If you have type-2 diabetes and need help managing your blood sugars, Ozempic (marketed by Novo Nordisk who hold the rights for all semaglutide-based medications — they have the logo with the Apis bull!) could be the right choice for you.
A GLP-1 receptor agonist, Ozempic is primarily used to treat adults with type-2 diabetes, as well as those who need weight management assistance and have a BMI of 27 or over.
Multiple studies and anecdotal evidence have shown that Ozempic is highly effective at both glycemic control and as a tool for weight management. But just how much does it cost?
In this article we’ll cover:
- What Ozempic insurance coverage is and who’s eligible
- The types of insurance available
- The costs associated with Ozempic
- The benefits of Ozempic for persons with type-2 diabetes
- Side effects to be aware of
- Ways you can save money on the drug
- Frequently asked questions.
Let’s dive in!
What Is Ozempic Insurance Coverage?
Health insurance generally covers major medical expenses, as well as prescription drugs. However, what services exactly will be deductible depend entirely on your insurance provider, your personal circumstances, premium, and your policy.
Depending on what you’ve been prescribed Ozempic for, your insurance may or may not cover treatment, and you’ll need to pay some or all of the costs out-of-pocket. Depending on your dose, length of treatment, and where you fulfil your prescription, this could make the amount you pay on the medicine unmanageable.
If you aren’t sure whether your insurance will cover your Ozempic treatment and claims, it’s always best to call your provider to talk through your circumstances and policy with them.
Who Is Eligible for Ozempic Insurance Coverage?
To be eligible for Ozempic insurance coverage in Canada, most insurance companies require you to be a legal adult with either a type-2 diabetes diagnosis or a BMI of 27 or higher if you’ve been prescribed the drug for assistance with weight management. Manulife also requires patients to have tried oral medications first before switching to Ozempic.
Typically, the criteria that must be met will depend on which insurance company you are with. Eligibility for public insurance coverage of Ozempic will depend on your province, and what criteria your public health system has in place.
Alberta Specific Insurance Coverage
In Alberta, you may be able to access insurance coverage for Ozempic through the Alberta Health Care Insurance Plan (AHCIP), as long as you are prescribed it as step therapy.
That means that other drugs such as metformin (for at least six months) and sulfonylureas have been ineffective, and insulin is not an option, or any of the above are contraindicated for the patient.
Additionally, you will need to be in one of the ten approved insurance groups.
You can find more information by checking the Drug Benefit List here.
British Columbia Specific Insurance Coverage
In British Columbia, you may be able to access BC PharmaCare, which partially covers the cost of Ozempic.
There are 12 different PharmaCare plans, so regardless of your circumstances, as long as you’re a B.C. resident, you’ll likely be able to find a plan to cover some, if not all, of your Ozempic prescription costs.
Newfoundland and Labrador Specific Insurance Coverage
If you’re in Newfoundland and Labrador, you may be able to access the Newfoundland and Labrador Prescription Drug Program (NLPDP) under five different plans.
There are various different eligibility criteria for each plan, but you should note that this insurance program is known as payor of last resort. That means that they will cover the cost of your prescription as long as you’re eligible and no other third party is able to cover the cost on your behalf.
Ozempic is covered under this program, but eligibility does vary.
Ontario Specific Insurance Coverage
If you’re based in Ontario and have Ontario Health Insurance Plan (OHIP) coverage, you may be eligible for OHIP+ and the Ontario Drug Benefit (ODB) program.
As long as you’re under 24 and don’t have private insurance, this will enable you to access over 5,000 different drugs for free, including Ozempic.
Additionally, you can also access the ODB if you are
- Aged 65+
- Live in either a long-term or special care home
- Receive professional and community care services
- Are enrolled in the Trillium Drug Program, Ontario Works, or the Ontario Disability Support Program.
You can check your eligibility for different medications under the ODB on the Ontario website.
Saskatchewan Specific Insurance Coverage
In Saskatchewan, you may be eligible for the Drug Plan which could cover some or all of the cost of Ozempic if you are receiving one of the following:
- Supplementary Health Program benefits
- Special benefits from the Saskatchewan Aids to Independent Living (SAIL)
- Qualify for palliative care
- Qualify for the Special Support Program.
If you aren’t sure if you qualify, you can check this calculator to see if you’d be able to access Ozempic for less than list price.
Once you have determined what coverage is available to you and you have enrolled in the specific program, your pharmacist will be able to submit prescription claim information online for you to the Drug Plan claims system. This will then automatically tell them how much you need to pay for the drug.
