TORONTO – Anne Welch worked a physically demanding job at her local SPCA — lifting pets, cleaning kennels and walking dogs — until she retired at age 71.
With the loss of that physical activity, coupled with an underactive thyroid, “the weight just started piling on,” the now-77 year old said in an interview from her home in Paris, Ont.
”(I’m) definitely feeling very down at times because I try so hard and I’ll go for a few weeks and I won’t eat any sweets and I’ll try to eat salads and then all of the sudden I wake up one morning and all I can think about is eating sweets,” Welch said.
“I’m sure that my back issues and my other issues would be helped by me being able to lose weight,” she said.
Welch asked her doctor if Ozempic was an option.
She said her doctor told her that the GLP-1 medication would be helpful and “she was more than happy to prescribe it for me.”
But because Welch doesn’t have diabetes, the Health Canada approved condition for which Ozempic is prescribed, the Ontario Drug Benefit program that covers medications for seniors 65 and older doesn’t fund it.
That’s in line with public drug plans across the country, according to the Canadian Institute for Health Information (CIHI).
Living on a fixed income of the Canada Pension Plan and Old Age Security, Welch said she can’t afford to pay for the drug — which often costs a few hundred dollars a month — out of pocket.
It’s “very frustrating,” she said, because she’s watched her husband Steve lose 30 to 40 pounds on Ozempic and keep it off.
He got coverage from the provincial drug program because he has a diagnosis of diabetes.
Welch is hoping that one of the nine generic semaglutide drugs — the active ingredient in Ozempic — currently under review by Health Canada will soon be approved.
Generic semaglutide would be cheaper than brand-name Ozempic, but how much depends on how many generic options are approved and hit the market, said Mina Tadrous, a pharmaceutical policy expert at the University of Toronto.
According to the pricing structure of the pan-Canadian Pharmaceutical Alliance, the first generic medication could cost 75 to 85 per cent of the brand name. Once a second medication enters the market, the price for both drops to 50 per cent. When there are three or more generic products available in Canada, the cost would decrease to about 35 per cent of brand-name Ozempic’s price.
Welch isn’t sure if that will bring the cost down low enough for her to afford, but she’s willing to try.
“Probably if it was under 150 (dollars), I could barely …squeeze by, but yeah, I could probably cut corners in a few places.”
Ozempic has become the largest single medication to drive up public prescription medication spending, accounting for $807 million of the total $20.1 billion spent in public drug systems across Canada, according to data released by CIHI in March.
Dr. Megha Poddar, an endocrinologist and an assistant clinical professor at McMaster University in Hamilton, said cost is the biggest barrier for patients who don’t have diabetes but need GLP-1 medications for obesity treatment.
“A lot of the generics conversation is actually coming from us as health-care providers to say, ‘hey, we know that this isn’t an option for you right now because of cost but it will likely be an option for you very soon because of the generics and the hopefulness around reduction in cost,’” Poddar said.
Canada was poised to become the first country to authorize generic semaglutide after manufacturer Novo Nordisk’s patent protection ran out and it became legal to produce generics in January.
But India’s drug agency — where the company’s patent expired in March — announced the approval of two generic versions that month.
One of those generics, made by India-based Dr. Reddy’s Laboratories, was submitted to Health Canada for review in early 2024.
“We are currently awaiting approval from the Canadian authority for our generic semaglutide and we will proceed with the launch in the region once the approval is received,” a spokesperson for the company said in an emailed response on Friday.
The Canadian Press reached out to Health Canada for an update on when the first semaglutide generics might be approved
Spokesperson Marie-Pier Burelle said the agency is “on track to meet review targets for generic semaglutide drug submissions,” noting that the “initial review” timeline is about six months.
But that doesn’t include the time needed for companies to address Health Canada requests for additional data.
“Generic semaglutide drugs submissions are complex. The original drug is a biologic, meaning it is produced using biological processes (i.e., using living organisms),” Burelle said in an emailed statement.
“Generic semaglutide products are complex synthetic products that are pharmaceutically equivalent to the brand name drug, but with possible differences that could impact safety and efficacy. The manufacturer must show that these differences do not affect the safety, efficacy, or quality of the drug.”
Cost is also a barrier for patients with diabetes who need Ozempic but aren’t seniors and don’t have private insurance.
One of them, Brenda Rogers, is hoping that generic semaglutide will be available in Canada by this summer, but she’s not feeling optimistic.
The 53-year-old online business manager in Vancouver is rationing her last doses of Mounjaro — a rival GLP-1 medication manufactured by Eli Lilly — now that she no longer has a drug benefit plan since losing her job in December.
“My body is adjusting to the lower dose. It’s not ideal as I’m noticing increased hunger but I’m happy to still have some medication. It will last longer this way,” said Rogers, who has diabetes and has struggled with her weight.
Both Ozempic, which she started taking a couple of years ago while in a previous job with drug coverage, and Mounjaro have been “life-changing” in conjunction with diet and exercise changes, she said.
“I was now sleeping better. I was eating better. I was able to move better. I was thinking better,” Rogers said.
Her plan is to switch to a generic semaglutide once it’s available, hoping the cost will be low enough for her to pay out of pocket.
“My big passion is accessibility and affordability for getting these medications, because now I don’t have the job with the extended benefits, so now what happens with my whole health journey?”
