A pharmacist displays a box of Mounjaro at a pharmacy in Provo, Utah. Canada’s Drug Agency recommends public plans cover the drug for type 2 diabetes.George Frey/Reuters
Public health plans should cover the blockbuster drug Mounjaro for patients with Type 2 diabetes, Canada’s Drug Agency says, as long as manufacturer Eli Lilly LLY-N offers a discount.
CDA is a government-funded non-profit that issues non-binding recommendations to federal and provincial health insurance plans. When a drug maker applies to get their medication publicly funded, CDA committees examine factors such as a drug’s clinical benefit and whether its list price is cost effective compared to other available drugs.
Tirzepatide, the active ingredient in Mounjaro, got a generally positive recommendation in a draft CDA report published Thursday. It should be covered in a similar way to semaglutide, the active ingredient in Ozempic, the report suggests.
Mounjaro tends to sell for higher prices than Ozempic. The list price of Mounjaro was between $300 and $540 as of the beginning of this year, depending on dosage. The list price of Ozempic is currently about $228. Those prices do not include pharmacy and distributor markups and cover a four-week supply of each drug.
CDA’s recommendations change depending on dosage. At the low end, the agency’s committee says the evidence suggests five-milligram dosing of Mounjaro is similar in effectiveness to one milligram of Ozempic, and so public plans should pay no more for Mounjaro at that dosage than they pay for Ozempic.
At higher dosages, the report generally recommends public plans seek a discount of 25 to 49 per cent off the list price of Mounjaro.
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Ozempic is the best-selling drug in Canada and has contributed to higher public spending on prescription drugs. Public plans spent $794-million on Ozempic in 2024, according to the most recent data.
If public plans cover Mounjaro, it could cost them an estimated $1.97-billion over three years, the report estimates, about $820-million more than the plans currently spend on comparable drugs over a similar period.
Generic forms of Ozempic are currently being reviewed by Health Canada, and the report notes that when those hit the market the price of Ozempic will fall substantially, which could affect future cost-effectiveness analysis of Mounjaro.
It is common for CDA to suggest some level of price discount when it recommends a drug. The suggested discount typically serves as a starting point for negotiations between the drug manufacturer and public drug plans, which are represented by a body called the pan-Canadian Pharmaceutical Alliance.
Eli Lilly said that, despite the draft recommendation being positive, the company had concerns about some of the details.
“The draft does not fully reflect the totality of evidence for Mounjaro, including its [blood sugar management] and weight-loss advantages versus semaglutide 1 mg,” Ethan Pigott, director of communications and external affairs at Eli Lilly Canada, wrote in a statement.
He said Eli Lilly would “engage constructively” with CDA as it finalizes its recommendations.
Patient group Diabetes Canada told the CDA committee that current treatments for Type 2 diabetes are generally easy to use and effective, but patients could experience problems with supply, cost and lack of insurance coverage, the report says.
Mounjaro’s price in Canada has gone through ups and downs since it was approved by Health Canada in late 2022.
Eli Lilly first sold Mounjaro in a cheaper vial form. In 2025, the company hiked prices and moved patients to an injectable pen format that is more convenient and more expensive. The company then slashed prices by 20 per cent or more (depending on dosage) at the end of the year.
Eli Lilly first filed a Mounjaro application to CDA in 2022, and later withdrew the application. The company has not said why.
CDA is still examining Eli Lilly’s applications for Mounjaro’s sister drug Zepbound, which contains the same active pharmaceutical ingredient. Eli Lilly is seeking public coverage for Zepbound for two separate conditions: weight management and sleep apnea.