How the Ontario Drug Benefit lists Ozempic
The Ontario Drug Benefit (ODB) is the province’s public drug plan, and its formulary is the list of drugs it pays for. Since 31 January 2024, Ozempic has been a limited use benefit, meaning the plan pays only when the prescriber confirms specific criteria on the prescription.
The criteria are type 2 diabetes in an adult when blood sugar isn’t controlled on the highest metformin dose a person can tolerate, or when metformin is contraindicated or not suitable. The plan doesn’t fund Ozempic together with another GLP-1 or a DPP-4 inhibitor, or with oral semaglutide.
Who is on the ODB, and what OHIP+ means
ODB eligibility includes people 65 and over, residents of long-term care, people receiving home care, people on Ontario Works or ODSP, and Trillium Drug Program enrollees. OHIP+ covers people under 25 who have no private insurance.
Seniors pay a yearly deductible plus a per-prescription amount. Other eligible groups pay a small flat fee per fill, which we’ve left out until we confirm the current amount. None of this applies unless the drug meets its listing criteria first.
What the listing does not say
The notice lists Ozempic for type 2 diabetes. It says Ozempic is not funded for ODB recipients who don’t meet the criteria, and that pharmacy claims for those recipients are subject to recovery. Weight management is not part of the listing.
We haven’t confirmed whether any other Ontario program, such as the Exceptional Access Program (which reviews requests for drugs not on the formulary) or Trillium, would apply to someone outside the criteria. Ask your prescriber or the Ministry of Health.
What you’d pay at an Ontario pharmacy
Without ODB funding, you pay the pharmacy’s quote: drug cost, markup and dispensing fee. We haven’t confirmed what Ontario pharmacies charge for Ozempic or how their dispensing fees compare. Ask for the drug price and the fee separately.
We haven’t confirmed whether Ontario pharmacists can start or renew a GLP-1. Treat your prescriber as the route for Ozempic until we have.
Next steps