A public service worker in Ottawa is calling out the federal government’s insurance plan after she was denied drug coverage for her chronically ill daughter. Julie Jewett’s 8-year-old daughter Lily was diagnosed with a brain tumour when she was four months old. She’s been through a number of surgeries with many complications, including a stroke, seizures and lost vision. The most recent “ended up significantly damaging the part of her brain that controls her hormones, her appetite, her metabolism, her sleep, all these various functions,” Jewett said. It means that, for her age and height, Lily is considered obese and is constantly asking for food. “All day with Lily she tells me that she’s hungry and she wants food; it’s constant. It never ends,” Jewett said. “She definitely has the capacity to learn to walk but the weight is a huge hindrance on that.” A doctor prescribed weight-loss drug Wegovy for Lily, but Jewett’s federal healthcare plan won’t cover the cost of the prescription because the drug isn’t approved for use in kids under the age of 12. “I’m really disappointed that the sole reason they’re denying it is Lily’s age. That’s exceptionally disappointing for me and very worrisome about insurance being able to dictate treatment for kids,” Jewett said. Jewett said Lily’s doctors don’t want her to start the drug without coverage. “It’s hundreds of dollars every month and there’s also the no endpoint to it so I feel like it’s something that you can maybe absorb short term but really is a big risk to start something that we don’t know if long term we can afford.” In a statement, the Treasury Board of Canada Secretariat said the Public Service Health Care Plan “does not cover expenses for prescription drugs to treat a condition or conditions not recommended by the manufacturer of the drugs (i.e., off-label use) or that do not meet Health Canada-approved indications, even if a prescription from a medical health practitioner is submitted with a prior authorization form.” It adds that eligible drug coverage under the PSHCP is based on “Health Canada-approved indications, which are founded on thorough scientific reviews, assessment of clinical trials, and consultations with drug manufacturers.” In a statement, a Canada Life spokesperson says it “empathizes with all those who are facing difficult health challenges,” adding the “Government of Canada determines what is covered under their plan, and Canada Life must administer claims in compliance with the Public Service Health Care Plan Directive.” Jewett appealed the decision to the Federal PSHCP Administration Authority twice —the first time she was denied and is still awaiting a decision for the second appeal. In a letter sent to Jewett in May 2025, an appeals analyst stated that upon reviewing the case and specific circumstances “the directors determined that the original decision to deny your prior authorization request for Wegovy must be maintained.” “I regret the answer could not be more positive; however, the Directors are responsible for ensuring that the PSHCP is administered in accordance with the provisions that govern the plan for all members,” the analyst wrote in the letter. Dr. Tom McLaughlin, a pediatrician and chair of the drug therapy committee at the Canadian Paediatric Society, said it’s not unusual for a child to be prescribed a drug off label. “We estimate 50 and 80 per cent of pediatric prescribing is off label and it’s important to know off-label means that it doesn’t necessarily have a listed license from Health Canada, but it doesn’t mean it’s off evidence, it doesn’t mean that it’s experimental,” McLauglin said, adding there’s more Canada can do to improve the situation. “Many countries have systems that require manufacturers to apply for pediatric indications or reasons for their license. We could and should do that. And similarly, we could have our reimbursement system be based more on a holistic view of evidence and pediatric expertise, rather than only narrowly on what is on the licensed indication for a drug.” Jewett says she feels like she’s running out of options. “It’s just been roadblocks and I feel now like we’ve just hit a wall and I don’t know what our next options are other than looking at human rights violations and that age is one of the protected forms of grounds of discrimination.”
