In June, France became the first country in the European Union to start reimbursing the costs of weight-loss drugs like Ozempic and Wegovy for people without diabetes but diagnosed with obesity, and now Germany, which has been dragging its heels on the issue, looks as though it might follow suit, reports Euractiv.
French Health Minister Stéphanie Rist, estimating the cost of this policy at €100m a year, had said: “These are the people who would normally be eligible for surgery to correct their obesity.”
Germany, usually rather generous when it comes to drug reimbursement, has not been ready to pay, maintaining that the medication is too expensive.
However, that may change, after an influential health official indicated that insurance coverage should be considered under certain conditions.
Last week, German media outlet Der Spiegel published an interview with the chair of the national health expert body G-BA, which has an important say on drug pricing. “It would certainly be worth considering … under certain conditions,” said G-BA chair Sonja Optendrenk.
Currently, Germany considers weight-loss medication to be “lifestyle drugs”, which puts it in the same category as sexual enhancers and hair growth product. Paradoxically, health insurers nevertheless cover weight-loss interventions such as surgery, psychotherapy for eating disorders and digital apps to track diet and exercise.
But reimbursement for the drugs has so far remained firmly out of reach, even if they are prescribed by a doctor in preparation for weight loss surgery. Pre-diabetic patients who might want to take them to prevent diabetes must still pay for them out of pocket. However, if the same patient develops diabetes, the drugs are covered by insurance.
Public health insurers defend this practice. “As long as there are unanswered questions about these drugs’ long-term and side effects, and the health insurance funds are stretched to their limits, they should not be covered by insurance,” said Kai Behrens, press secretary at AOK, Germany’s biggest health insurance fund.
But others are calling for this policy to be changed, arguing that obesity is a complex chronic disease requiring medical intervention rather than being the result of individual failure.
Several medical societies have repeatedly advocated for reimbursement. Most prominent among them was the national academy of sciences Leopoldina, which called obesity an “epidemic”, and urged German legislators to “change the law to allow obesity patients access to modern drugs”.
Research indicates that drugs from the GLP-1 receptor agonist class are significantly more effective than their predecessors and could, for the first time, offer a way out of the obesity epidemic and its financial burden. However, most people regained their weight after stopping treatment.
Optendrenk referred to this in her interview with Der Spiegel: “As long as the weight returns immediately after discontinuation, an injection on its own does not constitute a treatment plan.”
But she called on bringing the “lifestyle paragraph” up to date. “The legislator could, for example, instruct the G-BA to clarify which patient groups should receive these medicines, for how long, and with what accompanying measures.”
In Germany, according to one estimate, obesity and related conditions like cardiovascular disease cost the medical system about €29bn a year. Lost productivity from sick days and early retirement adds another €34bn.
Germany, where around 20% of adults are obese, might finally come to a similar conclusion to France, where the rate is 17%.
At current GLP-1 prices, health insurer Barmer estimates that it would cost between €1.4bn and €5.5bn a year to treat all obesity patients without Type 2 diabetes.
However, prices are about to drop. The tablet form of Wegovy will start being sold in Europe later this summer after being approved in July. Eli Lilly’s Foundayo is expected to follow. In the US, both tablets are already on the market, costing about $149 per month, around $50 less than the injection.
In the medium term, competition will also put downward pressure on prices. Other pharma companies, such as Boehringer Ingelheim and Innoven Bio, are developing new weight-loss drugs from the GLP-1 class. They’re in the final stages of clinical trials, which means they are likely to reach the market in 2028 at the earliest.
Euractiv article – Germany signals rethink over 'lifestyle drugs' Ozempic, Wegovy (Open access)
See more from MedicalBrief archives:
Weight-loss treatment on brink of another dramatic shift
Weight-gain fears after stopping Ozempic unfounded – Cleveland Clinic study
Why I think weight loss drugs are not the answer – US obesity expert
Costly Ozempic can be made for less than $5 month – UK study