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PharmaCare expands diabetes, heart failure, blood clot drugs coverage

Thousands of people in British Columbia will benefit from BC PharmaCare’s expanded coverage of medications used to treat Type 2 diabetes, heart failure and blood clots.

Effective Thursday, Jan. 5, 2023, drug coverage for two medications will be expanded from limited coverage to regular benefit. The two drugs that are becoming regular benefits are dapagliflozin (Forxiga) and apixaban (generics). At the same time, two other medications namely, empagliflozin (Jardiance) and semaglutide (Ozempic), that are covered by PharmaCare under specific medical circumstances will have their limited coverage criteria expanded. This means that more patients will be eligible for coverage of these drugs.

The changes will ensure that coverage is aligned with clinical evidence and will improve patient access to appropriate medications.

Dapagliflozin (Forxiga) is approved by Health Canada to treat several conditions such as heart failure, Type 2 diabetes and chronic kidney disease. It was first listed as a limited coverage benefit on the BC PharmaCare formulary for patients with heart failure with “reduced ejection fraction” on Jan. 11, 2022, a condition where the muscle of the left ventricle is not pumping as well as normal. Currently, approximately 2,000 patients in British Columbia benefit from dapagliflozin under limited coverage. The expansion to a regular benefit is expected to benefit 5,000 more patients in the first year.

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Apixaban (generics) is a blood thinner medication used to prevent or treat blood clots. Currently, 45,000 patients in British Columbia benefit from apixaban under limited coverage. The expansion to a regular benefit is projected to benefit approximately 24,000 more patients.

The expansion of limited coverage criteria for empagliflozin (Jardiance) and semaglutide (Ozempic) will make it easier for patients to apply for coverage of these two medications that work to lower blood sugar levels in adults with Type 2 diabetes.

In 2019, PharmaCare provided limited coverage for empagliflozin (Jardiance) and in 2020 limited coverage for semaglutide (Ozempic) to patients with Type 2 diabetes after they had tried and been unable to control their blood sugar levels by taking two other drugs, metformin and a sulfonylurea drug (e.g., glyburide), or metformin and an insulin.

PharmaCare is changing the coverage from third-line to second-line. Patients now only have to try one drug, metformin, before their physician can request coverage of empagliflozin or semaglutide.

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