Weight Loss Syringes: Cost Concerns for BMG

The fact that GLP-1 receptor agonists such as semaglutide and co. can lead to effective weight loss has already been proven in several studies. Nevertheless, patients have to bear the costs for the hyped weight loss preparations themselves. Now the Federal Ministry of Health is to examine a corresponding petition to cover the costs of weight-loss injections.

“Medicines whose use is intended to increase the quality of life – so-called lifestyle medicines – may not be prescribed as a statutory health insurance benefit,” the Federal Joint Committee clarifies. In addition to preparations for treating erectile dysfunction, increasing sexual potency and improving hair growth, these also include appetite suppressants and so-called weight loss medications.

These are excluded from reimbursement according to the law because they

• “not or not exclusively intended for the treatment of diseases,
• Serve to satisfy individual needs or improve self-esteem,
• serve to treat conditions that are merely the result of natural aging processes and whose treatment is not medically necessary, or
• “Can be used for cosmetic findings for which treatment is not medically necessary.”

Weight loss injections with active ingredients such as semaglutide, liraglutide and the like are also considered lifestyle medicines and are therefore not reimbursed. That could change soon. The Petitions Committee of the Bundestag wants the Federal Ministry of Health to examine the assumption of costs for weight-loss injections.

By the way: Medicines for smoking cessation were also considered lifestyle medicines for a long time. However, since August, nicotine replacement preparations have been allowed to be prescribed at the expense of health insurance companies – at least under certain conditions.

Covering the costs of weight loss injections: BMG should examine petition

In a recent meeting, the experts discussed petition 165851 “Cost coverage of the weight loss injection if medically necessary from April 9th, 2024”. The committee considers this to be at least “worth considering”. Therefore, the members passed the recommendation with a large majority to the Bundestag to transfer a petition to this effect to the Federal Ministry of Health (BMG) “as material”.

The reason: If weight loss injections are used when there is a medical need – including obesity – it is a disease with enormous health risks, as one patient says in the petition. While the costs for measures such as stomach reduction would be reimbursed, this does not apply to weight loss injections, although the overall costs would be significantly lower.

The committee makes it clear that it is addressing the question of whether Wegovy (Semaglutide, Novo Nordisk) and Co. are actually purely lifestyle medications. However, meaningful study data for relevant patient groups on long-term effects on cardiovascular endpoints in particular and on the long-term safety of the active ingredients remain to be seen, according to a statement. Nevertheless, due to the positive health effects, the experts decided to transfer the petition to the BMG as material “so that it can be included in appropriate considerations to improve the situation of those affected”.

Attention: In the indication for diabetes treatment, the costs for GLP-1 receptor agonists are covered by health insurance companies.

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Annabelle

Annabell Wagner has been part of the editorial team of PTA IN LOVE since 2019 and has been deputy editor-in-chief since summer 2023. She is familiar with health topics because she has been providing readers with exciting news from the world of pharmaceuticals, medicine and health policy since 2016. Annabell is a pharmacy fan and appreciates the friendly, personable and competent advice from her colleagues on site.