Generic semaglutide could reshape diabetes drug coverage in Canada

The arrival of generic semaglutide in Canada significantly improves the cost-effectiveness and affordability of recommended treatments for up to 2.1 million Canadians living with Type 2 diabetes who face a high risk of cardiovascular disease, according to a simulation study led by researchers at McGill University and the Research Institute of the McGill University Health Centre.

In February, the authors estimated that glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, are not cost-effective for patients with Type 2 diabetes and high cardiorenal risk when compared with sodium-glucose cotransporter-2 (SGLT2) inhibitors, a less expensive class of drugs that also helps prevent diabetes complications. That analysis used 2025 prices reimbursed by Quebec’s public drug plan.

In the five months since that publication, Health Canada has approved three generic semaglutide products, with more approvals expected in the coming weeks and months. Canada is one of the first countries to have access to generic semaglutide, years before it is expected to become available in the United States and much of Europe.

Generic semaglutide products are now available through Quebec’s public drug plan at an annual cost of approximately $1,060, including pharmacy dispensing fees. At that price, the authors estimate a 35 per cent probability that combination therapy, using both a GLP-1 receptor agonist and an SGLT2 inhibitor, would be the most cost-effective treatment strategy compared with either therapy alone or other standard treatments. Prices are expected to drop further as more manufacturers enter the market. If the annual semaglutide price falls to $880, the authors estimate an 80 per cent probability that combination therapy would provide better value than SGLT2 inhibitors alone.

Published in the Canadian Journal of Cardiology, the findings suggest lower prices could help remove a major barrier to treatment. At 2025 brand-name prices, providing GLP-1 RA therapies to all eligible Canadians with Type 2 diabetes and high cardiovascular risk would cost between $3.35 billion and $5.31 billion annually, the authors estimate. Generic pricing is expected to reduce that amount by at least half.

The findings strengthen the case for broader coverage through public and private drug plans. These medications can help patients avoid hospitalization and reduce their risk of heart and kidney disease. The analysis does not consider the implications of lower semaglutide prices for other indications, including obesity treatment.