1-888-601-9980
Do health plans cover Ozempic for weight loss?
Group health plans in Canada may provide limited coverage for Ozempic as a weight loss medication, depending on the plan and whether medical necessity is established and prior authorization has been sought. While Ozempic is primarily prescribed for Type 2 diabetes, some insurers might cover it if specific conditions are met. Ozempic costs around $250 per month without insurance. Group insurance coverage may partially or fully cover Ozempic and reduce the cost to as low as $25 per month.
- What is Ozempic?
- Can I get Ozempic covered by health insurance in Canada?
- Who is eligible for Ozempic coverage under a group benefits plan?
- Factors affecting coverage for Ozempic and weight loss medications in Canada
- How much does Ozempic cost in Canada?
- How much is a 3-month prescription of Ozempic?
- Which insurance companies offer coverage for Ozempic in Canada?
- How do I get Ozempic covered if I am not diabetic?
- Are there any alternatives for weight loss coverage in a group health plan?
- Frequently asked questions
Some group health plans may cover Ozempic for weight loss, but it depends on your insurer, your employer’s group plan, and whether certain conditions are met.
While Ozempic is mostly used for treating Type 2 diabetes, some group insurance plans may offer coverage for weight loss purposes if medically required. In such cases, most insurers require pre-authorization for the use of Ozempic.
Wondering if your group health plan covers Ozempic for weight loss? In this blog, we explore whether group health plans in Canada cover Ozempic for weight loss, the costs involved, and what factors affect coverage eligibility.
What is Ozempic?
Ozempic is a prescription medication primarily used to treat Type 2 diabetes. It contains semaglutide, which works by stimulating insulin production and reducing blood sugar levels.
Recently, Ozempic has gained popularity for its secondary use: promoting weight loss. Due to its effectiveness in appetite suppression and weight management, it has become a sought-after option for people seeking to lose weight under medical supervision.
While Ozempic is not specifically approved for weight loss in Canada, many healthcare providers may prescribe it off-label for patients who could benefit from its weight management effects. Its popularity has raised questions about whether group health insurance plans cover Ozempic when it is prescribed for weight loss.
Can I get Ozempic covered by health insurance in Canada?
Health insurance may cover Ozempic, but mostly for diabetes rather than weight loss. In Canada, insurance coverage for Ozempic varies based on the insurer, intended purpose, and specific plan. Ozempic is generally covered for diabetes management, but when prescribed solely for weight loss, coverage becomes less likely due to strict guidelines and the need for prior authorization.
If weight loss is your goal, meeting BMI criteria or demonstrating obesity-related health risks may improve your chances of approval. In most cases, prior authorization is needed, requiring healthcare documentation and a review by the insurance provider.
Who is eligible for Ozempic coverage under a group benefits plan?
To qualify for Ozempic coverage, insurers typically require a Type 2 diabetes diagnosis, a BMI over 27 for weight management, and evidence of failure of other diabetes medications.
You may be eligible for Ozempic coverage if you meet the following criteria:
- Type of diabetes: Most insurance companies require a diagnosis of Type 2 diabetes for Ozempic coverage
- BMI requirements: A Body Mass Index (BMI) of 27 or higher is usually required for those using Ozempic for weight management
- Prior medication trials: Insurers like Manulife may require patients to try other oral diabetes medications like Metformin before approving coverage for Ozempic
Call 1-888-601-9980 to speak to our licensed advisors right away, or book some time with them below.
Factors affecting coverage for Ozempic and weight loss medications in Canada
Coverage for Ozempic under employee insurance often depends on medical necessity, plan design, and whether Ozempic is included in the insurer’s drug formulary.
