Diabetes Medications and BC Coverage Information

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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