The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) not to reimburse semaglutide (Wegovy®) from the basic health insurance package. This medicinal product can be used in certain patients with obesity. Although the National Health Care Institute deems the medicinal product to have been proven effective for reducing bodyweight, there are major uncertainties about its health effects on patients. There are risks, including risks for the healthcare budget. Inclusion in the basic health insurance package is therefore currently not ‘socially justifiable’ in the eyes of the National Health Care Institute.
Current state of affairs: advisory report sent to the minister
The National Health Care Institute has sent this advice to the Minister of VWS. The Minister makes the final decision on whether or not to reimburse the medicinal product from the basic health insurance package.
Semaglutide is intended for certain people with obesity
Semaglutide is the active substance. The brand name is Wegovy®. The medicinal product is available for administration once weekly by subcutaneous injection. The patient can self-administer the medicinal product in the abdomen or upper leg.
Semaglutide (Wegovy®) is intended for weight control in adults with obesity. Obesity is the medical term for severe overweight. Of the 7 million people in the Netherlands who are overweight, 14% are severely overweight (meaning a BMI – body mass index – of 30 or higher). The BMI is a calculation of the healthy weight for a person in relation to their height. The manufacturer has obtained licensing for the medicinal product for patients with a BMI of over 27 and at least one weight-related condition. Obesity adds to the risk of conditions such as cardiovascular disease and type 2 diabetes.
Advice from the National Health Care Institute on the reimbursement of semaglutide
The National Health Care Institute advises the Minister of VWS not to reimburse semaglutide (Wegovy®) through the basic health insurance package.
For more information on the Medicine Reimbursement System (GVS) and the Lists 1A, 1B and 2, see page 'Reimbursements of outpatient medicines'.
More information or questions?
If you have any questions about this advice, please send your question to the National Health Care Institute via warcg@zinl.nl. If you have questions about the reimbursement of a medicinal product, the personal expenses or whether you should pay a contribution, please ask your health insurance provider.
How did the advice come about?
The Scientific Advisory Board (WAR) advises the National Health Care Institute about this assessment. The Minister makes the final decision whether or not to reimburse the medicinal product from the basic health care package.
Explanation about the reimbursement of medicinal products
Semaglutide is an extramural medicinal product. ‘Extramural’ means medicines for home use that can be obtained at the pharmacy with a prescription from a physician. They are only reimbursed from the basic health insurance package if they are listed in the GVS.