Ozempic Insurance Coverage: Do Group Plans Cover Ozempic?

Ozempic is a prescription injectable medication for treatment of type 2 diabetes in adults. The drug acts as an appetite suppressant and can help with weight loss, but it is not approved for that purpose. 

Given that Ozempic comes with a high price tag, if you are using it for diabetes management or want to use it as a weight loss treatment, you may wonder: “Do group plans cover Ozempic? And what about private health insurance — does it cover Ozempic?”  

We’ve put together this guide to help you find out everything you need to know about Ozempic insurance coverage in Canada. 

What is Ozempic?

Ozempic, known generically as semaglutide, is used to treat type 2 diabetes in adults. It is a weekly injection and dose is gradually increased over a period of a few weeks until a maintenance dose is reached.  

Ozempic helps regulate sugar levels by stimulating the pancreas to produce more insulin. It is also used to reduce the risk of major cardiovascular events, such as stroke or heart attack. 

Ozempic can be used on its own to treat type 2 diabetes. Or it can be prescribed with other diabetes medication, such as sulphonylureas or metaformin. 

Although Ozempic isn’t approved for weight loss, some physicians prescribe it off-label for weight loss treatment. Prescribing a medicine “off-label” means using it in a different way than that stated in its license. This is a fairly common practice. For instance, your doctor may prescribe an anti-seizure medicine to treat anxiety or aspirin to prevent blood clots if you are a heart patient. 

How does Ozempic work for weight loss? 

Ozempic’s active ingredient — semaglutide — mimics the role of the GLP-1 hormone, which tells the brain that you’re full after eating. Thus, Ozempic can help regulate your appetite by making you feel fuller for longer and reducing cravings. When combined with regular exercise and healthy eating habits, Ozempic can be an effective weight loss treatment. 

In fact, Ozempic contains the same active ingredient as Wegovy, which is approved for weight loss in Canada and several other countries. Ozempic is used off-label for weight loss precisely because semaglutide (the active compound in both Ozempic and Wegovy) has been shown to help with weight loss. 

However, confusing Ozempic with Wegovy will be a mistake. For one, Wegovy is approved for weight loss but Ozempic is not. Secondly, Wegovy has a higher dose of semaglutide than Wegovy. 

Understanding how Ozempic coverage works?

Some health insurance providers in Canada like Canada Life cover Ozempic, but only if it is prescribed for diabetes. Even then, you may need to meet a certain criteria and have prior authorization to recoup some or all of the treatment cost from the insurer. 

Carefully read the insurance contract to find out if it covers Ozempic for diabetes, and if it does, what the eligibility criteria is and whether the plan will cover the entire cost of treatment or part of it. If you find policy wording difficult to understand, consult your insurance broker or speak to the health insurance company. If you have a group policy, speak with the plan administrator. 

When Ozempic is prescribed for weight loss management (i.e. an off-label use), most insurers won’t cover it. 

Can I find an insurer that covers Ozempic in Canada?

Health insurance providers in Canada may cover Ozempic, but only with your doctor’s approval and for treatment of type 2 diabetes. The extent of insurance coverage for Ozempic varies depending on the insurance provider, the purpose of the prescription, and the specific plan in place. 

Typically, Ozempic is covered for the management of diabetes. However, when prescribed exclusively for weight loss, the likelihood of receiving coverage seriously reduces because Ozempic doesn’t have a license for treating obesity. 

Do group health insurance plans cover Ozempic in Canada? 

When you’re planning to use Ozempic as a weight loss treatment, you may wonder, “Do group plans cover Ozempic in Canada?”  

The short answer is: It depends. 

The long answer is many insurance companies cover Ozempic for diabetes. Most plans, however, require prior authorization. Some plans require patients to meet additional criteria, such as having tried oral medications for diabetes or meeting specific disease severity thresholds.  

However, when Ozempic is used as a weight loss treatment, Canadian insurance companies will most likely offer no reimbursement. 

Having said that, anti-obesity medications have evolved considerably in the last few years. Also, the use of weight loss medications among employer-sponsored benefits plan members has increased by almost 92% since 2020, according to a report. Since larger groups, due to their buying power, can negotiate favorable terms (and lower premium rates), it’s worth checking if your group plan covers Ozempic for weight loss management. 

Can I get coverage for Ozempic for weight loss treatment in Canada?

Most Canadian insurance carriers cover Ozempic when used for treating diabetes, not weight loss. It’s highly unlikely that you’ll be able to secure coverage for Ozempic for weight loss treatment. 

If your physician prescribes Ozempic for weight loss instead of diabetes management, but your insurer refuses to cover it, you may have other other options. 

You may ask your doctor to prescribe Wegovy for weight loss treatment rather than Ozempic. Wegovy has the same active ingredient as Ozempic, but in a higher dosage. But most importantly, Wegovy is on the label for weight loss, meaning it is an approved weight loss medication.

Though personal health insurance plans in Canada aren’t likely to cover Wegovy, some group plans may cover it with Special Authorization requirements. If you have access to employer-sponsored health benefits, check the plan details to find out if it covers Wegovy. 

Another option is to use Saxenda, a prescription medication used for weight management in adults who are obese or overweight. Saxenda usually isn't paid for by provincial health insurance for weight loss. Some private insurance plans might cover it, but this depends on the specific provider and the details of the plan.

What is the eligibility criteria for Ozempic coverage under a group health insurance plan? 

Coverage for Ozempic for the treatment of diabetes is available under most group plans. However, you will likely need a prior authorization. Depending on the plan, additional requirements must be met to get cover for Ozempic. 

Typically, you can get Ozempic coverage for diabetes if: 

• Ozempic is mentioned in the list of medications that are covered by your group plan
• You get a prior authorization for covering Ozempic and use it for treatment of diabetes type 2
• You have previously used oral diabetes medicines without success. For example, Manulife may cover Ozempic for diabetes if the patient has tried oral diabetes drugs such as Metformin. 

