariatric Medicine in Ottawa.

Dr. Friedoff said the positive impact of obesity medicine is broad for individuals, the health system and employers, for example, reducing absenteeism rates, targeting comorbidities and reducing disability claims and hospitalizations.

He estimates that the annual cost of generic GLP-1s will likely be around $1,000 per Canadian, but that could be even lower after negotiations between manufacturers and public health plans.

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It’s “impossible to imagine” that insurers won’t catch on sooner, Dr. Friedoff said, given that there is a strong economic case that it will save them money over time. “I think it’s inevitable that there will be universal coverage, whether it’s through employers or through the government or both.”

The obesity rate in Canada has risen to nearly one in three adults due to a variety of factors, including rising food prices, sedentary lifestyles and poor nutrition. And while brand-name drugs like Ozympic and Vigovi have revolutionized obesity and diabetes care, access is still limited.

Medical organizations in Canada and abroad have long recognized obesity as a chronic condition rather than a lifestyle choice. But policymakers are reluctant to do the same — increasing barriers to treatment. Alberta is the only province that officially recognizes obesity, but it does not cover GLP-1s specifically for weight management.

Public and private coverage for these drugs varies across Canada and is generally limited to certain criteria, not just weight loss. Currently, Ozympic is approved through Health Canada for the treatment of type 2 diabetes and Vigoy, a high-dose version, for chronic weight management.

In December, the Pan-Canadian Pharmaceutical Association (pCPA), an organization representing provincial, territorial and federal drug plans, and Danish drugmaker Novo Nordisk stopped negotiations to cover Wegovy. pCPA said the manufacturer refused to negotiate the price of Vigovi.

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Several versions of generic semaglutide, the active ingredient in Ozympic and Vigovi, are expected by the end of this year.

Sanjeev Saklingam, Obesity Canada’s scientific director, said expanding semaglutide coverage in public health plans would help a “significant portion” of the population. But he said provinces will likely struggle with eligibility criteria for coverage.

“Are they going to say you have to have a high BMI with other health conditions to be eligible and treat someone who has more?” he said. “Or are some provinces going to be bold and say we want to stop things from going up?”

In an ideal world, body mass index, or BMI, should be used as a screening tool but not as a single metric, Dr. Saklingam said. Other health problems such as diabetes or high blood pressure should also be considered.

The Globe and Mail reached out to all provinces and territories, many of which said they are waiting for Health Canada’s approval to make coverage decisions. A generic drug must be approved by Health Canada before it can be sold.

Manitoba did not respond to a request for comment.

How will cheap Ozympic versions tip the scales?

The federal government, which runs the uninsured health benefits program for eligible First Nations and Inuit, said it oversees work by the pCPA.

Dr. Sabrina Coon, medical director of the Northern Alberta Obesity Center in Edmonton, said stigma and the upfront cost of covering obesity drugs for large populations are likely reasons public coverage has been limited so far.

She said provinces need to look at the bigger picture: These drugs are not just for weight loss, but have broader benefits that can reduce pressure on the health care system and society. For example, GLP-1s are very effective in improving blood pressure, diabetes and cholesterol, Dr. Kwon said.

“Maybe you’re actually reducing the cost of this person having a heart attack in the future and then needing the heart cocktail that comes with it,” she explained.

Mauro Chase, executive director of the pCPA, said in a statement that the organization would consider negotiating new labels for Ozympic or Vigo if it receives an offer from the Canadian Drug Agency or the Quebec equivalent.

“No generic semaglutide products have received Health Canada approval at this time. If a manufacturer receives approval, we are ready to work with them on behalf of Canada’s public drug plans,” Mr. Chase said.

Dr. Saklingam emphasized that, as treatment becomes more accessible, other supports should be strengthened in concert, noting that the risks associated with obesity medications include eating disorders and mental health problems.