When it comes to Quebec’s public health insurance plan, there are strict rules that the province must not break. Medications prescribed for weight loss are not reimbursed.
Some doctors are calling for at least a bend in that rule.
In Quebec, semaglutide, marketed under the name Ozempic, can only be prescribed to treat type 2 diabetes.
Ozempic is also known to promote weight loss, and its side effects, along with the fact that the drug has been endorsed on social media by celebrities and influencers over the last few months, have contributed to the increased demand for the drug. doing. especially in the US
Many doctors in Quebec agree that Ozempic shouldn’t be prescribed only to people who want to lose a few pounds, but it is being considered by the province’s health insurance commission, known by its French acronym RAMQ. Some say that there should be exceptions.
Here’s what some medical experts are saying and why, despite their recommendations, the Quebec Ministry of Health doesn’t seem to have any plans to change its stance on Ozempic.
doctor’s opinion
Dr. Rémi Rabasa-Lhoret is one of the doctors who have asked the Quebec government to allow some exceptions to its rules and make Ozempic available to some patients.
Rabasa-Lhoret says some of his patients have type 1 diabetes and are too obese to be candidates for islet transplants. into the recipient’s liver to produce
Because these patients have type 1 diabetes, not type 2, they are not covered by Ozempic’s public health insurance, even if Ozempic helps provide access to potentially life-saving treatments. not.
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Rabasa-Lhoret says some of these patients are just a few pounds above the transplant eligibility limit.
“Whenever you ask for an exception for RAMQ, it’s never granted…there are no exceptions,” the doctor said, also emphasizing that it can be very difficult for people with type 1 diabetes to lose weight.
“In these specific cases, we believe there may be patient exceptions that can be discussed with RAMQ to limit approval of that drug to specific patients of that type.”
If you want to use Ozempic without financial support from RAMQ, that means paying around $300 per month.
Rabasa-Lhoret said that one of his patients could benefit from the drug, but that his condition meant he could no longer work and that paying such money was impractical. Says.
Dr. Marie-Philippe Moran, who works at the Cardiopulmonary Institute in Quebec and specializes in the treatment of obesity, said RAMQ was designed for patients who need transplants, “those who are severely obese with many comorbidities, and who I can’t have bariatric surgery for a variety of reasons.”
“Reports should be exceptional,” she said.
Why Quebec Doesn’t Pay It
The state pays for approximately 8,000 prescription drugs. But there are many others that are not covered, including the one stipulated in:
- For cosmetic or aesthetic reasons.
- Erectile dysfunction treatment.
- Treating cachexia or stimulating appetite.
- Obesity treatment.
RAMQ states that “other drugs not on the list may also be covered exceptionally,” but Ozempic, even on that exceptional standard, seems unacceptable for weight loss.
In a statement, a spokesperson for the Quebec Department of Health said RAMQ aims to provide “fair and reasonable access” to medicines and the province will continue to monitor clinical data on the use of medicines for obesity. said it does.
“At the moment, there remain many uncertainties when it comes to replacing existing medications for the treatment of obesity, particularly regarding the extent and durability of benefits,” said Dr. Robert Miranda.
The spokesperson also stressed that Ozempic’s situation is not state-specific and the drug is not approved for the treatment of obesity in Canada.
Miranda also said the inappropriate use of weight loss drugs is a cause for great concern, further complicating the issue of public funding for these drugs.
Novo Nordisk, the maker of Ozempic, also markets higher doses of semaglutide in a drug called Wegovy designed specifically to target obesity.
Health Canada has approved Wegovy for people who are overweight or suffer from serious weight-related conditions such as high blood pressure, diabetes and obstructive sleep apnea.
Can laws be changed?
Rabasa-Lhoret is also president of the Quebec Diabetes Professional Council, and said his organization meets with the province several times a year.
In the medium to long term, he said, RAMQ will need to soften its stance.
He admits the drug is expensive, but says Quebec’s public health system will end up paying a higher price by not reimbursing those patients. .
“Care and visits in the emergency department will probably cost a lot more than Ozempic can afford in this particular situation,” said Rabasa-Lhoret.
