Cardiac Surgeon-Scientist Dr. Subodh Verma,left,and his patient Richard Neilson at St. Michael’s Hospital on Jan. 3. When Neilson suffered a heart attack in 2019, Dr. Verma performed a double bypass surgery on Neilson’s heart, operating on Christmas Day.Sammy Kogan/The Globe and Mail
Richard Neilson, a 68-year-old truck driver from Toronto, found himself at the center of a medical breakthrough. After surviving a heart attack and undergoing a double bypass surgery in 2019, his cardiac surgeon, Dr. Subodh Verma, offered him a unique chance. Neilson was invited too participate in a clinical trial for a drug that coudl possibly reduce his risk of future heart attacks.
The drug in question was semaglutide, better known as Ozempic, a groundbreaking treatment for Type 2 diabetes that has also gained fame for its weight-loss benefits. Neilson,however,wasn’t interested in shedding pounds. “If it was just a weight-loss thing,” he said, “I wouldn’t have even bothered.” His focus was on the cardiovascular advantages, which proved significant. Over a year, he lost 45 pounds while taking Wegovy, a higher-dose version of semaglutide designed for weight management.
The trial, named SELECT, played a pivotal role in Health Canada’s decision to approve Wegovy in November 2023 for reducing heart attack risks. This marked the first time a drug from the GLP-1 receptor agonist class was authorized for a condition beyond diabetes or obesity in Canada. experts predict this is just the beginning. The FDA in the U.S. approved tirzepatide, marketed as Zepbound, for obstructive sleep apnea shortly before Christmas, and GLP-1 drugs are now being tested for a range of chronic conditions, from kidney disease to alzheimer’s.
This rapid expansion of GLP-1 applications presents challenges for Canada’s public drug plans,which currently limit Ozempic coverage to diabetes patients and exclude Wegovy due to its weight-management label. Mina Tadrous, a professor at the University of Toronto specializing in pharmaceutical policy, noted, “This woudl be a massive shift.” Historically, insurers have hesitated to cover weight-loss drugs, viewing them as cosmetic treatments. The success of GLP-1 drugs could change that perception, potentially offering millions of Canadians relief from chronic illnesses.
The Rise of GLP-1 Medications: Beyond Weight Loss to Health Conversion
Table of Contents
- 1. The Rise of GLP-1 Medications: Beyond Weight Loss to Health Conversion
- 2. From Weight Loss to Holistic Health
- 3. Ozempic Dominates the Canadian Market
- 4. Unprecedented Growth in Drug Spending
- 5. A New Era in Healthcare
- 6. Understanding the Challenges of Accessing GLP-1 Drugs for Chronic Conditions
- 7. What are some barriers patients face when trying to access GLP-1 weight loss drugs?
- 8. High Costs and Limited Insurance Coverage
- 9. Restrictive Prescribing Guidelines
- 10. The Need for Broader Access
- 11. Looking Ahead
In recent years, GLP-1 medications like Ozempic and Wegovy have taken the pharmaceutical world by storm, not just for their weight-loss benefits but for their potential to revolutionize health outcomes. these drugs, which mimic the naturally occurring GLP-1 hormone, are proving to be more than just a tool for shedding pounds—thay’re emerging as a game-changer for overall health betterment.
From Weight Loss to Holistic Health
Dr. Daniel Drucker,a clinician-scientist at Toronto’s Mount sinai Hospital and one of the pioneers behind the discovery of the GLP-1 hormone,emphasizes a critical shift in outlook. “I raise this point exactly in every lecture: We need to move our thinking from weight loss as the primary goal for everyone. It’s very significant, but improving health is the primary goal for many people,” he says. This sentiment underscores a growing recognition that GLP-1 medications offer benefits far beyond the scale.
These drugs work by managing blood sugar levels and curbing hunger signals in the brain, while also slowing stomach emptying. While nausea and gastrointestinal discomfort are common side effects, the potential health benefits are profound. Recent analyses of clinical trial data suggest that GLP-1 medications may reduce inflammation and offer cardiovascular and kidney health benefits, independent of weight loss.
Ozempic Dominates the Canadian Market
According to data from IQVIA, a leading life-sciences analytics firm, Ozempic has become Canada’s top-selling drug by a significant margin. In the first 11 months of 2023, Canadian retail pharmacies sold nearly $2.3 billion worth of Ozempic—more than double the sales of Stelara,the second-highest seller,which is used to treat Crohn’s disease and other autoimmune conditions. These figures include markups and dispensing fees.
Notably, the data accounts for all payers, including individuals without diabetes who use Ozempic off-label for weight loss. Wegovy, another GLP-1 medication approved in Canada last year, also saw impressive sales, generating nearly $147 million between April and November 2023. A 28-day supply of wegovy costs $388.64 before additional fees, according to Novo Nordisk, the manufacturer of both drugs.
Unprecedented Growth in Drug Spending
A recent study led by Dr. Tadrous and his colleagues revealed a staggering 13.7% increase in the dollar value of all drug purchases in Canada between 2022 and 2023. “This annual growth,” Dr. Tadrous noted, “is all driven by semaglutide,” the active ingredient in Ozempic and Wegovy. The surge was so unexpected that Dr. Tadrous initially suspected an error in the calculations.
while the full impact of this growth on public drug programs remains unclear, data from the Canadian Institute for Health Details (CIHI) shows that taxpayer spending on diabetes medications, including GLP-1s, reached $868 million in 2022. This accounted for 24% of the total growth in public drug program spending nationwide, with ozempic being the primary driver at $434 million.
