The shortage of diabetes medications in North Macedonia is becoming a concern for chronic patients, especially when it comes to Ozempic.
This drug helps prevent cardiovascular complications in patients with type 2 diabetes, whose number in North Macedonia reaches about 136.000.
Ozempic is an injectable medication, used through a ready-made pen, the North Macedonian Agency for Medicines and Medical Devices (MALMED) explained to Radio Free Europe.
Its use does not cause pain and is similar to that of insulin.
In insulin pharmacies in North Macedonia, Ozempic is given free of charge to patients with type 2 diabetes, as it not only helps prevent cardiovascular complications, but also reduces the need for hospital treatment.
The experience of a patient from Veles
If Ozempic is not used to treat the disease, this can worsen the fragile health of patients, as Dime Velevi's experience shows.
For three months last year, Velev, who is also the president of the Union of Associations of People with Diabetes, was unable to obtain Ozempic and, in November, due to a blocked artery, was forced to undergo a coronary angiography.
"I had inflammation and high sugar levels, but I reacted in time together with the doctors, with additional therapy and biochemical analyses. I was one step away from having a stent placed in my heart," Velev told Radio Free Europe.
The following month, he managed to obtain this drug from the insulin pharmacy in Veles, where he lives, but says that it is currently unavailable to about 400-500 patients.
Velev says that their treatment is like "Russian roulette" - you never know if there will be enough insulin in pharmacies.
"If a pharmacy needs to supply 50 patients, the distribution is for 43, and every month they change which 7 will not receive the therapy," says Velev.
The explanation he and other patients have received from health authorities is that the medicine was purchased in sufficient quantities, but "due to a technical problem" it was not distributed.
The North Macedonian Ministry of Health did not respond to Radio Free Europe's question about the reason for its shortage, but said it has secured quantities of the medicine for 1.800 patients.
"With the new public procurement 2025-2027, the quantity for this medicine has increased by 400 more patients, compared to the previous public procurement, when quantities for 1.400 patients were provided," the Ministry of Health's written response states.
How is Ozempic purchased?
The Ministry of Health purchases Ozempic through the Program for the Provision of Insulin, Glucagon, Insulin Needles and Glucose Metering Strips, Insulin Pumps with Consumables and Continuous Glucose Monitoring Sensors.
Therefore, this medicine is not on the Positive List and, as such, is not a burden on the Health Insurance Fund.
"This means that the Fund does not provide funds for the purchase and distribution of this medicine to any category of patients, including patients with diabetes," the Health Insurance Fund emphasizes in a response to Radio Free Europe.
According to MALMED's authorization, the drug can be obtained in pharmacies only with a medical prescription, but outside insulin pharmacies, the cost falls on the patient.
Ozempic as a prevention of hospitalization
Endocrinologist Irfan Ahmeti explains to Radio Free Europe/Radio Liberty that Ozempic is extremely important for patients with type 2 diabetes, who also have comorbidities and are obese.
He says that Ozempic can also be taken by obese patients without diabetes, but that he and his colleagues, based on guidelines from the American and European Diabetes Associations, do not prescribe this weight loss drug to patients who do not have diabetes.
"The guidelines clearly indicate which group of patients should be given Ozempic. It's about patients with proven cardiovascular risk, due to diabetes and obesity, and we try to describe it exactly like that, to adapt to our regulations," explains Ahmeti.
He emphasizes that the use of Ozempic has brought about a revolutionary change in the management of type 2 diabetes.
"Ozempic, in addition to regulating blood sugar, has a positive effect on reducing body weight in obese patients with type 2 diabetes. It also reduces the risk of cardiovascular problems, such as stroke. New studies show that this group of drugs also helps slow the progression of kidney disease, peripheral artery disease and fatty liver," says Ahmeti.
He adds that the drug can also be prescribed to diabetics who do not have complications, for the purpose of weight loss. In this case, it is not given for free, but can be purchased at any private pharmacy for about 6.000 denars, or less than 100 euros.
Using Ozempic for weight loss
The purchase of Ozempic without a medical prescription, even when not used for treatment, has become a phenomenon among overweight Macedonian citizens.
They can find the medicine in the most well-stocked pharmacies.
Riste S. from Skopje recounts that, while waiting at a pharmacy in the city center, a woman wanted to buy Ozempic, but there was no stock.
"The employees said it was sold privately and that their sales were being hurt by illegal imports through Kosovo, where it is sold cheaper. I got involved in the conversation and they told me I could buy it, but only when it is available," says the interlocutor of Radio Free Europe.
Radio Free Europe also asked at a pharmacy outside Skopje whether Ozempik could be purchased for weight loss, and the pharmacist confirmed it.
"The monthly dose is 5.400 denars," he replied curtly, without mentioning the possible risks of using the medicine in this way.
Endocrinologist Ahmeti warns citizens not to use this medication without medical guidance.
"This remains their responsibility. If they act in this way, they endanger themselves. We, the doctors, appeal that every registered drug that has side effects be prescribed by a specialist doctor," he says.
Velev says that Ozempic is not a supplement or cosmetic, but a medical therapy.
"There are serious risks if you take it when you are healthy," he said.
MALMED inspections have not found any counterfeit Ozempic and there is no evidence of misuse during the 2024-2025 period.
The agency emphasizes that the drug should only be used with a relevant medical prescription and that any violations can be reported to it./REL