Types of Insurance Coverage Available for Ozempic
There’s a couple of main types of insurance coverage available in Canada. However, your eligibility will vary even within these categories, so if you aren’t certain about your policy’s restrictions, contact your provider for information and support.
An Overview of Commercial Insurance Coverage
Generally commercial insurance is used for business-related losses and expenses, so it’s not likely you could have an Ozempic prescription covered on commercial insurance.
However, some companies do offer health insurance benefits to their employees. You will need to ask your employer if it’s possible for your Ozempic prescription to be covered by company benefits.
Bear in mind that only certain conditions are likely to be covered in this circumstance.
An Overview of Private Insurance Coverage
Your private insurance coverage of Ozempic will depend on your provider’s criteria for eligibility and the company’s policy. Most insurance plans and companies in Canada will be happy to assist in the cost of Ozempic, but you will most likely need to meet a certain medical criteria.
Ozempic is approved by Health Canada for adults with type-2 diabetes or a BMI of 27 or over, so if you have neither of these, it’s unlikely that your insurance will cover the cost of treatment.
What Are the Costs Associated With Ozempic Treatment?
While the list price of Ozempic may seem quite costly, don’t forget that if you are able to use your insurance to cover some or all of the cost, you’ll be able to make huge savings on the drug.
Let’s break down the costs.
Determining Ozempic’s Cost Without Insurance
Ozempic ranges from between $250–400, depending on the pharmacy you purchase it from. However, if you have private or commercial insurance that covers your treatment, you may not have to pay the full price.
Actual Cost of Ozempic
Depending on your insurance company and your province’s public health funding, you may be able to significantly reduce the cost of your treatment, or even access it for free.
While there are currently no supply issues in Canada, you should be aware that Ozempic is a popular drug and this could affect list price in the future.
If you’re hoping to use your insurance to cover Ozempic treatment, it’s best to contact your provider for full information and to find out what your policy covers.
How to Access Discounts from Insurance Companies
Depending on what plan you are on, your insurance company may offer various discounts for your health insurance. Some companies may also offer an intro discount if you have only recently joined.
To access these, go to your provider’s website or contact them directly for more information.
There are many benefits to Ozempic, and these have been widely observed in multiple studies. Here we break down our top four.
Weight Loss Benefits from Ozempic
While Ozempic was created to assist those with type-2 diabetes, its active ingredient — semaglutide — mimics glucagon-like peptide-1 (GLP-1) receptor agonists. These not only help with glycemic control but also target the hunger centres in the brain.
You may also see semaglutide marketed under a variety of other trademarks, including Wegovy and Rybelsus.
As this helps patients feel more full and satiated, they often end up in a caloric deficit, which leads to improved weight management. In fact, in Ozempic’s clinical trials, adults lost up to 14 pounds of body mass.
In addition to approving Ozempic for treatment for type-2 diabetes, they have also approved it for the treatment of those with obesity, notably with a BMI of 27 or higher. In these cases, the drug is most effective when combined with other lifestyle intervention, such as a healthy diet and regular exercise.
Of course, there are plenty of benefits to improved weight management, particularly if you’ve struggled with your weight in the past, but it should be noted that any loss of body mass should be monitored and regulated by your medical team.
Generally speaking, aiming for two pounds a week is considered to be safe and sustainable. Be sure to keep communicating with your medical team during this process so that they may monitor your progress and make adjustments to your treatment as necessary.
Also bear in mind that weight management is often partially psychological, and you may benefit from other intervention measures, such as working with a dietician or therapist. Therapy can be vital to understand your underlying relationship with food and your eating habits, so that you can work to overcome them.
Improvement in Blood Sugar Levels and Glycemic Control
As GLP-1 receptor agonist, Ozempic is known to help with blood sugar levels and glycemic control. Studies have shown that use of Ozempic lowers A1C levels — vital for those with type-2 diabetes.
Ozempic is a drug that can greatly improve the quality of life for many people thanks to its ability to manage blood sugars in adults with type2 diabetes, assist with weight management, and reduce the risk of major cardiovascular events.
There are multiple accounts from people who have used Ozempic and have increased their quality of life, from increased mobility, to reduced back pain, and more.
Of course, not everyone is suitable for Ozempic or other semaglutide medications. If you’re considering Ozempic, be sure to pay attention to the safety information, as well as consult with your medical team to discuss your suitability for the drug.
Additionally, as Ozempic is self-administered by patients using a pre-dosed Ozempic pen, it’s simple for patients to stay on top of their own injections and treatment.
