Ozempic, diabetes, weight loss, and your benefits coverage
September 28, 2023
For business owners, plan sponsors and administrators
A lot of people are talking about Ozempic these days – a prescription drug approved by Health Canada to treat type 2 diabetes.
The drug has also been shown to contribute to weight loss, and across social media, celebrities and influencers have widely promoted the drug as an approach to weight management. This publicity has created curiosity about the medication from people hoping to address their own weight concerns – including interest from people who don’t have diabetes.1
What is Ozempic, how does it work, and what is it approved for?
Ozempic is a form of semaglutide that’s delivered by a self-injectable pen. The drug is designed to regulate insulin and lower blood glucose levels.
Ozempic mimics a hormone in the human body called glucagon-like peptide -1 (GLP-1). After someone eats a meal, their sugar levels rise, and GLP-1 stimulates the body to create more insulin. This added insulin is helpful to people with type 2 diabetes because it lowers their blood sugar levels. GLP-1 also reduces hunger and food cravings.2 By addressing some of the underlying causes for diabetes, Ozempic (semaglutide) can contribute to a loss of 6 to 11 per cent of body weight after 3 to 6 months of use.3
Ozempic for weight loss?
With such notable results, some doctors have been prescribing Ozempic off-label, meaning for purposes not officially approved by Health Canada, to patients who are experiencing or who are at risk for weight-related health conditions, such as high blood pressure. And thanks to pop-culture endorsements, media reports find that Canadian doctors are noticing a growing number of requests for the drug from patients who don’t have diabetes or weight-related health concerns.4, 5 In some countries, this demand has led to shortages of the medication for individuals who have been prescribed the medication to manage type 2 diabetes, and in August 2023, Health Canada said it expected temporary shortages of the drug from late-August until early-October due to increased demand combined with global supply constraints.6
Does Manulife cover Ozempic?
As a diabetes medication, yes. Manulife follows Health Canada’s guidelines. If Ozempic is prescribed for treatment of type 2 diabetes, drug plans will pay claims for the medication according to your plan contract. If Ozempic is prescribed for off-label use, Manulife will not pay the claim.
Ozempic and your benefits plan
On April 5, 2023, Ozempic was placed on Manulife’s list of drugs requiring prior authorization. This added step in the claims management process helps ensure the drug is being prescribed, used, and taken in a dosage that’s in line with Health Canada approvals.
To avoid any disruption to a treatment plan that was underway before the change in claims practice, plan members who were approved for Ozempic use before April 5 continue to receive reimbursement without interruption.*
"Ozempic is a newer tool that can be used in combination with other strategies to improve the health of patients with type 2 diabetes”, says Dr. Steve Pomedli of Cleveland Clinic Canada, Manulife’s Medical Director. “These other strategies should include unlocking those resources that are readily available through the benefits plan to support a person in managing this chronic condition.”
Virtual health coaching; counselling on food, nutrition, and meal planning; support and encouragement for physical activity; and other resources found within the benefits plan can all be brought into alignment to support employees who are managing diabetes.
Effective new innovations, like Ozempic, offer hope to people managing type 2 diabetes. We continue to expand our group benefits plan features to keep pace with these advancements and to help make life better and easier for anyone living with a chronic condition.
Support for employees around weight management
Like diabetes, your plan can support employees who are pursuing their weight management goals, through behavioural and coaching supports and healthy lifestyle changes, as well as medications.
Fortunately, other medications that address weight loss are approved by Health Canada to support weight management and can be included in benefits plans.7 This includes newer formulations of semaglutide (other than Ozempic) that are anticipated to be available in Canada in the near future. Coverage is subject to plan design. If you want to make sure your plan is supporting employees and family members who are living with obesity, talk to your Manulife representative.
This article is for information only and is intended to inform you about current events. It is not intended to provide medical advice. If you have questions or concerns about your specific situation, speak with an appropriate healthcare professional.
Note: Before April 5, Ozempic claims were managed through Manulife’s automated prior-authorization program for diabetes which is applied at the pharmacy. The system looks back 6 months for a step 1 drug to ensure that first line therapies for diabetes (such as Metformin) are tried before a second line therapy (such as Ozempic) is considered under the plan. First line therapies are generally less costly. Standard prior authorization requires the prescribing physician to complete a form to obtain the medical information required (not limited to previous therapies), before a decision can be made about the coverage under the drug plan.
Sources:
1 Ozempic: The trendy drug Americans are shopping for in Canada amid shortages - National | Globalnews.ca, 2023
2 Mayo Clinic; GLP-1 antagonists: Diabetes drugs and weight loss, 2022
3 JAMA Network, Weight Loss Outcomes Associated with Semaglutide Treatment for Patients with Overweight or Obesity, 2022
4 Despite social media buzz, Ozempic is not a quick-fix weight loss solution, doctors say | CBC News, 2023
5 Ozempic in Canada: Diabetes drug being used for weight loss | CTV News, 2023
6 Health Canada, The supply and use of Ozempic, 2023
7 Prescription Medications - Obesity Canada, undated. Accessed July 2023
