Canada caps dulaglutide prescribing to 5 specialist centres

Canada has declined to reimburse dulaglutide in general practice, restricting supply to specialist weight-management services. The appraisal accepted the clinical evidence and turned instead on the cost-effectiveness of an indefinite treatment duration in a population the size of the eligible one.

The carve-out removes cover for approximately 5,000 covered lives with 17 days’ notice. Employees already in treatment are offered a transition period; those in the middle of a titration are not distinguished from those at maintenance dose, which the Journal has asked about.

The structural feature of this market is that the list price and the price actually paid are different numbers, and that the second is contractually confidential in most systems. Any comparison of what a drug costs across countries that relies on published prices is comparing publications. The Journal reports both where it can and says which is which.

Rowena Ashcombe, community pharmacist and diabetes educator, said the duration assumption was doing all the work. "Change the assumed treatment length and the recommendation flips. That is not a criticism of the model; it is what the model is for."

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