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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