Medications Within Borders: Canada Limits Ozempic Purchase

Recently, the health minister of British Columbia, Canada, convened a press briefing. At this meeting, he announced that effective immediately, the province was restricting sales of the glucagon-like peptide 1 (GLP-1) receptor agonist Ozempic (semaglutide). Non-Canadians would henceforth not be able to procure the medication. This was the first instance in recent times that such a step was taken for any drug in any part of Canada. What led the minister to decide to take this step?

Canada and Mexico: Neighboring Pharmacies for Americans

The health minister relayed that a single physician in Texas who held a license to practice in Nova Scotia, Canada, had allegedly written over 17,000 prescriptions in a 3-month period that were all filled at two online pharmacies in British Columbia, Canada. The prescriptions were then shipped to various destinations in the US. This roughly amounted to 15% of all prescriptions filled for the medication in the entire province of British Columbia for the same time period. This is a 37-fold increase compared with prescriptions typically filled for Americans in British Columbia for other medications.

If one assumes that this physician worked every day for 90 days and only saw patients who needed GLP-1 receptor agonist prescriptions for their type 2 diabetes, based on the number of prescriptions, it would mean that he or she saw 188 patients per day. This clearly raises questions about the circumstances leading to such prescribing. After the release of this information, the College of Physicians and Surgeons of Nova Scotia has temporarily suspended the license of the physician in question, who has apparently not lived in Nova Scotia for the past 40 years, while they are looking into this matter.

Although the prescribing pattern of a single physician is being reviewed, the phenomenon isn't limited to a single instance. Countless Americans have used pharmacies based in Canada or Mexico for decades now for access to medications. When I was pursuing my residency in Rochester, New York, and fellowship in Los Angeles, California, I personally knew scores of patients who would drive across the border to Canada and Mexico, respectively, to purchase insulin on a regular basis.

When asked why they bypassed the highly regulated US drug monitoring and dispensing system, they all had exactly the same answer: drug costs.

It's well-known that drug prices in the US are the highest in the world. Medications routinely prescribed in the US cost only a fraction of their US price in other countries. In this case, a 1-month supply of Ozempic, when shipped to the US from an online Canadian pharmacy, typically costs about $250, whereas the same drug costs nearly $1000 in the US for individuals bearing the entire cost of the medication out-of-pocket.

It has been previously reported that nearly 18% of Americans don't fill a prescription because of the cost. It's a no-brainer, then, that people struggling financially, especially during times of inflation, will resort to getting their medication at a much cheaper cost from foreign shores if their own country's medical system makes drug costs prohibitive.

Do People With Diabetes Have 'More Right' than Those With Obesity to Access Ozempic?

In the recent past, Ozempic has garnered a lot of attention in mainstream and social media for its use in weight loss by individuals who may not necessarily be suffering from the ramifications of increased adiposity (the active ingredient of Ozempic, semaglutide, is also approved for obesity in the US and Canada and sold under a different brand name, Wegovy). There is clinical evidence that semaglutide helps manage obesity to a degree not seen with previous medications.

People with obesity dealing with the constant metabolic, mechanical, and mental complications of the disease now have the opportunity to utilize a very effective pharmacotherapy as an adjunct to lifestyle modifications and behavioral therapy. This has led to a debate about people with obesity "creating a shortage of the medication intended for diabetes."

Let's be clear that as healthcare providers, we have no business either promoting or participating in the belief that people with one disease have "more right" to access to medications than those with other conditions. The bigger issue here is the clear lack of effective therapy for management of a disease like obesity/overweight that over 60% of US adults are living with.

Equally important is recognizing the undue emphasis that society places on certain body images, which pressures people to resort to taking medications to lose weight even when they they don't have obesity/overweight.

No wonder, then, that as soon as medications such as Ozempic and Mounjaro (tirzepatide, a similar agent, which is licensed for use in type 2 diabetes but not yet approved for obesity) were released in the US, the demand for these medications was unprecedented, leading to short supply of these medications not just in the US but, as a ripple effect, in many other countries too. Worse, in a desperate attempt to get medications at a cheaper cost, many people even resorted to getting unregulated semaglutide from compounding pharmacies, putting them at significant risk for bodily harm.

Limiting Sales to Foreigners

Many people on social media felt that the move by the Canadian health minister to restrict sales to non-Canadians was "unfriendly" and "harsh." It's important to note that drug manufacturers allocate supplies to countries on the basis of perceived needs for the citizens of that country and don't factor thousands of prescriptions being shipped to other countries into their calculations.

It's unlikely that medication manufacturers would then allocate more supplies to a country, especially if it finds that the drug is making its way to a market with different regulations and higher price points. With Ozempic already being in short supply in many other countries across the world, the minister suggested that this move was purely with the intention of preserving the interests of Canadians.

Multiple attempts have been made in the past to reel in the cost of medications in the US, with limited success (Korcok; Rawson and Binder; White House). It's well known that conditions such as obesity and type 2 diabetes and their complications tend to affect those from lower socioeconomic backgrounds much more than other sections of the society.

Drug cost regulation is a highly complex issue that has needed a solution for a long time now. In the absence of equitable access to medications, we fail the very people for whom the medications are developed in the first place. Until such a solution is available, one can't be surprised that people with medical conditions are forced to source medications from any possible avenue, including other countries, or worse — unregulated markets including compounding pharmacies.

Akshay B. Jain, MD, is a clinical endocrinologist who has practiced in three countries, focusing on mitigating the complications of diabetes and obesity. He is fluent in six languages and has spoken at more than 500 programs internationally.

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