If federal, provincial and territorial governments follow the CDA’s advice, Wegovy would be the first prescription weight loss drug to be covered by public insurance plans.Hollie Adams/Reuters
Provincial governments should pay for the weight-loss drug Wegovy for people who are overweight and have survived a heart attack or stroke, according to a new report from the organization that advises Canadian public drug plans on which new medications to cover.
Canada’s Drug Agency, which released the draft recommendation on Thursday, said taxpayer-funded drug plans should reimburse Wegovy for people with a body mass index of 27 or higher and pre-existing cardiovascular disease because a clinical trial found the once-weekly injection cut their risk of another heart attack, stroke or cardiovascular death by 20 per cent.
If federal, provincial and territorial governments follow the CDA’s advice – as they usually do – Wegovy would be the first prescription drug marketed for weight loss to be covered by public insurance plans, albeit only for a subset of overweight patients who also have cardiovascular disease or peripheral arterial disease, a condition that can lead to lower limb amputations.
“This is a huge landmark moment in that we’re looking at obesity in a much more holistic sense,” said Sanjeev Sockalingam, the scientific director of Obesity Canada, a non-profit research and advocacy organization.
Wegovy is one of the brand names of semaglutide, a medication better known as Ozempic. Ozempic is approved by Health Canada for the treatment of Type 2 diabetes, but it has become a sales and cultural juggernaut because of how readily it helps users lose weight.
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Wegovy is the higher-dose version of semaglutide approved for weight management. Health Canada added an authorization for cardiovascular disease to the medication’s label late last year.
Canada’s Drug Agency estimates that covering Wegovy for overweight patients with pre-existing cardiovascular disease would cost the public purse approximately $600-million over three years, but the tab could run as high as $3.5-billion, depending on uptake.
The report says Wegovy-maker Novo Nordisk Inc. would have to cut the drug’s sticker price by 67 per cent to make it cost-effective for taxpayers. A year’s worth of the maintenance dose of Wegovy costs just over $5,000.
It is common practice for public drug plans in Canada to jointly negotiate lower, confidential prices after medications receive a positive recommendation from the CDA.
Canadian public drug plans generally cover social-assistance recipients, senior citizens and people whose drugs come with bank-account-busting price tags, although policies differ from jurisdiction to jurisdiction.
Canadian private insurers, meanwhile, paid out $77-million in claims for weight-management drugs last year, up from nearly $38-million the year before, according to a recent Telus Health drug report.
Public insurers in Canada and around the world have generally declined to cover prescription drugs for weight loss, dismissing them as cosmetic treatments akin to Botox for wrinkles.
The CDA’s predecessor recommended against funding Wegovy in 2022 because, at the time, there was no high-quality scientific evidence of the drug’s health benefits beyond helping patients shed pounds.
Novo Nordisk asked the CDA to give the drug a second look after a large randomized control trial called SELECT found Wegovy cut the risk of major cardiovascular events by 20 per cent.
The SELECT trial enrolled participants with a BMI of at least 27 – which means a 5-foot-6 person would have to be 177 pounds or heavier to qualify – and a previous heart attack or stroke. The CDA recommendation matches the trial criteria.
Subodh Verma, a cardiac surgeon and scientist at St. Michael’s Hospital who co-led the SELECT trial, said people who struggle with obesity might wonder why they can’t access public funding before suffering a heart attack or stroke.
“I totally get it, and I think we just have to wait,” he said. “Those trials are ongoing right now. This is the first step.”
Dr. Verma has disclosed receiving funding from Wegovy-maker Novo Nordisk, as has Obesity Canada.
