- Lower Saxony’s Health Minister Andreas Philippi (SPD) is calling for Ozempic to be approved at health insurance costs for obesity, based on clear criteria and pretreatment.
- Bremen’s Health Senator Claudia Bernhard (Left) supports the assumption of costs only if medically necessary and after proof of failed conservative therapies.
- Health insurance companies such as AOK Bremen/Bremerhaven and HKK express concerns about side effects, costs and a lack of long-term studies and warn of high premium increases.
The Lower Saxony Health Minister Andreas Philippi (SPD) is demanding that doctors be allowed to prescribe drugs such as the diabetes preparation Ozempic in the future for people who are very overweight (obesity) at health insurance costs. The costs for the use of “weight loss injections” currently have to be borne by obese patients themselves. The Bundestag’s Petitions Committee announced last week that it considers the assumption of costs to be “worth considering”.
How is the initiative being received in Bremen?
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“I support the suggestion that – as with the issue of stomach reduction – covering the costs could only be discussed with the definition of clear requirements and criteria for the prescription,” says Bremen’s Health Senator Claudia Bernhard (Left). This includes, for example, proof of unsuccessful conservative previous treatments. The individually defined medical necessity must always be at the forefront of the discussion. Under no circumstances should costs be covered for pure lifestyle use. “The products currently available on the market are primarily diabetes medications; security of supply for people with diabetes must be guaranteed at all times,” emphasizes the senator. Philippi had suggested that patients would have to prove that they have been unsuccessfully participating in weight loss programs for years and are suffering from overweight – similar to those wishing to have a stomach reduction.
How do the Bremen health insurance companies react?
“No, we cannot and must not support that,” emphasizes the spokesman for AOK Bremen/Bremerhaven, Jörn Hons. “The long-term consequences and the sometimes serious side effects of weight loss injections have still not been sufficiently researched. What are the sustainable medical benefits, and what about patient safety?” It is not for nothing that if such drugs were prescribed for patients with type 2 diabetes, other serious and long-term weight loss strategies must have been unsuccessful. Doctors would have to decide on this, but politicians must set the framework. According to Hons, AOK Bremen/Bremerhaven is currently providing treatment with the injections for almost 1,600 insured people, which is around 7.9 percent of patients with type 2 diabetes.
Last year, 12.7 percent of the insured people at the Handelskrankenkasse (HKK) had type 2 diabetes. Obesity is a chronic disease that affects several areas of life, according to HKK spokeswoman Gabriele Nottelmann. Successful treatment usually requires nutritional therapy, exercise and behavioral training. “Medicines alone are no substitute for an overall treatment concept.”
How would assuming the cost of the weight loss injection affect health insurance contributions?
“A general assumption of costs would lead to a very significant increase in costs relevant to the contribution rate,” says the Bremen AOK spokesman. The question arises: “Is it justified to impose them at the expense of the contributors?” The cost-effectiveness requirement applies to all statutory health insurance policies, said Nottelmann. Services must always meet the triad of medical necessity, effectiveness and appropriateness in relation to costs. Side effects, dropout rates and the patient’s lifestyle would also have to be taken into account. The injections are given weekly; If they are discontinued, there is a risk of weight gain again.
The AOK Rhineland-Palatinate has calculated in a SWR report: If the annual therapy costs of almost 4,000 euros were multiplied by the number of people who have a body mass index over 30 (obesity), “then you would end up with expenses of 45 billion euros” for those with statutory health insurance. The health insurance companies would have spent almost as much on all medicines combined in 2024.
What do doctors say?
Obesity is a risk factor for diabetes, cardiovascular disease or cancer. “It’s a shame that we finally have effective and fairly safe medications that contribute to significant weight loss, but many don’t have access to them because they cost too much. This is two-tier medicine,” said nutritional doctor and obesity specialist Hans Hauner from the Technical University of Munich Spiegel online. 80 percent of his patients who are severely overweight lose weight reliably – with manageable side effects.
Politicians such as Lower Saxony’s Health Minister Andreas Philippi are in favor of health insurance companies covering the costs of weight loss injections such as Ozempic for type 2 diabetics and for long-term obese patients after unsuccessful weight loss programs, but not for purely aesthetic or lifestyle reasons. To date, health insurance companies have only covered the costs if there is a medical indication, while drugs such as Wegovy are currently not reimbursed despite being approved for the treatment of obesity. Representatives of pharmacists’ chambers and professional societies are critical of off-label use, warn of risks associated with unauthorized use and emphasize the responsibility of doctors, although many people are currently using the syringe at their own expense via private prescription.
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Experts rate the medical effectiveness of weight loss medications such as Ozempic for people who are very overweight or have type 2 diabetes mellitus as proven; Studies show an average weight loss of ten to 15 percent within about one and a half years. However, they warn against risks such as side effects (e.g. nausea, diarrhea, heartburn) and against use outside of the approved indication, since the long-term consequences in particular are not fully known and a yo-yo effect can occur when discontinuing. Widespread prescription also leads to supply shortages for diabetes patients and poses the moral and medical risk of misusing urgently needed medications.
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