Gary Sawatzky | Chief Operating Officer, ARTA

As you may have read in January’s ARTAfacts newsletter, new antidiabetic and weight‑loss medications are leading to considerable cost increases to private benefit plans, like ARTA’s — and to public plans that cover these medications.

The first medication, Ozempic (which uses a medicinal ingredient named semaglutide) is used to treat type 2 diabetes. Ozempic works by mimicking the effects of a naturally occurring hormone called GLP-1, which helps regulate blood sugar levels. It is typically administered as a weekly injection and is often used in combination with diet and exercise.

Another medication containing semaglutide is called Rybelsus, which is available as an oral tablet. While the two medications use the exact same medicinal ingredient, albeit at different dosages, most people prefer to use Ozempic because it has also been approved to reduce the risk of heart attack or stroke in adults with type 2 diabetes and heart disease.

Semaglutide has several side effects, including weight loss; this has led to its manufacturer selling yet another version of semaglutide at a higher dose, called Wegovy. This high-dose version is specifically prescribed for chronic weight management in adults with obesity or who are overweight and have at least one weight-related condition. While it was approved for sale in Canada as a weight-loss medication in November 2021, stock is not yet available because of its popularity in other countries — the supply of Wegovy has not yet caught up to its demand.

The second antidiabetic medication that is just beginning to enter the marketplace is Mounjaro (generic name tirzepatide). It has been proven to be slightly more effective than Ozempic in scientific studies. Mounjaro also has a side effect of weight loss, and, like Ozempic, it also has a weight-loss version available at a higher dosage called Zepbound. Zepbound was just approved for sale in the United States in November 2023, but has not yet been submitted to Health Canada for approval as of this writing. And following on the heels of Zepbound is an even newer medication called MariTide, which is undergoing clinical trials but promises to be just as effective as Wegovy, but with fewer side effects and is better at keeping weight off in the long term.

Both Wegovy and Zepbound have been proven to be very effective medicines for weight loss. According to scientific studies, users of Wegovy have been able to reduce their weight by up to 15%, and Zepbound users have reduced their weight by as much as 22%. These promising results have led to people trying to use the antidiabetic versions of the two medications to take advantage of their weight-loss capabilities, with some people attempting to get prescriptions to use the medications “off-label” (for a purpose that has not been approved for use by Health Canada). For example, people who do not have diabetes have been trying (often successfully) to get a prescription for the antidiabetic medications Ozempic, Rybelsus, or Mounjaro to take advantage of their weight-loss side effects. This situation has led to a significant shortage of these medications, as well as a few potential health complications for people who are taking these medications when they are not diabetic, such as pancreatitis, biliary disease, bowel obstruction, and gastroparesis.

Ozempic has been quite popular with ARTA’s members — the benefit plan paid over $400,000 for Ozempic in 2023, and our plan was the second payor (behind public-sponsored plans) in most cases. ARTA’s benefit plans currently cover Ozempic and Rybelsus under its prior authorization program, meaning your physician needs to complete a form outlining the medication’s treatment protocol and confirming it will be used as approved by Health Canada. In other words, these medications cannot be used off-label and receive coverage from ARTA’s benefit plans — we only cover drugs for use as approved by Health Canada.

Mounjaro is not currently covered by ARTA’s plans, but coverage is expected to be approved once it has been reviewed by the public health care plans, by the Canadian Agency for Drugs and Technology in Health, and by our claims adjudicator.

We will continue to monitor new breakthrough drugs that enter the marketplace and report our findings to ARTA members.

After working in group benefits consulting for twenty years, Gary joined ARTA to serve as Chief Operations Officer in November 2017. Gary has his certified Employee Benefits Specialist designation.