A woman in Malmö applied for financial assistance for treatment with Ozempic or Wegovy (Semaglutide) against her severe obesity, obesity.
The Social Administration in Malmö City felt that she did not need money for unoccupied drugs to achieve the Social Services Act’s requirements for a reasonable standard of living. The Social Administration rejected the application and motivated the decision that the woman’s risk of future sequelae due to obesity is not serious enough.
The woman appealed and now the Administrative Court in Malmö has sentenced to her advantage. It is the first judgment of its kind.
– It’s leaning at that we will not appeal against the judgment of the Administrative Court. But certainly you can think that there may be more applications for extra financial assistance for this type of medicine now, says Anna-Clara Lindberg, head of the labor market and social services Södra in the City of Malmö, to the pharmaceutical world.
The doctor certifies the need for ozempic
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The woman receives financial assistance, what was previously called social assistance, to cope with her livelihood.
Today’s rules provide the right to financial assistance for reasonable costs for medicines within the high -cost protection. This is to achieve the Social Services Act’s requirement for a reasonable standard of living.
Financial assistance for medicines outside the high -cost protection, as in this case, is usually not given. Then there should be very strong health reasons. In addition, the current drug should not be able to be replaced by any other drug that is part of the high -cost protection.
Costs over SEK 1,000 per month
Both the woman and the woman’s doctor certify that her morbid obesity causes great suffering, both physically and mentally.
She is in pain in the knees and back and needs help with going shopping. The overweight also deteriorates her mental mood, as she is so ashamed of it that she isolate herself even more.
The woman’s health center physician warns in one of their certificates for the risk of sequelae such as hypertension, diabetes, osteoarthritis of the joints and cardiovascular disease.
Since treatment with Semaglutide against Obesitas is not included in the high -cost protection for medicines, the cost of treatment would be SEK 1045 a month.
Have already tested everything else
Previous attempts to lose weight on your own have not succeeded. In addition, the woman has done an operation to reduce the stomach that has not helped. The only drug against obesity and obesity, orlistat, which today is included in the high -cost protection she has tried, but she got that stomach problems.
“A doctor has Examined me and she thinks I am in great need of the medicine. I have tried everything possible and this seems to be the only thing left to test, ”she writes in her appeal.
Does not need ozempic for reasonable standard of living
But so the social service in the City of Malmö did not want to pay.
“A reasonable standard of living must correspond to what a low -income earner in Malmö can pay. The current cost of medicines that are not covered by the high -cost protection is not deemed to be included in the concept of a reasonable standard of living, ”the social service writes in its rejection decision.
Anna-Clara Lindberg, who cannot go into the individual case but generally comments, says:
– Medicines outside the high -cost protection Only in the exception to be paid for with assistance, tax funds. Then all other roads should be exhausted. Our investigations are deep and look at the individual’s entire situation and background. However, we do not make medical decisions – but we make financial decisions on medical grounds.
– We are based on how an ordinary working low -income earner in Malmö would think in this situation. Would one choose to pay for this drug?
Gave the woman money to sim card instead
It is clear from the social service’s decision that they believe that the woman does not have sufficiently strong reasons to get money for the obesity drug. Among other things, it is emphasized that “the risk of sequelae in the future is not considered to be serious enough that you do not achieve a reasonable standard of living without the medicine”.
Furthermore, the social services argue that she has already received extra money for a card so that she can go and swim and that she can redistribute costs within the existing budget.
The right goes on the woman’s line
But the Administrative Court points out in its judgment that the woman has already tried all available alternatives. Neither weight loss on its own, stomach surgery nor the only drug against obesity and obesity within the high -cost protection has produced the desired result.
The right thinks that The doctor’s certificate is sufficiently clear and detailed to show that the woman needs treatment with semaglutut. Both with regard to current physical and mental illness and the risk of future sequelae.
Since all other treatment options are exhausted and the medicine is deemed necessary for her to be able to achieve a reasonable standard of living, the right thinks that the requirements for assistance are met.
Will not appeal
According to Anna-Clara Lindberg at the Social Administration, it is unlikely that they will appeal the verdict.
– It’s good that it has been tested so that our clients receive support and we make legal assessments. Of course, if we get a judgment that goes against our decisions, we always need to review whether we need to change methods, develop support or skills.
– These are brand new medicines that are used in a new way, it is a learning for us.
That the new ones The drugs against Obesitas are at risk of becoming an economic burden on society is a concern that has been presented, including Sweden’s municipalities and regions, Skr. As the pharmaceutical world reported, Skr, in its latest financial report, expresses concern that new obesity drugs, such as Wegovy and Mounjaro, will be costly.
The pharmaceutical world has sought a comment on the new judgment’s possible consequences for municipalities and regions. But the organization does not want to comment on the case and replies through the press service that: “We have no overview”.
