Should Wegovy, the $400-a-month obesity drug, be covered by the provinces?

The popular weight loss drug Wegovy has been available in Canada since early May, but anyone hoping to use it will have to pay about $400 a month.

A lawyer says the lack of coverage will hurt the country in the long run.

“There’s a cost of inaction in terms of not getting care, right? More people showing up in emergency departments with complications … or increased medication costs for all the other co-morbidities, like diabetes, high cholesterol, said Dr. Sanjeev Sockalingam, scientific director of Obesity Canada, an organization dedicated to improving the lives of people living with obesity.

Wegovy is a weekly injection made by Novo Nordisk, the Danish company that makes the diabetes drug Ozempic. Both drugs have the same active ingredient – semaglutide – but Wegovy is a higher dose.

Approved by Health Canada more than 2 years ago

Health Canada approved Wegovy to treat people diagnosed with obesity in November 2021, but Canada’s drug agency recommended that provinces and territories not be reimbursed for its use. The Canadian Agency for Drugs and Technologies in Health (CADTH) said 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.

Sockalingham told CBC Radio host Matt Galloway The present one that Wegovy should be covered by provincial drug plans.

“As we continue to lack access, we have more people living with obesity, developing complications … and living with impaired quality of life,” he said.

LISTEN | Wegovy costs $400 per month. Should the provinces pay?

He said that even beyond weight loss there is evidence that the drug helps some people with pre-existing cardiovascular disease. Studies are also being done to see if it helps with sleep apnea and liver inflammation, he said.

Sockalingham said it makes sense to do a cost-benefit analysis of a drug that costs thousands a year, but that obesity is widespread enough in Canada to justify the expense.

“If I told you that we had a cancer drug that seemed to work better than other agents, had better long-term health benefits, and we told patients living with cancer that we wouldn’t offer coverage for it, maybe we would have a blast,” he said.

‘Affordable and accessible to all Canadians’

The founder of a support group for people living with obesity told The Canadian Press last month that Wegovy’s high cost raises the issue of equal access.

“Many in our community, and especially those in the lower socioeconomic group, they find these treatments financially out of reach,” said Priti Chawla, executive director of Obesity Matters.

“It is essential that we work to make Wegovy affordable and accessible to all Canadians who need it.”

However, at least one expert says Canada should wait for more evidence before covering a drug that is expensive and taken indefinitely.

Dr. Joel Lexchin, a retired physician and professor emeritus at York University’s school of health policy and management, said data on the drug’s long-term effectiveness is very limited. He would like to see more studies before there is blanket coverage.

Lexchin said the money could be better spent on improving public education or access to high-quality food. In the meantime, he’d prefer to see Wegovy used on a limited basis while more data comes in.

“And preferably, we should also need those trials to be publicly funded, rather than coming from drug studies that are funded by drug companies,” he said.

Wegovy treats obesity at the individual level when it should be treated at the societal level, he said.

Lexchin said he expects private insurers to cover the drug, as is typical, but that they may put a time limit on coverage.

Chronic medical condition

Wegovy arrived after extensive marketing of Ozempic and a surge in social media demand for the weight-loss drug’s off-label use. Experts say it is critical that prescribers, including family doctors, ensure that Wegovy is only given to patients who meet specific obesity criteria.

Sockalingham says obesity should be treated like diabetes and other chronic diseases. He stressed that the use of Wegovy for obesity is about treating a medical condition, not cosmetic changes.

“Many people still believe this is a no-eat-more-exercise phenomenon. “It’s about willpower. It’s not a medical condition.” And so the validity of obesity as a chronic medical condition continues to be questioned, despite the evidence, despite the neurobiology of obesity and how we understand obesity in 2024, despite treatments that actually show benefits for it’s about results and weight loss,” he said.

The Canadian drug agency declined an interview but said in a statement that new trial results have been released since Wegovy’s initial review in 2022. Nova Nordisk is free to make a new submission, the statement said.