Rush for diabetes and weight-loss drug Ozempic puts cross-border sales in spotlight

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The B.C. government's bid to restrict the sale of diabetes drug Ozempic to prevent non-Canadian residents draining supplies was the right move and a long time coming, says Brett Skinner, founder and CEO of the Canadian Health Policy Institute.

Nearly two decades ago, Skinner warned that policymakers in Canada had to wise up to the market realities for pharmaceuticals and realize large-scale demand from Americans for cheaper Canadian drugs threatened the country's limited supplies.

In the case of Ozempic, its popularity has soared in recent years thanks to a ubiquitous advertising campaign coupled with celebrity-driven social media chatter about its effectiveness as a means of losing weight, a so-called “off label” use for the drug.

B.C. Health Minister Adrian Dix said on Tuesday he wants a federal clampdown on sales to non-residents after it was discovered that Americans were being sent thousands of doses of Ozempic in the mail from B.C., the majority prescribed by a single practitioner in Nova Scotia.

“It's Ozempic today, it might be another drug tomorrow, but I don't think this is a short-term thing,” Dix said. “It's a significant drug and it's part of our PharmaCare system.”

The health minister said that advertising and social media hype had fuelled American demand for Ozempic, and B.C. pharmacies that ship products by mail have enabled it and created an “unacceptable situation.”

“We would never have sufficient supply of Ozempic in British Columbia to satisfy the needs of the American market,” Dix said. “We have to protect patients here.”

Dix said upwards of 15 per cent of Ozempic prescriptions in the first two months of 2023 went to Americans.

A Health Ministry spokesperson said in a statement that data available to the ministry did not enable it to identify the practitioners from Nova Scotia prescribing Ozempic to U.S. residents via B.C. pharmacies.

“That is why the minister is requesting the Nova Scotia College of Physicians and Surgeons to immediately initiate an investigation ... and to take action to address this unacceptable issue.”

Nova Scotia's Department of Health and Wellness said it is aware of the situation and has reached out to the province's College of Physicians and Surgeons about “what is taking place.”

The College of Physicians and Surgeons of B.C. said in a statement that “if the Minister identified patterns of prescribing and dispensing of Ozempic that suggested a registrant wasn't following the College's professional guideline … the College would open an investigative file to ensure high standards of patient care.”

The move by the B.C. government was vindicating for Skinner, he said, because he and others had predicted such a scenario years ago, but not with a drug like Ozempic in mind.

Skinner said that no matter the drug or what's driving demand, Canada cannot satisfy American appetites for cheaper pharmaceuticals.

He said he understands why Americans would look to Canada for their drugs, but the phenomenon puts pharmaceutical companies in an awkward position.

“It's perfectly rational economic behaviour for consumers to seek the lowest price for the same product,” he said.

“From a business point of view, (pharmaceutical companies) can't allow Canadians to be shipping products intended for Canadian patients across the border to Americans and undermining the American price, which is the foundation of revenues in the industry … so naturally they only ship as much as they intended to ship for the Canadian population and no more.”

Skinner said that's the position the B.C. government finds itself in with Ozempic. Moving to restrict exports is exactly what he and others predicted “would have to happen in order to protect our drug supply.”

Demand for Ozempic has exploded in recent years, leading to shortages elsewhere that B.C. is hoping to avoid.

Expenditures by drug coverage plans on the injectable treatment ballooned from $13.5 million in 2019 to $227 million in 2021, a study by the Canadian Agency for Drugs and Technologies and Health found.

Kate Hanna, spokesperson for Ozempic's manufacturer Novo Nordisk, said the company and the B.C. government have a “shared interest” in ensuring the province's supply.

“Earlier this year, the B.C. government approached Novo Nordisk with concerns about cross-border sales of Ozempic. The government has now highlighted specific concerns regarding the sale of a significant amount of Ozempic to non-Canadian residents,” Hanna said in a statement to The Canadian Press.

“We will work with and support all governments in the efforts to limit the sale of Ozempic to non-Canadian residents. We've also engaged Health Canada on this issue in the hopes of identifying a national solution.”

The Canadian Pharmacists Association said protecting Canadian drug supplies from mass exportation to the U.S. market remains a priority.

Joelle Walker, the association's vice-president of public and professional affairs, said cross-border sales of Canadian drugs to Americans seeking lower prices has been a long-standing issue for the country's health-care system.

Walker said the concern is not with small numbers of Americans coming over the border to buy cheaper drugs, but rather any large-scale quantities of drugs being exported and diverted from Canada's limited supply.

In the case of Ozempic, which is approved to treat Type 2 diabetes, Walker said the internet and intense media coverage have fuelled demand for the drug for its weight-loss properties.

Walker said online sales of Ozempic from Canadian pharmacies to non-residents also highlight how virtual service providers have proliferated, making it a “complicated” situation for policymakers and regulators.

“Online pharmacies have been around for a long time, but again I don't think we've ever seen an example of the kind of numbers we're talking about there and I think that's what raised more of the concern,” she said.

The association, Walker said, remains opposed to any large-scale schemes that would see Canadian drugs shipped over the border that could lead to Canadians being unable to access essential medications.

“From a shortages perspective, the province has indicated that that's sort of their primary concern and I think that's probably where the priority needs to be,” she said.

Walker said a national conversation about whether something needed to be done to “protect Canadians” was “probably very timely.”

This report by The Canadian Press was first published March 30, 2023.