Insurers Detail How Generic Semaglutide Will Flow Through Plans

Major Canadian insurers are detailing how generic semaglutide will be processed through group benefit plans, with iA Financial pharmacist Frédéric Leblanc telling The Globe and Mail he expects generics to "significantly impact" plans and prices to reach 35 per cent of the Ozempic brand price once at least three generic options are on the market [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/].

Claims Volume Already Climbing

Total claims paid out by Canadian insurers for weight-loss drugs spiked to $77-million in 2024 from nearly $38-million a year prior [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/]. The Globe reports the current list price of Ozempic at about $2,899 a year before pharmacy and distributor markups, and Wegovy at about $5,066 a year [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/].

How the Switch Will Work at the Counter

Sun Life spokesperson Jolene Sonshine told The Globe that, generally, when plan sponsors have a drug already listed such as Ozempic or Wegovy, listings of the generic product will occur right away, and patients who choose to stay on the branded product must pay the difference [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/]. Amélie Gagnon, vice-president of product development and transformation at Desjardins Insurance, said prior authorization will still be required for any generic equivalents of Ozempic, but a plan member already approved for Ozempic reimbursement will be able to switch to a generic without submitting an additional request [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/].

The Neighbourhood Pharmacy Association of Canada said pharmacists are able to substitute the generic for the brand product in accordance with existing provincial substitution rules, unless the prescriber has indicated otherwise or there is a clinical reason the patient requires the brand product [Source: globalnews.ca/news/11857122/generic-semaglutide-canada-sales-begin/]. Whether and when public and private drug plans choose to reimburse the generic versions instead of the brand product will be determined independently by each provincial drug plan and private insurer, association spokesperson Alison Kraayvanger said [Source: globalnews.ca/news/11857122/generic-semaglutide-canada-sales-begin/].

Coverage Scope May Expand

Only about 30 per cent of plan members insured through iA have coverage for obesity and weight management — which includes Wegovy — compared with Ozempic, which is widely covered by most employers, according to Leblanc [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/]. Sunil Hirjee, vice-president of sales at Beneva Inc., told The Globe the industry is starting to ask, "Why aren't we acknowledging as an industry that obesity is a chronic condition" [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/].

Colin Ferguson, a senior benefits consultant with Quinn Advisory, described the introduction of generics as a double-edged sword for the industry — as costs per claim decrease, the number of claims will jump significantly [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/]. Manulife spokesperson Fiona McLean said in an e-mail that "These are high-demand therapies, and affordability remains a priority" [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/].

Pricing Cross-Check

The Globe cited annualized list prices of roughly $2,899 for Ozempic and $5,066 for Wegovy [Source: theglobeandmail.com/business/article-ozempic-wegovy-generics-insurance-costs/]. Those figures translate to roughly $242 and $422 per month respectively, which align with current pharmacy price ranges on GLP1Prices.ca of $222–$663 for Ozempic and $270–$490 for Wegovy. Global News reported Ozempic and Wegovy currently cost hundreds of dollars a month depending on the dosage dispensed — in some cases more than $450 [Source: globalnews.ca/news/11857122/generic-semaglutide-canada-sales-begin/].

Pipeline Behind the First Two

CBC reports Health Canada is reviewing nine submissions for generic versions of semaglutide [Source: cbc.ca/news/health/ozempic-glp1-health-canada-generic-9.7034498]. Apotex said its generic semaglutide will be approximately one-third the price of Novo Nordisk's brand-name Ozempic [Source: globalnews.ca/news/11857122/generic-semaglutide-canada-sales-begin/]. Patients tracking the rollout can consult the generic semaglutide tracker or the insurance coverage checker, and additional context is available in the FAQ. Tirzepatide products Mounjaro and Zepbound are not affected by the semaglutide patent expiry.

This article is for informational purposes only and does not constitute medical advice.