Are you considering Ozempic but still trying to determine your insurance coverage, or if any programs can help you cover the expense?
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 for folks located in Ontario (Note: Felix is currently only offering Ozempic in Ontario).
People in Ontario may have options like the Ontario Drug Benefit or private insurance.
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 weight management. Provincial guidelines do not currently recognize it as a weight loss or management treatment. People looking to use Ozempic for weight loss will have to pay out of pocket or through their private insurance without the help of ODB coverage.
Patients with private drug plans may be eligible for coverage of Ozempic, depending on the insurance provider and specific plan. Coverage options can vary, from partial prescription drug coverage to requiring additional out-of-pocket costs or having a maximum amount the company will cover. Approximately 40% of our patients have their first prescription partially or fully covered by their insurance.
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, people will also need to meet specific medical criteria or provide documentation from their healthcare practitioner to be eligible for coverage.
The views expressed here are those of the author and, as with the rest of the content on Health Guide, are not a substitute for professional medical advice, diagnosis, or treatment. If you have any medical questions or concerns, please talk to your healthcare practitioner.
