The National Health Care Institute has assessed whether tirzepatide (Mounjaro®) can be included in the Medicine Reimbursement System (GVS). This medicinal product can be used to treat certain patients with type 2 diabetes mellitus. This is the medical term for a specific type of diabetes. The National Health Care Institute advises the Minister of Health, Welfare and Sport (VWS) to include tirzepatide on List 1A and List 2 of the GVS.
Indication for which reimbursement has been requested
Tirzepatide is used to reduce blood sugar levels. Tirzepatide ensures that the amount of insulin is better maintained after a meal and that the body converts less sugar. Patients are given the medicinal product in addition to diet and exercise.
Advice from the National Health Care Institute
The National Health Care Institute advises the Minister of VWS to include tirzepatide on List 1A in the cluster 0A10BXAP V, with a standard dose of 0.71 mg per day. In addition, we recommend that tirzepatide is placed on List 2, with the same conditions as the other medicinal products in the cluster.
Only for insured persons aged 18 years or older with type 2 diabetes mellitus and:
- a Body Mass Index (BMI) ≥ 30 kg/m² whose blood glucose levels cannot be sufficiently controlled with the combination of metformin and a sulphonylurea derivative at the maximum doses tolerated, and who do not use insulin;
- as an addition to metformin and basal insulin (NPH insulin/long-acting analogue insulin) and a BMI ≥ 30 kg/m2, whose blood glucose values are insufficiently controlled after ≥ 3 months of treatment with optimal titrated basal insulin in combination with metformin (with or without a sulphonylurea derivative) in a maximum dose tolerated.
Medicine Reimbursement System (GVS)
Tirzepatide is an extramural drug. Extramural drugs are medicinal products for home use, available at the pharmacy on prescription from a physician. They will only be reimbursed from the basic health care package if they are listed in the GVS. The amount of the reimbursement depends on the list the product is in. Interchangeable medicinal products are clustered in List 1A. These may be subject to a reimbursement limit. Unique medicinal products are listed in List 1B. There is no reimbursement limit for these products. Additional conditions may apply for reimbursement. In that case, a medicinal product is also listed in List 2.
The Scientific Advisory Board (WAR) advises the National Health Care Institute about the assessment. Based on the assessment, the National Health Care Institute sends an advisory report to the Minister of Health, Welfare and Sport. The Minister makes the final decision whether or not to reimburse the medication from the basic health care package.