The streets of Vancouver’s Downtown Eastside tell a story of two medical realities. In the window of a sleek wellness clinic, advertisements for weight loss medications shimmer under recessed lighting. Just blocks away, community pharmacist Heidi Wong counts out metformin tablets for diabetes patients who struggle to afford even these basic medications.
“Every day I see patients making impossible choices between medications and rent,” Wong tells me as she seals a prescription bag. “Meanwhile, people with means are spending hundreds monthly on newer drugs that might help them lose weight but remain out of reach for most Canadians.”
This disparity grew sharper last week when Health Canada rejected Dr. Reddy’s Laboratories’ application to produce a generic version of semaglutide, better known by its brand name Ozempic. The Indian pharmaceutical giant sought approval for a lower-cost alternative to the diabetes drug that’s gained celebrity status for its weight-loss properties.
For Canadians living with diabetes, this decision extends a frustrating wait. Ozempic currently costs between $200-$300 monthly for those without comprehensive drug coverage. Health Canada cited “insufficient bioequivalence data” in their rejection letter, essentially stating that Dr. Reddy’s hadn’t adequately proven their generic version performs identically to Novo Nordisk’s original formulation.
Dr. Anita Palepu, Head of Medicine at Vancouver General Hospital, explains why this matters: “Generics typically cost 80% less than brand-name drugs. When we delay generic entry, we’re essentially maintaining a system where many patients simply can’t afford optimal treatment.”
The rejection raises questions about Canada’s generic drug approval process. According to the Canadian Generic Pharmaceutical Association, generic medications saved our healthcare system nearly $35 billion between 2018 and 2020. Yet Health Canada’s stringent requirements can delay these cost-saving alternatives from reaching patients.
When I visited Bobbi Jean Nicolson at her East Vancouver apartment, the 67-year-old retiree showed me a small journal where she tracks her medication expenses against her pension payments. Diagnosed with Type 2 diabetes three years ago, her doctor recently suggested Ozempic might help control her blood sugar more effectively than her current regimen.
“I laughed when he mentioned it,” Nicolson says, pointing to the $275 monthly price tag. “That’s nearly a quarter of my monthly income. I told him I’ll stick with what I can afford.”
What makes this situation particularly frustrating is that while Health Canada demands exacting evidence from generic manufacturers, Novo Nordisk has reaped massive profits from Ozempic’s off-label use for weight loss. The company reported a 25% increase in global sales last year, driven significantly by Ozempic prescriptions for non-diabetic patients seeking its weight-loss effects.
University of British Columbia pharmaceutical policy researcher Dr. Michael Law sees a troubling pattern. “Our regulatory framework was designed to ensure safety, not accessibility,” he explains during our conversation at UBC’s School of Population and Public Health. “When a drug becomes a cultural phenomenon like Ozempic has, we see how quickly our system creates winners and losers based on ability to pay.”
Dr. Reddy’s Laboratories isn’t giving up. The company stated they plan to address Health Canada’s concerns and resubmit their application later this year. But this means months more waiting for patients who could benefit from lower-cost options.
The issue extends beyond individual patient budgets. Provincial drug plans and private insurers across Canada have implemented strict criteria for covering Ozempic precisely because of its high cost. Many plans will only cover it for diabetes patients who have failed multiple other medications first.
“The absence of generic options affects public health at a systems level,” says Dr. Naveed Nawaz, an endocrinologist at Surrey Memorial Hospital. “When effective medications remain unaffordable, we see more diabetes complications, more hospitalizations, and ultimately higher costs to our healthcare system than if we’d simply covered the medication.”
Walking through Vancouver’s community health centers reveals the real-world impact of these high-level policy decisions. At the REACH Community Health Centre, nurse practitioner Simran Gill shows me a cabinet filled with medication samples.
“We save the Ozempic samples for our most vulnerable patients,” Gill explains. “But samples only last so long. When they run out, patients often return to less effective medications or sometimes nothing at all.”
While Health Canada maintains its decision is based purely on scientific evaluation, some policy experts question whether regulatory frameworks adequately consider access and equity. The Canadian Diabetes Association has called for faster pathways to generic approval for essential medications, especially those treating chronic conditions affecting millions of Canadians.
For Bobbi Jean Nicolson and countless others, these regulatory decisions have immediate consequences. “I understand they need to make sure drugs are safe,” she says as we finish our conversation. “But being safe doesn’t help me much if I can’t afford it in the first place.”
As Canada grapples with healthcare sustainability challenges, the tension between stringent regulatory standards and medication access will only grow. Dr. Reddy’s rejection highlights how our approval systems can unintentionally preserve pharmaceutical monopolies and exacerbate health inequities.
When I check back with pharmacist Heidi Wong a few days after our initial conversation, she’s helping a patient navigate a complex insurance rejection for Ozempic. The patient eventually leaves without the medication.
“This is the reality most people don’t see when they read about miracle weight loss drugs in magazines,” Wong says, watching the patient leave. “Behind every regulatory decision are thousands of patients making tough choices at pharmacy counters across the country.”
