Diabetes patients in B.C. face unreasonable challenges getting vital drug through PharmaCare, doctors say

This story is part of Situation Critical, a series from CBC British Columbia reporting on the barriers people in this province face in accessing timely and appropriate health care.

B.C. doctors who treat diabetes say they've been forced to jump through hoops to get coverage for potentially life-saving drugs, including making patients try cheaper but more dangerous alternatives first.

Dr. Ali Zentner, a Vancouver specialist in internal medicine and obesity, said game-changing new drugs and devices for diabetes patients have appeared in recent years.

That includes pharmaceuticals like Ozempic for people with Type 2 diabetes, which also helps with weight loss and reduces the chance of heart attack or stroke and continuous glucose monitoring, which tracks glucose levels every few minutes.

But these options are expensive, and Zentner said she's been asked to go to increasingly unreasonable lengths to prove her patients should have coverage under PharmaCare, the public program that covers the cost of some drugs.

"I could have a patient where there's a medication that, according to the Canadian diabetes guidelines, American diabetes guidelines, European diabetes guidelines, would be an ideal either first- or second-line therapy for this patient," Zentner said.

"But according to PharmaCare, they have to have failed two other agents before I can even attempt to get coverage for this patient."

The issue is that options like Ozempic and continuous glucose monitoring are only available under what's known as special authority.

The designation is given to certain drugs that aren't generally covered by PharmaCare. Coverage is only provided to patients under certain circumstances when a request is made by their doctor, and in cases like this, it's only granted when cheaper drugs have failed.

"It should piss you off and frighten you that my clinical decisions are actually not made on what's best for you and what's healthiest and safest for your long-term care but actually what's cheapest for this government," Zentner said.

Dr. Tom Elliott, the medical director for B.C. Diabetes, said he's been dealing with the same problem. Special authority generally means he has to prove his patients have tried a class of drugs known as sulfonylureas first. 

"I don't prescribe these drugs ever because they're dangerous," he said, explaining that they can cause a person's blood sugar levels to dip so low that they pass out, have a seizure or even die.

Elliott was so concerned about the potential side-effects, he says, that he asked his patients to fill a prescription so there would be a paper trail in the provincial database, but then told them not to take the drugs.

The practice resulted in a complaint against him to the College of Physicians and Surgeons, he said.