If semaglutide becomes generic, we can offer it more easily to our patients
A political gesture in Washington has cast an unexpected light northward, prompting Canadians to examine their own relationship with a class of drugs that has quietly reshaped how medicine thinks about weight and metabolic disease. While President Trump's deal with Eli Lilly and Novo Nordisk promises to lower GLP-1 drug costs for Americans, Canada finds itself on the eve of a more structural shift — the expiration of a key patent that could make semaglutide dramatically more affordable without any political intervention. The deeper question is not one of price alone, but of who gains access, who bears the cost, and how medicine navigates the space between clinical need and commercial availability.
- Trump's announcement of $50 copays and a new direct-purchase program signals a major accessibility push in the U.S., where GLP-1 drugs have long been financially out of reach for millions.
- Canadian patients and physicians are watching closely, but the real disruption is domestic — Novo Nordisk's semaglutide patent expires in Canada in January, potentially collapsing monthly costs from $400 to under $100.
- Provincial drug budgets, already strained by a $3 billion rise in prescription spending between 2017 and 2023, face a paradox: cheaper drugs could mean more prescriptions, not less financial pressure.
- Wegovy remains uncovered by any Canadian provincial plan, leaving a patchwork of private insurance to determine who can access weight-loss treatment — a gap that cheaper generics may widen rather than close.
- Physicians like Dr. Nisha Gupta welcome the prospect of affordable semaglutide but caution that uncertainty remains around dosing, formulation, and the boundaries of off-label prescribing.
When President Trump announced a deal with Eli Lilly and Novo Nordisk to lower the cost of GLP-1 weight-loss drugs for Americans, the news landed differently in Canada. Under the agreement, Medicare-eligible patients will pay $50 copays for Zepbound and Wegovy, while uninsured Americans can access them through a new program called TrumpRx at roughly $350, dropping to $245 over two years. In the U.S., where monthly costs have often exceeded $500, this represents a meaningful shift.
For Canada, the picture is already different. Dr. Nisha Gupta, an endocrinologist at McGill University, points out that when exchange rates are considered, Canadians are paying substantially less than uninsured Americans — though monthly costs of $300 to $500 remain significant. Ozempic alone is used by more than 200,000 Canadians, approved for diabetes, while Wegovy carries approval for weight loss.
The more consequential development for Canada may have nothing to do with Washington. Novo Nordisk's patent on semaglutide — the active ingredient in both drugs — is set to expire in Canada in January. Pharmaceutical pricing researcher Mina Tadrous of the University of Toronto estimates that generics could bring monthly costs below $100, down from roughly $400. That kind of drop would be transformative.
The stakes are real. Canadian public drug spending rose by more than $3 billion between 2017 and 2023, with antidiabetic medications including Ozempic accounting for a notable share of that growth. Cheaper access could expand the patient population significantly — but it also raises harder questions. Wegovy is not covered by any provincial plan, and private insurance coverage varies widely. If semaglutide becomes generic and affordable, demand for both approved and off-label uses is likely to rise, placing physicians in the position of navigating clinical judgment against an uncertain and evolving coverage landscape.
On Thursday, President Trump announced a deal with two major pharmaceutical companies aimed at making weight-loss drugs cheaper and more accessible to Americans. The agreement with Eli Lilly and Novo Nordisk will expand Medicare coverage for Zepbound and Wegovy—medications that belong to a class called GLP-1 receptor agonists—starting next year. For those who qualify, the copay will drop to $50. For uninsured Americans, a new program called TrumpRx will allow direct purchases from manufacturers at roughly $350 initially, falling to $245 over the next two years. In the U.S., these drugs have remained out of reach for many people, with monthly costs often exceeding $500 before insurance.
But the announcement, while significant for Americans, arrives at a moment when Canada is already ahead on price. Dr. Nisha Gupta, an endocrinologist at McGill University, notes that when exchange rates are factored in, Canadians are already paying substantially less for GLP-1 medications than their American counterparts. Here, monthly costs range from $300 to $500—still high, but lower than what uninsured Americans face. Ozempic, approved in Canada for diabetes, and Wegovy, approved for weight loss, are both made by Novo Nordisk and have become enormously popular, with Ozempic alone serving more than 200,000 Canadians.
What could reshape the Canadian landscape has nothing to do with Trump's deal. In January, Novo Nordisk's patent protection for semaglutide—the active ingredient in both Ozempic and Wegovy—is set to expire in Canada. When that happens, generic versions will likely flood the market. Mina Tadrous, a pharmaceutical pricing researcher at the University of Toronto, estimates the price could plummet from $400 to under $100 per month for the same strength. That potential drop would be transformative for a country where these drugs have already begun straining provincial budgets.
The scale of that strain is substantial. Between 2017 and 2023, spending on prescription drugs through Canada's public plans rose by more than $3 billion, reaching over $14 billion annually. Three antidiabetic medications, including Ozempic, accounted for nearly two percent of that growth. The drug has become so widely prescribed that any significant price drop could either make it available to far more people or, conversely, ease pressure on provincial drug plans that have been absorbing the cost.
But cheaper access raises its own questions. Wegovy is not covered by any provincial government in Canada, though some private insurance plans may cover it depending on their criteria. If semaglutide becomes generic and affordable, more patients might seek prescriptions—not just for approved uses like diabetes and obesity, but for off-label purposes as well. Dr. Gupta sees the potential benefit: "If semaglutide becomes generic, it'll be something we can offer more easily to our patients who are overweight or obese." Yet she also acknowledges the uncertainty. What type of generic will arrive, at what doses, and for what conditions remains unclear. Whether physicians will prescribe it beyond its approved uses will depend entirely on individual clinical judgment and the evolving landscape of insurance coverage.
Citas Notables
If semaglutide becomes generic, it'll be something we can offer more easily to our patients who are overweight or obese.— Dr. Nisha Gupta, endocrinologist at McGill University
Whether others will prescribe it for other things that are not approved, that's very physician-dependent.— Dr. Nisha Gupta
La Conversación del Hearth Otra perspectiva de la historia
So Trump's deal sounds like a big win for Americans. Does it change anything for Canadians?
Not directly. Our prices are already lower because of how our drug system works. But what matters more is what happens in January when Novo Nordisk's patent expires here.
And that's when generics arrive?
Exactly. One researcher estimates the price could drop from $400 to under $100 a month. That's the real story for Canada.
But if it gets that cheap, won't everyone want it?
Possibly. Right now Wegovy isn't covered by provinces at all. If it becomes affordable, we might see a lot more prescriptions—for weight loss, for diabetes, maybe for things it's not officially approved for.
Is that a problem?
It depends. Cheaper access means more people get help. But it also means provinces and insurers have to figure out what they'll actually pay for, and doctors have to decide when it's appropriate to prescribe.