For three years, Sandra paid hundreds of dollars a month out of pocket for semaglutide and similar medications. When the price of her weight-loss prescription climbed to $571 a month, she resorted to putting some of it on a credit card, cutting back on other spending, and stretching the time between doses from seven days to 10 (not something her doctor had advised).
But this past April, Health Canada authorized the first generic version of semaglutide – the drug behind Ozempic and Wegovy – and another in May. And last week, Sandra picked up her first pen of generic semaglutide from an Ontario pharmacy.
The final price, including pharmacy fees and markup? $88.88.
“I was relieved,” says Sandra, whom The Margin is identifying by a pseudonym to protect her medical privacy. “I was on the borderline of being in debt [due] to being on the medication.”
The arrival of Canada’s first generic semaglutide products brings with it the potential of major savings for other patients, but Health Canada's approval didn't produce a seamless switch. Pharmacy supply remains inconsistent, provincial drug plans haven't all added the generics, and private insurance rules can still block people from receiving coverage, leaving them to pay for it themselves.
The first two generics are lower-cost alternatives to Ozempic, approved for adults with Type 2 diabetes, though some doctors prescribe semaglutide off-label for weight loss as well. A third, called Sevmia, was recently authorized as a generic version of Wegovy specifically for weight management. Although Ozempic and Wegovy both contain semaglutide, Health Canada approves each generic against a specific brand-name reference product, which is why the diabetes and weight-loss versions required separate approvals.
Even then, though, the cheaper versions don't guarantee access. Paul Grootendorst, a professor at the University of Toronto's Leslie Dan Faculty of Pharmacy who studies pharmaceutical markets and drug pricing, says insurers that won't cover Wegovy today probably won't cover a cheaper version, either – at least, not without a fight. The generic drug still costs enough that insurance plans would have reason to restrict their coverage.
Kristen Watt, an Ontario pharmacist and incoming chair of the Ontario Pharmacists Association’s board, admits that many pharmacies are experiencing uneven supply and are struggling to consistently keep the new generic products in stock.
“It has been hit-or-miss, but we are seeing increasing stock supplies reaching pharmacy shelves,” she says.
Some pharmacies have received limited stock; others couldn't obtain it at all on certain days. Availability is improving, Watt says, but she expects the situation to get harder before it gets easier: once public and private plans start covering the generic more widely, the current supply probably won't be enough to meet the demand.
For now, most patients getting the generic are paying out of pocket. Ontario's public drug plan hasn't added it yet, and a lot of private insurers haven't updated their coverage. Even patients who want to switch from Ozempic can't always do so automatically, because Ontario pharmacists can only substitute a generic if the prescription is written for semaglutide, not the brand name. Anyone whose doctor wrote "Ozempic" on the prescription has to go back and get a new one.
Both generic products have a wholesale price of $78.14 per pen. One pen typically contains four doses, making it a fraction of the cost of Ozempic.
For those who can get their hands on the generic and pay for it themselves, the savings are immediate. According to Watt, both generic products have a wholesale price of $78.14 per pen, before pharmacy markup and dispensing fees. One pen typically contains four doses, making it a fraction of what Sandra paid for her previous prescription. That discount is partly by design. Under federal rules, once two companies are selling a generic version of the same drug, the manufacturer price is capped at 50% of the brand-name list price. And the companies can decide to charge even less.
But the cap applies to what manufacturers charge, not what patients pay, and pharmacy fees and markups can raise the retail price. And a lower manufacturer price doesn't automatically mean better access, since each province decides for itself when and whether to add a drug to its public plan. That can leave insured patients facing more obstacles than someone who can afford to pay at the counter.
Some pharmacies report limited supply, or even receiving zero doses of generic semaglutide.
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Tiffanie, who lives in East York, Ont., knows how those restrictions can play out. She was prescribed Ozempic in January 2024 for Type 2 diabetes. Her private insurance initially covered about 90% of the cost, but stopped paying after less than a year, demanding more information from Tiffanie about why she was on the medication.
By then, Tiffanie says, the medication had improved her blood sugar, weight, and blood pressure, and she didn't want to stop taking it. So when her coverage ended, she resigned herself to paying hundreds of dollars a month to keep taking Ozempic. “It meant I definitely had to hold back on some of the things that I would normally buy,” she says.
In fall 2025, she tried to regain coverage. To do that, the insurer required her to complete a prior authorization process and to instead try metformin, a low-cost pill often used as the first medication for Type 2 diabetes. But when metformin didn't work, Tiffanie's claim was still denied – her A1C, a measure of average blood sugar over two to three months, was below the plan’s required threshold of 7.0%. That threshold is even higher than the 6.5% that Diabetes Canada uses to diagnose the condition in the first place.
Tiffanie restarted the brand-name Ozempic at the beginning of 2026 and went back to paying out of pocket.
“I was feeling like I really needed to go back on it, even despite the cost,” she says. She hasn't switched to the generic version because her doctor advised that she stay with her current treatment while some other health problems get assessed. But, Tiffanie admits, a lower price would have changed her earlier decision to stop.
“I would have kept going on [with the medication],” she says.
Tiffanie's A1C, a measure of average blood sugar over two to three months, was below the plan’s required threshold of 7.0%. That threshold is even higher than the 6.5% that Diabetes Canada uses to diagnose the condition in the first place.
Grootendorst says the early demand for generic semaglutide is “probably a mix of people switching from the brand and some people entering the market given the lower price.” He doubts that broader insurance coverage is driving the demand yet, because plans haven't substantially changed their rules.
However, he's less optimistic about what'll happen when a generic version of Wegovy eventually arrives.
“It’s cheaper, but it’s not going to be dirt cheap,” Grootendorst says. “I’d imagine there would still be some roadblocks. Insurers that were restricting access to the branded version would probably still have restrictions on the generic.”
He thinks prices may eventually fall low enough that insurers devote less effort to limiting access, but couldn't point to a specific threshold. For now, a generic may reduce the cost of treatment, but it can't change the eligibility rules patients have to meet.
For Sandra, the lower price made a dramatic difference. She began with Ozempic, then changed to Wegovy, and later a non-semaglutide medication called Mounjaro that was the most expensive of them all – she nearly stopped treatment because of the cost. Even after finding a manufacturer discount, she still shelled out $339 a month, all out of pocket. Paying just $88.88 for generic semaglutide means that Sandra no longer has to put her prescription on a credit card, stretch the time between doses, or cut back elsewhere.
But Sandra's story is also a reminder of who benefits first from the generic rollout: the ones who can get the right prescription, find the drug in stock, and pay for it themselves at the counter. For anyone waiting on public coverage or fighting their insurer, those savings are still much harder to get.
