Make Ozempic free for weight loss patients in 'specific cases,' Quebec doctors say

When it comes to the public drug insurance plan in Quebec, there's a strict rule the province doesn't break: It won't reimburse you for medication that was prescribed for weight loss.

Some doctors are calling for that rule to be, at the very least, bent.

In Quebec, the drug semaglutide, sold under the name Ozempic, can only be prescribed to treat Type 2 diabetes.

Ozempic is also known to stimulate weight loss and that side-effect — along with the fact that the drug has received several endorsements from celebrities and influencers on social media in recent months — has contributed to a growing demand for the drug, especially in the U.S.

Although many physicians in Quebec agree that Ozempic should not be prescribed to just anyone who wants to drop a few pounds, some of them say there are exceptions that should be considered by the province's health insurance board, known by its French acronym RAMQ.

Here's what some medical experts are saying and why, in spite of their recommendations, Quebec's Health Ministry appears to have no plans to change its stance on Ozempic.

What doctors say

Dr. Rémi Rabasa-Lhoret is one of the physicians urging the Quebec government to allow some exceptions to its rule and make Ozempic available to some patients.

Rabasa-Lhoret says some of his patients have Type 1 diabetes and are too overweight to be eligible for an islet transplant. During that procedure, islet cells are removed from the pancreas of a person who has died and put into the liver of a recipient for them to produce insulin.

Since those patients have Type 1 diabetes — not Type 2 — they're not eligible for public health coverage of Ozempic, even if the drug could ultimately help give them access to a potentially life-saving treatment.

Rabasa-Lhoret says some of those patients are just a few pounds over the eligibility limit for a transplant.

"Whenever we ask for exceptions to RAMQ, it is never allowed …There's just no exception," said the physician, who also stressed that it can be very difficult for people with Type 1 diabetes to lose weight. 

"In those specific cases, we think that there could be patient exceptions that could be discussed with RAMQ to have limited approval of that drug for that kind of specific patient."

If someone wants to go through with using Ozempic without financial support from RAMQ, that means coughing up about $300 per month.

Rabasa-Lhoret says one of his patients, who could benefit from the drug, can no longer work because of his condition and paying that kind of money isn't realistic.

Dr. Marie-Philippe Morin, who works at the Heart and Lung Institute in Quebec City and specializes in treating obesity, says RAMQ should loosen its rules for patients in need of transplants and "for people who have severe obesity with a lot of comorbidities and they cannot have bariatric surgery for different reasons."

"The coverage should be for exceptions," she said. "We need to open the door a little more, for more severe patients."

Why Quebec won't pay for it

The province pays for about 8,000 prescription drugs. But there are many others that are not covered, including those prescribed for:

• Cosmetic or esthetic reasons.
• Treating erectile dysfunction.
• Treating cachexia or stimulating appetite.
• Treating obesity.

The RAMQ says "other drugs not on the list may also be covered on an exceptional basis," but Ozempic does not seem to be accepted for weight loss even on that exceptional basis.

In a statement, a spokesperson for Quebec's Health Ministry said the RAMQ aims to provide "equitable and reasonable access" to drugs, and the province continues to monitor clinical data regarding the use of medication for obesity.

"At the moment, a lot of uncertainty remains when it comes to the place of existing pharmacotherapy for the treatment of obesity, particularly with regards to the extent of the benefits and their lasting power," said Robert Miranda.

The spokesperson also stressed that the situation with Ozempic is not unique to the province, and the drug is not approved as a treatment for obesity in Canada.

Miranda also said the inappropriate use of weight-loss medication is the source of major concerns and adds a layer of complexity to the issue of publicly financing those drugs.

Novo Nordisk, Ozempic's manufacturer, also sells semaglutide in a drug called Wegovy that is specifically designed to target obesity. 

Health Canada has approved Wegovy for people who are overweight and also suffering from a serious weight-related condition such as hypertension, diabetes or obstructive sleep apnea.

Can the law change?

Rabasa-Lhoret also serves as the president of the Professional Council of Diabetes Québec, says his organization meets with the province a few times a year.

He says in the medium to long term, RAMQ will have to soften its stance.

He acknowledges that the drug is expensive, but says Quebec's public health system will ultimately pay a steeper price by not reimbursing those patients.

"The care and the number of visits at the emergency ward probably costs far more than Ozempic could cost in those kind of specific situations," said Rabasa-Lhoret.