Sask. sees astronomical spike in Ozempic claims, many for weight loss

Chamundi Selvaraj takes a weekly dose of Ozempic because she's afraid of dying from diabetes-related kidney failure like her mother and four aunts, who all passed away in their 60s.

But Selvaraj is in the minority among Ozempic users in Saskatchewan in a few ways.

First, she's using the drug for the reason it was initially designed: to improve her blood sugar levels.

Second, she qualifies for Ozempic coverage through the provincial drug plan and private insurance. Saskatchewan only approves patients who have Type 2 diabetes.

And finally, she's not shy about revealing her Ozempic use.

"I felt like this was a very good turning point in my life," Selvaraj said.

The retired grandmother had no idea Ozempic's side effect of weight loss has made it a much-sought-after drug for off-label reasons. Its active ingredient, semaglutide, mimics a hormone that controls blood sugar levels and curbs hunger.

A spike in claims

There's been a huge surge in Ozempic claims in the province.

There were 5,755 Ozempic claims in Saskatchewan in 2019. That number jumped to 194,916 by the end of 2023 an increase of close to3,300 per cent. One prescription may result in several claims.

Of those 194,916 claims, only about 78,000 or 40 per cent were eligible forprovincial drug plan benefits. People would still be on the hook for some cost or rely onprivate insurance to cover the balance.

According to the province, the other 60 per cent of the claimsdidn't meet the medical criteria of Type 2 diabetesor, in some cases, the patient might not have applied for coverage or may have been federally insured through First Nations and Inuit Health.

Indigenous Services Canada said it covered 34,133 claims in 2023, but it's hard to say how many were for diabetes or weight loss because the federal department has "not set restrictions on access to Ozempic," in order to ease the administrative burden on diabetics.

This likely means that between 40 and60 per cent of all Saskatchewan claims for Ozempic are not for diabetes.

Experts say this shows the drug is being used in many cases for off-label purposes, such as weight loss.

• CBC's Just Askingwants to know:What questions do you have about Ozempic? What's your experience accessing or trying to access the drug in Canada?Fill out the details onthis formand send us your questions ahead of our show on June 15.

Calls for more coverage

CBC News spoke with several Ozempic users who do not have diabetes. Most did not want to speak publicly because of backlash over Ozempic supply shortages and stigma attached to using medication to treat obesity.

Some pay out of pocket for the drug. Others qualify for private insurance coverage, but fear having it cut off, as has been the case for some people.

Health policy analyst Steven Lewis said the spike in off-label Ozempic prescriptions is proof that access to and coverage for obesity-fighting drugs has become an emerging issue for governments and insurance companies.

Lewis quoted recent studies that show 30 per cent of Canadians are obese.

"If you could actually reduce that number significantly and reduce it permanently, over the long haul, these people will be healthier and they will use the health-care system less for serious conditions." Lewis said.

WATCH | Making the case for provinces to cover obesity-treating drugs:

Making the case for provinces to cover obesity-treating drugs

4 months ago

Duration 2:14

Claims for the diabetes drug Ozempic have seen an astronomical jump in Saskatchewan, and government figures show many are not for Type 2 diabetes. Some users and advocacy groups are pushing for more coverage of weight loss drugs to combat obesity.

Ian Patton, advocacy director for Obesity Canada, said "some insurance providers cover obesity management, but they're in the minority."

He said there is resistance among governments, insurance providers and taxpayers.

"We're not talking about people who have a small amount of weight theywant to lose for, you know, a wedding or something like that, or, you know, beach season," Patton said."This is about people who have a chronic disease, a serious chronic condition, and they need support."

He argued it boils down to a kind of "bias" or "discrimination" between diseases, favouring diabetes over obesity, even though they're both recognized as chronic diseases.

Losing weight

Hartley Macklin, who runs a Facebook support group for Ozempic users, uses Ozempic to stop himself from overeating. At his heaviest, the Winnipeg man was 300 pounds.

"I had just really gotten big and felt that this was causing trouble," he said. "As soon as I started taking the medication, I became satisfied with less food almost immediately."

He qualified for private insurance coverage despite not being diagnosed with diabetes because his blood sugar levels were high enough that he was considered "pre-diabetic."

"You don't want to wait until you're already suffering from [Type 2] diabetes before you start to manage it," he said.

He has dropped 70 poundsmore than 20 per cent of his body weight.

"The only way I could get covered by the [Manitoba] government would be if I went off [Ozempic], started to have bad blood sugar levels again, and tried every other medication known to man, and then, if those failed, they would cover me."

Macklin wants to switch to Ozempic's sister drug, Wegovy, a higher-dose version approved for weight loss that became available in Canada in early May, but he knows qualifying for insurance would be challenging. Most people have to shell out about $400 a month.

'Big-ticket item'

Health Canada approved Wegovy to treat people diagnosed with obesity in November 2021, but Canada's drug agency recommended provinces and territories not provide reimbursement for its use.

The Canadian Agency for Drugs and Technologies in Healthsaid Wegovy was effective and had an acceptable side-effect profile, but that it was unclear whether it reduced co-morbidities and improved quality of life.

Lewis said he can understand why governments would drag their feet on covering these obesity-fighting drugs. He points to the need for more long-term studies on efficacy and side effects, a more stable supply chainand more clarity on a specific obesity criteria to complete a cost-benefit analysis.

He said the drug is a pretty good deal at the individual level about $300 per month per person but the sheer number of obese people who could qualify, depending on the criteria, could make the overall cost astronomical.

"It's a big-ticket item if massive numbers of people use it."