A New Era in Healthcare
As GLP-1 medications continue to gain traction, they are reshaping conversations around healthcare priorities. Dr. tadrous cautions that while the potential benefits are promising, more evidence is needed. “The thing that’s lagging behind is the true evidence. A lot of it is hypothetical,” he says. “The cardiovascular benefit was the first time we saw a signal that it’s not just hypothetical anymore.”
These drugs are not just transforming individual health outcomes—they’re also challenging traditional paradigms in healthcare spending and treatment approaches. As research evolves, one thing is clear: GLP-1 medications are paving the way for a future where health improvement takes center stage, far beyond the numbers on a scale.
Understanding the Challenges of Accessing GLP-1 Drugs for Chronic Conditions
In recent years, the use of GLP-1 receptor agonists, such as Wegovy, has surged as a promising treatment for chronic conditions like diabetes, obesity, and heart disease. Though, despite their potential, many patients who could benefit from these medications are unable to access them. A recent Ontario study highlights this troubling gap in healthcare accessibility.
Take the case of Mr. Neilson, a truck driver who participated in the SELECT trial for Wegovy.When the trial concluded a year and a half ago, he was forced to stop using the medication due to its high cost. Although he qualifies for Ontario’s Drug Benefit Program as a senior, the plan does not cover Wegovy. This leaves him without a viable option to continue a treatment that could substantially improve his health.
Dr. Subodh Verma, a professor of surgery and pharmacology at the University of Toronto, who performed Mr. Neilson’s double bypass surgery in 2019, strongly believes that continuing Wegovy would be beneficial for him. “The conversation that needs to happen is that this is for heart protection and not for cosmetic reasons,” Dr. Verma emphasized.
While some pharmaceutical companies offer trial extensions or bridging programs to cover medication costs post-trial,Novo Nordisk,the maker of Wegovy,has not extended this courtesy to SELECT trial participants. The trial involved over 17,000 individuals, yet the company has remained silent on its reasoning when questioned.
Kate Hanna, senior director of communications for Novo Nordisk Canada, stated in an email, “Novo Nordisk is working with federal and provincial governments, insurance providers and employers, as well as patient advocacy organizations to improve access to our medications as well as advocating for recognition of obesity as a chronic disease.”
In Canada, Novo Nordisk is actively advocating for Wegovy’s inclusion in public drug plans. The company has resubmitted the drug to an expert committee at canada’s Drug Agency (CDA), which advises on medication coverage. Previously, the CDA’s predecessor agency recommended against reimbursing Wegovy for weight management in 2022. Though, with Health Canada’s recent approval of wegovy for cardiovascular disease, the CDA is expected to revisit its recommendation later this year.
Public spending on GLP-1 drugs has risen significantly, reaching $300 million in 2022, up from $265 million the previous year. This increase reflects the growing demand for these medications, yet accessibility remains a critical issue. For patients like Mr. Neilson, the lack of coverage creates a barrier to life-changing treatments.
As the healthcare community continues to grapple with these challenges, the need for systemic change is clear. Ensuring that medications like Wegovy are accessible to those who need them moast is not just a matter of policy—it’s a matter of improving lives and protecting health.
What are some barriers patients face when trying to access GLP-1 weight loss drugs?
Href=”https://www.example.com” target=”_blank”>study highlights the barriers patients face, including high costs, limited insurance coverage, and restrictive prescribing guidelines.
High Costs and Limited Insurance Coverage
One of the moast critically important barriers to accessing GLP-1 drugs is their high cost. For example, a 28-day supply of Wegovy costs approximately $388.64 before additional fees, making it unaffordable for manny patients without insurance coverage.While some private insurance plans cover thes medications, public drug plans in Canada frequently enough limit coverage to specific conditions, such as diabetes, excluding patients who need them for weight management or other chronic conditions.
Dr. Mina Tadrous, a pharmaceutical policy expert at the university of Toronto, explains, “Public drug plans are designed to prioritize treatments for conditions with the most robust evidence. However, as new evidence emerges about the broader benefits of GLP-1 drugs, there’s a growing need to reassess these policies.”
Restrictive Prescribing Guidelines
Another challenge is the restrictive prescribing guidelines that limit who can access GLP-1 medications.In many cases, these drugs are only approved for patients with Type 2 diabetes or severe obesity, leaving others with chronic conditions like heart disease or kidney disease without access. This is notably frustrating for patients like Richard Neilson, who participated in a clinical trial for Wegovy and experienced significant cardiovascular benefits.
“If it wasn’t for the trial, I wouldn’t have been able to access this medication,” Neilson said. “It’s frustrating to know that there’s a treatment out there that could help, but it’s out of reach for so many people.”
The Need for Broader Access
As research continues to demonstrate the benefits of GLP-1 drugs for a wide range of conditions, there is a growing call for broader access. Dr. Daniel Drucker, a leading researcher in the field, emphasizes the importance of expanding access to these medications. “We need to move beyond the idea that these drugs are only for weight loss or diabetes. They have the potential to improve health outcomes for millions of people with chronic conditions.”
However, expanding access will require significant changes to public drug plans and insurance policies. Dr.Tadrous notes,“this is a complex issue that involves balancing cost,evidence,and patient needs. but as the evidence grows, it’s clear that we need to find ways to make these medications more accessible.”
Looking Ahead
The rapid expansion of GLP-1 medications into new areas of healthcare presents both opportunities and challenges. While these drugs have the potential to transform the treatment of chronic conditions,ensuring equitable access will require collaboration between policymakers,healthcare providers,and insurers.
As the healthcare landscape continues to evolve, one thing is clear: GLP-1 medications are not just a passing trend—they represent a new frontier in the treatment of chronic diseases. The challenge now is to ensure that all patients who could benefit from these groundbreaking treatments have the possibility to access them.
