Canadian GLP-1 coverage — anyone have experience?

Dr.PathRoch said:

Telehealth prescriber review for cost and coverage: I've used 2 different telehealth platforms to get my GLP-1 prescription.

Financial impact of cost and coverage weight loss beyond medication cost:

• Groceries: SAVED $204/month (eating less)
• Restaurants: SAVED $174/month (fewer meals out)
• Alcohol: SAVED $124/month (stopped drinking)
• Life insurance: Premium REDUCED by $34/month (lower BMI)
• Copays: SAVED $54/month (fewer BP/cholesterol meds)

Net impact after medication cost: approximately BREAKING EVEN. The medication pays for itself through reduced food spending and healthcare costs. This surprised me.

CanadaChris said:

Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives: Prior authorization appeal…

Thank you for spelling out the reasoning rather than just the conclusion.

Dr.PathRoch said:

Telehealth prescriber review for cost and coverage: I've used 2 different telehealth platforms to get my GLP-1 prescription.

Insurance update relevant to cost and coverage: I just got my prior auth approved through Anthem after 3 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (sleep apnea + prediabetes), and referencing the SELECT trial data.

If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.

lisa_labSD said:

Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…

lisa_labSD said:

...regarding the discontinuation data for cost and coverage...

I want to reframe the discontinuation narrative. We don't say "insulin fails because blood sugar rises when you stop it." We don't say "antihypertensives fail because BP goes up without them."

Why do we apply different logic to anti-obesity medications? The answer is stigma. We still, unconsciously, believe obesity is about willpower rather than biology. The discontinuation data actually PROVES it's a chronic biological condition requiring ongoing treatment.

This reframing isn't semantic — it has implications for insurance coverage, treatment duration, and patient expectations.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful.