Is Ozempic Covered by Insurance?
- Approximately 40% of Felix patients have private insurance coverage for Ozempic.
- Ozempic is not covered under the Ontario Drug Benefit (ODB) program.
- BC PharmaCare provides coverage for Ozempic as a treatment for type 2 diabetes, but not for weight loss.
Note: The below are based on broad coverage guidelines but your pharmacy will have more details on your individual coverage options.
Understanding how to access insurance coverage for Ozempic is important, since sometimes medications like this may be costly. Let’s explore what insurance coverage and financial support is available (Note: Felix is currently only offering Ozempic in Ontario and BC).
Private drug plan coverage
Patients with private drug plans may be eligible for coverage of Ozempic, depending on the insurance provider and specific plan. Approximately 40% of our patients have their first prescription partially or fully covered by their insurance. However, insurance plans vary, and in our experience long-term coverage is not common or can change from injector to injector.
To determine your coverage, contact your benefits administrator with your details and the Drug Identification Number (DIN) 02471477 or 02471469 (depending on the pen provided to you) and your drug name. In some cases, you will also need to meet specific medical criteria or provide documentation from your healthcare practitioner to be eligible for coverage.
Ontario Drug Benefit coverage
Typically, to be eligible for the Ontario Drug Benefit (ODB) program, the patient must have attempted other diabetic medications and meet the necessary criteria set by ODB. Patients who meet these conditions can access financial support for Ozempic.
Unfortunately, Ozempic is not covered under the ODB program or the Trillium Drug plan for other uses. People looking to use Ozempic off-label will have to pay out of pocket or through their private insurance without the help of ODB coverage.
BC PharmaCare coverage
Currently, "BC PharmaCare provides coverage for Ozempic to help patients manage blood-sugar levels when metformin is not effective. The cost is not reimbursed for weight loss." People in BC will need to pay out of pocket or through their private insurance.
If you need insurance paperwork from your Felix healthcare practitioner, please don't hesitate to email us at hello@felixforyou.ca—we'll gladly help.
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