Photo illustration by The Globe and Mail
On Feb. 27, reporters Kelly Grant and Chris Hannay answered reader questions on the rise of Ozempic and similar drugs in Canada, what experts are saying about the health risks and benefits and how it will change the pharmaceutical industry in the country.
Readers asked about the side effects of GLP-1s, hitting weight-loss goals on different drugs and when major insurance companies will cover weight-loss drugs. Here are some highlights from the Q&A.
The health effects of GLP-1s
What’s the difference between GLP-1s like Ozempic, Mounjaro and Wegovy?
Kelly Grant: Ozempic and Wegovy are the exact same drug called semaglutide. Both are made by the Danish company Novo Nordisk. The main difference is that Ozempic is Health Canada-approved and marketed for diabetes and kidney disease, while Wegovy is approved and marketed for weight loss, plus weight-related cardiovascular and liver disease. Mounjaro is a different drug called tirzepatide, made by Eli Lilly. Tirzepatide targets two satiety-inducing hormones: GLP-1, and another abbreviated as GIP. Zepbound is the version of tirzepatide approved and marketed for weight loss.
How will cheaper versions of Ozempic tip the scales?
Should I continue taking GLP-1s once I’ve hit my weight-loss goal? Once the weight objective is reached, is there a maintenance dose for Ozempic to maintain new weight?
Grant: That’s up to you, of course. The evidence is fairly clear that people regain weight once they go off GLP-1s. This editorial and meta-analysis in the BMJ lay out how patients seem to regain weight even faster after stopping GLP-1s than after quitting traditional diets.
But I’ve also interviewed patients who stopped taking GLP-1s or tapered their doses after hitting a weight-loss goal who say they’ve maintained their weight, at least in the short term. It’s something you’ll want to discuss with your doctor.
Health reporter Kelly Grant says Ozempic and Wegovy are the exact same drug called semaglutide. The main difference is their approved purpose by Health Canada.Hollie Adams/Reuters
I’m concerned about loss of muscle tissue while taking a GLP-1. How much and what type of weight training is required to offset this downside?
Grant: Sarcopenia, or muscle loss, is a risk whenever people lose a lot of weight. The studies I’ve read and doctors I’ve interviewed don’t point to sarcopenia being worse with GLP-1 drugs than with other methods of weight loss. It’s just that those other methods (except for bariatric surgery) don’t work as well, so we haven’t had to think about weight-loss-related sarcopenia as much in the past as we do in the age of Ozempic. Resistance training is hugely important if you’re losing weight on a GLP-1, especially if you’re a senior citizen.
I’m interested in Ozempic, but am worried about potential side effects. Is it too new to fully know its effects on our bodies long-term?
Grant: These are two good, but different, questions. We know a lot about the side effects. Vomiting, nausea, diarrhea, constipation and other gastrointestinal issues are common with GLP-1s. Some patients find the side effects intolerable and quit the drugs as a result. Others say they’re minimal or fade over time. Doctors generally start patients on low doses to allow the body to adjust.
Long-term effects are another matter. We don’t have decades and decades of safety data on these drugs, but we have more than most people realize. That’s because the earliest short-acting versions of GLP-1s (which had to be injected daily and were prescribed only for diabetes) have been around for 20 years.
Where does the rise of GLP-1s leave the body positivity movement?
I have heard conflicting information on whether Ozempic is beneficial or harmful to your kidneys. Can you shed some light on this topic?
Grant: The evidence is actually pretty clear that GLP-1s help rather than harm your kidneys. Last year, Health Canada added an indication to the label for Ozempic approving it for the treatment of kidney disease in people with diabetes. That was based on the results of the FLOW trial, which you can check out here. Other studies suggest GLP-1s also provide kidney benefits to people who don’t have diabetes.
A custom-designed pharmaceutical production line before it will be shipped from Italy to Applied Pharmaceutical Innovation in Edmonton, a company set to produce generic semaglutide.Alberto Bernasconi/The Globe and Mail
The business of GLP-1s
How long will it take for major insurance companies to start covering GLP-1s under their health insurance policies? It’s so expensive right now.
Chris Hannay: It depends on what you are taking the GLP-1 drug for. Nearly all public and private insurance plans cover Ozempic for Type 2 diabetes. On Mounjaro, many private plans will cover for Type 2 diabetes (though that may depend on the employer). Mounjaro is currently being assessed by Canada’s Drug Agency and we should find out in weeks whether it’s looking like public plans will cover it.
As far as taking the drugs to manage obesity, most plans do not currently cover it. Some private plans will cover Wegovy or Zepbound if there is another condition, such as cardiac disease. Public plans do not currently cover Wegovy because the manufacturer (Novo Nordisk) did not want to negotiate with the body that represents federal and provincial drug plans. But when generics come out later this year, that could change. I expect by the end of this year many more insurance plans will cover GLP-1s, though again, it can depend on what the drug is being prescribed for.
Canada will be a launching pad in the global race for generic Ozempic
How is everyone getting Ozempic prescriptions so easily? Is that safe?
Hannay: From what data I have seen, the vast majority of Ozempic prescriptions are still coming from physicians at in-person visits. So why are there so many people getting prescriptions? Presumably there are a whole lot of Canadians who are “asking their doctors.”
On safety, any drug that has been obtained from a reputable pharmacy would have passed through many regulators along the way – Health Canada approving the drug in the first place, granting the manufacturing facility a licence, the pharmacy has to be approved by a provincial college, etc. Doctors and pharmacists can help manage any side effects or adverse reactions.
Why is Novo Nordisk struggling if they make billions on Ozempic?
Hannay: It depends what you mean by “struggling.” The company has been enormously successful in recent years because of Ozempic. It is still profitable. But the company has said that growth is slowing and the stock price has declined quite a bit (really a measure of the fact that investors aren’t confident the company’s future will be as strong).
There are a couple of reasons for that. One is that they have lost a lot of market share in the U.S., which is the biggest pharmaceutical market in the world. (About half of all global drug spending is in the U.S.) Eli Lilly has about 60-per-cent market share of GLP-1 drugs in the U.S. for a variety of reasons. The other reason investors are questioning Novo Nordisk’s future is that it is not seen as having as strong of a pipeline of future drugs as its rivals, particularly Eli Lilly and some others.
Dozens of online-pharmacy ads, including for weight-loss drugs, appear to violate federal rules
Has Health Canada let Canadians down given they have been reviewing generic semaglutide for almost two years?
Hannay: Health Canada has a public database that shows generic drug submissions and when they were sent in (scroll down and search for “semaglutide”).
Has Health Canada let down Canadians? Certainly many of the companies have expressed that they wish the approval process went faster – Health Canada’s guidelines say they should get through an application in six months. And there are many patients who wish they had cheaper generic options.
If you talk to Health Canada, they would say they are doing their due diligence to make sure these drugs are safe for Canadians to take.
What other ripple effects do you predict are coming in other facets of society when more affordable versions of Ozempic hit the market?
Hannay: The price of generic forms of Ozempic is expected to hit 35 per cent of the brand price by the end of this year. So somewhere around $100 for a four-week supply (depending on where a patient is buying it from, if insurance is covering it, etc.). Everyone I’ve spoken to in the industry expects demand to only go up when that happens. What does that mean for society? Well, some folks who really support the drug say it could mean people get a lot healthier, no matter what condition they are taking the drug for. But there are all sorts of other questions that have been raised about what it means for beauty standards and more. It’ll be a continuing discussion for all of us.
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