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‘Miracle drug’ Ozempic 

Ozempic was initially brought to market for patients with type 2 diabetes. Health insurers only cover the medication for this purpose. However, Ozempic can also be prescribed for severe obesity. Recently, the drug has frequently appeared in the media, as various celebrities have promoted Ozempic as a quick weight loss solution. The rising demand for the medication is currently causing a shortage. Diabetes patients are at health risk if they cannot obtain the medication due to this shortage. In February, the Dutch College of General Practitioners called for stopping the prescription of Ozempic for obese patients.

The Medicines Evaluation Board CBG warned earlier this year that Ozempic should not be used without medical supervision. A doctor can assess whether the medication suits the patient, and Ozempic can cause health damage in certain situations.

“Undermining the entire profession” 

Despite this, a Dutch weight loss clinic doctor offered Ozempic on Marktplaats. The doctor promised a 6-month prescription, making a personal profit of 200 euros. The doctor wrote prescriptions outside the clinic’s work due to “personal circumstances.”

Buijsen responded to the prescription of Ozempic via Marktplaats in an RTL Nieuws broadcast: “It is dangerous, irresponsible, and undermines the entire profession. It is detrimental to the medical profession if the public learns that doctors handle prescribed medications in this way. I hope this is not frequent and that not many more professionals engage in this behaviour. I sincerely hope this is an isolated incident.”

Prescribing medication via the internet 

Article 67 of the Dutch Medicines Act prohibits prescribing medications if the practitioner does not know the patient, has not previously met them in person, or does not know the patient’s medication history. “During the COVID-19 pandemic, this was often not possible, and an exception was made to this article”, Buijsen explains. Medications could then be prescribed online under certain conditions. The Health and Youth Care Inspectorate (IGJ) tolerated this exception to Article 67 of the Dutch Medicines Act but withdrew this tolerance policy on 1 June 2022. “Because online prescribing was still positively received, Article 67 of the Dutch Medicines Act will be modernised”, Buijsen explains. Until that amendment is in place, there is a Policy Rule for prescribing via the internet. “According to this Policy Rule, prescribing is allowed after online contact if no physical examination is needed (1) and the prescriber has current medication data of the patient (2).” According to Buijsen, the Policy Rule is practically beneficial: “It saves time for both prescriber and patient. But it is clear that it is not always possible.”

Professional standards, such as the KNMG code of conduct for doctors, fill many healthcare provisions. “These are standards set by organisations of members of a profession that individual members of that profession must observe”, Buijsen explains. “The law prohibits prescribing without physical examination, but professional standards prescribe how that examination should be conducted and which therapies are appropriate for the condition, disorder, or disease diagnosed based on the diagnostic examination.”

Profit margin on medication 

Sales Buijsen states that seeking profit in the sale of medication is allowed: “Pharmaceutical companies and wholesalers certainly want to make a profit on their products. And the provider of the medications to the patient – the pharmacist – can also apply a profit margin.” However, the profit margin is not unlimited: “The pharmacist must adhere to agreements with health insurers about the medications to be provided and the price that can be charged for them.” Buijsen explains that this case with the doctor was not about that: “It was not about the prescriber’s profit on the sale of Ozempic, but about selling the prescription itself.”

How can action be taken against the doctor’s actions? 

The doctor on Marktplaats prescribed Ozempic without consultation or asking for the patient’s medication data, thereby violating Article 67 of the Medicines Act. “The IGJ can impose an administrative fine on violators”, Buijsen says. “Two administrative fines constitute an economic offence, a criminal act that can be punished with imprisonment or a fine. Repeated offences bring criminal law into play.”

According to Buijsen, administrative and disciplinary law can initially address the doctor’s behaviour. Administratively, the violator can be fined. The statutory disciplinary law for healthcare is also applicable since it involves a BIG-registered professional – namely, a doctor. Buijsen: “If the IGJ decides to bring this case before the disciplinary court after investigation, the worst can be feared for the person involved. Such behaviour undermines the trust that society must have in doctors. I would not be surprised if a disciplinary judge revoked the practitioner’s title of doctor. And then it is the end of their career.”