Is Ozempic Covered by OHIP – Insurance Coverage & Financial Options
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Last Updated on December 20, 2023
Ozempic has made waves for its role in managing type-2 diabetes and supporting weight management, but let’s address the elephant in the room—the coverage conundrum.
Ozempic for Weight Loss in Canada isn’t cheap, and without coverage, it can be a significant financial burden.
Since Ozempic has exploded in popularity insurance companies have become more strict about whether they will cover Ozempic or not, and many Canadians in Ontario are asking: “Is Ozempic covered by OHIP?”
In this article, we’ll delve into the Ozempic Insurance Coverage considerations and challenges that individuals may face when seeking Ozempic for their health management. We’ll cover what insurance companies are looking for when it comes to coverage and how much Ozempic costs each month and every year.
Keep reading to learn:
- What is Ozempic used for?
- is Ozempic covered in Canada for Weight loss?
- Is Ozempic covered by insurance?
- How much is Ozempic without insurance?
- Navigating your weight loss management options
Ozempic Insurance Coverage – Key Takeaways:
- Ozempic’s Annual Price Tag: Brace for impact on your budget if you’re in Canada and uninsured for Ozempic – with Novo Nordisk setting prices between $500 to $720 monthly, you’re looking at a yearly expense of $6,500 to $9,360 for your health investment.
- Insurance Coverage Caveats in Canada: Majority of Canadian insurance companies have tightened the reins on Ozempic coverage, reserving it primarily for those with a history of Diabetes Mellitus with failed therapies like Metformin. They will also require proof of this with lab results showing suboptimal fasting glucose and HbA1C. Weight management users face a steep climb, needing to provide a detailed history of weight management attempts to stand a chance for coverage assistance.
- Weight Loss Beyond Ozempic: When the goal is transformative, lasting weight loss, weight loss surgery, especially sleeve surgery, proves to be a more encompassing and effective solution compared to medications like Ozempic.
What is Ozempic used for?
Before we dive into the financial aspects, let’s briefly recap what Ozempic is and why it’s important. Ozempic, scientifically known as semaglutide, belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. It plays a pivotal role in managing type-2 diabetes and aiding in weight loss.
This medication stimulates insulin production, inhibits the release of glucagon, slows gastric emptying, and promotes a feeling of fullness. All of these actions contribute to improved blood sugar control and can assist with weight management.
Is Ozempic a prescription medication?
In order to receive an Ozempic prescription, a licensed healthcare professional must assess your need for the drug and write you a prescription outlining a treatment plan. Once you have a medical prescription for Ozempic, your local pharmacy is able to fill the prescription, depending on product availability.
Ozempic is a prescription drug approved by Health Canada to treat type 2 diabetes mellitus. Ozempic is administered through injection in doses of 0.5mg, 1mg, or 2mg, as per your doctor’s recommendation.
Is Ozempic covered by OHIP
Whether or not your Ozempic prescription is going to be covered by OHIP depends on several factors. Some of these factors include if you are 65+, reside in a long-term care home or home for special care, or if you receive professional home care or community care. OHIP coverage for medications can be complex and often depends on specific criteria and eligibility. While OHIP may cover certain medical expenses, the coverage for Ozempic may not be as comprehensive as one would hope.
It’s essential to consult with your healthcare provider or pharmacist to determine your eligibility for OHIP coverage and understand what costs you may need to bear.
What are the eligibility criteria for an Ozempic prescription
In order to be declared eligible for an Ozempic prescription in Canada, it is mandatory to book a consultation with a licensed healthcare professional, such as your family doctor.
Only through an in-person assessment will your doctor be able to determine whether Ozempic is right for you and determine a prescription and treatment plan accordingly.
You can learn more about the risk factors and side effects of Ozempic on the Government of Canada’s website.
Is Ozempic covered by insurance?
In Canada, many insurance companies are increasingly refusing to cover Ozempic for weight loss without proof of a diabetes diagnosis.
According to the Ozempic® website the price you pay for your Ozempic prescription will depend on your insurance provider. These decisions are made on a case-by-case basis by your health insurance, employer, or prescription-benefit company.
You can also connect with a NovoCare® Specialist who will verify your cost and coverage by calling 844-668-6463 Monday through Friday from 8:00 AM to 11:00 PM ET or Saturday from 11:00 AM to 7:00 PM ET.
