GERMANY — Novo Nordisk, a leading pharmaceutical company, is set to launch its highly popular obesity drug, Wegovy, in Germany this month, marking its third European market entry.
However, access to the drug will be limited to individuals who can afford to pay out-of-pocket or possess specific private health insurance plans, news agency Reuters reports.
This restriction stems from a decades-old German law that classifies weight-loss drugs as lifestyle choices rather than medical necessities, preventing public health insurance schemes from covering their costs.
The prohibition also extends to other drugs such as those for impotency or baldness.
As a result, the majority of Germans covered by public health insurance plans, which accounts for 90% of the population, will not have Wegovy costs reimbursed.
While Novo Nordisk has yet to disclose the price of Wegovy in Germany, which is Europe’s largest pharmaceutical market, the drug carries a list price of US$1,350 per month in the United States.
Germany’s strict stance on weight-loss drugs stands out in Europe, despite a higher-than-average percentage of its population being overweight.
Some doctors argue that Wegovy could help alleviate weight-related conditions such as heart disease and joint pain, which can be costly to treat.
Martin Merkel, a medical professor and member of the German Endocrinology Society, emphasized the potential of the drug in reducing weight and preventing associated diseases.
Merkel posed the question, “How many knees would not have to be operated on if we were all slimmer?” He expressed skepticism about the limited success of relying solely on diet and exercise.
The challenge for Novo Nordisk and its competitors lies in persuading European governments to cover the costs of obesity drugs, which analysts predict will hinder their uptake in the region.
On the other hand, some researchers, including Duane Mellor, a dietician and senior lecturer at Aston University in Birmingham, England, argue that promoting a healthier lifestyle should take precedence over prescribing drugs.
Slower rollout
The rollout of Wegovy in Europe has been slower than expected due to production issues and difficulties in meeting overwhelming demand in the United States.
Novo Nordisk CEO Lars Fruergaard Jorgensen stated in a newspaper interview on June 24 that the company plans to launch the drug in Germany by the end of July.
Despite the challenges, Germany’s health ministry has confirmed that there are no plans to amend the existing law to include coverage for weight-loss drugs.
Concerns about the financial burden on the strained healthcare budget were cited by an anonymous lawmaker in Berlin.
Reimbursement expert panels would assess the drug’s benefits beyond weight loss, as is the standard protocol for approvals.
Michael Wirtz, a representative of the advocacy group Obesity Help Germany, criticized this short-sighted approach.
He emphasized that weight-loss drugs could extend lives and help individuals remain productive in the workforce. Wirtz clarified that the goal is not solely about attaining a lean and attractive appearance.
Germany is not alone in imposing restrictions on coverage for obesity drugs. Public health insurance schemes in Norway and Denmark, the two other European countries where Wegovy is available, do not cover the drug due to the perceived high costs compared to the benefits.
Denmark’s largest private health insurer will also cease coverage next year due to high demand.
In France, payment schemes only cover Wegovy for treating individuals with a body mass index (BMI) of 35 or above, which is a higher threshold than indicated by European regulators when they approved the drug in January 2022.
In the United Kingdom, initial access to Wegovy will be limited to hospital specialists and restricted to individuals with a BMI of 35 or above.
The government plans to authorize family doctors to prescribe the drug after a two-year pilot scheme.
Variable coverage for weight-loss drugs and uncertainties for Mounjaro in the UK
In the United States, the federal Medicare health plan for older Americans is not permitted to cover weight-loss drugs.
However, many health plans offered by large employers may cover drugs like Wegovy, although they often require patients to attempt rigorous diet programs or try cheaper alternatives first.
Terence McManus, a fund manager at Bellevue Asset Management based in Switzerland, highlights the varying coverage for weight-loss drugs across Europe and the rest of the world.
The global market for obesity drugs is expected to grow to over US$60 billion by 2030, with the United States accounting for around 60% and the European Union around 26% of the market, according to Barclays analysts.
Currently, approximately 53% of people in the 27-country EU are overweight or obese, compared to approximately 74% in the United States.
However, the EU statistics office has warned that weight problems are rapidly increasing in most member states.
For Europe’s predominantly universal health schemes, the primary concern is the potential surge in costs rather than the long-term rise in weight-related issues, according to Phil McEwan, CEO of health economics consultancy Heor in Cardiff, Wales, who advises Novo Nordisk on market access.
McEwan emphasizes that the United States has a larger population of morbidly obese individuals, implying they have more to gain from weight-loss drugs.
In a separate development, the UK’s National Institute for Health and Care Excellence (NICE) recently announced that it would not recommend Eli Lilly’s Mounjaro, a weight-loss medication, for people with type 2 diabetes without additional evidence.
Mounjaro, also known as tirzepatide, has received approval in the United States for type 2 diabetes and is expected to gain regulatory approval for obesity later this year.
Alongside drugs like Wegovy and Ozempic from Novo Nordisk, Mounjaro has demonstrated significant weight loss results, leading to a surge in demand and high sales expectations.
However, NICE, which assesses the cost-effectiveness of medications, expressed the need for additional data from Lilly to address uncertainties in the clinical evidence when compared to other alternative treatments.
NICE’s recommendations influence the National Health Service’s decisions regarding the provision of specific medications.
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