Roughly three million Canadian adults are now taking GLP-1 drugs, such as Ozempic and Mounjaro, with another two million saying they would like to but are held back by cost and coverage.
For health insurers and group benefits sponsors, that scale of demand is turning GLP-1s from a niche therapy into a major driver of claims, plan design and risk.
According to a survey from Leger Healthcare, 8% of respondents are currently on a prescription GLP-1. Extrapolated to the national adult population, that equates to about three million people. Meanwhile, a further 6% said they are interested in taking a GLP‑1 but are not doing so at present.
Weight loss was the main reason cited by those taking or considering GLP‑1s (58%), ahead of diabetes (42%) and heart health (22%). That mix of motivations matters for insurers because public drug plans generally only cover GLP‑1s for type 2 diabetes, leaving most obesity‑focused use in the private market, the survey said.
Leger’s survey also underlined how uneven coverage is today. Among respondents currently taking a GLP‑1, one quarter said they are paying the full cost out of pocket. Just over a quarter reported that their medication is fully covered by either private or public insurance, while almost half said they have partial coverage. Given that GLP‑1s can cost hundreds of dollars per month, those figures translate into a substantial out‑of‑pocket burden for many users, and a material claims cost for both public and private plans where cover exists.
More than half of those interested in starting a GLP‑1 said that having insurance coverage or lower‑cost generics would affect their decision, reinforcing the role of benefits design and underwriting criteria in determining future uptake. Side‑effects are another constraint on demand: 36% of interested non‑users said they would be more likely to take a GLP‑1 if the risk of adverse effects were lower.
Gastrointestinal issues such as nausea, vomiting, constipation and diarrhoea are common, with more serious complications including gallbladder inflammation and pancreatitis reported in a minority of patients.
For private health insurers, GLP‑1s raise several immediate questions. The first is sustainability. If current usage of around three million adults rises closer to the additional two million who said they would like to start, even a modest increase in plan coverage could produce a sharp uptick in drug spend. The survey suggested that many of those would only proceed with insurance support, signalling further cost pressure on employer‑sponsored and individual health plans.
The second issue is plan design and eligibility. The split between weight‑loss and diabetes indications meant carriers and sponsors will need clear criteria on whether to restrict coverage to diabetes (and, if so, under what clinical rules), or to extend support to obesity and cardiometabolic risk reduction more broadly. That in turn raises equity questions between members who qualify for public drug coverage and those who do not.
The third consideration is risk management and long‑term outcomes. The survey indicated that GLP-1 users are changing their behavior, with more than half reported decreased appetite, 40% fewer food cravings, around 30% less frequent restaurant or take-out spending, and about 35% smaller portions, "lighter" choices or not finishing meals. Thirty-six percent (36%) reported reduced alcohol consumption. Around a third said they are buying more fresh fruit, vegetables and protein-rich foods, and many reported increased spending on fitness and personal care.
From a morbidity and life‑insurance perspective, those shifts could be positive, pointing to improvements in weight, blood sugar and cardiovascular risk over time. But they also depend on adherence. If cost or side‑effects drive high discontinuation rates, any underwriting or pricing assumptions based on sustained use could quickly become outdated.
The survey also highlighted how much of the current GLP‑1 burden is being carried outside public drug plans, concentrating financial risk in employer and individual health products, and in some cases on the individual entirely.
For group benefits advisers and insurers, likely responses include tighter prior‑authorization processes, especially for non‑diabetes indications; the use of maximums or step‑therapy requirements to manage utilisation; and closer integration with wellness, weight‑management and disease‑management programmes to try to translate drug use into durable health gains.
At the same time, the finding that more than half of would‑be users are waiting on insurance coverage or lower‑cost generics points to a potentially large “shadow” demand. As patents expire and lower‑priced options emerge, insurers may see renewed pressure from plan sponsors and members to expand coverage criteria.
