By Janice Harvey, RPh, CDE
There are many drug shortages in the Canadian market, but perhaps the one that is garnering the most discussion is Ozempic. Why is that? How long do we expect it to last? And what can we do about it?
Why is Ozempic in such demand?
Ozempic is one of a class of medications called GLP-1 receptor agonists (GLP-1 RAs). These medications help with weight loss by suppressing appetite and delaying gastric emptying, both of which cause you to eat less, because you feel full after eating. For diabetes, when people lose weight, their cells become more sensitive to insulin. At the same time, GLP-1 RAs cause the body to release more insulin in response to food intake, which results in sugar moving into cells to provide energy, thus lowering the amount of glucose in the blood stream (known as “blood sugars” or “blood glucose”). In addition, drugs in this class reduce cardiovascular risk.
Sounds like a winning combination, doesn’t it? With so many people using it for different purposes, no wonder the manufacturer is having a hard time producing enough to meet demand.
How long is the shortage expected to last?
Initially, the shortage involved only the 1 mg pen, but then more people switched to using the starter pen, which allows for either a 0.25 mg dose or a 0.5 mg dose, sometimes getting two pens to get the same amount of Ozempic. This has led to there being a shortage of both pens. While the shortage was originally expected to last until the end of October 2023 for the 1 mg pen only, Novo Nordisk (the manufacturer) has now expanded this to include both pens and extended the date to the end of March 2024.
Are pharmacies still able to get Ozempic?
Yes … and no. Pharmacies are receiving very limited supplies (called allocations) of Ozempic and deliveries are not consistent. For example, we are allotted 1 or 2 of each pen each day. But in reality, we might receive one of each pen per day for two days and then nothing for the rest of the week.
Novo Nordisk is encouraging pharmacies to limit refills to one pen (we really don’t have any other choice) and suggest that patients contact their pharmacies well in advance of running out of their current supply. We suggest that you let us know the date of your next injection after finishing your last dose (this would be 7 days after your last dose). We have started a list of our patients taking Ozempic and their injection dates so we can distribute pens fairly and ensure patients are not missing doses. We get several phone calls every day asking for Ozempic. However, we are filling Ozempic prescriptions for our own patients only to ensure that we have a sufficient supply.
Are there alternatives?
Yes, other options do exist.
- Injectable semaglutide (Ozempic) comes in pre-filled pens that deliver subcutaneous doses of 0.25 mg, 0.5 mg or 1 mg. Using two 0.5 mg doses of Ozempic at the same time to achieve a 1 mg dose is an option, but since both pens are in short supply and you would need to buy two pens for 28 days, rather than one pen, the cost will double and supply will become an even bigger problem. PharmaCare and most third-party insurers will not cover the cost of two pens. Some patients have chosen to reduce their dose to 0.5 mg during the shortage in order to stay on Ozempic.
- Oral semaglutide (Rybelsus) comes as 3 mg, 7 mg and 14 mg tablets that are taken once daily. The manufacturer has not provided guidance on an equivalent oral dose if switching from the injectable form, but some experts suggest going from a 1 mg subcutaneous dose to the 14 mg tablet, starting within 7 days of the last injection. Rybelus is not covered by BC PharmaCare.
- Dulaglutide (Trulicity) is also a GLP-1 RA that is injected subcutaneously once weekly. The starting dose is 0.75 mg, but if switching from Ozempic, you would start on the maintenance dose of 1.5 mg. During the Ozempic shortage, BC PharmaCare is covering this medication. If you are interested in switching, we can adapt your prescription.
- Liraglutide (Victoza) is another GLP-1 RA that is injected subcutaneously; however, this medication is injected daily. Dosing ranges from a starting dose of 0.6 mg to maintenance doses of 1.5 mg or 1.8 mg. Victoza is not covered by BC PharmaCare.
- Liraglutide/insulin degludec (Xultophy) is a combination GLP-1 RA and long-acting insulin. It is not covered by BC PharmaCare.
A NEW OPTION COMES TO CANADA
Tirzepatide (Mounjaro) was approved by Health Canada on November 1, 2023. Like Ozempic, it is a GLP-1 RA. It also stimulates the GIP receptor (causing the body to make more GIP, which increases insulin release in response to the presence of glucose) and has been shown to be of more benefit than Ozempic. Dosing starts at 2.5 mg injected subcutaneously once weekly, increasing by 2.5 mg each month to a maximum of 15 mg weekly. Each dose comes in a single-use vial, so needs to be drawn into a syringe for injection.
At this time, Mounjaro is not covered by BC PharmaCare and has coverage from only one third-party insurer: Canada Life. More widespread coverage is expected.
All of the above options are meant to be used for diabetes. Semaglutide for weight loss (Wegovy) is approved for use in Canada, but is not being sold here, which has likely contributed to the Ozempic shortage. When it comes to weight loss medications, there are few options available, and none are covered by BC PharmaCare.
- Liraglutide (Saxenda) is injected subcutaneously once daily. Yes, this is the same as Victoza above, but with dosing up to 3 mg (vs. 1.8 mg for diabetes). Some third-party insurance plans will cover this for weight loss for individuals who do not have a diagnosis of diabetes.
- Bupropion/naltrexone (Contrave) is an oral tablet that is taken twice daily. It’s use in weight loss is not well understood, but it is thought that it may regulate food intake through a couple brain pathways.
- Orlistat (Xenical) is an oral capule that is taken up to three times a day with each main meal that contains fat. As this medication works by limiting fat absorption, it is the least effective of all the options.
Co-pay discount cards are available for both Trulicity and Mounjaro. Ask our Certified Diabetes Educator for more information.
RISKS OF COMPOUNDED SEMAGLUTIDE
We have heard of some people getting semaglutide compounded and provided in a vial. Please be aware that, for safety reasons, this can only be done by a pharmacy that does sterile compounding (there are three compounding pharmacies in the Comox Valley). Further, know that compounded semaglutide sodium and semaglutide acetate (the salt forms being used for compounding) have not been studied in a clinical trial alongside Ozempic, so there is no way to know if they are bioequivalent in terms of the way the drugs are absorbed and how they work in the body, nor can we know about long-term effects. Read more about compounded semaglutide at GoodRx Health.