Canada's Drug Agency recommends Zepbound for prediabetes - will this cut cost for Canadians?

Prediabetes is extremely common, affecting 14-37% of people with obesity (depending on the population studied and the criteria used to diagnose prediabetes and obesity) . About 25% of people with prediabetes will develop type 2 diabetes over 3-5 years.

Several weight management medications have been shown to reduce risk of developing type 2 diabetes, or increase likelihood of normalizing blood sugars, in people with prediabetes (as discussed extensively in our 2025 Obesity Canada Pharmacotherapy Clinical Practice Guidelines, on which I am the lead author). Tirzepatide for weight management (called Zepbound in some countries, Mounjaro in others) has proven to be particularly powerful to reduce the risk of developing type 2 diabetes in people with prediabetes by 93% over the 3 year SURMOUNT-1 study.

Canada’s Drug Agency (CDA) has just issued a positive recommendation to reimburse Zepbound for people with prediabetes and a BMI of 27 or higher.

This positive recommendation is important for many reasons. First, it is a clear message that a ‘watch and see’ approach to prediabetes is unacceptable. Prediabetes is not a benign condition, as it is associated with increased risk of complications traditionally associated with diabetes, including neuropathy and cardiovascular events.

This recommendation is also a clear message that obesity needs to be treated EARLIER in the natural history of the condition. Why wait until a person has developed type 2 diabetes before addressing weight management? If we intervene earlier – in prediabetes, or even earlier, before prediabetes has even developed – we can help keep people healthier, with better quality of life (more on this blogged here). This analogy can be drawn for any obesity-related health condition, be that MASH (formerly ‘fatty liver disease’), cardiovascular disease, sleep apnea, osteoarthritis, heart failure, and so on. I would have liked to see CDA recommend reimbursement of tirzepatide also for people without prediabetes, but it is unlikely that obesity meds will ever be covered for all, as the cost is simply too high for any health care system to sustain.

Support for medication to treat prediabetes in people with elevated weight also reflects the increasing acceptance that ‘eat less move more’ does not work for the vast majority of people (something we have known in the obesity science world for many years), and that medications exist that are very beneficial to support weight management AND treat or prevent associated health issues (as detailed extensively in our 2025 Pharmacotherapy Guidelines).

Finally, the message is clear that provincial and federal drug plans, as well as private insurers, need to get on board to pay for Zepbound for people with prediabetes and elevated weight. Having a positive recommendation from CDA does not mean automatic coverage for anyone, but it’s an important step towards getting improved access.

BOTTOM LINE: Prediabetes is common in people with elevated weight, and it is not a benign condition. Canada’s Drug Agency recommendation to reimburse Zepbound (tirzepatide) for people with prediabetes and obesity is an important step to recognizing the importance of treating obesity earlier in the course of metabolic disease and improving access to medication for Canadians.

Disclaimer: I am an investigator in clinical trials of tirzepatide. I receive honoraria as a continuing medical education speaker and consultant from the makers of tirzepatide (Eli Lilly).

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