PharmaCare, B.C.’s public drug plan, stands to save millions of dollars after a review of evidence lead the plan to change its coverage of a class of diabetes drugs called dipeptidyl peptidase-4 (DPP-4) inhibitor drugs.

After a thorough therapeutic review, PharmaCare now covers two DPP-4 inhibitor drugs, linagliptin and saxagliptin.  PharmaCare no longer covers a third, more expensive drug, sitagliptin (Januvia.) These drugs are used for Type 2 diabetics, when insulin and other first-line treatments have not worked. Experts agree all three drugs are equally effective and safe; sitagliptin (Januvia) products may cost up to 35% more than the two DPP-4 inhibitor drugs PharmaCare now covers.

“This decision is in line with PharmaCare’s efforts to reduce drug costs while increasing coverage. PharmaCare is choosing to cover the two more economical options, to ensure value for money for taxpayers. This decision will save PharmaCare millions of dollars a year, in order to fund other drugs and programs. “

PharmaCare used to be one of the fastest growing areas of the health care budget; however, the ministry has been able to reduce PharmaCare’s budget by more than 8% this fiscal year, even as the plan covered more drugs and therapies.

For patients on sitagliptin (Januvia), PharmaCare is allowing six months for them to transition to one of the two covered DPP-4 drugs. The transition period began Aug. 5, 2014, and ends Feb. 5, 2015. This allows patients to use any drug supply they may have, and to have their prescription adjusted at their next regular doctor visit.

In making this decision, PharmaCare sought advice from the province’s expert Drug Benefit Council, engaged drug manufacturers, and consulted with endocrinologists, patient advocacy groups, Doctors of B.C. and other stakeholders. 

Patients who are unable to tolerate linagliptin or saxagliptin may apply for exceptional coverage for sitagliptin (Januvia) through PharmaCare’s Special Authority process.

This type of switch from one drug to another within a class of drugs is called therapeutic substitution. It is considered a safe and effective practice, which B.C. has used for a number of years. Since 2008, therapeutic adaptation (substitution) is also something pharmacists do routinely in B.C. for certain drug classes, as authorized by the College of Pharmacists of B.C.

Scientific evaluations of B.C.’s policies on therapeutic substitution have been published in the New England Journal of Medicine and the Canadian Medical Association Journal. These studies found substitution was safe for patients and saved money. Harvard researchers found these policies did not have negative patient or health system effects, but resulted in savings of millions of dollars.

Nova Scotia, Saskatchewan and Quebec also use therapeutic substitution in their public drug plans. Many other countries use therapeutic substitution, including Australia, Belgium, Denmark, Germany, Italy, New Zealand, the Netherlands, Portugal, Spain, Sweden and various private health-care plans in the United States.

Learn more:

To read the drug coverage decision summary, please visit: http://www.health.gov.bc.ca/pharmacare/pdf/DDS-0054.pdf

To learn more about PharmaCare, please visit: http://www.health.gov.bc.ca/pharmacare/

Media Contacts:

Kristy Anderson
Media Relations Manager
Ministry of Health
250 952-1887 (media line)