The loophole that lets people pay for Ozempic (and other) prescriptions

CLIP You’re listening to a frequency podcast network production in association with CityNews.

Jordan Heath-Rawlings It’s no exaggeration to say that this is the hottest drug on the continent. It might even be something of an understatement to say that in Canada, however, the endless commercials aren’t actually allowed to tell you what this drug does. So you get this? I just asked. I asked.

CLIP: Yeah, I asked.

Jordan: Evidently though, those cryptic commercials are working, the

CLIP: Demand for the drug is as high as ever high enough to fuel ongoing supply issues.

Jordan: Now naturally, with a shortage impacting the needs of patients who have been using Ozempic to manage their chronic conditions, you would think it would become more difficult to get a prescription to take the drug for an off-label use, which is of course weight loss, especially you might imagine in a universal healthcare system like Canada’s with all of its checks and balances and boring rules and regulations and necessary safe bureaucracy. Right? No, you might think that you’d be very wrong, nevermind going to your doctor’s office, having a video consultation or even picking up the phone in Ontario right now, at least one reporter was able to secure an OZEMPIC prescription with an online application and a few words in a chat box, all for the low, low price. Yes, I set a price of $99. Now, is this our healthcare system working as intended? Is this a massive loophole just waiting to be exploited or is it the inevitable result of regulations that simply can’t keep up with the pace of technology? I’m Jordan Heath Rawlings. This is The Big Story. Morgan Bocknek is an investigative reporter with the Toronto Star who yes, now has a prescription for Ozempic. Hello Morgan. How’s it going?

Morgan Bocknek: I’m pretty good. I’m recovering from Covid. How are You?

Jordan: I am sorry. It feels like you and a lot of people in this country right now, I’m recovering from a non covid illness, but enough about our illnesses. Let’s talk about drugs. For those who might not know, who may have been living under a rock somewhere, explain to us what Ozempic is and who is supposed to be taking this drug.

Morgan Bocknek: So Ozempic is a drug that is approved to treat type two diabetes. It basically helps the body’s insulin production, it lowers blood sugar. People who are on the drug for type two diabetes have found that it takes less food to feel full and they feel full for longer. And so that’s led it to being prescribed as a weight loss drug. And because of how effective it is and how visible the results are, how visibly people lose weight on it, it’s gripped the cultural zeitgeist faster than any fad diet I’ve ever seen.

Jordan: And because it’s relevant to this story, maybe explain to us how exactly it’s being marketed because this drug and similar semaglutide are being marketed like crazy, right?

Morgan Bocknek: Yeah. So it’s marketed on Toronto Street Streetcar, on the famous Scotiabank Theater stairs and a billboard on the Gardener Expressway. And it shows the very tantalizing catchphrase that Ozempic has used to market their drug, which is I just asked because when you market a drug, you can’t say what it is supposed to do. Exactly. They use this vague catchphrase that implores you to ask your doctor about it. And the marketing for Ozempic includes online telehealth platforms that prescribe it. And so they’re as blanket social media as well and the angle for patients who are looking for help with weight loss. So you’ll see ads that show what the medication itself physically looks like. It looks like a pen that is a needle. And so if you know what Ozempic looks like that that’s what they are marketing.

Jordan: And before we get into your experience, maybe just walk us through, in an ideal world, what would the process be to be prescribed ozempic or similar drugs?

Morgan Bocknek: I can’t speak to similar drugs, but any kind of medication that is being prescribed to a person, no matter how it’s done, if it’s in person or remotely or through a doctor or a nurse practitioner medication should only be prescribed. Once a medical professional has established that doing so is safe and necessary, that means that there’s a clinical assessment, a consideration of risks and benefits and a diagnosis is made and it’s determined that it’s appropriate. But as easy access to primary care family doctors is kind of out of reach for a lot of people. In Canada. The proliferation of online telehealth websites is becoming more common, and so you may be less likely to see a doctor in person these days because its might be easier for you to access one online. How

Jordan: Did you obtain your prescription? You went through this online process, can you just walk us through it so people have an idea of what this actually looks like?

Morgan Bocknek: One day my editor was like, I keep getting ads for Ozempic and everyone I know keeps getting ads for Ozempic on Instagram and Facebook. I wonder how easy it would be for you to get it. Can you try to see if you could get it? So I was like, yeah, absolutely. I love the internet. Lemme see if I can get it. So I went onto a bunch of these different telehealth websites that uc advertised online, and the one that had what seemed to me to be the least oversight was live. Well, most of these online telehealth platforms have you fill out a questionnaire to kind of determine what kind of patient and candidate you are for different medications. But in my case, I went on to Live Well’s website, I answered a couple dozen questions for a weight loss consultation. It was like, what is your height and weight? So we decided my editors and I that we would only lie about my weight and nothing else. Everything else I put in was true except when you went to enter your height and weight, it had a suggested height and weight that you put in a lighter kind of gray scale than what you would actually if you actually entered. Right,

Jordan: Like a prompt.

