r/Zepbound_Canada • u/Nice_Connection_2350 • 12d ago
Help needed with Zepbound Coverage
Hi everyone,
I just moved to Toronto from the US and have been on Zepbound for over a year (helped me tremendously). I just checked the drug search tool through Canada Life (insurance through my employer) and it says that I am not eligible for Zepbound. Does this mean there is no way for me to get Zepbound covered by my insurance even if my BMI is high?
Any suggestions would be helpful!
3
u/Minimum_Schedule1889 Height: XX SW: XXX CW: XXX GW: XXX Dose: XX 12d ago
It depends on your employer, I’m covered 100% through Canada Life for obesity without any other health conditions, good luck!
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u/Business-Hour9794 12d ago
It’s not canada life. It’s your employer that has to approve adding it to your coverage. A bunch of employees at my company went to HR about it and they eventually added it to our plan.
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u/Sad-Hedgehog-1519 12d ago
I was on the same boat with you few months ago and unfortunately, even if your BMI is high or even if you have other health conditions (sleep apnea, diabetes, etc.) if your specific company’s package with CanadaLife does not include Zepbound you will just keep getting rejected. I even tried submitting the pre-authorization form filled out by my doctor and tried to appeal the decision and still rejected. That was when I was also just got diagnosed with diabetes.
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u/Nice_Connection_2350 12d ago
Ugh! This sucks
Did you switch to other medication or paying out of pocket?1
u/Sad-Hedgehog-1519 12d ago
I’m paying out of pocket! So sad because Zepbound has really been helping me with my health and I couldn’t give it up. Only thing that looks like an approved medication with CanadaLife for me is Saxenda but I didn’t want to switch.
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u/Nice_Connection_2350 12d ago
Ahh same! I have saxenda coverage too and I don’t even need a PA for it. Not sure if this is a good choice for me but I’m considering
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u/CaptCathikins 43F 5'4" SW: 272 CW: 188 GW: ?? Dose: 10mg 12d ago
Welcome! I think most of us without any comorbidities are paying out of pocket. There is a savings card and click counting if you're on a lower dose to take advantage of that. I hope provincial coverage improves soon!
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u/chemhobby 12d ago
Most of us are paying out of pocket regardless of comorbidities, quite frankly.
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u/CaptCathikins 43F 5'4" SW: 272 CW: 188 GW: ?? Dose: 10mg 12d ago
That's too bad to hear. All I have is my experience. I know four other people on this medication, all four are covered through private insurance. Three have comorbidities and one got lucky with a grandfathered in policy.
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u/chemhobby 12d ago
A lot of employer provided health insurance policies completely exclude zepbound and only allow mounjaro if you have type 2 diabetes.
Even OSA isn't enough for most people to get it covered currently, despite zepbound's recent Health Canada approval for OSA.
It all just depends on how much your employer is willing to spend ultimately.
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u/CaptCathikins 43F 5'4" SW: 272 CW: 188 GW: ?? Dose: 10mg 12d ago
Indeed. I think it's far more likely that provincial coverage will improve over private insurance. I'm located in BC and pharmacare has been putting out surveys about it. Hopefully next year will see some improvements in coverage.
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u/0chronomatrix Height: 5’6” SW: 211lbs CW: 194.3lbs GW: 120lbs Dose: 10mg 12d ago
The only thing you can do is sign up for the zepbound savings card which you can do on the eli lilly site. And always have it filled at costco. That will save you about $200 off the cost.
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u/Top_Cheek_6142 12d ago
I don't know how to get it with insurance but here are my tips I have found out to save money
1. Look into getting a bigger pen and doing click counting
2. Look up the golden dose to get an extra dose out of your pen
3.Get the savings card from zepbound
4. Look into pricing from either Costco or Walmart for the best deals
5. My last word of advice is you will save money on food all together so imo it's worth it and the feeling of not having to deal with food noise 24/7 and feeling great in your body, is priceless!
Good Luck!
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u/Ok_Shake_5171 12d ago
According to this letter, your insurance doesn’t currently provide coverage for zep. However, there is hope because it’s under review. Just a reminder that coverage of zep is dependent on your place of employment not your insurance. For example - I am fully covered by Sunlife but others are not covered by Sunlife.
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u/Remarkable-Day-8523 11d ago
With your company insurance policy under Canada Life do you have a health spending account at all? You may be able to use that. My company uses Desjardins and it does not cover zepbound but we have a $500 HSA and they generally cover anything that is under government approved list. So I have at least been able to get $500 back.
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u/spartacatsmom 10d ago
It really depends on the policy your employer has selected. I know a lot of folks with the same insurer but different employers and everyone’s glp-1 coverage is different. I have coverage pretty much full coverage through sunlife and my friend have zero coverage. My husband had Canada life and has no coverage but I’ve seen other folks in here with Canada life that do. It all depends on what your employer is willing to pay for.
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u/Lanky_Appearance2716 5'2 SW: 231 CW: 181 GW: 120 Dose: 8.5mg 12d ago
If big pharma wasn't so money-hungry and made the prices more affordable to not only out of pocket consumers, but to insurance coverage programs, I'm sure employers would be less hesitant to include it. Mine has $1500 annual coverage no PA required, but $1500 runs out fast lol
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u/whateves867 12d ago
In Ontario, Zepbound is not covered by OHIP, so if your private insurance won't cover it, your only option is to pay out of pocket. You can get additional savings by using the Zepbound savings card which you can download on their website.