- Requirements for medical necessity and prior authorization: Most group health insurance plans will require that Ozempic be deemed medically necessary to qualify for coverage. Prior authorization is also common, meaning the insurer must approve the prescription before it is covered
- Employer preferences and group plan customization: Employers have some say in the customization of their group health insurance offerings. This means that coverage for certain medications, including Ozempic for weight loss, might be included or excluded based on the employer’s decisions
- Inclusion in drug formularies and approval criteria: The insurance company’s drug formulary is a list of medications covered under the group health plan. If Ozempic is included, the insurer may cover it under specific conditions
How much does Ozempic cost in Canada?
Ozempic in Canada costs between $200 and $400 for approximately 4 doses. A one-month Ozempic supply costs approximately $935.77, but these costs may vary depending on the province you reside in or the pharmacy you’re sourcing your medication from.
For example, here’s how much Ozempic costs in various pharmacies for a 0.5 mg pen, as listed on SingleCare:
| Pharmacy | Ozempic price (.5 mg pen) |
| Kroger | $814.30 |
| Walgreens | $823.93 |
| Walmart | $848.98 |
| Costco | $1,012 |
How much is a 3-month prescription of Ozempic?
A 3-month prescription of Ozempic typically costs around $450, while a 2-month supply is priced at approximately $300.
If you have group insurance, you may qualify for savings programs that can reduce your out-of-pocket expenses. If you’re eligible, the Ozempic Savings Card can reduce costs to as low as $25 for a 3-month prescription, depending on your coverage.
What is an Ozempic Savings Card?
Ozempic Savings Card is a coupon card offered by Novo Nordisk, Ozempic’s manufacturer, to help buyers reduce the cost of their prescription. To qualify for the Ozempic Savings Card in Canada, you must have private health insurance, be prescribed Ozempic for the treatment of type 2 diabetes, and receive prior authorization from your healthcare provider.
Which insurance companies offer coverage for Ozempic in Canada?
Insurers such as Manulife, Blue Cross, and Canada Life may offer coverage for Ozempic in Canada. Coverage for Ozempic and other weight loss medications depends largely on the insurer and the specific group health plan an employer selects. Some top Canadian insurers that may offer coverage include:
- Manulife: Manulife offers group benefit plans that may include coverage for specialty medications like Ozempic. Employees may need to complete a prior authorization form to determine eligibility
- Blue Cross: Blue Cross also provides coverage for specialty drugs under some group plans. Coverage details, including any conditions that must be met, depend on the group plan’s specifics
- Canada Life: Similar to other insurers, Canada Life requires a completed authorization form for specialty medications. Group plans can be customized, which means Ozempic might be covered under certain conditions
Does Manulife cover Ozempic for weight loss?
No, Manulife does not cover Ozempic for weight loss, except under the Manulife Guaranteed Issue Enhanced Plan. Ozempic is only covered for individuals with Type 2 diabetes and solely when prescribed for managing that condition. Manulife adheres to Health Canada’s guidelines, which do not approve Ozempic for obesity treatment.
How do I get Ozempic covered if I am not diabetic?
Most insurance providers cover Ozempic only for Type 2 Diabetes. However, if you have a diagnosis that may require you to take Ozempic, you can appeal to your insurance provider. For this, you need to consult your doctor and request them to write you a detailed Letter of Medical Necessity explaining why Ozempic is crucial for your condition.
Please note, coverage for Ozempic usage for any condition other than Type 2 diabetes is generally difficult to obtain from a Canadian insurer.
Does Manulife cover Ozempic for weight loss?
No, Manulife does not cover Ozempic for weight loss when it is prescribed for off-label use. However, if Ozempic is prescribed to treat Type 2 diabetes, it may be covered, but only with prior authorization. This step ensures that the medication is being used as per Health Canada’s guidelines for approved dosage and treatment.
While Ozempic for weight loss is not covered, Manulife offers a variety of resources like virtual health coaching, nutrition counseling, meal planning advice, and support for physical activity. These benefits can help employees achieve their weight management goals through behavioral changes and healthy lifestyle choices.
Does Blue Cross cover Ozempic for weight loss?
No, Blue Cross covers Ozempic exclusively for treating Type 2 diabetes. Such coverage is given only through a special authorization process which is in line with Health Canada’s approval criteria.
