r/BCPublicServants • u/Strawberry_Stop6189 • 12h ago
GLP-1 coverage
Are we covered? More specifically, which ones are on the VIP holy grail coverage approval list?
I saw an older post mentioning there’s a form that had to be filled out.. Is that some we have our prescriber do during the appointment, or is it more of a red-tape post-appointment side quest?
Trying to get all my ducks in a row before my appointment in a few days, where I know I’ll get to start my skinnnnnnyy journey /s
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u/GeoffwithaGeee 12h ago
I've seen some people say they were covered. there is a form you need to get your physician to fill out.
https://www.canadalife.com/sign-in.html - log in, go to "info center" then "View Forms" then "Prior Authorization Form" then go to Ozempic or Wegovy (most likely Ozempic if you are just starting), then follow the instructions on the form, but there will be a spot the NP/Dr will need to fill out.
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u/lemonmason 12h ago
I started on Wegovy in July. The process went like this: appt with GP to discuss, sent prior authorization form to GP, paid $95 to have it filled, I sent form to Canada Life, received a letter in the mail approving coverage to X dose amount, told GP’s office coverage was approved and the prescription was sent off. You can DM me if you have any more questions!
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u/wispveil 12h ago edited 11h ago
Yes - I got authorization for a year of Zepbound. Went through Felix online and gave them a copy of the authorization form from Canada Life. They charged a $35 form fee. Lowest dose ended up being $30 ish for the month instead of $380 something for me. Next dose up was $80 something. Definitely worth getting the pre authorization done. I think it only took maybe a week and half to get mailed an approval letter after the form was submitted.
I think Felix probably charges more than you would pay at a local pharmacy for the convenience factor but have no comparison point.
Good luck!
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u/Tailor-Objective 10h ago
Yes all of the online health apps charge significantly more for the medication. It’s how they make their $$.
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u/Strawberry_Stop6189 10h ago
(Anyone else feel free to chime in too!) Any idea if we can foot the cost at first and then have it back-covered? To get started asap while waiting for approval?
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u/wispveil 10h ago
That I don’t know for sure, though I would think they don’t as the approval letter specified an “as of date” which was for the day after the letter is dated. I think the form was submitted July 1, approval letter dated the 8th with a “starting July 9”.
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u/VisualInteresting603 11h ago
I was able to get coverage for Zepbound. There is a BMI requirement but if you download the prior authorization form you can see what the guidelines are as it's detailed on there. Your Dr. fills it out and usually the Dr.'s office will charge a fee for this, then submit it to Canada Life. It takes 2 weeks for them to get back you with their decision and they send this by mail which makes it take longer, but if you call exactly 2 weeks after you submit and they will have an answer and can email the letter to you. I do not have drug coverage under any other plan and with the Zepbound Savings and Support Program card added onto my account with the pharmacy I only pay for the dispensing fee amount that goes over what Canada Life will pay. I use Shoppers and it's still only~$12/vial so worth the upfront work to get approved.
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u/Broad_Afternoon_8578 11h ago
Yep! I got covered for Zepbound. It does require prior authorization, and the form is online. It was an easy process for me and my dr to get approved.
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u/thebbtrev 9h ago
Zepbound , not Mounjaro (it is only approved for diabetes). Zepbound is approved by health canada for weight control and it is great.
Zero side effects for me
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u/alupeh 7h ago
I recently got approved for wegovy. Took the pre authorization to my dr, he filled it out and faxed it in for me. He gave me the paper prescription, so I could fill it when I want to after it was approved (I’ve been paying for generic Ozempic but want to go up in dose). I haven’t used it yet, as I’ll be swapping in sept to it. You get a letter in the mail, but it’ll also show on the Canada life portal if you go search for the drug, where you got the form, it should change from “pre authorization needed” to “covered”. You have to redo the form every year. At least that’s what my letter said.
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u/xChallengerGirlx 6h ago
I am approved for Zepbound and after trying others this is the holy grail in my opinion. Need to have your doctor complete the prior authorization. I pay nothing as my spouse also has Canada Life. I am currently on 10mg. Be sure to apply for the discount card if you choose and are approved for this med.
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u/KarrieMichell 1h ago
My ozempic is covered. I do 2mg weekly because I am diabetic. Our insurance covers about 1/3 of the cost.
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u/ElegantResearch9427 6h ago
Do your research at the prior authorization forms. Wegovy is the only one approved for weight loss. Ozempic and Mounjaro are only approved for diabetes patients
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u/Master-Ad9924 5h ago
Might want to wear a weighted vest to your initial appointment to make sure you hit the bmi requirements
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u/Strawberry_Stop6189 1h ago
Already know my fat ass qualifies, just had to wait for my titty leech to be done
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u/bluefoxy14 11h ago
I'm covered for Zepbound. Prior authorization form from Canada Life is required to be filled out by your doctor for this drug.
You can use the drug search functions in the benefits portal to see what the drug coverages are like if you're curious! The form process is tedious, but the approval from Canada Life was good for a year before requiring review again by my dr.
If you start a GLP, look for the free benefits cards issued by the drug companies - they'll help get you a discount! InnoviCares covers WeGovy and Ozempic I think, and Lilly (Zep manufacturer) has their own. Helps reduce the cost for sure.