Americans keep coming for our drugs, this time snapping up thousands of doses of a much-hyped diabetes drug for weight-loss in a mini-scandal involving doctors and pharmacists on opposite sides of the country.
The British Columbia government revealed this week that more than 15,000 doses of Ozempic were dispensed to U.S. citizens in the first two months of this year alone. The bulk of those scripts – 88 per cent – were dispensed by two Vancouver pharmacies, and 95 per cent of those prescriptions written by “one or more prescribers” who identified themselves as a practitioner from Nova Scotia.
The B.C health ministry has asked the College of Physicians & Surgeons of Nova Scotia to initiate an immediate investigation into “this unacceptable issue,” a ministry spokesperson wrote in an email to the National Post, while the registrar of the doctors’ college says the situation is “worrisome” and “disturbing,” and that Nova Scotians who have wondered on social media, who has time to write all these prescriptions if there’s a doctor shortage in the province, are entirely entitled to be upset.
“It’s a very disappointing story,” said Dr. Gus Grant, college registrar and CEO.
Details remained fuzzy Thursday as to the identity of the parties involved. “I don’t have the name of the prescribers; I don’t have the details of the prescribing,” Grant said. The College of Pharmacists of British Columbia is “currently assessing the situation,” a spokesperson said, “to determine an appropriate path forward.”
Americans have long sought cheaper drugs from Canada. The U.S. dollar is stronger than ours, Canada’s drug pricing regulator was mandated to ensure patented (brand-name) drug costs aren’t “excessive,” pricing controls that aren’t in place in the U.S., and Americans can expect to save upwards of 50 to 80 per cent of what they would pay at home for the same medicine.
Vermont senator Bernie Sanders and a caravan of Americans living with diabetes once rolled over the border from Detroit to Windsor to buy insulin at roughly one-tenth the price it cost in the United States.
While hard numbers weren’t available Thursday, Tim Smith, general manager of the Canadian International Pharmacy Association, whose members operate online (mail-order) pharmacies, said “a few hundred thousand, perhaps,” prescriptions for U.S. residents are filled across his membership each year.
Smith said that he doesn’t believe, based on the information he’s seen, that the two Vancouver pharmacies doling out script after script of Ozempic are CIPA members.
But he said Americans generally look north for “maintenance” medications for ongoing, chronic conditions like high blood pressure or diabetes. “They’re not people who are trying to game the system, by any means,” Smith said. And while numerous states are looking to import drugs in bulk from Canada, this isn’t about that. It’s about American buying medicines for their personal use.
The drug they want now is Ozempic, a buzzy diabetes medication people are injecting for weight loss. A one-month supply costs roughly US$1,000, versus US$350 from Canadian pharmacies.
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When used for type 2 diabetes, Ozempic lowers blood-sugar levels. In people without diabetes, it helps control cravings, hunger and eating. In the field of obesity, Ozempic has been called a “home run” by some obesity specialists.
While not officially approved for obesity, doctors are permitted to prescribe Ozempic “off label” for weight management.
Pharmacies in B.C. and other provinces are able to fill prescriptions for Americans written by U.S. doctors, provided the prescription is “co-signed” by a prescriber licensed to practice in one of the provinces or territories.
It’s not clear how many Canadian doctors are lending their names to U.S. prescriptions, or how much they are paid for doing so. Smith said his members’ companies are privately held, competitive businesses. “As a result, we don’t maintain that information.”
American residents made up almost a fifth of the people who bought Ozempic in B.C. in January and February, buying up 15 per cent of all Ozempic dispensed in the province during that period. Normally, less than half a per cent of drugs in B.C. are dispensed via mail-order to non-residents.
Fearing a shortage of Ozempic for diabetics, B.C. Health Minister Adrian Dix wants the drug restricted to British Columbians and other Canadians. “We have to protect patients here,” he said this week.
The Canadian Medical Protective Association, the powerful body that provides medical legal defence to most of the nation’s doctors, has warned that any doctor who signs or co-signs an internet prescription for a person “with whom they have no prior recognized doctor-patient relationship” is engaging in a medically and legally risky activity that licensing bodies would consider unacceptable.
In non-urgent situations, colleges would expect that, before prescribing a drug, doctors first “obtain an adequate history, perform appropriate physical examinations, make a diagnosis, obtain informed consent, and arrange appropriate follow-up care,” the CMPA says on its website.
“Hence, physicians engaging in (cross-border prescribing) are at risk of sanctions by their college.”
The organization will also generally “not extend” (their emphasis) assistance to a doctor for any complaint, investigation or legal action “arising from this activity.”
The B.C. health ministry, when contacted by the National Post, said their data from PharmaNet do not make it possible to identify the practitioners from Nova Scotia.
Pharmacists, and pharmacies, also have a professional responsibility to assess whether a prescription is appropriate. “It seems staggering to me that two pharmacies have dispensed over 15,000 prescriptions co-signed, if you will, by Canadian prescribers for American residents,” Grant, of the College of Physicians and Surgeons of Nova Scotia said.
He personally tries not to use the term “co-signing.”
“There is no such thing as co-signing in the eyes of the regulator,” Grant said. “This is an act of prescribing and when we have the details in hand, we will examine whether the prescribing in question is appropriate and in keeping with the standards of the profession.”
On the face of it, this certainly sounds like a potentially serious breach of professional conduct, he said. It’s not clear whether the physician, or physicians, involved had appointments with any patients “or whether it was just a simple paper transaction,” Grant said.
If the conduct is found unacceptable, there’s a broad range of disciplinary sanctions available to the college, he said, up to and including revocation of licence.