Are there any alternatives for weight loss coverage in a group health plan?
When Ozempic is not covered, there are other options available to employees under group health plans that may help with weight loss such as non-prescription weight management support, group health wellness programs, etc.
- Coverage for other prescription weight loss drugs: Many group health plans may cover other prescription weight loss medications that are specifically approved for treating obesity
- Non-prescription weight management support: Some group health plans offer reimbursement for non-prescription weight management support. This can include weight loss programs, nutritional counseling, and dietitian services
- Group health wellness programs: Employers may also offer wellness programs as part of their group health plans. These wellness programs can include gym memberships, weight management workshops, mental health support, and access to digital tools or health coaches
How can employers support employees with obesity?
To support employees with obesity, employers can offer health benefits like dietitian consultations, psychotherapists, conduct employee training programs and promote respectful and inclusive language in the workplace.
Frequently Asked Questions
How do insurers differentiate between diabetes and weight-loss uses of Ozempic?
Insurers differentiate based on the diagnosis provided by the healthcare professional. For Ozempic to be covered for diabetes, a diagnosis of Type 2 diabetes must be documented. For weight loss, additional approval processes, including medical necessity assessments and prior authorization, are often required.
How do I know if I’m eligible/authorized for Ozempic coverage?
Eligibility depends on your group health plan. Check with your insurer or group benefits administrator. They may require a prescription from your healthcare provider along with proof of medical necessity and prior authorization.
Will my provincial healthcare plan cover Ozempic?
Provincial healthcare plans may cover some or all of your Ozempic costs, depending on your location and health diagnosis, and co-pay options may be available.
In Ontario, Prince Edward Island, Alberta, and under the Non-Insured Health Benefits program, Ozempic is publicly reimbursed, but you’ll need to meet very specific medical criteria in each case.
What diagnosis will cover Ozempic?
Ozempic is approved by the Food and Drug Administration (FDA) solely for the treatment of type 2 diabetes. Using it for conditions like prediabetes is considered off-label use.
Is there any way to lower the cost of Ozempic without insurance?
There are a few ways to potentially lower the cost of Ozempic. For example, Novo Nordisk offers an Ozempic savings card for up to a 90-day supply. Eligible individuals with private or group insurance can save as much as $150 off a one-month prescription and $450 off a three-month prescription, depending on their insurance coverage. At certain pharmacies, purchasing a 90-day supply of Ozempic may reduce the cost per dose compared to buying a one-month or two-month supply.
Are there any alternatives to Ozempic?
There are other medications similar to Ozempic that may be covered by insurance. Alternatives such as Wegovy, Saxenda, and Contrave also support weight loss, and some of these medications have approvals specific to weight management, potentially increasing your chance of insurance coverage.
What is the monthly cost of Ozempic in Canada?
The monthly cost of Ozempic in Canada can be significant without insurance, averaging around $936. However, prices can vary slightly depending on the pharmacy and region. Some insurance plans can reduce this cost substantially, but it’s important to check with your provider for exact cost-sharing details.
How do you qualify for Ozempic in Canada?
To qualify for Ozempic, patients typically need a prescription from their healthcare provider, often with proof of Type 2 diabetes or significant medical need. For insurance to cover it, most providers also require prior authorization, verifying the patient meets criteria such as specific BMI thresholds or the presence of comorbidities.
Is Ozempic covered for weight loss or diabetes only?
Ozempic coverage is typically limited to diabetes management, as many insurance plans do not recognize weight loss as a primary treatment purpose for this medication. However, some plans may cover it under strict criteria if prescribed for weight-related comorbidities.
- Some group health plans may cover Ozempic for weight loss, but coverage is typically reserved for treating Type 2 diabetes
- Coverage for Ozempic as a weight-loss drug often requires proof of medical necessity and prior authorization
- Employers can choose to include or exclude specialty drugs like Ozempic in their group benefits, impacting employee coverage
