Ozempic is an approved diabetes treatment medication receiving enormous attention on social media. Much of the hype, however, is not directed at its primary and approved user group in Canada—individuals with type 2 diabetes—and shifted as the drug gains popularity as a weight loss aid.
First, we will discuss Ozempic’s primary role as a type 2 diabetes treatment. Diabetes is one of the top chronic illnesses in Canada. In 2022, Diabetes Canada reported the following statistics regarding Type 1 and Type 2 diabetes1:
| Prevalence | 2022: # individuals / % of Canadians |
|---|---|
| Diabetes (type 1 + type 2 diagnosed + type 2 undiagnosed) | 5,719,000 / 14% |
| Diabetes (type 1 and type 2 diagnosed) | 4,003,000 / 10% |
| Diabetes (type 1) | 5-10% of total diabetes prevalence |
| Diabetes (type 1 + type 2 diagnosed + type 2 undiagnosed) and prediabetes combined | 11,704,000 / 30% |
Ozempic is not a substitute for insulin and should not be used to treat type 1 diabetes. But with 30% of Canadians, 90-95% of whom are living with or at risk of developing type 2 diabetes, the current and projected cost of treatment have employers concerned about their benefits programs’ viability.
It is important to note that the cost of treatment continues to rise not only due to increased diabetes prevalence but also due to new treatment options. Ozempic is a popular, more recent medication due to its “convenience” and its side effect of weight loss.
Ozempic is a convenient but costly type 2 diabetes treatment alternative
Metformin is the most common treatment for type 2 diabetes.2 Metformin dosage is once or twice daily, with or without food, or as advised by the individual’s physician. Ozempic is an injection administered once a week. If an individual does not want to be burdened with taking oral medication daily, Ozempic is a convenient alternative.
Using Ozempic comes at a higher cost from a financial and efficiency perspective. As noted in a study conducted by Pocket Pills,3 the average annual price of Ozempic is $2,544 versus $130 for Metformin. People with diabetes also rate the effectiveness of Ozempic to be inferior to Metformin.
Ozempic is on the prior authorization list with Canadian insurance companies; however, it is a gray area regarding when this more expensive alternative should be prescribed. This is evident in the increasing number of Ozempic drug claims across benefit plans. As this trend continues, consultants and plan sponsors will continue to work closely with insurance companies to “tighten” the approval process for Ozempic.
Ozempic as a weight reduction medication
Shifting to the application of Ozempic as a weight reduction medication, Ozempic has not been approved by the U.S. Federal Drug Agency or Health Canada for weight loss. Physicians are aware of its effectiveness in weight loss, however. As a result, many are prescribing Ozempic off-label for weight reduction to those suffering from obesity. Ozempic may not be the “best” solution as the extra weight will return if behaviour and lifestyle are not modified when an individual stops taking Ozempic.
Obesity Canada defines obesity as any individual with a body mass index (BMI) of 30 or greater. Many health risk factors are associated with obesity. A holistic view of weight management is needed. Obesity Canada4 recommends that “the overall goal of obesity management is the improvement of health and well-being. The first step is to prevent further weight gain. In addition, even a modest reduction in body weight can lead to significant improvements in health. It’s important to look past the scale and focus on the big picture of why a change is needed.”
From a plan cost perspective, Ozempic’s approval by Health Canada as a weight loss medication could result in a long-term plan cost. Individuals may not work with their physician to approach obesity with a 360-degree view, resulting in long-term use of Ozempic to keep weight off.
The insurers and your consulting teams will watch Ozempic’s journey. As the situation evolves, they will inform you of any changes to Health Canada’s approval and insurer pre-authorization programs. Contact your Cowan consultant to learn more.
Sources:
1 Diabetes Canada. (2023). Diabetes in Canada. Retrieved from URL.
2, 3 Pocketpills. (September 22, 2022). Ozempic vs Metformin: Side effects, results, price & ease of use compared. Retrieved from URL.
4 Obesity Canada. (2023). Measuring Obesity. Retrieved from URL.