For very specific information about your particular situation and the costs you may have to pay for your Ozempic prescription, call that number above.
For more general information, keep reading to learn what I know about the challenges of getting an insurance company on-board with covering Ozempic costs, and the average costs of Ozempic over time.
The cost of Ozempic without insurance
As far as I’m aware, the insurance companies in Canada have stopped covering Ozempic unless you can prove that you’re diabetic.
For many of my patients, who are using Ozempic as an effort to manage their weight, this creates a huge challenge in terms of cost.
I am aware of some cases in which insurance companies will assist with covering Ozempic prescriptions for weight management, but only in very specific circumstances. In order to qualify for this, you will have had to document every past attempt to manage your weight and include details about each other method you’ve attempted to use prior to seeking an Ozempic prescription.
The cost of Ozempic over time
You can still buy Ozempic without insurance – but it’s going to cost you.
Now, contrary to what many people might think, Ozempic isn’t a short-term use drug. Ozempic is an ongoing treatment method – which means you can’t just take Ozempic a few times and experience radical changes.
Ozempic is a long-term plan, not a one-time solution
If you’re exploring Ozempic for weight management, you need to consider the following:
- Ozempic isn’t a cure, it’s a long-term and ongoing treatment plan for weight management.
- You will lose approximately 5-10% of your total excess weight.
- Your relationship with food may also be psychological and social. Ozempic might reduce your appetite or minimize your food cravings, but without ongoing support, you could relapse despite being on the drug.
- Ozempic can come with a number of side effects – some that lead to patients no longer being able to take the medication
What I’m getting at is, based on the numbers above, Ozempic is going to cost you around $6,500 – $9,360 per year if you don’t have insurance.
And even if you do have insurance, there’s no guarantee it’ll cover the entire cost of your prescription if you’re using Ozempic as a weight management tool, rather than a tool to treat symptoms of diabetes.
Ozempic as a lifelong commitment
According to long-time users of Ozempic, this medication isn’t a “cure” to obesity – rather, it’s just one piece of a much larger puzzle. It’s a supportive tool, not a final solution.
In order to make life-altering changes to your health more concrete solutions are necessary.
On the journey of managing type-2 diabetes and achieving lasting weight loss, it’s important to recognize that Ozempic is often a long-term commitment, and its financial aspects can be a concern. However, I want to emphasize that while Ozempic is a valuable tool, it’s not the only path towards better health.
For those who are looking for ways to lose a sustainable amount of life transforming weight, exploring alternatives such as gastric sleeve surgery can be a viable option.
Navigating your weight loss management options
As someone who has personally faced the challenges of weight management and opted for gastric sleeve surgery, I understand the profound impact that such decisions can have on your life.
I’ve been on both sides of the healthcare equation—as a bariatric surgeon and as a patient. I’ve experienced the financial and emotional aspects of managing my weight and health. It’s taught me that while Ozempic is a valuable option, it’s not the only path and it’s just one tool in our toolkit to fight obesity.
I want to assure you that you’re not alone in your journey. Whether you choose Ozempic, consider surgery, or explore other avenues, there is a network of compassionate professionals and support systems available to guide you. The financial commitment involved in long-term health management is an important consideration, but remember, your health is an investment that pays lifelong dividends.
Your health journey is a testament to your strength and resilience. I encourage you to engage in open and honest conversations with your healthcare provider, explore the options available, and choose the path that aligns with your goals and aspirations. We’re also always happy to talk with you here at The Sleeve Clinic for a casual no-obligation call to explore if sleeve surgery might be for you.
Whatever you decide, know that you have the power to take control of your health and well-being.
Exploring gastric surgery
If you’re thinking about sleeve surgery, here’s some next steps to take:
- Evaluate your eligibility: Take a quick online quiz to see if you qualify for sleeve surgery – How Much Will I lose After Sleeve Surgery? Calculate weight loss
- Seek expert advice: Speak with a Sleeve Clinic Program Advisor
- Become part of our community: Follow The Sleeve Clinic on Instagram
Please note that the information provided in this article is for general informational purposes only and should not replace medical advice. It is always recommended to consult with a qualified healthcare professional for personalized guidance regarding weight loss surgery.
If you are considering sleeve surgery you can book a consultation with our weight loss clinic here: Contact us!