Name-Brand Versus Generic Weight Loss Drugs
We have all heard the commercials that say, “ask your doctor” when it comes to weight loss medications. But what about asking your benefits provider?
In recent years, employers have seen an increase in the request for coverage of Ozempic, Wegovy, and Rybelsus as weight loss treatments. These drugs contain the ingredient semaglutide, a class of medication known as glucagon-like peptide-1 agonists (GLP-1s), designed to regulate blood sugar levels and appetite.
Wegovy and Rybelsus are designed and approved by Health Canada to assist with weight loss and covered through benefit plans. However, Ozempic is designed and approved for the treatment of Type 2 diabetes, weight loss is one of its side effects but not what it is approved for. This is called “off-label prescription.” It is not covered under benefit plans which means employees are forced to pay out-of-pocket.
How can employees receive effective coverage for weight loss treatments?
With generic off-brand drugs designed for weight loss being introduced to the Canadian market this year, employers can offer cost friendly drugs to their employees. The more generic versions offered, the less each one costs. The typical framework is that if you only have one, it comes down from the list price to 75 per cent of the name-brand version, if you have two, it goes down to 50 per cent, and down to 35 per cent if you have three or more.
The cost of the generic version to treat Type 2 diabetes will save employers a significant amount on their plans and employees will see a decrease in costs when they use the generic versions for weight loss. The cost of generic versions may be significantly less, but the strength of semaglutide in the product to treat Type 2 diabetes and assist with weight loss is the same as the name-brand version.