Morning Update: The big promise of blockbuster weight-loss drugs

Good morning. Ozempic’s lesser-known relative Wegovy is no longer approved just for weight loss in Canada, and experts say more drugs like it could be greenlit for chronic diseases linked to obesity. More on that below, plus progress in Israel-Hamas ceasefire talks and a jump in digital platform employment. But first:

Today’s headlines

• Mark Carney talked about tariffs, Trump and Liberal leadership in a Daily Show interview
• After her return from Mar-a-Lago, Alberta Premier Danielle Smith opposes Ottawa’s proposal to cut off energy exports to the U.S.
• Haiti’s elites loom large in the country’s history of strife

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Health

Same drug, new prescription

I’m Kelly Grant, a health reporter at The Globe and Mail. I was intrigued when I saw that Health Canada approved Wegovy – a higher-dose version of the wildly popular diabetes drug Ozempic – for reducing the risk of heart attacks late last year.

I wondered what the approval might mean for Canada’s public drug plans. I wrote about that today in a story featuring a Toronto man who took part in the clinical trial that led to the cardiovascular approval. The 68-year-old trucker stopped taking Wegovy when the trial ended because he can’t afford it. Ontario’s drug benefit program doesn’t cover it.

You may not have heard of Wegovy, but you’ve definitely heard of Ozempic, the diabetes treatment with the earworm jingle (Oh-Oh-Oh-Ozempic!) and the capacity to make celebrities and regular humans thin. Wegovy and Ozempic are the same drug, semaglutide. Wegovy is simply sold at a higher dose and marketed for weight loss instead of diabetes.

I was interested in the cardiovascular authorization because of what it could mean for public coverage of Wegovy and other drugs that belong to a class called glucagon-like peptide-1 receptor agonists. GLP-1 drugs are proving to be remarkable weight-loss aids for people who’ve struggled to shed pounds all their lives, but Canada’s provincial and territorial drug programs have generally refused to pay for them – or for any prescription drugs they consider cosmetic.

Could that change now that research shows semaglutide cuts the risk of heart attacks, strokes and death from cardiovascular causes by 20 per cent in people with pre-existing cardiovascular disease who are overweight or obese but who don’t have diabetes?

If trends in the United States and Europe are any guide, the answer will be yes. South of the border, Medicare and Medicaid didn’t start covering Wegovy until the Food and Drug Administration approved it for cardiovascular protection.

In a related development, the Centers for Medicare & Medicaid Services announced just last week that they will pay for another GLP-1 drug, tirzepatide, sold as Zepbound, for obstructive sleep apnea. The FDA approved Zepbound for sleep apnea on Dec. 20.

In this country, the organization that sets the tone for public coverage of medications is called Canada’s Drug Agency, formerly the Canadian Agency for Drugs and Technologies in Health (CADTH).

In 2022, a CADTH expert committee advised public drug plans not to cover Wegovy for weight loss because, at the time, there wasn’t enough high-quality scientific evidence that semaglutide-induced weight loss improved other diseases associated with obesity.

Now, with positive clinical trials and the new Health Canada indication in hand, the Danish pharmaceutical giant Novo Nordisk confirmed to me that it has asked Canada’s Drug Agency to take a second look. A fresh verdict on Wegovy is expected later this year.

Tucked into CADTH’s dense 2022 report are some estimates of what it might cost to fund Wegovy for every Canadian who meets the Health Canada criteria for taking the drug, and who qualifies for a taxpayer-funded drug program. (Public plans differ from province to province, but they usually cover the old and the poor.)

Novo Nordisk submitted a three-year budget impact assessment of $1.06-billion; CADTH’s experts countered that the budget impact could be as high as $4-billion over three years, although both sides agreed it would be less if Wegovy were covered for a narrow subset of patients.

Predicting how new drugs might affect public health spending is always a challenge. Policy makers have to balance the upfront cost of prescriptions with the hope that keeping people healthy and out of hospital will save money in the future.

There are many complicating factors when it comes to judging the cost effectiveness of medications that are widely used or prohibitively expensive, not the least of which is the fact that real drug prices are often kept secret. Public payers routinely negotiate confidential discounts off the sticker price.

In the end, decision makers have to contend with a reality that Subodh Verma, a Toronto cardiac surgeon-scientist who helped lead several pivotal clinical trials of GLP-1 drugs for cardiovascular disease, put bluntly to me in an interview: “Saving lives costs money.”

The Shot

‘The Syrian criminal justice system is a mess, as you can imagine.’

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The Commission for International Justice and Accountability (CIJA) has been compiling a case against Bashar al-Assad since 2012. With the regime gone, investigators estimate there could be another 20 or 30 million pages of potential evidence, which could help bring more officials to justice.

The Wrap

What else we’re following

At home: Federal security agencies plan to co-operate to keep an eye on potential foreign interference in the Liberal leadership race.

Abroad: Officials say that mediators have made significant progress in talks over a Israel-Hamas ceasefire and hostage release.

Strong winds: More firefighters arrive in Los Angeles as powerful winds threaten to trigger new wildfires and the death toll rises to 24.

On the apps: According to Statistics Canada, nearly 700,000 Canadians did paid work through digital platforms in 2024, up 44-per-cent from 2023.