At Alberta Blue Cross®, we pride ourselves on our approach to drug management. Simply put, we consider the scientific, therapeutic and economic value of drugs to create plans that are sustainable while prioritizing our plan members’ health needs. And because of our expertise in drug management, we field a lot of questions from our clients—plan sponsors large and small.
One category of drug we’re getting questions about is Ozempic.
Ozempic is approved by Health Canada as a treatment for adults with Type 2 diabetes. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists. This class of medication has been successful in managing diabetes as it lowers blood sugar levels while improving overall blood sugar control.
Ozempic has been featured in the news a lot lately, and not just because of the impact it has on people with Type 2 diabetes. It’s been getting media coverage for a use for which it isn’t approved in Canada: weight loss.
In addition to media coverage, insurers are talking about it as well. The growth in Ozempic use is driving up diabetic drug costs as well as overall costs of drug plans. To ensure Ozempic is being used for its approved purpose, other insurers now need to tighten their management of the drug.
How is Alberta Blue Cross® managing this drug?
From day 1, on our most utilized formulary—our managed formulary—we have been managing Ozempic through our Special Authorization process. Coverage has been, and will continue to be, approved only for use in Type 2 diabetes as per the Health Canada approved indication.
Health Canada provides guidance on prescription drugs as they are Canada’s regulatory body that approves drugs and their indications for use. We therefore align our Special Authorization criteria to a drug’s Health Canada-approved use(s).
If you’re not an Alberta Blue Cross® plan sponsor, you may wish to find out how Ozempic is being managed on your plan.
Chronic obesity was recently designated a chronic disease by the World Health Organization (WHO). It can lead to other serious and costly health conditions including cardiovascular disease, diabetes and even certain types of cancer. In Canada, about 1 in 4 people are living with obesity. In Alberta, our obesity rate is slightly higher at about 28 per cent.
Historically, private drug plans haven’t covered weight loss drugs as it was classified as a ‘lifestyle’ drug category. However, given the recognition of obesity as a chronic health condition with costly co-morbidities, many plan sponsors are looking to update and modernize their drugs plans to include coverage for weight loss drugs.
Currently, weight loss drugs available in Canada include Contrave, Saxenda and Xenical. Wegovy, which contains the same ingredient as Ozempic, but in a higher dose, is also approved in Canada; however, it isn’t available to Canadians yet because of supply issues due to the high demand internationally, particularly in the US.
At Alberta Blue Cross®, we closely monitor the growing pipeline of new drugs, evaluating their impact on our benefit plans at the earliest stages. This strategy ultimately drove our decision to list Ozempic via Special Authorization on our managed plans, ensuring the best use of drug plan dollars from day 1.
Monitoring drug and health technology pipeline is just one of the many ways we stay up to date on the ever-changing benefits landscape. We are happy to share this expertise to help clients achieve their benefit plan goals.
We’re here to help you make the best decisions for your company and your workforce. If you have any questions about this topic or other plan management strategies, please don’t hesitate to contact your Alberta Blue Cross® representative.