Obesity Medication Coverage in the Netherlands: A Closer Look

The Dutch Healthcare Institute is considering adding Wegovy and Mounjaro to the basic health insurance package, joining three other already-reimbursed obesity medications. This development is viewed positively by internist-endocrinologist Liesbeth van Rossum, professor of obesity and stress research at Erasmus MC in Rotterdam.

Currently, reimbursement is limited to two patient groups: individuals with obesity (BMI of 30 or higher) and a weight-related condition (heart failure, apnea, knee osteoarthritis), and those who are severely or very severely obese (BMI of 35 or higher).

So not everyone who is overweight is reimbursed for obesity medication?

Liesbeth van Rossum explains, “The European medicines Agency (EMA) advises for Mounjaro and Wegovy use with a BMI of 27. In the Netherlands, we are a bit stricter, and I understand that. While science confirms the effectiveness of obesity medication, affordability is also a key consideration.” The average cost of obesity medication is around 250 euros per month per patient. Reimbursing the 4.1 million Dutch individuals with a BMI of 30 or more would cost an estimated 10 billion euros annually, according to the Healthcare Institute.

It is indeed difficult that the NHG recommends three medications,one of which,Wegovy,is not reimbursed

Only the severe cases receive medication?

“Before medication is considered,patients must complete a year-long combined lifestyle intervention. If this proves insufficient, medication becomes an option. A BMI of 27 or 30 isn’t automatically considered an insufficient indication, especially when related diseases like sleep apnea syndrome, knee osteoarthritis, prediabetes, heart failure, and fatty liver disease are present. These conditions are often treated separately – with angioplasty, knee surgery, or other medications. Addressing obesity with medication can be medically effective and cost-saving by reducing or preventing these diseases.”

Patients complain that GPs do not want to prescribe obesity medication.

“The new NHG guideline from Dutch general practitioners includes medication. I regularly provide further training to GPs who may not be fully equipped to address obesity. Their patients are learning about medication through social media and requesting it, with some even obtaining it illegally. The situation is intricate by the fact that the NHG recommends three obesity medications, but only two are currently reimbursed – Wegovy is not.”

In 2024, the Healthcare Institute still gave negative advice about Wegovy.First the long-term effect had to be investigated.

“That…