On behalf of the Board of Trustees of the NB Pipe Trades Health Plan, and NexgenRx, our office would like to inform you that there are changes being made to the coverage for Ozempic 1 MG/DOSE (4 MG) PEN DIN 02471469 and Ozempic 0.25 - 0.5 MG/DOSE PEN DIN 02471477. Health Canada has approved this medication to improve blood glucose control with individuals with type 2 diabetes, it is not approved for weight loss; therefore, effective June 1, 2023 Ozempic will no longer be a covered benefit if used only for weight loss.
We understand that this may have an impact on our plan members' and eligible dependent's health and well-being, and we want to ensure that you have access to medication when appropriate. Under this plan Ozempic will now require prior authorization to ensure this medication is being used for individuals with type 2 diabetes. However, if you or any eligible dependent are currently on Ozempic, and your claim history indicates that within the last six months you have claimed for any diabetes drugs or blood glucose monitoring products then Ozempic will continue to be paid. If you claim for Ozempic with no history of blood glucose monitoring products or any diabetes drugs, then your claim will be denied. For individuals whose claims are denied, and have recently been diagnosed as a type 2 diabetic, please complete the enclosed Prior Authorization Form - Ozempic and return it to our office for consideration for coverage.
We value our members' health and well-being and are committed to providing the best options for your care.
If you have any questions regarding this memorandum, please contact our office at 506-459-6040 ext 1.
Sincerely,
Dawna Gallant
