Limited coverage drugs – semaglutide

Generic name

semaglutide

Strength

1.34 mg/mL

Form

solution for subcutaneous injection

Special Authority criteria

Approval period

As part of treatment for type 2 diabetes mellitus:

  • After inadequate glycemic control on maximum tolerated dose of metformin

Indefinite

Practitioner exemptions

  • None

Special notes

  • A minimum 3-month trial of metformin should be considered
  • Special Authority coverage of semaglutide is available for up to a maximum dose of 1 mg weekly, in a pen delivery device intended to give a 1 mg dose. The 2 mg dose is currently under review for reimbursement
  • Note: Taking two 0.5 mg doses from a pen delivery device designed to give a 0.5 mg dose is not covered, because the cost is approximately double the cost of a single 1 mg dose in a 1 mg/dose pen
  • Coverage will be provided for either semaglutide or an eligible dipeptidyl peptidase-4 (DPP-4) inhibitor – not both at the same time
  • For patients with Special Authority coverage for a DPP-4 inhibitor, approval for semaglutide coverage will result in discontinuation of coverage for the DPP-4 inhibitor 

Special Authority requests