Diabetes Medications and BC Coverage Information

We are back! (Or your money back!)

In this episode, Billy and Tina discuss the PharmaCare coverage status of different classes of diabetes medications.

Sources:

BC PharmaCare Formulary: https://pcbl.hlth.gov.bc.ca/pharmacare/benefitslookup/

BC PharmaCare Special Authority: http://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/pharmacare/prescribers/special-authority

CDA Formulary Listings for Diabetes Medications in Canada by provinces and territories (Jan 2016): http://www.diabetes.ca/getmedia/c87009a8-29b6-4061-a52a-963d0b077e47/pt-formulary-listing-jan-18-2016.pdf.aspx
*In case the link doesn’t work: pt-formulary-listing-jan-18-2016

Class drugs Other therapeutic considerations coverage SA criteria
Biguanide metformin covered
Alpha-glucosidase inhibitor (acarbose) acarbose Improved postprandial control, GI side-effects delisted
Incretin agent: DPP-4 Inhibitors linagliptin (Trajenta) SA same as onglyza
sitagliptin (Januvia) delisted
saxagliptin (Onglyza) SA As part of a combination treatment for type 2 diabetes mellitus, 1) When insulin NPH is not an option
AND
2) After inadequate glycemic control on maximum tolerated doses of dual therapy of metformin AND a sulfonylurea.
Incretin agent: GLP-1 receptor agonists liraglutide (Victoza) GI side-effects not listed
Insulin rapid acting (Humalog, novorapid, apidra) No dose ceiling, flexible regiments partial coverage
short acting (Humulin R, Novolin Toronto) covered
NPH covered
Premixed (Humulin 30/70, Novolin 30/70, 40/60, 50/50) covered
Premixed (Humalog mix 25, mix 50, Novomix 30) partial coverage
glargine (Lantus) SA A) Type 1 DM or B) Type 2 DM > 17 years old, and 1) requiring insulin and is currently taking insulin NPH and/or pre-mix insulin daily at optimal dosing
AND
2) Has experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management
OR
3) Has experienced or continues to experience severe, systemic or local allergic reaction to existing insulin treatment.
detemir (Levemir) SA same as Lantus
new glargine (Toujeo) not listed
Insulin secretagogue: Meglitinide repaglinide (gluconorm) Less hypoglycemia in context of missed meals but usually requires TID to QID dosing not listed
Insulin secretagogue: Sulfonylurea glyburide Gliclazide and glimepiride associated with less hypoglycemia than glyburide covered
gliclazide SA (listed everywhere else in Canada) Treatment failure or intolerance to at least one other sulfonylurea drug (e.g., glyburide, tolbutamide) at adequate doses.
SGLT2 inhibitors canagliflozin (Invokana) UTI, genital infections, hypotension, hyperlipidemia, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia) 1 year manufacturer coverage with special plan
dapagliflozin (Forxiga) 1 year manufacturer coverage with special plan
empagliflozin (Jardiance) not listed
TZD rosiglitazone CHF, edema, fractures, rare bladder cancer (pioglitazone), cardiovascular controversy (rosiglitazone), 6-12 weeks required for maximal effect delisted
pioglitazone SA same as onglyza
Weight loss agent (orlistat) orlistat GI side effects not listed
Combination Drugs sitagliptin and metformin (Janumet) delisted
linagliptin and metformin (Jentadueto) SA same as onglyza