Selectpath Urges Plan Sponsors to Mandate Generic Substitution

The plan-sponsor warning

Written by Selectpath advisor James Deware, the advisory notes that public drug plan spending on Ozempic reached $662 million in 2023, up from $434 million the year before, and that GLP-1 drugs accounted for roughly 25% of the entire growth in public drug plan spending that year [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/]. Semaglutide held the top spot for private drug plan spend in both 2023 and 2024 [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/].

Why lower prices may not lower total spend

The Selectpath analysis argues that today's branded prices act as a natural brake on demand, and that when that brake lifts, the question is not whether utilization increases but how much and how quickly [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/].

Statistics Canada's Canadian Health Measures Survey, cited in the advisory, shows more than two thirds of adults aged 18 to 79 now classify as overweight or having obesity, up from 60% before the pandemic, with obesity alone rising from 25% to 33% in that period [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/]. Obesity rates have climbed fastest among working-age adults between 18 and 39 — the population most likely to be on employer plans [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/].

Expanding indications add complexity

The advisory also flags that Wegovy gained an expanded indication in late 2024 for reducing the risk of nonfatal heart attack in overweight adults with established cardiovascular disease, and that in December 2025 Health Canada approved a further indication on December 10, 2025 [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/]. Each new approval increases the eligible patient pool plan sponsors must underwrite.

Selectpath estimates generic semaglutide could be priced as low as 35% of the current branded cost, but cautions that per-unit savings can be offset by volume growth [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/].

What Selectpath recommends

• Revisit prior authorization criteria that were built around branded pricing [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/].
• Adopt mandatory generic substitution so members are required to use the lowest cost equivalent rather than the branded version [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/].
• Make intentional decisions about plan design before the second wave of GLP-1 cost pressure arrives [Source: selectpath.ca/blogs-vlogs/cheaper-ozempic-is-coming-to-canada-dont-celebrate-yet/].

Market context

The Selectpath note lands as Novo Nordisk has moved to defend brand share. The Danish manufacturer said it would reduce the price of brand-name Ozempic for some Canadian consumers, with eligible Canadians who do not have public or private coverage able to buy Ozempic at a reduced price using a Novo Nordisk Savings Card at local pharmacies across Canada, excluding Quebec, and applied automatically at Novo Nordisk Care Rx operated by Rexall [Source: globalnews.ca/news/11863331/novo-nordisk-slash-ozempic-price-generics/]. Apotex said its generic semaglutide will be approximately one-third the price of Novo Nordisk's brand-name Ozempic [Source: globalnews.ca/news/11863331/novo-nordisk-slash-ozempic-price-generics/].

The BBC reports there are an estimated three million Canadians taking GLP-1 medications [Source: bbc.com/news/articles/c142y4p2eyxo]. In December 2025, negotiations that could have led to coverage of Wegovy under Canadian public health plans broke down, with the pan-Canadian Pharmaceutical Alliance stating those negotiations concluded without agreement after the manufacturer declined negotiation [Source: globalnews.ca/news/11863331/novo-nordisk-slash-ozempic-price-generics/].

For reference, current pharmacy listings on GLP1Prices.ca show Ozempic 1 mg four-week supply ranging from $230 at Costco to $429.79 at PharmaServe in Ontario, with the broader database range spanning $215 to $663. Plan sponsors weighing substitution rules can compare current pricing using the insurance coverage checker and the generic semaglutide tracker, or review the FAQ for details on how generic substitution works at the pharmacy counter. Coverage rules for Mounjaro, Zepbound and Rybelsus remain unchanged by the semaglutide generic launches.