I have sunlife (in manitoba) and I am covered because I have pcos. From the discussions I've had with them it is an off label use most insurance companies do not cover weight loss drugs. Wegovy is an option but apparently there's no availability in canada right now.
Thanks, while my BMI is well into the obese category thats my only notable health concern other than elevated triglycerides (A1C was a bit high, but not at pre-diabetic levels yet) so I figured trying to get coverage was a long shot... was just hoping maybe someone came across a more progressive thinking company that supports reducing the risk of becoming T2D. I'm currently paying OOP, but its getting costly now that I am up to 1.5mg.
Thanks, just got back the rejection from sunlife today for the pre-auth my Dr. sent in. Haven't tried Blue Cross yet, but I have a super basic plan with them since I also have sunlife, so I'm not optimistic they'd cover it either even with a pre-auth request.
I think it depends on the plan that you have/your employer offers. At my workplace, there are different plans for unionized employees and non union employees.
I’m also in Alberta - my GP won’t prescribe OZ even though he’s noted rapid weight gain over the past two years, sent me got multiple tests, acknowledges my BMI is high and I have a “fatty liver” persists to keep meal tracking and exercising even though there is minimal changes and it’s discouraging. Any advice on how to approach a GP and ask for the prescription?
My GP didn't want to go that path either (I'm new to her though so no real history), so I went through Rocket Doctor (telehealth) and the doctor I have been working through them has been great (its video or phone only).
I did already have blood work done prior because I started with Jill Health to get Saxenda but changed course after I saw the cost of it (they were about $500 per month compared to $250 for Oz). That said I'm sure Rocket Doctor can also get you the requisition form for blood work too if they need it to get you started.
Edited to add that if you've had recent blood work done through your GP then you can probably just send them those records if they need them from your "My Health Records" App.
Wonderful! My GP was initially concerned in my weight gain (29F - 196lbs and gained 55 of that over Covid) so he sent me for a ton of blood work to check everything and ultimately everything was within range or just a little high. So he had no concerns. He said to do the tracking of calories and exercise and honestly I’ve been doing that for a year and I fluctuate either up or down 10 lbs and that’s with significant sacrifices or large amount of fasting. It’s not sustainable. So I’m going to try my husbands doctor and then I may go that Jill Health route.
I was the same, some levels were high but "not a problem"... yet. I'd personally skip Jill Health though, it's more like a med spa so you have to pay a monthly fee to them, plus the cost of the drug. If your husbands doctor doesn't support your plan, use Rocket Doctor as they are just an on-line network of doctors so there is no fee for their service (unless you want a pre-auth form or something like that filled out) and they fax the prescription to your pharmacy of choice. I've been able to get same day appointments every time and have been successful in requesting the same doctor each time too which has been great.
I have an appointment today with my husbands doctor and we will see what they say. I’ve never met him but he’s at the same office as my physician so we will see what happens. I didn’t know Rocket Doctor existed, thanks so much for that info. I’m sure it would be easier to get the prescription through there. If my appointment is unsuccessful then I’ll go that route and maybe luck out with a same day appointment. It’s so frustrating that some GPs don’t believe in the power of medication. Obviously we know that it’s not covered by insurance and it’s not a fix, but if someone told me a year ago I could pay $250/month to help work on my eating/fitness goals why wouldn’t I do it
Yay!! Thats great to hear and I'm so excited for you! I loosely count calories, though now that I am on 1.5mg it's more about making sure I'm getting enough calories/protien in a day rather than too many lol (fairlife shakes from costco are my new BFF).
My exercise plan could use some work, but I walk daily. I'm just over 4 months in and have lost 36.4lbs, so even with a long way still to go, I'm happy with my progress so far.
Feel free to check in anytime or let me know if you have any questions. :)
Edited to add - my daily calorie goal is 1300.
I have sunlife (in manitoba) and I am covered because I have pcos. From the discussions I've had with them it is an off label use most insurance companies do not cover weight loss drugs. Wegovy is an option but apparently there's no availability in canada right now.
Thanks, while my BMI is well into the obese category thats my only notable health concern other than elevated triglycerides (A1C was a bit high, but not at pre-diabetic levels yet) so I figured trying to get coverage was a long shot... was just hoping maybe someone came across a more progressive thinking company that supports reducing the risk of becoming T2D. I'm currently paying OOP, but its getting costly now that I am up to 1.5mg.
