The growing availability—and social media buzz—around brand-name weight loss drugs in Canada has brought a lot of attention to their short-term effectiveness. While your ASEBP benefit plan does provide coverage for many of these special authorization drugs, there are important considerations to keep in mind before starting treatment. This includes how to apply for special authorization, eligibility criteria, and how refills are managed over time. 

This article offers a clear overview of what ASEBP covers, how to access these benefits, and what to expect throughout the process. If you still have questions after reading, please connect with a benefit specialist for personalized support. 

What is covered? 

ASEBP only covers weight loss drugs approved by Health Canada including: Wegovy, Contrave, Saxenda, and Orlistat, provided you meet specific eligibility criteria.  

Your reimbursement amount depends on your Extended Health Care coverage, which can be found on the back of your ASEBP ID card or by logging into My ASEBP. 

Special authorization process 

Many weight-loss drugs require special authorization before they are covered. This process ensures the drugs are used safely and for medically appropriate reasons. 

To qualify, your health care provider must submit a special authorization request to ASEBP’s third-party administrator. Each drug has its own eligibility criteria, which typically include: 

• A body mass index (BMI) of 30 or higher or a BMI of 27 or higher with at least one weight-related condition (e.g., high blood pressure, high cholesterol, or Type 2 diabetes). 

• A record of previous weight loss treatments. 

• A commitment to lifestyle changes, including healthy eating and regular physical activity. 

Some drugs may also have rules around prescription refills or follow-up evaluations. Your health care provider can work directly with ASEBP’s third-party administrator to determine whether you meet the necessary criteria for coverage. 

Note: While you are free to make your own choices regarding medications, ASEBP/ABC will only consider approval for one special authorization weight loss drug at a time. Combination use is not eligible for coverage. If you stop using one brand, you may apply for coverage of another, provided you continue to meet the eligibility criteria. 

How to apply

Talk to your health care provider: Book an appointment to discuss your weight management history and goals. Your provider will document your baseline weight and complete the special authorization form on your behalf. They may charge a fee for completing this paperwork, which you can cover using your Health Spending Account if available.

Start your medication:

• Saxenda/Contrave: Initial coverage provides a 30-day supply at a time for the first four months, followed by a weight check with your health care provider. If you have lost more than five per cent of your starting weight, you may be approved for an additional 12 months of coverage.
• Wegovy: The initial period lasts six months, followed by a weight check. Continued coverage also depends on five per cent weight loss.
• Refills are typically limited to three months at a time.

Ongoing authorization and monitoring: After 12 months of treatment, your health care provider must submit a new special authorization request. You will need a weight check to confirm you have maintained at least five per cent of your baseline weight loss. If you continue to meet the criteria, you will receive an additional 12 months of coverage. As long as your provider submits annual requests and you meet the eligibility criteria, your ASEBP plan will continue to cover the cost of these drugs until you either stop taking them or are no longer maintaining your weight loss.

Note: Make sure to submit your renewal request a few weeks before your current authorization expires to avoid a gap in coverage. 

When does a trial end?  

Your trial may end if: 

• You stop maintaining the required five per cent weight loss (from your baseline weight). 

• You discontinue the medication or choose to stop treatment. 

• You do not meet the criteria during an annual reassessment. 

In some cases—such as hospitalization or pregnancy—ASEBP may consider exceptions on a case-by-case basis.  

Which medications are covered? 

ASEBP covers several weight loss drugs, each with specific requirements, medication types, and trial limits. To see a side-by-side breakdown of available options—including whether special authorization is needed and how many lifetime trials are allowed—check out this fact sheet.  

Note: Ozempic and Mounjaro are only covered for treating Type 2 diabetes—not for weight loss—even with a special authorization request. ASEBP/ABC only approves drugs for weight loss that are officially approved for that purpose by Health Canada. 

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.

Tracking your application status 

All special authorization decisions are posted in your My ASEBP account and shared with your health care provider. You will receive an email notification once a decision is available. Log in, go to Documents, and select Drug Special Authorizations. It may take up to 14 business days from the time your provider submits the request. 

Potential side effects 

Like many medications, weight loss drugs can have side effects. Common ones include: 

• Nausea and vomiting 

• Stomach pain 

• Oily or greasy stools 

• Severe diarrhea 

Speak to your provider if symptoms are persistent or disruptive. 

What you won’t hear from celebrities and social influencers  

Even with newer medications, clinical research shows that weight loss often levels out after about one year. The body can adapt to medication, and many people regain weight after stopping—especially if no long-term lifestyle changes are in place. 

To support lasting results, focus on: 

• Limiting daily calories and drinking plenty of water. 

• Getting at least 150 minutes of moderate physical activity each week. 

• Working with health professionals like dietitians or behavioural counsellors. 

Weight loss medications can be an effective part of a broader health strategy—but they work best when combined with sustainable lifestyle habits. Talk to your health care provider to determine whether these medications are right for you.