At Dr. David Macklin’s weight management practice in Toronto, the name Ozempic is mentioned almost daily in appointments. But recently, another word is coming up just as often — generics.
“It is a regular conversation, daily in fact, where patients will be asking when their … medications may be less expensive,” said Macklin, who is the director of the Medcan Weight Management Program.
Novo Nordisk — the company behind blockbuster diabetes and weight-loss drugs Ozempic and Wegovy — had for years held a patent on semaglutide, the active ingredient in those drugs that mimics the hormone insulin and is used to treat diabetes and to aid weight loss.
The patents kept costs high because Novo Nordisk was the only company that could make the drugs. According to Macklin, a monthly supply of Ozempic or Wegovy costs between $300 and $400 — sometimes even more depending on the dose.
But Novo Nordisk’s patent expired in Canada in January, followed by a number of other countries including India just last week — paving the way for cheaper, generic versions.
While it’s not clear exactly when generic versions of these drugs will be available in Canada, patients and doctors are eagerly anticipating that moment, because it means the medications will become more cost effective and accessible to those who need them.
“It’s an extremely exciting prospect that individuals living with this real disease have access to a remarkably safe and effective medication,” said Macklin, referring to obesity and generics lowering the cost.
Macklin receives honoraria and consulting fees and serves on the national advisory boards for the manufacturers of Novo Nordisk and Eli Lilly, which makes Mounjaro, a different Type 2 diabetes drug also used for weight loss.
Right now, Health Canada says there are nine generic semaglutide medications under review for approval in Canada. The agency’s target timeline for initial review of a generic drug is 180 days, and it says it’s “on track to meet review targets” for submissions for generic semaglutide medications.
While Health Canada doesn’t give any further timeline as to when drugs might be approved, Mina Tadrous, associate professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto, says he estimates generics might be available by this summer or early fall.
In India, a number of companies secured early approval for generics and started selling them the day the patents expired. One Indian company was offering generics for as little as $19 Cdn a month. Analysts expect around 50 generics could enter the Indian market within months.
Tadrous says that while India is a major supplier of pharmaceuticals and ingredients to Canada and often gets generics first, all of those drugs still have to go through Health Canada’s approval process before they can be sold here. So it’s unlikely generics approved there will have any short-term impact on Canada.
How much the generics will cost depends on a number of factors based on Canada’s drug pricing framework, but Tadrous says once enough generics come online, it could be around $100 a month or less depending on the dosage — a substantial savings for Canadians.
“I think it’ll be a big turning point,” he said.
Patients like Sarah Brooks are eagerly awaiting generics.
She first went on Ozempic in 2023 to help manage her weight and “food noise” — persistent food thoughts and cravings. It also helped Brooks feel full after eating in a way she never had before.
But when Brooks lost her job in late 2024, she also lost her benefits and couldn’t afford the medication. When that happened, she regained the weight she’d lost, a common occurrence for patients who stop taking semaglutides.
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Brooks has been back on semaglutide for a year — she now uses Wegovy — as her new job’s benefits do cover some of the cost. But she has to use a discretionary benefit amount, as semaglutides aren’t covered like other prescriptions under her plan.
“Our benefits allot us $2,000 a year, and I’m gonna blow that all on [the meds],” Brooks said.
She hopes the generics come online soon, as her benefits will only cover a few more months of Wegovy. She thinks she might be able to pay out of pocket to stay on the medication for a little while, but depending on other personal costs, she says she might consider skipping some doses.
“I hope it doesn’t get to that,” Brooks said, adding the medication “just makes life easier.”
Nav Persaud, Canada Research Chair in Health Justice and a staff physician at St. Michael’s Hospital in Toronto, says cost is a major issue for his patients.
Even those with insurance can struggle to afford the co-payments because it’s so expensive. Persaud says patients without coverage almost always have to reduce their dose or stop taking the medication entirely, often leading to tough decisions about whether to prioritize their prescriptions or necessities like groceries.
He says patients who have to go off the meds often find it frustrating to regain the weight.
“In that situation, most people regret having taken the medication and wish that they had never heard of it because they’re out the money and they are at the same weight or higher than when they started.”
For that reason, doctors like Persaud who treat obesity are glad generics are finally on the way — though he says Canadians shouldn’t have to wait until patents expire to access life-changing drugs like GLP-1s.
He says the federal government could have issued a compulsory licence to allow a third party to make semaglutide drugs so Canadians could access the medications at a more reasonable cost before the patents came off.
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Macklin, the weight management doctor, says improving access to generics could have societal benefits as well, because obesity is still so heavily stigmatized.
He says it’s seen as a “disease of choice, where people are eating too much and not trying hard enough and don’t have enough willpower.”
But when his patients see how much the medication helps them if diets and excercise don’t work, he says they often realize the issue is a medical one — not a personal failing.
“By expanding access, it could counter bias as more people have that ‘aha’ moment,” Macklin said.
He also hopes that generics providing wider access to medical intervention could reduce the cost and burden on the health-care system. Obesity Canada puts the cost of not treating obesity at $27.6 billion annually.
As a family medicine practitioner and clinical researcher in Toronto, Dr. Iris Gorfinkel says GLP-1 medications are brought up daily, often by patients who don’t fit the criteria for their use.
Because of societal standards, Gorfinkel says female patients in particular tend to ask for the drug to help lose a stubborn 10 or 15 pounds for cosmetic reasons.
She says the introduction of generics means the drugs will not only become more accessible for those who need them, but also “to individuals who technically are not approved.”
Gorfinkel also points out that the drugs are not always a simple solution. Many patients end up discontinuing their use in the long run, and symptoms can include nausea, vomiting, diarrhea and stomach pain.
As interest in GLP-1 drugs for weight loss grows, sites allowing easy access have already popped up, prompting a warning from Health Canada about fake or unauthorized versions earlier this year.
And in 2023, a Toronto Star investigation documented how reporters accessed Ozempic for weight loss simply by entering an inaccurate height and weight through a for-profit telehealth website.
But Persaud says the proliferation of these online services are likely fuelled in part by the high cost of the drugs.
“I think, ironically, we would actually probably see less of that if the medication was lower in price,” he said. “There’d be less of an incentive to set up these systems to dispense these medicines.”