Morgan Bocknek: Yeah. So I entered what it suggested my weight be, which was 230 pounds. But when I answered my real weight, which is not that it wouldn’t let me proceed with the questionnaire, it said that I was not a good candidate for the program. But when I answered the weight that suggested it had no issue with that. So then I answered some other questions about do I have different conditions or stuff like that and do I have a history or a family history of other conditions? And I was asked to upload a photo of myself to confirm I guess that I visibly looked like I was 230 pounds. So I uploaded a photo where I don’t look overweight in it, I’m just wearing baggy clothes. And then the next day a nurse practitioner reached out to me on the website’s chat platform and she asked if I had done blood work in the past year. I said yes, because I have done blood work in the past year, but she didn’t ask to see it. And then she said, okay, I’ve approved you for two months of ozempic and if you don’t provide a blood work requisition within eight to 12 months, we may not feel comfortable renewing this prescription. For the privilege of that conversation, I was charged $99 and prescribed a drug.

Jordan: Wow. What exactly is LiveWell and I mean, tell us about these telehealth companies in general. How do they operate? Is this a profit motive? Just take us into that world a bit.

Morgan Bocknek: So LiveWell is part of this wave of for-profit all online telehealth platforms. LiveWell specifically is a hundred percent online and they say that they connect patients to licensed healthcare professionals in all Canadian provinces. They offer targeted support. They say for conditions that require lifestyle medications, like if you were looking for an acne cream or erectile dysfunction medication or hair loss medications, medications that are common and generally seem low risk, very routinely used, very known side effects. It’s very known how they operate. And so through an online questionnaire you answer some questions and then on LiveWell you connect with a licensed medical provider. They say it used to say licensed Canadian doctor on their website, but after I post as a patient and got the ozempic prescription, the website was changed to no longer include the expectation of a doctor consultation. Now it just more generally says that you can connect with a healthcare provider or practitioner LiveWell offers. You just communicate through chat messages with a doctor and then if it’s appropriate they say you get a prescription. But some of these other online telehealth platforms have more oversight and more involved doctors and nurse practitioners behind them. So like Felix for example, when I tried to get ozempic from them, they said that to proceed I would have to get new blood work done and they provided the requisition and that I would have to do a video call with a healthcare professional where I would have to get on a scale at some point as well to confirm

Jordan: How can they vary so much from one to the other. What kind of regulations govern telehealth platforms in general? I guess

Morgan Bocknek: I don’t think I can say with certainty how they’re allowed to do this. It seems like improper care, and I was definitely prescribed inappropriately, but I was deliberately trying to see how the system could be manipulated and what the cracks were. I mean, if someone is in good faith using this service, it could work well for them. But basically you should get the same care because no matter where you go, because the same rules apply to all healthcare practitioners across the province. But what I can say is the Canada Health Act, which covers the country, prohibits charging patients for medically necessary services that are covered under provincial health plans. So basically a doctor can’t charge a patient for services that they receive or for healthcare because the government is already footing the bill. But those rules don’t apply in the same way to nurse practitioners, even if they’re performing the exact same service because nurse practitioners are salaried employees and so they’re not being paid from oip, so they’re allowed to charge for services that would otherwise be free if you were seeing a doctor. And so experts we spoke to said that the for-profit telehealth industry is exploiting this loophole. If a doctor is seeing you for a virtual consultation in traditional circumstances, they would bill OHIP between 15 or $20 for that interaction. But because I saw a nurse practitioner at LiveWell, I was charged $99 for this virtual consultation to get ozempic, and one of my colleagues was charged $39 to get a prescription for acne cream. Even though the photo that he submitted to LiveWell that showed his acne didn’t actually show any acne, it was just like a blurry photo of pores on his nose.

Jordan: When you asked doctors or medical associations about this practice and described what you’d done to Ghet Ozempic, what was their reaction?