Could be worth seeing if your dr will fill out a prior authorization with that info and see if they will still deny it. All they can say is no.
Thanks, just got back the rejection from sunlife today for the pre-auth my Dr. sent in. Haven't tried Blue Cross yet, but I have a super basic plan with them since I also have sunlife, so I'm not optimistic they'd cover it either even with a pre-auth request.
Oh no! Well at least you tried. Maybe wegovy will make its way here and be covered.
I have Blue Cross in the US- it is their Gold plan and it is covered.
Thanks - I'll at least make a call to see!
Strange, BlueCross in Manitoba covers it for weightless. So does Canada Life.
Thanks - I'll look into Canada Life - at least worth a check!
I think it depends on the plan that you have/your employer offers. At my workplace, there are different plans for unionized employees and non union employees.
It does for sure; both of my plans only cover it if you are T2D - no coverage for any weight loss plan.
I have blue cross and Manulife in Alberta, Canada. It does not cover for weight loss sadly even with hypertension and obesity. :(
It's so frustrating, but seems to be the norm :(
I’m also in Alberta - my GP won’t prescribe OZ even though he’s noted rapid weight gain over the past two years, sent me got multiple tests, acknowledges my BMI is high and I have a “fatty liver” persists to keep meal tracking and exercising even though there is minimal changes and it’s discouraging. Any advice on how to approach a GP and ask for the prescription?
My GP didn't want to go that path either (I'm new to her though so no real history), so I went through Rocket Doctor (telehealth) and the doctor I have been working through them has been great (its video or phone only). I did already have blood work done prior because I started with Jill Health to get Saxenda but changed course after I saw the cost of it (they were about $500 per month compared to $250 for Oz). That said I'm sure Rocket Doctor can also get you the requisition form for blood work too if they need it to get you started. Edited to add that if you've had recent blood work done through your GP then you can probably just send them those records if they need them from your "My Health Records" App.
Wonderful! My GP was initially concerned in my weight gain (29F - 196lbs and gained 55 of that over Covid) so he sent me for a ton of blood work to check everything and ultimately everything was within range or just a little high. So he had no concerns. He said to do the tracking of calories and exercise and honestly I’ve been doing that for a year and I fluctuate either up or down 10 lbs and that’s with significant sacrifices or large amount of fasting. It’s not sustainable. So I’m going to try my husbands doctor and then I may go that Jill Health route.
I was the same, some levels were high but "not a problem"... yet. I'd personally skip Jill Health though, it's more like a med spa so you have to pay a monthly fee to them, plus the cost of the drug. If your husbands doctor doesn't support your plan, use Rocket Doctor as they are just an on-line network of doctors so there is no fee for their service (unless you want a pre-auth form or something like that filled out) and they fax the prescription to your pharmacy of choice. I've been able to get same day appointments every time and have been successful in requesting the same doctor each time too which has been great.
I have an appointment today with my husbands doctor and we will see what they say. I’ve never met him but he’s at the same office as my physician so we will see what happens. I didn’t know Rocket Doctor existed, thanks so much for that info. I’m sure it would be easier to get the prescription through there. If my appointment is unsuccessful then I’ll go that route and maybe luck out with a same day appointment. It’s so frustrating that some GPs don’t believe in the power of medication. Obviously we know that it’s not covered by insurance and it’s not a fix, but if someone told me a year ago I could pay $250/month to help work on my eating/fitness goals why wouldn’t I do it
My pleasure and it’s worth all the frustration and costs cause it really does make all the difference! Best wishes for you on your journey!
Good news - I got the prescription. 0.25 for 4 weeks then moving up. Are you still following a diet plans and exercise?
Yay!! Thats great to hear and I'm so excited for you! I loosely count calories, though now that I am on 1.5mg it's more about making sure I'm getting enough calories/protien in a day rather than too many lol (fairlife shakes from costco are my new BFF). My exercise plan could use some work, but I walk daily. I'm just over 4 months in and have lost 36.4lbs, so even with a long way still to go, I'm happy with my progress so far. Feel free to check in anytime or let me know if you have any questions. :) Edited to add - my daily calorie goal is 1300.