Understanding Your Coverage for Weight Loss Medications

ASEBP’s benefit plan only covers weight loss medications that are approved by Health Canada.   

• ASEBP only covers drugs approved for weight loss including: Wegovy, Contrave, Saxenda, and Orlistat. Covered members must meet eligibility criteria. Your reimbursement will vary based on the plan you are enrolled in. Find your Extended Health Care coverage on the back of your ASEBP ID card or by logging into My ASEBP.  
• Many weight-loss drugs require your health care provider to apply for special authorization coverage on your behalf. This helps ensure these drugs are taken for their intended medical purpose. 
• Special authorization includes drug-specific criteria (e.g., body mass index, other risk factors) for coverage, and may include requirements for prescription refills. 
• Your health care provider can work directly with ASEBP’s third-party administrator to confirm the criteria for special authorization weight loss drugs. 

How can I check the status of my special authorization request? 

All decisions are posted to My ASEBP and shared with your health care provider. You will receive an email notification when a decision is available. Once you log in, click, or tap Documents, then Drug Special Authorizations. A decision may take up to 14 business days once submitted by your health care provider. 

Similarities and differences

Wegovy*  Medication type: Weekly injection Coverage maximum: Two lifetime trials	Contrave*  Medication type: Daily tablet, taken multiple times/day  Coverage maximum: Two lifetime trials
Saxenda*  Medication type: Daily injection  Coverage maximum: Two lifetime trials	Orlistat (Xenical)  Medication type: Daily tablet, taken multiple times/day  Coverage maximum: none  Other considerations:  Does not require special authorization approval  Not as effective as newer weight-loss drugs

*Other considerations: 

For special authorization approval, individuals must:  

• Have a body mass index (BMI) of 27 or higher and at least one weight-related condition, such as high blood pressure/cholesterol or Type 2 diabetes. 
• Have a BMI of 30 (or greater), even if no other risk factors are present. 
• Provide a medical history regarding previous treatments for weight loss management. 
• Make lifestyle changes, such as daily physical activity and a healthy diet. 

If you stop one brand-name weight loss drug, you can apply for special authorization approval for another brand. You are still required to meet all eligibility criteria. Special authorization weight loss drugs cannot be used in combination with each other at the same time. 

ASEBP members are limited to two lifetime trials for each weight loss drug brand/molecule. A trial ends when you stop taking the product or are unable to maintain your weight loss as per special authorization criteria. 

ASEBP only covers Ozempic and Mounjaro when prescribed to manage type 2 diabetes. If you intend to use these products for weight loss, it will not be approved, even if your health care provider submits a special authorization request.

Zepbound, a new weight loss medication, was recently approved by Health Canada. At this time, it has not yet completed the necessary reviews to be considered for coverage under ASEBP plans. We will update this page when more information becomes available.

Applying for special authorization coverage 

1. See your health care provider: Make an appointment with your health care provider to gather your medical history and establish your baseline weight. Your physician or nurse practitioner will weigh you and include this information on the special authorization form that is submitted to ASEBP’s third-party administrator. Please note that your health care provider may charge a fee for filling out this form. If you have a Health Spending Account, you can use these funds to cover the fee. 
2. Begin taking the weight loss drug.

   Saxenda/Contrave: your ASEBP plan covers a 30-day supply at a time for the first four months, then you must follow up with your health care provider for a weight check. If you have lost more than five per cent of your baseline weight, you are eligible for an additional 12 months of coverage. Refills are limited to a three-month  supply.

   Wegovy: the initial start period is six months, then you must follow up with your health care provider for a weight check. If you have lost more than five per cent of your baseline weight, you are eligible for an additional 12 months of coverage. Refills are limited to a three-month supply.

3. Continue your treatment (how to obtain additional refills): After 12 months of continuous treatment, you must see your physician or nurse practitioner to submit a new special authorization request. ASEBP recommends submitting this request several weeks before your original approval expires, or you will not be eligible for additional drug coverage. Your health care provider will check your weight to confirm you have maintained your baseline weight loss. If you meet all criteria, your initial trial will continue, and you will receive an additional 12-months coverage. If your health care provider continues to submit an annual special authorization request, your ASEBP plan will cover the cost of these drugs until you stop taking them or are no longer maintaining your weight loss. 

When does a trial end?

Your trial will end if you no longer maintain your initial five per cent weight loss (from your baseline weight). This may occur after you complete an initial four-to-six months of treatment or during the annual request process when you see your health care provider for a weight check. Alternatively, your trial will end if you stop taking the drug or discontinue treatment. If required, ASEBP will review these situations on a case-by-case basis for potential exemptions (e.g., hospitalization, pregnancy, etc.). 

You may experience uncomfortable, sometimes painful, or embarrassing side effects: 

• Nausea and vomiting 
• Stomach pain 
• Severe diarrhea 
• Greasy/oily stools  

What you won’t hear from celebrities and social influencers 

Clinical research has shown that, even when taking newer drugs, weight loss levels-out within the first year because, over time, the body adapts to the same treatment or approach.  

After stopping any weight loss medication, people often regain most of the weight they lost within 12 months if they do not make healthy lifestyle changes. 

Limiting daily calories, drinking water, and getting 150-minutes of moderate intensity physical activity every week is key to maintaining weight loss. 

Working with knowledgeable health providers, such a registered dietitians and counsellors who specialize in behavioural therapy, to support a healthy weight and habits. 

Ask your health care provider about Health at Every Size® principles. 

Additional free support to help you manage your weight 

Get up to four hours of free support each calendar year from a registered dietitian, nutritionist, or fitness coach if you have ASEBP’s Employee and Family Assistance Program (EFAP). Visit wellness.asebp.ca/efap for details. 

Or lean into your Wellness Spending Account 

If you have one, use these funds to purchase: 

• home exercise equipment 
• fitness centre fees and instructed classes (monthly fees, passes) 
• Sports league/facility fees 
• Weight and nutrition counselling