How much does Ozempic cost in Canada?

The cost of Ozempic in Canada can vary, but typically, you can expect to pay between $200 and $300 for a month's supply (or 4 doses). 

Shared below is the cost of a 0.5 mg Ozempic pen in different pharmacies: 

Keep in mind that Ozempic prescription may be covered by your provincial healthcare plan. Since each province regulates its own provincial health insurance plan, prescription drug coverage and plan details may vary slightly from one province to another. 

However, it’s worth mentioning that in all Canadian provinces Ozempic is only approved for type 2 diabetes. Because weight loss is not an approved use of Ozempic, no publicly-funded drug program in Canada will reimburse the cost if you use it for losing weight. 

What is Ozempic Savings Card?

This is a savings card offered by Novo Nordisk, the manufacturer of Ozempic, to help reduce the out-of-pocket cost of Ozempic. You can use this card in combination with health insurance, either self-paid or employer-sponsored. With an Ozempic savings card, your cost can be as low as $25 for up to 3 month’s supply of Ozempic. To get this deal, your prescription needs to be for 1, 2, or 3-month supply. 

Who is eligible for the Ozempic savings card?

To qualify for the Ozempic savings card, you must:

• Have private or commercial insurance that covers Ozempic 
• Have a prescription for a 1, 2, 3-month supply of Ozempic

The coupon offers the following maximum savings:

• $150 for a 1-month prescription
• $300 for a 2-month prescription
• $450 for a 3-month prescription

The coupon is valid for up to 24 months from the date of activation. You can't combine the Ozempic coupon with provincial health insurance. 

What is Novo Nordisk Care Financial Assistance?

Novo Nordisk Care Financial Assistance provides medications made by Novo Nordisk, including Ozempic, at no cost to those who qualify. This option is only available to patients who don’t have private or commercial insurance and can’t afford their cost of treatment. 

You may qualify for financial assistance from Novo Nordisk if: 

• You are a legal resident of Canada
• You don’t have access to a private or public drug plan
• Your household income is below a certain threshold 
• You have a prescription for a drug covered by this program

You can contact Novo Nordisk Customer Care at nncicustomercare@novonordisk.com or 1-800-465-4334 to know more about this financial assistance program. 

Which Canadian insurance carriers cover Ozempic? 

Insurance companies such as Canada Life, Blue Cross, and Manulife may cover Ozempic in Canada. However, Canadian insurance carriers cover Ozempic only when it is used for diabetes management with prior authorization. 

Is Ozempic covered by Manulife for weight loss?

No, it doesn’t. Weight loss management is an off-label use of Ozempic. Using medicines outside the terms of their license is a common practice, but insurers may not cover off-label use of certain drugs. So, while Manulife covers Ozempic for diabetes management, it won’t help you financially if you use the drug to lose weight. 

Do Sun Life personal health insurance plans cover Ozempic for weight loss?

No, Sun Life doesn’t cover Ozempic for weight loss. 

Does it cover Ozempic for diabetes? Yes, it does, but you may need to obtain prior authorization. 

However, since Sun Life offers several personal health insurance plans and each plan has its own list of medications that are covered, read the policy document for confirmation.   

Is Ozempic covered by Blue Cross for weight loss management?

No, it doesn’t. However, it covers Ozempic for treatment of diabetes type 2 through a special assessment process.

Is Ozempic covered in British Columbia and other provinces?

Provincial healthcare plans cover prescription drugs, so you can expect them to cover Ozempic for diabetes. 

British Columbia PharmCare covers Ozempic, as does Ontario Health Insurance Plan (OHIP). However, Ozempic is covered only if:

• It is prescribed for diabetes management in patients with treatment resistant diabetes
• The patient is able to meet specific medical criteria 

Similar coverage rules apply for Ozempic in other Canadian provinces. As of now, provincial healthcare plans do not cover Ozempic for weight loss.

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Conclusion

Whether Ozempic is covered by insurance varies based on your insurer, your diagnosis, and the details of the plan. Each individual or group health policy has a list of covered medications and may have specific eligibility criteria for some of the covered drugs.

Typically, insurance providers in Canada cover Ozempic for type 2 diabetes if certain conditions are met. But they don’t cover it for weight loss treatment. 

If you are looking for a personal or group health insurance plan that covers Ozempic, Dundas Life can help. We’ll walk you through your options, get a price quote from multiple providers, and help compare them so you can find the best deal. Reach out to us today.

FAQs

Do I qualify for Ozempic coverage if I have diabetes?

If you have personal or employer-sponsored health insurance and are diagnosed with diabetes type 2, you may be eligible for Ozempic coverage, depending on your plan details. 

Does my provincial healthcare plan cover Ozempic? 

Provincial healthcare plans cover Ozempic for treatment of diabetes type 2 if you meet specific eligibility criteria, which may vary by province. 

What are some reliable alternatives to Ozempic for weight loss management?

Wegovy and Saxenda are two popular alternatives to Ozempic for weight loss management in adults who are overweight or obese. Both the drugs are licensed for weight loss. Some employer-sponsored health insurance plans in Canada may cover Wegovy for weight loss while Saxenda might be covered by some personal plans, as well as group plans. 

Does provincial healthcare cover Ozempic?

Yes, provincial healthcare covers Ozempic, but only if you use it to treat diabetes type 2 and meet specific eligibility criteria. 

Can I get Ozempic covered if I am not diabetic?

It is highly unlikely that you will be able to get coverage for Ozempic if you don’t have diabetes type 2. Canadian insurance carriers don’t cover Ozempic for weight loss treatment because it is not licensed for that purpose.