Overview
Use this article to understand why the MedExpress Canada clinical team may deem a treatment request unsuitable after reviewing your consultation, the clinical safety guidelines that determine eligibility, what happens to your payment, and what steps to take when an order is declined.
Use this article when you want to:
Learn why a consultation request was declined or deemed unsuitable.
Understand age, BMI, and medical eligibility criteria for weight management injectables.
Review safety considerations, drug interactions, and medical contraindications for GLP-1 weight management injectables and erectile dysfunction (ED) treatments.
Check refund policies for orders deemed clinically unsuitable.
Find out what options are available after a consultation is declined.
Why Was My Consultation Declined?
Every consultation submitted to MedExpress Canada is reviewed individually by a licensed Canadian healthcare professional. If your request was deemed unsuitable, the reviewing clinician determined that the requested medication was not safe, appropriate, or clinically indicated for you based on your consultation responses and health profile.
MedExpress Canada adheres strictly to Health Canada regulations, pharmacy guidelines, and clinical safety standards. Common reasons a treatment request may be declined include:
1. Age and BMI Eligibility Criteria (Weight Management)
For weight management injectables (including Generic Semaglutide, Ozempic®, Wegovy®, Mounjaro®, and Zepbound®), eligibility is determined by age and Body Mass Index (BMI) thresholds:
Age Limits: You must be between 18 and 75 years old to receive treatment. Consultation requests for anyone outside this age range will be declined.
BMI of 30 or Higher: Standard threshold for adults living with obesity.
BMI of 27 or Higher: Eligible if accompanied by weight-related health conditions, such as:
Prediabetes or Type 2 diabetes
High blood pressure (hypertension)
High cholesterol
Sleep apnea
Heart disease
BMI Between 25 and 30: Off-label prescribing may be considered on an individual clinical basis, but orders below standard thresholds may not be fulfilled without supplemental documentation.
Adjusted Ethnic Thresholds: Because individuals from certain ethnic backgrounds face higher health risks at lower BMI levels, thresholds are lowered by 2.5 (e.g., a threshold of 27.5 instead of 30 without additional health conditions) for individuals from Asian, Black African, African-Caribbean, or Middle Eastern backgrounds.
Sub-Threshold BMI: Requests submitted below clinical treatment thresholds without qualifying health conditions or off-label justification are declined.
2. Dosing and Titration Requirements
New prescriptions for GLP-1 medications must begin at standard starting doses (such as 0.25 mg for semaglutide products or 2.5 mg for tirzepatide products) to ensure safe dose titration. Requests for higher starting doses without verified evidence of prior prescription use will be adjusted or declined.
3. Medical Safety and Contraindications
For GLP-1 Injectables (Generic Semaglutide, Ozempic®, Wegovy®, Mounjaro®, Zepbound®):
Treatment will be declined or deemed unsafe if you have:
Pregnancy, plans to become pregnant, or are currently breastfeeding
A history of thyroid cancer (such as medullary thyroid carcinoma) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
A history of pancreatitis or gallbladder disease
Severe kidney disease or severe liver disease
Severe stomach or digestive conditions (such as severe gastroparesis or delayed stomach emptying)
Diabetic eye disease (retinopathy) alongside type 2 diabetes
A current or past history of suicidal thoughts, suicidal behavior, or severe depression
Known severe allergies to GLP-1 medications or any of their ingredients
Planned surgeries or medical procedures requiring general anesthesia or deep sedation
For ED Medications (Sildenafil, Tadalafil, Cialis®, Viagra®):
Treatment will be declined if you:
Take any form of nitrate medication (tablets, sprays, patches, or ointments used for chest pain or angina)
Use recreational nitrate or nitrite inhalants ("poppers", including amyl nitrate)
Take pulmonary hypertension medications such as riociguat
Have a history of serious allergic reactions to sildenafil, tadalafil, or any tablet ingredients
Have been advised by a physician that sexual activity is unsafe due to severe heart risks
Have experienced vision loss from non-arteritic anterior ischemic optic neuropathy (NAION)
Have uncontrolled high blood pressure, low blood pressure, severe liver/kidney issues, recent stroke history (within 6 months), Peyronie's disease, deformed penis shape, or conditions increasing priapism risks (such as sickle cell anemia, multiple myeloma, or leukemia)
4. Unsafe Medication Interactions
If you take prescription drugs or supplements that interact dangerously with the requested medication, the clinician will adjust your dosage or decline the request to protect your health.
GLP-1 Treatments: Critical interactions can occur with insulin or sulfonylureas (diabetes medications that lower blood sugar), increasing the risk of severe hypoglycemia.
ED Treatments: Critical interactions occur with alpha-blockers, prescription blood pressure treatments, HIV medications (such as ritonavir or saquinavir), antifungals (such as ketoconazole), antibiotics (such as erythromycin), or concurrent use of other erectile dysfunction medications.
5. Unverified ID or BMI Evidence
If requested documentation (such as a government-issued photo ID, full-body photo for BMI verification, or proof of a prior prescription) is missing, incomplete, or inconsistent, the order cannot proceed and may be canceled.
Important Safety and Lifestyle Guidelines for ED Medications
Nitrate Safety Warning: Combining ED medications with nitrates or recreational nitrate inhalants ("poppers") causes a sudden, dangerous drop in blood pressure that can be life-threatening.
Alcohol Intake: Limit alcohol consumption. Excessive drinking can impair your ability to achieve an erection, reduce medication effectiveness, and increase side effects like dizziness or low blood pressure. Moderate alcohol intake (1 or 2 standard drinks) is generally safe.
Food Considerations: Tadalafil tablets and chewable mints can be taken with or without food. Sildenafil works best on an empty stomach or after a light meal, as high-fat meals can delay absorption.
What Happens if You Don't Meet the Criteria for Treatment?
If the clinical team determines that treatment is not appropriate for medical reasons, a prescription will not be issued, and you will receive a full refund.
This full refund includes:
The consultation fee
Any medication costs paid as part of your order
This ensures you are only charged if treatment is confirmed to be safe and suitable for you.
What to Do After a Declined Consultation
Review Prescriber Communication: Check your registered email or log in to your MedExpress Canada account dashboard to review the specific clinical feedback provided by the reviewing practitioner.
In-Person Care: If online treatment is not clinically appropriate, consult your primary care physician or local healthcare provider to discuss alternative, in-person management options.
Need Further Support?
If you still need help after reviewing the information above, additional assistance is available.