Reduction in Risk of Heart Attack and Other Complications
Type-2 diabetes and obesity puts you at a greater risk for major cardiovascular events. This includes heart disease, heart failures, heart attacks, stroke, high blood pressure, high cholesterol, and death.
However, research from a 2023 study found that those who used semaglutide were associated with fewer heart complications, and the risk of developing major cardiovascular events was lessened. This is thanks to the weight management benefits of the drug.
Side Effects of Ozempic Treatment for Adults with Type 2 Diabetes
There are a number of side effects associated with Ozempic, some of which are common and less serious, and some which are rarer but more serious. Additionally, Ozempic has a number of contraindications with other medicines, vitamins, and supplements.
If you’re considering taking Ozempic, be sure to talk to your medical team and fully disclose any prescription medications or supplements you may be taking so that they can help you determine if Ozempic is right for you.
Common Side Effects of Ozempic
The most commonly reported side effects of Ozempic include:
- Stomach pains
- Nausea
- Diarrhoea
- Constipation
- Vomiting.
These side effects are often more prevalent when beginning the medication or when increasing your dose. However, they will likely dissipate over time.
If you’re concerned about your side effects or they’ve worsened, contact your medical team for guidance.
Rare Side Effects of Ozempic
While Ozempic is considered to be a safe drug, in rare cases, these more serious side effects can occur in patients:
- Pancreatitis (inflammation of the pancreas)
- Gallbladder complications
- Severe allergic reactions
- Kidney issues
- Hypoglycemia
- Diabetic retinopathy (changes in vision)
- Thyroid tumours.
If you experience any of the above more serious side effects, you should discontinue your use of Ozempic immediately and contact your medical team, or go directly to your local ER.
It’s also important to know that certain individuals should not use Ozempic or other semaglutide products. This includes those who have a personal or family history of medullary thyroid cancer (MTC) or multiple endocrine neoplasia type-2 (MEN 2), as well as those who are pregnant, intending on conceiving in the next couple of months, or breastfeeding.
You should also be aware that studies on rodents using semaglutide resulted in the development of thyroid cancer. However, it’s unknown if the same results would be seen in humans.
If you notice any of the following signs or symptoms, discontinue your use of Ozempic immediately and contact your medical team:
- A lump or swelling in the neck
- Pain in the front of the neck
- A hoarse throat
- Difficulty swallowing and breathing
- A persistent cough.
How to Save on Ozempic
There are many ways to get some or all of the cost of your Ozempic prescription covered in Canada.
Because Canada’s healthcare system is made up of a combination of public healthcare, private insurance, and out-of-pocket payments, you may need to do some research on what your province will cover, and what your private insurance will cover.
If your current policy does not cover your Ozempic prescription, there may be additional riders you can purchase. Talk to your provider for more information.
Key Takeaways
Ozempic’s list price in Canada is roughly $250–400 depending on where you fulfil your prescription. This price may be greatly reduced or fully covered depending on your private health insurance, commercial health insurance, and public health program.
If you’re considering Ozempic for type-2 diabetes or for assistance with weight management, you can benefit from the many health benefits associated with this drug. However, you should also be aware that there are a number of side effects that could affect your use.
Be sure to talk to your medical team about whether or not Ozempic is right for you, and follow up with your insurance provider network for full information about what your policy will cover.
Frequently Asked Questions (FAQs)
Does Medicare cover Ozempic?
Medicare (the Canadian version of Medicaid) may cover all or part of your Ozempic, depending on where you’re based. You may be able to use copay.
Ozempic is publicly reimbursed in Ontario, Prince Edward Island, Alberta, and through the Non-Insured Health Benefits program. You will need to meet a certain medical criteria for each of these.
What other diabetes medications are covered by insurance?
If you discover Ozempic isn’t for you, there are many other medications for type-2 diabetes available on the Canadian market that you may be able to get partially or fully covered by insurance.
Many insulin products are partially and fully covered in several Canadian provinces. For example, pre-mixed insulins such as Humulin and Novolin are partially or fully covered in every province, according to their public health programs.
Getting diabetes medication covered by your private or commercial insurance depends on which insurance company you are with. However, your private insurance will most likely be happy to cover some or all of the cost of insulin.
Can I appeal if my insurance does not cover Ozempic?
You can always appeal to your private or commercial insurance company to have a denied claim reviewed and reconsidered. If your claim is denied a second time, you do have options of applying for an external review. In extreme cases, you can file a lawsuit if you feel the rejection is unreasonable.
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