Is Ozempic Covered by Insurance?

Key Takeaways
  • 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: Before speaking to your healthcare practitioner about your medication, ensure that you speak with your insurance provider to confirm:

  • Whether your insurance provider will only cover Wegovy or Ozempic
  • If they do cover Wegovy or Ozempic, what are the eligibility requirements

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.

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, 02540258 or 02471469 (depending on the pen provided to you) and your drug name. It may also be worthwhile to inquire about two other medications we offer: Contrave (DIN 02472945) and Saxenda (DIN 02437899). 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 looking to use Ozempic off-label in BC will have to pay out of pocket or through their private insurance

Saskatchewan drug plan & MB Pharmacare

Similarly, the Saskatchewan drug plan and the Manitoba Pharmacare program list Ozempic as an Exception Drug Status, meaning certain medical criteria must be met for coverage. Coverage is provided for the treatment of type 2 diabetes in combination with metformin and a sulfonylurea, when diet and exercise plus dual therapy with metformin and a sulfonylurea do not achieve adequate glycemic control.

The cost is not reimbursed for weight loss. People looking to use Ozempic off-label in Saskatchewan or Manitoba will have 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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References

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