The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to expand the Annex 2 conditions for tirzepatide (Mounjaro®) for people with diabetes and a very high risk of cardiovascular disease. Tirzepatide is already registered in the Medicine Reimbursement System (GVS) with reimbursement conditions. If the Minister adopts our advice, these reimbursement conditions will be extended.
Current state of affairs: advisory report sent to the Minister
The National Health Care Institute has sent this advice to the Minister of Health, Welfare and Sport (VWS). The Minister makes the final decision whether or not to extend the conditions of reimbursement.
Tirzepatide is intended for certain people with diabetes.
Tirzepatide is the active substance. The brand name is Mounjaro®. Tirzepatide is a glucagon-like peptide-1 (GLP1) agonist. It is also a glucose-dependent insulinotropic polypeptide (GIP) agonist. This means that the medicine regulates blood sugar levels and reduces appetite. The medicinal product is administered by injection.
The medication can be used in people with type 2 diabetes mellitus. This is the medical term for diabetes. People with diabetes have high blood sugar levels. This means there is too much sugar in the blood. People with diabetes can suffer from frequent urination, thirst, fatigue, weight loss and bladder infections. If people have high blood sugar levels for a prolonged time, more symptoms may occur. For example, impaired vision, pain in the arms and legs, reduced sensitivity in the feet, poor wound healing and difficulty walking. People with diabetes are also at higher risk of developing cardiovascular diseases, such as myocardial infarction or stroke.
Tirzepatide is currently already being reimbursed for the treatment of certain adults with type 2 diabetes mellitus when they cannot be adequately treated with other medicinal products.
Advice from the National Health Care Institute on the expansion of the reimbursement conditions for tirzepatide
The National Health Care Institute advises the Minister of VWS to expand the reimbursement conditions for tirzepatide (Mounjaro®) for patients with type 2 diabetes mellitus and a very high risk of cardiovascular disease. These are the so-called List 2 conditions.
For more information on the GVS and the Lists 1A, 1B and 2, see page ‘Reimbursement of outpatient medicines’.
Expansion of conditions for the reimbursement of tirzepatide (Mounjaro®®)
Tirzepatide has been included in the GVS for certain patients with type 2 diabetes mellitus since 1 October 2023. With advice of 19 March 2026, we advise the Minister to expand the List 2 conditions as follows:
only for an insured person aged 18 years and older:
- with type 2 diabetes mellitus and a BMI ≥ 30kg/m2, whose blood glucose levels are not adequately controlled with the combination of metformin and a sulphonylurea derivative at the maximum tolerated doses, and who do not use insulin, or
- as an adjunct to metformin and basal insulin (NHP insulin/long-acting insulin analogue) in an insured person with type 2 diabetes mellitus and a BMI ≥ 30 kg/m2, whose blood glucose levels are not adequately controlled after ≥ 3 months of treatment with optimally titrated basal insulin in combination with metformin (with or without a sulphonylurea derivative) at the maximum tolerated dose
- as an adjunct to an SGLT2 inhibitor and metformin, or where there is a contraindication for an SGLT2 inhibitor, added to standard treatment in an insured person with type 2 diabetes mellitus and a very high risk of cardiovascular disease (in accordance with the NHG guideline for type 2 diabetes mellitus):
- with previously diagnosed cardiovascular disease, and/or
- chronic kidney damage
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 Minister of VWS asks the National Health Care Institute to make an assessment. The Minister makes the final decision whether or not to reimburse the medicinal product from the basic health insurance package.
Explanation about the reimbursement of medicinal products
Tirzepatide is an outpatient medicinal product. ‘Outpatient’ 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.