Ozempic-cousin Wegovy unlikely to be covered by basic Dutch health insurance
The Dutch Healthcare Institute has advised against covering the popular weight loss medicine Wegovy in the basic health insurance package. According to the Healthcare Institute, there are too many uncertainties about the medicine's long-term health effects. It also worries about how many people will qualify for the drug and what that will cost.
Wegovy is a drug by the pharmaceutical company Novo Nordisk, which also makes Ozempic. Both drugs have the same active ingredient - semaglutide - but Ozempic is targeted at people with diabetes, while Wegovy is aimed at people with obesity. Those taking Wegovy get a single-use injection pen per week, while one Ozempic injection pen is used approximately four times per month. Wegovy is also sold in some markets with a higher maximum dosage. The Dutch basic health insurance already covers Ozempic for diabetes patients.
According to the Healthcare Institute, there is no doubt that Wegovy works for weight loss. Research shows that it can help patients lose an average of between 6 and 10 percent of their weight. However, there are uncertainties about the long-term efficacy of the drug and what happens when people stop taking it. “Studies into the responsible phasing out of semaglutide once sufficient weight loss has been achieved are lacking,” the Healthcare Institute said. The Healthcare Institute also thinks that there is a social discussion to be had about how society deals with obesity - diet and exercise or medicine.
The Healthcare Institute is also concerned about what adding Wegovy to the basic health insurance package would cost. When it added a similar drug - Saxenda with active ingredient liraglutide - to the basic health insurance two years ago, the number of users was much higher than estimated. The Institute assumed 250 users in the first year, increasing to 657 in the third year, with associated costs increasing from 365,000 euros to 1.2 million euros. However, in the first months after the approval, there were already thousands of users.
The Healthcare Institute expects significantly higher patient numbers for Wegovy. While Saxenda is only approved for obese patients with a body mass index of 35 or higher, Wegovy is recommended for people with a BMI over 30. People with a BMI over 27 and other chronic conditions could also qualify under certain conditions.
If every qualifying patient starts using Wegovy, that will amount to around 4.2 million users, costing 1.3 billion euros in three years. The drug costs about 2,750 euros per year per patient.
Mireille Serlie, an internist-endocrinologist and professor at Amsterdam UMC and Yale University, is surprised by the Healthcare Institute’s reasoning, she told AD. Research has shown that semaglutide, Wegovy’s active ingredient, can reduce cardiovascular diseases by 20 percent in the short term. And patients who undergo gastric reduction for comparable weight loss are also known to have long-term health benefits. “I think this is a bit of a slap in the face to people with obesity who suffer from it,” she told the newspaper.
She understands that Wegovy has a big price tag, but she thinks the outright negative advice is going too far. “It is right that the Healthcare Institute wants to know for whom the medicines are most effective. But they can also put a break on the provision. For example, start with a specific group of patients,” Serlie said.
Research by Maastricht University previously showed that overweight and obesity currently cost Dutch society 79 billion euros per year.
Liesbeth van Rossum, a professor of obesity, internist, and chairman of the Overweight Netherlands Partnership, understands that the Healthcare Institute does not want to unnecessarily “medicalize” obesity. But that is already happening by treating many obesity-related diseases, but not the obesity itself, she told AD. “We prescribe patients with antiacids, give them blood pressure lower drugs, give them antidepressants, injections for joint pain, and so on. Many of these drugs also lead to weight gain. A better approach is to treat obesity properly. There are more and more options for that.”
