Understanding RAMQ Guidelines for Reimbursing Ozempic in Quebec

2024-04-11 10:26:37

The Régie de l’assurance santé du Québec (RAMQ) cannot reimburse these medications for the indication of weight loss.

In an email sent to The Canadian Press, the organization, which reports to the Ministry of Health and Social Services, assures that the reimbursement rules for Ozempic are strict. “The only indication allowing reimbursement by the public plan is to have type 2 diabetes and also to respect the other reimbursement conditions developed by INESSS,” maintains the RAMQ.

Public drug plan payments for Ozempic have skyrocketed in recent years. They increased from some $87,000 in 2019 to 119 million in 2023. From January 1 to February 18, 2024, RAMQ had already paid more than 15 million.

Cumulative since 2019, when Ozempic was included on the list of drugs covered by the province, the State has reimbursed more than 280 million.

In 2020, approximately 30,000 new prescriptions for Ozempic covered by the public plan were filled, which includes dosage adjustments that are treated as a new prescription. Since then, new prescriptions have continued to grow, reaching a peak of 135,786 last year.

These statistics do not include Ozempic which may be prescribed for patients looking to lose weight. According to RAMQ data, last year, more than 61,000 people received an uncovered prescription for Ozempic. As of February 18, 2024, there were already 52,000 patients who had received a prescription that did not warrant reimbursement. In 2019, there were barely 254.

Ozempic is primarily an injectable medication to control type 2 diabetes, but one of its effects is to impact satiety, which can lead to significant weight loss.

The company Novo Nordisk markets Ozempic in Canada. Its product comes in the form of a pen filled with semaglutide that patients will inject, thereby regulating insulin levels and reducing blood sugar levels.

It is a glucagon-like peptide−1 (GLP−1) receptor agonist administered once weekly to improve glycemic control in adults with type 2 diabetes.

There are other GLP−1 agonist drugs such as Trulicity (dulaglutide), but their popularity among Quebecers does not match Ozempic.

In comparison, last year, 5,672 people not covered by RAMQ received a prescription for Trulicity and 24 for Rybelsus (semaglutide).

Several doctors surveyed by The Canadian Press say they have been asked for Ozempic on a daily basis for a year.

“The marketing that was done directly to patients was very important and this translates into everyday practice by patients who ask me: ‘what is Ozempic’ or who have been see on the internet and who tells me: ”I would like to lose weight, can you prescribe it for me?”, declared Dr René Wittmer who is a family doctor.

Statistics on social networks bear witness to this rise. On TikTok and Instagram, there are hundreds of thousands of results with the hashtag ozempic, a very large proportion showing extreme transformations.

Ozempic became so popular that there were problems with the supply of semaglutide around the world. Quebec has not escaped this. At the end of 2023, we noted stock shortages mainly affecting the 1 mg content.

Novo Nordisk has since informed Health Canada that the shortages of Ozempic for the 1m and 0.25mg/0.5mg pens have been resolved.

The Canadian Press’ health content receives funding through a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for editorial choices.

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