Canada · Coverage

Renewing GLP-1 coverage in Canada: public plans and private insurers

Whether your GLP-1 coverage needs renewing in Canada depends on who pays: a provincial plan or a private insurer. Here is what BC and Ontario publish, what two private insurers' forms ask for at renewal, and what to gather. It can't tell you whether you qualify — only your plan decides that.

British Columbia

Special Authority requests are submitted by prescribers, not patients; the current turnaround for faxed requests is 4 weeks, and coverage is not backdated^[5]. Semaglutide is covered for type 2 diabetes after inadequate control on metformin, with an indefinite approval period — so there is no periodic renewal for that coverage^[1][6].

Ontario

Ozempic became a Limited Use benefit on January 31, 2024, for adults with type 2 diabetes, with an indefinite authorization period — no Limited Use renewal is required^[2]. For drugs outside the formulary, only a physician or nurse practitioner can apply to the Exceptional Access Program, and how long coverage lasts depends on the drug and condition^[7].

Private insurers

Express Scripts Canada's Wegovy form asks, for an adult renewal, for documented loss of 5% or more of body weight, with baseline and current weights and dates^[3]. Desjardins' form for obesity medications asks, at renewal, for weight, height and BMI at the start of treatment and from the most recent visit, and confirmation of a reduced-calorie diet and physical activity; continuing beyond the authorized period needs a new request^[4]. Canada Life added Wegovy to its prior authorization program in 2023^[8]. Always use your own insurer's current form, unaltered.

If a request or renewal is declined, questions to ask your insurer, plan or prescriber's office:

• Which criterion wasn't met, or which document or measurement was missing?
• Can my prescriber send more information or a new request, and is there a deadline?
• Is there a review or appeal process, and how do I start it?
• Is a different form, program or exception available for my situation?

Asking doesn't change the criteria or promise a different decision. It helps you and your prescriber see what's missing.

What to gather before your authorization ends

• Your approval letter or notice: the drug, the authorized period, and any reference number.
• Your starting weight, height and the date; your most recent weight and the date.
• Your insurer's current prior authorization form (linked from its website or your plan booklet).
• The date to contact your prescriber — renewals are completed by your prescriber's office.

To keep track of these in one place, use the coverage renewal brief — a blank checklist that keeps the dates apart and prints a summary for your prescriber. It stays in your browser.

General information, not legal, insurance or medical advice. Criteria and forms change; your plan decides.