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Ontario coverage, price, criteria word for word, Health Canada status and shortages for one product

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SEMAGLUTIDE

All products: Limited Use (codes 738)

Rybelsus · DIN 02551012 · 1.5mg · tablet

Limited Use — Reason for Use code 738 requiredMarketed · checked 2026-09-02
StatusLimited Use — Reason for Use code 738 required
Write on scriptLU code 738 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 738
Reason for Use code 738 For the treatment of adult patients with type 2 diabetes when adequate glycemic control is not achieved on the maximum tolerated dose of metformin or where metformin is contraindicated or inappropriate. Semaglutide is not funded in combination with another glucagon like peptide-1 receptor agonist (GLP-1 RA) or dipeptidyl peptidase-4 (DPP-4) inhibitor. Oral semaglutide is not funded in combination with injectable semaglutide. Coverage is only provided for one dosage format. Maximum reimbursed dose: 1.5mg once daily. Coverage limit: LU Authorization Period: Indefinite
No interchangeable product listed in the Ontario extract
Rybelsus · DIN 02551012 Manufacturer: Novo Nordisk Canada Inc; listing date 2026-03-31 Health Canada: Marketed since 2026-03-13 · brand RYBELSUS · ATC A10BJ06 SEMAGLUTIDE · form Tablet · route Oral · ingredients SEMAGLUTIDE 1.5 MG · company Novo nordisk canada inc · schedule Prescription, Schedule d
Check this DIN again · Health Canada product record

Rybelsus: Formulary list price $7.5303/unit (unit not stated in source; not the patient's cost)

Ministry pays: $7.5303 per source unit.

Source explanation: The formulary price is what ODB pays; the cash price at the counter is set by the pharmacy.

Formulary data: Ontario extract of Aug 26, 2026 · Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=103977 · Verify on the e-Formulary ↗ (DIN 02551012)

Source record
DIN 02551012: Rybelsus Raw flags: insOH=Y, sec12=Y, sec3=Y Item: 682006010; group id 762; item number 1867; lccId 00428; manufacturer id NOO Source form: Tab; strength: 1.5mg Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below; diabetes medication flag Source prices (unrounded): $7.5303; ministry $7.5303 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02551012 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=103977
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada) Source: https://healthproductshortages.ca/search?term=02551012
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Other drugs in the same formulary class (68:20:06 Incretin Mimetics) and how they are covered

Matched class: 68:20:06 Incretin Mimetics

Drug-class inventory only. Lists recorded Ontario formulary products, not every Canadian medication; does not recommend treatment. Covered without a code on the Ontario formulary: INSULIN GLARGINE & LIXISENATIDE 68:20:06 Incretin Mimetics

INSULIN GLARGINE & LIXISENATIDE

· 1 products · General benefit · strengths: 100U/mL & 33mcg/mL · Inj Sol-Pref Pen 5x3mL Pk Source: formulary-ed43-front-matter.txt Part V; ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26; class 68:20:06
Full class listing Related classes: 68:20:02 Oral Anti-Diabetic Agents, 68:20:10 Insulins (Rapid Acting), 68:20:12 Insulins (Intermediate Acting), 68:20:14 Insulins (Long Acting), 68:20:16 Insulins (Pre-Mixed) Same formulary class, not same indication: class membership alone does not establish equivalent uses.
Other drugs whose Health Canada label lists a similar indication: major adverse cardiovascular events, type 2 diabetes
From Health Canada product monographs; label wording only, not a treatment recommendation. Matching is lexical and uses one held product label per generic; formulations and qualifying criteria may differ. Covered without a code on the Ontario formulary: CANAGLIFLOZIN ACARBOSE · Listed, not a benefit (2), Limited Use, codes 175, 176 (2) INDICATIONS AND CLINICAL USE • MAR-ACARBOSE (acarbose), as monotherapy, is indicated as an adjunct to prescribed diet for the management of blood glucose levels in patients with type 2 diabetes mellitus who are inadequately controlled by diet alone. PM: https://pdf.hres.ca/dpd_pm/00053914.PDF; date not captured; DIN 02494078; fetched 2026-09-10 Product monograph CANAGLIFLOZIN · General benefit Add-On Combination in Patients with Established Cardiovascular Disease: INVOKANA is indicated as an adjunct to diet, exercise, and standard of care therapy to reduce the risk of major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and nonfatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease (CVD). PM: https://pdf.hres.ca/dpd_pm/00074895.PDF; date May 22, 2014; DIN 02425483; fetched 2026-09-10 Product monograph Coverage source: ON formulary extract 2026-08-26
What the Health Canada label says it is for
1. Indications OZEMPIC® is indicated for the once-weekly treatment of adult patients with type 2 diabetes to improve glycemic control, in combination with: • diet and exercise in patients for whom metformin is inappropriate due to contraindication or intolerance. • metformin, when diet and exercise plus maximal tolerated dose of metformin do not achieve adequate glycemic control. • metformin and a sulfonylurea, when diet and exercise plus dual therapy with metformin and a sulfonylurea do not achieve adequate glycemic control. • metformin or a sulfonylurea and a sodium-glucose cotransporter 2 inhibitor (SGLT2i), when diet and exercise plus metformin or a sulfonylurea, in addition to an SGLT2i, do not achieve adequate glycemic control. • basal insulin with metformin, when diet and exercise plus basal insulin with metformin do not achieve adequate glycemic control (see 14 Clinical Trials). OZEMPIC® is indicated as an adjunct to diet, exercise, and standard of care to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, … https://pdf.hres.ca/dpd_pm/00085314.PDF PM date: 2026-07-13 Source product: OZEMPIC; DIN 02471469; fetched 2026-09-10 Product monograph posted by Health Canada; excerpt for lookup only.