Diabetic Drug Changes in the Insurance Industry

August 1, 2023

The insurance industry is seeing an uptick in the use of diabetic drugs being used by those who are not diabetic. Due to this, many insurance providers are changing how these drugs are put through their claims system. 

Ozempic is now highly publicized online by social media influencers and celebrities alike that are using this drug for weight loss. Ozempic is classified as a glucagon-like peptide 1 drug (GLP-1). While indicated for diabetes, it has been noted that a number of claimants are solely using GLP-1 drugs with no other first-line diabetic medications in their claim’s history.

For the insurance providers, many are now requiring proof of plan members having tried a first-line diabetic medication, confirmation of a diabetes diagnosis, or prior authorization from their physician to have the medication covered. Some argue that these drugs should be covered to manage weight loss, especially if a diabetes diagnosis is a possibility for that person.

First Nations Health Authority has information online about preventing and managing diabetes, as well as a summary of the diabetic drugs and supplies that are covered. In their article "Living With Diabetes in a Good, Balanced Way",  it says "Many of the mainstream messages we see and hear about diabetes focus only on the physical self. As Indigenous people, we know that our health and wellness goes well beyond this, and that we must also nurture our mental, emotional and spiritual health." Read the full article here.

The 2023 Drug Trend Report by Telus Health, the diabetes category saw an overall cost increase of $745.2 million, representing nearly 17 per cent growth and helping to vault this category into the No. 1 spot. A strong increase in claims for the diabetes drug Ozempic was a main contributor to why diabetes was the most expensive category in 2022. Source: https://www.benefitscanada.com/events/conference-coverage/2023-bps-coverage-diabetes-asthma-adhd-account-for-high-drug-claims-in-2022/

If you require a diabetic drug to manage your diabetes, we can assist you with having it covered on your plan. For more information on how your insurance provider is handling diabetic drugs, please contact our office at 1-800-667-7830.