Summary: We are back! (Or your money back!) 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
