Does Canada Life Cover Ozempic? Prior Authorization, Costs, and Denials

Canada Life does cover Ozempic, but only when it is prescribed for a Health Canada-approved medical condition and only after a prior authorization request from the prescribing physician has been approved. The drug is not reimbursed when prescribed for weight loss. Since November 27, 2023, every new Ozempic claim through Canada Life has required prior authorization before any reimbursement is issued.¹

Which Conditions Qualify for Coverage

Canada Life’s current prior authorization form, updated in mid-2026, recognizes three eligible indications for Ozempic:

Type 2 diabetes, where the patient has an HbA1c of 7.0% or higher, inadequate blood sugar control despite diet and exercise, and has tried and failed on the maximum tolerated dose of metformin or has a documented reason they cannot take it.
Chronic kidney disease with type 2 diabetes, where the patient meets specific eGFR and urine albumin thresholds and has already been on the maximum tolerated dose of a RAAS-blocking blood-pressure medication for at least four weeks.
Cardiovascular risk reduction in patients who have type 2 diabetes, an HbA1c of 7.0% or higher, and established heart disease such as a prior heart attack, stroke, or angina, with at least four weeks of optimized standard treatment for both conditions.

The kidney and cardiovascular indications were added after Health Canada expanded Ozempic’s approval in August 2025 to include reducing the risk of kidney failure and heart-related death in adults with type 2 diabetes and chronic kidney disease.²

Weight Loss Is Not Covered

Canada Life excludes Ozempic for chronic weight management.³ A patient seeking insurance coverage for semaglutide as a weight-loss treatment must apply through Canada Life’s separate Wegovy prior authorization form. Wegovy is a higher-dose formulation of the same active ingredient, approved by Health Canada for obesity.

Even then, coverage is not guaranteed. Canada Life’s forms warn that “Wegovy is not covered under all benefit plans” and direct members to check their specific plan using the Drug Search Tool on the My Canada Life at Work portal before submitting a request.³ A 2023 industry survey found that half of plan sponsors in Canada excluded weight-loss medications entirely, though about one in five were considering adding coverage with clinical safeguards.⁴

How Prior Authorization Works

The physician does most of the work. The Drug Prior Authorization Form asks for:

Prescription details, including dosage, regimen, and expected treatment duration.
A medical rationale explaining why Ozempic was chosen over other drugs in the same therapeutic class.
A full treatment history listing previous and current diabetes medications, with dosages, start and end dates, and clinical outcomes.
Supporting lab results and clinical notes such as HbA1c values, kidney function tests, or specialist consultations, depending on the indication.
The physician’s signed attestation and license number certifying the information is true and complete.⁵

Completed forms go to Canada Life’s Winnipeg office by mail, by fax at 1-204-946-7664, or by email to cldrug.services@canadalife.com. Canada Life has advised that high request volumes can push assessments past normal turnaround times.³

If You Live in a Province With a Public Drug Program

Members in Alberta (Coverage for Seniors), British Columbia (PharmaCare), Manitoba (Pharmacare), or Saskatchewan (Drug Plan) must apply to their provincial program first. Proof of the provincial decision, whether an approval or a denial, has to be included with the Canada Life submission.³

If Your Request Is Denied

A denial means no reimbursement, but it is not necessarily the final word. Canada Life offers a two-level written appeal process:⁶

At Appeal Level 1, you submit a written request with any additional medical information from your physician. Canada Life reviews it within 10 calendar days and responds by mail.
At Appeal Level 2, if the first appeal is unsuccessful, you can submit a second written request with all claim details and any new supporting documentation, again reviewed within 10 calendar days.
After the second appeal, you can request escalation to Canada Life’s formal customer complaint process.

Canada Life does not publish success rates for these appeals. If every level is exhausted, the remaining options are discussing an alternative medication with your physician or paying out of pocket.

Public Service Health Care Plan Members

If your coverage is through the Public Service Health Care Plan, which Canada Life administers for federal public servants, the rules are a little different. Under the PSHCP, Ozempic is covered for type 2 diabetes only, and chronic weight management is explicitly excluded.⁷ The clinical thresholds mirror the general plan: HbA1c of 7.0% or higher, a failed metformin trial, and no concurrent use with another GLP-1 receptor agonist.

Approved claims are reimbursed at 80% of the drug cost set by Canada Life’s price file. The plan also reimburses pharmacy dispensing fees up to $8 at the same 80% rate, with maintenance medications capped at five dispensing fees per calendar year.⁸ Mandatory generic substitution applies: when a lower-cost generic equivalent is available, reimbursement is based on the generic price.⁹ PSHCP forms go to a different address: CLPrior.Authorization@canadalife.com or fax 1-833-204-5809. Physician fees for completing the forms are not reimbursed.¹⁰

What You Will Pay, and What Generics Change

Brand-name Ozempic runs about $400 per month in Canada.¹¹¹²¹³ Further generic submissions from Teva, Sandoz, and others are under review.¹⁴

Canada Life has already updated its prior authorization form to cover “semaglutide (Ozempic and generics)” under identical clinical criteria, so the paperwork does not change based on which version is prescribed.⁵ For PSHCP members, mandatory generic substitution means reimbursement will be based on the lowest-priced generic once those products settle into Canada Life’s price file. Analysts have estimated generics could eventually bring the monthly cost below $100.¹¹

1
Canada Life. Ozempic and Rybelsus Prior Authorization Notice
2
Reuters. Canada Approves Ozempic to Cut Risk of Kidney Failure, Heart-Related Deaths
3
Canada Life. Drug Prior Authorization Form: GLP-1 Medications
4
Benefits Canada. How Benefits Plan Sponsors, Insurers Are Managing Newer and Effective GLP-1 Medications
5
Canada Life. Drug Prior Authorization Form: Semaglutide (Ozempic and Generics)
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Canada Life. Prior Authorization Drug Claims Process
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Canada Life. PSHCP Drug Prior Authorization Form: Ozempic
8
PSHCP. Drug Benefit
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Government of Canada. Update on the Public Service Health Care Plan Transition
10
Canada Life. PSHCP Drug Prior Authorization Form: GLP-1 Medications
11
CBC News. Ozempic Generic Canada
12
Apotex. Apotex Launches Apo-Semaglutide Injection, a Generic Equivalent of Ozempic, in Canada
13
Pearce IP. First Generic Ozempic (Semaglutide) Approved in Canada for Dr. Reddy’s, Apotex
14
Reuters. Hims Offers Apotex’s Generic Semaglutide in Canada After Novo Patent Expiry