Morgan Bocknek: Oh, it was a lot of just nervous laughter and then like, oh man, oh, oh no. But basically they said it was not a medical service. What I received, I received a business interaction, or they called it inappropriate, potentially dangerous, because what should happen is a doctor needs to appropriately assess a patient looking at their blood work and all different kinds of parameters. You have to see and visualize the actual person you’re talking to who needs a medication, especially with something so serious as a type two diabetes medication that’s being prescribed. But I was told that it’s a demonstration of why for-profit care can be dangerous to the health of Canadians because you get care that’s driven by profit, not what’s appropriate for patient health. Bob Bell who said that he’s a former deputy minister of health, an orthopedic surgeon, he said, it’s so egregious, it makes my blood boil.

Jordan: What did the provincial government say about it? Did you talk to the minister or talk to the Ministry of Health in Ontario where this was done?

Morgan Bocknek: I tried very hard to talk to them, but they did not respond to me or answer my calls or emails. But they made a comment on this last, in October of 2023 when an Ottawa clinic opened that was run by nurse practitioners and it was charging patients $400 a year to access their services. At that time, health Minister Sylvia Jones said that action was on the horizon and while clinics led by nurse practitioners are not covered by OHIP at this time, the province was taking steps to review this and shutting down bad actors who were taking advantage of patients, but they didn’t want to. Talk to me about this

Jordan: In this specific case in terms of ozempic, which is obviously, as you’ve mentioned, a highly marketed and also hugely popular drug. What happens when there are ways for people like yourself or others who aren’t in dire medical need of it to access it? Because presumably someone might like to drop a few pounds quickly.

Morgan Bocknek: I mean, what springs to mind at first is people who have eating disorders, who are trying to lose weight quickly or who are trying to lose weight for many different reasons, it puts them at risk because if there’s not proper screening, then this method of prescribing could be taken advantage of. It just puts the general public at risk. This is a fairly new drug that’s only been on the market for a few years. It’s approved as a diabetes drug and it’s being used off-label as a weight loss drug. And so the long-term effects for people who don’t have diabetes and even those who do because this is such a new medication, how it impacts people, long-term is not known. That in itself does not necessarily mean it’s unsafe by any means, but there is that risk of not knowing. And also the side effects can be quite serious. And studies have shown that when you stop taking this medication, you’ll regain the weight that you lost. And so as a short-term quick fix, it doesn’t actually offer that. We don’t know the ramifications of short-term use for stuff like that. I think we anecdotally or observationally and with assumptions placed see it happening with celebrities who appear on red carpets having dropped a lot of weight, really what seems like really quickly, but that’s making a lot of assumptions about how someone may be behaving or what medications they may be taking.

Jordan: And meanwhile, there’s a shortage of ozempic in this country right now. So there are people with type two diabetes having trouble finding it.

Morgan Bocknek: Yeah, I got a lot of emails from type two diabetics after the release of this story talking about how it’s difficult for them to get this medication right now, but I can’t say with any kind of certainty who is being prescribed this medication improperly. And if people have been prescribed this medication properly for weight loss off-label, then it’s not like they’re taking it from the type two diabetics and they shouldn’t be on it. If this is the right medication for someone, then they have equal rights to be on it. That blame should not be placed on any person. That blame could go onto Novo Nordisk, the manufacturer who holds the patent for this because they hold the patent until 2032. I believe what you see happening is compounding pharmacies are making the closest thing that they can to this medication, but it’s not actually the same medication.

Jordan: Is there a way that we could have just closed this loophole if the regulations were matching kind of the advancements in the field? Know

Morgan Bocknek: Joris Greenspan, who’s CEO of the Registered Nurses Association of Ontario, said that one way the Ontario government could regulate this kind of thing is to create a parallel OHIP system for nurse practitioners. And there is a parallel OHIP system coming for Alberta’s nurses sometime early this year, where nurse practitioners can build a province directly and open publicly funded independent practices. The Alberta Provincial government has even promised grants to help with recruitment set up and support for those clinics as well. So that’s one solution.

Jordan: Morgan, thank you so much for this. Really appreciate it.

Morgan Bocknek: It’s my pleasure.

Jordan: Morgan Bocknek from the Toronto Star. That was The Big Story. For more head to The Big Story podcast.ca, you can type ozempic into the search bar and find a previous episode that will explain what these drugs are, what they do in context, and whether or not we should be prescribing them for their off-label uses. If you’ve got feedback on this episode or that episode I just mentioned, or any other episode of this podcast that you have ever heard, you can send it to us. The email address is hello at The Big Story podcast.ca. And the phone number if you want to call and leave a voicemail is 6 9 3 5 5 9 3 5, the big stories and all your podcast players. And of course, it should be in your friends podcast players too. So if it’s not, tell ’em to put it there or just grab their phone when they walk away and do it for ’em. Thanks for listening. I’m Jordan Heath Rawlings. We’ll talk tomorrow.