Quebec public insurance won’t cover Wegovy due to high cost, uncertain benefits

Quebec's health research institute says Wegovy costs are too high and the benefits are uncertain.

The popular weight loss drug, Wegovy, is currently not covered by Quebec’s public drug insurance plan as the provincial health research institute (INESSS) says costs are too high and the benefits uncertain.

Some doctors, however, hope that could soon change.

“So, Ozempic and Wegovy are the same medication just prescribed at different doses for different reasons,” said cardiologist Dr. Christopher Labos. “Ozempic is prescribed for diabetes and Wegovy is prescribed for weight loss.”

Labos says there are medical benefits to treating obesity beyond cosmetic reasons.

“It leads to complications, diabetes, high blood pressure increases the risk of heart disease and cancer. The reason we treat obesity is to prevent cardiovascular events,” he said.

In two recent evaluations of Wegovy, however, INESS recommended that the government not reimburse the drug under the public insurance plan.

“Given its modest efficacy, safety concerns, its disproportionate cost relative to the clinical benefits it provides, and its excessive budgetary impact, the members consider that reimbursing Wegovy for the secondary prevention of cardiovascular events is not a responsible, fair, or equitable decision,” it wrote.

The drug does come with side effects such as nausea, vomiting, and bloating.

Labos says, however, that those side effects typically go away for most patients.

As for the cost, INESSS estimates that it would be close to $1 billion over five years, which would jeopardize the sustainability of the public insurance plan.

“If you’re going to exclude it on a cost-benefit ratio because of the cost, that’s a point of view, but I think we’re going to be having a very different conversation about these medications a year from now,” said Labos.

Labos says this is because Wegovy’s maker allowed its patent to expire in Canada in January, and generics could soon start flooding the market, which would bring the price down.

“Maybe the risk-benefit calculation is going to change in their minds, but from a purely medical scientific standpoint, if you want scientific studies showing that there’s a cardiovascular benefit to this medication, it’s there,” said Labos.

INESS says that the price would have to come down around 70 to 80 per cent for it to be cost-effective.

Quebec’s Health Ministry has postponed making a final decision on the drug.