High Proportion of BC Diabetes Drug Sales Goes to Americans

Data from the Canadian province of British Columbia (BC) reveal that an unusually high percentage of all dispenses of semaglutide, marketed as Ozempic, have been sold to residents of the United States. For January and February alone, 15% or 15,798 of all semaglutide dispenses from pharmacies in BC were sold to US residents.

In addition, 88% of the 15,798 dispenses for US residents were issued by two BC pharmacies. “This is very concerning,” according to a statement from the BC Ministry of Health.

Semaglutide is a medical therapy for type 2 diabetes that has become popular because of its weight-loss benefits. The situation raises questions about ensuring the adequate supply of drugs for Canadians and maintaining necessary drug safety monitoring.

David Davison, MD, a doctor from Nova Scotia now living in Texas, wrote many of the semaglutide prescriptions that were dispensed in BC. His license to practice in Nova Scotia was suspended. “Based on volume alone, the prescribing is not in keeping with the standards of the profession,” Gus Grant, MD, registrar and CEO of the College of Physicians & Surgeons of Nova Scotia, said in a statement.

Securing the Supply

BC Health Minister Adrian Dix has asked the province’s pharmacists to curb the sale of the drug to nonresidents of Canada and focus on prescribing it to patients with type 2 diabetes. The measures are intended to protect the supply of the drug for patients.

BC has not experienced any shortages of the 1-mg formulation of injectable semaglutide, but a national shortage in Canada was reported in mid-March.

“The situation is concerning, and we need to ensure that those who need this drug the most in BC, and in Canada, continue to have access to it,” according to the BC Ministry of Health’s statement.

“Coverage of Ozempic in BC is only available for residents of Canada with type 2 diabetes mellitus who have tried metformin before and need a new treatment,” according to the health ministry. “It is not for people with other diseases or for those looking to lose weight.” The ministry is asking physicians who prescribe semaglutide and pharmacists who dispense semaglutide to comply with the product’s approved indication in Canada.

Dr. Alika Lafontaine

Dix has also written to his counterparts in Canada’s other provinces and territories and the Canadian Minister of Health, and is engaging in discussions with other provincial and territorial governments.

CMA Voices Concerns

The phenomenon of Americans procuring medications from Canada is not new, and the situation raises concerns beyond safeguarding the supply of medical therapies for Canadians, said Canadian Medical Association (CMA) President Alika Lafontaine, MD, an anesthesiologist in Grande Prairie, Alberta.

“Americans often turn to Canada for cheaper access to pharmaceuticals,” Lafontaine told Medscape Medical News. “This is not a new issue. I think the thing that we are starting to consider is whether it’s this drug or another drug, how does it impact Canadian supply, the safety of these prescriptions, and how do we ensure that patients who receive access to these drugs, wherever these patients come from, take it in a safe way and have that safety monitored appropriately? I think those are the core issues we have to work out.”

Dr Jennifer Lake

Off-label use of semaglutide may mean that patients who do not have type 2 diabetes and are not obese or overweight are using the drug for a “quick fix” for weight loss and are not considering adverse events associated with the therapy, said Jennifer Lake, PharmD, PhD, assistant professor of pharmacology and pharmacotherapeutics at the University of Toronto, Ontario.

“I think from a healthcare professional point of view that patients who need it for health reasons, which for me would be patients with type 2 diabetes and patients who are obese and at risk of health conditions, are definitely people that are benefiting from this drug,” Lake told Medscape Medical News. “When we start to move from overweight into slightly overweight and into normal weight [patients], that is where the risks may start to outweigh the benefits.”

Lake noted that Americans procuring the drug in Canada are not benefiting from counseling that they would otherwise receive from their local healthcare professional. “They are really losing out on that therapeutic relationship that they have with primary care providers, their specialty physicians, and their local pharmacists that they normally deal with,” she said.

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